Racial Health Disparities and Black Heterogeneity in COVID-19: A Case Study of Miami Gardens

Abstract

The COVID-19 pandemic is a critical public health concern that has disproportionately affected the Black community in the United States. The purpose of this study was to examine the risk and protective factors faced by residents in the City of Miami Gardens during the COVID-19 pandemic, with emphases placed on racial health disparities and Black heterogeneity. Using convenience and snowball sampling, quantitative and qualitative data for this study were collected via an anonymous online questionnaire using QuestionPro. Survey links were distributed by e-mail invitations with assistance from city officials to the residents of this predominantly Black city in Florida (n = 83). Descriptive statistics and relevant qualitative responses are presented. Furthermore, a machine learning (ML) approach was used to select the most critical variables that characterized the two racial groups (Black versus non-Black participants) based on four ML feature selectors. Study findings offered important and interesting insights. Specifically, despite the greater prevalence of adopting measures to protect themselves and others from COVID-19, Black participants were more susceptible to activities that increased their COVID-19 risk levels. In addition, their rate of infection, particularly among the Afro-Caribbean ethnic group, was reported to be higher, indicating the need to further investigate the underlying conditions and root causes (including vaccine hesitancy and refusal) that contribute to their greater health disparities.

Keywords

COVID-19 health disparities Black heterogeneity risk of infection mental health resilience

The COVID-19 pandemic is a public health crisis that has dramatically transformed the lives of many, taking a substantial toll on our nation’s healthcare system and economy (Udalova 2021). Following the declaration of the pandemic as a global emergency by the World Health Organization (Sohrabi et al. 2020), shelter-in-place was used to restrict movement and slow the virus spread (Feyman et al. 2020). As of the writing of this article, the United States has over 97 million reported coronavirus cases and more than one million deaths (The New York Times 2022). High morbidity and mortality from the virus spread have led to the closure of many schools and non-essential businesses (e.g., Camera 2021; Song et al. 2021). The pandemic has also had accompanying economic consequences (e.g., job losses, unemployment), and mental health repercussions (e.g., fear, anxiety, and loneliness) that can undoubtedly exert lingering and lasting health effects (e.g., Godinic, Obrenovic, and Khudaykulov 2020; Kontoangelos, Economou, and Papageorgiou 2020). Among the pandemic-related ramifications, consistent evidence suggests that the COVID-19 pandemic has disproportionately affected the racial minority community by increasing disparities in health effects, with stark discrepancies observed among Black Americans, who make up approximately 12.4 percent of the nation’s population but constitute approximately 23 percent of reported COVID-19 cases (Lovelace 2020).

The postulation that Black Americans, including Afro-descendants, sustain persistent inequities in health care and outcomes in the United States is generally uncontested (Centers for Disease Control and Prevention [CDC] 2021b; Etowa et al. 2021). In addition to their more prevalent poor physical and mental health phenomena, the Black population bears a higher cost of health outcomes (i.e., a higher rate of diagnoses, premature death, chronic diseases, and mortality) (CDC 2017; National Academies of Sciences, Engineering, and Medicine [NASEM] et al. 2017). Empirical studies have found that Blacks are more likely to suffer from pre-existing health conditions and are more susceptible to hospitalization due to the increased prevalence of comorbidity (e.g., Egbuche et al. 2021; Phillips et al. 2021). Furthermore, they are disproportionately affected by heart disease, high blood pressure, diabetes, stroke, HIV, obesity, asthma, influenza, and pneumonia, of which many are leading causes of morbidity and mortality in the United States (CDC 2020a; Office of Minority Health Resource Center [OMHRC] 2021a, 2021b). When considered in the context of the COVID-19 pandemic, the CDC notes the disproportionate burden of COVID-19 infections, hospitalizations, and deaths attributed to this racial minority group (CDC 2021a; Romano et al. 2021). Yet, few studies have taken proactive steps to uncover the impact of the COVID-19 pandemic on the Afro-Caribbeans, who accounted for the largest origin region of Black immigrants in the United States but are a historically overlooked and excluded racial-ethnic group (Tamir 2022). In addition, most studies on Black Americans do not consider their ethnic origins and Black heterogeneity. The present study examined the risk exposure, protective factors, needs, and challenges faced by residents during the COVID-19 pandemic in the City of Miami Gardens, a predominately Black city in the State of Florida in the United States, taking into consideration both racial health disparities and Black heterogeneity simultaneously.

