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NCUIH Releases “2022 Annual Policy Assessment”

The Policy assessment informs urban Indian organization policy priorities in 2023, identifies traditional healing barriers, and addresses mental and behavioral health needs.

2022 Policy Assessment thumbnailThe National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2022 Annual Policy Assessment. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2023, as they relate to the Indian Health Service (IHS) designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The focus groups were held on October 18, 21, and 24, 2022. Additional information was also collected from the UIOs via a questionnaire sent out on November 15, 2022.

Together these tools allow NCUIH to work with UIOs to identify policy priorities in 2023 and identify barriers that impact delivery of care to Native patients and their communities.  Of 41 UIOs, 26 attended the focus groups and/or participated in the questionnaire. This is the third year that NCUIH has conducted the assessment via focus groups and follow up questionnaire. This is also the highest response from UIOs NCUIH has seen since following this process.

Overview of Policy Assessment

2022 Policy Assessment chartAfter the height of the COVID-19 pandemic, newfound priorities were identified for 2023, including workforce development and retention, increased funding for traditional healing, and expanded access to care and telehealth services. Existing priorities also remain a key focus across UIOs, especially increasing funding amounts for the urban Indian health line item and IHS, maintaining advance appropriations for IHS, establishing permanent 100% Federal Medical Assistance Percentage (FMAP) for UIOs, reauthorizing the Special Diabetes Program for Indians (SDPI), and increasing behavioral health funding.

 

Key findings from the discussions are as follows:

  • Funding Flexibility is Key to Expanding Services
  • Need for Funding Security Remains a Priority
  • Advance Appropriations Mitigates Funding Insecurities Generated by Government Shutdowns and Continuing Resolutions
  • Facility Funding Directly Impacting UIOs
  • Permanent 100% FMAP Increases Available Financial Resources to UIOs
  • Workforce Concerns Amidst Inflation and Market Changes
  • Traditional Healing Crucial to Advance Comprehensive Native Healthcare
  • Addressing Access and Quality of Native Veteran Care
  • Health Information Technology and Electronic Health Record Modernization
  • New Barriers Limit UIO Distribution of Vaccines
  • HIV, Behavioral Health, and Substance Abuse Report
  • Reauthorizing the Special Diabetes Program for Indians
  • UIOs Find Current NCUIH Services Beneficial

Next Steps

NCUIH will release a comprehensive document of the 2023 Policy Priorities in the coming weeks.

Past Resources:

RESOURCE: COVID-19 Public Health Emergency Medicaid Unwinding Toolkit Released

The National Council of Urban Indian Health (NCUIH) recently released a Medicaid unwinding toolkit for urban Indian organizations (UIOs) as they prepare for changes in Medicaid coverage at the end of the COVID-19 pandemic Public Health Emergency (PHE). After the PHE, states will resume normal operations, which includes processing eligibility renewals and ending coverage for individuals no longer eligible for Medicaid and CHIP in a process known as “unwinding.” This document outlines the impact of Medicaid unwinding on American Indians/Alaska Natives (AI/ANs) and the steps UIOs can take to assist their patients with their coverage, such as working with their state, Tribes, federal agencies, and their community.

Background

Medicaid Unwinding Toolkit

Prior to the pandemic’s PHE, Medicaid provided health insurance for more than one-third of AI/AN adults.  At the beginning of the pandemic, the Families First Coronavirus Response Act (FFCRA) Medicaid and Children’s Health Insurance Program (CHIP) “continuous coverage” requirement  allowed people to retain Medicaid coverage and receive needed care during the PHE.

Medicaid Unwinding Toolkit

After the PHE, states will resume normal operations, which includes processing eligibility renewals and ending coverage for individuals no longer eligible for Medicaid and CHIP in a process known as “unwinding.” According to the Department of Health and Human Services (HHS), nearly 15 million people could lose their current coverage. This will be the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act (ACA). This process is expected to disproportionately impact AI/ANs, particularly those living off-reservation.

While the unwinding process will vary by state, each state will have up to 12 months to start an eligibility renewal for every individual enrolled in their entire Medicaid and CHIP population. The unwinding process will create several challenges and will result in a loss or gaps in coverage for individuals.

Impact on AI/AN Communities

Medicaid Unwinding Toolkit

AI/ANs may be at an increased risk of disenrollment in Medicaid and CHIP programs once the PHE ends. Medicaid coverage losses are estimated to take twice the toll on AI/AN communities than they will take among non-Hispanic white families. Disenrollment of AI/ANs from Medicaid and CHIP will have significant consequences for the health and well-being of Native people – these programs are critical to fulfilling the United States’ trust responsibility to maintain and improve AI/AN health. Inadequate health insurance coverage is a significant barrier to healthcare access and often causes patients to delay or avoid medical care altogether. Alarmingly, when the PHE expires, 12% of all AI/AN children and 6% of all AI/AN adults nationwide are expected to lose CHIP or Medicaid coverage.

