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Luningham JM, Akpan IN, Alkhatib S, Taskin T, Desai P, Vishwanatha JK, Thompson EL. COVID-19 clinical trial participation and awareness in Texas. Hum Vaccin Immunother 2024; 20:2340692. [PMID: 38658140 PMCID: PMC11057562 DOI: 10.1080/21645515.2024.2340692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
The COVID-19 pandemic required the rapid development of COVID-19 vaccines and treatments, necessitating quick yet representative clinical trial enrollment to evaluate these preventive measures. However, misinformation around the COVID-19 pandemic and general concerns about clinical trial participation in the U.S. hindered clinical trial enrollment. This study assessed awareness of, willingness to participate in, and enrollment in COVID-19 vaccine and treatment clinical trials in Texas. A quota sample of 1,089 Texas residents was collected online from June - July 2022. Respondents were asked if they were aware of, willing to participate in, and had enrolled in clinical trials for COVID-19 vaccines or treatments. Overall, 45.8% of respondents reported being aware of clinical trials for COVID-19 treatments or vaccines, but only 21.7% knew how to enroll and only 13.2% had enrolled in a COVID-19 clinical trial. Respondents with bachelor's or graduate degrees were more likely to be aware of clinical trials, more likely to have enrolled in trials, and more willing to participate in treatment trials. Women were less willing to participate and less likely to have enrolled in COVID-19 clinical trials than men. Respondents aged 55 years and older were more willing to participate, but less likely to have enrolled in COVID-19 clinical trials than 18-to-24-year-olds. Common reasons given for not participating in clinical trials included concerns that COVID-19 treatments may not be safe, government distrust, and uncertainty about what clinical trial participation would entail. Substantial progress is needed to build community awareness and increase enrollment in clinical trials.
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Affiliation(s)
- Justin M. Luningham
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Idara N. Akpan
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Sarah Alkhatib
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Tanjila Taskin
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Palak Desai
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Jamboor K. Vishwanatha
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Erika L. Thompson
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
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Paulus K, Bauerle Bass S, Cabey W, Singley K, Luck C, Hoadley A, Kerstetter M, Rotaru AM, Knight E, Murali S, Verma S, Wilson-Shabazz I, Gardiner H. Using cluster analysis to explore COVID-19 vaccine booster hesitancy by levels of medical mistrust in fully vaccinated US adults. Ann Med 2024; 56:2401122. [PMID: 39258584 PMCID: PMC11391872 DOI: 10.1080/07853890.2024.2401122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Underlying causes of vaccine hesitancy could significantly affect successful uptake of the SARS-CoV2 vaccine booster doses during new waves of COVID-19. Booster rates among US adults are far below what is needed for immunity, but little is known about booster hesitancy among fully vaccinated adults and whether medical mistrust exacerbates barriers to uptake. METHODS A cross-sectional survey was completed among 119 adults in Philadelphia, PA who reported having received the primary SARS-CoV2 vaccine series but not a booster dose. Using the LaVeist Medical Mistrust (MM) Index, a k-means cluster analysis showed two clusters (Low MM, High MM) and differences in attitudes and perceptions about COVID-19 booster vaccines were assessed using F-tests. RESULTS Respondents were 62% Black and female; mean age was 41; 46% reported earning less than $25,000 and 53% had a high school education or less. Overall intention to get boosted was low (mean 3.3 on 0-10 scale). Differences in COVID-19 booster perceptions between those with High (n = 56) vs. Low (n = 59) MM were found, independent of any demographic differences. Most statements (7/10) related to reasons to not be boosted were significant, with those with High MM indicating more concern about feeling sick from the vaccine (F=-3.91, p≤ .001), beliefs that boosters are ineffective for vaccinated people (F= -3.46, p≤ .001), and long-term side effect worries (F=-4.34, p≤ .001). Those with High MM were also more concerned about the adverse effects of the vaccine (F=-2.48, p=.02), but were more likely to trust getting information from doctors or healthcare providers (F= -2.25, p=.03). CONCLUSIONS Results indicate that medical mistrust is an important independent construct when understanding current COVID-19 booster hesitancy. While much work has looked at demographic differences to explain vaccine hesitancy, these results suggest that further research into understanding and addressing medical mistrust could be important for implementing interventions to increase booster rates.
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Affiliation(s)
- Kirsten Paulus
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Whitney Cabey
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Katie Singley
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Caseem Luck
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Ariel Hoadley
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Molly Kerstetter
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Alexandru-Mircea Rotaru
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Elizabeth Knight
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Swathi Murali
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Shreya Verma
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Imani Wilson-Shabazz
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Heather Gardiner
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
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López-Cevallos DF, Harvey SM. Validation of a Modified Group-Based Medical Mistrust Scale Among Young Latinx Adults in the United States. J Community Health 2024; 49:942-949. [PMID: 38980508 DOI: 10.1007/s10900-024-01373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/10/2024]
Abstract
Medical mistrust is an important barrier to accessing health care among Latinx populations in the United States (US). However, research on the validity and reliability of medical mistrust scales is limited. We examined the validity and reliability of a modified bilingual version of the Group-Based Medical Mistrust scale (mGBMMS) among a sample of Latinx adults. Participants included 308 Latinx adults (ages 18-25), who responded in Spanish (n = 134) or English (n = 174). Following feedback from bilingual/bicultural staff during the English-Spanish translation process, we made three changes to the original GBMMS. Validation testing of our 12-item mGBMMS scale included: split-half and internal consistency reliability; discriminant, convergent, and predictive validity; and both exploratory and confirmatory factor analyses. The mGBMMS had good internal consistency (overall sample: Cronbach's α = 0.79; Spanish: Cronbach's α = 0.73; English: Cronbach's α = 0.83). The mGBMMS showed good convergent (moderately correlated with the experiences of discrimination scale, r = 0.46, p < 0.001) and discriminant (weakly correlated with the acculturation scale, r = 0.11, p = 0.06) validity. Split-half reliability was 0.71 (p < 0.001). Exploratory and confirmatory factor analyses found a two-factor solution. The mGBMMS was associated with satisfaction with care (OR = 0.60, 95%CI: 0.42-0.87), a sign of good predictive validity. Findings suggest that the mGBMMS is a valid and reliable scale to utilize among bilingual (Spanish/English) populations in the US. Further validation studies should be considered among Latinx respondents of different ages, backgrounds, languages, and US regions.
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Affiliation(s)
- Daniel F López-Cevallos
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N Pleasant St, Amherst, MA, 01003, USA.
| | - S Marie Harvey
- College of Health, Oregon State University, Women's Building 124, Corvallis, OR, 97331, USA
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Wright CG, Bowling J, Platt J, Carpino T, Low A, Mantell J, Hoos D, Castor D, El-Sadr W, Greenleaf AR. COVID-19 Knowledge Among Sexual and Gender Minority Adults in New York City. LGBT Health 2024. [PMID: 39288085 DOI: 10.1089/lgbt.2023.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Purpose: This study describes sources of COVID-19 vaccine information and COVID-19 knowledge among sexual and gender minority (SGM) adults in New York City (NYC). Methods: A sample of 986 SGM adults in NYC completed an online survey between June 25 and December 1, 2021. Participants indicated their top three sources of COVID-19 vaccine information from a list of 10 options. Participants were also categorized into low or high COVID-19 knowledge using a 14-item questionnaire. We described knowledge sources, then conducted bivariate and multivariable logistic regression to identify characteristics associated with greater knowledge. Results: The mean age of participants was 29 years (range 18-68 years). Only 12.5% identified their health care provider as a main COVID-19 vaccine information source. Social media (54.9%) and TV news channels (51.4%) were most reported as a main COVID-19 vaccine information source. COVID-19 vaccine knowledge was moderate, with four of eight questions showing correct responses in approximately 70% or more participants. In the multivariable logistic regression model, having at least some college education (adjusted odds ratio [aOR]: 2.34, 95% confidence interval [CI]: 1.55-3.52), attaining a master's degree (aOR: 3.28, 95% CI: 1.93-5.57), reporting a household income of $25,000-$49,999 per year (aOR: 1.68, 95% CI: 1.14-2.46), and having health insurance (aOR: 2.12, 95% CI: 1.51-2.96) were significantly associated with high COVID-19 knowledge. Conclusion: Our sample demonstrated high levels of COVID-19 knowledge, particularly among educated individuals and those with health insurance. Primary access to health information was through social media and TV news channels.
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Affiliation(s)
- Connor G Wright
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina - Charlotte, Charlotte, North Carolina, USA
| | - Joey Platt
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tom Carpino
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrea Low
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joanne Mantell
- New York State Psychiatric Institute and Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, Columbia University Irving Medical Center, New York, New York, USA
| | - David Hoos
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Delivette Castor
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Wafaa El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Abigail R Greenleaf
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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Helary A, Botelho-Nevers E, Bonneton M, Khennouf L, Sambourg J, Launay O, Gagneux-Brunon A. Factors, motivations and barriers associated with eagerness to volunteer in COVID-19 vaccine clinical trials in France: A mixed-method study. Vaccine 2024; 42:126035. [PMID: 38910094 DOI: 10.1016/j.vaccine.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/03/2024] [Accepted: 06/01/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION During the COVID-19 pandemic, there was an unprecedented effort to engage people in clinical vaccine research. Most of the French volunteers registered in the first weeks after the launch in October 2020 of COVIREIVAC, an electronic platform dedicated to COVID-19 vaccine clinical trials (VCT). In the context of pandemic preparedness, identifying factors associated with eagerness or hesitancy to participate in VCT may help to increase recruitment of volunteers from diverse backgrounds. METHODS We used a mixed-method survey offered to the volunteers registered on the COVIREIVAC platform, and semi-directed interviews in participants to COVID-19 VCTs. Volunteers were divided into three categories: early volunteers (EV), registered before the launch of the COVID-19 vaccination campaign, middle volunteers (MV) registered between the first of January 2021 and the generalization of the COVID-19 vaccination to the entire population in May 2021, and late volunteers (LV) registered afterward. RESULTS Among the 56,101 COVIREIVAC registered volunteers, 2,741 (4.9 %) completed the survey, 1,915 (69.6%) were EV, 301 (11.0%) were MV and 525 (19.2 %) were LV. Sixteen were face-to-face interviewed. Age, educational level, attitudes toward vaccination evaluated with the 5C-model did not differ between EV and MV. Women gender and the possibility to choose the vaccine platform was associated with being a MV. LV were significantly younger, had a lower educational level and had less positive attitudes toward vaccines than EV and MV. The main motivations for participation in VCTs were altruistic notably in EV and MV. For LV, they registered in the hope to choice the vaccine technology. Among the respondents, 2,041 (74.5 %) would consider to participate in a non-COVID-19 VCT. CONCLUSION LV on the COVIREIVAC platform had a distinct profile from EV and MV, and were less confident in vaccines. Restoring confidence in vaccines and clinical may help to engage more diverse populations in VCTs.
