American Journal of Preventive Medicine focuses on public health aspects of COVID-19

News brief #1

Ann Arbor, May 13, 2020

New research and guidance in the American Journal of Preventive Medicine, published by Elsevier, focus on critical topics pertaining to community and individual health during the COVID-19 epidemic.

Researchers outline guidelines to help address the unique and often overlooked risks posed by COVID-19 to both prison inmates and correctional officers

The correctional environment is often considered distinct or isolated from the wider society and health system, but the wellbeing of correctional workers and prisoners is inexorably linked to the health of the country as a whole. Almost 3 million people are incarcerated, or work in, state and federal prisons, local jails, and other detention facilities. Their safety is inherently a matter of public health. Researchers highlight some of the inherent risks within correctional systems that may increase COVID-19 transmission among and between inmates and staff. They outline recommendations from the Centers for Disease Control and Prevention, WHO, and other organizations to help correctional professionals mitigate these risks and protect and treat anyone who lives and works in their institution. This includes collaboration between correctional systems and their local public health authorities, adherence to the principles of infectious disease control, and early release or furlough of prisoners whose release would pose fewer public safety risks than their continued incarceration.

“Both correctional employees and inmates have long been overlooked by our society, community leaders, and legislators,” said lead author Andre Montoya-Barthelemy, MD, MPH, HealthPartners Occupational and Environmental Medicine, St. Paul, MN; and American College of Occupational and Environmental Medicine, Elk Grove Village, IL. “As we researched this article, we were immediately struck by how abruptly COVID-19 has exposed our neglect of those who live and work within the prison system, and how the health of our neighbors in the correctional environment is so tightly bound to our own.”

COVID-19 and the Correctional Environment: The American Prison as a Focal Point for Public Health,” by Andre Montoya-Barthelemy, MD, MPH, Charles D. Lee, MD, JD, MBA, CCHP-P, Dave Cundiff, MD, MPH, and Eric Smith, DO, MPH, CTWH ( Journalists wishing to speak with the authors should contact

Vulnerable populations may pay the highest price in the COVID-19 epidemic, researchers warn

Marginalized in the best of times, people who are homeless, incarcerated, or using drugs are likely to experience a higher risk of exposure to SARS-CoV-2 because of their social circumstances. A response to these forgotten populations must be central to the COVID-19 response. Planning should incorporate dedicated efforts, funding, and guidelines specific to these populations, both because they deserve care and services and not doing so poses greater risk to the broader community.

Researchers note that homeless shelters are ideal for viral transmission. They caution that healthcare resources may be prioritized for those at least risk of death, and vulnerable populations may be further marginalized. “People who are homeless, incarcerated or living with opioid use disorder already experience significant stigma and health inequities. It is critical that public health responses to SARS-CoV-2 account for these populations so as not to exacerbate existing disparities and to hamper community transmission,” explains lead author Elizabeth M. Salisbury-Afshar, MD, MPH, of the Center for Addiction Research and Effective Solutions, American Institutes for Research, Chicago IL.

Rush University students and faculty screen guests at a homeless shelter on the West Side of Chicago
Rush University students and faculty screen guests at a homeless shelter on the West Side of Chicago. Credit: Dr. Steven Rothschild.

Vulnerable Populations: Weathering the Pandemic Storm,” by Elizabeth M. Salisbury-Afshar, MD, MPH, Josiah D. Rich, MD, MPH, and  Eli Y. Adashi, MD, MS ( Journalists wishing to speak with the authors should contact

Researchers find clear racial and income disparities in risk factors for severe COVID-19, which should be considered in physical distancing and other protective measures

Identifying those at heightened risk of several illness from COVID-19 is essential for modeling disease, designing return to work criteria, allocating economic assistance, advancing health equity, and limiting morbidity and mortality. To date there has been limited analysis of the population at risk based on income, and racial and ethnic factors, but preliminary national data suggest that disparities in hospitalization are already developing. Using data from the 2018 Behavioral Risk Factor Surveillance System, a nationally representative study of more than 400,000 adults, Matthew Raifman MPP, of the Department of Environmental Health, and Julia Raifman, ScD, of the Department of Health Law, Policy and Management, both at the Boston University School of Public Health, Boston, MA, found clear disparities in the prevalence of risk factors for severe COVID-19. In particular, Non-Hispanic Black Americans and American Indians are disproportionately at higher risk of severe illness relative to non-Hispanic White Americans. People with lower incomes are more likely to be at risk; 25 million Americans living in households receiving less than $25,000 a year have at least one risk factor for severe COVID-19 illness.

