Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff.

BACKGROUND: In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS: We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS: Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS: Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

Structural racism and health inequities in the USA: evidence and interventions.

Despite growing interest in understanding how social factors drive poor health outcomes, many academics, policy makers, scientists, elected officials, journalists, and others responsible for defining and responding to the public discourse remain reluctant to identify racism as a root cause of racial health inequities. In this conceptual report, the third in a Series on equity and equality in health in the USA, we use a contemporary and historical perspective to discuss research and interventions that grapple with the implications of what is known as structural racism on population health and health inequities. Structural racism refers to the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. These patterns and practices in turn reinforce discriminatory beliefs, values, and distribution of resources. We argue that a focus on structural racism offers a concrete, feasible, and promising approach towards advancing health equity and improving population health.

Estimating Potential Reductions in Premature Mortality in New York City From Raising the Minimum Wage to $15.

OBJECTIVES: To assess potential reductions in premature mortality that could have been achieved in 2008 to 2012 if the minimum wage had been $15 per hour in New York City. METHODS: Using the 2008 to 2012 American Community Survey, we performed simulations to assess how the proportion of low-income residents in each neighborhood might change with a hypothetical $15 minimum wage under alternative assumptions of labor market dynamics. We developed an ecological model of premature death to determine the differences between the levels of premature mortality as predicted by the actual proportions of low-income residents in 2008 to 2012 and the levels predicted by the proportions of low-income residents under a hypothetical $15 minimum wage. RESULTS: A $15 minimum wage could have averted 2800 to 5500 premature deaths between 2008 and 2012 in New York City, representing 4% to 8% of total premature deaths in that period. Most of these avertable deaths would be realized in lower-income communities, in which residents are predominantly people of color. CONCLUSIONS: A higher minimum wage may have substantial positive effects on health and should be considered as an instrument to address health disparities.

Influence of community social norms on spousal violence: a population-based multilevel study of Nigerian women.

OBJECTIVES: We examined whether social norms toward spousal violence in Nigeria, at the state level, are associated with a woman's exposure to physical and sexual violence perpetrated by her husband. METHODS: Using data from the 2008 Demographic and Health Survey, we fit four 3-level random intercepts models to examine contextual factors associated with spousal violence while accounting for individual-level predictors. RESULTS: Of the 18,798 ever-married Nigerian women in our sample, 18.7% reported exposure to spousal sexual or physical violence. The prevalence was geographically patterned by state and ranged from 3% to 50%. Permissive state-level social norms toward spousal violence were positively associated with a woman's report of physical and sexual violence perpetrated by her husband (odds ratio [OR] = 1.80; 95% confidence interval [CI] = 1.17, 2.77), after adjusting for individual-level characteristics. A number of individual-level variables were significantly associated with victimization, including a woman's accepting beliefs toward spousal violence (OR = 1.11; 95% CI = 1.09, 1.14). Women living in states with Sharia law were less likely to report spousal violence (OR = 0.58; 95% CI = 0.35, 0.95). CONCLUSIONS: Efforts to end violence against women, particularly spousal violence, should consider broader social and contextual determinants of violence including social norms.

Identifying Silver Linings During the Pandemic Through Natural Language Processing.

COVID-19 has presented an unprecedented challenge to human welfare. Indeed, we have witnessed people experiencing a rise of depression, acute stress disorder, and worsening levels of subclinical psychological distress. Finding ways to support individuals' mental health has been particularly difficult during this pandemic. An opportunity for intervention to protect individuals' health & well-being is to identify the existing sources of consolation and hope that have helped people persevere through the early days of the pandemic. In this paper, we identified positive aspects, or "silver linings," that people experienced during the COVID-19 crisis using computational natural language processing methods and qualitative thematic content analysis. These silver linings revealed sources of strength that included finding a sense of community, closeness, gratitude, and a belief that the pandemic may spur positive social change. People's abilities to engage in benefit-finding and leverage protective factors can be bolstered and reinforced by public health policy to improve society's resilience to the distress of this pandemic and potential future health crises.

Women's autonomy and support for wife beating: findings from a population-based survey in Jordan.

