Pandemic Hit Poor and Minority Americans Harder

(Reuters Health) – The wellbeing of minority and poor families in the U.S. took harder hits during the pandemic in the realms of financial worry, food insecurity, family routines, child sleep, and child health access, a new study finds.

An analysis of data from nearly 10,000 children and their caregivers revealed that social determinants of inequity were associated with transgenerational impacts of COVID-19, above and beyond factors such as preexisting medical and psychiatric conditions, according to the report published in JAMA Psychiatry.

“People from racial and ethnic minoritized backgrounds have been disproportionately affected by the COVID-19 pandemic, despite being more likely to engage in health and safety precautions than their white counterparts,” said study coauthor Dr. Ayana Jordan, the Barbara Wilson Associate Professor of Psychiatry at NYU Langone Health’s Department of Psychiatry in New York City, and an assistant professor adjunct of psychiatry at Yale School of Medicine in New Haven, Connecticut.

“Our results underscore that families most affected by inequity during the pandemic were more likely to abide by safe practices like social distancing and handwashing, despite the popular narrative that minoritized groups are less likely to engage in such behaviors,” Dr. Jordan said in an email.

“The findings indicate that community-level, transgenerational intervention strategies are necessary to combat the impact of the pandemic on these families, Yip said. “Universal child care, increased access to school meals, universal basic income to cover fundamental needs, and continued unemployment assistance could be effective in either preventing or combatting negative COVID-19 experiences across multiple generations within a single family,” she added.

To take a closer look at pandemic disparities related to minority and socioeconomic status, the researchers turned to data collected between 2016 and 2020 by the ongoing Adolescent Brain and Cognitive Development (ABCD) study of child and adolescent development. The study enrolled 11, 875 American youth when they were between the ages of 9 and 10 along with their caregivers.

ABCD’s baseline assessment is based on measures across child and parent domains. In response to the pandemic, the ABCD consortium developed a battery of COVID-19 questionnaires comprising 281 items that were filled out by both the youth and their parents.

The assessments covered multiple dimensions, including school attendance and activities, family stressors, access to needs, social distancing, attitudes, change in routine, sleep, physical activity, screen time, mental health, and physical health, including self-reports of COVID-19 infection.

Using a multivariate pattern-learning analysis on data collected May – August 2020 from 9,267 parents and children, the researchers found two main pre-pandemic areas that were linked to poorer pandemic related outcomes for families. The primary correlates of negative COVID-19 experiences for families were social determinants of inequity at baseline. Non-white and Spanish speaking families were found to have decreased resources, a higher likelihood of financial worry, and food insecurity.

A second important predictor of negative COVID-19 experiences came down to family demographics and structure, including parent demographics, language preference, household size, parent marital status and parental employment. The researchers found a reduced COVID-19-associated impact in white families, those with higher pre-pandemic income, and those with a parent with a postgraduate degree present.

Families lower on the socioeconomic scale were more likely to experience changes in the family routines, impacts on children’s sleep and screen time, and childcare issues that impacted parental employment, household responsibilities and parental perceptions of COVID-19 severity.

“This study shows that the children most negatively impacted financially and emotionally from COVID did not have more health or psychological burdens before the pandemic,” said Dr. Carol Horowitz, a professor of medicine, a professor of population health, and director of the Institute for Health Equity Research at the Icahn School of Medicine at Mount Sinai in New York City, who wasn’t involved in the study.

“Instead, these children suffer more because they are non-white and live in households with single, lower income, and less formally educated caregivers,” Dr. Horowitz said in an email. “The impacts are not trivial. They include financial stress, food insecurity, family conflict, isolation and less sleep and more screen time.”

“It is critical to note that the factors that lead to these profound and unfortunate impacts are due to structural inequities in our nation that lead to racial and social class inequities,” Dr. Horowitz said. “I hope these findings help people move beyond biases that poorer health and wellness are due to negative attitudes and behaviors of low income, non-white people. Instead, when it comes to the actions and choices caregivers do have control over, more vulnerable families take more positive actions than their more privileged counterparts: they are more likely to teach their children to wash their hands, social distance, and protect their elders.”

The new findings provide “strong evidence for policy makers that the COVID-19 pandemic was not an ‘equal opportunity’ in terms of its negative effects on children,” said Nina Schwalbe, adjunct assistant professor of population and family health at the Columbia University Mailman School of Public Health in New York City, who wasn’t involved in the study.

“Children from poor families and racial minorities were much harder hit in terms of their day to day lived experienced. Race, ethnicity, access to education and other services, like childcare, all affect how different communities experience disease and its consequences.”

The study should be a clarion call to policy makers to find ways to help those in vulnerable communities, Schwalbe said in an email. “From childcare coverage to food supplementation, a range of targeted programs – rather than a ‘one size fits all’ policy response – could have made a real difference to those most at risk,” she added.

SOURCE: JAMA Psychiatry, online February 9, 2022.

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