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Affiliation(s)
- Aloïs Helary
- Inserm, F-CRIN, I-REIVAC/COVIREIVAC, 75679 Paris, France
| | - Elisabeth Botelho-Nevers
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, France; CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, France; Chaire PREVACCI, Université Jean Monnet, Saint-Etienne, France
| | - Marion Bonneton
- PCCEI, UMR 1058, Université de Montpellier, INSERM, EFS, France
| | - Léa Khennouf
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, France; CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, France; Chaire PREVACCI, Université Jean Monnet, Saint-Etienne, France
| | | | - Odile Launay
- Inserm, F-CRIN, I-REIVAC/COVIREIVAC, 75679 Paris, France; Université de Paris, Inserm CIC 1417, Assistance publique - Hôpitaux de Paris, hôpital Cochin, 75679 Paris, France
| | - Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, France; CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, France; Chaire PREVACCI, Université Jean Monnet, Saint-Etienne, France.
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Marin DB, Sharma V, Costello Z, Prieto V, DePierro J, Starkweather S, Robinson M, Goulbourne D, Jandorf L. Sustainability and Adaptability of a Community Health Advisor-Led Educational Program in Faith-Based Organizations in Underserved Communities during the COVID-19 Pandemic. J Community Health 2024:10.1007/s10900-024-01397-8. [PMID: 39235542 DOI: 10.1007/s10900-024-01397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/06/2024]
Abstract
The COVID-19 pandemic caused unprecedented disruption in all activities, especially those related to group gatherings. During the lockdown period, faith-based organizations, which are resources for both religious and health promotion activities, had to develop alternative strategies to meet those goals. The purpose of this paper is to describe the sustainability of M.I.C.A.H. Project HEAL, a partnership between an academic medical center and faith-based organizations in underserved communities in New York City, during the initial pandemic lockdown period. The use of virtual platforms facilitated Community Health Advisors (CHAs) in 13 organizations to conduct 47 health education workshops, reaching over 800 participants. Reliance on virtual platforms continued after in person gatherings were permitted. These data further support the benefits of academic partnerships with faith-based organizations to provide timely health information during a public health crisis.
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Affiliation(s)
- Deborah B Marin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Vanshdeep Sharma
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zorina Costello
- Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Vilma Prieto
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jonathan DePierro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Sydney Starkweather
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mimsie Robinson
- Bethel Gospel Assembly, Inc. 2-26 East 120th St, New York, NY, 10035, USA
| | - Desna Goulbourne
- United Moravian Church, 200 E 127th Street, New York, NY, 10035, USA
| | - Lina Jandorf
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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Leonard SI, Pizii CT, Zhao Y, Céspedes A, Kingston S, Bruzzese JM. Group-Based Medical Mistrust in Adolescents With Poorly Controlled Asthma Living in Rural Areas. Health Promot Pract 2024; 25:758-762. [PMID: 36655727 DOI: 10.1177/15248399221150913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Black youth and rural adolescents are two groups who experience asthma disparities. Racism and discrimination in health care likely lead to group-based (systems-level) medical mistrust for some adolescents. Group-based medical mistrust, one pathway by which racism drives health inequities, is associated with poorer outcomes for patients with chronic conditions. Despite its potential importance in adolescent asthma, previous research has not considered group-based medical mistrust in this population. To fill this gap, we characterize group-based medical mistrust among rural adolescents with poorly controlled asthma, examining demographic differences. We analyzed baseline data from a school-based clinical trial in which 164 adolescents (mean age = 16.3; 76.2% Black) completed the Group-Based Medical Mistrust Scale (GBMMS). Using linear regression, we tested associations with race, gender, and age, controlling for recent medical visits and insurance status. The total GBMMS mean score was 2.3 (SD = 1.22); subscale scores ranged from 2.3 to 2.4. Black adolescents reported significantly higher total GBMMS scores (β = .45, p = .003) and significantly higher scores on two GBMMS subscales: suspicion of health care providers (β = .56, p = .007) and lack of support from health care providers (β = .36, p = .007). Gender and age were not associated with GBMMS scores. Health care providers need to consider medical mistrust and its role in their clinical care. Together with their institutions, health care providers and researchers should work toward changing systems that perpetuate racism to build trust as a means of reducing asthma disparities among adolescents.
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Affiliation(s)
| | - Connor T Pizii
- Medical University of South Carolina, Charleston, SC, USA
| | - Yihong Zhao
- Columbia University School of Nursing, New York, NY, USA
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Cueva KL, Marshall AR, Snyder CR, Young BA, Brown CE. Medical Mistrust Among Black Patients with Serious Illness: A Mixed Methods Study. J Gen Intern Med 2024:10.1007/s11606-024-08997-z. [PMID: 39187720 DOI: 10.1007/s11606-024-08997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Medical mistrust among Black patients has been used to explain the existence of well-documented racial inequities at the end of life that negatively impact this group. However, there are few studies that describe patient perspectives around the impact of racism and discriminatory experiences on mistrust within the context of serious illness. OBJECTIVE To better characterize experiences of racism and discrimination among patients with serious illness and its association with medical mistrust. PARTICIPANTS Seventy-two Black participants with serious illness hospitalized at an academic county hospital. APPROACH This is a convergent mixed methods study using data from participant-completed surveys and existing semi-structured interviews eliciting participants' perspectives around their experiences with medical racism, communication, and decision-making. MAIN MEASURES The experience of medical racism and its association with Group-Based Medical Mistrust (GBMM) scale scores, a validated measure of medical mistrust. KEY RESULTS Of the 72 Black participants, 35% participated in interviews. Participants were mostly men who had significant socioeconomic disadvantage, including low levels of wealth, income, and educational attainment. There were reported high levels of race-based mistrust in the overall GBMM scale score (mean [SD], 36.6 [9.9]), as well as high scores within the suspicion (14.2 [5.0]), group disparities in healthcare (9.9 [2.8]), and lack of support (9.1 [2.7]) subscales. Three qualitative themes aligned with the GBMM subscales. Participants expressed skepticism of healthcare workers (HCWs) and modern medicine, recounted personal experiences of discrimination in the medical setting, and were frustrated with poor communication from HCWs. CONCLUSIONS This study found high levels of mistrust among Black patients with serious illness. Suspicion of HCWs, disparities in healthcare by race, and a lack of support from HCWs were overarching themes that influenced medical mistrust. Critical, race-conscious approaches are needed to create strategies and frameworks to improve the trustworthiness of healthcare institutions and workers.
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Affiliation(s)
| | - Arisa R Marshall
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Cyndy R Snyder
- Department of Family Medicine, Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle, WA, USA
| | - Bessie A Young
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
- UW Justice, Equity, and Inclusion Center for Transformational Research, Office of Healthcare Equity, UW Medicine, University of Washington, Seattle, WA, USA
| | - Crystal E Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA, USA
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
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Carosella EA, Su M, Testa MA, Arzilli G, Conni A, Savoia E. COVID-19 Vaccine Hesitancy and Misinformation Endorsement among a Sample of Native Spanish-Speakers in the US: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1545. [PMID: 39120248 PMCID: PMC11311759 DOI: 10.3390/healthcare12151545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
Research on COVID-19 vaccine hesitancy and misinformation endorsement among Spanish-speaking Americans is limited. This cross-sectional study used a Spanish-language survey from May-August 2021 among 483 Spanish speakers living in the US and Puerto Rico. We applied multivariable Poisson regression with robust error variances to assess the association between independent variables and binary outcomes for vaccine acceptance versus hesitance, as well as misinformation endorsement. Vaccine acceptance was associated with COVID-19 risk perception score (PR = 1.7 high vs. low perceived risk), opinion of government transparency (PR = 2.2 very transparent vs. not transparent), and trust in vaccine information (PR = 1.8 high vs. low). There was also an interaction between time spent on social media and social media as a main source of COVID-19 information (p = 0.0484). Misinformation endorsement was associated with opinion about government transparency (PR = 0.5 moderately vs. not transparent), trust in vaccine information (PR = 0.5 high vs. low trust), social media impact on vaccine confidence (PR = 2.1 decreased vs. increased confidence), distrust vaccines (PR = 1.9 distrust vs. trust), using vaccine information from Facebook (PR = 1.4 yes vs. no), and time spent on social media by those using social media as main source of COVID-19 vaccine information (p = 0.0120). Vaccine acceptance in respondents with high misinformation endorsement scores was 0.7 times those with low scores. These findings highlight the importance of effective information dissemination, the positive role of social media, and government transparency in boosting vaccine uptake among Spanish speakers in the US.
