Psychosocial impacts of the COVID-19 pandemic among settled women: A longitudinal study / Os impactos psicossociais da pandemia de COVID-19 entre mulheres assentadas: estudo longitudinal / Impactos psicosociales de la pandemia de COVID-19 en mujeres de asentamientos rurales: estudio longitudinal

Abstract Objective: to analyze the psychosocial impacts of the COVID-19 pandemic among Brazilian women from rural settlements. Method: this is a quantitative and longitudinal study conducted with 13 settled women. The data were collected between January 2020 and September 2021 using questionnaires on the perception of the social environment (quality of life, social support, self-efficacy), common mental disorder symptoms and sociodemographic aspects. The data were analyzed using descriptive statistics, cluster analysis and variance analysis. Results: intersecting vulnerability conditions were identified that possibly intensified the challenges arising from the pandemic. The Quality of Life physical domain fluctuated differently and inversely according to the mental disorder symptoms. As for the psychological domain, at the end of the segment, an increase over time was identified in the entire sample, as the women's perception was better than before the pandemic. Conclusion: worsening of the participants' physical health deserves to be highlighted and, probably, it can be related to the difficulty accessing health services in this period as well as to the fear of contamination. Despite this, the participants were emotionally resilient throughout the period, including signs of improvement in terms of psychological aspects, suggesting a possible effect of the community organization of the settlement.

Resumo Objetivo: analisar os impactos psicossociais da pandemia de COVID-19 entre mulheres brasileiras de assentamentos rurais. Método: trata-se de um estudo quantitativo longitudinal com 13 mulheres assentadas. Os dados foram coletados entre janeiro de 2020 e setembro de 2021 utilizando questionários sobre a percepção do ambiente social (qualidade de vida, apoio social, autoeficácia), sintomas de transtorno mental comum e aspectos sociodemográficos. Os dados foram analisados por meio de estatística descritiva, análise de agrupamento e de variância. Resultados: foram identificadas condições de vulnerabilidade interseccionadas que, possivelmente, exacerbaram os desafios decorrentes da pandemia. O domínio físico da qualidade de vida oscilou diferentemente e inversamente de acordo com os sintomas de transtorno mental. Quanto ao domínio psicológico, no final do segmento, identificou-se em toda a amostra um incremento ao longo do tempo, pois a percepção das mulheres estava melhor do que antes da pandemia. Conclusão: a piora na saúde física das participantes merece destaque e, provavelmente, pode estar relacionada à dificuldade de acesso aos serviços de saúde neste período bem como ao medo da contaminação. Apesar disso, as participantes apresentaram-se emocionalmente resilientes em todo o período, inclusive, com sinais de melhora em relação aos aspectos psicológicos, sugerindo um possível efeito da organização comunitária do assentamento.

Resumen Objetivo: analizar los impactos psicosociales de la pandemia de COVID-19 en mujeres brasileñas de asentamientos rurales. Método: se trata de un estudio longitudinal cuantitativo con 13 mujeres asentadas. Los datos se recolectaron entre enero de 2020 y septiembre de 2021 mediante cuestionarios sobre percepción del entorno social (calidad de vida, apoyo social, autoeficacia), síntomas de trastorno mental común y aspectos sociodemográficos. Los datos se analizaron mediante estadística descriptiva, análisis de conglomerados y análisis de varianza. Resultados: se identificaron condiciones de vulnerabilidad entrelazadas que posiblemente exacerbaron los desafíos impuestos por la pandemia. El dominio físico de la calidad de vida fluctuó de manera diferente e inversa de acuerdo a los síntomas del trastorno mental. En cuanto al dominio psicológico, al final del segmento, se identificó un aumento en el tiempo en toda la muestra, dado que la percepción de las mujeres era mejor que antes de la pandemia. Conclusión: hay que destacar el empeoramiento de la salud física de las participantes que, probablemente, puede estar relacionado con la dificultad para acceder a los servicios de salud durante ese período y el miedo al contagio. A pesar de eso, las participantes fueron resilientes emocionalmente durante todo el período e, inclusive, tuvieron signos de mejoría en los aspectos psicológicos, lo que sugiere un posible efecto de la organización comunitaria del asentamiento.

Disaster exposure and patterns of disaster preparedness: A multilevel social vulnerability and engagement perspective.

