SHADAC COVID-19 Survey Results

May 2020:

The SHADAC COVID-19 Survey on the impacts of the coronavirus pandemic on health care access and insurance coverage was conducted as part of the AmeriSpeak omnibus survey conducted by NORC at the University of Chicago. The survey was conducted using a mix of phone and online modes from April 24 and 26, 2020, among a nationally representative sample of 1,007 respondents age 18 and older. 

These briefs highlight key results from the survey, relating to loss of health insurance coverage, delayed medical care due to cost, and increased stress due to the coronavirus pandemic, for a nationally representative sample of U.S. adults (age 18 and older). 

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

90 percent of U.S. adults report increased stress due to pandemic

Colin Planalp, MPA, Giovann Alarcon, MPP, Lynn A. Blewett, PhD,

The coronavirus pandemic and ensuing economic crisis have introduced a new and unique set of conditions that trigger stress in the United States population. Many individuals are concerned about contracting the virus and developing COVID-19 symptoms, worried about job loss, and experiencing other strains caused by stay-at-home orders. The SHADAC COVID-19 Survey, conducted between April 24 and 26, 2020, by NORC at the University of Chicago, asked a nationally representative sample of U.S. adults how they were coping with the stress caused by the pandemic. This brief highlights key results from the survey, relating to stress and coping mechanisms for a nationally representative sample of U.S. adults (age 18 and older). More information on the SHADAC COVID-19 Survey findings regarding worries about COVID-19 costs are available here.

Elevated stress was reported consistently across demographic groups
The SHADAC COVID-19 Survey found that 90.4 percent of U.S. adults reported feeling additional levels of stress specifically caused by the COVID-19 pandemic (Figure 1). Rates of coronavirus-based elevated stress were consistently high across the subgroups we examined, with only minor variation. Demographically, the lowest rate of additional stress was reported by Hispanics (87.2 percent), and the highest rate was reported by females (92.8 percent).

The survey also asked respondents how they were coping with stress caused by the pandemic. The most commonly reported coping responses were “talking more with friends and family” (40.5 percent) and “increased use of social media” (30.3 percent) (Figure 2). However, many people also reported coping responses with potentially negative health consequences, such as “increased eating” (30.2 percent) and “eating of unhealthy foods” (25.0 percent); “increased alcohol consumption” (15.4 percent); and “increased smoking or vaping of e-cigarettes” (7.9 percent). Many people also reported changing their exercise habits in response to stress caused by the coronavirus crisis (41.9 percent), split roughly in half between those who increased their level of exercise and those who decreased their level of exercise (19.2 percent and 22.9 percent, respectively).

People with poor or fair health reported higher coping responses with health risks
Although only 16.9 percent of respondents reported being in “poor or fair” health, those people reported coping responses that differed significantly from their counterparts with “excellent or good” health in multiple areas.

Increased smoking or vaping
People with poor/fair health reported increased smoking or vaping at rates almost triple those of people with excellent/good health (16.1 percent vs. 5.8 percent), which was a statistically significant difference (Figure 3).

Eating more and eating unhealthy foods
People with poor/fair health reported increased consumption of unhealthy foods at almost double the rate of people with excellent/good health (39.9 percent vs. 21.2 percent), while also reporting higher rates of increased eating (39.2 percent vs. 27.9 percent)—both of which were statistically significant differences.

Less exercise
People with poor/fair health also were more likely to report reduced exercise in response to pandemic stress than people with excellent/good health (35.2 percent vs. 19.8 percent), and they were correspondingly less likely to report exercising more in response to pandemic stress (8.9 percent vs. 21.8 percent). Both of these differences in rates of exercise were statistically significant.

Social connections
As with the other indicators listed in the SHADAC COVID-19 Survey, people with poor/fair health were significantly less likely to report talking more with friends and family to cope with stress than their counterparts with excellent/good health (29.5 percent vs. 43.2 percent).

Coping responses with health risks also found among other subpopulations
The SHADAC COVID-19 Survey also found that certain coping responses with greater potential health risks were more prevalent within other subpopulations:

Higher alcohol consumption by younger adults
Younger adults (age 18-29) were significantly more likely to report increased alcohol consumption than elderly adults (age 65 and older), who had the lowest rate (23.5 percent vs. 4.0 percent), as well as unhealthy changes in eating (eating more, eating more unhealthy foods) as compared with elderly adults, who again reported the lowest rate (48.2 percent vs. 27.1 percent). Younger adults were also significantly more likely to report increased social media use than elderly adults (41.2 percent vs. 23.8 percent).