Literature Review

Increasing evidence suggests that COVID-19 racial health disparities are linked to a number of racial-related structural disadvantages, including inequities in healthcare utilization/access, systemic economic deprivation, deteriorated quality of life, and variations in pre-existing underlying health conditions (CDC 2020b). The Social Determinants of Health framework, which stresses how various environmental factors (e.g., economic stability, healthcare access, safe housing) intersect to shape well-being and health outcomes, can be used to understand the health disparities Black communities face (CDC 2021c). Specifically, Blacks’ highest rates of COVID-19 cases in the nation reflect a continuous history of the systemic intersection of socioeconomic disparities, structural racism, and the cumulative disadvantages of health and other social determinants (Egede and Walker 2020). Disparities may stem from divergent access to quality medical care, healthy food, and adequate health insurance coverage (e.g., NASEM et al. 2017; OMHRC 2021b). With respect to their living environment, Blacks are more likely to reside in disadvantaged neighborhoods with concentrated economic hardship, greater prevalence of pollution, and high deficiencies in healthcare resources/access (e.g., medical care) (American Lung Association 2022; Hastings and Snowden 2019; NASEM et al. 2017). Compared with their White counterparts, Blacks, in particular, also tend to have fewer economic resources (e.g., income, employment opportunities) and lower educational attainment (Holzer 2021; OMHRC 2021b). Poverty is linked to health disparities (e.g., higher rates of comorbidities), which are more prevalent in resource-constrained communities (e.g., Saltzman et al. 2021). Limited socioeconomic mobility due to systemic racism can shape health through different pathways. Aside from their low levels of home ownership (Choi et al. 2019), race and class differences can lead to differential access to high-quality infrastructure and resources that promote good health and support clean water, safe transportation, and healthy food (NASEM et al. 2017). Indeed, Blacks are also more likely to experience environmental health barriers (e.g., accessibility, noises) that increase exposure to environmental toxins and risks for physical injuries (Gee and Payne-Sturges 2004; Jacobs 2011).

Among other social determinants of health, Blacks are more likely to face poorer life opportunities, confront higher unemployment rates, hold lower-wage jobs, and exhibit lower health literacy than their White U.S. counterparts (OMHRC 2021b; Weekes 2012). On one hand, high out-of-pocket healthcare costs prevent and dissuade uninsured or under-insured Blacks from using the healthcare system that supports disease prevention (NASEM 2018). On the other hand, lack of insurance and access to insurance can lead to disenfranchisement from the healthcare system (e.g., limited access to a primary care provider and needed health services, such as access to intensive care unit beds), which in turn exerts severe ramifications on their health outcomes during the COVID-19 pandemic. The CDC, for example, reported that non-Hispanic Blacks have COVID-19 hospitalization rates that are almost five times more than non-Hispanic Whites (CDC 2020b). Furthermore, long-standing systemic racism that permeates the United States can lead to discriminatory practices that increase inequality and segregation. Residential segregation and residence in neighborhoods with concentrated crime rates are intimately related to poor health outcomes (Gillispie-Bell 2021). In addition to their higher rates of incarceration and homelessness (Essien and Venkataramani 2020), Blacks are more likely to experience targeted mass incarceration and racially biased policies pertinent to the inequitable distribution of health resources (see Sawyer 2020). Indeed, unconscious bias and stereotyping against communities of color in the healthcare system can contribute to racial disparities in healthcare. There is evidence that Blacks are more likely to receive substandard treatment from their healthcare providers (Hall et al. 2015). Inferior medical mistreatment and unethical medical research in the past due to implicit racial bias can create mistrust toward medical professionals (e.g., Tuskegee syphilis experiment) (Scharff et al. 2010). Many Blacks distrust the U.S. healthcare system, which likely hinders their efforts to seek medical help (Chandler et al. 2021). Distrust related to COVID-19 may stem from misinformation shared during the early stage of the pandemic, in particular, misleading information spread through different platforms, such as the Internet and social media (Chandler et al. 2021). Despite the fact that culture is essential in effective community-engaged public health communication, contemporary COVID-19-related communication messages tend to be more individual-risk oriented rather than targeting community risks due to current inequities (Airhihenbuwa et al. 2020).

Social distancing, which requires staying at least six feet from other persons, hinders close interactions such as hugging and handshaking (CDC 2022), but it is regarded as a useful strategy for mitigating the risk of infection (Glogowsky, Hansen, and Schächtele 2021). Yet, current social distancing patterns highlight the racial disparities perpetuated by COVID-19 exposure, in part because Blacks are more likely to live in multigenerational households, interconnected communities, and densely populated residential areas where practicing social distancing proves challenging, all of which are likely to make them more at risk of contraction of the infection (Ahmed 2020). Furthermore, Blacks’ occupational roles also increase their risk of disease exposure given their disproportionate representation in low-wage and security jobs as frontline and essential workers, including but not limited to grocery store workers, bus drivers, and farm workers, which inhibits their ability to practice social distancing (CDC 2020b; Goldman et al. 2021). In addition, low-wage workers (of which Blacks are overly represented) are more likely to use public transportation and have less opportunity to work from home, all of which increase the probability of infection (Holmes et al. 2020; U.S. Bureau of Labor Statistics 2019).