This study examined how community vulnerabilities contextualized the impact of exposure to five major disasters in 2017 on individuals' disaster preparedness. We pooled two panels of the Federal Emergency Management Agency (FEMA)'s National Household Survey in 2017 (pre-disaster) and 2018 (post-disaster) and further merged the data with 15 Centers for Disease Control and Prevention Social Vulnerability Index factors to examine the moderating impact of county-level vulnerabilities. Latent class analysis was used to identify patterns of disaster preparedness based on six preparedness items defined by FEMA with a total of 10,045 individuals. Three groups were identified and named basic preparedness (BP) group, high preparedness: socially engaged (HP-SE) group, and high preparedness: advanced socially engaged (HP-ASE) group. A working sample with a smaller sample size was constructed to include 2,179 individuals from 92 counties with disaster declarations of Hurricane Harvey, Hurricane Irma, Hurricane Maria, Hurricane Nate, and California Wildfires in 2017. Multinomial logistic regression indicated that post-disaster respondents were more likely to be in the HP-SE relative to the BP group. Two-level multinomial logistic regression showed that post-disaster respondents in communities with higher percentages of single-parent households and those of no vehicles were less likely to be in the HP-SE vs. the BP group. Post-disaster respondents in communities with higher percentages of unemployment, no high school diploma, and occupied housing units with more people than rooms were less likely to be in the HP-ASE vs. the BP group. Post-disaster respondents in communities with higher percentages of older adults and mobile homes were more likely to be in the HP-SE vs. the BP group. The findings also highlighted the importance of social engagement in disaster preparedness disparities and the need for community-level intervention to promote individuals' disaster preparedness.

Toxic Tides and Environmental Injustice: Social Vulnerability to Sea Level Rise and Flooding of Hazardous Sites in Coastal California.

Sea level rise (SLR) and heavy precipitation events are increasing the frequency and extent of coastal flooding, which can trigger releases of toxic chemicals from hazardous sites, many of which are in low-income communities of color. We used regression models to estimate the association between facility flood risk and social vulnerability indicators in low-lying block groups in California. We applied dasymetric mapping techniques to refine facility boundaries and population estimates and probabilistic SLR projections to estimate facilities' future flood risk. We estimate that 423 facilities are at risk of flooding in 2100 under a high emissions scenario (RCP 8.5). One unit standard deviation increases in nonvoters, poverty rate, renters, residents of color, and linguistically isolated households were associated with a 1.5-2.2 times higher odds of the presence of an at-risk site within 1 km (ORs [95% CIs]: 2.2 [1.8, 2.8], 1.9 [1.5, 2.3], 1.7 [1.4, 1.9], 1.5 [1.2, 1.9], and 1.5 [1.2, 1.9], respectively). Among block groups near at least one at-risk site, the number of sites increased with poverty, proportion of renters and residents of color, and lower voter turnout. These results underscore the need for further research and disaster planning that addresses the differential hazards and health risks of SLR.

A cross-sectional study on gaming intensity and social vulnerability in adolescents that have a chronic condition.

Background: Adolescents growing up with a chronic condition might experience more social vulnerabilities compared to their healthy peers as an indirect result of their conditions. This can lead to a relatedness need frustration for these adolescents. Consequently, they might spend more time playing video games compared to their peers. Research shows that both social vulnerability and gaming intensity are predictors for problematic gaming. Therefore, we investigated if social vulnerability and gaming intensity are more pronounced in adolescents that have a chronic condition compared to the general population; and if these levels reflect the levels of a clinical group being treated for Internet Gaming Disorder (IGD). Methods: Data on peer problems and gaming intensity were compared from three separate samples: a national representative sample of adolescents, a clinical sample of adolescents that are undergoing treatment for IGD, and a sample of adolescents diagnosed with a chronic condition. Results: No differences were found on either peer problems or gaming intensity between the group of adolescents that have chronic conditions and the national representative group. The group with chronic conditions scored significantly lower on gaming intensity than the clinical group. No significant differences were found between these groups on peer problems. We repeated the analyses for boys only. Similar results were found for the group with chronic conditions compared to the national representative group. The group with chronic conditions now scored significantly lower on both peer problems and gaming intensity than the clinical group. Conclusion: Adolescents growing up with a chronic condition appear similar in their gaming intensity and peer problems compared to their healthy peers.

County-level social vulnerability and nonfatal drug overdose emergency department visits and hospitalizations, January 2018-December 2020.

BACKGROUND: Nonfatal drug overdoses (NFODs) are often attributed to individual behaviors and risk factors; however, identifying community-level social determinants of health (SDOH) associated with increased NFOD rates may allow public health and clinical providers to develop more targeted interventions to address substance use and overdose health disparities. CDC's Social Vulnerability Index (SVI), which aggregates social vulnerability data from the American Community Survey to produce ranked county-level vulnerability scores, can help identify community factors associated with NFOD rates. This study aims to describe associations between county-level social vulnerability, urbanicity, and NFOD rates. METHODS: We analyzed county-level 2018-2020 emergency department (ED) and hospitalization discharge data submitted to CDC's Drug Overdose Surveillance and Epidemiology system. Counties were ranked in vulnerability quartiles based on SVI data. We used crude and adjusted negative binomial regression models, by drug category, to calculate rate ratios and 95% confidence intervals comparing NFOD rates by vulnerability. RESULTS: Generally, as social vulnerability scores increased, ED and hospitalization NFOD rates increased; however, the magnitude of the association varied across drugs, visit type, and urbanicity. SVI-related theme and individual variable analyses highlighted specific community characteristics associated with NFOD rates. CONCLUSIONS: The SVI can help identify associations between social vulnerabilities and NFOD rates. Development of an overdose-specific validated index could improve translation of findings to public health action. The development and implementation of overdose prevention strategies should consider a socioecological perspective and address health inequities and structural barriers associated with increased risk of NFODs at all levels of the social ecology.

