In fall 2019, 12.7% of families reported never eating out (P < .001). Sharma S, Marshall A, Chow J, Ranjit N, Bounds G, Hearne K, et al. The 30-item self-report survey took approximately 10 minutes to complete. As of September 2020, the United States is the epicenter of the pandemic, with more than 6.3 million confirmed cases and more than 189,000 fatalities (2). Little is known about the social needs of low-income households with children during the coronavirus-2019 (COVID-19) pandemic. In fall 2019, before Brighter Bites, 71.5% of respondents reported being food insecure (P < .001) (Figure). Accessed April 3, 2020. Quantitative data analysis. Prev Chronic Dis 2017;14:E101. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. It’s been difficult to find fresh produce in the stores. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. https://cancercontrol.cancer.gov/brp/hbrb/flashe.html. Overall, diagnosis of COVID-19 and prevalence of pre-existing conditions, such as diabetes, heart disease, and being immune compromised, were less than 5% among respondents at the time of survey completion. The survey provided a checklist for these 8 items, and respondents could check all that applied. ©2020 American Planning Association. A lifestyle of healthy foods and exercise helps prevent the onset of chronic health conditions. f 1-way analysis of variance. Determinant One: Low Income. Health Aff (Millwood) 2020;39(6):927–35. COVID-19 and African Americans. The social gradient not only represents the effects of income on health but also the importance … The survey asked respondents about their concerns during the pandemic about financial stability, employment status, availability of food, affordability of food, availability or affordability of housing, access to reliable transportation, access to childcare, and access to a clinic or physician. Qualitative comments provided additional insight, with many respondents expressing a concern about a general scarcity of food. This is a global phenomenon, seen in low, middle and high income countries. Prev Chronic Dis 2011;8(2):A49. Currently he is working in the areas of health inequalities, marginalization, political advocacy, health policy, and the social determinants of health… The COVID-19 pandemic is occurring in the context of a global economic crisis, both of which highlight health and social challenges for the most vulnerable people in our communities. Basic human needs, also called the social determinants of health, include employment, food security, housing security, access to health care, and transportation; the lack of these is linked to poor health outcomes (9). No copyrighted materials were used in this article. I’m worried about my children’s safety. WHO director-general’s opening remarks at the media briefing on COVID-19 — 11 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020. Beyond health care: the role of social determinants in promoting health and health equity. For low-income, vulnerable households there are particular challenges in creating a sense of home in a new tenancy which may have substantial effects on health and wellbeing. The survey was administered electronically in April 2020 to 16,436 Brighter Bites families who were enrolled in the program during the 2019–2020 school year. The American Planning Association’s Planning and Community Health Center has partnered with the American Public Health Association at the national level. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. 5 ICD-10-CM coding options include: Z59.5 extreme poverty Z59.6 low income Program staff members distributed survey links through text messages. Overall, 93.5% of respondents reported being food insecure, a 22-percentage-point increase since fall 2019. Accessed August 27, 2020. We obtained informed consent from all respondents, and one parent or adult per family completed the survey. A greater proportion in Houston and Washington, DC, than in the other 2 locations received Medicaid or CHIP (P < .001), whereas a smaller proportion of children in Dallas than in the other 3 locations participated in free or reduced-price meals programs (P = .04). 4Department of Health Promotion and Behavioral Sciences. Prev Chronic Dis 2020;17:200322. Inequities exist in social and structural factors, such as access to food, employment, transportation, housing, poverty, education, and health literacy (24). Introduction Tobacco smoking is a leading cause of premature death and disability, and over 80% of the world's smokers live in low- or middle-income countries. Breastfeeding is an issue of health equity. Worry/fear of future financial challenges. Email: Shreela.V.Sharma@uth.tmc.edu. Response rates by location were 7.7%, Houston; 3.8%, Dallas; 6.4%, Washington, DC; and 6.9%, Southwest Florida. A smaller proportion of African American respondents than respondents in other racial/ethnic groups were concerned about being infected with COVID-19 themselves (38.7%) and about their child being infected (39.3%) (P < .001). Brighter Bites is a nonprofit, evidence-based school health program that distributes fresh produce weekly to low-income families and provides nutrition education in school and for parents (10,11). Texas Health & Human Services Commission. Social Determinants of Health-Related Needs During COVID-19 Among Low-Income Households With Children Our study highlights the compounding effect of the COVID-19 pandemic on households with children across the spectrum of social needs. Early screening and identification of social determinants of health through interactive conversations with members is one way to ensure low-income populations are