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Affiliation(s)
- Elizabeth A. Carosella
- Emergency Preparedness Research Evaluation & Practice Program (EPREP), Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (E.A.C.); (M.S.); (M.A.T.)
- Mathematica Policy Research, Mathematica, Princeton, NJ 08540, USA
| | - Maxwell Su
- Emergency Preparedness Research Evaluation & Practice Program (EPREP), Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (E.A.C.); (M.S.); (M.A.T.)
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Marcia A. Testa
- Emergency Preparedness Research Evaluation & Practice Program (EPREP), Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (E.A.C.); (M.S.); (M.A.T.)
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Alice Conni
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Elena Savoia
- Emergency Preparedness Research Evaluation & Practice Program (EPREP), Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (E.A.C.); (M.S.); (M.A.T.)
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Harris M, Sherrod D, Walsh JL, Hunt BR, Jacobs J, Valencia J, Baumer-Mouradian S, Quinn KG. The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago. J Racial Ethn Health Disparities 2024; 11:2425-2434. [PMID: 37531019 DOI: 10.1007/s40615-023-01708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023]
Abstract
Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.
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Affiliation(s)
- Melissa Harris
- Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Darielle Sherrod
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bijou R Hunt
- Sinai Health System, Sinai Infectious Disease Center, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jesus Valencia
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
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11
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Khazanchi R, Rader B, Cantor J, McManus KA, Bravata DM, Weintraub R, Whaley C, Brownstein JS. Spatial Accessibility and Uptake of Pediatric COVID-19 Vaccinations by Social Vulnerability. Pediatrics 2024; 154:e2024065938. [PMID: 39028301 DOI: 10.1542/peds.2024-065938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Geographic accessibility predicts pediatric preventive care utilization, including vaccine uptake. However, spatial inequities in the pediatric coronavirus disease 2019 (COVID-19) vaccination rollout remain underexplored. We assessed the spatial accessibility of vaccination sites and analyzed predictors of vaccine uptake. METHODS In this cross-sectional study of pediatric COVID-19 vaccinations from the US Vaccine Tracking System as of July 29, 2022, we described spatial accessibility by geocoding vaccination sites, measuring travel times from each Census tract population center to the nearest site, and weighting tracts by their population demographics to obtain nationally representative estimates. We used quasi-Poisson regressions to calculate incidence rate ratios, comparing vaccine uptake between counties with highest and lowest quartile Social Vulnerability Index scores: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation. RESULTS We analyzed 15 233 956 doses administered across 27 526 sites. Rural, uninsured, white, and Native American populations experienced longer travel times to the nearest site than urban, insured, Hispanic, Black, and Asian American populations. Overall Social Vulnerability Index, SES, and HCD were associated with decreased vaccine uptake among children aged 6 months to 4 years (overall: incidence rate ratio 0.70 [95% confidence interval 0.60-0.81]; SES: 0.66 [0.58-0.75]; HCD: 0.38 [0.33-0.44]) and 5 years to 11 years (overall: 0.85 [0.77-0.95]; SES: 0.71 [0.65-0.78]; HCD: 0.67 [0.61-0.74]), whereas social vulnerability by MSL was associated with increased uptake (6 months-4 years: 5.16 [3.59-7.42]; 5 years-11 years: 1.73 [1.44-2.08]). CONCLUSIONS Pediatric COVID-19 vaccine uptake and accessibility differed by race, rurality, and social vulnerability. National supply data, spatial accessibility measurement, and place-based vulnerability indices can be applied throughout public health resource allocation, surveillance, and research.
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Affiliation(s)
- Rohan Khazanchi
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, Massachusetts
- Departments of Internal Medicine
- Pediatrics
- FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts
| | - Benjamin Rader
- Computational Epidemiology Laboratory, Boston Children's Hospital, Boston, Massachusetts
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Kathleen A McManus
- Division of Infectious Diseases and International Health, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia
| | - Dena M Bravata
- Castlight Health, San Francisco, California
- Center for Primary Care & Outcomes Research, and Stanford University, Palo Alto, California
| | - Rebecca Weintraub
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Ariadne Laboratories, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher Whaley
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
- Brown University, Providence, Rhode Island
| | - John S Brownstein
- Pediatrics
- Computational Epidemiology Laboratory, Boston Children's Hospital, Boston, Massachusetts
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12
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Yu H, Bauermeister J, Oyiborhoro U, Morales K, Aryal S, Glanz K, Villarruel A, Bonett S. The relationship between trust in federal oversight of vaccine safety and willingness to participate in COVID-19 clinical trials: a repeated measures study of Philadelphia residents (September 2021 - March 2023). BMC Public Health 2024; 24:2059. [PMID: 39085794 PMCID: PMC11290126 DOI: 10.1186/s12889-024-19602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic precipitated an urgent need for clinical trials to discover safe and efficacious treatments. We examined how COVID-19 experiences, clinical trial awareness, and trust in the vaccine safety process were associated with willingness to participate in COVID-19 clinical trials. The objective was to investigate the relationship between trust in federal oversight of vaccine safety and willingness to participate in clinical trials for COVID-19 treatment across four distinct time points over an 18-month period during the COVID-19 pandemic. METHODS We used four waves of data collected from September 2021 to March 2023 among 582 Philadelphia residents (with a missing data rate of 0.9%). Generalized estimating equations estimated the association between willingness to participate in COVID-19 clinical trials and participants' trust in the federal government's oversight of COVID-19 vaccine safety, COVID-19-related variables (COVID-19 related health challenges, history of COVID-19 infection), awareness of clinical trials and how to enroll in them, and sociodemographic characteristics (age, race/ethnicity, sexual orientation, gender, parental status, education, and insurance). RESULTS On average, willingness to participate in a COVID-19 clinical trial was positively associated with greater trust in the federal government's oversight of vaccine safety [β = 0.34, 95% confidence interval (CI): 0.15-0.53], having COVID-19 (β = 0.40, 95% CI: 0.08-0.73), awareness of clinical trials (β = 0.38, 95% CI: 0.04-0.73), and knowledge of how to enroll (β = 0.83, 95% CI: 0.44-1.23). Among sociodemographic characteristics, race/ethnicity (p = 0.001) and gender (p = 0.018) were identified as predictors for COVID-19 trial willingness. CONCLUSION Willingness to participate in clinical trials may be bolstered by strengthening the public's trust in the federal government's role within vaccine safety oversight, increasing the perceived relevance of clinical trials to individuals' health and well-being, and offering tailored information to educate diverse communities about ongoing trials and how to enroll in them.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Ufuoma Oyiborhoro
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Knashawn Morales
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Subhash Aryal
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Karen Glanz
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Antonia Villarruel
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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13
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Howie CM, Cichos KH, Shoreibah MG, Jordan EM, Niknam KR, Chen AF, Hansen EN, McGwin GG, Ghanem ES. Racial Disparities in Treatment and Outcomes of Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty. J Arthroplasty 2024; 39:1671-1678. [PMID: 38331360 DOI: 10.1016/j.arth.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND African Americans have the highest prevalence of chronic Hepatitis C virus (HCV) infection. Racial disparities in outcome are observed after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study sought to identify if disparities in treatments and outcomes exist between Black and White patients who have HCV prior to elective THA and TKA. METHODS Patient demographics, comorbidities, HCV characteristics, perioperative variables, in-hospital outcomes, and postoperative complications at 1-year follow-up were collected and compared between the 2 races. Patients who have preoperative positive viral load (PVL) and undetectable viral load were identified. Chi-square and Fisher's exact tests were used to compare categorical variables, while 2-tailed Student's Kruskal-Wallis t-tests were used for continuous variables. A P value of less than .05 was statistically significant. RESULTS The liver function parameters, including aspartate aminotransferase and model for end-stage liver disease scores, were all higher preoperatively in Black patients undergoing THA (P = .01; P < .001) and TKA (P = .03; P = .003), respectively. Black patients were more likely to undergo THA (65.8% versus 35.6%; P = .002) and TKA (72.1% versus 37.3%; 0.009) without receiving prior treatment for HCV. Consequently, Black patients had higher rates of preoperative PVL compared to White patients in both THA (66% versus 38%, P = .006) and TKA (72% versus 37%, P < .001) groups. Black patients had a longer length of stay for both THA (3.7 versus 3.3; P = .008) and TKA (4.1 versus 3.0; P = .02). CONCLUSIONS The HCV treatment prior to THA and TKA with undetectable viral load has been shown to be a key factor in mitigating postoperative complications, including joint infection. We noted that Black patients were more likely to undergo joint arthroplasty who did not receive treatment and with a PVL. While PVL rates decreased over time for both races, a significant gap persists for Black patients.
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Affiliation(s)
- Cole M Howie
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kyle H Cichos
- Hughston Foundation, Columbus, Georgia; Hughston Clinic, Columbus, Georgia
| | - Mohamed G Shoreibah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric M Jordan
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Kian R Niknam
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Erik N Hansen
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Gerald G McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elie S Ghanem
- Department of Orthopaedic Surgery, University of Missouri at Columbia, Columbia, Missouri
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Halim A, Zhang D, FitzPatrick S, Fishman F. Professionalism in Hand Surgery: Treating the Noncompliant Patient. J Hand Surg Am 2024; 49:702-705. [PMID: 38713111 DOI: 10.1016/j.jhsa.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/09/2024] [Accepted: 03/09/2024] [Indexed: 05/08/2024]
Abstract
Every practicing hand surgeon has had the challenging experience of treating a patient who demonstrates difficulty with, or inability to comply with medical advice. Patient noncompliance can lead to not only poor patient outcomes but also deterioration in the therapeutic relationship, physician burnout, high cost of care, and medical-legal risk. The guiding principles in the ethical practice of medicine render it important to consider noncompliance as a potentially modifiable risk factor, and every attempt should be made to work with these noncompliant patients to achieve the best possible outcomes. Data suggest that noncompliance may be affected by socioeconomic status and race; many of these patients are among the vulnerable. However, in some instances, treatment options may warrant alteration or adjustment to reflect the noncompliance of the patient. Rarely, it may be reasonable for a physician to discharge a patient from care once any urgent problems have been managed. Ethical and responsible management of a noncompliant patient requires a thoughtful and measured approach.