The minority stress model postulated that marginalized groups exhibit a greater prevalence of psychosocial stress due to their racial classification (Obinna 2021). Black women, for instance, are more likely to face multiple responsibilities (including single parenting or caregiving for their children and elderly parents), which increase the risks for the development of acute and chronic stressors. Other scholars noted that Blacks also have a higher propensity for experiencing psychological traumas resulting from interacting with other authorities (e.g., police brutality) and exposure to systemic injustice that can become a potential source of racial stress that impacts well-being across the life course (Alang et al. 2017). Historically, Black communities have tended to cope with racism through different means such as social support, religion, avoidance, and problem-focused coping (Jacob et al. 2022). Prolonged social distancing due to the COVID-19 pandemic can exert severe mental health ramifications on the Black community (Saltzman et al. 2021). In terms of mental health, a number of studies found that loneliness is linked to worsening mental health, with those experiencing social isolation during the pandemic more at risk for mental health challenges such as depression and anxiety (Marroquín, Vine, and Morgan 2020; Mushtaq et al. 2014). Restriction in social contacts and daily routine due to social distancing practice can increase isolation and loneliness and alter interactions with families and friends (Marroquín et al. 2020). The practice of social distancing may substantially impact Black communities that are highly integrated into their circles of socialization. Mental health disparities, in turn, can be attributed to socioeconomic challenges and difficulties in accessing care, which may ultimately result in more perpetual, lasting mental health impacts (Saltzman et al. 2021). Globally, COVID-19 has exacerbated health disparities among the African, Caribbean, and Black (ACB) populations owing to their lack of representation in decision-making and factors pertaining to cultural competency and appropriateness in health care (Dabone et al. 2022). In their retrospective ecological study, Chaudhuri et al. (2021) found that minority ethnic groups (including Black ethnic minorities) experienced a greater risk of developing COVID-19 and poorer outcomes than their White counterparts.

Study Site

The City of Miami Gardens, located in Miami-Dade County and approximately 16 miles north of downtown Miami, is the largest predominately Black American municipality in the State of Florida and the third largest city in Miami-Dade County, after Miami and Hialeah. Consisting of over 110,000 residents, the City of Miami Gardens is part of the Miami metropolitan area that represents the seventh largest metropolitan area in the country. Located between Fort Lauderdale and Miami, the city measures approximately 20 square miles and can be accessed through Interstate 95, the Palmetto Expressway, and the Florida Turnpike (Miami Gardens N.d.; New World Encyclopedia N.d.). About 70.8 percent of the residents are Black (compared with 16.9 percent in Florida and 13.4 percent in the United States). With respect to nativity, 32.3 percent of the residents were foreign-born, of which many came from the Caribbean. Socioeconomic disparities represent a significant concern for this community. In particular, the median household income of the city residents is $44,064, which is substantially lower than that of the state’s and the country’s median income ($55,660 and $62,843, respectively). About 14.1 percent of the residents hold a bachelor’s degree or higher (compared with 29.9 percent in Florida and 32.1 percent in the United States). Currently, about 21.0 percent of the residents live in poverty, compared with 12.4 percent in Florida and 11.4 percent in the United States (U.S. Census Bureau N.d.).

Methods

Data from our study were collected from an anonymous online survey (n = 83) conducted by researchers (i.e., first and second authors) from the University of Texas at El Paso and Florida Memorial University between late January and early February 2021 using QuestionPro, an online survey platform. Upon receiving approval from the Institutional Review Boards from both universities, a survey link was distributed by e-mail invitations, with assistance from officials from the City of Miami Gardens and staff members from Live Healthy Miami Gardens to the residents, with the goal to understand the protective and risk factors (including needs and challenges) faced by residents during the COVID-19 pandemic. To participate in this study, participants had to be 18 years or older and reside in the City of Miami Gardens. Information about the study and their rights as human research subjects, potential risks and benefits, the voluntary and anonymous nature of the survey, and the researchers’ use of research data was available on the survey’s website. In addition, participants were also encouraged to share the survey link with any city residents who would like to contribute their perspectives. The survey, which took the participants an average of nine minutes to complete and had a 72.3 percent completion rate among the participants who began the survey, contained 54 closed-ended questions about their sociodemographics, protective measures, history with COVID-19 infection and vaccination, health behaviors, and assistance needed and received, and one open-ended question that allowed them to provide any information that they would like to share about the COVID-19 pandemic. A total of 31 participants responded to this open-ended item.