Medicaid Unwinding Toolkit

Medicaid-eligible AI/ANs face challenges in enrolling coverage due geographical remoteness, limited access to internet or phone service, language barriers, cultural factors, distrust of government programs, lack of knowledge of the benefits of coverage, or movement between non-reservation and reservation land.

Medicaid Unwinding and UIOs

UIOs play an important role in enrolling AI/ANs in Medicaid and CHIP as well as treating Medicaid beneficiaries, and will therefore, be critical in informing and helping eligible AI/AN maintain enrollment if eligible or explore other options. NCUIH’s resource highlights ways in which UIOs can work with states and other partners including Tribes and Tribal organizations, federal agencies like CMS and Indian Health Service (IHS), and their local communities:

Work with Your State

  • Request a meeting your state regarding unwinding.
  • Request that your state share renewal data via a spreadsheet or database so that you can speak with beneficiaries who utilize your services.
  • Work with your state to develop targeted communication for AI/AN communities about the state’s unwinding activities.
    • States can leverage Unwinding Communications Toolkit materials published by the Centers for Medicare & Medicaid Services (CMS).
    • Ask your state to provide AI/AN-specific guidance on maintaining coverage through Affordable Care Act (ACA) Marketplace plans for those no longer eligible for Medicaid. AI/AN beneficiaries may have access to low-cost zero and limited cost-sharing plans on the Exchanges.
  • Advocate that your state apply for Section 1902(e)(14)(a) waivers if necessary and applicable.

Work with Tribes

  • Collaborate with Tribes to request a meeting with your state regarding unwinding.
  • Develop partnerships with Tribes to provide necessary information to AI/AN beneficiaries.

Work with CMS, Indian Health Service (IHS), and Partner Organizations

  • Request consultation and confer with CMS and IHS to discuss coverage loss concerns and oversight.
  • Culturally appropriate materials are available through CMS, IHS, and the National Indian Health Board.

Work with Your Community

  • Work with beneficiaries to ensure that their contact information is updated with the state Medicaid office, including addresses, emails, and phone numbers, to ensure that individuals receive information on renewals.
  • Screen for potential Medicaid eligibility for all patients and refer current Medicaid recipients to your benefit specialists to update applications.
  • Engage community partners, health plans, and the provider community to encourage individuals to update their contact information and to provide assistance with renewals.
  • Educate patients, including utilizing outreach and educational materials in your clinic waiting rooms, patient rooms, and patient registration/in-take desks, regarding the unwinding and the risk of a loss in coverage.

Bivalent COVID-19 Targeting Vaccine Formula Approved as Booster for 5-11 Year Olds

On October 12, 2022, the US Food and Drug Administration (FDA) amended the previously issued emergency use authorizations (EUAs) for both the Moderna COVID-19 and Pfizer-BioNTech COVID-19 bivalent vaccine formulas, authorizing their use as a single booster dose for those 5-11 years old. Following FDA’s announcement, Centers for Disease Control (CDC) released a decision memo, signed by Director Rochelle Walensky, expanding the recommendations for the use of bivalent vaccines matching the EUA expansions. As such, the Moderna formulation is now available for use in children six and older, at least two months post-completion of a primary series or previous booster dose. The Pfizer formulation is now authorized for use in children five and older, at least two months post-completion of a primary series or booster dose.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of it, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized, and 2.2 times more likely to die due to COVID-19. Indian country has had highly successful vaccine rollouts and urban Indian organizations (UIOs) have been instrumental in the success of vaccinating AI/AN populations in urban areas. As of October 2022, AI/ANs have some of the highest vaccination administration rates in the US with 75.7% of AI/ANs having received at least one dose, and 62.9% having completed the primary series. However, just under half of AI/ANs (47.3%) have received their first booster, and even less have received the second booster dose (37.4%), per CDC data.

The National Council of Urban Indian Health (NCUIH) will continue to monitor and provide updates on any changes in COVID-19 vaccine guidance, or other COVID-19 updates. For more information on the changes to COVID-19 vaccine guidance or the success UIOs have had with the vaccine rollout, see below:

New Omicron Targeting Vaccine Formula Approved as Booster Dose for Individuals 12 years and Older

On August 31, 2022, the US Food and Drug Administration (FDA) amended the previously issued emergency use authorizations (EUAs) for both the Moderna and the Pfizer-BioNTech (Pfizer) COVID-19 vaccines to authorize the use of bivalent formulations for boosters. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend both the Moderna and Pfizer bivalent formulation boosters on September 1, 2022. This new formulation, which can be administered at least two months following the completion of a primary series or a previous booster dose, targets both the original virus and the current Omicron variants.  During a monthly call with Tribal and urban Indian organization (UIO) leaders, the Indian Health Service (IHS) stated that it started shipping the bivalent formulation the week of Labor Day and that these boosters will replace all booster formulations once rolled out. Currently, Omicron variants make up more than 99% of COVID-19 cases within the US.

As it stands, the monovalent (original) COVID vaccine is no longer the recommended booster for people ages 12 and up. In order for an individual to be considered ‘up to date’ on their COVID vaccination, they must have received the bivalent booster, regardless of previous booster status. Individuals who have previously caught COVID-19 can be vaccinated up to three months after the infection.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of the pandemic, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized, and 2.2 times more likely to die to due COIVD-19.

