Covid19, Mental Health Issue, Violence
Conditions
Keywords
Latino health, Immigrant health, Syndemic
Brief summary
Latinos have been one of the racial/ethnic groups most impacted by the COVID-19 pandemic, and evidence of effective strategies to curb the pandemic, reduce disparities, and mitigate its impact is lacking and very urgent. The goal of this competitive revision is to expand an ongoing academic-community partnership to adapt, implement, and evaluate a multi-level intervention to mitigate the multi-dimensional toll of COVID19 among Latino immigrant communities in Philadelphia.
Detailed description
This goal of this competitive revision is to expand our original project to adapt, implement and evaluate a multi-level intervention to mitigate the multi-dimensional toll of COVID19 among Latino immigrant communities in Philadelphia. Evidence of effective strategies to curb the pandemic, reduce disparities and mitigate its impact is lacking and very urgent. In the US, Latino immigrants are one of the groups hardest hit by this pandemic, with recent steep increases in COVID-19 deaths among this group corroborating their continued increased risk of infection and increased susceptibility. Latino immigrants have long exhibited disparities in diabetes, obesity and hypertension, factors known to increase COVID-19 related severity, and also in Substance Abuse, Violence exposure, HIV/AIDS, and MEntal health (SAVAME) syndemic. These syndemic conditions have been worsened in the context of COVID-19. Latino immigrants represent a hard-to-reach and marginalized population, with extremely limited access to adequate health care and safety nets. This group faces many structural barriers, and social vulnerabilities, that hinder their capacity to access COVID-19 testing and treatment services and to adhere to public health interventions and measures to decrease the spread of COVID-19. Latinos often rely on a thin and fragmented network of health and social services organizations. Intervention to mitigate the impact of COVID-19 on this population will need to have a broad stakeholder engagement and address a wide range of health determinants. Peer-driven interventions have been effective for the prevention and control of infectious diseases such as HIV, STIs among Latino populations. Strengthening the links between community members and these organizations and promoting inter-organizational coordination to meet syndemic health, behavioral, economic, and legal needs of Latino communities are essential elements to mitigate the impact of COVID-19 on this low-resource population. In direct response to the NOT-MD-20-022/PAR PA-18-935, our ongoing community-academic partnership proposes to evaluate CRISOL Contigo, a multi-level intervention to address the needs created or magnified by the COVID-19 pandemic among Latino communities in Philadelphia. CRISOL Contigo includes a peer-driven program and mobilization of Latino-serving organizations. In aim 1, the investigative team will adapt an ongoing Popular Opinion Leader (POL) program to address the unique health, social, and economic needs related to COVID-19 and the SAVAME syndemic. In aim 2, the investigative team will assess the efficacy of CRISOL Contigo to improve COVID-19 related preventive health behaviors and use and access to COVID-19 related testing and care (co-primary outcomes). In aim 3, the investigative team will examine the impact of CRISOL Contigo on community assets, interagency collaborations, and coordination among the Latino-serving organizations in Philadelphia. There are almost 20 million Latino immigrants in the US, and they play a central role in sustaining the vital parts of the US economy Tailored, multi-level interventions that consider the unique needs of Latinos are urgently needed to mitigate the impact of this and future outbreaks of COVID-19 on this disadvantaged population.
Interventions
A community popular opinion leader (POL) based intervention to promote measures to reduce COVID-19 risk, transmission, access to testing and treatment, reduction of the impact of COVID-19, and addressing the Substance Abuse, Violence, HIV/AIDS, and MEntal health (SAVAME) syndemic in the community. POLs will interact within their networks counseling regarding COVID-19 and SAVAME factors. The POLs will refer individuals to appropriate community services. POLs will record basic sociodemographic characteristics of all community contacts, the issue addressed, and their response to it. The first 300 community contacts will be invited to complete a baseline and 3-month follow up surveys (via internet or phone). The content of the surveys includes: 1) COVID-19 related questions (knowledge, impact, symptoms, risk factors, access to testing and care, acceptability contact tracing, vaccine) 2) Biological risk factors, 3) Social determinants of health, 4) SAVAME outcomes and access to services.