Data Analyses

Descriptive statistics for the closed-ended quantitative data were tabulated using SPSS 27 and displayed using graphical representations (i.e., pie charts). Descriptive statistical analyses were conducted to examine the between-group differences among the participants (Blacks versus non-Blacks) and within-group differences among the Black participants (Black Americans versus Afro-Caribbeans) on their risk exposure, use of protective measures, and history of testing, diagnoses, and vaccinations. A machine learning (ML) approach was used to select the most critical features (i.e., variables) that characterized the two racial groups (Black versus non-Black participants) based on four ML supervised-based feature selectors (i.e., ReliefF Ranking Filter [Urbanowicz et al. 2018], Correlation Ranking Filter [Tsanas, Little, and McSharry 2010], ZeroR Classifier Feature Selector [Koehrsen 2018], and Correlation-based Feature Selector [M. A. Hall 1999]) that are available on Weka software (Weka N.d.). The ML approach is a data-driven analytical method programmed to learn the data, identify patterns, and make decisions with minimal human intervention. Each selector used its algorithm to identify the best set of features (i.e., variables) based on its performance metrics. Once these four sets of variables were obtained, they were intersected to form two groups of variables that are significant to each racial group. This approach is called the ensemble method. Then, these two sets of variables were ranked based on the number of ML models that selected these features. All four feature selectors used the racial group as the target variable to learn the relevant and non-redundant features. Next, thematic analyses were employed to analyze the qualitative response of the participants, where they were asked to provide other information about the COVID-19 pandemic they would like to share with the research team. Specifically, to generate insights, comments were examined reiteratively to identify repeated patterns, common themes, similarities, and differences. Due to the small number of qualitative responses obtained, only a few participants’ quotes are presented in this article.

Results

We used the term “Black Americans” to refer to Americans of African descent and the term “Afro-Caribbeans” to refer to Caribbean people of African descent. Table 1 shows the sociodemographic characteristics of the participants. About 15.7 percent of the participants were male, with an average age of 52.9 years old. While less than 10.0 percent of the participants were Hispanic (i.e., 8.6 percent), almost one-quarter of the participants self-identified as people of Caribbean descent or West Indians (i.e., 23.8 percent). In terms of racial classifications, 83.1 percent of the participants self-identified as Blacks, of which 20.6 percent were Caribbean descent. Furthermore, approximately 63.2 percent of the participants were college graduates. Over one-half of the participants were employed full-time (i.e., 58.8 percent). About 10.6 percent of the participants reported attending school (e.g., college classes, vocational training, General Educational Development Program [GED]). With respect to marital status, about 4 in 10 participants were married. An average household size constituted close to four people (including the participants), with about one child.

Table 1.

Sociodemographic Variables.

Variables	Percentage
Male	15.7%
Age (mean)	52.9 years
Hispanic	8.6%
Caribbean/West Indian	23.8%
Black	83.1%
Black American	79.4%
Afro-Caribbean	20.6%
Non-Black	16.9%
Education attainment
Less than high school	1.2%
High school diploma or equivalent (e.g., GED)	14.3%
Associate degree	14.3%
Vocational training certification	7.1%
Bachelor’s degree	27.4%
Master’s degree	28.6%
PhD	3.6%
Professional degree such as MD or JD	3.6%
Employment status
Employed full-time	58.8%
Employed part-time	4.7%
Not employed, but seeking	5.9%
Not employed, not seeking	1.2%
Retired	29.4%
Attending class/training	10.6%
Marital status
Single	36.5%
Married	43.5%
Divorced	15.3%
Widowed	1.2%
Other	3.5%
Household size (not including participants)	2.93 (range: 0–8)
Number of live-in children	0.91 (range: 0–4)

Note. Sample size = 83. Percentages were calculated based on valid data.

