Exploring Pathways to Post-COVID-19 Resilience in Santa Ana Via Promotora-Led Community Engagement
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Health crises such as COVID-19 exert a disproportionate burden on low-income communities of color. Santa Ana hosts a Latinx immigrant community that is both burdened by social risks (e.g., poverty) and buffered by social strengths (e.g., community engagement). The proposed study measures the impact of COVID-19 among Santa Ana’s Latinx immigrant families, identifies factors that promote resilience, and examines healthcare agency response, in order to inform the development of interventions to promote biopsychosocial health in the wake of COVID-19. For the past three years, UCI researchers have partnered with Latino Health Access (LHA) to co-develop and test a family-based group intervention to reduce youth violence, strengthen parent-youth relationships, and improve mental health for 8-to-17-year-old youth and their mothers (N=350). Preliminary findings suggest the program improves health and relationships. However, the precautions necessary to protect against the COVID-19 pandemic suddenly halted this program, removing care during a time of peak need. This study will randomly select a subsample of 80 mother-youth participants (40 intervention, 40 control) from this program. Leveraging data collected from families prior to the pandemic as a baseline, we will 1) investigate the impact of COVID-19 on mental, physical, and relational health, 2) identify existing individual and family strengths (e.g., connection to family and community) that may buffer families from these effects, and 3) explore how LHA has adapted its services to meet unprecedented challenges while determining strategies to overcome ongoing barriers to care. Exploratory analyses will assess whether intervention participation promotes youth resilience to biopsychosocial effects of COVID-19. Findings will fuel ongoing collaboration between LHA and UCI in the service of developing targeted interventions that address emerging needs, capitalize on existing strengths, and adapt to new healthcare delivery barriers, in order to reduce physical, mental, and relational health disparities in the wake of COVID-19.
Perinatal social support and mental health during the COVID-19 pandemic: A qualitative community based survey of postpartum women
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Low-income postpartum women are experiencing a high burden of psychological distress during the COVID-19 pandemic while being deprived of crucial post-delivery social support due to social distancing practices. This situation may lead to adverse outcomes such as maternal depression and negative perinatal health. Health care providers cannot assess the full social context that impacts women’s health. Furthermore, we need to understand if the concerns of our patients are included in the current validated screening questionnaires for identifying high postpartum isolation rates and mental health risk and identify coping strategies. The UC Irvine, Department of Obstetrics and Gynecology, has an established community partnership with Maternal Outreach Management System (MOMS). We propose to examine how isolation and social distancing practices impact postpartum social support. We hypothesize that social isolation practices increase the number of or exacerbate current stressors experienced by postpartum women. We will conduct semi-structured interviews with 30 postpartum women who delivered within one year and speak English, Spanish or Vietnamese. MOMS community health workers will inform women at their virtual meetings about the opportunity to participate in the interviews and, if interested, to provide research staff with their contact information. Research staff will consent women to a phone or zoom interview and permission to abstract demographic and medical data from their records. We will elicit women’s perceptions involving: 1) personal and family/friends’ experiences with COVID-19 infection, treatment, and testing, 2) the impact of isolation practices on daily life, 3) impediments to receiving social support and 4) coping strategies during the postpartum period. Findings will provide actionable suggestions for the design of effective interventions in times of the COVID-19 pandemic that identify women who are at risk of depression.
Orange County Health Equity COVID-19 Community-Academic Partnership: Ensuring Equity in COVID-19 Mitigation and Recovery
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COVID-19 disparately affects the social, economic, and physical wellbeing of low-income communities of color, reflecting enduring structural inequities exacerbated by the pandemic. We are in the same storm, but not the same boat. In Orange County (OC), Latina/o/x, Asian, Black, and Native Hawaiian Pacific Islander residents have higher COVID-19 mortality risks than White residents.
