COVID-19 Testing Among US Children, Parental Preferences for Testing Venues, and Acceptability of School-Based Testing

Objectives: Testing remains critical for identifying pediatric cases of COVID-19 and as a public health intervention to contain infections. We surveyed US parents to measure the proportion of children tested for COVID-19 since the start of the pandemic, preferred testing venues for children, and acceptability of school-based COVID-19 testing. Methods: We conducted an online survey of 2074 US parents of children aged ≤12 years in March 2021. We applied survey weights to generate national estimates, and we used Rao–Scott adjusted Pearson χ2 tests to compare incidence by selected sociodemographic characteristics. We used Poisson regression models with robust SEs to estimate adjusted risk ratios (aRRs) of pediatric testing. Results: Among US parents, 35.9% reported their youngest child had ever been tested for COVID-19. Parents who were female versus male (aRR = 0.69; 95% CI, 0.60-0.79), Asian versus non-Hispanic White (aRR = 0.58; 95% CI, 0.39-0.87), and from the Midwest versus the Northeast (aRR = 0.76; 95% CI, 0.63-0.91) were less likely to report testing of a child. Children who had health insurance versus no health insurance (aRR = 1.38; 95% CI, 1.05-1.81), were attending in-person school/daycare versus not attending (aRR = 1.67; 95% CI, 1.43-1.95), and were from households with annual household income ≥$100 000 versus income <$50 000-$99 999 (aRR = 1.19; 95% CI, 1.02-1.40) were more likely to have tested for COVID-19. Half of parents (52.7%) reported the pediatrician’s office as the most preferred testing venue, and 50.6% said they would allow their youngest child to be tested for COVID-19 at school/daycare if required. Conclusions: Greater efforts are needed to ensure access to COVID-19 testing for US children, including those without health insurance.

Development and Implementation of a Hybrid Online and In-Person Food Sovereignty and Nutrition Education Curriculum for Native American Parents: The FRESH Study

The Food Resource Equity and Sustainability for Health (“FRESH”) study is an Indigenous-led intervention to increase vegetable and fruit intake among Native American children. As part of this study, we developed a hybrid (online and in-person) food sovereignty and nutrition education curriculum for the parents of these children. This 16-week curriculum was developed to promote household- and community-level healthy eating and food sovereignty practices to parents of preschool-aged children residing in Osage Nation, Oklahoma. A total of 81 parent/caregivers participated in the curriculum component of the FRESH study, with a median age of 34 years (range: 23–54 years). Most study participants were female (88.9%) and less than half (45.7%) had an annual household income of more than US$50,000. Most were married or had a significant other (76.5%) and worked full-time (65.4%). The median total number of children in the home <18 years of age was three (range: 1–8). Participation among the 94 parents was 56% during the first week and was 12% in the final week. Having some college or technical training (vs. having a college degree) and having an annual household income of US$20,000–US$50,000 (vs. more than US$50,000) were associated with fewer sessions attended ( p = 0.004 and 0.02, respectively) Being married (vs. not) was associated with higher attendance ( p < .0001). Participation in a hybrid food sovereignty and nutrition education curriculum for parents was generally low, but income, education, and marital status were associated with curriculum participation. Our research adds to the literature by describing the development and implementation of this curriculum and recommendations for future research incorporating Indigenous approaches to health.

Play & Grow: prospective observational cohort of toddlers to inform obesity prevention, Columbus, Ohio, USA