Table 2 shows the prevalence of risk exposure among Black and non-Black participants. Overall, a higher percentage of Black participants reported engaging in social activities that increased their risk of exposure/infection, including attending a house party or gathering with more than five people, dining in a restaurant, drinking at a bar, frequenting a hair salon, nail salon, and/or tourist location, working outside of the home, and smoking. In terms of the greater within-group variation among the Black participants, Afro-Caribbean participants were more likely to frequent tourist locations. In contrast, Black Americans were less likely to work remotely. Table 3 shows that Black participants were more likely than their non-Black counterparts to adopt protective measures to protect themselves and others from the COVID-19 infection by engaging in preventive behaviors that included washing hands with soap regularly, practicing physical distancing, and home quarantining. In terms of infection, Black participants were more likely to test positive for COVID-19 and/or had household members who tested positive for the disease. In terms of vaccination, Blacks were less likely to have plans to be vaccinated, were more likely to refuse vaccination, and felt undecided about vaccination despite a higher rate of infection. Among the Black participants, despite the fact that Afro-Caribbean participants were more likely to take protective measures compared with their Black American counterparts, a greater percentage of them and their household members had tested positive for COVID-19. With respect to their needs for assistance, while a greater share of the Black participants had received assistance than their non-Black counterparts, they were more likely to express the need for employment assistance, mental health counseling, housing, and childcare assistance while their non-Black counterparts were more likely to indicate that they needed food and financial assistance due to the COVID-19 pandemic, as shown in Table 4. Among the Black participants, Black Americans expressed more need for various services than their Afro-Caribbean counterparts.

Table 2.

Engaging in Activities That Increased Exposure to Risk (in Percentages).

Variables	Black	Non-Black	Black
Variables	Black	Non-Black	Black American	Afro-Caribbean
Attending a house party or gathering with 5 people or fewer	24.6	28.6	22.2	35.7
Attending a house party or gathering with more than 5 people	20.3	7.1	22.2	14.3
Eating out/dining in a restaurant	58.0	57.1	59.3	50.0
Getting a drink at a bar	11.6	0	11.1	14.3
Getting your hair done (e.g., cut, perm, color) at a hair salon	40.6	21.4	40.7	42.9
Getting your nails done at a nail salon	43.5	14.3	44.4	35.7
Getting a massage at a massage parlor	7.3	14.3	5.6	7.1
Visiting a tourist location with other tourists	10.1	7.1	5.6	21.4
Current employment did not allow working from home	35.3	28.6	41.5	7.1
Smoked cigarettes, vaped, or used any tobacco products	3.0	0	3.8	0

Note. Higher values are bold-faced.

Table 3.

Protective Measures, Testing, Diagnoses, and Vaccination (in Percentages).

Variables	Black	Non-Black	Black
Variables	Black	Non-Black	Black American	Afro-Caribbean
Protective measures
Taking the measures to protect oneself from the COVID-19 pandemic
Washing hands with soap regularly	100	92.9	100	100
Wearing a face mask in public	100	100	100	100
Maintaining physical distancing (6 feet apart from other people)	95.7	92.9	94.4	100
Home quarantine	50.7	42.9	48.2	57.1
Taking measures to protect others from the COVID-19 pandemic
Washing hands with soap regularly	98.6	78.6	98.2	100
Wearing a face mask in public	100	85.7	100	100
Maintaining physical distancing (6 feet apart from other people)	97.1	85.7	96.3	100
Home quarantine	46.4	35.7	42.6	57.1
Testing and diagnoses
Had been tested for COVID-19	71.0	78.6	68.5	85.7
Had been tested for COVID-19 antibodies	27.5	30.8	25.9	35.7
Had ever tested positive for COVID-19	13.2	8.3	11.3	21.4
Had ever tested positive for COVID-19 antibodies	8.7	0	7.4	14.3
Household member(s) ever tested positive for COVID-19	17.7	7.69	11.3	35.7
Household member(s) ever tested positive for COVID-19 antibodies	8.7	0	3.7	28.6
Vaccination
Had been vaccinated for COVID-19	15.9	0	20.4	0
Planned to be vaccinated for COVID-19	46.6	61.5	53.5	28.6
Did not plan to be vaccinated for COVID-19	19.0	15.4	16.3	21.4
Unsure or undecided about being vaccinated for COVID-19	34.5	23.1	30.2	50.0

Note. Higher values are bold-faced.

Table 4.

Assistance (in Percentages).

Variables	Black	Non-Black	Black
Variables	Black	Non-Black	Black American	Afro-Caribbean
Services currently received due to the COVID-19 pandemic
Food assistance	17.4	0	18.5	14.3
Financial assistance	8.7	0	7.4	14.3
Employment assistance	1.5	0	1.9	0
Mental health counseling	7.3	0	3.7	14.3
Housing assistance	5.8	0	5.6	7.1
Childcare assistance	1.5	14.3	1.9	0
Services not received but were in need due to the COVID-19 pandemic
Food assistance	15.9	21.4	18.5	0
Financial assistance	23.2	28.6	25.9	14.3
Employment assistance	8.7	0	11.1	0
Mental health counseling	13.0	7.1	14.8	7.1
Housing assistance	18.8	14.3	20.4	14.3
Childcare assistance	11.6	0	11.1	14.3
Received the first stimulus check (full amount)	76.2	90.9	78.0	66.7
Received the second stimulus check (full amount)	50.0	58.3	51.0	41.7

Note. Higher values are bold-faced.

