Examining Social Vulnerability and the Association With COVID-19 Incidence in Harris County, Texas

Studies have investigated the association between social vulnerability and SARS-CoV-2 incidence. However, few studies have examined small geographic units such as census tracts, examined geographic regions with large numbers of Hispanic and Black populations, controlled for testing rates, and incorporated stay-at-home measures into their analyses. Understanding the relationship between social vulnerability and SARS-CoV-2 incidence is critical to understanding the interplay between social determinants and implementing risk mitigation guidelines to curtail the spread of infectious diseases. The objective of this study was to examine the relationship between CDC's Social Vulnerability Index (SVI) and SARS-CoV-2 incidence while controlling for testing rates and the proportion of those who stayed completely at home among 783 Harris County, Texas census tracts. SARS-CoV-2 incidence data were collected between May 15 and October 1, 2020. The SVI and its themes were the primary exposures. Median percent time at home was used as a covariate to measure the effect of staying at home on the association between social vulnerability and SARS-CoV-2 incidence. Data were analyzed using Kruskal Wallis and negative binomial regressions (NBR) controlling for testing rates and staying at home. Results showed that a unit increase in the SVI score and the SVI themes were associated with significant increases in SARS-CoV-2 incidence. The incidence risk ratio (IRR) was 1.090 (95% CI, 1.082, 1.098) for the overall SVI; 1.107 (95% CI, 1.098, 1.115) for minority status/language; 1.090 (95% CI, 1.083, 1.098) for socioeconomic; 1.060 (95% CI, 1.050, 1.071) for household composition/disability, and 1.057 (95% CI, 1.047, 1.066) for housing type/transportation. When controlling for stay-at-home, the association between SVI themes and SARS-CoV-2 incidence remained significant. In the NBR model that included all four SVI themes, only the socioeconomic and minority status/language themes remained significantly associated with SARS-CoV-2 incidence. Community-level infections were not explained by a communities' inability to stay at home. These findings suggest that community-level social vulnerability, such as socioeconomic status, language barriers, use of public transportation, and housing density may play a role in the risk of SARS-CoV-2 infection regardless of the ability of some communities to stay at home because of the need to work or other reasons.

Health Disparities and Climate Change: The Intersection of Three Disaster Events on Vulnerable Communities in Houston, Texas

Although evidence suggests that successive climate disasters are on the rise, few studies have documented the disproportionate impacts on communities of color. Through the unique lens of successive disaster events (Hurricane Harvey and Winter Storm Uri) coupled with the COVID-19 pandemic, we assessed disaster exposure in minority communities in Harris County, Texas. A mixed methods approach employing qualitative and quantitative designs was used to examine the relationships between successive disasters (and the role of climate change), population geography, race, and health disparities-related outcomes. This study identified four communities in the greater Houston area with predominantly non-Hispanic African American residents. We used data chronicling the local community and environment to build base maps and conducted spatial analyses using Geographic Information System (GIS) mapping. We complemented these data with focus groups to assess participants’ experiences in disaster planning and recovery, as well as community resilience. Thematic analysis was used to identify key patterns. Across all four communities, we observed significant Hurricane Harvey flooding and significantly greater exposure to 10 of the 11 COVID-19 risk factors examined, compared to the rest of the county. Spatial analyses reveal higher disease burden, greater social vulnerability, and significantly higher community-level risk factors for both pandemics and disaster events in the four communities, compared to all other communities in Harris County. Two themes emerged from thematic data analysis: (1) Prior disaster exposure prepared minority populations in Harris County to better handle subsequent disaster suggesting enhanced disaster resilience, and (2) social connectedness was key to disaster resiliency. Long-standing disparities make people of color at greater risk for social vulnerability. Addressing climate change offers the potential to alleviate these health disparities.

The unequal commute: Comparing commuting patterns across income and racial worker subgroups

The spatial dimension of the journey-to-work has important implications for land use and development policymaking and has been widely studied. One thrust of this research is concerned with the disaggregation of workers into subgroups for understanding disparities in commute. Most of these studies, however, were limited to the disaggregation by single socioeconomic class. Hence, this research aims to examine commuting disparities across commuter subgroups stratified by two socioeconomic variables—income and race—using a visual analytics approach. By applying the doubly constrained spatial interaction model to the 2014 Longitudinal Employer-Household Dynamics data, this research first synthesizes commuting flows for Downtown Houston workers across income-race subgroups at the tract level in Harris County, Texas, USA. It then uses bivariate choropleth mapping to visualize the spatial distributions of major Downtown Houston commuter neighborhoods by income-race classes, and significant commuting disparities are identified across income-race subgroups. The results highlight the importance of considering income and race simultaneously for commuting research. The visualization could help policymakers clearly identify the unequal commute across worker subgroups and inform policymaking.

A Qualitative Examination of COVID-19’s Impacts on Physical Activity and Perceptions of Remote Delivery Interventions

Purpose The COVID-19 pandemic is correlated with decreased physical activity (PA). Transitioning to remote work may impact people’s acceptability and preferences for remotely delivered behavioral interventions, including PA. The objective was to examine perceptions of COVID-19 impacts on PA engagement and motivation, and perspectives related to remotely delivered PA interventions. Design Cross-sectional small-group interview. Setting Harris County, Texas. Participants: Insufficiently active, overweight/obese adults (16 healthy adults [aged 25–52 years], and 7 cancer survivors [aged 50–74 years]). Method Group discussion was guided by semi-structured questions. Audio-transcribed data (278 pages) was analyzed using Braun and Clarke’s process centering identification, analysis, organization, description, and reports. Results Overall, participants expressed a decreased level of PA due to the pandemic. Difficulties (e.g., care-taking activities, working from home, and safety concerns) negatively affected motivation. Participants indicated high acceptability of remotely delivered PA interventions, with advantages of virtual technology features (e.g., did not have to maintain a gym membership) and even accountability in maintaining a PA routine (e.g., using virtual groups to engage in community support). Conclusion Participants described COVID-19 negatively affects access to PA opportunities yet also expressed willingness to engage in remotely delivered PA interventions instead of in-person programs because of their COVID-19 experiences. Remote interventions can greatly increase accessibility and offer opportunities to provide personalized motivation and accountability that people need to be more physically active.

