The coronavirus (COVID-19) pandemic has had widespread social, psychological, and economic repercussions in the United States, along with devastating morbidity and mortality. However, these effects have not impacted all populations equally. Surveillance data show that racial/ethnic minorities, including Black, Latinx, and Indigenous populations, have been disproportionately burdened by both the disease and its financial and social consequences. Similarly, sexual and gender minority (SGM) groups, while not captured in national surveillance data, experience high levels of vulnerability, suggesting that they too may be experiencing higher rates of infection and related ramifications of COVID-19. Crucially, as the pandemic has continued to develop in the US, a greater number of cases have been identified among youth and young adults (YYA) aged 14-24 years, a population previously thought to be at low risk. Given the high mobility and lower perceived risk of this population, this may result in larger outbreaks not only within YYA, but also overall and in additional vulnerable groups. Therefore, understanding and increasing testing and preventive behaviors among YYA, especially vulnerable SGM YYA (SGMY) and racial/ethnic minority YYA (REMY), is necessary to stop further COVID-19 spread. Unfortunately, COVID-19 impacts, testing, and preventive behaviors in this population have remained markedly understudied. Critically, disparities in testing and preventive behaviors are highly influenced by outside factors. For example, experiences of stigma, at the individual, interpersonal, and structural level, may impact care engagement and prevention among marginalized populations. Furthermore, policy-level factors, including availability of tests, healthcare, governmental messaging, and re-opening patterns, are also likely to influence rates of testing and rates of infection. As such, given the dearth of information surrounding COVID-19 among SGMY and REMY, and the rising rates of infection in these groups, this project will use a geographically diverse quantitative survey to assess patterns and disparities in COVID- 19 testing and preventive behaviors longitudinally across 6 months, as well as the impact of multilevel factors, including stigma and policy. Informed by the results of this survey, and guided by the Information, Motivation, and Behavioral Skills (IMB) Model, we will use a mixed-methods approach to iteratively develop a community engaged, health messaging intervention tailored towards SGMY and REMY to increase testing and preventive behaviors, provisionally titled Prev_Cvd. This text messaging intervention will be pilot testied by 100 REMY and SGMY to refine content and determine feasibility and acceptability. Given the lack of messaging guidelines for this population, this will be the first evidence-based messaging intervention for COVID-19 prevention among YYA. Developing and pilot testing such an intervention with active input from the community will allow for the intervention, if effective, to be rapidly scaled up and widely implemented to address disparities in COVID-19 among YYA and reduce overall transmission.
As the COVID-19 pandemic continues to escalate in the US, youth and young adults (YYA) have become a plurality of cases, with disparities heavily impacting sexual and gender minority (SGM) and racial/ethnic minority communities, making it increasingly important to understand the causes and correlates of testing, awareness, and preventive behaviors in marginalized populations, especially SGM YYA (SGMY) and racial/ethnic minority YYA (REMY). As such, we propose a competitive revision which builds on the collaborative health equity research established within R01 AA024409 to deploy a community-engaged, mixed methods approach to characterize disparities in COVID-19 testing, awareness, and preventive behaviors among marginalized YYA, with a focus on how individual, interpersonal, and structural stigma impact disparities. We will subsequently use these findings, in partnership with leading local and national community organizations, to develop and pilot test Prev_Cvd, a health messaging intervention based on the Information, Motivation, Behavioral Skills (IMB) Model in order to increase testing and preventive behaviors among SGM and racial/ethnic minority YYA and reduce spread of COVID-19 overall.