Table 5 shows the results from the ML approach. Groups of important features identified using the ML solutions were represented by two levels, where Level 1 presents a set of variables selected by at least three out of four ML models, and Level 2 refers to the sets of variables selected by only 2 ML models. Three variables were identified as Level 1 variables, namely, washing hands with soap regularly for self-protection, washing hands with soap regularly to protect others, and working from home. The results are consistent with the aforementioned descriptive statistics, where the Black participants took more preventive precautions than non-Black participants. Blacks also had higher risk exposure at work (i.e., 35.3 percent of Black participants versus 28.6 percent of non-Black participants who were not able to work from home). At Level 2, a number of features distinguished the Black and the non-Black participants. First, the weight of the Black participants increased by 2.0 percent on average since the beginning of the COVID-19 pandemic, but there was a 5.3 percent increase among the non-Black participants. In addition, Black participants were more likely to feel indifferent than non-Black participants since the COVID-19 pandemic. Furthermore, Black participants were less likely than their non-Black community to receive childcare assistance due to the COVID-19 pandemic. Lastly, the ML approach suggested that the Black participants were more socially engaged than their non-Black counterparts.

Table 5.

Results from the Machine Learning Approach.

Level 1 (at least 3 out of 4 ML methods selected)	Black	Non-Black
Washing hands with soap regularly to protect self	100%	92.9%
Washing hands with soap regularly to protect others	98.6%	78.6%
Currently employed (working from home)	30.4%	50.0%
Level 2 (only 2 ML methods selected)	Black	Non-Black
Average weight before COVID-19 pandemic (lbs)	199.7	173. 6
Average weight since COVID-19 pandemic (lbs)	203.7	182.7
Average weight increase since COVID-19 pandemic (lbs)	2.0	5.3
Have been tested for COVID-19	71.0%	78.6%
Number of times being tested for COVID-19 (mean)	0.4	0.7
Feeling indifferent since COVID-19 pandemic (mean score; range: 1-4)	2.1	1.8
Getting a drink at a bar	11.6%	0%
Getting nails done at a nail salon	43.5%	14.3%
Attending a house party or gathering with more than 5 people	20.3%	7.1%
Receiving childcare assistance due to COVID-19 pandemic	1.5%	14.3%

Note. Higher values are bold-faced. ML = machine learning.

Figure 1 shows the pie charts of the participants’ frequencies of experiences with a range of positive and negative emotions since the beginning of the COVID-19 pandemic. A number of emotions stood out in the data analyses. Specifically, compared with their non-Black counterparts, a smaller proportion of the Black participants reported anxiety, anger, fear, and hopelessness. However, a greater proportion of the Black participants reported feeling lonely but indifferent due to the pandemic. Overall, in-depth data analyses showed that both Black and non-Black participants rated their physical and mental health less positively since the COVID-19 pandemic began.

Figure 1.

Participants’ emotional and mental health responses.

Findings on mental health concerns were echoed in our qualitative data. Given that less than 40 percent of our participants provided a qualitative response, we did not group the comments by racial groups. Instead, we provided excerpts from the participants to illustrate their attitudes and the context of the coping mechanism they relied on. In addition to the participants who expressed their need for services and vaccination, others expressed gratitude and remained hopeful for their future, indicating their resilience to adapt and overcome the challenging experience associated with the COVID-19 pandemic (Table 6).

Table 6.

Selected Qualitative Responses on the Participants’ Attitudes toward the Pandemic.

