Joint Effects of Socioeconomic Position, Race/Ethnicity, and Gender on COVID-19 Mortality among Working-Age Adults in the United States

Substantial racial/ethnic and gender disparities in COVID-19 mortality have been previously documented. However, few studies have investigated the impact of individual socioeconomic position (SEP) on these disparities. Objectives: To determine the joint effects of SEP, race/ethnicity, and gender on the burden of COVID-19 mortality. A secondary objective was to determine whether differences in opportunities for remote work were correlated with COVID-19 death rates for sociodemographic groups. Design: Annual mortality study which used a special government tabulation of 2020 COVID-19-related deaths stratified by decedents’ SEP (measured by educational attainment), gender, and race/ethnicity. Setting: United States in 2020. Participants: COVID-19 decedents aged 25 to 64 years old (n = 69,001). Exposures: Socioeconomic position (low, intermediate, and high), race/ethnicity (Hispanic, Black, Asian, Indigenous, multiracial, and non-Hispanic white), and gender (women and men). Detailed census data on occupations held by adults in 2020 in each of the 36 sociodemographic groups studied were used to quantify the possibility of remote work for each group. Main Outcomes and Measures: Age-adjusted COVID-19 death rates for 36 sociodemographic groups. Disparities were quantified by relative risks and 95% confidence intervals. High-SEP adults were the (low-risk) referent group for all relative risk calculations. Results: A higher proportion of Hispanics, Blacks, and Indigenous people were in a low SEP in 2020, compared with whites. COVID-19 mortality was five times higher for low vs. high-SEP adults (72.2 vs. 14.6 deaths per 100,000, RR = 4.94, 95% CI 4.82–5.05). The joint detriments of low SEP, Hispanic ethnicity, and male gender resulted in a COVID-19 death rate which was over 27 times higher (178.0 vs. 6.5 deaths/100,000, RR = 27.4, 95% CI 25.9–28.9) for low-SEP Hispanic men vs. high-SEP white women. In regression modeling, percent of the labor force in never remote jobs explained 72% of the variance in COVID-19 death rates. Conclusions and Relevance: SARS-CoV-2 infection control efforts should prioritize low-SEP adults (i.e., the working class), particularly the majority with “never remote” jobs characterized by inflexible and unsafe working conditions (i.e., blue collar, service, and retail sales workers)

Creating Community-Academic Partnerships for Cancer Disparities Research and Health Promotion

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, and awareness activities in addition to applied research projects that are rooted in communities and guided by CBPR methods. This article describes these activities as examples of partnership building to positively affect cancer disparities, promote community health, and set the stage for community-based research partnerships

Feminine hygiene practices and the risk for HPV infection and cervical dysplasia among Haitian women in Miami, Florida

A2 Haitian women in South Florida experience an increased risk of cervical carcinoma. This disparity likely ensues from the interplay of multiple factors, including underutilization of Pap smear screening and a high prevalence of Human Papilloma Virus (HPV) infection. Preliminary data suggests that Haitian women, particularly those residing in Little Haiti, the predominately Haitian area in Miami, Florida, have higher rates of infection than other racial/ethnic minorities and immigrant population sub-groups in the Miami metropolitan area. The excess rate of infection may, in part, ensue from a cultural practice known as twalet deba. Simply put, twalet deba is a feminine hygiene practice performed regularly to clean the vagina and external genitalia, as well as, to induce tightening and drying of the vagina for enhanced sexual pleasure of male partners. This practice often involves the use of herbs/ leaves and commercial products, manufactured outside the United States and sold in area markets (known as botanicas in Haitian Creole), which include, among other ingredients: boric acid, potassium permanganate, and sulfuric acid. Such products and their herbal counterparts may contribute to the excess incidence of HPV among Haitian women, and also to the etiology of invasive cervical carcinoma within this population sub-group by :(1) causing sub-clinical and clinical changes in the cervical mucosa that increase susceptibility to infection; (2) creating prolonged inflammation of the cervix that acts synergistically with HPV to induce cervical carcinogenesis; and/or, (3) damaging the DNA of cervical mucosal cells such that when exposed to HPV infection they become mutagenic. Our research integrates the methods of community-based participatory research (CBPR) with laboratory-based science to test in-vitro hypotheses about differences in rates of HPV infection and cervical dysplasia among Haitian women who regularly practice twalet deba versus those who do not. Community Health Workers (CHWs), who are indigenous to Little Haiti and fluent in English and Haitian Creole, canvass door-to-door in the area to identify 350 women who meet study eligibility criteria (e.g., Haitian descent, 18 years of age and older, no history of cervical cancer or surgical hysterectomy). Women who agree to participate receive instruction on how to use the Fournier self-sampler, a self-administered cervical sampling device with similar efficacy to the Pap smear, and complete a short interview which assesses, among other things, use of twalet deba. The cervical specimens, collected using the Fournier device, are then evaluated by a certified pathologist for cytologic changes, and are also tested for HPV using polymerase chain reaction (PCR). Preliminary findings indicate that Haitian women who report practicing twalet deba experience an increased risk of HPV infection and cervical dysplasia, even after controlling for other known risk factors for HPV infection, such as age, number of lifetime male partners, use of oral contraceptives, and co-infection with Chlamydia trachomatis. Future research must examine differences in risk for infection and dysplasia between categories of users (e.g., type of product and frequency of use), as well as, identify which commonly used products provide a safe, culturally-acceptable alternative for this practice