Indian Country has had highly successful vaccine rollouts and UIOs have been instrumental in the success of vaccinating AI/AN populations in urban Areas. As of August 2022, AI/ANs have the highest vaccination administration rates in the US with 74.5% of AI/ANs having received at least one dose of one of the three previously available COVID-19 vaccines, per CDC data.

CDC Endorses Fourth COVID-19 Vaccine for Adults

On Tuesday, July 19, 2022, the Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD, MPH, endorsed the CDC Advisory Committee on Immunization Practices’ recommendation for Novavax’s COVID-19 vaccine as another primary series option for adults 18 and older. Novavax’s vaccine, Adjuvanted, was granted an emergency use authorization on July 13, 2022, by the US Food and Drug Administration.

The Novavax vaccine, Adjuvanted, is another two-dose vaccine that will be available to administer to adults 18 and older in the coming weeks. The Novavax vaccine is administered three weeks apart and uses a more traditional technology for vaccine delivery. In total, there are now four different COVID-19 vaccines for adults 18 and older to choose from; Moderna, Pfizer, Johnson & Johnson, and Novavax.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of the pandemic, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized and 2.2 times more likely to due to du COIVD-19.

Indian Country has had highly successful vaccine rollouts and Urban Indian Organizations have been instrumental in the success of vaccinating AI/AN populations in urban Areas. As of July 2022, AI/ANs have the highest vaccination administration rates in the US with 73% of AI/ANs having received at least one dose of one of the three previously available COVID-19 vaccines, per CDC data.

CDC Expands Eligibility of COVID-19 Boosters for Youth

On Thursday, May 19th, the Centers for Disease Control and Prevention (CDC) expanded eligibility of COVID-19 vaccine boosters for everyone 5-years and older. This expansion follows a meeting of the Advisory Committee on Immunization Practices’ (ACIP) and its recommendations. With this expansion of eligibility, the CDC recommendations for children are the following:

  • Children 5-11 years old should receive a booster shot 5 months post initial series of the Pfizer-BioNTech vaccine
  • Children 12 and older, who are immunocompromised, should receive a second booster at least 4 months after their first booster.

If you are eligible for a booster, be it the first or second dose of such, and you have not had one since December 2021, now is the time to do so. To see if you are eligible for a booster, click here.

COVID-19 and Native Communities

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of it, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized, and 2.2 times more likely to die due to COVID-19. Since the pandemic began, nearly 5 million kids, ages 5 to 11, have been diagnosed with COVID, 15,000 have been hospitalized, and over 180 have died.

Indian Country has had highly successful vaccine rollouts and Urban Indian Organizations (UIO) have been instrumental in the success of vaccinating AI/AN populations in urban areas. As of June 2022, AI/ANs have the highest vaccination administration rates in the U.S with 73% of AI/ANs having received at least one dose of the COVID-19 vaccine, according to CDC Vaccine Administration Data. As of June 2022, UIOs that use IHS vaccine distribution have administered over 174,105 doses of the COVID-19 vaccine and fully vaccinated 67,883 people.

NCUIH Endorses Bicameral Bill that Extends Grants to Urban Indian Organizations to Treat Long COVID

On April 7, 2022, Representative Ayanna Pressley (D-MA-07) and Senator Tammy Duckworth (D-IL) introduced the bicameral Targeting Resources for Equitable Access to Treatment for Long COVID (TREAT Long COVID) Act (H.R. 7482/S. 4015) to increase access to medical care and treatment for communities and individuals struggling with Long COVID. Specifically, this legislation would establish a grant program for eligible entities, including urban Indian organizations (UIOs), for the purpose of creating or enhancing capacity to treat patients with Long COVID through a multidisciplinary approach. The bill authorizes up to $2 million in grant funding to eligible entities and the period of a grant shall be up to three years, with an opportunity for renewal.

The TREAT Long COVID Act is co-sponsored by Rep. Donald Beyer (D-VA-8), Rep. Lisa Rochester (D-DE-1), Sen. Tim Kaine (D-VA), and Sen. Edward J. Markey (D-MA). The National Council of Urban Indian Health (NCUIH) endorses this bill that brings critical funding to UIOs to treat the lasting effects of COVID on the American Indian/Alaska Native (AI/AN) community.

“NCUIH is pleased to endorse Rep. Ayanna Pressley and Sen. Tammy Duckworth’s Targeting Resources for Equitable Access to Treatment for Long COVID Act. The COVID-19 pandemic has disproportionately impacted Native communities and we are left to deal with the devastating lasting impacts of this disease. We are grateful for the inclusion of urban Indian organizations to be eligible for these critical grants to address Long COVID conditions,” – Francys Crevier (Algonquin), CEO, NCUIH.

Next Steps

The bill was referred to the House Energy and Commerce and Senate Health, Education, Labor, and Pensions Committees. It currently awaits consideration. This bill has been added to the NCUIH legislative tracker and can be found here.