[The] pandemic ruined my travel plans and limited my ability to see family. But it offered an opportunity to [sic] me to relax, recover from workload, and reconnect with myself. (31-year-old Black male)
COVID-19 has taught me a lesson of humanity, kindness, and the resiliency of this country. (52-year-old Black female)
I find the lack of available vaccines to be extremely troubling and frustrating. . . . I feel I have a responsibility to isolate myself as much as possible. I do not want to be part of the problem. I would rather be part of the solution. (61-year-old White female)
Although this pandemic has created trying [sic] times for plenty of people, I tend to look at this from a grateful point of view. Being appreciative of what I have and DON’T [sic] have (covid [sic], loss of loved ones due to covid [sic], etc.) has prevented a lot of depressive and fearful moods/episodes for me. I do my best to protect myself, my family, and others. I pray to God and listen to the scientific guidelines associated with covid [sic]. (29-year-old Black female)
I have learned to live your [sic] life day by day. Do the things you want to do now, do not put it off. You never know what tomorrow brings. (68-year-old Black female)
A lot of people are suffering. I pray a lot and that helps. I also try to be a blessing in whatever small or big way I can. . . . My faith in God keeps me going. I know there are many who are having a much harder time than me, so [I] give thanks for all I have. (53-year-old Asian female)
I have applied for disability which is currently being processed hopefully for approval.
I’m in fear of losing my life. . . . I need the vaccination, please. (64-year-old Black female)

Discussion and Conclusion

The COVID-19 pandemic is a critical public health concern that has disproportionately affected the Black American community in the United States, with Black adults more susceptible to health risks linked to severe COVID-19 infections than their non-Black counterparts (Selden and Berdahl 2020; Udalova 2021). In addition to their disproportionately higher rates of mortality and morbidity, the systemic social inequities and economic disparities that the Black community experiences can exacerbate high-risk health conditions that contribute to disparities in COVID-19 (Egede and Walker 2020; Lovelace 2020). Given the infectious nature of COVID-19 and the consistent epidemiological data that show the disproportionate impact of this disease, it is critical to examine how this racial minority community adapt to the pandemic, taking into account Black heterogeneity to help healthcare providers and practitioners leverage strategies to address inequities in social determinants of health, overcome vulnerabilities/susceptibility, and facilitate access to reliable/secure medical resources (e.g., prevention and insurance access). This study examined the risk and protective factors, as well as between and within-group differences in health disparities in COVID-19, in the City of Miami Gardens. Overall, our study showed racial and ethnic disparities in risk of exposure/infection, disease infection, access to care/services, and mental health resilience among the residents. Study findings can offer important insights and information that can be used to tailor public health interventions to improve health equity among the Black American and Afro-Caribbean communities amid this public health crisis, taking into consideration the heterogeneity of the Black community.

First, this study showed that Black participants were more likely to engage in social activities that increased their risk of COVID-19 infection more than their non-Black counterparts. Despite their greater prevalence of adopting measures to protect themselves and others from diseases—such as washing their hands, wearing masks, and practicing social distancing and home quarantine—their rate of infection was reported to be higher, particularly among the Afro-Caribbean participants, indicating the need to investigate further the underlying conditions and root causes that contribute to these health disparities. There is evidence that Blacks were less likely to hold the job positions that allowed them to work from home, in part because occupational segregation along racial lines is still a prevalent phenomenon in the United States, where Blacks are overly concentrated in the service sector that offers fewer remote working opportunities (CDC 2020b). Although social distancing has been deemed effective and imperative in curbing the spread of this infectious disease, this straightforward mitigation strategy proves challenging for close-knit Black communities where cultural and religious gatherings are an integral part of their social structure and community norms. The Black Immunity Myth, which erroneously assumes that the Black population is immune to COVID-19 and cannot contract the disease (Laurencin and McClinton 2020), can endanger their health and exert severe implications on this marginalized population that sustains not only disproportionately higher risks of COVID-19 infection but also confronts a higher likelihood of spreading this disease unknowingly to others (Pew Research Center 2020).

Next, our study showed that Blacks experienced a greater need for different types of assistance (i.e., employment, counseling, housing, and childcare) during the pandemic. This is especially true among Black Americans. This finding calls for the need to improve the social and living conditions of the Black community to eliminate health disparities and alleviate the impact resulting from the COVID-19 pandemic. A systematic review and meta-analysis study by Paradies et al. (2015) showed that racism is linked to a range of poorer physical and mental health conditions, including anxiety, depression, and psychological distress. In addition to posing barriers to prevention and treatment efforts, structural racism caused by discrimination can be reinforced by an inequitable healthcare system that plays a significant role in addressing the social determinants of health (see Gee and Ford 2011). Contrary to a number of studies that postulated that Blacks experience higher levels of psychosocial stressors, elevated depression, anxiety, and post-traumatic stress disorder (Sibrava et al. 2019; Williams 2018), our study shows that Black participants were less likely to express negative emotions characterized by anxiety, fearfulness, anger, and hopefulness, but were more likely to feel indifferent during the pandemic. High mental health resilience might have helped the participants adapt quickly and unexpectedly to life-changing situations. For example, one Black participant (a 52-year-old female) shared, “COVID-19 has taught me a lesson of humanity, kindness, and the resiliency of this country.” Another Black participant (a 29-year-old female) noted,

I tend to look at this from a grateful point of view. Being appreciative of what I have and DON’T [sic] have (covid [sic], loss of loved ones due to covid [sic], etc.) has prevented a lot of depressive and fearful moods/episodes for me. . . . I pray to God and listen to the scientific guidelines associated with covid [sic].