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Affiliation(s)
- Andrea Halim
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT.
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Felicity Fishman
- Stritch School of Medicine, Loyola University, Maywood, Chicago, IL
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15
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Petruzzi L, Smithwick J, Lee L, Delva J, Fox L, Wilkinson G, Vohra-Gupta S, Aranda M, Valdez C, Jones B. Community Health Work and Social Work Collaboration: Integration in Health Care and Public Health Settings: A Conceptual Framework. J Ambul Care Manage 2024; 47:187-202. [PMID: 38775666 DOI: 10.1097/jac.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Community health worker (CHW) and social worker (SW) collaboration is crucial to illness prevention and intervention, yet systems often engage the 2 workforces in silos and miss opportunities for cross-sector alignment. In 2021, a national workgroup of over 2 dozen CHWs, SWs, and public health experts convened to improve CHW/SW collaboration and integration across the United States. The workgroup developed a conceptual framework that describes structural, systemic, and organizational factors that influence CHW/SW collaboration. Best practices include standardized training, delineated roles and scopes of practice, clear workflows, regular communication, a shared system for documentation, and ongoing support or supervision.
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Affiliation(s)
- Liana Petruzzi
- Author Affiliations: Dell Medical School at the University of Texas at Austin, Austin, Texas (Drs Petruzzi, Valdez, and Jones); Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Mss Smithwick and Fox); Knowledge Transfer Exchange Strategies, LLC, Corona, California (Dr Lee); Center for Innovation in Social Work Health, Boston University School of Social Work, Boston, Massachusetts (Dr Delva and Mr Wilkinson); Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas (Drs Vohra-Gupta, Valdez, and Jones); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr Aranda)
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16
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Munoz-Lavanderos C, Oluyomi A, Rosales O, Hernandez N, Mensah-Bonsu N, Badr H. Development, Implementation, and Evaluation of Three Outreach Events to Improve COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Communities in Houston, Texas, 2022. Public Health Rep 2024; 139:71S-80S. [PMID: 38140821 PMCID: PMC11339676 DOI: 10.1177/00333549231213848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities. METHODS Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored to the needs of these communities in January-March 2022. We used program evaluation surveys to assess attendee characteristics and satisfaction with the events. Vaccinated attendees also completed surveys on what motivated them to get vaccinated. RESULTS Two communities were predominantly Hispanic, and the third had an equal number of Black and Hispanic residents. Based on community stakeholder input, the study team organized 2 health fairs and 1 community festival featuring dialogue-based COVID-19 vaccine engagement in January and March 2022. Across the 3 events, a total of 865 attendees received COVID-19 education and 205 (24.0%) attendees received a COVID-19 vaccine or booster. Of 90 attendees who completed program evaluation surveys, 81 (90%) rated the outreach event as good or excellent. Of 145 attendees who completed postvaccination surveys, 132 (91%) endorsed ≥1 key program feature as motivating them to either get vaccinated or vaccinate their child that day. CONCLUSION Community outreach events are important strategies for disseminating information, building trust, and facilitating COVID-19 vaccine uptake.
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Affiliation(s)
| | - Abiodun Oluyomi
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Omar Rosales
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Norvin Hernandez
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nana Mensah-Bonsu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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17
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Morris N, Biggs MA, Baba CF, Seymour JW, White K, Grossman D. Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States. Womens Health Issues 2024; 34:381-390. [PMID: 38658288 DOI: 10.1016/j.whi.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients' interest in these models. METHODS Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants. RESULTS Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly. CONCLUSIONS Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.
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Affiliation(s)
- Natalie Morris
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - C Finley Baba
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Jane W Seymour
- Collaborative for Reproductive Equity, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kari White
- Resound Research for Reproductive Health, Austin, Texas
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Goddard-Eckrich D, Stringer KL, Richer A, Dasgupta A, Brooks D, Cervantes M, Downey DL, Kelleher P, Bell SL, Hunt T, Wu E, Johnson KA, Hall J, Guy-Cupid GAN, Thomas BV, Edwards K, Ramesh V, Gilbert L. 'Yeah, they suck. It's like they don't care about our health.' Medical mistrust among Black women under community supervision in New York city. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38915232 DOI: 10.1080/13691058.2024.2358084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 05/17/2024] [Indexed: 06/26/2024]
Abstract
Black women in the USA experience some of the poorest health outcomes and this is especially true for those involved in the carceral system who are at elevated risks for HIV/STIs, reproductive health, and chronic diseases. This study aimed to investigate Black women's experience accessing healthcare services. We conducted semi-structured interviews with 43 women from Project EWORTH under community supervision in New York City. We analysed responses focusing on barriers to healthcare engagement. All interviews were recorded, and data analysis was conducted using NVivo. Themes influencing Black women's ability to engage with healthcare providers and systems included: 1) disclosed provider mistrust/judgement; 2) feeling disrespected by providers and the medical system; 3) mistrust of medical providers/system/hospital/government; 4) lack of health communication; 5) low health literacy; 6) provider gender preference. Findings highlight the need to improve trust and collaboration between healthcare providers and Black women. This study addresses the critical gap in understanding perceptions of discrimination, stigma, and barriers to attaining health care. Funders and accreditation agencies must hold providers and organisations accountable for acquiring and making available diversity, equity and inclusion training for providers, demonstrating increasingly equitable medical relationships through responsiveness to patient feedback, and increasing the number of Black providers.
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Affiliation(s)
- Dawn Goddard-Eckrich
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Kristi L Stringer
- Department of Health and Human Performance, Public Health. Middle Tennessee State University, Murfreesboro, TN, USA
| | - Ariel Richer
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Anindita Dasgupta
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Deidra Brooks
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Melissa Cervantes
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Dget L Downey
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Phoebe Kelleher
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Sydney L Bell
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Timothy Hunt
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Elwin Wu
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Karen A Johnson
- School of Social Work, University of AL, Tuscaloosa, AL, USA
| | - Jennifer Hall
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Gail-Ann N Guy-Cupid
- College of Liberal Arts & Social Sciences, Social Work Program, University of The Virgin Islands, Saint. Thomas/Saint Croix, UVI, USA
| | - Brittany V Thomas
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Kevonyah Edwards
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Vineha Ramesh
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Louisa Gilbert
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
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Austin CA, Seligman B, Shan-Bala S, Kuchel GA, Loh KP, Kistler CE, Batsis JA. Aging precisely: Precision medicine through the lens of an older adult. J Am Geriatr Soc 2024. [PMID: 38888213 DOI: 10.1111/jgs.19036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024]
Abstract
Precision medicine presents an opportunity to use novel, data-driven strategies to improve patient care. The field of precision medicine has undergone many advancements over the past few years. It has moved beyond incorporation of individualized genetic risk into medical decision-making to include multiple other factors such as unique social, demographic, behavioral, and clinical characteristics. Geriatric medicine stands to benefit heavily from the integration of precision medicine into its standard practices. Older adults, compared with other populations, have high clinical and biological heterogeneity that can alter the risks and benefits of different approaches to patient care. These factors have not been routinely considered previously by geriatricians. Yet, geriatricians' ability to address older adults' baseline heterogeneity is increasingly recognized as a cornerstone of delivering quality care in a geriatric medical practice. Given the shared focus of individualized decision-making, precision medicine is a natural fit for geriatric medicine. This manuscript provides, via cases and discussion, examples that illustrate how precision medicine can improve the care of our older patients today. We will share specific and existing tools and evidence, and review the existing multilevel barriers to further incorporate and implement these tools into clinical practice. We propose methods to address these barriers and to help realize the full potential of precision medicine for the care of older adults. We conclude with a brief discussion of potential future directions of research of precision medicine in the care of older adults.
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Affiliation(s)
- C Adrian Austin
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Benjamin Seligman
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, California, USA
- Division of Geriatric Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sangeetha Shan-Bala
- Division of Geriatric Medicine, Department of Medicine, Inova Health System, Fairfax Medical Campus, Falls Church, Virginia, USA
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Chrissy E Kistler
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John A Batsis
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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20
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Brewer SE, Bertin KB, Suresh K, LoudHawk-Hedgepeth C, Tamez M, Reno JE, Kwan BM, Nease DE. Factors in COVID-19 vaccine uptake in five racial/ethnic Colorado communities: A report from the Colorado CEAL project. PLoS One 2024; 19:e0305160. [PMID: 38865424 PMCID: PMC11168616 DOI: 10.1371/journal.pone.0305160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024] Open
Abstract
PURPOSE To understand motivators, concerns, and factors associated with COVID-19 vaccine initiation for adults in five racial/ethnic communities across Colorado. METHODS Community-based data collectors surveyed participants from five Colorado communities (urban and rural Latina/o/x, urban Black, rural African American immigrant, and urban American Indian) about vaccine attitudes, intentions, and uptake from September to December 2021. Bivariate and multivariable logistic regression models were used to examine factors associated with the primary outcome of COVID-19 vaccine "initiation." RESULTS Most participants (71.1%) reported having initiated COVID-19 vaccination; vaccine series completion was 65.1%. Both motivators and concerns about COVID-19 vaccines were prevalent. Vaccine hesitancy (OR: 0.41, 95% CI:0.32-0.53; p < .001) and low perceptions of COVID-19 vaccination social norms (OR: 0.48, 95% CI:0.27-0.84; p = .01) were associated with vaccine initiation. CONCLUSION Despite the limitation of a moderate sample size, our findings support the need for further interventions to increase vaccination against COVID-19 by reducing vaccine hesitancy and improving perceived social norms of vaccination in underserved Colorado communities. IMPLICATIONS To improve trust in vaccines and promote vaccine uptake, community messaging should be tailored to vaccination motivators and concerns and demonstrate COVID-19 vaccination as the community default.
