{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:43:50Z","timestamp":1777859030581,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The COVID-19 pandemic highlighted significant health disparities across the United States, with Texas ranking among the lowest in healthcare quality. This study explores the relationship between county-level factors and COVID-19 cases in Texas daycare centers. Unlike broader studies on COVID-19 disparities, this research uniquely examines the daycare population, a critical yet understudied environment, through county-level social determinants of health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using 2020-2022 Covid data from the Texas Health &amp; Human Services Commission and the 2020 County Health Rankings, we analyzed COVID-19 case counts among children and staff in licensed daycare facilities across 225 Texas counties. We classified counties into 4 patterns: high child-high staff, high child-low staff, low child-high staff, and low child-low staff. We also examined the association between county-level determinants and pandemic patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Counties with higher COVID-19 cases in daycare centers have higher proportions of racial\/ethnic minorities, but with better access to primary care physicians, better socioeconomic conditions (eg, % of children in poverty and median household income) and greater urbanization (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.05). Spatial analysis of child and staff cases show the clustered transmission areas, in which southeastern counties with more Native Indians (1.48%) have a higher number of staff affected by COVID-19 than counties with fewer Native Indians (1.21%-1.26%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These findings underscore the influence of better access to screening on the COVID-19 counts, highlighting the importance of epidemiological surveillance. Improving healthcare access, addressing economic inequalities, and tailoring mitigation strategies are key to closing the gaps in different transmission rates among daycare centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319261417913","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T04:53:01Z","timestamp":1771476781000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Examine COVID-19 Pandemic Patterns in Daycare Centers: How Access to Screening Matters"],"prefix":"10.1177","volume":"17","author":[{"given":"Meghana","family":"Potturu","sequence":"first","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nova C.","family":"Phillips-Latham","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Mathis","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4333-5444","authenticated-orcid":false,"given":"Wei-Chen","family":"Lee","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Health Insurance Coverage of the Total Population. 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