PurposeObesity prevention is increasingly focused on early childhood, but toddlers have not been well-studied, and children born preterm are frequently excluded. The Play & Grow Cohort was established to investigate child growth in relation to parent-child interactions in mealtime and non-mealtime settings.ParticipantsBetween December 2017 and May 2019, 300 toddlers and primary caregivers were recruited from records of a large paediatric care provider in Columbus, Ohio, USA. This report describes recruitment of the cohort and outlines the data collection protocols for two toddler and two preschool-age visits. The first study visit coincided with enrolment and occurred when children (57% boys) were a mean (SD) calendar age of 18.2 (0.7) months.Findings to dateChildren in the cohort are diverse relative to gestational age at birth (16%, 28–31 completed weeks’ gestation; 21%, 32–36 weeks’ gestation; 63%, ≥37 weeks’ gestation) and race/ethnicity (8%, Hispanic; 35%, non-Hispanic black; 46%, non-Hispanic white). Caregivers enrolled in the cohort are primarily the child’s biological mother (93%) and are diverse in age (range 18–54 years), education (23%, high school or less; 20% graduate degree) and annual household income (27%, <US$20 000 24%, ≥US$90 000). Parent-child interactions were video-recorded during play in the laboratory at 18 months (n=299) and during play, reading and mealtime in the home (n=284) at 24 months. The preschool phase of the study was impacted by COVID-19. Parent-child interactions were video-recorded during play and mealtime at home at 36 months (n=141) and during a standardised buffet meal in the laboratory at 42 months (n=50). Caregivers unable to participate in face-to-face visits due to COVID-19 completed questionnaires.Future plansAssessment during middle childhood is being planned. Future visits will include anthropometric measurements and parent-child interactions at mealtime. School-based outcomes are additionally being considered.

The Economic Burden and Determinant Factors of Parents/Caregivers of Children with Cerebral Palsy in Malaysia: A Mixed Methods Study

The economic burden is a major concern for parents/caregivers of children with cerebral palsy (CP). This study used the sequential explanatory mixed-method approach to explorethe economic burden on parents/caregivers with a CP child in Malaysia and the factors associated with the economic burden. The study period spanned April 2020 and December 2020. A total of 106 questionnaire respondents were selected for the quantitative part, and 15 were interviewed to obtain qualitative input. A retrospective costing analysis was conducted based on the cost data obtained from the questionnaire. The majority of the children were GrossMotor Function Classification System (GMFCS) Level 5 (71%), quadriplegic (63%), and aged >4 years (90%). The estimated annual median total economic burden on the parents/caregivers per child in 2020 was RM52,540.00 (~USD12,515.03), with indirect cost being the greatest cost (RM28,800.00, ~USD6860.16), followed by developmental cost (RM16,200.00, ~USD3858.84), direct healthcare cost (RM4540.00, ~USD1081.43) and direct non-healthcare cost (RM3000.00, ~USD714.60). The annual household income was identified as a significant determinant factor (p=0.019, 95% CI: 0.04, 0.40) of the economic burden. The participants’ responses during the in-depth interview in the qualitative part of the study supported the premise that socioeconomic factors play a substantial role in determining the total economic burden. Our findings may aid local policymakers when planning the greater provision of support to the affected families in the future, especially for the parents/caregivers of children with CP, who are facing socioeconomic challenges.

Can Tourism Development Make Cities More Livable? Investigating 40 Cities in China

The field of rapid urbanization has recently paid more attention to the relationship between tourism development and liveable city construction. Previous studies have mainly focused on the experiences of tourists in tourist cities and seldom paid attention to the perceptions of local residents. Based on survey data of nearly 10,000 permanent residents in 40 key tourist cities in China, this study uses a multilevel model to quantitatively analyse the natural environment characteristics, sociocultural environment characteristics and comprehensive attraction of tourism in different tourist cities to explore their impact on urban liveability satisfaction. Results show that the developed tourist cities do not exactly correspond to the cities with a high liveability evaluation. The objective evaluation of both the natural environment and the sociocultural environment has an important influence on the liveability of cities, but the influence of the natural environment is stronger than that of the sociocultural environment. An intermediary effect exists in the subjective evaluation of the natural environment and environments for liveability perception. Simultaneously, residents’ liveability satisfaction varies according to their age, education level, annual household income and other social and economic conditions. These findings provide insights for developing countries to further improve residents’ living quality and urban construction under the condition of the rapid development of tourism.

