Study Background

Inequalities in COVID-19 infection, hospitalization, and death in understudied, underserved, underrepresented, and underreported (U4) groups of people are severe. A growing number of studies have assessed the impact of individual risk factors. But few studies have assessed which factors are the greatest drivers of COVID-19 disparities from a wider perspective.

This is a cross-sectional population-based survey designed within a syndemic framework to characterize the impacts of the COVID-19 pandemic on U4 women. We hypothesize that U4 women are experiencing and will have experienced a worsening of mental, physical, and socio-economic status as a result of the COVID-19 pandemic and that pre-pandemic indicators of U4 status and related exposures will be associated with adverse mental, physical, and SES effects of the COVID-19 pandemic. In addition to facing disproportionately higher environmental exposures, problems with healthcare access and quality, and increased prevalence of a broad range of chronic health conditions, U4 women face particularly high disparities in reproductive-health outcomes that have the potential to be strongly impacted by the COVID-19 pandemic including preterm birth, complications of pregnancy, and maternal mortality. The study ultimately seeks to collect baseline data for a long-term follow-up study of U4 women, as well as identify high impact targets for public health interventions to build resiliency in U4 communities.

All participants will complete a 45-minute baseline survey. Women ages 18–50 will be invited to complete an optional 15-minute reproductive survey. Participants have the option to provide biological samples including blood, urine, saliva, household dust, and toenails and to wear a personal exposure (wrist) band.