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The coronavirus pandemic has brought a number of challenges to schools, which were forced to close in the spring to help slow the spread of infection. One major challenge for schools was ensuring that students’ nutritional supplementation needs were met when they were not attending school in person.

As schools across the country begin to welcome students back in person or for virtual learning, equity must be at the forefront of decisions pertaining to school emergency food services, finds a new study from the Brown School at Washington University in St. Louis.

“Ensuring access to food during these critical times is of paramount importance to meeting the public health needs of vulnerable populations at greatest risk for food security. Further, as schools contemplate re-opening plans, a greater emphasis should be placed on ways to maintain practices developed over the closure period, protecting access to supplemental nutrition,” said Gabriella McLoughlin, postdoctoral research associate at the Brown School’s Prevention Research Center.

McLoughlin is lead author of the paper “Addressing Food Insecurity Through a Health Equity Lens: A Case Study of Large Urban School Districts During the COVID-19 Pandemic,” published in the August edition of the Journal of Urban Health.

McLoughlin and her co-authors conducted a mixed-methods study evaluating emergency meal distribution and strategy implementation from March to May in four large urban school districts: Chicago Public Schools, Houston Independent School District, Los Angeles Unified School District and New York City Department of Education.

“We found that these four urban districts took distinctive steps to enhancing participation in emergency feeding programs through a health equity lens,” McLoughlin said. “However, given the significantly lower than typical participation rates observed in each district, we present key ways that this could be mitigated by focusing on equity as a key priority. Geographic Information Systems (GIS) technology and document analysis highlighted some gaps in reach and potential ways that they can increase participation in emergency meal programs.”

Federal nutrition assistance programs like the School Breakfast Program (SBP) and National School Lunch Program (NSLP) help to address child food insecurity and improve access to healthy foods, McLoughlin said.

“Nearly 30 million students participate in SBP and NSLP daily, and 85% of SBP and 71% of NSLP participants receive free or reduced-price meals based on household income, meaning their families do not have adequate means to purchase food absent safety net programs,” she said. “For many students, school meals make up one-third to one-half of their caloric intake in a day.”

“Given the detrimental impact of COVID-19 on the economic landscape of the U.S. and subsequent surge in food insecurity prevalence, continuation of meal sites that serve meals to students and families may serve as a vital strategy to offset ongoing depravity,” McLoughlin and her co-authors wrote. “This will be especially important for families/children at a greater risk for contracting COVID-19 who wish to remain at home and/or for parents who still cannot return to work through job loss or ongoing furlough.

“Further, depending on the school schedule and whether schools opt for a rotation system — minimizing attendance and asking students to be at school on certain days of the week — operating walk-up and drive-up meal sites would facilitate equitable access to supplemental nutrition despite students not attending schools full time. Continuation of various waivers granted by the USDA may therefore be necessary to combat rising food insecurity rates and ease the transition of going back to school amid the pandemic.”

The authors of the study are members of the COVID-19 School Nutrition Implications Working Group, jointly supported by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, and the Nutrition and Obesity Policy Research and Evaluation Network.

A recent study from the Brown School at Washington University in St. Louis provides the first explicit analysis of the timing, determinants and impacts of mitigation interventions for all states and Washington, D.C., during the first five weeks of the pandemic.

States initially with high prevalence rates of COVID-19 enacted mitigation interventions, like social distancing, in a delayed fashion, which explained why the U.S case/death counts of the virus remained high for a long period.

“Because there is no preventive vaccine and because there are few potentially effective treatments, recent reductions in new cases and deaths must be due, in large part, to the social interventions delivered by states. Our study suggests that the policy of reopening the economy needs to be implemented carefully,” said Shenyang Guo, the Frank J. Bruno Distinguished Professor of Social Work Research.

Guo is lead author of the study “Social Distancing Interventions in the United States: An Exploratory Investigation of Determinants and Impacts,” which is available online and will be published in an upcoming issue of the journal Research on Social Work Practice.

Through an impact analysis, the researchers explored the effects of the interventions and the potential risks of removing them under the context of reopening the economy.

“Unlike other studies that evaluated the stay-at-home order by using simulated data, our study employed the real data of various case counts of COVID-19,” Guo said.

The study revealed two main findings:

The study also found evidence that vulnerable populations — minorities, poor and unemployed people — have suffered most severely from the pandemic, “which helps to emphasize the significant resurgence in the Black Lives Matter and anti-racism movements,” Guo said.