Background

Native communities face some of the harshest disparities in health outcomes of any population in the U.S. and are disproportionately impacted by the COVID-19 pandemic. American Indians and Alaska Natives have infection rates over 3.5 times higher than non-Hispanic whites, are over 3.2 times more likely to be hospitalized as a result of COVID-19 and have higher rates of mortality at younger ages than non-Hispanic whites.

The impact of COVID-19 on American Indian and Alaska Native health will continue beyond the pandemic. Lasting illness such as Long COVID need to be addressed.

NCUIH Resource: American Indian/Alaska Native Data on COVID-19

The TREAT Long COVID Act would expand treatment for Long COVID nationwide by:

  • Authorizing the Department of Health and Human Services to award grants up to $2,000,000 to health care providers, including community health centers;
  • Granting funding for the creation and expansion of multidisciplinary Long COVID clinics to address the physical and mental health needs of patients;
  • Prioritizing funding for health providers that plan to engage medically underserved populations and populations disproportionately impacted by COVID-19;
  • Ensuring that treatment is not denied based on insurance coverage, date or method of diagnosis, or previous hospitalization;
  • Encouraging ongoing medical training for physicians in Long COVID Clinics and other health care workers serving patients; and
  • Requiring grantees to submit an annual report on its activities that includes evaluations from patients.

Full Text of the House Bill

Full Text of the Senate Bill

Resource: American Indian/Alaska Native Data on COVID-19 Document Released on NCUIH Website

The National Council of Urban Indian Health (NCUIH) recently released an infographic about American Indian/Alaska Native (AI/AN) Data on COVID-19 on the NCUIH website. This document shows the disproportionate impacts of the COVID-19 pandemic on AI/ANs and Indian Country’s success with vaccinations for the virus. Native communities face some of the harshest disparities in health outcomes of any population in the U.S. and are disproportionately impacted by the COVID-19 pandemic. The impact of COVID-19 on American Indian and Alaska Native health will continue beyond the pandemic. Loss of American Indian and Alaska Native lives—especially the loss of elders—means loss of Native culture, including language, ceremonies, and more.

View the resource

Disproportionate Rates of COVID-19 Cases, Hospitalizations, and Mortality Among AI/ANs

American Indians and Alaska Natives have infection rates over 3.5 times higher than non-Hispanic whites, are over 3.2 times more likely to be hospitalized as a result of COVID-19 and have higher rates of mortality at younger ages than non-Hispanic whites.

AI/AN Children and Orphanhood Due to COVID-19

1 of every 168 AI/AN children experienced orphanhood or death of caregivers due to the pandemic, and AI/AN children were 4.5 times more likely than white children to lose a parent or grandparent caregiver.

Indian Country Lead on Vaccination Rates

As of February 2022, AI/ANs have the highest vaccination administration rates in the U.S with 70.6% of AI/ANs having received at least one dose of the COVID-19 vaccine, according to CDC Vaccine Administration Data. As of January 2022, UIOs that use IHS vaccine distribution have administered over 164,095 doses of the COVID-19 vaccine and fully vaccinated 65,957 people.

AI/AN Food Insecurity and COVID-19

NCUIH Endorses Bill to Understand and Address Long COVID, Including in Urban Indian Communities

On March 3, 2022, Senator Tim Kaine (D-VA) introduced the Comprehensive Access to Resources and Education (CARE) for Long COVID Act (S. 3726). This bill would improve research on long COVID as well as expand resources for those dealing with the long-term impacts of the virus. Specifically, the bill authorizes $50 million for each of fiscal years 2023 through 2027 to fund grants to eligible entities, including Tribes, Tribal organizations, and urban Indian organizations (UIOs), to support legal and social service assistance for individuals with long COVID or related post-viral illnesses. Additionally, UIOs are included in outreach and research activities of the long-term symptoms of COVID–19 by the Patient-Centered Outcomes Research Trust Fund.

“The National Council of Urban Indian Health (NCUIH) is pleased to endorse Senator Kaine’s Comprehensive Access to Resources and Education (CARE) for Long COVID Act. The pandemic has taken a disproportionate toll Indian Country and the public health crisis continues to affect Native communities experiencing symptoms of long COVID. This bill is a step in the right direction to better understand the long-term effects of the virus and provide support for those suffering.” – Francys Crevier (Algonquin), CEO, NCUIH.

The Comprehensive Access to Resources and Education (CARE) for Long COVID Act is co-sponsored by Senators Richard Blumenthal (D-CT), Tammy Duckworth (D-IL), Edward Markey (D-MA), and Tina Smith (D-MN). The bill was referred to the Senate Health, Education, Labor, and Pensions Committee. It currently awaits consideration.

This bill has been added to the NCUIH legislative tracker and can be found here.