Females reported higher unhealthy eating habits
Females were more likely to report changes in unhealthy eating (eating more, eating more unhealthy foods) than males (43.2 percent vs. 32.9 percent). Females also were significantly more likely than males to report talking more with friends or family (46.9 percent vs. 33.6 percent), and more likely to report increased social media use (36.5 percent vs. 23.8 percent).

Higher smoking and vaping by people with high school or less education
People with a high school education or less were significantly more likely to report increased smoking or vaping than people with a bachelor’s degree or more (11.9 percent vs. 5.3 percent). They also were less likely to report exercising more (12.5 percent vs. 27.6 percent).

People with higher incomes were more likely to report increased exercise
People with incomes of $100,000 or more were significantly more likely to report increased levels of exercising than those with incomes of less than $30,000 (30.1 percent vs. 11.9 percent). Conversely, people with incomes below $30,000 were significantly more likely to report greater unhealthy eating habits (eating more, eating more unhealthy foods) (44.2 percent vs. 31.6 percent).

Conclusion
Coping strategies are a natural response to increased stress levels due to concerns about the coronavirus pandemic. From the results of the SHADAC COVID-19 Survey, we found variation in coping responses by age, sex, education and income. However, some of the most distinctive differences in stress-coping responses were among people reporting poor or fair health, who reported higher rates of responses with potentially negative health impacts, such as increased alcohol consumption, reduced exercise and unhealthy eating habits. People with poor or fair health also reported lower rates of talking more with friends and family, raising concerns about greater social isolation for these people at a time when stay-at-home-orders have been official policies in many states.

It is critical that individuals are aware of their stress levels and the methods by which they are using to cope, and make sure that they take care of themselves and others. It is also critical to reach out to people with poorer health, who may need increased social supports during times of an economic and public health crisis. The U.S. Centers for Disease Control and Prevention (CDC) recommends the following activities as ways to deal with stress ¹:

• Take breaks from the news.
• Take care of your body, including eating well-balanced healthy meals, exercise, get enough sleep, and avoid alcohol and drugs.
• Schedule time to unwind and do activities that you enjoy.
• Connect with others, including people you trust, family, and friends.

Moderating stress levels with healthy behaviors can contribute to an overall feeling of health and wellbeing that is important to cultivate during this time of an unprecedented pandemic. 

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

Most U.S. Adults Report Reduced Access to Health Care due to Coronavirus Pandemic

More than half worried about their ability to pay for COVID-19 health care

Colin Planalp, MPA, Kathleen Thiede Call, PhD, Giovann Alarcon, MPP, Lynn A. Blewett, PhD

According to results from a new April 2020 survey, a majority of adults in the United States say that their access to health care services has been negatively affected by the coronavirus (COVID-19) pandemic, with the crisis causing delayed or canceled health care appointments. Over half of adult respondents also reported being “very worried” or “somewhat worried” about their ability to afford health care if they contract COVID-19. These findings come from a recent nationally representative survey of U.S. adults conducted between April 8 and 13, 2020, by survey firm SSRS and the State Health Access Data Assistance Center (SHADAC).

Worries about affordability of care for COVID-19
The survey asked respondents how worried they were about being able to afford health care if they contracted COVID-19. Responses revealed that 54.5 percent of U.S. adults were “very worried” or “somewhat worried” about their ability to afford health care if they were to contract the coronavirus (Figure 1). However, that rate varied substantially across different segments of the population.

Nearly three-quarters (72.6 percent) of U.S. adults age 18-29 reported being “very” or “somewhat worried” about their ability to afford care should they contract COVID-19, and almost two-thirds (63.5 percent) of persons of color (e.g., American Indian, Asian and Pacific Islander, Black and Hispanic) also reported being “very” or “somewhat worried.” Both of those rates were significantly higher than the overall rate of 54.5 percent.

Higher rates of worry about COVID-19-related health care affordability may be influenced in part by higher rates of uninsurance. The SSRS/SHADAC survey also confirmed evidence of persistent disparities in health insurance coverage, finding that uninsurance rates were significantly higher among adults age 18-29 (18.2 percent) and persons of color (14.7 percent) as compared to the overall adult population (9.2 percent) at the onset of the crisis.

