Changes in dental visits and oral health for children by race and ethnicity during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic created new barriers to oral health care, which may worsen oral health and exacerbate disparities. The authors quantified changes in children's dental care receipt and oral health outcomes during the pandemic and examined differences among racial and ethnic groups. METHODS: Using the National Survey of Children's Health (163,948 child observations from 2017-2021), the authors used weighted modified Poisson models to examine caregiver-reported receipt of a dental visit (for any reason and for preventive care) and adverse oral health outcomes (teeth in fair or poor condition; difficulty with toothaches, cavities, or bleeding gums) from 2017 through 2019 (prepandemic) compared with 2020 and 2021. The authors examined outcomes within and across racial and ethnic groups. RESULTS: Children from all racial and ethnic groups experienced declines in receipt of dental visits, but there were limited changes in adverse oral health outcomes during 2020 and 2021. Prepandemic disparities in receipt of dental visits persisted for Black children and Asian children compared with White children. Hispanic children experienced larger increases in risk of experiencing both adverse oral health outcomes compared with White children in 2020 and in having teeth in fair or poor condition in 2021. CONCLUSIONS: The pandemic did not create new disparities in receipt of dental visits or oral health outcomes, but disparities in care persisted, and the oral health of Hispanic children was affected differentially. PRACTICAL IMPLICATIONS: Continued monitoring of dental visits and adverse oral health outcomes by race and ethnicity is critical to ensuring all children have access to oral health care. This information can help develop targeted interventions to improve children's oral health, including for minoritized racial and ethnic groups.

Engaging Youth and Young Adults in the COVID-19 Pandemic Response via the "It's Our Turn" Crowdsourcing Contest.

As the coronavirus disease (COVID-19) pandemic continued to progress into 2021, appeals were made to take a stronger focus on the perceptions and practices of youth and young adults (YYAs) regarding COVID-19 mitigation, as well as the impact of mitigation strategies on the overall wellbeing of YYAs. In this paper, we describe our efforts to increase YYA engagement in Arizona's COVID-19 response by pairing embedded values from youth participatory action research (YPAR) with a crowdsourcing challenge contest design. The research protocol and implementation are described, followed by a thematic analysis of YYA-led messaging portrayed in 23 contest submissions and reflections formed by 223 community voters after viewing contest submissions. The authors conclude that a YYA-led crowdsourcing contest presented an opportunity to (a.) investigate the perceptions and behaviors of YYAs and their networks regarding the COVID-19 pandemic and mitigation efforts and (b.) amplify the voices of YYAs in the pandemic response. Perhaps even more importantly, this approach also offered insight into the exacerbated impact of the pandemic on YYA mental health and wellbeing, and the utility of YPAR in raising awareness of these effects among the contexts and social networks of YYAs.

Community Engagement Alliance (CEAL) Against COVID-19 Disparities: Academic-community partnership to support workforce capacity building among Arizona community health workers.

The COVID-19 pandemic has both highlighted and worsened existing health inequities among communities of color and structurally vulnerable populations. Community Health Workers, inclusive of Community Health Representatives (CHW/Rs) have entered the spotlight as essential to COVID-19 prevention and control. To learn about community experiences and perspectives related to COVID-19 and inform CHW/R workforce capacity building efforts, a series of focus groups were conducted with CHW/Rs throughout Arizona at two time points in 2021. Throughout the data collection and analysis process, researchers and community partners engaged in ongoing and open dialogue about what CHW/Rs on the ground were reporting as priority community concerns, needs, and challenges. Thus, CHW/Rs informed the development of culturally and linguistically relevant health education messages, materials, and training for CHW/Rs. In this community case study, we detail the efforts of partnership between a statewide CHW professional association and an academic research team that facilitated rapid decision-making and knowledge sharing to create community-grounded tools and resources supportive of CHW/R workforce capacity building in the context of the COVID-19 pandemic.

Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake.

The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.

