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Disparities and Temporal Trends in COVID-19 Exposures and Mitigating Behaviors Among Black and Hispanic Adults in an Urban Setting

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What behaviors and disparities in health resources are associated with the spread of COVID-19 in predominantly Black and Hispanic communities?

Findings  In this survey study of adults living in a large US city, consistent masking was associated with a decrease in SARS-CoV-2 acquisition; however, Hispanic individuals were at higher risk for infection, more often worked outside the home, and were less likely to have received economic aid through stimulus checks or unemployment benefits.

Meaning  These results suggest public health messaging may have improved preventive behaviors over time but should be customized for Hispanic communities.


Importance  COVID-19, caused by SARS-CoV-2 virus, has disproportionately affected Black and Hispanic communities in the US, which can be attributed to social factors including inconsistent public health messaging and suboptimal adoption of prevention efforts.

Objectives  To identify behaviors and evaluate trends in COVID-19–mitigating practices in a predominantly Black and Hispanic population, to identify differences in practices by self-reported ethnicity, and to evaluate whether federal emergency financial assistance was associated with SARS-CoV-2 acquisition.

Design, Setting, and Participants  This survey study was conducted by telephone from July 1 through August 30, 2020, on a random sample of adults who underwent SARS-CoV-2 testing at a safety-net health care system in Chicago during the surge in COVID-19 cases in the spring of 2020. Behaviors and receipt of a stimulus check were compared between participants testing positive and negative for SARS-CoV-2. Differences in behaviors and temporal trends were assessed by race and ethnicity.

Main Outcomes and Measures  SARS-CoV-2 infection was assessed using nasopharyngeal quantitative reverse transcriptase–polymerase chain reaction testing. Mitigating behaviors and federal emergency financial assistance were assessed by survey. Race and ethnicity data were collected from electronic health records.

Results  Of 750 randomly sampled individuals, 314 (41.9%) consented to participate (169 [53.8%] women). Of those, 159 (51%) self-reported as Hispanic and 155 (49%) as non-Hispanic (120 [38.2%] Black), of whom 133 (84%) and 76 (49%) tested positive for SARS-CoV-2, respectively. For all participants, consistent mask use (public transport: adjusted odds ratio [aOR], 0.00; 95% CI, 0.00-0.34; social gatherings: aOR, 0.10; 95% CI, 0.00-0.50; running errands: aOR, 0.18; 95% CI, 0.07-0.42; at work: aOR, 0.23; 95% CI, 0.07-0.79) and hand sanitizer use (aOR, 0.26; 95% CI, 0.13-0.52) were associated with lower odds of infection. During 3 sampled weeks, mitigation practices were less frequent among Hispanic compared with non-Hispanic participants (eg, mask use while running errands: aOR, 0.26; 95% CI, 0.15-0.46). Hispanic participants were at high risk of infection (aOR, 5.52; 95% CI, 4.30-7.08) and more likely to work outside the home (aOR, 2.05; 95% CI, 1.27-3.30) compared with non-Hispanic participants, possibly because of limited receipt of stimulus checks (aOR, 0.03; 95% CI, 0.02-0.07) or unemployment benefits (aOR, 0.36; 95% CI, 0.16-0.74).

Conclusions and Relevance  In this survey study of adults in a large US city, public health messaging improved preventive behaviors over time but lagged among Hispanic participants; messaging tailored to Hispanic communities, especially for mask use, should be prioritized. Hispanic individuals were at higher risk for infection, more often worked outside the home, and were less likely to have received a stimulus check; this suggests larger studies are needed to evaluate the provision of economic support on SARS-CoV-2 transmission dynamics in low-income populations.

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Article Information

Accepted for Publication: July 13, 2021.

Published: September 28, 2021. doi:10.1001/jamanetworkopen.2021.25187

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Badri S et al. JAMA Network Open.

Corresponding Author: Sheila Badri, MD, Cook County Health, Division of Infectious Diseases, Department of Medicine, 1900 W Polk St, Room 651, Chicago, IL 60612 (sbadri@cookcountyhhs.org).

Author Contributions: Dr Badri had full access to all of the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Badri, Sardá, Merçon, Rezai, Weinstein, Trick.

Acquisition, analysis, or interpretation of data: Badri, Sardá, Soria Moncada, Trick.

Drafting of the manuscript: Badri, Sardá, Merçon, Rezai.

Critical revision of the manuscript for important intellectual content: Badri, Sardá, Soria Moncada, Merçon, Weinstein, Trick.

Statistical analysis: Badri, Sardá, Trick.

Administrative, technical, or material support: Soria Moncada, Merçon, Rezai, Weinstein.

Supervision: Weinstein, Trick.

Conflict of Interest Disclosures: None reported.

Additional Contributions: The authors gratefully acknowledge the data entry contributions provided by medical students from Rush Medical College for this work: Samson Maxwell Frendo, Aparna Nutakki, Antonios Skondras, J. Roberto Varela, Timothy J. Huang, Stephanie E. Moss, Rebecca Wornhoff, Emily Beltran, Laura Hurley, Diana Vazquez Parker, Safira S. Amsili, Abigail Bawden, Lauren Delmastro, Hannah C. Silverman, Rachel L. Sandowsky, Kristen J. Hulbert, Ranya Khateeb, Abhiroop Ganguly, and Ahmad Gill. No additional compensation was provided for these contributions.

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