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Affiliation(s)
- Sarah E. Brewer
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Family Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Kaitlyn B. Bertin
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Crystal LoudHawk-Hedgepeth
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- American Indian College Fund, Denver, CO, United States of America
| | - Montelle Tamez
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Jenna E. Reno
- Center for Communication and Engagement Research, RTI International, Aurora, CO, United States of America
| | - Bethany M. Kwan
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Emergency Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Donald E. Nease
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Family Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
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21
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Khan MMM, Munir MM, Woldesenbet S, Khalil M, Endo Y, Katayama E, Altaf A, Dillhoff M, Obeng-Gyasi S, Pawlik TM. Disparities in clinical trial enrollment among patients with gastrointestinal cancer relative to minority-serving and safety-netting hospitals. J Gastrointest Surg 2024; 28:896-902. [PMID: 38555017 DOI: 10.1016/j.gassur.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND For results to be generalizable to all patients with cancer, clinical trials need to include a diverse patient demographic that is representative of the general population. We sought to characterize the effect of receiving care at a minority-serving hospital (MSH) and/or safety-net hospital on clinical trial enrollment among patients with gastrointestinal (GI) malignancies. METHODS Adult patients with GI cancer who underwent oncologic surgery and were enrolled in institutional-/National Cancer Institute-funded clinical trials between 2012 and 2019 were identified in the National Cancer Database. Multivariable regression was used to assess the relationship between MSH and safety-net status relative to clinical trial enrollment. RESULTS Among 1,112,594 patients, 994,598 (89.4%) were treated at a non-MSH, whereas 117,996 (10.6%) were treated at an MSH. Only 1857 patients (0.2%) were enrolled in a clinical trial; most patients received care at a non-MSH (1794 [96.6%]). On multivariable analysis, the odds of enrollment in a clinical trial were markedly lower among patients treated at an MSH vs non-MSH (odds ratio [OR], 0.32; 95% CI, 0.22-0.46). In addition, even after controlling for receipt of care at MSH, Black patients remained at lower odds of enrollment in a clinical trial than White patients (OR, 0.57; 95% CI, 0.45-0.73; both P < .05). CONCLUSION Overall, clinical trial participation among patients with GI cancer was extremely low. Patients treated at an MSH and high safety-net burden hospitals and Black individuals were much less likely to be enrolled in a clinical trial. Efforts should be made to improve trial enrollment and address disparities in trial representation.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mujtaba Khalil
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erryk Katayama
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Abdullah Altaf
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mary Dillhoff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
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22
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Guan D, Dave S, Ebrahim M, Laroche JA. Factors associated with childhood non-vaccination against COVID-19 in Canada: A national survey analysis. Vaccine X 2024; 18:100478. [PMID: 38572339 PMCID: PMC10988031 DOI: 10.1016/j.jvacx.2024.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
Background COVID-19 vaccination efforts are critical in mitigating the impact of the virus, but despite proven safety and efficacy, vaccination rates among children in Canada are lower than in adults, prompting a need to explore determinants of childhood COVID-19 non-vaccination to improve uptake. Method This study analyzed data from the Canadian COVID-19 Immunization Coverage Survey 2022. Using multivariable logistic regression, it examined the association between COVID-19 non-vaccination among children aged 5-17 and factors such as parental sociodemographic characteristics, vaccine knowledge, attitudes, and beliefs (KAB), and vaccination history. Results The analysis revealed that negative KAB towards vaccines, reflected in higher KAB composite scores, significantly increased the likelihood of non-vaccination. Additionally, factors such as lower household incomes, rural residence, employment in sectors not at risk for vaccine-preventable diseases, and younger parental age were associated with higher non-vaccination. The study also highlighted ethnic disparities in vaccination odds and found that children with incomplete routine vaccinations or inconsistent flu vaccination histories were more likely to be unvaccinated against COVID-19. Surprisingly, children of parents who consistently received flu vaccinations were more likely to be unvaccinated against COVID-19. Furthermore, parental education levels showed a complex relationship with children's COVID-19 vaccination status, indicating nuanced influences on vaccination decisions. Conclusion The findings offer vital insights into the factors influencing COVID-19 vaccination uptake among children in Canada, suggesting avenues for targeted strategies to improve vaccine coverage.
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Affiliation(s)
- David Guan
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Sailly Dave
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Marwa Ebrahim
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Julie A. Laroche
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
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23
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Greberman E, Kerrison EMT, Chalfin A, Hyatt JM. Understanding Vaccine Hesitancy in U.S. Prisons: Perspectives from a Statewide Survey of Incarcerated People. Vaccines (Basel) 2024; 12:600. [PMID: 38932328 PMCID: PMC11209440 DOI: 10.3390/vaccines12060600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
Much of the American response to the COVID-19 pandemic was characterized by a divergence between general public opinion and public health policy. With little attention paid to individuals incarcerated during this time, there is limited direct evidence regarding how incarcerated people perceived efforts to mediate the harms of COVID-19. Prisons operate as a microcosm of society in many ways but they also face unique public health challenges. This study examines vaccine hesitancy-and acceptance-among a sample of individuals incarcerated within adult prisons in Pennsylvania. Using administrative records as well as rich attitudinal data from a survey of the incarcerated population, this study identifies a variety of social and historical factors that are-and are not-associated with an incarcerated person's willingness to receive the COVID-19 vaccine. Our findings highlight vaccination challenges unique to the carceral context and offer policy recommendations to improve trust in credible health messengers and health service provision for this often overlooked but vulnerable population.
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Affiliation(s)
- Emily Greberman
- School of Criminal Justice, Rutgers University, Newark, NJ 07102, USA
| | | | - Aaron Chalfin
- Department of Criminology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jordan M. Hyatt
- Department of Criminology & Justice Studies, Center for Public Policy, Drexel University, Philadelphia, PA 19104, USA;
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24
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Tiruneh YM, Cuccaro PM, Elliott KS, Xie J, Martinez J, Owens M, Alvarado CR, Yamal JM. Vaccine Uptake and Intentions: Insights from a Texas Survey on Factors Influencing COVID-19 Vaccination Decisions. Vaccines (Basel) 2024; 12:601. [PMID: 38932330 PMCID: PMC11209159 DOI: 10.3390/vaccines12060601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The effectiveness of COVID-19 vaccines depends on widespread vaccine uptake. Employing a telephone-administered weighted survey with 19,502 participants, we examined the determinants of COVID-19 vaccine acceptance among adults in Texas. We used multiple regression analysis with LASSO-selected variables to identify factors associated with COVID-19 vaccine uptake and intentions to receive the vaccine among the unvaccinated. The prevalence of unvaccinated individuals (22%) was higher among those aged 18-39, males, White respondents, English speakers, uninsured individuals, those facing financial challenges, and individuals expressing no concern about contracting the illness. In a fully adjusted regression model, higher odds of being unvaccinated were observed among males (aOR 1.11), the uninsured (aOR 1.38), smokers (aOR 1.56), and those facing financial struggles (aOR 1.62). Conversely, Asians, Blacks, and Hispanics were less likely to be unvaccinated compared to Whites. Among the unvaccinated, factors associated with stronger intent to receive the vaccine included age (over 65 years), Black and Hispanic ethnicity, and perceived risk of infection. Hispanic individuals, the uninsured, those covered by public insurance, and those facing financial challenges were more likely to encounter barriers to vaccine receipt. These findings underscore the importance of devising tailored strategies, emphasizing nuanced approaches that account for demographic, socioeconomic, and attitudinal factors in vaccine distribution and public health interventions.
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Affiliation(s)
- Yordanos M. Tiruneh
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA
- Department of Internal Medicine, School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Paula M. Cuccaro
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 78701, USA;
| | - Kimberly S. Elliott
- Department of Health Policy, Economics, and Management, School of Professions, University of Texas at Tyler, Tyler, TX 75708, USA;
| | - Jing Xie
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (J.X.); (J.M.); (J.-M.Y.)
| | - Journey Martinez
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (J.X.); (J.M.); (J.-M.Y.)
| | - Mark Owens
- Department of Political Science, School of Humanities and Social Sciences, The Citadel, Charleston, SC 29409, USA;
| | - Christian R. Alvarado
- Department of Epidemiology and Biostatistics, School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA;
| | - Jose-Miguel Yamal
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (J.X.); (J.M.); (J.-M.Y.)
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25
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Fedewa SA, Valentino LA, Koo A, Cafuir L, Tran DQ, Antun A, Kempton CL. Race and ethnicity reporting and representation in hemophilia clinical trials. Blood Adv 2024; 8:2351-2360. [PMID: 38547444 PMCID: PMC11127208 DOI: 10.1182/bloodadvances.2024012862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
ABSTRACT Racial and ethnic representativeness in clinical trials is crucial to mitigate disparities in outcomes; however, diversity among hemophilia trials is unknown. The aim of this study is to examine the reporting and representation of race and ethnicity in trials of people with hemophilia (PwH). In this cross-sectional study, the ClinicalTrials.gov database was queried in April 2023 for interventional clinical trials involving PwH between 2007 and 2022. The distribution of participants (observed) was compared with expected proportions based on US Hemophilia Treatment Center (HTC) and country-specific census data with observed-to-expected ratios (OERs). Of 129 trials included, 94.6% were industry sponsored, with a mean of 62 participants and mean age of 26.8 years. Overall, 52.0% (n = 66) of trials reported data on race and ethnicity, increasing from 13.9% in 2007-2012 to 22.5% in 2013-2016 to 100% in 2017-2022 (P = .001). Among these 66 trials, 65.8%, 22.8%, 5.1%, 3.9% of participants were White, Asian, Hispanic, and Black, respectively. OERs were 10% to 20% lower for White participants vs US HTC, and US, UK, and Canadian census populations and ∼75% lower for Black or Hispanic participants when compared with US HTC and US census population. OERs for Asian participants were 1.6 to 3 times higher than Canada, US, and UK census populations. The reporting of race and ethnicity in hemophilia trials has drastically improved; however, Black and Hispanic PwH remain especially underrepresented. To address these disparities, stakeholders across the clinical trial enterprise need to implement strategies to ensure equitable participation.