Sociodemographic Factors Associated with Vaccine Hesitancy in Central Texas Immediately Prior to COVID-19 Vaccine Availability

Vaccine-induced herd immunity remains the best opportunity for ending the COVID-19 pandemic. However, COVID-19 vaccine hesitancy is a real concern. In this paper, we report on vaccine hesitancy in Central Texas immediately prior to the release of the two mRNA COVID-19 vaccines in late December 2020. A total of 1648 individuals 18 years or older with health insurance living in Central Texas completed a survey on sociodemographic factors and plans to obtain the COVID-19 vaccine. Of the respondents, 64.1% planned to obtain the COVID-19 vaccine. Logistic regression identified the following sociodemographic factors associated with vaccine hesitancy: Black or African American race (POR: 0.351, p < 0.001, 95% CI: 0.211, 0.584), female sex (POR: 0.650, p < 0.001, 95% CI: 0.518, 0.816), age of 35–49 years old (POR: 0.689, p = 0.004, 95% CI: 0.534, 0.890), annual household income of less than US$10,000 (POR: 0.565, p = 0.041, 95% CI: 0.327, 0.976), a high school education or less (POR: 0.565, p = 0.001, 95% CI: 0.401, 0.795), and a high school education but less than a 4-year college degree (POR: 0.572, p < 0.001, 95% CI: 0.442, 0.739). Real-world evidence provided by individuals on plans to get vaccinated can reveal COVID-19 vaccine hesitancy associated heterogeneity.

A 3-Item Measure of Digital Healthcare Literacy: Development and Validation (Preprint)

BACKGROUND With increased reliance on digital healthcare, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with utilizing these services. OBJECTIVE The goal of this study was to develop and validate a brief scale that assesses digital healthcare literacy. METHODS We first developed an item pool using the existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either online or over the phone. We randomized participants into a development and confirmatory sample stratifying by language so that exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) could be performed with a separate sample of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital healthcare use. RESULTS Participants (N=507) were, on average, aged 33.7 (SD 7.7) years and 89% female. Approximately half (55%) preferred English as their primary language, 31% preferred Spanish, and 14% Arabic. Around half (45%) had a high school degree or less and 45% had an annual household income less than US $35,000. Using the EFA, three items were retained in a reduced score with excellent reliability (Cronbach’s alpha = 0.90) and a high variance explained (78%). The reduced scale had excellent CFA fit with factor loadings between 0.82 and 0.94. All fit statistics exceeded the criteria for good fit between the proposed factor structure and the data. We refer to this scale as the Digital Healthcare Literacy Scale (DHLS). The scale was positively associated with education (ρ =0.139, p=.005) and income (ρ =0.379, p<.001). Arabic speakers had lower scores compared to English (p<.001) and Spanish speakers (p=.015), and Spanish speakers had lower scores relative to English speakers (p<.001). Participants who did not own a smartphone (p=0.13) or laptop (p<.001) had lower scores than those who did own these devices. Finally, participants who had not used digital tools, including health apps (p<.001) and video telehealth (p<.001), had lower scores than those who had. CONCLUSIONS Despite the potential for digital healthcare to improve quality of life and clinical outcomes, many individuals may not have the skills to engage with and benefit from it. Moreover, these individuals may be those who already experience worse outcomes. A screening tool like DHLS could be a useful resource to identify patients who require additional assistance to use digital health services and help ensure health equity. CLINICALTRIAL N/A

Prospective Cohort Study of Sociodemographic Factors, Including Occupation and Subsequent Unemployment, Under COVID-19 in Japan