Coming up short: Comparing venous blood, dried blood spots & saliva samples for measuring telomere length in health equity research.

BACKGROUND: Telomere length (TL) in peripheral blood mononuclear cells (PBMC) from fresh venous blood is increasingly used to estimate molecular impacts of accumulated social adversity on population health. Sometimes, TL extracted from saliva or dried blood spots (DBS) are substituted as less invasive and more scalable specimen collection methods; yet, are they interchangeable with fresh blood? Studies find TL is correlated across tissues, but have not addressed the critical question for social epidemiological applications: Do different specimen types show the same association between TL and social constructs? METHODS: We integrate expertise in social epidemiology, molecular biology, and the statistical impact of measurement error on parameter estimates. Recruiting a diverse sample of 132 Metro-Detroit women, we measure TL for each woman from fresh blood PBMC, DBS, and saliva. Using regression methods, we estimate associations between social characteristics and TL, comparing estimates across specimen types for each woman. RESULTS: Associations between TL and social characteristics vary by specimen type collected from the same woman, sometimes qualitatively altering estimates of the magnitude or direction of a theorized relationship. Being Black is associated with shorter TL in PBMC, but longer TL in saliva or DBS. Education is positively associated with TL in fresh blood, but negatively associated with TL using DBS. CONCLUSION: Findings raise concerns about the use of TL measures derived from different tissues in social epidemiological research. Investigators need to consider the possibility that associations between social variables and TL may be systematically related to specimen type, rather than be valid indicators of socially-patterned biopsychosocial processes.

How are social determinants of health integrated into epigenetic research? A systematic review.

OBJECTIVE: We systematically review the literature on social epigenetics, examining how empirical research to date has conceptualized and operationalized social determinants of health (SDOH). METHODS: Using comprehensive search procedures, we identified studies that consider the impact of SDOH on DNA methylation (DNAm), the most common measure of epigenetic change in research on human adult populations. We analyzed the studies to determine: 1) which populations and environments have been investigated in the literature; 2) how SDOH are defined and operationalized; 3) which SDOH have been linked to DNAm; and 4) what lessons from the SDOH literature can be better integrated into future studies exploring the social determinants of health and epigenetic outcomes. RESULTS: We identified 67 studies, with 39 to 8397 participants. The SDOH most commonly considered were early life socioeconomic exposures and early life trauma or mental health. Our review highlights four broad challenges: a) high dependence on convenience sampling, b) limited racial/ethnic, and geographic diversity in sampling frames, c) overreliance on individual sociodemographic characteristics as proxies for broader stratification processes, and d) a focus on downstream social determinants of health and individualized experiences with social stressors. CONCLUSIONS: Future social epigenetics research should prioritize larger, more diverse and representative population-based samples and employ the SDOH framework to better inform the conceptualization of research questions and interpretation of findings. In particular, the simplified depiction of race/ethnicity, gender, and socioeconomic status as individual-level characteristics should be updated with an explicit acknowledgement that these characteristics are more accurately interpreted as cues used by society to differentiate subpopulations. Social epigenetics research can then more clearly elucidate the biological consequences of these social exposures for patterns of gene expression, subsequent disease etiology, and health inequities.

Structural racism, economic opportunity and racial health disparities: Evidence from U.S. counties.

In this study, we introduce the 'racial opportunity gap' as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial variation in the racial mortality gap. First we demonstrate a correlation between the racial opportunity gap and the racial mortality gap across U.S. counties; where the gap in the adult earnings of black and white children born to families at the same income level is greater so, too, is the gap in mortality. Second, we show in a multivariable framework that the racial opportunity gap is associated with the racial mortality gap net of differences in the socioeconomic composition of the two groups. In so doing, we aim to provide population health researchers with a new empirical tool and analytic framework for examining the role of structural racism in generating racial health disparities.

SYSTEMATICALLY SHORTCHANGED, YET CARRYING ON: Black Adolescent Girls in the Detroit Metropolitan School Reform Environment.