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Affiliation(s)
- Stacey A. Fedewa
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | | | - Andee Koo
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Lorraine Cafuir
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | | | - Ana Antun
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | - Christine L. Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
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26
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Grant SJ, Mills JA, Telfair J, Erisnor G, Wildes TM, Bates‐Fraser LC, Olshan AF, Kent EE, Muss HB, Mihas P. "They don't care to study it": Trust, race, and health care experiences among patient-caregiver dyads with multiple myeloma. Cancer Med 2024; 13:e7297. [PMID: 38770636 PMCID: PMC11106687 DOI: 10.1002/cam4.7297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 04/02/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Medical mistrust, rooted in unethical research, is a barrier to cancer-related health care for Black/African American (AA) persons. Understanding trust, mistrust, and health care experiences is crucial, especially in multiple myeloma (MM), which disproportionately burdens Black/AA persons in incidence and survival. STUDY PURPOSE This study qualitatively examines the experiences of Black/AA and White dyads (patient with MM and adult caregiver) to gain insights into these phenomena. METHODS From November 2021 to April 2022, we recruited 21 dyads from the UNC Lineberger Comprehensive Cancer Center. Participants completed a sociodemographic survey and a 60-90 min semi-structured interview. We used ATLAS.ti v9 for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk Inc). RESULTS We interviewed 21 racially concordant dyads (11 Black/AA, 10 White) with mean patient ages of 70 (Black/AA) and 72 (White) at enrollment. Both Black/AA and White caregivers had a mean enrollment age of 68. The mean duration from MM diagnosis to enrollment for all patients was 5.5 years. Four key themes emerged: (1) knowledge and trust, (2) heightened emotions and discomfort, (3) differing mental constructs of health care experiences, and (4) mitigating mistrust, which varied by self-identified race. Black/AA participants had greater knowledge of historical events like the U.S. Public Health Service Untreated Syphilis Study at Tuskegee and carried the emotional burden longer. They also emphasized self-learning and self-guided research about MM for informed medical decision-making. Both Black/AA and White dyads emphasized the pivotal role of patient-provider relationships and effective communication in fostering trust and addressing concerns. CONCLUSION Our study offers contextual insights into the enduring challenges of medical mistrust, particularly within the Black/AA community, and its implications for patients and caregivers accessing and receiving MM-related care. Future studies should leverage these insights to guide the development of multilevel interventions addressing medical mistrust within the Black/AA community.
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Affiliation(s)
- Shakira J. Grant
- Division of HematologyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer CenterThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Jiona A. Mills
- Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Joseph Telfair
- Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Jiann‐Ping Hsu College of Public Health, Georgia Southern UniversityStatesboroGeorgiaUSA
| | - Gabriell Erisnor
- School of MedicineCity University of New YorkNew YorkNew York CityUSA
| | - Tanya M. Wildes
- Division of Hematology/OncologyUniversity of Nebraska Medical Center/Nebraska Medical CenterOmahaNebraskaUSA
| | - Lauren C. Bates‐Fraser
- Department of Allied Health SciencesThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Andrew F. Olshan
- Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Erin E. Kent
- Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Hyman B. Muss
- Division of Medical OncologyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Paul Mihas
- Odum Institute for Research in Social Sciences, The University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Richmond J, Anderson A, Cunningham-Erves J, Ozawa S, Wilkins CH. Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness. Annu Rev Public Health 2024; 45:465-484. [PMID: 38100649 PMCID: PMC11156570 DOI: 10.1146/annurev-publhealth-061022-044737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.
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Affiliation(s)
- Jennifer Richmond
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew Anderson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Consuelo H Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
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28
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Tamargo JA, Martin HR, Diaz-Martinez J, Delgado-Enciso I, Johnson A, Bastida Rodriguez JA, Trepka MJ, Brown DR, Garba NA, Roldan EO, Hernandez Suarez Y, Marty AM, Bursac Z, Campa A, Baum MK. Drug use and COVID-19 testing, vaccination, and infection among underserved, minority communities in Miami, Florida. PLoS One 2024; 19:e0297327. [PMID: 38687734 PMCID: PMC11060546 DOI: 10.1371/journal.pone.0297327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/24/2023] [Indexed: 05/02/2024] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted people who use drugs (PWUD). This study explored relationships between drug use, COVID-19 testing, vaccination, and infection. This cross-sectional study was conducted in Miami, Florida between March 2021 and October 2022 as part of the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative and the Miami Adult Studies on HIV (MASH) cohort. Users of cannabis, cocaine/crack, heroin/fentanyl, methamphetamines, hallucinogens, and/or prescription drug misuse in the previous 12 months were considered PWUD. Sociodemographic data, COVID-19 testing history, and vaccination-related beliefs were self-reported. Vaccinations were confirmed with medical records and positivity was determined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Statistical analyses included chi-square tests and logistic regression. Of 1,780 participants, median age was 57 years, 50.7% were male, 50.2% Non-Hispanic Black, and 66.0% reported an annual income less than $15,000. Nearly 28.0% used drugs. PWUD were less likely than non-users to self-report ever testing positive for SARS-CoV-2 (14.7% vs. 21.0%, p = 0.006). However, 2.6% of participants tested positive for SARS-CoV-2, with no significant differences between PWUD and non-users (3.7% vs. 2.2%, p = 0.076). PWUD were more likely than non-users to experience difficulties accessing testing (10.2% vs. 7.1%, p = 0.033), vaccine hesitancy (58.9% vs. 43.4%, p = 0.002) and had lower odds of receiving any dose of a COVID-19 vaccine compared to non-users (aOR, 0.63; 95% CI, 0.49-0.81; p<0.001). PWUD presented with greater difficulties accessing COVID-19 testing, greater vaccine hesitancy, and lower odds of vaccination. Testing and immunization plans that are tailored to the needs of PWUD and consider access, trust-building campaigns, and education may be needed.
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Affiliation(s)
- Javier A. Tamargo
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Haley R. Martin
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Janet Diaz-Martinez
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Ivan Delgado-Enciso
- Faculty of Medicine, University of Colima, Las Víboras, Colima, Mexico
- Cancerology State Institute, Colima State Health Services, La Esperanza, Colima, Mexico
| | - Angelique Johnson
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Jose A. Bastida Rodriguez
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Mary Jo Trepka
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - David R. Brown
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Nana A. Garba
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Eneida O. Roldan
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Yolangel Hernandez Suarez
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Aileen M. Marty
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Zoran Bursac
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Adriana Campa
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Marianna K. Baum
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
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Medina C, Akinkunmi A, Bland N, Velthorst E, Reichenberg A, Khachadourian V, Modabbernia A, Janecka M. Differences in schizophrenia treatments by race and ethnicity-analysis of electronic health records. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:48. [PMID: 38671009 PMCID: PMC11053048 DOI: 10.1038/s41537-024-00470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Racial disparities in prescriptions of anti-psychotics have been highlighted before. However, (i) the evidence on other medications, including anti-depressant or mood stabilizing medications is lacking, and (ii) the role of potentially confounding factors and (iii) specificity of such disparities to schizophrenia (SCZ), are still unknown. We used electronic health records (EHRs) from 224,212 adults to estimate the odds ratios of receiving a prescription for different nervous system medications among patients with SCZ of different race/ethnicity, and analogous linear models to investigate differences in prescribed medication doses. To verify specificity of the observed patterns to SCZ, we conducted analogous analyses in depression and bipolar disorder (BD) patients. We found that Black/African American (AA) and Hispanic patients with SCZ were more likely to be prescribed haloperidol (Black/AA: OR = 1.52 (1.33-1.74); Hispanic: OR = 1.32 (1.12-1.55)) or risperidone (Black/AA: OR = 1.27 (1.11-1.45); Hispanic: OR = 1.40 (1.19-1.64)), but less likely to be prescribed clozapine (Black/AA: OR = 0.40 (0.33-0.49); Hispanic: OR = 0.45 (0.35-0.58)), compared to white patients. There were no race/ethnicity-related differences in the prescribed medication doses. These patterns were not specific to SCZ: Asian, Hispanic and Black/AA patients with BD or depression were more likely to be prescribed anti-psychotics, but less likely to be prescribed antidepressants or mood-stabilizers. In conclusion, we found racial/ethnic disparities in the medications prescribed to patients with SCZ and other psychiatric conditions. We discuss the potential implications for the quality of care for patients of diverse races/ethnicities.
