Shah Co-Authors Report on Disproportionate COVID-19 Risk Among Latinos Local context is a key factor in the level of risk, the study of Medicaid patients in Contra Costa County finds

By Stan Paul

UCLA Luskin Professor of Public Policy Manisha Shah co-authored a study, published in the American Journal of Preventive Medicine, that showed Latinos had much higher odds of testing positive for COVID-19 than whites.

The USC-UCLA study, conducted in a Northern California regional medical center with a diverse group of adults enrolled in a county Medicaid managed care plan, also indicated a marked racial disparity in odds of hospitalization and death from COVID-19. Researchers noted that, while the coronavirus has disproportionately affected racial and ethnic minorities nationwide, in their California study, infection, hospitalization and death were higher for Latinos, but not Black patients, relative to white patients.

The researchers point out that socioeconomic differences may confound racial and ethnic differences in testing and that “the role of sociodemographic, clinical and neighborhood factors in accounting for racial/ethnic differences in COVID-19 outcomes remains unclear.”

The study included data from more than 84,000 adult Medicaid patients at Contra Costa Regional Medical Center. The researchers hypothesized that, because all of the patients had Medicaid, “racial/ethnic disparities in testing and outcomes would narrow when controlling for demographics, comorbidities and ZIP code-level characteristics.”

They also expected that these characteristics would be reduced relative to previous studies, given similar insurance coverage, household income and access to health-care providers. Among their conclusions, the researchers highlighted that racial and ethnic disparities depend on local context, citing studies from other states with differing results.

“The substantially higher risk facing Latinos should be a key consideration in California’s strategies to mitigate disease transmission and harm,” they recommend.

“We learned a lot about testing and hospitalization disparities through this study,” Shah said. “We recently implemented a randomized controlled trial with our Contra Costa County partners to better understand vaccine take-up among the vaccine hesitant.”

Shah said that the research team is testing the role of financial incentives, reducing appointment scheduling frictions, and provider messages on COVID-19 vaccine take-up in this diverse Medicaid managed care population.

“We are excited to share the results from this vaccine take-up study very soon,” Shah said.

Additional authors include Mireille Jacobson, associate professor at the USC Leonard Davis School of Gerontology and senior fellow at the USC Schaeffer School for Health Policy and Economics; Tom Chang, associate professor of finance and business economics at the USC Marshall School of Business; Samir Shah, CEO of Contra Costa Regional Medical Center; and Rajiv Pramanik at Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Service.

Shah Calls for Decriminalization of Sex Work

Global Lab for Research in Action Director Manisha Shah co-authored a Medium article about the unintended consequences of policies meant to protect sex workers. “Sex work is work. And evidence shows that when it is treated as such, everyone benefits,” wrote Shah and Global Lab intern Rachel DuRose. Research shows that decriminalization of sex work leads to a decline in incidents of abuse and rape, sexually transmitted infections and sex trafficking. Shah, a professor of public policy, explained that sex workers “are becoming victims of the very policies meant to protect them,” with increased levels of rape in communities that have banned the purchase of sex as well as increased prevalence of STI symptoms. The authors called on lawmakers and government leaders to decriminalize sex work. “Only when the community and leaders understand that sex work is work, can positive change at the local, federal and international level be achieved,” they concluded. 

Shah Promotes Healthy Behavior Among Adolescents

Public Policy Professor Manisha Shah authored an article in the Conversation about her work to improve adolescent sexual and reproductive health in Tanzania. Adolescent girls in sub-Saharan Africa experience high rates of HIV infection, unintended teenage pregnancy and intimate partner violence. While many reproductive health programs and services focus exclusively on females, Shah and her team developed a program to encourage adolescent boys and young men to make better choices around their sexual and reproductive health through sports programming. They also focused on empowering adolescent girls and young women to make healthy, informed decisions by using goal-setting exercises. The study found that both the men’s soccer league and the goal-setting activity for women reduced intimate partner violence and increased adolescents’ sense of personal agency to make better choices around sexual relationships. Shah concluded that “offering contraception alone, without focusing on behavior change for females and males, won’t necessarily improve sexual and reproductive health for adolescents.”

Examining the Science Behind Decriminalizing Sex Work

Governments have cited protection of public health as a rationale for outlawing sex work, yet evidence shows that decriminalizing the trade increases health and safety and reduces the risk of disease, according to a new policy brief from researchers at UCLA. Released on International Sex Worker Rights Day, the brief reviews global data showing that the public health justification for criminalization and regulation of sex work is not supported by science. “There is scant evidence that criminalizing the sex trade has any positive effects on public health and the health of sex workers,” the brief states. Instead, it cites empirical studies linking criminalization to a rise in sexually transmitted infection and HIV transmission, as well as an increased risk of violence against sex workers. The authors draw a distinction between sex work, which is consensual, and sex trafficking, which is based on force, fraud or coercion or involves the participation of minors. The policy brief calls for further study on how laws and policies related to the sex trade can improve public health. While decriminalization may not fully eliminate the stigma and victimization of sex workers, the authors argue that “by removing criminal liability from the picture, approaches that seek to integrate sex workers into society can advance both human rights and labor rights of communities made vulnerable by multiple systems of oppression.” The policy brief was issued by researchers from UCLA’s Center for HIV Identification, Prevention and Treatment Services, Southern California HIV/AIDS Policy Research Center and Global Lab for Research in Action in partnership with the Sex Workers Outreach Project — Los Angeles.