School reform policies, such as the closure of "low-performing" schools and the competitive introduction of school choice and charters, were presented to communities of color as the fix to educational inequities and the lifeline needed for urban Black students to have a chance at a quality education and social mobility. The ways in which reforms have under-delivered on this promise, and in some cases exacerbated negative academic outcomes, particularly for Black boys, are documented. Yet, research on the experience of Black adolescent girls is sparse. We explore ways that policies aimed at delivering a school choice environment have affected daily life for Black adolescent girls. We examine this issue in the context of the Detroit metropolitan area with Black adolescent girls, reflecting on their high school education experiences that spanned a time-period of rapid transitions in the schooling environment (2014-2016) prompted by a series of school reforms in Michigan. Through in-depth interviews we found that girls sought to invest in their high school education as a path to college; yet the very reforms advanced as ways to clear this path, hindered their ability to spend time on the human and social capital activities believed to be important to their academic success and social mobility. Our findings suggest advantages for those students with proximal access to high quality neighborhood schools cannot be replicated in a choice environment. There may also be health consequences of the coping strategies girls are compelled to employ to carry on under adverse educational circumstances.

Biopsychosocial Predictors of Fall Events Among Older African Americans.

This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective, we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010-2012 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed.

Health promotion and surveillance: the establishment of an IUHPE global working group.

Following a series of international meetings on behavioral monitoring and surveillance, in 2007 the Italian Ministry of Health (Ministerio della Salute) and the Institute for Health (Istituto Superiore della Sanità) hosted the 5(th) International Conference on Behavioral Risk Factor Surveillance (BRFS) in Rome. A key focus of the conference was on how current surveillance systems could be applied to the field of health promotion, particularly in building the evidence base for health promotion practice. As a result of these discussions, the World Alliance for Risk Factor Surveillance (WARFS), an IUHPE Global Working Group, was formed to work toward providing knowledge and expertise in surveillance as a tool for advancing health promotion. For those IUHPE members interested in participation, this article provides an overview on the strategic direction of WARFS and the newly formed sub-working groups.

Did the Ottawa Charter play a role in the push to assess the effectiveness of health promotion?

The Ottawa Charter contains no explicit mention of the role evidence should play in supporting the development of health promotion, nor is there a discussion on the available methods or recommendations for assessing the effectiveness of health promotion programs and policies. The authors of this paper suggest evidence and effectiveness were not prioritized in the Ottawa Charter, and consequently, attracted little attention during the early development of health promotion practice. This paper reflects upon the various implications of a push to assess the effectiveness of health promotion well after the release of the Ottawa Charter; examines progress in this area since the Ottawa Charter; and challenges the reader to continue on in their own contemplation of remaining challenges ahead, in preparation for the 19th IUHPE World Conference, of which "assessing health promotion effectiveness" is one of the key themes.

Did the Ottawa Charter play a role in the push to assess the effectiveness of health promotion?

La Carta de Ottawa no hace mención explícita al papel de apoyo que debería desempeñar la evidencia en el desarrollo de la promoción de la salud, ni tampoco contiene debate alguno sobre los métodos disponibles para evaluar la efectividad de los programas y políticas de promoción de la salud, ni hace recomendaciones al respecto. Los autores de este artículo señalan que ni la evidencia, ni la efectividad fueron cuestiones prioritarias de la Carta de Ottawa y, por consiguiente, suscitaron poco interés durante los primeros tiempos del desarrollo de las prácticas de la promoción de la salud. El artículo reflexiona sobre las diversas repercusiones del avance que ha experimentado la evaluación de la efectividad de la promoción de la salud mucho después de la redacción de la Carta de Ottawa; examina los progresos en este campo desde entonces y anima al lector a seguir considerando los retos que quedan pendientes, mientras se prepara para la 19ª Conferencia Mundial de la UIPES, en la cual, uno de los temas principales es, precisamente, "evaluar la efectividad de la promoción de la salud."(AU)