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Affiliation(s)
- Candice Medina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Nevaeh Bland
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eva Velthorst
- GGZ Noord Holland Noord, Stationsplein, Heerhugowaard, Netherlands
| | - Avi Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Genetic & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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Vargas S, Siddiqi S, King B, Nguyen C, Diep J, Gilbert L, Nguyen BM. Vietnamese Americans' level of trust in sources of information and willingness to participate in COVID-19 clinical trials. J Clin Transl Sci 2024; 8:e88. [PMID: 38784109 PMCID: PMC11112424 DOI: 10.1017/cts.2024.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/24/2024] [Accepted: 02/28/2024] [Indexed: 05/25/2024] Open
Abstract
The survey investigates COVID-19 information source trust levels and Vietnamese Americans' willingness to participate in clinical trials. An analysis of 212 completed surveys revealed that trust in coronavirus disease 2019 (COVID-19) clinical trial information from university hospitals and drug companies was associated with willingness to participate in clinical trials. Trust in COVID-19 information from federal governments and state governments was also associated with willingness to participate in clinical trials. However, trust in local health facilities was linked to trial participation reluctance. The results suggest that Vietnamese Americans' participation in clinical trials can be increased by identifying and using trusted sources of information.
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Affiliation(s)
- Shielene Vargas
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Saba Siddiqi
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Ben King
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Celine Nguyen
- Boat People SOS Houston, Houston, TX, USA
- Rice University, Houston, TX, USA
| | | | - Lauren Gilbert
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Bich-May Nguyen
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
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Nanaw J, Sherchan JS, Fernandez JR, Strassle PD, Powell W, Forde AT. Racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19. BMC Public Health 2024; 24:1084. [PMID: 38641573 PMCID: PMC11027359 DOI: 10.1186/s12889-024-18526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Trust in the healthcare system may impact adherence to recommended healthcare practices, including willingness to test for and vaccinate against COVID-19. This study examined racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19 during the first year of the pandemic. METHODS This cross-sectional study used data from the REACH-US study, a nationally representative online survey conducted among a diverse sample of U.S. adults from January 26, 2021-March 3, 2021 (N = 5,121). Multivariable logistic regression estimated the associations between trust in the U.S. healthcare system (measured as "Always", "Most of the time", "Sometimes/Almost Never", and "Never") and willingness to test for COVID-19, and willingness to receive the COVID-19 vaccine. Racial/ethnic differences in these associations were examined using interaction terms and multigroup analyses. RESULTS Always trusting the U.S. healthcare system was highest among Hispanic/Latino Spanish Language Preference (24.9%) and Asian (16.7%) adults and lowest among Multiracial (8.7%) and Black/African American (10.7%) adults. Always trusting the U.S. healthcare system, compared to never, was associated with greater willingness to test for COVID-19 (AOR: 3.20, 95% CI: 2.38-4.30) and greater willingness to receive the COVID-19 vaccine (AOR: 2.68, 95% CI: 1.97-3.65). CONCLUSIONS Trust in the U.S. healthcare system was associated with greater willingness to test for COVID-19 and receive the COVID-19 vaccine, however, trust in the U.S. healthcare system was lower among most marginalized racial/ethnic groups. Efforts to establish a more equitable healthcare system that increases trust may encourage COVID-19 preventive behaviors.
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Affiliation(s)
- Judy Nanaw
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Juliana S Sherchan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jessica R Fernandez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | | | - Allana T Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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Budhu JA, Chukwueke UN, Jackson S, Lee EQ, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Galanis E, Hervey-Jumper SL, Wen PY, Porter AB. Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort. Neuro Oncol 2024; 26:596-608. [PMID: 38071654 PMCID: PMC10995510 DOI: 10.1093/neuonc/noad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.
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Affiliation(s)
- Joshua A Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Ugonma N Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahalia Dalmage
- Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Patrick Y Wen
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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Yang H, Poudel N, Simpson S, Chou C, Ngorsuraches S. Important Barriers to COVID-19 Vaccination Among African Americans in Black Belt Region. J Racial Ethn Health Disparities 2024; 11:1033-1044. [PMID: 37071332 PMCID: PMC10112325 DOI: 10.1007/s40615-023-01583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND To identify important barriers to COVID-19 vaccination among African Americans living in the Black Belt region. METHODS A cross-sectional, web-based questionnaire survey was conducted using best-worst scaling case 1 (the object case). Thirty-two potential barriers to COVID-19 vaccination were identified from the literature and confirmed by an expert. A nested balanced incomplete block design was used to generate 62 sets of 16 choice tasks. Each choice task included six barriers. Participants were asked to choose the most and least important barriers to their COVID-19 vaccination in each choice task of one set. The natural logarithm of the square root of best counts divided by the worst counts of each barrier was calculated to rank the importance of barriers. RESULTS Responses from a total of 808 participants were included. Among 32 barriers to COVID-19 vaccination, the five most important barriers were "safety concern of COVID-19 vaccines," "rapid mutation of COVID-19," "ingredients of COVID-19 vaccines," "Emergency Use Authorization (Fast-track approval) of COVID-19 vaccines," and "inconsistent information of COVID-19 vaccines." On the other hand, the five least important barriers were "religious reasons," "lack of time to get COVID-19 vaccine," "no support from my family and friends," "political reasons," and "fear of the needle." CONCLUSIONS Important barriers to the COVID-19 vaccination for African Americans living in the Black Belt region centered around the issues that could be resolved by communication strategies.
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Affiliation(s)
- Heqin Yang
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Savanah Simpson
- Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA.
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Crockett AK, Laden BF, Tumin D, Whiteside JL. Predictors of planned home birth before and during the COVID-19 pandemic. J Perinat Med 2024; 52:283-287. [PMID: 38296773 DOI: 10.1515/jpm-2023-0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To determine how demographic and clinical predictors of home birth have changed since the onset of the COVID-19 pandemic in the US. METHODS Using National Vital Statistics birth certificate data, a retrospective population-based cohort study was performed with planned home births and hospital births among women age ≥18 years during calendar years 2019 (pre-pandemic) and 2021 (pandemic-era). Birth location (planned home birth vs. hospital birth) was analyzed using univariate and multivariable logistic regression, systematically examining the interaction of each demographic and clinical covariate with study year. RESULTS After exclusions, a total of 6,087,768 birth records were retained for analysis, with the proportion of home births increasing from 0.82 % in 2019 to 1.24 % in 2021 (p<0.001). In the final multivariable logistic regression model of planned home birth, five demographic variables retained a statistically significant interaction with year: race and ethnicity, age, educational attainment, parity, and WIC participation. In each case, demographic differences between those having planned home births and hospital births became smaller (odds ratios closer to 1) in 2021 compared to 2019. CONCLUSIONS Planned home births increased by more than 50 % during the pandemic, with greater socioeconomic diversity in the pandemic-era home birth cohort. The presence of clinical risk factors remained a strong predictor of hospital birth, with no evidence that pandemic-era home births had a higher clinical risk profile as compared to the pre-pandemic period.
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Affiliation(s)
- Allison K Crockett
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Department of Obstetrics and Gynecology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Bethany F Laden
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - James L Whiteside
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Chatters R, Dimairo M, Cooper C, Ditta S, Woodward J, Biggs K, Ogunleye D, Thistlethwaite F, Yap C, Rothman A. Exploring the barriers to, and importance of, participant diversity in early-phase clinical trials: an interview-based qualitative study of professionals and patient and public representatives. BMJ Open 2024; 14:e075547. [PMID: 38508621 PMCID: PMC10952868 DOI: 10.1136/bmjopen-2023-075547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To explore the importance of, and barriers to achieving, diversity in early-phase clinical trials. DESIGN Qualitative interviews analysed using thematic analysis. SETTING AND PARTICIPANTS Five professionals (clinical researchers and methodologists) and three patient and public representatives (those with experience of early-phase clinical trials and/or those from ethnic minority backgrounds) were interviewed between June and August 2022. Participants were identified via their institutional web page, existing contacts or social media (eg, X, formerly known as Twitter). RESULTS Professionals viewed that diversity is not currently considered in all early-phase clinical trials but felt that it should always be taken into account. Such trials are primarily undertaken at a small number of centres, thus limiting the populations they can access. Referrals from clinicians based in the community may increase diversity; however, those referred are often not from underserved groups. Referrals may be hindered by the extra resources required to approach and recruit underserved groups and participants often having to undertake 'self-driven' referrals. Patient and public representatives stated that diversity is important in research staff and that potential participants should be informed of the need for diversity. Those from underserved groups may require clarification regarding the potential harms of a treatment, even if these are unknown. Education may improve awareness and perception of early-phase clinical trials. We provide 14 recommendations to improve diversity in early-phase clinical trials. CONCLUSIONS Diversity should be considered in all early-phase trials. Consideration is required regarding the extent of diversity and how it is addressed. The increased resources needed to recruit those from underserved groups may warrant funders to increase the funds to support the recruitment of such participants. The potential harms and societal benefits of the research should be presented to potential participants in a balanced but accurate way to increase transparency.
