Background In the United States, racial and ethnic minorities are disproportionately affected by COVID-19, with persistent social and structural factors contributing to these disparities. At the intersection of race/ethnicity and gender, women of color may be disadvantaged in terms of COVID-19 outcomes due to their role as essential workers, their higher prevalence of pre-existing conditions, their increased stress and anxiety from the loss of wages and caregiving, and domestic violence. Objective The purpose of this study is to examine racial and ethnic differences in the prevalence of COVID-19 outcomes, stressors, fear, and prevention behaviors among adult women residing in the United States. Methods Between May and June 2020, women were recruited into the Capturing Women’s Experiences in Outbreak and Pandemic Environments (COPE) Study, a web-based cross-sectional study, using advertisements on Facebook; 491 eligible women completed a self-administered internet-based cross-sectional survey. Descriptive statistics were used to examine racial and ethnic differences (White; Asian; Native Hawaiian or other Pacific Islander; Black; Hispanic, Latina, or Spanish Origin; American Indian or Alaskan Native; multiracial or some other race, ethnicity, or origin) on COVID-19 outcomes, stressors, fear, and prevention behaviors. Results Among our sample of women, 16% (73/470) reported COVID-19 symptoms, 22% (18/82) were concerned about possible exposure from the people they knew who tested positive for COVID-19, and 51.4% (227/442) knew where to get tested; yet, only 5.8% (27/469) had been tested. Racial/ethnic differences were observed, with racial/ethnic minority women being less likely to know where to get tested. Significant differences in race/ethnicity were observed for select stressors (food insecurity, not enough money, homeschooling children, unable to have a doctor or telemedicine appointment) and prevention behaviors (handwashing with soap, self-isolation if sick, public glove use, not leaving home for any activities). Although no racial/ethnic differences emerged from the Fear of COVID-19 Scale, significant racial/ethnic differences were observed for some of the individual scale items (eg, being afraid of getting COVID-19, sleep loss, and heart racing due to worrying about COVID-19). Conclusions The low prevalence of COVID-19 testing and knowledge of where to get tested indicate a critical need to expand testing for women in the United States, particularly among racial/ethnic minority women. Although the overall prevalence of engagement in prevention behaviors was high, targeted education and promotion of prevention activities are warranted in communities of color, particularly with consideration for stressors and adverse mental health.
The novel coronavirus (COVID-19) pandemic has significantly impacted United States residents. Prevention behaviors are critical to minimizing transmission of SARS-CoV-2 in the U.S., to ultimately reduce the health, social, and economic burdens of COVID-19. Yet, health behavior decision-making is complex, and uptake of preventative behaviors has been variable. Women may provide pro-prevention behavior modeling to their networks, facilitating uptake diffusion. The COPE Study enrolled 491 women residing in the United States from May to June of 2020; women completed an online survey of COVID-19 experiences and prevention behaviors. We employed binary logistic modeling to identify factors predicting women’s practice of (1) staying home except for essential activities, (2) physical distancing in public, and (3) wearing a face mask in public. Findings demonstrate that women’s prevention behaviors are influenced by multilevel factors. Women living in urban environments, having minimal formal education, or having a household annual income of USD 30,000–50,000 are less likely to practice prevention behaviors. Cultural context may be an important factor in the decision-making process. Results aid in the identification what interventional “levers” may warrant consideration to promote uptake of such behaviors, and whom to engage. Because women are modelers of behavior, it is critical to engage them in prevention behavior interventions.
In the U.S., Black women living with HIV/ AIDS (WLHA) are affected disproportionately by interpersonal violence, which often co-occurs with adverse mental health and/or substance use, and exacerbates existing poor HIV care outcomes. Peer navigation has been successful in improving HIV care; however, HIV clinics often lack resources for sustainability and may not account for socio-structural barriers unique to Black WLHA. To address this gap, we developed LinkPositively, a culturally-tailored, trauma-informed WebApp for Black WLHA affected by interpersonal violence to improve HIV care outcomes. Using focus group data from nine Black WLHA and peer navigators, we developed LinkPositively. Core components include: virtual peer navigation to facilitate skill-building to cope with barriers and navigate care; social networking platform for peer support; educational and self-care tips; GPS-enabled resource locator for HIV care and support service agencies; and medication self-monitoring/ reminder system. If efficacious, LinkPositively will shift the HIV prevention and care paradigm for Black WLHA.
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