The Impact of the COVID-19 Pandemic on Staffing Levels in Philadelphia Nursing Homes: Disparities Based on the Racial Composition of Geographical Areas.

Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020-2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults.

Diversity supplements: An underutilized opportunity to improve the diversity of the health sciences research workforce.

Purpose: This paper describes the process developed at the University of Pittsburgh to increase the number of NIH-funded Diversity Supplements. Method: The authors formed a Diversity in Academia Workgroup where we created the infrastructure and process to increase the number of Diversity Supplements. Each year, the Office of Sponsored Programs provided a list of grants that would be eligible to submit a Diversity Supplement. We surveyed the Principal Investigators inquiring about their interest in working with a trainee on a Diversity Supplement. If yes, we included their information in a database we built so that trainees could search for eligible research studies. The Diversity Deans then identified underrepresented faculty and postdoctoral researchers. We invited Program Officers from NIH to participate in a panel presentation for trainees, which was well attended. Results: The number of Diversity Supplements awarded to Pitt researchers has significantly increased from 7 in 2020 to 10 in 2021 and to 15 in 2022. Six more have been awarded in the first half of 2023. Conclusions: We created the Diversity in Academia Workgroup with the goal to increase the number of Diversity Supplements at the University of Pittsburgh and in so doing, increase the diversity in the biomedical research workforce. While challenging, we know the critical importance and benefits of increased diversity at the University, and we have made significant strides toward this goal.

An Equity Response to COVID-19 in Allegheny County, Pennsylvania: The Development and Work of the Black Equity Coalition.

From the onset of the pandemic in the United States, racial disparities in COVID-19 outcomes have been evident. In April 2020, several events prompted a concerned group of colleagues to form the Black Equity Coalition (BEC), a Black-led coalition in Allegheny County, Pennsylvania, which brings together professionals from multiple sectors who aim to ensure an equitable response to the COVID-19 pandemic. Several significant milestones have been achieved, and this article describes the development, functioning, and outcomes of the Coalition in the first 15 months of operation (April 2020-June 2021). COVID-19 was the reason for such an unprecedented effort, but this BEC infrastructure will be needed long after COVID-19 is controlled. In addition to short-term activities and reactive measures to prevent and mitigate COVID-19 in Black populations, the BEC is serving as a crucial link between government, health care stakeholders, and communities to produce long-term systemic change.

A Prematurity Collaborative Birth Equity Consensus Statement for Mothers and Babies.

INTRODUCTION: In 2016, March of Dimes (MOD) launched its Prematurity Collaborative to engage a broad cross section of national experts to address persistent and widening racial disparities in preterm birth by achieving equity and demonstrated improvements in preterm birth. African-American and Native American women continue to have disproportionate rates of preterm birth and maternal death. As part of the Collaborative, MOD created the Health Equity Workgroup whose task was the creation of a scientific consensus statement articulating core values and a call to action to achieve equity in preterm birth utilizing health equity and social determinants of health frameworks. METHODS: Health Equity Workgroup members engaged in-person and virtually to discuss key determinant contributors and resolutions for disparate maternal and birth outcomes. Workgroup members then drafted the Birth Equity Consensus Statement that contained value statements and a call to action. The birth equity consensus statement was presented at professional conferences to seek broader support. This article highlights the background and context towards arriving at the core values and call to action, which are the two major components of the consensus statement and presents the core values and call to action themselves. RESULTS: The result was the creation of a birth equity consensus statement that highlights risks and protections of social determinants based on the prevailing science, and identifies promising solutions for reducing preterm birth and eliminating racial disparities. CONCLUSION: The birth equity consensus statement provides a mandate, guiding the work of March of Dimes and the broader MCH community, for equity-based research, practice, and policy advocacy at local, state, and federal levels. SIGNIFICANCE: This field report adds to the current knowledge base on racial and ethnic disparities in birth and maternal health outcomes. Research has documented the science behind eliminating health disparities. Scientists and practitioners should continue to explore in practice how the social determinants of birth and maternal health, which manifest historically and contemporarily, can be addressed.

The impact of prenatal WIC participation on infant mortality and racial disparities.

OBJECTIVES: We assessed the value of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services as a public health intervention seeking to improve birth outcomes and reduce racial disparities. METHODS: We compared the infant mortality rate (IMR) per 1000 live births and percentage of preterm births overall and by race for prenatal WIC versus non-WIC participants in Hamilton County, Ohio, from 2005 to 2008. RESULTS: The IMR was lower for WIC participants than for non-WIC participants (8.0 vs 10.6; P = .04). For African Americans, the IMR of WIC participants was much lower than that of non-WIC participants (9.6 vs 21.0; P < .001). For Whites, IMR and preterm birth rates were not improved by WIC participation; however, there was a higher rate of maternal smoking among Whites. The racial disparity in IMR was dramatically reduced in WIC participants (9.6 for African Americans vs 6.7 for Whites; P = .14) as compared with non-WIC participants (21.0 for African Americans vs 7.8 for Whites; P < .001). CONCLUSIONS: Prenatal WIC participation is associated with significant improvements in African American IMR. WIC participation reduces racial disparities in IMR between African Americans and Whites.

Child and adolescent violent deaths: an epidemiologic investigation.

OBJECTIVES: An apparent increase in violent deaths among children and adolescents in Detroit, MI in 2002 prompted a coordinated epidemiologic investigation involving federal, state and local organizations. METHODS: A descriptive analysis of cases and violent deaths (homicide, suicide or firearm-related) among juveniles <17 years was conducted, along with a case-control study using records from the medical examiner, police, schools and social service agencies. RESULTS: Twenty-nine cases were identified. Median age was 10 years (range 1 day-16 years), and 15 (52%) were male. There were 25 homicides, two suicides and two unintentional firearm-related deaths. Nine (31%) homicides resulted from child abuse and neglect, and eight (28%) were among bystanders. The most common mechanism of fatal injury was firearm (63%). Victims' families were more likely to have a history of familial violence, prior contact with the state social services agency, > or = 2 adults and > or = 4 persons in the household (P<0.05). CONCLUSIONS: The 2002 deaths did not represent a statistically significant increase from previous years. Several findings were remarkable: the proportion of deaths among bystanders, females and children age <5.