Background

The COVID-19 pandemic has had devastating and disproportionate impacts on American Indians/Alaska Natives and continue to feel the lingering effects of the virus. This legislation aims to address this issue by:

  • Accelerating research by centralizing data regarding long COVID patient experiences;
  • Increasing understanding of treatment efficacy and disparities by expanding research to provide recommendations to improve the health care system’s responses to long COVID;
  • Educating long COVID patients and medical providers by working with the CDC to develop and provide the public with information on common symptoms, treatment, and other related illnesses;
  • Facilitating interagency coordination to educate employers and schools on the impact of long COVID and employment, disability, and education rights for people with long COVID; and
  • Developing partnerships between community-based organizations, social service providers, and legal assistance providers to help people with long COVID access needed services.

 

Senate Text of Bill

Senator Kaine’s Press Release

CDC and FDA Approve COVID-19 Boosters for Certain Individuals

On March 29, 2022, the Food and Drug Administration (FDA) authorized secondary booster doses of either Pfizer-BioNTech or Moderna COVID-19 vaccines for older adults and certain immunocompromised individuals. The Centers for Disease Control and Prevention (CDC) also updated its recommendations following the approval. The updated CDC recommendations acknowledge the increased risk of severe COVID-19 for the elderly, those over the age of 50 with underlying conditions, and are given based on available data on vaccine and booster effectiveness and FDA recommendations.

The FDA amended the emergency use authorizations with the following:

  • Individuals 50 years of age and older, who received their first booster of any authorized or approved COVID-19 vaccine at least 4 months prior, may receive a second booster dose of either the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 vaccine
  • Individuals 12 years of age and older with certain immunocompromises, who received their first booster dose of any authorized or approved COVID-19 vaccine at least 4 months prior, may receive a second booster dose of the Pfizer-BioNTech COVID-19 vaccine.
  • Individuals 18 years of age and older, who received their first booster dose of any authorized or approved COVID-19 vaccine at least 4 months prior, may receive a secondary booster dose of the Moderna COVID-19 vaccine.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of it, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized and 2.2 times more likely to die due to COVID-19. Due to NCUIH advocacy, UIOs were included in initial vaccine rollout plans and efforts.  NCUIH also partnered with Native American Lifelines – Baltimore and the University of Maryland to create a vaccine clinic for urban AI/ANs in the DC area.

KRC Articles

Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake

Authors: Matt Ignacio, Sabrina Oesterl , Micaela Mercado, Ann Carver, Gilberto Lopez 3, Wendy Wolfersteig 2, Stephanie Ayers, Seol Ki , Kathryn Hamm, Sairam Parthasarathy, Adam Berryhill, Linnea Evans, Samantha Sabo, Chyke Doubeni

Publication Year: 2023

Last Updated: April 2023

Journal:

Keywords: Awareness; Covid-19; Cultural Sensitivity and Appropriateness; Health Disparities; Infection Disease; Minority Groups; Vaccination/Immunization

 

Short Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals.

 

Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942760/

Type of Resource: Peer-reviewed scientific article

Disparity in Access to Virtual Care for Urinary Tract Infections During the COVID-19 Era

Authors: Molly E DeWitt-Foy, Jacob A Albersheim, Shawn T Grove, Lina Hamid, Sally Berryman, Sean P Elliot

Publication Year: 2023

Last Updated: January 2023

Journal: Société Internationale d'Urologie Journal

Keywords: Covid-19; Infection Disease; Urinary; Telehealth

 

Short Abstract: Objective: To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic variables in the COVID-19 era.

 

Abstract: Objective: To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic variables in the COVID-19 era. Methods: We conducted a retrospective review of outpatient encounters for UTIs across a large health care system. The cohort was defined as patients with an encounter diagnosis of UTI via in-person or virtual care (telephone or technology-supported care), between March 1, 2020, and February 28, 2021. Analysis was limited to the first UTI encounter of the year for each patient. We compared the use of in-person and virtual visits by demographic variables using chi-square tests and multivariate logistic regression. Results: A total of 6744 patients, with a mean age of 61 years, were seen for UTI during the study period. The majority of patients were White (85.5%) and female (83.7%) and were seen in person (55.9%). Of those seen virtually, 52.0% participated in telephone-only visits, and 47.9% were seen via technology-supported care, using video or chat-based platforms. On multivariate logistic regression, age under 30, lowest-quartile income, male sex, and a primary language other than English increased the odds that patients had been seen in person. Among those seen virtually, age over 50 significantly increased the odds of a telephone visit, as did being Black or Native American, having a lower-quartile income, and speaking a non-English primary language. Conclusions: Although the expansion in virtual care has given some patients easier access to necessary care, the “digital divide” has worsened existing disparities for certain vulnerable populations. We demonstrate a difference in uptake of virtual health care by age, race, primary language, and income.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.siuj.org/index.php/siuj/article/view/233/180

Type of Resource: Peer-reviewed scientific article

Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States

Authors: Xu Gao, Fan Lv, Xinyuan He, Yunyu Zhao, Yi Liu, Jian Zu, Linda Henry, Jinhai Wang, Yee Hui Yeo, Fanpu Ji, Mindie H. Nguyen

Publication Year: 2023

Last Updated: January 2023

Journal: Journal of Hepatology

Keywords: Covid-19; Liver Disease

 

Short Abstract: Background & Aims The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the USA, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD).