Social Vulnerability and Risk of Suicide in US Adults, 2016-2020.

Importance: There were over 45 000 suicides in the US in 2020, making suicide the 12th leading cause of death. If social vulnerability is associated with suicide rates, targeted interventions for at-risk segments of the population may reduce US suicide rates. Objective: To determine the association between social vulnerability and suicide in adults. Design, Setting, and Participants: This cohort study analyzed 2 county-level social vulnerability measures (the Social Vulnerability Index [SVI] and the Social Vulnerability Metric [SVM]) and US Centers for Disease Control and Prevention-reported county-level suicides from 2016 to 2020. Data were analyzed November and December 2022. Exposures: County-level variability in social vulnerability. Main Outcomes and Measures: The primary outcome measure was number of county-level adult suicides from 2016 to 2020, offset by county adult population during those years. The association between social vulnerability (measured using the SVI and the newly created SVM for 2018) and suicide was modeled using a bayesian-censored Poisson regression model to account for the CDC's suppression of county-level suicide counts of less than 10, adjusted for age, racial and ethnic minority, and urban-rural county characteristics. Results: From 2016 to 2020, there were a total of 222 018 suicides in 3141 counties. Comparing the least socially vulnerable (0% to 10%) to the most socially vulnerable (90% to 100%) counties, there was a 56% increase in suicide rate (17.3 per 100 000 persons to 27.0 per 100 000 persons) as measured by the SVI (incidence rate ratio, 1.56; 95% credible interval, 1.51-1.60) and an 82% increase in suicide rate (13.8 per 100 000 persons to 25.1 per 100 000 persons) as measured by the SVM (incidence rate ratio, 1.82; 95% credible interval, 1.72-1.92). Conclusions and Relevance: This cohort study found that social vulnerability had a direct association with risk for adult suicide. Reducing social vulnerability may lead to life-saving reduction in the rate of suicide.

The social vulnerability index as a risk stratification tool for health disparity research in cancer patients: a scoping review.

PURPOSE: The social vulnerability index (SVI), developed by the Centers for Disease Control and Prevention, is a novel composite measure encompassing multiple variables that correspond to key social determinants of health. The objective of this review was to investigate innovative applications of the SVI to oncology research and to employ the framework of the cancer care continuum to elucidate further research opportunities. METHODS: A systematic search for relevant articles was performed in five databases from inception to 13 May 2022. Included studies applied the SVI to analyze outcomes in cancer patients. Study characteristics, patent populations, data sources, and outcomes were extracted from each article. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: In total, 31 studies were included. Along the cancer care continuum, five applied the SVI to examine geographic disparities in potentially cancer-causing exposures; seven in cancer diagnosis; fourteen in cancer treatment; nine in treatment recovery; one in survivorship care; and two in end-of-life care. Fifteen examined disparities in mortality. CONCLUSION: In highlighting place-based disparities in patient outcomes, the SVI represents a promising tool for future oncology research. As a reliable geocoded dataset, the SVI may inform the development and implementation of targeted interventions to prevent cancer morbidity and mortality at the neighborhood level.

Momentos clave en el camino hacia la equidad en salud en la Organización Panamericana de la Salud

[RESUMEN]. Hoy en día la equidad es un objetivo central para la Organización Panamericana de la Salud (OPS). Este objetivo es el resultado de movimientos multidimensionales que tienen una historia y que sólo pueden com- prenderse a la luz de las relaciones sociales que estructuran los procesos que llamamos de “salud”. De una preocupación por el comercio marítimo a un interés por los determinantes sociales de la salud, la OPS ha for- talecido sus esfuerzos por poner en el centro de sus acciones la idea de la equidad en salud como fin último. Se ha pasado de una idea de salud enfocada en el individuo, a una idea de salud para todas las personas, que contemple las diferencias de ser y hacer en el mundo. Estos cambios han producido políticas, análisis y estudios donde el género y la diversidad cultural son ejes transversales que deben ser contemplados en toda planificación y ejecución de políticas de salud en la Región de las Américas. En este artículo se analizan momentos clave en el camino hacia la equidad en salud en la Región desde una perspectiva histórica.

