A Community Case Study on Geographic, Environmental, and Social Health Disparities in COVID-19 Disease: Yakima, Washington

Casey Mace Firebaugh, Tishra Beeson, Amie Wojtyna, Lilian Bravo, Teresa Everson, Jaclyn Johnson, and Alberto Saldana. 

Open Journal of Preventive Medicine, 2020, 10, 288-297

Rural communities face challenges in responding to environmental and health events, when disparities pre-exist, and the events are simultaneously affecting communities with higher populations. Yakima County, Washington residents suffered under the conditions presented by the COVID-19 pandemic and summer wildfires of 2020. A rural county with a city center, Yakima County was ranked as the 5th worst city and 13th worst county for small particle air pollution by the American Lung Association in 2020. The county also ranked 27th for total annual pollution. Residents are subject to multiple risk factors for poor outcomes related to COVID-19 disease, most notably respiratory difficulties, and death. In August 2020, the COVID-19 infection rate was over 700 per 100,000 population and the county also experienced 14 consecutive days of unhealthy/hazardous air pollution.

This study examined the contributing factors that make Yakima County particularly at-risk for continued COVID-19 disease and related outcomes. This included handwashing, wearing facial coverings, physical distancing, and knowledge and attitudes about such prevention strategies. Researchers focused on environmental conditions in the environments where people are born, live, learn, work, play, worship, and age. These conditions affect a wide range of health, functioning, and quality-of-life outcomes and risks that may make these factors more difficult to adopt for Yakima residents. The findings suggest areas of study to pursue to lessen the impact on Hispanic/Latino communities, agricultural, food production, and other essential workers related to minimizing community transmission of COVID-19 disease.

Findings

• The barriers to isolation and quarantine need to be identified
• Beliefs/behaviors around COVID-19 disease need to be named
• Monitoring of indoor and outdoor air quality for the potential impact of COVID-19 disease
• Monitoring recovery of COVID-19 survivors related to air quality
• Examination of factors beyond the individual, household, and community control in trying to prevent and respond, these include policies, social, and environmental factors

A refined population health strategy should be implemented to address poor air quality, prevent COVID-19 disease through community strategies, and reduce health disparities for at-risk populations. Each of these factors should be understood on their own and in respect to one another. This complex situation demands environmental, structural, social, and policy level responses to support any individual or community interventions.

Increased PM2.5 Levels Associated With Increased Incidence of COVID-19: The Washington Wildfires of 2020

Casey Mace Firebaugh, Tishra Beeson, Amie Wojtyna, and Ryan Arboleda.  

e-ISSN: 2595-5527, 10.32435/envsmoke.20214249-53, Volume 4, Número 2, 2021

The summer wildfires of 2020 in Washington state occurring during the first spring/summer season of the COVID-19 pandemic placed significant burden on Yakima County, Washington. The area was subject to an extraordinary wildfire season where small particle air pollution (PM2.5) made for unhealthy air for 14 days. Unfortunately, the fire and smoke season began at the same time as the COVID-19 pandemic. Virus and small particle are known to cause lung illness or injury. This study accessed publicly available data to investigate if small particle air pollution levels were associated with increased cases of COVID-19 disease. Daily associations were calculated between small particle air pollution and cases of COVID-19 from March 1, 2020-October 15, 2020. Total running cases of COVID-19, daily death, and total running death rates were compared.

 Findings

 All days with high small particle air pollution levels were found to be significantly positively associated with daily COVID-19 cases and total running counts of COVID-19.

• The total running death rates from COVID-19 disease were significantly associated with daily small particle air pollution
• Daily death rates of COVID-19 disease were not significantly related to daily small particle air pollution
• This simple analysis provides preliminary evidence that high small particle air pollution is associated with higher rates of confirmed COVID-19 disease, therefore the lung impacts from small particle air pollution exposure and COVID-19 disease could be synergistic

Correlation does not imply causation, but it indicates that further study is needed to understand the association between small particle air pollution and COVID-19 disease. 

Mental Distress Associated with Air Quality Vulnerability During COVID-19.

Casey Mace Firebaugh, Tishra Beeson, Stephanie M Morgan, Amie Wojtyna, Hannah Lascano, and Melody Madlem.  

European Journal of Environment and Public Health, 2022, 6(1), em0103, e-ISSN: 2542-4904

Yakima County, Washington is an area with a history of lengthy periods of poor air quality. It was also one of the earliest and hardest hit counties for COVID-19 disease in the Western United States. The poor health outcomes from the combination of poor air quality and COVID-19 have been well documented; however, the mental health impact of these combined exposures are unknown.

This study randomly surveyed 232 households in Yakima County between Dec 2020-Jan 2021 to help understand the spread of COVID-19 in this community. Questions were asked about behaviors, home air filter systems, and use of community clean air shelters.  Areas of mental stress related to the experience of COVID-19 were also measured.