 

Abstract: Background & Aims The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the USA, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Methods Using data from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform and ICD-10 codes, we identified deaths associated with liver disease. We evaluated observed vs. predicted mortality for 2020–2021 based on trends from 2010–2019 with joinpoint and prediction modelling analysis. Results Among 626,090 chronic liver disease-related deaths between 2010 and 2021, Age-standardised mortality rates (ASMRs) for ALD dramatically increased between 2010–2019 and 2020–2021 (annual percentage change [APC] 3.5% to 17.6%, p <0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (15.67 vs. 13.04) and 2021 (17.42 vs. 13.41). ASMR for NAFLD also increased during the pandemic (APC: 14.5%), whereas the rates for hepatitis B and C decreased. Notably, the ASMR rise for ALD was most pronounced in non-Hispanic Whites, Blacks, and Alaska Indians/Native Americans (APC: 11.7%, 10.8%, 18.0%, all p <0.05), with similar but less critical findings for NAFLD, whereas rates were steady for non-Hispanic Asians throughout 2010–2021 (APC: 4.9%). The ASMR rise for ALD was particularly severe for the 25–44 age group (APC: 34.6%, vs. 13.7% and 12.6% for 45–64 and ≥65, all p <0.01), which were also all higher than pre-COVID-19 rates (all p <0.01). Conclusions ASMRs for ALD and NAFLD increased at an alarming rate during the COVID-19 pandemic with the largest disparities among the young, non-Hispanic White, and Alaska Indian/Native American populations. Impact and implications The pandemic has led to an increase of deaths directly and indirectly related to SARS-CoV-2 infection. As shown in this study, age-standardised mortality rates for alcohol-associated liver disease and non-alcoholic fatty liver disease substantially increased during the COVID-19 pandemic in the USA and far exceeded expected levels predicted from past trends, especially among the young, non-Hispanic White, and Alaska Indian/Native American populations. However, much of this increase was not directly related to COVID-19. Therefore, for the ongoing pandemic as well as its recovery phase, adherence to regular monitoring and care for people with chronic liver disease should be prioritised and awareness should be raised among patients, care providers, healthcare systems, and public health policy makers.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.sciencedirect.com/science/article/pii/S0168827822029944

Type of Resource: Peer-reviewed scientific article

COVID Vulnerability and Impact Summary for Urban Natives (VISUN) — February 2023

Email to Request Report: research@ncuih.org

Authors: Alexander Zeymo

Publication Year: 2023

Last Updated: March 17, 2023

Journal:

Keywords: Covid-19; Infection Disease; Vaccination/Immunization

 

Short Abstract: This report is created using data that is publicly available and provided directly to the National Council for Urban Indian Health from the Office of Urban Indian Health.

 

Source:

Type of Resource: NCUIH data products

Food Insecurity Trajectories in the US During the First Year of the COVID-19 Pandemic

Authors: Jin E. Kim-Mozeleski; Stephanie N. Pike Moore; Erika S. Trapl; Adam T. Perzynski; Janice Y. Tsoh; Douglas D. Gunzler

Publication Year: 2023

Last Updated: January 19, 2023

Journal: CDC Preventing Chronic Disease

Keywords: Covid-19; Nutrition

 

Short Abstract: The objective of this study was to characterize population-level trajectories in the probability of food insecurity in the US during the first year of the COVID-19 pandemic and to examine sociodemographic correlates associated with identified trajectories.

 

Abstract: Introduction The objective of this study was to characterize population-level trajectories in the probability of food insecurity in the US during the first year of the COVID-19 pandemic and to examine sociodemographic correlates associated with identified trajectories. Methods We analyzed data from the Understanding America Study survey, a nationally representative panel (N = 7,944) that assessed food insecurity every 2 weeks from April 1, 2020, through March 16, 2021. We used latent class growth analysis to determine patterns (or classes) of pandemic-related food insecurity during a 1-year period. Results We found 10 classes of trajectories of food insecurity, including 1 class of consistent food security (64.7%), 1 class of consistent food insecurity (3.4%), 5 classes of decreasing food insecurity (15.8%), 2 classes of increasing food insecurity (4.6%), and 1 class of stable but elevated food insecurity (11.6%). Relative to the class that remained food secure, other classes were younger, had a greater proportion of women, and tended to identify with a racial or ethnic minority group. Conclusion We found heterogeneous longitudinal patterns in the development, resolution, or persistence of food insecurity during the first year of the COVID-19 pandemic. Experiences of food insecurity were highly variable across the US population, with one-third experiencing some form of food insecurity risk. Findings have implications for identifying population groups who are at increased risk of food insecurity and related health disparities beyond the first year of the pandemic.

 

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Source: https://www.cdc.gov/Pcd/issues/2023/22_0212.htm#print

Type of Resource: Peer-reviewed scientific article

 

Reaching Unvaccinated Urban Native Americans: A COVID-19 Study for the Department of Indian Work

Authors: Maria Robisnon

Publication Year: 2022

Last Updated: June 2022

Journal:

Keywords: Covid-19; Cultural Sensitivity and Appropriateness; Health Disparities; Vaccination/Immunization; Messaging; Mistrust

 

Short Abstract: Through interviews with experts in the field, unvaccinated individuals, and a scan of what other organizations around the U.S. that serve urban Native American populations are doing, we found that COVID-19 vaccine-related messaging and strategies should use a culturally based approach centering the Native American community.