[ABSTRACT]. Equity has become a key objective for the Pan American Health Organization (PAHO). This is the result of multidimensional movements with a history that can only be understood in the light of social relations that structure the processes we refer to as "health". From an initial concern for maritime trade to a current interest in the social determinants of health, PAHO has strengthened its efforts to make the concept of health equity the ultimate goal of its actions. The idea of health focused on the individual has given way to the idea of health for all people, which considers the differences between being and doing in the world. These changes have produced policies, analyses, and studies in which gender and cultural diversity are cross-cutting themes that must be considered in all planning and implementation of health policies in the Region of the Americas. This article discusses milestones on the road to health equity in the Region from a historical perspective.

[RESUMO]. Hoje, a equidade é um objetivo central para a Organização Pan-Americana da Saúde (OPAS). Esse objetivo é fruto de movimentos multidimensionais que têm uma história e que só podem ser compreendidos à luz das relações sociais que estruturam os processos que chamamos de “saúde”. Da preocupação com o comércio marítimo ao interesse pelos determinantes sociais da saúde, a OPAS tem intensificado seus esforços para colocar no cerne de suas ações a ideia da equidade em saúde como objetivo final. Passou de uma ideia de saúde centrada no indivíduo a uma ideia de saúde para todas as pessoas, que contempla as diferenças entre o ser e o fazer no mundo. Essas mudanças produziram políticas, análises e estudos onde o gênero e a diversidade cultural são eixos transversais que devem ser considerados em todo planejamento e execução de políticas de saúde na Região das Américas. Este artigo analisa momentos-chave no caminho rumo à equi- dade em saúde na região, a partir de uma perspectiva histórica.

Main social vulnerability indicators in the COVID-19 pandemic in Iran.

Background: Social factors play the main role in the vulnerability of exposed countries to disasters. The COVID-19 pandemic as a disaster is not an exception to this fact. This study aimed to determine the main social vulnerability indicators in the COVID-19 pandemic in Iran. Methods: This study was conducted during the period of 2021-2022 in three phases, including a systematic review, a virtual panel expert, and the Analytical Hierarchy Process. First, the draft of social vulnerability indicators in COVID-19 was extracted through a systematic review. Then, the extracted indicators were finalized and prioritized by the expert panel and the AHP, respectively. Results: Initially, the literature review found five domains and 38 indicators of social vulnerability in COVID-19. The outcome of the expert panel increased the related domains to six but decreased the indicators to 31. The three prioritized social vulnerability indicators that were determined by the AHP were population density, accessibility to healthcare facilities, and relevant services and vulnerable groups. Conclusion: Measuring social vulnerability with the identified indicators is valuable for addressing high COVID-19 incidence among socially vulnerable hotspot areas. Regarding the result of this study, further research should be conducted to validate the identified indicators.

Use of pregnancy personalised follow-up in case of maternal social vulnerability to reduce prematurity and neonatal morbidity.

BACKGROUND: Social deprivation is a major risk factor of adverse pregnancy outcomes. Yet, there is few studies evaluating interventions aiming at reducing the impact of social vulnerability on pregnancy outcomes. OBJECTIVE: To compare pregnancy outcomes between patients that received personalized pregnancy follow-up (PPFU) to address social vulnerability versus standard care. METHODS: Retrospective comparative cohort in a single institution between 2020 and 2021. A total of 3958 women with social vulnerability that delivered a singleton after 14 gestational weeks were included, within which 686 patients had a PPFU. Social vulnerability was defined by the presence of at least one of the following characteristics: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance (these four variables were combined as a social deprivation index (SDI)), recent immigration (< 12 month), interpersonal violence during pregnancy, being handicaped or minor, addiction during pregnancy. Maternal characteristics and pregnancy outcomes were compared between patients that received PPFU versus standard care. The associations between poor pregnancy outcomes (premature birth before 37 gestational weeks (GW), premature birth before 34 GW, small for gestational age (SGA) and PPFU were tested using multivariate logistic regression and propensity score matching. RESULTS: After adjustment on SDI, maternal age, parity, body mass index, maternal origin and both high medical and obstetrical risk level before pregnancy, PPFU was an independent protective factor of premature birth before 37 gestational weeks (GW) (aOR = 0.63, 95%CI[0.46-0.86]). The result was similar for premature birth before 34 GW (aOR = 0.53, 95%CI [0.34-0.79]). There was no association between PPFU and SGA (aOR = 1.06, 95%CI [0.86 - 1.30]). Propensity score adjusted (PSa) OR for PPFU using the same variables unveiled similar results, PSaOR = 0.63, 95%CI[0.46-0.86] for premature birth before 37 GW, PSaOR = 0.52, 95%CI [0.34-0.78] for premature birth before 34 GW and PSaOR = 1.07, 95%CI [0.86 - 1.33] for SGA. CONCLUSIONS: This work suggests that PPFU improves pregnancy outcomes and emphasizes that the detection of social vulnerability during pregnancy is a major health issue.

