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We investigated racial and ethnic disparities in COVID-19 vaccine uptake, using data from the Centers for Disease Control and Prevention. As of March 29,2022, uptake of the first dose was higher among Hispanic and Asian people than among White and Black people. In contrast, uptake rates of the booster were higher among Asian and White people than among Black and Hispanic people. Black and Hispanic populations in the US have been disproportionately affected by COVID-19, having higher rates of death than the population average documented during the first wave of the pandemic.1 Uptake of the first dose of COVID-19 vaccines was slower and remains lower for Black people than for Asian, Hispanic, or White people.2 Numerous factors affect vaccination uptake. People may choose not to get vaccinated or may be willing to get vaccinated but face barriers including transportation and language, as well as the inability to take time off work.3 Improving vaccine uptake and achieving vaccine equity maybe particularly challenging in the US because it requires coordinating across federal and state public health infrastructures, instead of operating a single centralized vaccine delivery system, as in the UK.4We compared the rates of COVID-19 first dose and first booster vaccinations over time among eligible Asian, Black, Hispanic, and White people in the US (exhibits 1 and 2). All references to boosters include only the first COVID-19 booster dose.Despite efforts at the federal, state, and local levels to dismantle barriers and foster vaccine confidence,3'5'6 vaccination uptake for all groups remains low and is lowest among Black people. Although Hispanic people have the highest uptake for the first dose, their booster uptake is among the lowest. These disparities suggest that additional resources may be needed to mitigate inequities for the Black community and that booster-specific outreach may benefit Hispanic communities.

Background Implementation researchers are increasingly using economic evaluation to explore the benefits produced by implementing evidence-based practices (EBPs) in healthcare settings. However, the findings of typical economic evaluations (e.g., based on clinical trials) are rarely sufficient to inform decisions about how health service organizations and policymakers should finance investments in EBPs. This paper describes how economic evaluations can be translated into policy and practice through complementary research on financing strategies that support EBP implementation and sustainment. Main body We provide an overview of EBP implementation financing, which outlines key financing and health service delivery system stakeholders and their points of decision-making. We then illustrate how economic evaluations have informed decisions about EBP implementation and sustainment with three case examples: (1) use of Pay-for-Success financing to implement multisystemic therapy in underserved areas of Colorado, USA, based in part on the strength of evidence from economic evaluations; (2) an alternative payment model to sustain evidence-based oncology care, developed by the US Centers for Medicare and Medicaid Services through simulations of economic impact; and (3) use of a recently developed fiscal mapping process to collaboratively match financing strategies and needs during a pragmatic clinical trial for a newly adapted family support intervention for opioid use disorder. Conclusions EBP financing strategies can help overcome cost-related barriers to implementing and sustaining EBPs by translating economic evaluation results into policy and practice. We present a research agenda to advance understanding of financing strategies in five key areas raised by our case examples: (1) maximize the relevance of economic evaluations for real-world EBP implementation; (2) study ongoing changes in financing systems as part of economic evaluations; (3) identify the conditions under which a given financing strategy is most beneficial; (4) explore the use and impacts of financing strategies across pre-implementation, active implementation, and sustainment phases; and (5) advance research efforts through strong partnerships with stakeholder groups while attending to issues of power imbalance and transparency. Attention to these research areas will develop a robust body of scholarship around EBP financing strategies and, ultimately, enable greater public health impacts of EBPs.

Attempts to explain disparities in access to health care faced by racial and ethnic minorities and other underserved populations often focus on individual-level factors such as demographics, personal health beliefs, and health insurance status. This article proposes an examination of these disparities-and an effort to redress them-through the lens of public health. Public health agencies can link people to needed services such as immunizations, testing, and treatment; ensure the availability of health care; ensure the competency of the public health and personal health care workforce; and evaluate the effectiveness, accessibility, and quality of personal and population-based services. Approaching disparities through a public health framework can provide the foundation for developing more robust evidence to inform additional policies for improving access and reducing disparities. Adapted from the source document.

The United States has made tremendous progress in delivering COVID-19 vaccines. As of January 2022, more than 79% of the eligible population had received ≥1 dose of the vaccine.1 Encouragingly, the relative proportions of administered vaccines among Black and Latinx populations have increased compared with their population sizes.2 As of late July 2021, among the 58% of people who had received ≥1 vaccine dose and for whom race and ethnicity were known, Latinx and Black people had begun to receive a larger share of recent vaccinations compared with their total population share (30% vs 17% and 13% vs 12%, respectively).3 These recent trends provide reason for optimism. However, because vaccinations among Black and Latinx populations, who have been disproportionately impacted by COVID-19, have only just begun to match or exceed their population proportions, their overall vaccination rates continue to lag relative to White populations. While we lack vaccination data in more granular race and ethnicity categories, it seems likely that many other racial and ethnic groups, in addition to Black and Latinx populations, included under the broader term Black, Indigenous, and People of Color (BIPOC), are experiencing the same lag relative to White populations.