While COVID-19 can exacerbate distress, Blacks’ high social connectedness (e.g., greater involvement in the faith communities and a higher rate of religious involvement such as church attendance) may be fruitful in strengthening their mental health in times of despair (Mohamed 2021). Lewis-Coles and Constantine (2006) found that Black communities are more likely to use Afro-cultural coping strategies, such as cognitive/emotional debriefing, and spiritual-centered and collective coping in dealing with institutional racism-related stress. In their interviews of 62 African Americans during the early stages of the COVID-19 pandemic, Gillyard et al. (2022) found their participants adopted a number of strategies to cope with their stressors, including reframing their stress as opportunities for growth/development, engaging in health-promotion activities, behavior, and lifestyle (e.g., healthy cooking, exercise, meditation, and yoga), employing cognitive coping strategies (e.g., positive thinking, therapy), and establishing a routine, structure, and a sense of normalcy in their family. While our study did not tap into the coping mechanisms participants used to cope with the pandemic, it is also plausible that Black participants in this study were better adjusted than their non-Black counterparts whose standard of living has been more severely altered. It is critical to accurately assess the mental health condition of the Black community so that mental health providers can offer accurate and tailored information to address mental health needs among the Black community. More strategies that place emphasis on raising race consciousness and Black heterogeneity need to be implemented to foster trust in the healthcare system to mitigate the ongoing spread of disease (see Novacek et al. 2020). This is particularly relevant since Blacks have been found to be less willing to receive the vaccine, more likely to plan to delay receiving the vaccine, or do not want the vaccine (Kricorian and Turner 2021), a finding supported by our study.

Limitations

While our research has provided some insightful findings about the health disparities observed during the pandemic, it is not without limitations. Since we did not collect data on nativity (e.g., birthplace), we were not able to determine which participants were immigrants and the length of the Caribbean descent participants have remained in the States. Given that we used convenience sampling and had a small sample size, our study was not set up to provide in-depth between and within-group comparisons. Therefore, the findings in our study must be interpreted in light of these limitations. Like other studies relying on self-report data, our study is subjected to social desirability bias and recall bias. We recommend that more in-depth studies be conducted to understand the heterogeneity of the Black community, taking into consideration their nativity and immigration status, the information that is critical but absent in our study. Treating all Blacks as one homogeneous population and overlooking considerable discrepancies among racial groups and ethnic subgroups can be misleading. We hope that this preliminary study can encourage constructive dialogues and the development of strategies to tailor culturally sensitive healthcare interventions that reduce health disparities. Findings from this study may be used by social scientist researchers and health practitioners to develop practice, inform guidelines, and build an evidence base for effective public health interventions for this ethnic/racial group that has long been overlooked.

Footnotes

Acknowledgements

The authors thank the City of Miami Gardens, Live Healthy Miami Gardens, and Thamara Labrousse for assisting in facilitating the data collection process of this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Yok-Fong Paat

Author Biographies

Yok-Fong Paat, PhD, is an associate professor of social work at the University of Texas at El Paso. Her research focuses on health disparities, health behavior, high-risk behavior, family well-being, and mental health.

Max C. E. Orezzoli, PhD, is an associate professor of healthcare at Florida Memorial University. He holds a doctorate degree in sociology (medical) with an emphasis on quantitative analysis from Florida International University. He has 15 years of experience in community-based health disparities interventions that positively impact the health of underrepresented communities.

Chun-Kit Ngan, PhD, is an assistant teaching professor of data science at Worcester Polytechnic Institute. His research interests focus on decision guidance and support systems (DGSS), including optimization, algorithms, machine/deep learning, natural language processing (NLP), computer vision, and DGSS applications used to guide decision-makers to make better decisions and provide them with actionable recommendations.

Jeffrey T. Olimpo, PhD, is an associate professor of biological sciences at the University of Texas at El Paso and a discipline-based education researcher with nearly 10 years of experience in the design and evaluation of Course-Based Undergraduate Research Experiences (CUREs). He uses both quantitative and qualitative techniques to study the impact of professional development experiences on the career growth of science, technology, engineering, and mathematics graduate teaching assistants.

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