FIU Center for Reducing Health Disparities in Substance Abuse & HIV in South Florida (1)

SUMMARY Background: The United States (US) remains one of the epicenters of the global COVID-19 public health emergency, resulting in the government's implementation of mitigation policies to stem and contain the virus.Despite these measures, people of color (POC - Blacks, Latinx and American Indian/Alaska Native populations) in the US are disproportionately represented in the epidemic. Objectives: The overall objective of this study is to evaluate the impact of macro and ecological policies by (a) using state and county level data to report on COVID-19 health outcomes experienced by communities of color and (b) conducting in-depth interviews among community members and providers to understand their perceptions about accessing and providing healthcare services. Design: Firstly, there will be an ecological study at the US state and county levels examining the relationship between racial/ethnic density and COVID-19 outcomes, considering selected COVID-19 risk factors (crowding, poverty level, percentage of essential workers) as moderators in that relationship. Secondly, there will be a policy study of differences on timing, interpretation and implementationof federal and state level mitigation policies on COVID-19 outcomes. Finally, interviews will be conducted to understand provider and patient viewpoints about how macro level social and health policies implemented by federal and local governments influence providers' perception about delivery of care and community members'perception about accessing COVID-19 healthcare services. Analysis: Descriptive statistics will be used to describe COVID-19 prevalence by racial/ethnic density in states and counties, followed by bivariate correlations. Any statistically significant correlation (<0.10) in the bivariate correlations will be incorporated intothe regression models with COVID-19 incidence, prevalence and death rate as outcomes. Regression models will be used to determine the relationship between COVID-19 outcomes and state and county level demographic data and COVID-19 policy data. For the interviews, content analysis will be used to analyze qualitative data about perceived barriers and facilitators accessing and providing care. Significance: The results of this study will help to understand the underpinnings of social mechanisms and disparities contributingto the overrepresentation of underrepresented minority populations in the COVID-19 public health crisis. The study objectives are in line with recent NIMHD priorities issued for the COVID-19 response to support studies that investigate the "influence of state and local mitigation policies on differences in health services utilization and health outcomes, the role of community-level protective factors and interventions in mitigating the adverse consequences of the sector disruptions caused by the outbreak, the influence of COVID-19-related racism andother types of discrimination, and the role of social determinants of health in influencing preventive health behaviors".