Spatiotemporal distribution of power outages with climate events and social vulnerability in the USA.

Power outages threaten public health. While outages will likely increase with climate change, an aging electrical grid, and increased energy demand, little is known about their frequency and distribution within states. Here, we characterize 2018-2020 outages, finding an average of 520 million customer-hours total without power annually across 2447 US counties (73.7% of the US population). 17,484 8+ hour outages (a medically-relevant duration with potential health consequences) and 231,174 1+ hour outages took place, with greatest prevalence in Northeastern, Southern, and Appalachian counties. Arkansas, Louisiana, and Michigan counties experience a dual burden of frequent 8+ hour outages and high social vulnerability and prevalence of electricity-dependent durable medical equipment use. 62.1% of 8+ hour outages co-occur with extreme weather/climate events, particularly heavy precipitation, anomalous heat, and tropical cyclones. Results could support future large-scale epidemiology studies, inform equitable disaster preparedness and response, and prioritize geographic areas for resource allocation and interventions.

Place Still Matters: Social Vulnerabilities, Place-Level Disadvantage, and Food Insecurity during COVID-19.

COVID-19 variants continue to create public health danger impacting mortality and morbidity across the United States. The spillover effects of COVID-19 on the economy and social institutions pose a significant threat to broader wellbeing, including the food security of millions across the country. We aim to explore whether the context of place matters above and beyond individual and social vulnerabilities for food insecurity. To do so, we employ a multi-level framework using data from a survey of over 10,000 U.S. adults from March 2020 with American Community Survey (ACS) and John Hopkins COVID Dashboard county-level data. We find nearly two in five respondents were food insecure by March of 2020 with disparities across race, nativity, the presence of children in the home, unemployment, and age. Furthermore, we note that individuals living in more disadvantaged communities were more likely to report food insecurity above and beyond individual and social vulnerabilities. Overall, food insecurity is driven by complex, multi-level dynamics that remain a pressing public health concern for the current-but also future-public health crisis.

Disparities in Perceived Physical and Mental Wellness: Relationships Between Social Vulnerability, Cardiovascular Risk Factor Prevalence, and Health Behaviors Among Elderly US Residents.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death for males, females, and people of most racial and ethnic groups in the United States. In addition to known epidemiological and behavioral risk factors, recent evidence suggests that circumstantial or behavioral factors may also be associated with CVD. This study evaluates the contribution of cardiovascular disease (CVD) risk factors, community vulnerabilities, and individual health behaviors to individual physical and mental wellness among Black and White, male, and female Medicare beneficiaries. METHODS: This study utilized data from the Behavioral Risk Factor Surveillance System, county-level CVD risk factor prevalence, and selected items from the Social Vulnerability Index. RESULTS: Correlations were found between unhealthy days reported by males and area social vulnerabilities and health behaviors. Prevalence of disease was correlated with mentally unhealthy days for White males. Among White females, health behaviors, disease prevalence, and social vulnerability measures were associated with unhealthy days. Among Black females, disease prevalence was highly correlated with mentally unhealthy days. DISCUSSION: While individual-level health behaviors are highly associated with perceived physical and mental health, the self-reported health of Black respondents is also heavily correlated with local area vulnerabilities, including community poverty, group housing, and crowding.

Using the Social Vulnerability Index to Examine Disparities in Surgical Pediatric Trauma Patients.

INTRODUCTION: The Social Vulnerability Index (SVI) is a composite measure geocoded at the census tract level that has the potential to identify target populations at risk for postoperative surgical morbidity. We applied the SVI to examine demographics and disparities in surgical outcomes in pediatric trauma patients. METHODS: Surgical pediatric trauma patients (≤18-year-old) at our institution from 2010 to 2020 were included. Patients were geocoded to identify their census tract of residence and estimated SVI and were stratified into high (≥70th percentile) and low (<70th percentile) SVI groups. Demographics, clinical data, and outcomes were compared using Kruskal-Wallis and Fisher's exact tests. RESULTS: Of 355 patients included, 21.4% had high SVI percentiles while 78.6% had low SVI percentiles. Patients with high SVI were more likely to have government insurance (73.7% versus 37.2%, P < 0.001), be of minority race (49.8% versus 19.1%, P < 0.001), present with penetrating injuries (32.9% versus 19.7%, P = 0.007), and develop surgical site infections (3.9% versus 0.4%, P = 0.03) compared to the low SVI group. CONCLUSIONS: The SVI has the potential to examine health care disparities in pediatric trauma patients and identify discrete at-risk target populations for preventative resources allocation and intervention. Future studies are necessary to determine the utility of this tool in additional pediatric cohorts.

