An Intensive Longitudinal Assessment Approach to Surveilling Trajectories of Burnout over the First Year of the COVID Pandemic.

Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic's first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.

Racial/Ethnic Discrimination and Food Consumption: Examination in Diverse Samples.

BACKGROUND: Racial/ethnic discrimination has been linked to poor health outcomes. Effects of discrimination on health behaviors, including patterns of food consumption, may contribute to health outcomes. PURPOSE: We examined relations of discrimination to consumption of healthy and unhealthy foods in two diverse samples. Structural equation modeling was used to examine variations in associations of discrimination to consumption by the timing and type of discrimination, for healthy vs. unhealthy food, and by sample. METHODS: Study 1 included a racially and ethnically diverse sample of adults from New York City (NYC: N = 157); Study 2 included a sample of American Indian and Alaska Native (AI/AN) adults from the Denver metro area (N = 303), many of whom also identified with other racial/ethnic groups. Participants completed self-report measures of racial/ethnic discrimination, food consumption, life stressors, and sociodemographic variables. RESULTS: Structural equation models indicated discrimination was associated with food consumption. Tests of model invariance indicated that the model of discrimination to food consumption can be applied to both samples. Discrimination within the past-week was associated with more frequent consumption of both unhealthy and healthy foods, whereas lifetime discrimination was associated with more frequent consumption only of unhealthy foods. CONCLUSIONS: The data were limited to self-report measures and only the frequency of consumption was assessed. The findings suggest discrimination may contribute to health disparities through effects on food consumption. Differential effects for past-week and lifetime discrimination suggest that multiple mechanisms may be involved.

Experiencing racial discrimination may undermine health through effects on health behavior, including patterns of food consumption. In two studies, we tested whether racial discrimination was linked with food consumption, specifically the frequency with which people ate healthy and unhealthy foods. We investigated both lifetime exposure to discrimination as well as more recent (past-week) exposure as predictors of food consumption. Study 1 focused on racially and ethnically diverse adults from New York City (NYC); Study 2 focused on American Indian and Alaska Native (AI/AN) adults from the Denver metro area. Overall, we found that higher levels of discrimination were associated with more frequent consumption of both unhealthy and healthy food. The timing of discrimination mattered. Higher levels of discrimination within the past-week were associated with more frequent consumption of healthy and unhealthy foods. In contrast, higher levels of lifetime discrimination were associated only with more frequent consumption of unhealthy food. The links between discrimination and food consumption remained significant controlling for socioeconomic status. The relations of discrimination to food consumption were similar across the diverse sample from NYC and the AI/AN sample from Denver. These findings may help researchers understand how discrimination may contribute to health disparities.