 

Abstract: Through interviews with experts in the field, unvaccinated individuals, and a scan of what other organizations around the U.S. that serve urban Native American populations are doing, we found that COVID-19 vaccine-related messaging and strategies should use a culturally based approach centering the Native American community. Organizations should focus their efforts on targeting messages and strategies to those who may be on the fence about vaccinations and should not waste time and resources trying to convince those who feel strongly that they will not get vaccinated. With this in mind, some key findings are:  Communities of color, especially Native American communities, experience significant health disparities, such as higher rates of infectious and chronic diseases including COVID-19. Disparities have always existed but have been exacerbated by COVID-19.  Those least like to get vaccinated in the Native American community are: people age 20-50; those who identify as traditionalists or religious; women who are pregnant, nursing, or breastfeeding; and community members who are transient.  There is a lack of trust in government and western medical entities among the Native American community rooted in multigenerational experiences of racism and discrimination.  Use trusted messengers like family and friends to disseminate information about COVID-19 and the vaccine.  Education and understanding of how vaccines are created and approved would help address common misconceptions and concerns in the Native American community.

 

Source: Link to Original Article.

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Source: https://www.wilder.org/sites/default/files/imports/InterfaithAction_COVIDHotlineEvaluation_6-22revised.pdf

Type of Resource: Wilder Research Study Report

Association of death or illness from COVID-19 among family and friends on vaccine uptake within four months of the Emergency Use Authorization. Findings from a national survey in the United States

Authors: Sauralb Kalra, Deepak Kalra, Irina Grafova, Julia Sass Rubin, Alan Monheit, Joel Cantor, Paul Duberstein, Soumitra S. Bhuyan

Publication Year: 2023

Last Updated: January 13, 2023

Journal: Vaccine

Keywords: Covid-19; Vaccination/Immunization

 

Short Abstract: Objective To examine the relationship between knowing that a friend or family member became ill with, or died from, COVID-19 and receiving a vaccine dose within four months of the FDA’s Emergency Use Authorization.

 

Abstract: Objective To examine the relationship between knowing that a friend or family member became ill with, or died from, COVID-19 and receiving a vaccine dose within four months of the FDA’s Emergency Use Authorization. Methods A national sample of 1,517 respondents were surveyed from April 7 to April 12, 2021, 1,193 of whom were eligible for the vaccine when the data were collected. Results Respondents who knew someone who became ill with COVID-19 (AOR = 2.32, 95 % CI 1.74–3.09) or knew someone who died (AOR = 2.29, 95 % CI 1.32–3.99) from COVID-19 were more likely to receive at least a single COVID-19 vaccine dose. Conclusion Encouraging people to share their COVID-19 illness and bereavement experiences with their local network such as friends, families, social-networks and via social media might help increase vaccine uptake.

 

Source: Link to Original Article.

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Source: https://www.sciencedirect.com/science/article/pii/S0264410X2300035X?via%3Dihub

Type of Resource: Peer-reviewed scientific article

Cultural Sources of Strength and Resilience: A Case Study of Holistic Wellness Boxes for COVID-19 Response in Indigenous Communities

Authors: Kevin M. W. Aulandez et al.

Publication Year: 2021

Last Updated: February 2021

Journal: Frontiers in Sociology

Keywords: Covid-19; Cultural Sensitivity and Appropriateness; Health Disparities; Mental and Behavioral Health; Nutrition; Holistic Health; Community-Based Participatory Research; Pandemics

 

Short Abstract: The COVID-19 pandemic has had disproportionately severe impacts on Indigenous peoples in the United States compared to non-Indigenous populations. In addition to the threat of viral infection, COVID-19 poses an increased risk for psychosocial stress that may widen already existing physical, mental, and behavioral health inequities experienced by Indigenous communities.

 

Abstract: The COVID-19 pandemic has had disproportionately severe impacts on Indigenous peoples in the United States compared to non-Indigenous populations. In addition to the threat of viral infection, COVID-19 poses an increased risk for psychosocial stress that may widen already existing physical, mental, and behavioral health inequities experienced by Indigenous communities. In recognition of the impact of COVID-19-related psychosocial stressors on our tribal community partners, the Johns Hopkins Center for American Indian Health Great Lakes Hub began sending holistic wellness boxes to our community partners in 11 tribal communities in the Midwestern United States and Canada in the summer of 2020. Designed specifically to draw on culturally relevant sources of strength and resilience, these boxes contained a variety of items to support mental, emotional, cultural, and physical well-being. Feedback from recipients suggests that these wellness boxes provided a unique form of COVID-19 relief. Additional Johns Hopkins Center for American Indian Health offices have begun to adapt wellness boxes for the cultural context of their regions. This case study describes the conceptualization, creation, and contents of these wellness boxes and orients this intervention within a reflection on foundations of community-based participatory research, holistic relief, and drawing on cultural strengths in responding to COVID-19.