Investigating the Spatial Relationship between Social Vulnerability and Healthcare Facility Distribution in Nassau County, New York.

Health is a fundamental human right, yet healthcare facilities are not distributed equitably across all communities. This study aims to investigate the distribution of healthcare facilities in Nassau County, New York, and examine whether the distribution is equitable across different social vulnerability levels. An optimized hotspot analysis was conducted on a dataset of 1695 healthcare facilities-dental, dialysis, ophthalmic, and urgent care-in Nassau County, and social vulnerability was measured using the FPIS codes. The study found that healthcare facilities were disproportionately distributed in the county, with a higher concentration in areas of low social vulnerability compared to areas of high social vulnerability. The majority of healthcare facilities were found to be clustered in two ZIP codes-11020 and 11030-that rank among the top ten wealthiest in the county. The results of this study suggest that socially vulnerable residents in Nassau County are at a disadvantage when it comes to attaining equitable access to healthcare facilities. The distribution pattern highlights the need for interventions to improve access to care for marginalized communities and to address the underlying determinants of healthcare facility segregation in the county.

Examining neighborhood-level hot and cold spots of food insecurity in relation to social vulnerability in Houston, Texas.

Food insecurity is prevalent and associated with poor health outcomes, but little is known about its geographical nature. The aim of this study is to utilize geospatial modeling of individual-level food insecurity screening data ascertained in health care settings to test for neighborhood hot and cold spots of food insecurity in a large metropolitan area, and then compare these hot spot neighborhoods to cold spot neighborhoods in terms of the CDC's Social Vulnerability Index. In this cross-sectional secondary data analysis, we geocoded the home addresses of 6,749 unique participants screened for food insecurity at health care locations participating in CMS's Accountable Health Communities (AHC) Model, as implemented in Houston, TX. Next, we created census-tract level incidence profiles of positive food insecurity screens per 1,000 people. We used Anselin's Local Moran's I statistic to test for statistically significant census tract-level hot/cold spots of food insecurity. Finally, we utilized a Mann-Whitney-U test to compare hot spot tracts to cold spot tracts in relation to the CDC's Social Vulnerability Index. We found that hot spot tracts had higher overall social vulnerability index scores (P <0.001), higher subdomain scores, and higher percentages of individual variables like poverty (P <0.001), unemployment (P <0.001), limited English proficiency (P <0.001), and more. The combination of robust food insecurity screening data, geospatial modeling, and the CDC's Social Vulnerability Index offers a solid method to understand neighborhood food insecurity.

Unidades RISC: una estrategia para evaluar riesgos de salud en la población infantil de comunidades contaminadas

[RESUMEN]. Las crisis humanitarias pueden presentarse en sitios afectados por amenazas químicas, físicas, biológicas y sociales, sobre todo cuando estas amenazas interaccionan entre sí y causan una sindemia. A fin de evitar las crisis, en estos sitios se hace necesario introducir medidas de mitigación que hemos enmarcado bajo el término de “escenarios humanitarios”. Debido a su naturaleza, la implementación de dichas acciones de intervención requiere de la conformación de grupos operativos multidisciplinarios y de una estrategia de trabajo que permita integrarlos con la comunidad afectada. En el caso de la población infantil, el grupo ope- rativo recibió el nombre de unidad de riesgos infantiles en sitios contaminados (RISC), es decir, en localidades impactadas por amenazas químicas, físicas o biológicas. La estrategia consta de las siguientes seis fases: i) planificación para el estudio y la visita al sitio; ii) participación de la comunidad para identificar amena- zas, vulnerabilidades y rutas de exposición (el camino que deben seguir los contaminantes desde su fuente hasta la población receptora), así como para el trabajo conjunto en las siguientes fases; iii) priorización de riesgos identificados mediante el monitoreo ambiental y uso de biomarcadores de exposición y efectos; iv) prevención de riesgos a través de la creación de diversas capacidades y alternativas para la prevención ante amenazas sindémicas (CAPAS); v) promoción para implementar las CAPAS mediante la comunicación de riesgos y la capacitación local; y vi) protección con medidas que incluyen propuestas de telesalud, progreso social e innovación para mejorar la cobertura sanitaria. La estrategia ha sido aplicada en diferentes contextos, en algunos de los cuales, ha sido enriquecida con el análisis del respeto de los derechos humanos.