connected with effective interventions to address the underlying factors influencing health. Only schools that have more than 75% of children enrolled in a free or reduced-price meals program are eligible to participate in Brighter Bites. Published May 10, 2018. Published April 7, 2020. b Number is the total number of survey responses received overall and by race/ethnicity. That we don’t have masks, gloves, or disinfectant wipes because you can’t find them at the stores. social determinants or social influencers of health, are defined by the conditions and environment in which people are born, grow, live, work, and age. The authors also acknowledge the families who participated in this study. That they close all the stores where you can find food. The funder/sponsor did not participate in the work. We should stay home. “Everyday Experiences of Poverty” which collected over 800 autobiographical writings from people living in low-income situations. And I’m scared that we’re all going to get sick. Your research has connected housing with cardiovascular health, depression, sleep disorders, asthma, and obesity. Our study has several limitations. Food is running out for my children, I have no work, no money, I don’t even qualify for the check that Mr. Donald Trump is sending out. We collated and analyzed responses to the open-ended question, “Please share your greatest concern at this time, or any other thoughts you would like to share with us.” We used thematic analysis to analyze the survey data by using an inductive approach in which we derived codes and themes on the basis of the content from the survey data (16,17). In the U.S., there are significant differences in life expectancy between the wealthiest and poorest citizens and children from low-income households are more likely to suffer from chronic disease and poor health throughout their lives. I’m worried about how to feed my kids because there’s no work right now. Fear because of COVID-19 of having to go into work. University of Arkansas News. Accessed September 10, 2020. 1. October 18, 2016 4:19 PMCategory: Health Equity, by Matt Makara - MPH, Program Manager, Affiliate Affairs, American Public Health Association, Income can influence many aspects of a person’s life, including their health, where they live and the education that they receive. An open-ended question asked about their greatest concern. Finally, the coders used this codebook to reconfirm the coding of the themes and subthemes in qualitative comments. Most (81.8%) respondents reported knowing a great deal about COVID-19 and were concerned about being infected themselves (87.3%) or their children being infected (87.0%) (Table 2). As indicated in subthemes and comments, many respondents were concerned about contracting COVID-19 themselves or concerned about a family member contracting COVID-19. Measuring Social Determinants of Health among Low Income Populations Early Insights from State Initi This webinar, made by possible by The Commonwealth Fund, explored emerging state-level approaches to measuring SDOH among beneficiaries of publicly financed care. Even in affluent countries such as Canada the social gradient exists but is often masked by the high levels of overall population health status (Mikkonen & Raphael, 2010). A healthy diet is inextricably linked to overall health benefits , so improving eating habits should be crucial factor in improving health. Fear of grocery shopping because of COVID-19. Low income has been identified as a key social determinant of health.4 While the effect of income on health has been the subject of debate and study, research appears to uphold the link between low income and health. We used the χ2 test or Fisher exact test and 1-way analysis of variance to compute differences in responses by city and race/ethnicity. Frequency of grocery shopping decreased and food pantry usage increased. Braun V, Clarke V. Using thematic analysis in psychology. Although varying models exist, consideration of social determinants of health generally includes: individual and community behaviors, … The program, which uses a school co-op concept, is disseminated in Southwest Florida and 5 US cities: Houston, Austin, Dallas, New York City, and Washington, DC. Food shopping frequency and behavior. Prev Med 2016;91:8–17. Trying not to go out and follow the recommendation to stay at home and not expose kids to this virus. Overall, 93.5% of respondents reported being food insecure in April 2020. A small proportion of respondents expressed concern about reliable transportation (6.4%) and childcare (8.2%). Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 — COVID-NET, 14 states, March 1–30, 2020. Respondents could check all that applied. The major social determinants affecting the under 5 years' mortality and morbidity include poverty, malnutrition, inequity, lack of education, failure to implement the … However, as a result of COVID-19–related school closures, program implementation has paused. I worry that I get sick since I’m pregnant. d Fisher exact test. N Engl J Med 2010;363(1):6–9. g χ2 test. d Fisher exact test. Concern about increased prices of food in stores. c Significance set at P < .05 for all tests. Seligman HK, Schillinger D. Hunger and socioeconomic disparities in chronic disease. Addressing the social determinants of health has been highlighted by the U.S. government’s Healthy People 2020 initiative, National Partnership for Action to End Health Disparities, and National Prevention and Health Promotion Strategy as being integral to improving health for all. The role of housing as a social determinant of health is well-established, but