“COVID-19 is the most recent example in the long history of structural inequalities shaping the burden of disease in America,” the authors note. “Decades of inequitable policies have created conditions in which there are disparities by race and income in access to healthcare, wealth, education, and employment, each of which are associated with chronic diseases that elevate the risk of severe illness due to COVID-19. By focusing testing, case detection and treatment programs in communities most at risk of severe illness due to COVID-19, we may be able to reduce the overall toll of the disease.”

Disparities in the Population at Risk of Severe Illness from COVID-19 by Race/Ethnicity and Income,” by Matthew Raifman, MPP and Julia Raifman, ScD ( Journalists wishing to speak with the authors should contact

Mandatory social distancing measures in Clarke County, GA slowed the spread of COVID-19, compared to surrounding counties and the rest of the state

In the state of Georgia, Clarke County was among the first to adopt a mandatory policy of sheltering in place (SIP) in response to the COVID-19 epidemic, effective March 20, 2020. Except for one neighboring county, the counties surrounding Clarke County did not implement similar measures, and statewide measures were not put into effect until April 3, 2020. Mark H. Ebell, MD and Grace Bagwell-Adams, PhD, MPA, of the College of Public Health, University of Georgia, Athens, GA, explain that this variation in policies at a “hyperlocal” level created a natural experiment prior to the statewide policy change and allowed them to examine the relationship between SIP policy implementation and the doubling rates of COVID-19 cases for Clarke County versus surrounding counties. Doubling time is a key metric used to evaluate whether progress is being made in containing a virus:  the faster it takes the number of cases to double in an area, the faster the disease is spreading.

Dr. Ebell and Dr. Bagwell-Adams observed that doubling time in Clarke County was 11.3 days longer compared to surrounding counties and increased by an average of eight days compared with the entire state. Looking at percentage daily increases, they found a 30 percent decrease in percent increases in Clarke County compared with other counties. “Our report reinforces the fact that mandatory implementation of distancing measures is the most important way to slow the spread of the COVID-19 pandemic,” say Dr. Ebell and Dr. Bagwell-Adams. “Our mayor and commission were two weeks ahead of the rest of Georgia in mandating isolation measures, and we think the community has benefited as a result.”

Line graph displaying the doubling times for Clarke County, six surrounding counties, and the state of Georgia, USA.
Doubling times for Clarke County, six surrounding counties, and the state of Georgia.

Mandatory Social Distancing Associated with Increased Doubling Time: An Example Using Hyperlocal Data,” by Mark H. Ebell, MD, MS, and Grace Bagwell-Adams, PhD, MPA ( Journalists wishing to speak with the authors should contact


Notes for editors
Full text of these articles is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or They are also openly available.

The AJPM COVID-19 Pandemic Collection houses articles that cover important and pressing public health issues related to the COVID-19 pandemic, including vulnerable populations at risk, economic impacts, law and policy decision-making, community interventions, global retrospective studies, and much more. AJPM is committed to publishing the most robust, evidence-based research and commentary as they unfold to keep readers up to date and aware of issues relevant to this rapidly evolving global outbreak.

Elsevier’s Novel Coronavirus Information Center provides the latest early stage and peer-reviewed research on the novel coronavirus and COVID-19. All resources are free to access and include guidelines for clinicians and patients. The Information Center links to the Coronavirus Hub on ScienceDirect, with more than 26,000 articles relevant to coronavirus, SARS, and MERS freely available. The center also links to a Healthcare Hub with resources for clinicians treating COVID-19 patients.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

Media contact
Jillian B. Morgan, MPH, Managing Editor
+1 734 936 1590