Brown School co-authors on the study are: Ruopeng An, assistant professor; Timothy McBride, the Bernard Becker Professor; Linyun Fu, manager of global programs; and Yuanyuan Yang, a doctoral student; along with Danlin Yu, professor at Montclair State University.

COVID-19 caught public health systems in the U.S. unprepared to detect, track and contain the virus. The pandemic has exposed a multitude of deficiencies that require a wholesale reinvention of the field of public health, said four leading experts in a recently published essay.

“Our insufficient capabilities have been complicated by long-standing and worsening health inequalities and the rapid spread of misinformation that needs to be countered,” said Ross Brownson, the Steven H. and Susan U. Lipstein Distinguished Professor and director of the Prevention Research Center at Washington University in St. Louis.

Brownson is lead author of the essay “Reimagining Public Health in the Aftermath of a Pandemic,” published Aug. 20 in the American Journal of Public Health. Co-authors are: Graham A. Colditz, MD, DrPH, the Niess-Gain professor of surgery and director of the Division of Public Health Sciences at Washington University School of Medicine in St. Louis; Thomas Burke of Johns Hopkins University Bloomberg School of Public Health; and Jonathan Samet of the Colorado School of Public Health.

“Resources put into public health and prevention can have an amazing return on investment,” Colditz said. “This new vision for the public health system can help us harness that potential and move toward becoming a better prepared, more equitable and healthier nation. But it will take some effort.”

The essay suggests the reinvention will take place over the next five years, beginning with three phases of action to deal with the immediate crisis:

The COVID-19 pandemic will change the world permanently in ways that are not yet predictable, Brownson said. “The events of the past several months have revealed immediate health and social needs and pointed directly to the urgent need to redouble our commitment to prevention and public health investment. Without explicit attention to social determinants of health, the aftermath of the immediate societal outcomes of COVID-19 will be still greater health inequities.”

The authors list four ingredients that are needed to change public health:

“The lessons of COVID-19 present an opportunity and an urgency to reimagine public health,” the authors wrote. “We must recognize that public health is a public good that deserves greater investment — that message has never been more important. We must reach across the silos of the health system, reduce the burden and costs of poor health, and advance the science to identify and respond more quickly to emerging threats in our changing world.”

Thirteen years after they began, researchers in a landmark study of asset building in Oklahoma are poised to receive new information gathered despite obstacles posed by COVID-19, which struck just as the new phase of research was getting underway.

The experiment, SEED for Oklahoma Kids (SEED OK), began in 2007 with interviews of over 2,700 mothers of Oklahoma newborns. Next, half of the newborns automatically received $1,000 in a state-owned Oklahoma 529 plan account as part of this long-term study of the benefits of Child Development Accounts. Early analyses show promising results, some especially for financially vulnerable families, and also provide lessons from the Great Recession for the current COVID crisis.

In early 2020, a third round of surveys—Wave 3—began in order to assess the impact of the accounts as the children in the study turned age 12.

“As far as we know, SEED OK is the longest running social experiment in the country,” said Michael Sherraden, Director of the Center for Social Development (CSD) at Washington University in St. Louis, which is leading the study. “Research methods are robust, and results are informing policy innovations.” Deposits to the state 529 plan were funded by the Ford Foundation and SEED OK is administered by the Oklahoma State Treasurer’s office. As the study progresses, survey data from families and account and savings data from the Oklahoma 529 plan provide key information on outcomes, such as the growth of the accounts; the social development of children; and the mental health, parenting practices and educational expectations of mothers.

But the advent of COVID-19 made traditional information-gathering methods, such as call-center interviewing and in-person contacting, impossible, so major adjustments were required. An on-line data collection system was created, and the research timeframe was extended, with a continued focus on high-quality data and a high response rate.

“The very good news is that we are now on track to receive the SEED OK Wave 3 data set by mid-August,” said Margaret Clancy, CSD’s Policy Director who has been leading the study.

“The response rate will be over 66% of the initial sample, which is very respectable after 13 years. CSD has reviewed preliminary data files and we are well prepared to begin analyzing the data.”

A benefit of the delay is that CSD researchers will be able to test the impact of the virus, with survey data both before and after its arrival. CSD researchers also added some new survey questions about COVID-19 for study participants responding after its onset.

The success was achieved through intensive planning with RTI, the firm CSD contracted with to collect the data, and by adopting the following changes:

“We know from long experience that achieving high-quality data positions us to inform policy innovations going forward,” Clancy said. “We believe the SEED OK Wave 3 data will help us achieve this goal.”