This project involves a community-academic partnership focused on ensuring that equity and community priorities are central to COVID-19 responses in OC, with an emphasis on low-income communities of color. Pandemic mitigation includes prevention, testing, contact tracing (CT), and quarantine/isolation. Our partnership – including community leaders in health equity initiatives and UCI faculty/staff representing multiple disciplines – will engage low-income communities of color to integrate equity into pandemic mitigation and recovery efforts. This community participatory process will inform: the development of guiding principles for OC prevention, testing, CT, quarantine/isolation, and recovery efforts; recommended approaches for tailoring these strategies to the local social, economic, and political context and community priorities; the design of contextually- and culturally-sensitive CT curricula; and a health equity assessment of OC COVID-19 responses.
This partnership model is innovative in that it is designed to meet the needs in current conditions while also transforming systems of inequity to usher forward and sustain new systems that promote health equity. The expected outcomes can help mitigate the social and health inequities borne out by COVID-19 and underlying structural inequities for communities of color and low-income communities in OC. Our approach to integrating health equity and community perspectives into COVID-19 mitigation and recovery planning has the potential for translation into models that create value and positive impact in other contexts and communities as well, such as other California communities disproportionately affected by COVID-19, UCI (e.g., preparation to resume in-person teaching), and future pandemics or disasters.
Navigating Pacific Islanders through the COVID-19 Pandemic
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Pacific Islanders (PIs) are dying from COVID-19 at the highest rate of all ethnic groups in California. PIs are also at higher risk for COVID-19 death; age-adjusted mortality is 71.0 per 100,000 in Los Angeles County (Report on LA County COVID-19 Data Disaggregated). COVID-19 testing and data collection by race and ethnicity in OC remains a challenge, but hotspot COVID- 19 cities in OC coincide with where PI communities live. The findings highlight the urgent need for more intensive efforts to expand culturally competent testing, treatment, and prevention strategies. Many PIs have underlying health conditions that make them more susceptible to COVID-19. The leading cause of death for PIs in OC is heart disease, and they suffer disproportionately from diabetes, obesity, and certain cancers. Additionally, PI culture strongly values family and community. Many cohabitate in multi-generational households making it difficult to isolate and contain the spread of the virus. California is home to the second largest PI population outside of their native countries. This includes four of the top 15 cities in OC with a rapidly growing PI population between 2000 and 2010: Anaheim, Santa Ana, Orange, and Tustin (Census, 2010 & Community of Contrasts report, 2014). This project will strengthen PI channels of communication to benefit the community by increasing knowledge, capacity building, and resource identification regarding PI COVID-19 risk for infection and death. Our aims of this project are: AIM 1 – to increase the level of knowledge among PI leaders and media spokespeople about the risk factors for COVID-19 infection and mortality in OC; AIM 2 – to engage PI communication channels to increase knowledge, capacity building, and resource identification regarding PI COVID-19 risk for infection and death. Educating the PI community, understanding contact tracing, and getting tested are key in mitigating PI COVID-19 risk for infection and death.
COVID-19 prevalence and psychological distress among Vietnamese American cancer patients and other community members
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In the early days of COVID-19, very little public health information trickled into ethnic media serving Vietnamese-American residents of Orange County. This contributed to widespread misunderstanding and confusion regarding COVID-19 testing in the Vietnamese-American community. In this context of misunderstanding and mistrust, health professionals and community leaders face a grave challenge to combat COVID-19 which has disproportionately affected vulnerable, low-income communities. The proposed project is a partnership between UCI and the Vietnamese-American Cancer Foundation (VACF), which aims to inform the development of evidence-based practices to mitigate the mistrust that has shaken and disproportionately affected vulnerable, low-income communities. Our research will investigate the effect of recent community events on COVID-19-related attitudes and psychological distress in the Vietnamese community. We will enroll 150 Vietnamese-American participants from Little Saigon. Using validated survey instruments, we will assess knowledge, attitudes, and practices pertaining to COVID-19 among Vietnamese American cancer patients, who are particularly at high risk for severe COVID-19 disease and death. We will compare these results to data collected from Vietnamese-Americans without cancer. We will also assess fear and psychological distress triggered by COVID-19. Lastly, using biospecimen detection, we will determine the prevalence of SARS-CoV-2 infection among Vietnamese American cancer patients and other community members (non-invasive saliva sample testing for SARS-CoV-2 RNA and fingerprick ELISA tests for SARS-CoV-2 antibodies). This research will combine behavioral and laboratory data to produce critical knowledge for overcoming barriers to evidence-based COVID-19 programs among underserved communities to improve COVID-19 education, prevention, and service delivery. Moreover, our robust data collected through community- engaged research will provide infrastructure and preliminary data to establish a large-scale behavioral and laboratory surveillance study for understanding SARS-CoV-2 transmission and evaluate the effectiveness of interventions in other vulnerable communities.