The aim of this study is to examine attitudes among married women toward wife beating and to investigate the hypothesis that female individual empowerment is associated with such attitudes within a broader context of societal patriarchy in Jordan. The study uses data from a cross-sectional survey of a representative sample of married women (n = 5,390) conducted in 2002. Associations between acceptance of wife beating and several women's empowerment variables, including decision-making power, as well as other risk factors were assessed, using odds ratios from binary logistic regression models. The key finding is that the vast majority (87.5%) of Jordanian women believe that wife beating is justified in at least one hypothetical scenario, and justification is negatively associated with empowerment variables and some demographic, geographic, and socioeconomic factors.

Rethinking gender-based violence during war: is violence against civilian men a problem worth addressing?

Gender-based violence during conflict and post-conflict situations has received increased attention in research and in the work of development agencies. Viewed primarily as a form of violence against women, this commentary questions whether male civilians have also been victims of gender-based violence during conflict, invisible due to stereotypes surrounding masculinity and a culturally permissive approach towards violence perpetrated against men, especially at times of war. The experience of civilian males of violence, including sexual violence, during the war in Bosnia and Herzegovina and other contemporary wars, suggests that the discourse on gender-based violence and public health research should begin exploring the specific needs of men. Drawing on Nancy Krieger's (Krieger, N. (2003). Genders, sexes, and health: what are the connections-and why does it matter? International Journal of Epidemiology, 32, 652-657) analysis on the differential role of 'sex' and 'gender' on a given exposure-outcome association, this commentary suggests that the impact of gender-based violence on health during conflict may be different for men and women and may require distinct therapeutic approaches. Given that perpetrators are often male, an extra level of stigma is added when heterosexual men are sexually violated, which may lead to underreporting and reduced health-service seeking behavior. Further public health research is needed to guide the work of humanitarian agencies working with survivors of gender-based violence in conflict and post-conflict settings to ensure equal access to appropriate health services for men and women.

Predictors of help-seeking behaviour among women exposed to violence in Nigeria: a multilevel analysis to evaluate the impact of contextual and individual factors.

OBJECTIVES: To simultaneously examine contextual and individual-level predictors of help-seeking behaviour among women exposed to physical and sexual violence in Nigeria. DESIGN: A multi-level cross-sectional study. We fit three 3-level random intercepts models to examine contextual and individual-level characteristics associated with help seeking, simultaneously. SETTING: Nigerian Demographic and Health Survey for 2008. PARTICIPANTS: 5553 women (15-49 years) who reported physical or sexual violence, drawn from 23 715 women in the Nigerian Demographic and Health Survey that responded to questions on violence exposure. MAIN OUTCOME MEASURES: Help seeking to prevent future victimisation was based on self-report. RESULTS: In our sample of women exposed to physical and sexual violence, 39.7% reported that they sought help to stop the perpetrator from hurting them again. Rates of help seeking were geographically patterned by state (range: 12% to 65%). State-level development, measured by the Human Development Index (z-score), was positively associated with help seeking (OR=1.30, 95% CI 1.05 to 1.61), after adjusting for individual-level characteristics. State-level prevalence of violence against women (z-score) was negatively associated with help-seeking (OR=0.68, 95% CI 0.55 to 0.84), suggesting that service providers who may target their programmes to areas with high prevalence of violence, may need to simultaneously address barriers to help seeking. Few individual-level characteristics were associated with help seeking, including wealth, marital status, employment status, ethnicity, history of witnessing domestic violence and relationship to perpetrator. CONCLUSIONS: Efforts to support female survivors of violence should consider broader social and contextual determinants that are associated with help-seeking behaviours.

Husband's control and sexual coercion within marriage: findings from a population-based survey in Egypt.

This article examined sexual coercion within marriage in Egypt. Using cross-sectional survey data from a representative sample of married Egyptian women (N = 5,240), associations between forced intercourse and husband's control, as well as other relevant sociodemographic factors, were assessed through binary logistic regression models. The lifetime prevalence of forced intercourse was 6.2% and 4.6% during the past year, and husband's control was significantly associated with forced intercourse during a woman's lifetime (odds ratio = 3.5) and past year (odds ratio = 2.8). Interventions addressing gender patriarchy and men's control may decrease incidence of sexual coercion in Egypt and similar contexts.