[ABSTRACT]. Humanitarian crises can occur in places affected by chemical, physical, biological, and social threats, espe- cially when these threats interact with each other and cause a syndemic. In order to avoid crises in these places, it is necessary to introduce mitigation measures that we have framed as "humanitarian scenarios". Due to their nature, implementation of these interventions requires the creation of multidisciplinary operational groups with a work strategy that integrates them into the affected community. In the case of the child popula- tion, the operational group was called the ‘childhood risks in contaminated places’ (CRCP) unit; contaminated places meaning localities impacted by chemical, physical, or biological threats. The strategy has six phases: (i) planning the survey and site visit; (ii) community involvement in identifying threats, vulnerabilities, and routes of exposure (the path of pollutants from their source to the receiving population), and in preparing joint work for the subsequent phases; iii) prioritization of risks identified through environmental monitoring and use of bio- markers of exposure and effects; iv) risk prevention through the creation of various ‘capacities and alternatives for the prevention of syndemic threats’; (v) advocacy to implement these capacities and alternatives through risk communication and local training; and (vi) protection through measures that include telehealth, social pro- gress, and innovation to improve health coverage. The strategy has been implemented in different contexts, and in some of them it has been enriched by analysis of respect for human rights.

[RESUMO]. Crises humanitárias podem ocorrer em locais afetados por ameaças químicas, físicas, biológicas e sociais, principalmente quando essas ameaças interagem entre si e causam uma sindemia. Para evitar as crises, é necessário introduzir nesses locais medidas de mitigação que enquadramos no termo “cenários huma- nitários”. Por sua natureza, a implementação de tais ações de intervenção exige a formação de grupos operacionais multidisciplinares e de uma estratégia de trabalho que permita integrá-los à comunidade afe- tada. No caso da população infantil, o grupo operacional recebeu o nome de Unidade de Riscos Infantis em Áreas Contaminadas (na sigla em espanhol, RISC), ou seja, em locais impactados por ameaças químicas, físicas ou biológicas. A estratégia consiste nas seis fases a seguir: i) planejamento para o estudo e visita ao local; ii) participação da comunidade para identificar ameaças, vulnerabilidades e rotas de exposição (caminho que os contaminantes devem seguir desde a sua fonte até a população receptora), bem como para o trabalho conjunto nas fases seguintes; iii) priorização dos riscos identificados por meio do monitoramento ambiental e uso de biomarcadores de exposição e efeitos; iv) prevenção de riscos por meio da criação de diversas capacidades e alternativas para a prevenção diante de ameaças sindêmicas (CAPAS); v) promoção da implantação das CAPAS por meio da comunicação de riscos e capacitação local; e vi) proteção com medi- das que incluem propostas de telessaúde, progresso social e inovação para melhorar a cobertura de saúde. A estratégia foi aplicada em diferentes contextos, em alguns dos quais foi enriquecida com uma análise do respeito pelos direitos humanos.

Necesidades en salud sexual y reproductiva en migrantes de origen venezolano en el municipio de Cali (Colombia)

[RESUMEN]. Objetivo. Este estudio busca comprender las necesidades asociadas con la salud sexual y reproductiva (SSR) de migrantes de origen venezolano asentados de forma temporal o permanente en Santiago de Cali, Colombia. Método. Se realizó un estudio cualitativo con migrantes de origen venezolano de entre 15 y 60 años. Los par- ticipantes se seleccionaron mediante la técnica de bola de nieve, y la recopilación de la información se inició con personas referenciadas por las organizaciones de personas migrantes y luego con recorridos en zonas de alta concentración de personas migrantes de origen venezolano. Se realizaron entrevistas en profundidad y análisis de contenido temático. Resultados. Participaron 48 personas migrantes, de las cuales 70,8% no tenía regularizada su condición migratoria y se hallaban en condiciones de vulnerabilidad socioeconómica. Las personas participantes con- taban con pocos recursos económicos, tenían falta de oportunidades de trabajo, precariedad de capital humano y niveles variables de capital social, sumado a una integración social débil que limitaba su apro- piación como titulares de derechos. El estatus migratorio se constituye en una barrera para el acceso a los servicios de salud y otros servicios sociales. Sobresalen las necesidades de información sobre derechos de salud sexual y reproductiva, un mayor riesgo entre jóvenes de 15 y 29 años y en la comunidad LGBTIQ+, debido a la mayor vulnerabilidad y la exposición a espacios inseguros para su autocuidado, aseo personal e intimidad, necesidades de atención y tratamiento de infecciones de transmisión sexual, apoyo psicosocial por violencia, consumo de sustancias psicoactivas, conflictos familiares y procesos de transición de género. Conclusiones. Las necesidades en temas de salud sexual y reproductiva de las personas migrantes de ori- gen venezolano están determinadas por sus condiciones de vida y trayectorias migratorias.