 

Source: Link to Original Article.

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Source: https://www.frontiersin.org/articles/10.3389/fsoc.2021.612637/full

Type of Resource: Peer-reviewed scientific article

A Qualitative Study of COVID-19 Vaccine Decision-Making Among Urban Native Americans

Authors: Anna E. Epperson et al.

Publication Year: 2022

Last Updated:

Journal: Vaccine: X

Keywords: Covid-19; Health Disparities; Vaccination/Immunization; Community-engaged Research

 

Short Abstract: Background: Significant disparities in COVID-19 morbidity and mortality exist for Native American (NA) people, the majority of whom live in urban areas. COVID-19 vaccination is a key strategy for mitigating these disparities; however, vaccination disparities affect NA communities. The current study investigated COVID-19 vaccine decision-making before widespread vaccine rollout occurred, among urban NA communities. We aimed to understand vaccine decision-making factors to develop recommendations about COVID-19 vaccine outreach.

 

Abstract: Background: Significant disparities in COVID-19 morbidity and mortality exist for Native American (NA) people, the majority of whom live in urban areas. COVID-19 vaccination is a key strategy for mitigating these disparities; however, vaccination disparities affect NA communities. The current study investigated COVID-19 vaccine decision-making before widespread vaccine rollout occurred, among urban NA communities. We aimed to understand vaccine decision-making factors to develop recommendations about COVID-19 vaccine outreach. Methods: We conducted three in-depth virtual focus groups with 17 NA adults living in an urban community (Los Angeles County) between December 2020 and January 2021. Participants were recruited through NA community-based organizations and community stakeholders. Reflexive thematic analysis was conducted using Atlas.ti. Findings: Participants in this study identified two overarching themes with implications for health vaccination campaigns. First, participants described a need for tailored information and outreach, including NA vaccine outreach that addresses misconceptions about vaccine development to calm fears of experimentation and support communication of vaccine evidence specific to NA people. Second, participants suggested strategies to improve public health resources in the urban NA community, such as the need for unified, proactive communication across trusted NA entities, navigation support to improve vaccine accessibility, and adequately resourcing health partnerships with and among trusted NA community agencies for improved reach. Conclusion: In this qualitative study, we found that urban NA participants reported several factors that affected their vaccine decision-making, including a lack of tailored information for their communities. Our findings also underscore the need to work with tribes, tribal leadership, and urban NA serving organizations to coordinate vaccine communication and distribution to urban communities where the majority of NAs now reside. Further, these findings have implications for COVID-19 vaccine outreach among urban NA communities and demonstrate the need for clear and tailored engagement about the COVID19 vaccine.

 

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Type of Resource: Peer-reviewed scientific article

Feasibility and Acceptability of Virtual Implementation of a Sexual Reproductive Health Teen Pregnancy Prevention Program for Native Youth

Authors: Hima Patel et al.

Publication Year: 2022

Last Updated:

Journal: American Indian and Alaska Native Mental Health Research

Keywords: Communication Technologies; Covid-19; HIV/AIDS; Pregnancy; Women's Health; Substance Use; Youth; Virtual; Telehealth

 

Short Abstract: American Indian/Alaska Native (Native) youth face high rates of substance use, teen pregnancy and sexually transmitted infections. In response to the COVID-19 pandemic, Respecting the Circle of Life (RCL), a sexual reproductive health and teen pregnancy prevention program for Native youth and their trusted adult, was adapted and delivered in a virtual format with Native youth in a rural, reservation-based Native community.

 

Abstract: American Indian/Alaska Native (Native) youth face high rates of substance use, teen pregnancy and sexually transmitted infections. In response to the COVID-19 pandemic, Respecting the Circle of Life (RCL), a sexual reproductive health and teen pregnancy prevention program for Native youth and their trusted adult, was adapted and delivered in a virtual format with Native youth in a rural, reservation-based Native community. This manuscript describes the adaptation process, feasibility, and acceptability of virtual program implementation. The manuscript describes the process of rapidly shifting the RCL program into a virtual format. In addition, a mixed-methods process evaluation of implementation forms, program feedback forms, in-depth interviews with participants, and staff debriefing sessions was completed. Results show virtual implementation of RCL is both feasible and acceptable for Native youth and their trusted adults. A key benefit of virtual implementation is the flexibility in scheduling and ability to have smaller groups of youth, which offers greater privacy for youth participants compared to in-person implementation with larger groups. However, internet connectivity did present a challenge for virtual implementation. Ultimately, sexual and reproductive health programs seeking to reach Native youth and families should consider virtual implementation methods, both during and outside of pandemic situations. NOTE: This project was conducted to better understand how the virtual implementation of the program was received by participants and not to draw any conclusions about its utility or impact.

 

Source: Link to Original Article.

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Source: https://coloradosph.cuanschutz.edu/docs/librariesprovider205/journal_files/vol29/29_2_2022_63_patel.pdf

Type of Resource: Peer-reviewed scientific article