Experiencing a Natural Disaster Temporarily Boosts Relationship Satisfaction in Newlywed Couples

How do natural disasters affect intimate relationships? Some research suggests that couples are brought closer together after a disaster, whereas other research suggests that relationships become more strained in the aftermath. Yet all of this work is limited by a lack of predisaster data that would allow for examination of how relationships actually change. The current study is the first to use longitudinal data collected before and after a natural disaster to examine its effect on relationship outcomes. Using a sample of 231 married couples in Harris County, Texas, who experienced Hurricane Harvey, we found that spouses experienced significant increases in satisfaction from before to after the hurricane, but the increase was temporary; couples decreased in satisfaction after the initial boost. Thus, couples appear to grow closer in the immediate aftermath of a natural disaster but then revert to their prehurricane levels of functioning as the recovery period continues.

Effectiveness of Educational Materials Designed to Improve Knowledge Regarding Crying and Shaken Baby Syndrome in Mothers of Hispanic Population

Background: Caregiver frustration with inconsolable crying is a commonly cited antecedent factor of Abusive head trauma (AHT) in infants. Objective: To assess the effectiveness of an educational intervention to improve patients’ knowledge of normal crying patterns in infants and the implications of AHT among women of Hispanic population. Methods: The Period of PURPLE Crying program was piloted as part of Centering Prenatal Care at an outpatient clinic site in the Harris County Health Department system, which cares for a primarily underserved and Spanish speaking population. Educational material and direct counseling were delivered by the clinician. Demographic data was collected and a pre- and post-test survey was administrated to assess participant’s knowledge and behavior. Results: Between April 2017 and April 2018, 63 Hispanic women were included in this study. Prior to implementation of the educational tool, most of the survey questions were answered incorrectly. After the intervention, knowledge regarding normal infant crying patterns was significantly improved in all questions. However, knowledge gaps persisted especially in relation to the adequacy of parents’ ability to soothe a crying infant and normalcy of excessive crying. Conclusions: The educational curriculum was an effective tool for improving knowledge about normal infant crying patterns in Hispanic mothers.

Divergent Residential Pathways from Flood-Prone Areas: How Neighborhood Inequalities Are Shaping Urban Climate Adaptation

Flood risks are rising across the United States, putting the economic and social values of growing numbers of homes at risk. In response, the federal government is funding the purchase and demolition of housing in areas of greatest jeopardy, tacitly promoting residential resettlement as a strategy of climate adaptation, especially in cities. Despite these developments little is known about where people move when they engage in such resettlement or how answers to that question vary by the racial and economic status of their flood-prone neighborhoods. The present study begins to fill that gap. We introduce a new typology for classifying environmental resettlement along two socio-spatial dimensions of community attachment: (a) distance moved from one’s flood-prone home; and (b) average distance resettled from similarly relocated neighbors. Next, we analyze data from 1,572 homeowners who accepted government-funded buyouts across 39 neighborhood areas in Harris County, Texas – Houston’s urban core. Results indicate that homeowners from more privileged neighborhoods resettle closer to their flood-prone homes and to one another, thus helping to preserve the social and economic value of their homes; homeowners from less privileged areas end up farther away from both. Implications for understanding social inequities in government-funded urban climate adaptation are discussed.

Vote Centers and the Voter Experience

The scholarship regarding vote centers primarily focuses on their impact on voter turnout. Though previous literature suggests modest and conditional increases in voter participation, the mechanism by which vote centers increase participation is less understood. One suggested mechanism is that they provide voters a better experience at the polling place. In this article, we investigate whether voters who cast their ballot at vote centers have a better experience than those who vote at traditional precinct polling places. Utilizing a unique dataset collected from exit polls of Election Day voters before and after the implementation of vote centers in Harris County, Texas, we examine if vote centers improved the voters’ experience. Contrary to theoretical expectations, we find that those who voted at a vote center reported having a more negative experience. This negative experience is driven primarily by longer lines and less helpful poll workers.

Hospital Preparedness, Mitigation, and Response to Hurricane Harvey in Harris County, Texas

Objective: This case study documents Harris County hospitals’ flood preparedness and mitigation efforts before Hurricane Harvey, their collective response experience during Hurricane Harvey, and their lessons learned in the storm’s aftermath. Methods: The case study was constructed using a survey of hospital emergency managers, semi-structured interviews with local agencies involved in public health, emergency management, and health care, and an analysis of news reports and other documents from a variety of government agencies, local organizations, and hospitals themselves. Results: Harris County hospitals learned their most valuable lessons through their direct and repeated experience with flooding over the years, leading to improved preparedness before Hurricane Harvey. Hospital emergency response successes included infrastructure improvements, staff resilience, advanced planning, and pre-established collaboration. However, hospitals still experienced challenges with staff burnout, roadway flooding, and patient evacuation. Conclusions: Although the current state of hospital flood preparedness and mitigation is rather advanced and mature, it is advisable that Harris County takes steps to strengthen emergency management efforts in hospitals with fewer financial and staffing resources and less direct flood experience.