 Findings

• Almost half of respondents did not have a way to improve the air quality their homes
• Over half of respondents reported wanting to access community clean air shelters during periods of poor air quality, such as the smoke and wildfire season of 2020
• Respondents who were not able to improve the air quality in their households and could not access community clean air shelters had higher levels of mental distress
• These preliminary results show that those with less ability to reduce their exposure to poor air quality are at risk of worse mental health outcomes
• Those in leadership positions should consider individual or household level interventions as typical community response to fire and smoke

A 2-year Follow up on Pm2.5 Exposure and COVID-19 Morbidity and Mortality.

Casey Mace Firebaugh, Tishra Beeson, Debra Rich, Yasmin Vivana Barrios, and Amie Wojtyna. 

e-ISSN: 2595-5527, Doi: 10.32435/envsmoke.20225219-23, Volume 5, Issue 2, p. 19-23, 2022

The emergence of COVID-19 has presented a variety of public health challenges, not only due to the nature of the disease and associated illnesses, but also due to the exacerbation of previously existing public health issues. One such issue is poor air quality exposure and the associated hospitalizations and deaths related to particulate matter exposure in both the acute and long terms. A previous study was conducted to examine the relationship between poor air quality in the form of small particle air pollution (PM2.5) and COVID-19 disease Yakima County, Washington (USA). The results of that study showed there was a significant association between small particulate air pollution COVID-19 disease and death. The study was unable to determine if this association remained consistent over time.

The purpose of this second study was to investigate the association of another year of small particle air pollution with COVID-19 disease and death in the same population. Could the the findings of the previous study be confirmed again? Like the first study, this study added a perspective of rural areas with persistently poor air quality, which are distinct from urban air pollution areas.

 This study accessed publicly available data to investigate if small particle air pollution levels were associated with increased cases of COVID-19 disease. Daily associations were calculated between small particle air pollution and cases of COVID-19 from February 1, 2021, to December 20, 2021. Total running cases of COVID-19, daily death, and total running death rates were compared.

 Findings 

• Higher associations for daily case counts, daily hospitalizations, and daily death rates with small particle air pollution were found in the preliminary study
• In the initial study, small particle air pollution was not found to be significantly associated with daily death rates, but this investigation showed a small, significant association between them
• This study adds to the growing body of literature demonstrating the dangers of short and long-term small particle air pollution exposure in the era of COVID-19 disease
• Populations living in areas with continued poor air quality in the form of small particle air pollution should lessen the risks of both air pollution and COVID-19 exposures    
  

This study expands upon and confirm previous preliminary findings examining the association between poor small particle air pollution and harmful COVID-19 disease outcomes. Populations exposed to long-term small particle air pollution may need additional safeguards from COVID-19 disease as they may have a higher risk of infection, hospitalization, and death.

Examining Self-Efficacy and COVID-19 Disease Prevention Behaviors Among Socially Vulnerable Populations

Casey Mace Firebaugh, Amie Wojtyna, Debbie Rich, and Tishra Beeson

Journal of Community Psychology, 2022. e-ISSN: 1520-6629, DOI: 10.1002/jcop.22975

Social vulnerability can be defined as a person’s individual circumstances or community factors that make them more at risk for negative outcomes such as higher COVID-19 disease morbidity and mortality. Social vulnerabilities that overlap with COVID-19 disease include, household composition, socio-economic status, community capacity, minority status, and speaking English as a second language. Self-efficacy has been identified as one of the most significant factors in predicting adherence to a variety of preventative health behaviors such as masking, hand washing, social distancing, and staying home when one is sick. However, few studies have examined the intersection of social vulnerability and self-efficacy to perform COVID-19 prevention behaviors. Understanding self-efficacy of these behaviors in vulnerable populations can inform health interventions to improve COVID-19 disease outcomes in populations with higher risk.

This study was initiated to examine the spread and severity of COVID-19 disease in Yakima County, Washington, USA, an area with pronounced social, environmental, and health disparities. Participants aged 18 and over were recruited to complete an online survey, in English or Spanish, regarding their attitudes, beliefs, and experiences with COVID-19 disease.

 Findings 

• While self-efficacy did improve over time, socially vulnerable groups had consistently lower levels of self-efficacy to perform prevention behaviors.
• Household size, identifying as Hispanic/Latino, and measures of socio-economic status were significantly related to various self-efficacy beliefs about COVID-19 disease prevention behaviors and the ability to protect oneself from COVID-19 disease in general.
• Interventions to improve self-efficacy amongst these groups may increase overall self-efficacy and community resilience.

Future studies should examine ways to increase self-efficacy amongst populations that express lower levels of self-efficacy.