Strategies for Assessing Community Challenges and Strengths for Cancer Disparities Participatory Research and Outreach

Interventions involving community—academic partnerships must be driven by a participatory approach that is informed by a comprehensive understanding of the perspectives of communities or focus populations. Often research agendas of academics are different from perceived priority needs of community members. Successful and sustainable interventions are made possible with initial open dialogue among all collaborators so that roles are clearly defined and concerns are addressed. This article describes approaches used in the development of a participatory assessment of health and social issues as defined by community and academic partners, current findings, and lessons learned. The assessment is one initial activity of the Tampa Bay Community Cancer Network (TBCCN) to guide network directions through 2010. The TBCCN is one of 25 programs nationwide addressing cancer disparities through sustainable community-based participatory research, outreach, and screening activities

Patnè en Aksyon: Addressing Cancer Disparities in Little Haiti Through Research and Social Action

Haitian women living in Miami, Florida, experience an increased risk of developing and dying from cervical cancer compared with women in other racial/ethnic minority and immigrant groups in the area. In response to this disparity, academic investigators from a local university-based cancer center and community leaders from Little Haiti, the predominately Haitian neighborhood in Miami, created Patnè en Aksyon (Partners in Action), a campus-community partnership. We describe the partnership's effort to document the prevalence of lifetime and routine Papanicolau test use using community-based participatory research methods. Community health workers indigenous to the area recruited participants from various community venues throughout Little Haiti and administered informal, brief interviews to assess their screening practices. The results indicate that Haitian women are underscreened and underscore the importance of community involvement in study implementation

Strategies for Assessing Community Challenges and Strengths for Cancer Disparities Participatory Research and Outreach

Abstract available at publisher's web site

Creating Community-Academic Partnerships for Cancer Disparities Research and Health Promotion

Abstract available at publisher's web site

Contextualizing the Survivorship Experiences of Haitian Immigrant Women With Breast Cancer: Opportunities for Health Promotion

To examine challenges faced by Haitian immigrant women managing a breast cancer diagnosis. Trained community health workers conducted focus groups with Haitian women who were breast cancer survivors. A grounded theory approach guided analysis of transcripts. A large community-based organization in Miami, FL. 18 women took part in three focus groups. Participants were 40 years or older, were ethnically Haitian, and had been diagnosed with breast cancer 6-12 months prior to the study. Data were collected as part of an ongoing community-based participatory research initiative in Little Haiti, the largest enclave of Haitian settlement in Miami, FL. Community health workers, integral to the initiative, recruited participants through their extensive social networks and community contacts. Screening knowledge, illness beliefs, social and economic consequences of a breast cancer diagnosis, and advice for breast health education. Emergent themes suggest that Haitian breast cancer survivors face multiple challenges, including misperceptions about screening guidelines, disease etiology, and risk; a reduced capacity to earn a living because of physical debility; and diminished social support. Future research must continue to examine the impact of breast cancer on Haitian immigrant women and identify key strategies, such as community outreach and support programs, to improve their quality of life. Nurses can play an essential role in such strategies by providing culturally relevant clinical care and partnering with community stakeholders to define the scope and focus of public health intervention