At-Home Versus Onsite COVID-19 School-based Testing: A Randomized Noninferiority Trial.

OBJECTIVES: Equitable access to coronavirus 2019 (COVID-19) screening is important to reduce transmission and maintain in-person learning for middle school communities, particularly in disadvantaged schools. Rapid antigen testing, and at-home testing in particular, could offer substantial advantages over onsite testing from a school district's perspective, but it is unknown if engagement in at-home testing can be initiated and sustained. We hypothesized that an at-home COVID-19 school testing program would be noninferior to an onsite school COVID-19 testing program with regard to school participation rates and adherence to a weekly screening testing schedule. METHODS: We enrolled 3 middle schools within a large, predominantly Latinx-serving, independent school district into a noninferiority trial from October 2021 to March 2022. Two schools were randomized to onsite and 1 school to at-home COVID-19 testing programs. All students and staff were eligible to participate. RESULTS: Over the 21-week trial, at-home weekly screening testing participation rates were not inferior to onsite testing. Similarly, adherence to the weekly testing schedule was not inferior in the at-home arm. Participants in the at-home testing arm were able to test more consistently during and before returning from school breaks than those in the onsite arm. CONCLUSIONS: Results support the noninferiority of at-home testing versus onsite testing both in terms of participation in testing and adherence to weekly testing. Implementation of at-home COVID-19 screening testing should be part of schools' routine COVID-19 prevention efforts nationwide; however, adequate support is essential to ensure participation and persistence in regular at-home testing.

Social and built neighborhood environments and blood pressure 6 years later: Results from the Hispanic Community Health Study/Study of Latinos and the SOL CASAS ancillary study.

Neighborhood-level socioeconomic deprivation can increase risk for higher blood pressure or hypertension, while greater neighborhood safety and walkability may protect against hypertension. Large-scale prospective research, particularly among Hispanics/Latinos, is lacking. We examined cross-sectional and prospective associations between neighborhood environments and blood pressure and hypertension among 3851 Hispanic/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos San Diego, CA cohort. Addresses from Visit 1 (2008-2011) were geocoded and neighborhood characteristics were determined as part of the SOL CASAS ancillary study. Home addresses were geocoded and home areas created using 800 m circular radial buffers. Neighborhood indices socioeconomic deprivation, residential stability, and social disorder were created using Census and other publicly available data. Walkability was computed as density of intersections, retail spaces, and residences. Greenness was measured via satellite imagery using the Normalized Difference Vegetation Index. Visit 1 and Visit 2 (2014-2017) clinical outcomes included systolic (SBP) and diastolic (DBP) blood pressure, as well as prevalent and 6-year incident hypertension, defined as SBP/DBP ≥140/90 mmHg or antihypertensive medication use. Complex survey regression models adjusted for covariates revealed cross-sectional associations between greater walkability and lower SBP (B = -0.05; 95% CI: -0.09, -0.003). In prospective analyses, greater neighborhood social disorder was related to increasing SBP (B = 0.05; 95% CI: 0.01, 0.09) and DBP (B = 0.07; 95% CI: 0.02, 0.12) over time. Greater socioeconomic deprivation (OR = 1.47; 95% CI: 1.06, 2.04) and greater social disorder (OR = 1.25; 95% CI: 1.02, 1.54) were associated with higher odds of incident hypertension. All other associations were not significant. Beyond individual-level characteristics, greater neighborhood social disorder and socioeconomic deprivation were related to adverse changes in blood pressure over 6 years among Hispanics/Latinos. Neighborhood social environment may help identify, or be an area for future intervention for, cardiovascular risk among Hispanics/Latinos.

The Hispanic Community Health Study/Study of Latinos Community and Surrounding Areas Study: sample, design, and procedures.

PURPOSE: We describe the sample, design, and procedures for the Community and Surrounding Areas Study (CASAS), an ancillary to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The aim of SOL CASAS was to test an ecological model of macro- and micro-neighborhood environment factors, intermediate behavioral (physical activity) and psychosocial (e.g., depression and stress) mechanisms, and changes in cardiometabolic health in Hispanics/Latinos. METHODS: Between 2015 and 2017, approximately 6 years after the HCHS/SOL baseline (2008-2011), 1776 San Diego HCHS/SOL participants enrolled in SOL CASAS and completed a repeat physical activity assessment. Participants' residential addresses were geoprocessed, and macroenvironmental features of the home were derived from publicly available data concurrent with the HCHS/SOL baseline and Visit 2 (2014-2017). Microscale environmental attributes were coded for 943 unique routes for 1684 participants, with a validated observational tool, concurrent with Visit 2, for SOL CASAS participants only. RESULTS: Of 2520 HCHS/SOL participants approached, 70.5% enrolled (mean age 55.3 years; 94% Mexican; 67.5% female). Accelerometer adherence (three or more days with at least 10 hours wear time) was outstanding (94%). CONCLUSIONS: With its more comprehensive ecological model and well-characterized Hispanic/Latino population, SOL CASAS will advance the science concerning the contribution of neighborhood factors to cardiometabolic health.