the causal pathways are poorly understood beyond the direct effects of physical housing defects. Respondents reported the frequency (times per month) and type of store at which their household shopped for fruits and vegetables. Basic human needs, also called the social determinants of health, include employment, food security, housing security, access to health care, and transportation; the lack of these is linked to poor health outcomes (9). Finally, we thank Brighter Bites staff members, participating schools, and parents for their support of the project. I’m worried that my kids won’t have food (fruits, vegetables, milk, and basic hygiene items) because there’s not enough opportunity for work. This difference may be due to a disparity in health literacy and should be explored in future studies, given the high proportion of COVID-19–related complications and death in the African American population. SDOH refer to economic and social conditions and their distribution among the population thus influencing individual and group differences in health status. Brighter Bites collected all data and shared de-identified data with the University of Texas Health Science Center for analysis as part of a data-sharing agreement. We obtained further insights into the needs and concerns of survey respondents in the qualitative comments, which identified 4 themes: fear of contracting COVID-19, unemployment, financial hardship, and food insecurity. Yancy CW. US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Income: Lower Wages Come at Cost to Public Health, Housing is a Social Determinant of Health, Education is a Social Determinants of Health, Get to Know Social Determinants of Health, Planners4Health: A new approach to advancing practice at the intersection of planning and public health, Plan4Health connects people to nutrition, recreation in rural Oregon. Income inequity is related to the rates of poorer health in a number of areas, from alcohol-attributable hospitalisations and deaths, to child health, to oral health. Levitt L, Schwartz K, Lopez E. Estimated cost of treating the uninsured hospitalized with COVID-19. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. All values are number (percentage) unless otherwise indicated. In addition, the study fills a gap in knowledge on the social needs of low-income households with children during COVID-19. They are factors found in one’s living and working environments rather than individual risk factors such as behavior or genetics, which can impact one’s vulnerability to disease. The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains: Economic Stability; Education; Health and Health Care; Neighborhood and Built Environment; Social and Community Context; Poverty is a key issue in the Economic Stability domain. Sharma SV, Markham C, Chow J, Ranjit N, Pomeroy M, Raber M. Evaluating a school-based fruit and vegetable co-op in low-income children: a quasi-experimental study. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. We’re just worried about having a better standard of living than right now. Thousand Oaks (CA): Sage Publications, Inc; 1998. At the time the survey was conducted, all 4 locations were under shelter-in-place orders, which included social distancing, school closures, and suspension of all nonessential services. Health equity considerations and racial and ethnic minority groups. Chowkwanyun M, Reed AL Jr. The survey asked families enrolled in a coordinated school-based nutrition program about their social needs, COVID-19–related concerns, food insecurity, and diet-related behaviors during the pandemic. ORIGINAL RESEARCH â Volume 17 â October 1, 2020. To our knowledge, our study is the first to use a mixed-methods qualitative and quantitative assessment to understand the social needs of low-income families with children during the pandemic. Coronavirus resource center COVID-19 map. We acknowledge the Michael & Susan Dell Center for Healthy Living for their support of the project. They’re largely responsible for health disparities and can, therefore, impact cancer patients’ chances of survival. Pandemic-EBT (P-EBT) due to COVID-19. The concerns were due to various reasons, such as lack of personal protective equipment and working in frontline jobs. There are major differences in the leading causes of death between low-income, middle income, and high income countries (Moss, 2015). These resources include information on where to get tested for COVID-19, how to register for government assistance programs, COVID-19 prevention practices, and maintaining healthy eating, physical activity, and mental health. This key partnership ensures that the conversations, lessons learned, and experiences of towns and cities across the country are part of the national agenda to prevent chronic diseases. RTI International. Accessed April 24, 2020. All values are number (percentage) unless otherwise indicated. They refer to conditions that influence health outcomes, such as income, housing, food, transportation, race, and ethnicity. Our study demonstrated a significant increase in food insecurity during the pandemic and a decrease in intake of healthy food such as fruits and vegetables. The number of unemployed people in the United States increased by 11.5 million from February to September 2020 (25), and this number may increase. This variation among individuals and groups due to income is referred to as the "social gradient. Transforming qualitative information: thematic analysis and code development. Most (68.2%) respondents resided in Houston; 97.0% were female; 85.9% were Hispanic, 7.1% were African American, and 