Shah on Involving Men and Women to Address Intimate Partner Violence

Professor of Public Policy Manisha Shah was featured in a Global Citizen article about reducing intimate partner violence in Tanzania. In Tanzania, one in three women between the ages of 15 and 24 experiences intimate partner violence, including physical and sexual violence, stalking, or psychological harm by a current or former partner. A study by the Global Lab for Research in Action at UCLA Luskin found that educational health programs for men and boys and goal-setting exercises for women and girls can reduce intimate partner violence and improve sexual and reproductive health. “I have come to the conclusion that one of the only ways we will be able to shift social norms around violence against women and girls will be to get both males and females involved,” Shah said. Most existing reproductive and sexual health programs focus only on women, but the study found that using men’s soccer clubs to promote domestic violence education reduced intimate partner violence.

Criminalization of Sex Work Is Counterproductive, Shah Finds

Public Policy Professor Manisha Shah co-authored a Vox Dev article discussing the effects of criminalizing sex work in Indonesia. Previous studies in high-income countries have found that decriminalizing sex work has positive impacts on the health of sex workers and the general population. In a recent study, Shah analyzed the impact of criminalizing sex work in a low-income setting by interviewing female sex workers, their clients and their families after the government in East Java, Indonesia, announced that it would close all formal sex work locations. The closure caused the formal sex market to shrink, leading to increased rates of sexually transmitted infections and negatively impacting the well-being of sex workers who were forced out of work. Shah and her colleagues concluded that the criminalization of sex work is “counterproductive and can reverse the good work that many government health departments and NGOs are undertaking to reduce the spread of STIs and HIV/AIDS.”

Shah on Soccer, Setting Goals and Adolescent Health

A VoxDev video highlighted Public Policy Professor Manisha Shah’s study of interventions designed to reduce intimate partner violence among Tanzanian adolescents. This type of violence is highly prevalent among 15- to 24-year-olds in Sub-Saharan Africa. In the Tanzania study, interventions for girls included instruction on setting personal goals during sessions at after-school clubs. For boys, the interventions included a soccer program that wove in lessons on respecting women. “While they’re playing soccer, they’re also learning key messages, like when we respect girls and women, that’s better for all of us,” said Shah, director of the Global Lab for Research in Action at UCLA Luskin. In addition to a decline in sexual activity and intimate partner violence, the study found, girls who participated in the goal-setting activities chose partners who were closer to their age, more likely to be in school and more likely to use contraceptives.

Spotlight on Shah’s Research on Domestic Violence in India

A World Bank blog highlighted research methods used in a study of domestic violence in India that was conducted by Global Lab for Research in Action Director Manisha Shah and researcher Saravana Ravindran. The study found a significant increase in domestic violence and cybercrime complaints in May in Indian districts with the strictest COVID-19 lockdown measures relative to districts with the least strict measures. At the same time, reports of rape and sexual assault declined as people avoided public spaces during the lockdown. “Putting some numbers on a ‘shadow pandemic’ is important for informing policies to address it,” the article said, noting the difficulty of collecting real-time data on such sensitive subjects. “Lockdowns can be an effective way of controlling a pandemic, but they come with costs.”

Shah on Domestic Violence During India’s Lockdown

Public Policy Professor Manisha Shah spoke to Quartz about domestic violence in India during the COVID-19 lockdown. A study co-authored by Shah found a significant increase in domestic violence and cybercrime complaints in May in Indian districts with the strictest lockdown measures relative to districts with the least strict measures. Reports of rape and sexual assault declined as people avoided public spaces and workplaces during the lockdown. “We cannot rule out the possibility of some displacement of rape and sexual assault from public spaces outside homes to rape by family members inside homes,” explained Shah, director of the Global Lab for Research in Action at UCLA Luskin. Marital rape is vastly underreported in India, she said. “Women face a portfolio of danger, and policies such as lockdowns can improve certain types of violence outcomes while exacerbating others,” she said.

Luskin Summit: Global Data on Domestic Violence

A surge in domestic violence amid shelter in place orders has been reported around the world. Global advocates, policymakers, funders and others will hear from experts on emerging trends and data as they discuss the evidence and how it can lead to informed solutions, interventions and strategies.

With Nancy Lublin, founder & CEO, Crisis Text Line; Katie Ray-Jones, CEO, National Domestic Violence Hotline; and Manisha Shah, founder and professor, Global Lab for Research in Action at UCLA.

This Luskin Summit session is co-hosted by the UCLA’s Global Lab for Research in Action.