Sponsors
Study design
Eligibility
Inclusion criteria
* Self-reported Latino or Hispanic * Living in Philadelphia
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Number of Five Protective COVID-19 Risk Measures | Baseline and 3 months | This measure is the sum of the five protective COVID-19 risk measures: Use of mask, frequent hand washing, social distancing (including the ability to telework, and avoid crowded indoor spaces), and avoidance of contact with high-risk individuals. Scale ranged (0-5). The higher the score, the higher the number of protective behaviors |
| Number of Participants Who Lack Access to Health Care | Baseline and 3 months | This measure is a composite dichotomous outcome variable, that indicates not having health insurance or not having a regular primary care provider. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With SAVAME (Substance Abuse, Violence, HIV/AIDS, Mental Health)-Related Factors | Baseline and 3 months | Substance abuse (yes/no), defined as binge drinking (\>=4 or \>=5 drinks on one occasion for women, and men, respectively), or use of drugs other than those required for medical reasons (at least once a week). Intimate partner violence (yes/no), defined as experiencing verbal or physical violence, categorized using answers to the following questions: In the 30 days, how often has a partner or spouse, Yelled at you or said things to you that made you feel bad about yourself, embarrassed you in front of others, or frightened you?, Done things like push, grab, hit, slap, kick, or throw things at you during an argument or because they were angry with you?. Any answer other than never was considered yes. HIV/AIDS (yes/no), defined as having a history of a positive test. Mental health (Yes/no), defined as depressive (CES-D-10 \>=10) or anxiety (GAD-7 \>=5) symptoms. |
| Lack of Access to SAVAME Services | Baseline and 3 months | Self-report lack of access to any SAVAME (Substance abuse, Intimate partner violence, HIV/AIDS, or Mental health symptomatology) services, overall among all the participants |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Community Popular Opinion Leader (POL) A community popular opinion leader (POL) based intervention to promote measures to reduce COVID-19 risk, transmission, access to testing and treatment, reduction of the impact of COVID-19, and addressing the Substance Abuse, Violence, HIV/AIDS, and MEntal health (SAVAME) syndemic in the community. POLs will interact within their networks counseling regarding COVID-19 and SAVAME factors. The POLs will refer individuals to appropriate community services. POLs will record basic sociodemographic characteristics of all community contacts, the issue addressed, and their response to it. The first 300 community contacts will be invited to complete a baseline and 3-month follow up surveys (via internet or phone). The content of the surveys includes: 1) COVID-19 related questions (knowledge, impact, symptoms, risk factors, access to testing and care, acceptability contact tracing, vaccine) 2) Biological risk factors, 3) Social determinants of health, 4) SAVAME outcomes and access to services. | 178 |
| Total | 178 |
Baseline characteristics
| Characteristic | Community Popular Opinion Leader (POL) |
|---|---|
| Age, Continuous | 38.4 years STANDARD_DEVIATION 9.7 |
| Baseline Income Category $1000-$2000 usd | 38 Participants |
| Baseline Income Category <$1000 usd | 86 Participants |
| Baseline Income Category >$2000 usd | 21 Participants |
| Baseline Income Category Missing/Don't know | 33 Participants |
| Education Category High school or more | 32 Participants |
| Education Category Missing | 2 Participants |
| Education Category More than Primary & <= High School | 111 Participants |
| Education Category Primary or below | 33 Participants |
| Prevalence of COVID-19 positive | 51 Participants |
| Race/Ethnicity, Customized Latino Black | 4 Participants |
| Race/Ethnicity, Customized Latino Native American | 11 Participants |
| Race/Ethnicity, Customized Latino Other | 119 Participants |
| Race/Ethnicity, Customized Latino White | 12 Participants |
| Race/Ethnicity, Customized Prefer not to answer, Unknown, More than one | 39 Participants |
| Region of Enrollment United States | 178 participants |
| Sex: Female, Male Female | 135 Participants |
| Sex: Female, Male Male | 43 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 178 |
| other Total, other adverse events | 0 / 178 |
| serious Total, serious adverse events | 0 / 178 |
Outcome results
Mean Number of Five Protective COVID-19 Risk Measures
This measure is the sum of the five protective COVID-19 risk measures: Use of mask, frequent hand washing, social distancing (including the ability to telework, and avoid crowded indoor spaces), and avoidance of contact with high-risk individuals. Scale ranged (0-5). The higher the score, the higher the number of protective behaviors
Time frame: Baseline and 3 months
Population: Each of the rows indicates the mean (SD) of protective behaviors at baseline and 3 months follow up
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Community Popular Opinion Leader (POL) | Mean Number of Five Protective COVID-19 Risk Measures | Baseline | 2.79 score on a scale | Standard Deviation 1.23 |
| Community Popular Opinion Leader (POL) | Mean Number of Five Protective COVID-19 Risk Measures | 3 Months | 2.66 score on a scale | Standard Deviation 1.33 |
Number of Participants Who Lack Access to Health Care
This measure is a composite dichotomous outcome variable, that indicates not having health insurance or not having a regular primary care provider.
Time frame: Baseline and 3 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Community Popular Opinion Leader (POL) | Number of Participants Who Lack Access to Health Care | Baseline | 121 Participants |
| Community Popular Opinion Leader (POL) | Number of Participants Who Lack Access to Health Care | 3 Months | 122 Participants |
Lack of Access to SAVAME Services
Self-report lack of access to any SAVAME (Substance abuse, Intimate partner violence, HIV/AIDS, or Mental health symptomatology) services, overall among all the participants
Time frame: Baseline and 3 months
Population: Defined as self-report lack of access to any SAVAME services, overall among all the participants
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Community Popular Opinion Leader (POL) | Lack of Access to SAVAME Services | Baseline | 52 Participants |
| Community Popular Opinion Leader (POL) | Lack of Access to SAVAME Services | 3 Months | 43 Participants |
Number of Participants With SAVAME (Substance Abuse, Violence, HIV/AIDS, Mental Health)-Related Factors
Substance abuse (yes/no), defined as binge drinking (\>=4 or \>=5 drinks on one occasion for women, and men, respectively), or use of drugs other than those required for medical reasons (at least once a week). Intimate partner violence (yes/no), defined as experiencing verbal or physical violence, categorized using answers to the following questions: In the 30 days, how often has a partner or spouse, Yelled at you or said things to you that made you feel bad about yourself, embarrassed you in front of others, or frightened you?, Done things like push, grab, hit, slap, kick, or throw things at you during an argument or because they were angry with you?. Any answer other than never was considered yes. HIV/AIDS (yes/no), defined as having a history of a positive test. Mental health (Yes/no), defined as depressive (CES-D-10 \>=10) or anxiety (GAD-7 \>=5) symptoms.
Time frame: Baseline and 3 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Community Popular Opinion Leader (POL) | Number of Participants With SAVAME (Substance Abuse, Violence, HIV/AIDS, Mental Health)-Related Factors | Baseline | 64 Participants |
| Community Popular Opinion Leader (POL) | Number of Participants With SAVAME (Substance Abuse, Violence, HIV/AIDS, Mental Health)-Related Factors | 3 Months | 48 Participants |