50.5% were mostly or only Spanish speaking; the mean age was 36.7 years. Similarly, concerns about disruption of employment and financial hardship identified such acute problems as inability to pay rent or bills. These results underscore how COVID-19 and the related economic crisis have not only caused physical harm but have further destabilized people who were already struggling. b Number is the total number of survey responses received overall and in each city. Also, 41.4% reported a decrease in fruit and vegetable intake because of COVID-19. Response was voluntary. Collectively, all themes stemmed from fear of contracting COVID-19. Low-income racial/ethnic minority populations, predominantly Hispanic and African American populations, are struggling with an increased risk of COVID-19 infection and COVID-19–related complications and mortality (19–22). Dr Sharma is on the board of directors (an unpaid, advisory board position) of Brighter Bites, the goal of which is to improve access to fresh fruits and vegetables and nutrition education among underserved communities. For 3 variables (food insecurity, frequency of eating out, and frequency of shopping for produce) we compared responses on similar items in data collected from 3,880 families in the same 4 locations in fall 2019, before the start of the Brighter Bites program; we used the χ2 test to assess changes. When asked about their general health status, 25.0% of respondents reported their health status to be fair or poor, with no significant differences by race/ethnicity. A plethora of research has shown that people with lower incomes tend to have poorer health in addition to being less likely to have health insurance. Saving Lives, Protecting People, National Center for Chronic Disease Prevention and Health Promotion, U.S. Department of Health & Human Services. Concern about not having enough money to pay bills/utilities. Bartsch SM, Ferguson MC, McKinnell JA, O’Shea KJ, Wedlock PT, Siegmund SS, et al. The other authors have no conflicts of interest relevant to this article to disclose. c Significance set at P < .05 for all tests. Feeding low-income children during the Covid-19 pandemic. Households that cannot attain nutritious foods due to income poverty are most associated with the inadequate diet and disease that le… Going back to be in a store, park, schools and being with the family, without any worry of some infection. Finally, our cross-sectional descriptive study does not allow us to draw conclusions on cause and effect; our study is a snapshot at an early moment in the pandemic and serves as a baseline for examining patterns of change and causal associations in future studies. Qualitative assessment identified 4 main themes: 1) fear of contracting COVID-19, 2) disruption of employment status, 3) financial hardship, and 4) exacerbated food insecurity. The fall 2019 survey and April 2020 survey used similar questions for the 3 variables, except for the question on type of store. If a respondent answered “never true” to both questions, we considered the household food secure. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. A lot of fear about getting infected while going to the store early to buy food, and that my kids get sick. Because a lot of people already have the flu. Response options were a large chain grocery store or supermarket, a small local store or corner store, a farmers market/food co-op/farm stand, and a food bank/food pantry or other food distributions. Dietary habits. Chambers has documented the connections between housing and neighborhood conditions and health disparities among low-income Latinos in the Bronx. A significantly greater proportion of Hispanic respondents (94.7%) than respondents in other racial/ethnic groups reported food insecurity (P < .001) (Table 2). For most Americans, access to health care is directly related to employment, so that loss of employment means loss of health care. Accessed April 20, 20182020. The survey used items adapted from the National Cancer Institute’s 2007 Food Attitudes and Behavior Survey (14). Accessed August 27, 2020. Fear of stores closing and not being able to get food. Boyatzis RE. https://data.bls.gov/timeseries/LNS14000000. Accessed August 27, 2020. Accessed August 27, 2020. Telephone: 713-500-9344. Our qualitative assessment also demonstrated that although most respondents reported following safety guidelines, some expressed fear of becoming infected in public spaces. https://coronavirus.jhu.edu/map.html. Little is known about the social needs of low-income households with children during the coronavirus-2019 (COVID-19) pandemic. Whitby B, Fitzpatrick K. Survey shows regions of elevated food insecurity due to COVID-19 pandemic. Percentages may not add to 100 because of rounding. The parent or another adult in the family used the 2-item Hunger Vital Sign screening questionnaire developed and validated by Hager et al (13) to report household food security status during the COVID-19 pandemic. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity. DOI: http://dx.doi.org/10.5888/pcd17.200322external icon. Abbreviations: CHIP, Children’s Health Insurance Program; NA, not applicable; SNAP, Supplemental Nutrition Assistance Program; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children. The survey collected data on respondent’s sex, respondent’s relationship to the child, respondent’s and child’s race/ethnicity, respondent’s employment status, respondent’s education level, and enrollment in government assistance programs. What’s happening is really hard because there’s no work but being healthy is the important thing. These questions were adapted from previously administered surveys (12). Moreover, a smaller proportion of Hispanic respondents (6.3%) than African American (23.0%), Non-Hispanic White (15.8%), or “other” (17.1%) racial ethnic groups was concerned with access to childcare (P < .001) (Table 2). CDC twenty four seven. Blanck HM, Thompson OM, Nebeling L, Yaroch AL. Social determinants of health. In addition, 41% of respondents said that their intake of fruits and vegetables decreased because of COVID-19, and 83% said their frequency of eating food from restaurants decreased because COVID-19. https://www.kff.org/coronavirus-covid-19/issue-brief/estimated-cost-of-treating-the-uninsured-hospitalized-with-covid-19. Housing is one of the best-researched social determinants of health, and selected housing interventions for low-income people have been found to improve health outcomes and decrease health … Centers for Disease Control and Prevention. Additionally, the survey asked respondents about their store-shopping practices: whether they physically shopped inside the store, shopped online with curbside pick-up, or shopped online with goods delivered to home. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Children growing up in more deprived areas often suffer disadvantages throughout their lives, from educational attainment through to employment prospects, which in turn affe… National Cancer Institute, Division of Cancer Control and Population Sciences. Methods We used data, from the World Health Survey in 48 low-income and middle-income … https://www.dol.gov/general/topic/statistics/employment. Two trained coders independently coded the comments by using an open coding method in Microsoft Word to establish initial coding themes and subthemes. Also, 46.7% of families reported receiving Medicaid, and 74.4% of the children participated in free or reduced-price meals programs. ICD-10-CM coding options include: Z59.5 extreme poverty; Z59.6 low income Author Affiliations: 1Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas. Moreover, in fall 2019 only 3.2% reported shopping at a food bank or food pantry or at other distributions at least once per week, where 13.4% reported shopping at these food outlets at least once per week in April 2020 (P < .001). My worry is that my husband can lose his job due to the pandemic that we’re going through. 1 Socioeconomically marginalized (SEM) populations with low levels of education and income are much less likely to breastfeed than their relatively privileged peers with higher levels of income and education. The Atlantic. We computed means, standard deviations, and frequency distributions overall and stratified by race/ethnicity. Furthermore, thousands of people diagnosed and hospitalized with COVID-19 are experiencing employment challenges in conjunction with large medical bills (4–6). 3Brighter Bites, Houston, Texas. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. My biggest worry is not being able to pay next month’s rent and not knowing where to go. the economic spectrum, low-income individuals are particularly likely to face challenges related to housing, food, and transportation. The survey also asked if, because of COVID-19, their consumption of fruits and vegetables had increased, decreased, or stayed the same. My biggest worry is not having an income for my family and that our savings run out. In addition, 83.5% of respondents reported decreasing the frequency of eating out because of COVID-19, with a greater proportion of Hispanic families (84.9%) than families in other racial/ethnic groups reporting decreased frequency (P = .003). Interestingly, a smaller proportion of African American respondents than respondents in other racial/ethnic groups were concerned with being infected with COVID-19. Accessed September 8, 2020. Response options were on a 4-point Likert-type scale ranging from strongly disagree to strongly agree. Because demographic characteristics did not vary by site, our examination of COVID-19–related knowledge, risks, attitudes, and behaviors across racial/ethnic groups did not adjust for site differences. Accessed September 8, 2020. Kaiser Family Foundation. Concern about not having enough food for family and/or children. Brighter Bites developed a set of comprehensive resources to disseminate to their families via text, emailed newsletters, and the Brighter Bites website (www.brighterbites.org). Lack of healthy food accessibility is a form of food insecurity As a result, and it may arise the hardship of low-income people. Respondents also expressed concern about an inability to pay bills, rent, and for other basic needs because of closure-related unemployment. Income can influence many aspects of a person’s life, including their health, where they live and the education that they receive. There’s no work, no money and bills don’t offer forgiveness. We used thematic analysis and an inductive approach to examine the open-ended comments. Employment and unemployment. "1,2The social gradient illustrates that higher income levels result in better health outcomes, where lower income levels result in poorer health outcomes. Lack of seriousness about COVID-19 among other people. My biggest concern is about my husband who is working picking tomatoes and he says that a lot of the workers aren’t being as careful as they should about coronavirus and that the bosses don’t care about them. I’m worried about not having enough food for my kids. https://www.rti.org/focus-area/coronavirus-united-states-survey. Published August 2014. The overall survey response rate was 6.4% (1,048 of 16,436).
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