The COVID-19 pandemic required significant public health interventions from local governments. Although nonpharmaceutical interventions often were implemented as decision rules, few studies evaluated the robustness of those reopening plans under a wide range of uncertainties. This paper uses the Robust Decision Making approach to stress-test 78 alternative reopening strategies, using California as an example. This study uniquely considers a wide range of uncertainties and demonstrates that seemingly sensible reopening plans can lead to both unnecessary COVID-19 deaths and days of interventions. We find that plans using fixed COVID-19 case thresholds might be less effective than strategies with time-varying reopening thresholds. While we use California as an example, our results are particularly relevant for jurisdictions where vaccination roll-out has been slower. The approach used in this paper could also prove useful for other public health policy problems in which policymakers need to make robust decisions in the face of deep uncertainty.

The COVID-19 pandemic required significant public health interventions from local governments. Although nonpharmaceutical interventions often were implemented as decision rules, few studies evaluated the robustness of those reopening plans under a wide range of uncertainties. This paper uses the Robust Decision Making approach to stress-test 78 alternative reopening strategies, using California as an example. This study uniquely considers a wide range of uncertainties and demonstrates that seemingly sensible reopening plans can lead to both unnecessary COVID-19 deaths and days of interventions. We find that plans using fixed COVID-19 case thresholds might be less effective than strategies with time-varying reopening thresholds. While we use California as an example, our results are particularly relevant for jurisdictions where vaccination roll-out has been slower. The approach used in this paper could also prove useful for other public health policy problems in which policymakers need to make robust decisions in the face of deep uncertainty.

Prior research suggests that these characteristics relate to COVID-19 mortality and vaccination rates (3–7); moreover, most are among the factors used to calculate Social Vulnerability Index values and therefore are recognized as relevant to understanding geographic inequities (14). The 8 zip codes with index values below 0.7 are nearly 90% Black and have the lowest median household incomes, although their percentage of residents with health insurance and postsecondary education are higher than zip code groupings with index values near 1 (Table 1). The 6 zip codes with index values below 1 in June 2021 but increases of more than 0.1 were on average about two-thirds Hispanic and had higher percentages of residents without health insurance and without post–high school education than any other group (Table 2). Demographic and Socioeconomic Characteristics of Zip Codesa in Chicago, Grouped by COVID-19 Vaccination Equity Index, July 2022 Demographic/socioeconomic characteristic Vaccination Equity Indexb <0.70 0.70–0.79 0.80–0.99 1.00–1.25 >1.25 No. of ZIP codes 8 7 11 9 17 Population, no. 393,491 368,893 532,752 636,386 744,037 Total population, % 14.7 13.8 19.9 23.8 27.8 Cumulative vaccinated through July 2022, % 11.9 13.0 20.0 25.1 29.9 Cumulative deaths through July 2022, % 22.8 17.4 22.2 23.2 14.4 Race and ethnicity, % Asian 0.3 2.6 5.1 11.4 9.4 Black 89.1 42.0 18.2 16.1 8.7 Hispanic 4.3 35.7 40.0 43.4 17.2 White 4.5 18.0 34.7 26.6 61.1 Average median household income, $ 40,400 43,600 63,711 55,062 93,316 Postsecondary educationc, % 51.6 44.2 48.8

Are older Americans becoming more or less disabled? Unhealthy body weight has increased dramatically, but other data show that disability rates have declined. We use data from the Health and Retirement Study to estimate the association between obesity and disability, and we combine these data with trend estimates of obesity rates from the Behavioral Risk Factor Surveillance Survey. If current trends in obesity continue, disability rates will increase by 1 percent per year more in the 50-69 age group than if there were no further weight gain. [PUBLICATION ABSTRACT]

This survey study examines the prevalence of incentive receipt for COVID-19 vaccination and the association of various sociodemographic characteristics with perspectives on incentives’ influence on trust in the COVID-19 vaccine.

Emergency departments (EDs) are critical sources of care after natural disasters such as hurricanes. Understanding the impact on ED utilization by subpopulation and proximity to the hurricane's path can inform emergency preparedness planning. This study examines changes in ED utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016. This retrospective observational study used ED data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. ED utilization rates for weeks during and after hurricanes were compared with pre-hurricane rates, stratified by the proximity of the patient county to the hurricane path, age, and disease category. The overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. Utilization rates for respiratory disorders exhibited the largest post-hurricane increase, particularly 2-3 weeks following the hurricane. The change in population rates by disease categories and age tended to be larger for people residing in counties closer to the hurricane path. Changes in ED utilization following hurricanes depend on disease categories, age, and proximity to the hurricane path. Emergency managers could incorporate these factors into their planning processes.