Impact of COVID-19 Pandemic on the Incidence of Suspected Child Maltreatment in Orange and Los Angeles Counties
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Unprecedented changes resulting from COVID-19 and stay-at-home orders have raised serious concerns about child maltreatment. Maltreatment is widely known to increase in frequency and severity at times of high stress, yet referrals for maltreatment in Orange and nearby counties have dropped by 50%. These divergent patterns highlight an additional public health emergency arising from the pandemic. With mandated reporters no longer having regular contact with children, those who suffer maltreatment are unlikely to be identified until maltreatment is so severe that they present to medical settings. Empirical data are needed to test this concern so that outreach efforts can be effectively targeted. Our research, in partnership with Children’s Hospital Orange County (CHOC), will provide this information. We will collect maltreatment incidence, type, and severity data prior to and during COVID-19. Our work will highlight (a) how maltreatment referrals to medical specialists have changed during the pandemic, (b) which children are currently at greatest risk, and (c) whether child abuse and neglect have changed in unique and particularly detrimental ways.
Specifically, we will collect deidentified data from 11 clinics and hospitals in Orange and Los Angeles counties where maltreatment evaluations are conducted. Data will include demographics, maltreatment type and severity, and polyvictimization. Analyses will evaluate how a range of characteristics (e.g., age, gender, ethnicity, neighborhood) relate to maltreatment indices pre- vs. during- COVID-19, thereby revealing important predictors of incidence, severity and polyvictimization.
Given rapidly changing circumstances and anecdotal reports noting an increase in maltreatment severity, it is imperative to address this pandemic’s significant public health impact on vulnerable children. This work will provide clear guidance to front-line healthcare providers to improve identification efforts and adapt clinical responses. These improvements will have an immediate impact on the current crisis and will prepare providers, social services, and healthcare agencies for crises to come.
Health Enhancing Connection to At-risk Seniors during COVID-19
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Seniors are the most susceptible group to COVID-19 infection and at highest risk for severe disease and death. They also have higher prevalence rates of hypertension, cardiovascular disease and diabetes that puts them at higher risk. La Habra (the study cite) currently has the fifth highest city case rate of COVID-19 and 60% of residents are Latino. Understandable information is lacking in the community and many seniors are foregoing doctor visits, and unable to fill prescription medications. Research is needed on how to best support at-risk seniors in their homes.
Their feasibility study aims to determine engagement factors for isolated, at-risk seniors, and measure the rates of change for COVID-19 knowledge and behaviors, on-line accessibility, tele-health doctor visits, self-care, loneliness, and fall prevention excercises to reduce adverse medical events.
Over 200 at-risk seniors are being served currently by food assistance programs; all programs have agreed to partner in this study to distribute the “senior resourse kit” (low literacy senior health book, COVID-19 information and resources, fall prevention excercises, a home assessment for fall risk, and LED lights) and introduce the support coach for initial engagement. Clinical and utilization data, and a questionnaire to assess for COVID-19 knowledge and behavior, self-care, loneliness, exercise, and coordination with their doctor will be measured at baseline and post 6-months. Over the course of the study, the support coach will facilitate tele-health visits with their doctor and receipt of prescription medication, and assist the senior to use the senior health book and all the tools in the resource kit to stay well during COVID-19. Study aims to enroll 100 participants and compare with 100 “quasi-control” seniors.
This proposed study informs new practice and community approaches for facilitating tele-health visits, reducing COVID-19 trnasmission and adverse events, and maintaining health and function among at-risk seniors.
