November 2020 highlights from AJPH

Date: Oct 14 2020

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COVID-19: Time to Reinvent Public Health

“Articles and studies in this issue, ‘COVID-19: Time to Reinvent Public Health,’ are a fascinating examination of these turbulent times, which have revealed a major failure of the health care system, in particular, and its profound inequity with respect to access, diagnosis and treatment of care for people of color and disenfranchised people,” said Alfredo Morabia, MD, PhD, AJPH editor-in-chief. “We also show how police violence intersects with public health, and its residual impact on mental health, particularly for Blacks, Asian Americans, Hispanics and poor whites.”

American Journal of Public Health November issue research highlights:

  • Video telemedicine can reduce public health costs in TB care
  • The unique impact of police violence on mental health
  • Pandemic spurred innovations in school meals programs
  • Anti-Asian discrimination incidents and assaults increased during pandemic, but strategies emerge to fight racism

Video telemedicine can reduce public health costs in TB care

Video telemedicine has the potential to reduce public health costs related to tuberculosis control, compared to traditional in-person interventions, finds a study in the November issue of AJPH.

A key element of TB control is the use of directly observed therapy, or DOT, in which health department workers meet with patients in person to promote treatment adherence and monitor for medication side effects. However, a number of TB programs have adopted video-based DOT, or VDOT, in which patients and health workers meet remotely. 

To conduct the study, researchers reviewed health department costs for live and recorded video-based DOT and in-person DOT between August 2017 and June 2018 in New York City, Rhode Island and San Francisco. Patient costs were lowest for VDOT and highest for clinic-based DOT. 

Trials in the U.S. and the United Kingdom also suggested that VDOT can also reduce time and costs for health departments, the researchers said.

In the U.S., TB prevention and control efforts have led to a decline in TB incidence from 14.1 cases per 100,000 in 1974 to 2.8 cases per 100,000 in 2017. That decline has slowed in recent years, as funding has decreased, researchers said. Studies forecast that TB will not be eliminated within the U.S. within this century, they added.

[Author contact: Garrett R. Beeler Asay, PhD, Centers for Disease Control and Prevention, Atlanta, Georgia. “Cost of Tuberculosis Therapy Directly Observed on Video for Health Departments and Patients in New York City; San Francisco, California; and Rhode Island (2017-2018).”]

The unique impact of police violence on mental health

Police violence uniquely differs from other forms of risk exposures, with its own potential mental health and traumatic impacts, according to a November AJPH article. 

The researchers identified eight factors that may alter the relationship between police violence and mental health, including those that increase the chance of exposure to such violence, increase the psychological impact of police violence, and act as barriers to coping with or recovering from such exposures. 

The mental health effects of police violence may be less visible yet much more pervasive and potentially more impactful when considered across an entire community or population, though further research is needed, authors wrote. 

They added there is currently no theoretical framework with which researchers can better understand the unique contributions of police violence to mental health and illness, particularly among people of color.

[Author contact: Jordan DeVylder, PhD, Graduate School of Social Service, Fordham University, New York, New York. “Impact on Police Violence on Mental Health: A Theoretical Framework.”]

Pandemic spurred innovations in school meals programs

State and local school districts have taken a number of innovative approaches to making sure students maintain access to school meals during the pandemic, which could inform and strengthen school nutrition programs going forward, according to analysis in the November AJPH

When schools closed earlier this year, millions of students lost access to free or reduced-cost meals that they relied on for nutritional needs. Missed breakfasts and lunches peaked at 169.9 million, the authors reported.

To address the problem, school nutrition programs implemented innovative programs, such as expanding meal service to seven days per week, offering grab-and-go meals in outdoor locations, and offering up to a week of meals at once to reduce child hunger during the pandemic.

Many school districts also initiated meal delivery sites in centralized community locations, such as school parking lots, community centers, libraries, apartment complexes and churches. Others delivered meals at locations along school bus routes or provided home delivery.

Despite the extraordinary efforts by school nutrition programs, authors reported that there is still a large gap between the number of meals served in a typical school week and the number of meals currently being distributed as replacements. The pandemic offers us a unique opportunity to determine the best way to address nutrition gaps among school-aged children during times when school is closed, they wrote.

[Author contact: Eliza W. Kinsey, PhD, Columbia University, New York, New York. “School Closures During COVID-19: Opportunities for Innovation in Meal Services.”]
Anti-Asian discrimination incidents and assaults increased, but strategies emerge to fight racism

Episodes of Anti-Asian discrimination and assaults increased significantly during the COVID-19 pandemic, but emerging strategies can be used to report and track racial bias to promote factors that can help fight racism, according to an analysis in the November AJPH

During the pandemic, Asian Americans representing all ethnicities have been verbally attacked with racial slurs, coughed at, spat at and physically assaulted, the researchers said. Such actions are associated with increased health problems among Asians in the U.S., including anxiety, depression and suicidal ideation, they wrote. 

Public health professionals and policy makers should develop strategies to eliminate the racialization of diseases and its harmful effects on minority groups, the researchers said. They should continue to develop specific interventions targeting the negative health effects of racism among minority groups, building on previous innovations such as cognitive behavioral therapy for people facing oppression.

[Author contact: Justin A. Chen, MD, MPH, MGH, WACC, Boston, Massachusetts. Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School. “Potential Impact of COVID-19-Related Racial Discrimination on the Health of Asian Americans.”]

Check out the full list of AJPH research papers online.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at

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