One particular concern during the pandemic is that those who are uninsured and those who are worried about the cost of health care may either avoid or delay seeking health care for COVID-19—potentially putting them at greater risk of severe illness or death, and leading them to inadvertently expose others in the community to the virus. Given these risks, the disparity in uninsured rates for persons of color is especially troubling in light of research by the U.S. Centers for Disease Control and Prevention (CDC) finding that Black populations in the U.S. have higher rates of hospitalization due to COVID-19.¹

Reduced health care access caused by pandemic
While the American health care system has prepared for and, in some states, already experienced waves of patients suffering from COVID-19, the U.S. population has other continuing health care needs, including regular preventive care, treatment of chronic conditions, and medical emergencies, such as heart attacks and strokes.

Anticipation of the coronavirus surge, however, has caused some health care providers to cancel appointments for conditions other than COVID-19, and it has driven some individuals to cancel or delay care due to concerns of exposure to the virus.

Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity

In a new issue brief for the Robert Wood Johnson Foundation’s State Health and Value Strategies, SHADAC Senior Researchers Lacey Hartman, MPP, Elizabeth Lukanen, MPH, and Colin Planalp, MPA explain how researchers and policymakers can leverage federal survey data to inform and target interventions that seek to address social determinants of health and advance health equity. 

About the Issue Brief
As state Medicaid programs increasingly seek to understand and address social factors that contribute to poor health, they need data in order to identify priority areas of unmet social and economic needs, to execute SDOH initiatives, and to monitor and evaluate the impacts of these programs.

While Medicaid programs can choose to utilize data from a broad array of sources, this brief highlights several advantages to using data from one federal survey, the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity. The ACS contains a vast range of variables relevant to social determinants of health including but not limited to; food insecurity, unstable housing, and lack of access to social supports, and has a large sample size that supports estimates for smaller subpopulations.

This brief provides an overview of select social determinants of health measures and examples of how the data could be used to address questions and evaluate interventions related to housing, transportation, and nutrition. It also provides examples of states that use SDOH and health equity measures from the ACS, including which measures are used and what they are used for.

Access the new “Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity” brief in full to read more about how researchers can use federal-level SDOH survey data to advance health equity. Readers can also download the brief, along with a companion toolkit that includes a detailed data dictionary.

Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.

Choosing Between Federal Surveys That Measure Rent Affordability

December 2019:

Earlier this year, the U.S. Department of Housing and Urban Development released a policy brief recognizing the growing housing affordability crisis in the United States, especially as it affects metropolitan areas and rental units.¹ Lack of low-cost rental housing is one of the main factors fueling the crisis, according to Harvard University’s Joint Center for Housing Research, who pointed to a combination of rising median housing costs (11.0%) and falling incomes (-2.0%) over a fifteen-year period from 2001-2016.²

As housing affordability continues to have a demonstrated relationship with determining health outcomes, it is important to understand how this measure affects individuals and populations across the nation and how this varies by state.

A new brief from SHADAC researchers looks at the issue of unaffordable rents using and cross-comparing data from four different surveys:

The brief also explores the strengths and limitations of two different approaches to measuring rent affordability—the 30 percent affordability rule and perceived affordability rule—based on questions asked in each survey, and provides estimates on a national and state level for each approach where available.

Additionally, the brief includes reasons behind variation in the estimates across surveys, as well as key questions for researchers to consider when choosing which survey to use when measuring unaffordable rents.

Visit SHADAC and State Health Compare for More
SHADAC previously conducted an analysis into the issue of Unaffordable Rents in two blog posts: “Unaffordable Rents by Metropolitan Status: A New Breakdown on SHADAC’s State Health Compare” and “Housing Affordability Matters: Measuring and Addressing the Burden of Unaffordable Rents (Infographics)”; and as part of SHADAC’s “Measures That Matter” product series, “Examining Unaffordable Rents as a Social Determinant of Health (Infographics).”

The Unaffordable Rents measure is also available on SHADAC’s State Health Compare web tool. Data is available from 2012 through 2017 and can be broken down by race/ethnicity, household income categories, metropolitan status, Medicaid enrollment status, and disability status.

Learn more about the estimates used in this analysis, as well as other measures related to social and economic determinants of health, at State Health Compare. For more on how statistics are calculated using significance testing our methodological technical brief can be found here.

---

[1] U.S. Department of Housing and Urban Development. (2019). Addressing housing affordability in high-cost metropolitan areas in the United States. Retrieved from https://www.huduser.gov/portal/sites/default/files/pdf/Addressing-Housing-Affordability-High-Cost-Metropolitan-Areas.pdf
[2] Richardson, B. (2019, January 31). America’s housing affordability crisis only getting worse. Forbes. Retrieved from https://www.forbes.com/sites/brendarichardson/2019/01/31/americas-housing-affordability-crisis-only-getting-worse/#62e08461104b