Background: We examined the relationship between sociodemographic factors, including occupation and unemployment, among workers during COVID-19 in Japan.Methods: We conducted a prospective cohort study using a self-administrated questionnaire. We surveyed the socioeconomic status, personal characteristics, and occupation of recruited workers at baseline (December 22–25, 2020); subsequent unemployment was examined at follow-up (February 18-19, 2021). We determined the odds ratio (OR) of unemployment for sociodemographic status and occupation. The multivariate model was adjusted for sex and age.Results: Among the 19,941 participants, 725 (3.6%) had experienced unemployment. Multivariate analysis showed that the OR and 95% confidence interval (CI) of unemployment associated with sex were 1.35 (1.14–1.60) for women compared with men. With increasing age, the OR for unemployment was lower (OR, 0.98; 95% CI, 0.97–0.99; P <0.001), adjusted for sex. The OR and 95% CI for the association with marital status were as follows: 1.33 (1.03–1.71) for being married (spouse not working); 2.09 (1.65–2.64) for bereaved or divorced; and 1.29 (1.07–1.56) for unmarried compared with married (spouse working). The respective figures for the association with annual household income were as follows: 4.05 (3.00–5.46) for <2 million yen; 2.12 (1.62–2.78) for 2–4 million yen; and 1.46 (1.11–1.93) for 4–6 million yen, compared with >10 million yen. The figures for the association with education were 1.73 (1.12–2.66) for junior high or high school and 1.83 (1.19–2.83) for vocational school, junior college, or technical school. The association with occupation was 2.01 (1.63–2.48) for temporary or contract employees, 1.35 (1.02–1.78) for self-employed, and 3.02 (1.68–5.42) for agriculture, forestry, or fishing, compared with general employees; it was 0.56 (0.40–0.79) for public employees, faculty members, or non-profit organization employees. The association with job type was 1.25 (1.04–1.51) for jobs mainly involving interpersonal communication and 1.85 (1.55–2.21) for mainly manual or physical labor, compared with mainly desk work.Conclusions: COVID-19 appears to have created difficulties for previously vulnerable groups. This suggests the need for employment and economic support for such individuals.

What Affects the Production Technology of Labor-Intensive Agricultural Industries in the Context of Labor Aging? An Empirical Study Based on the Garlic Production in Lanling

While the aging of agricultural labor force and its impact on agricultural production have been attracting extensive attention, little is known about the relationship between aging of agricultural labor force and technical efficiency in the garlic production. Based on the survey data of garlic growers in Lanling County, Shandong Province, the Data envelopment analysis（DEA）model is used to measure the production technical efficiency of garlic growers in 84 villages in Lanling County, Shandong Province, with the aging of the labor force. The distribution characteristics and changing trends of garlic production technology efficiency are analyzed in terms of family characteristics and garlic planting characteristics, and regression analysis is performed on the differences of the results. The study found the following: (1) Garlic growers in Lanling County, Shandong Province, accounted for a high proportion of laborers over 60 years old, and their physical health status was weaker than that of young laborers, which reduced the technical efficiency of garlic planting and production. (2) The number of garlic varieties grown by garlic growers and the number of garlic planted in acres have a significant negative impact on the technical efficiency of garlic planting by farmers. (3) There is a significant positive correlation between the annual household income of farmers and the production technology efficiency of garlic growers; when the number of garlic training is not more than three times, it has a positive impact on the production technology efficiency of garlic planting by farmers, and more than three times are related to garlic production technology. The efficiency is negatively correlated.

Likelihood of COVID-19 Vaccination Among Individuals Living With Psoriatic Disease: Results From a Large Real-World Survey

Introduction: Development and dissemination of novel COVID-19 vaccines represent an opportunity to end the COVID-19 pandemic by vaccinating an estimated 80% of the population. Objectives: This study examines perceptions, and demographic and clinical factors influencing the likelihood of adults with psoriasis receiving a novel COVID-19 vaccine. Methods: A cross sectional study conducted from October–November 2020 of 1405 adults with psoriatic disease with prior contact to a patient advocacy organization. The main outcome of interest was the likelihood of receiving a COVID-19 vaccine. Chi-square tests and logistic regression examined the relationship between individual characteristics and likelihood of receiving a COVID-19 vaccine. Results: Most participants (65%) received a flu vaccination in the last 12 months and were (64.2%) likely to receive a COVID-19 vaccine, while 35.9% reported being unlikely receive a vaccine. Likelihood of COVID-19 vaccination was associated with receiving the flu vaccine, race, ethnicity, sex, BMI, age, income, severity of PsO and PsA. When controlling for ethnicity, race, male sex, overweight/obese status, age, biologic use, disease type, comorbidities linked with worse COVID-19 outcomes, PsA symptoms, and skin disease severity, individuals who received the flu vaccine and those with annual household income over $75,000 were most likely to receive a COVID-19 vaccine. Conclusions: Vaccine hesitancy among individuals with psoriatic disease is considerable. Dermatologists and rheumatologists can increase COVID-19 vaccine uptake by actively engaging their patients on this topic using guidance published by the National Psoriasis Foundation on the management of psoriatic disease during the COVID-19 pandemic.