There have been more than 3.5 million requests for assistance to 2-1-1 help lines around the United States since the coronavirus pandemic hit this spring. The impact was immediate and dramatic, said a Brown School researcher who tracks calls to 2-1-1 help lines across the U.S.

During COVID-19, the volume of requests to 2-1-1s has increased exponentially, said Matthew Kreuter, the Kahn Family Professor of Public Health at Washington University in St. Louis.

“Questions about COVID-19 symptoms and testing account for part of this increase, but mostly people need help dealing with the economic consequences of the pandemic,” said Kreuter, senior scientist at the university’s Health Communication Research Laboratory. The lab developed 2-1-1 Counts, the first tool to provide real-time, searchable and visual presentations of data from 2-1-1 call centers across the country.

2-1-1 is a free and confidential service that helps people across North America find the local resources they need 24 hours a day, seven days a week, in most communities. Each year, 2-1-1s receive 16 million requests, not only seeking emergency services, but also basic needs such as food, shelter and clothing.

The World Health Organization declared COVID-19 a pandemic on March 11. “In the first two full weeks afterward (March 16–29), food-related requests to 2-1-1s skyrocketed, increasing 486%,” Kreuter said in a recent Health Affairs blog post.

“Requests for rent assistance were up 137%, and, across all need categories, daily requests more than doubled compared to pre-COVID-19 rates in 2020,” he said. “The overall rate of increase is even more striking given that requests to 2-1-1 for help with some other social needs declined sharply as a direct result of COVID-19.

“The potential applications of 2-1-1’s social and economic needs data are many,” Kreuter and his co-authors wrote in the blog post. “For a social service safety-net system that is stretched thin in the best of times, COVID-19 presents a daunting challenge and a renewed sense of urgency for investment and improvement. When requests to 2-1-1 double, that means referrals to community-based agencies double as well. Understanding which needs are rising and falling in which neighborhoods should inform community priorities and resource allocation to better and more efficiently meet demand.”

Data tracked by 2-1-1 Counts can be searched and displayed by date, county, congressional district and more.

Kreuter’s team has established a web page, FOCUS-19, to report new findings daily.

To help address the international social, economic and public health ramifications of the outbreak, the McDonnell International Scholars Academy recently awarded $250,000 in seed grants to kick-start research projects led by Washington University faculty members and their international collaborators.

Three Brown School faculty members were among the awardees: Professor Rodrigo Reis, Assistant Professor Deborah Salvo, and Michal Grinstein-Weiss, Shanti K. Khinduka Distinguished Professor.

The call for proposals was met with a strong response: 34 teams from six of the university’s schools — with collaborators from 23 international partner institutions — presented projects for consideration. Eleven ultimately were chosen and received awards of up to $50,000. The projects will explore ways to address the global pandemic, but also help further solidify relationships forged between researchers at Washington University and their colleagues around the world.

Reis and Salvo will collaborate with Guillermo Rosas, a professor of political science at Washington University in St. Louis, to investigate the interaction of political attitudes and public health in the COVID-19 era in Brazil, Colombia, Chile, and Mexico.

Together the trio will lead an international, interdisciplinary team of epidemiologists and social scientists in the United States and Latin America.

Grinstein-Weiss’ project will compare the immediate and long-term economic impacts of COVID-19 on household welfare in Israel and the United States. This dovetails with her research at the Social Policy Institute at Washington University in St. Louis, where she serves as inaugural director.

The funded teams now will get to work tackling far-reaching COVID-19-related issues. In addition to the projects led by Brown School faculty, projects will focus on the pandemic’s impact on the retirement process in the United States, South Korea and Australia; HIV care in Ghana, Brazil and the United States; and intimate partner violence in St. Louis, Uganda and Chile. The teams expect to gain more insight into these problems by studying the phenomenon in multiple countries and by drawing on top experts from around the world.

“COVID 19 has been one of the most disruptive forces the world has experienced in decades,” said Kurt Dirks, vice chancellor for international affairs. “Our faculty were eager to tackle the multitude of problems, in collaboration with experts from across the globe, but needed some immediate resources to get started. Thanks to the generosity and foresight of Bethany and Bob Millard, the McDonnell Academy was able to provide the support needed to begin this very important work. The research is expected to yield insights to address the current problems.”

The Millards served as chairs of the Parents Council, Washington University’s undergraduate parent leadership group, this past academic year.