[ABSTRACT]. Objective. This study seeks to understand the needs associated with the sexual and reproductive health of migrants of Venezuelan origin settled temporarily or permanently in Santiago de Cali, Colombia. Methods. A qualitative study was conducted with Venezuelan migrants between 15 and 60 years old. Parti- cipants were selected using the snowball technique. Information was initially gathered from people identified by migrant organizations, followed by information gathering in areas with high concentrations of migrants of Venezuelan origin. In-depth interviews were held, and thematic content was analyzed. Results. Of the 48 migrants who participated, 70.8% did not have legal migratory status and were living in conditions of socioeconomic vulnerability. The participants had scarce economic resources, a lack of job opportunities, precarious human capital, and varying levels of social capital, coupled with weak social inte- gration that limited their awareness and appropriation of their rights. Immigration status constituted an access barrier to health services and other social services. There was a particular need for information on sexual and reproductive health rights, with increased risk among young people 15 to 29 years old and members of the LGBTIQ+ community, due to their greater vulnerability and exposure to unsafe spaces for self-care, personal hygiene, and privacy, in addition to their greater need for health care, treatment of sexually transmitted infec- tions, psychosocial support for violence, substance abuse, family conflicts, and gender transition processes. Conclusions. The sexual and reproductive health needs of Venezuelan migrants are determined by their living conditions and migratory experiences.

[RESUMO]. Objetivo. Compreender as necessidades associadas à saúde sexual e reprodutiva (SSR) dos migrantes de origem venezuelana estabelecidos temporária ou permanentemente em Santiago de Cali, Colômbia. Método. Foi realizado um estudo qualitativo com migrantes de origem venezuelana entre 15 e 60 anos. Os participantes foram selecionados pela técnica de bola de neve. A coleta de informações começou com pessoas encaminhadas por organizações de migrantes e, posteriormente, percorrendo áreas com alta con- centração de migrantes de origem venezuelana. Foram realizadas entrevistas em profundidade e análise de conteúdo temático. Resultados. Participaram 48 migrantes, dos quais 70,8% não tinham sua situação imigratória regularizada e se encontravam em situação de vulnerabilidade socioeconômica. Os participantes tinham poucos recur- sos econômicos, falta de oportunidades de trabalho, capital humano precário e níveis variáveis de capital social, somados a uma fraca integração social que limitava a efetivação dos direitos dos quais são titulares. O status migratório é uma barreira ao acesso aos serviços de saúde e outros serviços sociais. Destacam-se as necessidades de informação sobre direitos à saúde sexual e reprodutiva, maior risco entre jovens de 15 a 29 anos e na comunidade LGBTIQ+ – devido à maior vulnerabilidade e exposição a espaços inseguros para autocuidado, higiene pessoal e privacidade –, necessidade de cuidados e tratamento de infecções sexualmente transmissíveis, apoio psicossocial em casos de violência, consumo de substâncias psicoativas, conflitos familiares e processos de transição de gênero. Conclusões. As necessidades em matéria de saúde sexual e reprodutiva dos migrantes de origem venezue- lana são determinadas por suas condições de vida e trajetórias migratórias.

Associations Between Social Vulnerability and Providing Evidence-Based Diabetes Prevention and Management Activities in South Carolina, 2019.

We assessed associations between social vulnerability (ie, external stressors negatively affecting communities) and the provision of evidence-based diabetes prevention and management activities (eg, National Diabetes Prevention Program) in South Carolina counties with high burdens of diabetes and heart disease. These associations were examined by using relative risk estimation by Poisson regression with robust error variance. Results suggest that social vulnerability may have differential effects on the provision of evidence-based diabetes prevention and management activities in South Carolina. Findings support calls to identify upstream social factors contributing to adverse health outcomes and provide several potential points for intervention.

Measuring Historic and Longitudinal Social Vulnerability in Disaster-Prone Communities: A Modification to the Centers for Disease Control and Prevention Social Vulnerability Index (CDC-SVI).

OBJECTIVE: Researchers have developed numerous indices to identify vulnerable sub-populations. The Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) is the most common and highly serviceable, but it has some temporal limitations considering that some variables used in calculating the CDC-SVI were not available before 1980. Changes in societal composition over time can impact social vulnerability. This study defines an alternate, but similar, index that could serve as a surrogate for the CDC-SVI without the temporal limitations. METHODS: An inventory analysis of the historical census data (1960-2018) was used to develop a Modified SVI that allows for historic analyses. To consider the chronic effect of social vulnerabilities, a longitudinal SVI was introduced to elucidate how a community's multidimensional experiences exacerbate vulnerability to disaster events, such as the COVID-19 pandemic. We use Harris County, Texas, in this case study to examine how the Modified SVI performs against the original CDC-SVI. RESULTS: This Modified SVI was used to generate historical maps, find temporal patterns, and inform a longitudinal SVI measure. The results showed a good agreement among the developed indices and the CDC-SVI. We also observed satisfactory performance in identifying the areas that are most vulnerable to the COVID-19 pandemic. CONCLUSIONS: The Modified SVI overcomes temporal limitations associated with the CDC-SVI, and the longitudinal SVI captures a community's multidimensional experiences that exacerbate a community's vulnerability to disaster events over time.