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Affiliation(s)
- Robin Chatters
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Munyaradzi Dimairo
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Shamila Ditta
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jonathan Woodward
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Fiona Thistlethwaite
- The Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, UK
| | - Alexander Rothman
- Department of Infection, Immunity, and Cardiovascular Disease, The University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Weiss EM, Donohue PK, Wootton SH, Stevens E, Merhar SL, Puia-Dumitrescu M, Mercer A, Oslin E, Porter KM, Wilfond BS. Motivations for and against Participation in Neonatal Research: Insights from Interviews of Diverse Parents Approached for Neonatal Research in the United States. J Pediatr 2024; 275:113923. [PMID: 38492913 PMCID: PMC11399325 DOI: 10.1016/j.jpeds.2024.113923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To describe parents' motivations for and against participation in neonatal research, including the views of those who declined participation. STUDY DESIGN We performed 44 semi-structured, qualitative interviews of parents approached for neonatal research. Here we describe their motivations for and against participation. RESULTS Altruism was an important reason parents chose to participate. Some hoped participation in research would benefit their infant. Burdens of participation to the family, such as transportation to follow up (distinct from risks/burdens to the infant), were often deciding factors among those who declined participation. Perceived risks to the infant were reasons against participation, but parents often did not differentiate between baseline risks and incremental risk of study participation. Concerns regarding their infant being treated like a "guinea pig" were common among those who declined. Finally, historical abuses and institutional racism were reported as important concerns by some research decliners from minoritized populations. CONCLUSIONS Within a diverse sample of parents approached to enroll their infant in neonatal research, motivations for and against participation emerged, which may be targets of future interventions. These motivations included reasons for participation which we may hope to encourage, such as altruism. They also included reasons against participation, which we may hope to, as feasible, eliminate, mitigate, or at least acknowledge. These findings can help clinical trialists, regulators, and funders attempting to improve neonatal research recruitment processes.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan H Wootton
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Emily Stevens
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Amanda Mercer
- Counselor Education Department, Portland State University, Portland, OR
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Thorpe A, Fagerlin A, Drews FA, Shoemaker H, Brecha FS, Scherer LD. Predictors of COVID-19 vaccine uptake: an online three-wave survey study of US adults. BMC Infect Dis 2024; 24:304. [PMID: 38475702 DOI: 10.1186/s12879-024-09148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND To effectively promote vaccine uptake, it is important to understand which people are most and least inclined to be vaccinated and why. In this study, we examined predictors of COVID-19 vaccine uptake and reasons for non-vaccination. METHODS We conducted an online English-language survey study in December-2020, January-2021, and March-2021. A total of 930 US respondents completed all surveys. Multiple logistic regression models were run to test whether the early vaccine eligibility, demographic factors, and psychological factors predict getting at least one dose of a COVID-19 vaccination in January-2021 and in March-2021. RESULTS The proportion of respondents who received ≥ 1-dose of a COVID-19 vaccine increased from 18% (January) to 67% (March). Older age predicted vaccine uptake in January (OR = 2.02[95%CI = 1.14-3.78], p < .001) and March (10.92[6.76-18.05], p < .001). In January, additional predictors were higher numeracy (1.48[1.20-1.86], p < .001), COVID-19 risk perceptions (1.35[1.03-1.78], p = .029), and believing it is important adults get the COVID-19 vaccine (1.66[1.05-2.66], p = .033). In March, additional predictors of uptake were believing it is important adults get the COVID-19 vaccine (1.63[1.15-2.34], p = .006), prior COVID-19 vaccine intentions (1.37[1.10-1.72], p = .006), and belief in science (0.84[0.72-0.99], p = .041). Concerns about side effects and the development process were the most common reasons for non-vaccination. Unvaccinated respondents with no interest in getting a COVID-19 vaccine were younger (0.27[0.09-0.77], p = .016), held negative views about COVID-19 vaccines for adults (0.15[0.08-0.26], p < .001), had lower trust in healthcare (0.59[0.36-0.95], p = .032), and preferred to watch and wait in clinically ambiguous medical situations (0.66[0.48-0.89], p = .007). CONCLUSIONS Evidence that attitudes and intentions towards COVID-19 vaccines were important predictors of uptake provides validation for studies using these measures and reinforces the need to develop strategies for addressing safety and development concerns which remain at the forefront of vaccine hesitancy.
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Affiliation(s)
- Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA.
- Department of Applied Health Research, University College London, London, UK.
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Frank A Drews
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
- University of Utah College of Social and Behavioral Science, Salt Lake City, UT, USA
| | - Holly Shoemaker
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Federica S Brecha
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Laura D Scherer
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO, USA
- Denver VA Center of Innovation, Denver, CO, USA
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Vincent W. Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis. J Med Internet Res 2024; 26:e47448. [PMID: 38457790 PMCID: PMC10960216 DOI: 10.2196/47448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. OBJECTIVE This study compared sexual minority and heterosexual adults' willingness to use COVID-19-related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. METHODS We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. RESULTS On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. CONCLUSIONS In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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Mahmood B, Adu P, McKee G, Bharmal A, Wilton J, Janjua NZ. Ethnic Disparities in COVID-19 Vaccine Mistrust and Receipt in British Columbia, Canada: Population Survey. JMIR Public Health Surveill 2024; 10:e48466. [PMID: 38363596 PMCID: PMC10896316 DOI: 10.2196/48466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/16/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Racialized populations in the United States, Canada, and the United Kingdom have been disproportionately affected by COVID-19. Higher vaccine hesitancy has been reported among racial and ethnic minorities in some of these countries. In the United Kingdom, for example, higher vaccine hesitancy has been observed among the South Asian population and Black compared with the White population, and this has been attributed to lack of trust in government due to historical and ongoing racism and discrimination. OBJECTIVE This study aimed to assess vaccine receipt by ethnicity and its relationship with mistrust among ethnic groups in British Columbia (BC), Canada. METHODS We included adults ≥18 years of age who participated in the BC COVID-19 Population Mixing Patterns Survey (BC-Mix) from March 8, 2021, to August 8, 2022. The survey included questions about vaccine receipt and beliefs based on a behavioral framework. Multivariable logistic regression was used to assess the association between mistrust in vaccines and vaccine receipt among ethnic groups. RESULTS The analysis included 25,640 adults. Overall, 76.7% (22,010/28,696) of respondents reported having received at least 1 dose of COVID-19 vaccines (Chinese=86.1%, South Asian=79.6%, White=75.5%, and other ethnicity=73.2%). Overall, 13.7% (3513/25,640) of respondents reported mistrust of COVID-19 vaccines (Chinese=7.1%, South Asian=8.2%, White=15.4%, and other ethnicity=15.2%). In the multivariable model (adjusting for age, sex, ethnicity, educational attainment, and household size), mistrust was associated with a 93% reduced odds of vaccine receipt (adjusted odds ratio 0.07, 95% CI 0.06-0.08). In the models stratified by ethnicity, mistrust was associated with 81%, 92%, 94%, and 95% reduced odds of vaccine receipt among South Asian, Chinese, White, and other ethnicities, respectively. Indecision, whether to trust the vaccine or not, was significantly associated with a 70% and 78% reduced odds of vaccine receipt among those who identified as White and of other ethnic groups, respectively. CONCLUSIONS Vaccine receipt among those who identified as South Asian and Chinese in BC was higher than that among the White population. Vaccine mistrust was associated with a lower odds of vaccine receipt in all ethnicities, but it had a lower effect on vaccine receipt among the South Asian and Chinese populations. Future research needs to focus on sources of mistrust to better understand its potential influence on vaccine receipt among visible minorities in Canada.
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Affiliation(s)
- Bushra Mahmood
- Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Prince Adu
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH, United States
| | - Geoffrey McKee
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Aamir Bharmal
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - James Wilton
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Naveed Zafar Janjua
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada
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Sileo KM, Hirani IM, Luttinen RL, Hayward M, Fleming PJ. A Scoping Review on Gender/Sex Differences in COVID-19 Vaccine Intentions and Uptake in the United States. Am J Health Promot 2024; 38:242-274. [PMID: 37847250 PMCID: PMC10802093 DOI: 10.1177/08901171231200778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To explore the empirical literature on gender/sex differences in vaccine acceptance among U.S.-based adults and adolescents in approximately the first 2 years of the pandemic. DATA SOURCE Embase, Medline, PsycINFO, EBSCO, CINAHL, Web of Science. STUDY INCLUSION AND EXCLUSION CRITERIA Peer-reviewed studies conducted in the U.S. with those aged 12 and older, published in English before January 12, 2022, examining the relationship between gender/sex on COVID-19 vaccine intentions and/or uptake. DATA EXTRACTION Three authors screened studies and extracted data. DATA SYNTHESIS Univariate and multivariate results are summarized. RESULTS A total of 53 studies met inclusion criteria (48 intentions, 7 uptake), using mostly cross-sectional designs (92.5%) and non-random sampling (83.0%). The majority of studies supported men's greater intentions to vaccinate compared to women, and men's greater vaccine uptake in univariate analyses, but most multivariate analyses supported no gender differences in uptake. Few studies examined gender beyond binary categories (women/men), highlighting a gap in the studies inclusive of transgender or gender-diverse populations in analyses. CONCLUSION Women may have been more hesitant to get the vaccine than men early in the pandemic, but these differences may not translate to actual behavior. Future research should include non-binary/transgender populations, explore the gender-specific reasons for hesitancy and differences by sub-populations, utilize more rigorous designs, and test gender-sensitive public health campaigns to mitigate vaccine concerns.
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Affiliation(s)
- Katelyn M. Sileo
- The Department of Public Health, College of Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Inara M. Hirani
- The Department of Public Health, College of Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Rebecca L. Luttinen
- The Department of Demography, College of Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Matt Hayward
- The John Peace Library, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Paul J. Fleming
- The Department of Health Behavior and Health Education, The School of Public Health at the University of Michigan, Ann Arbor, MI, USA
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Gonzalez VM, Stewart TJ. COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust. J Behav Med 2024; 47:123-134. [PMID: 37634151 DOI: 10.1007/s10865-023-00443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.
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Affiliation(s)
- Vivian M Gonzalez
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA.
| | - Tracy J Stewart
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA
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Ishigami J, Jaar BG, Charleston JB, Lash JP, Brown J, Chen J, Mills KT, Taliercio JJ, Kansal S, Crews DC, Riekert KA, Dowdy DW, Appel LJ, Matsushita K. Factors Associated With Non-vaccination for Influenza Among Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2024; 83:196-207.e1. [PMID: 37717847 PMCID: PMC10872850 DOI: 10.1053/j.ajkd.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 09/19/2023]
Abstract
RATIONALE & OBJECTIVE Vaccination for influenza is strongly recommended for people with chronic kidney disease (CKD) due to their immunocompromised state. Identifying risk factors for not receiving an influenza vaccine (non-vaccination) could inform strategies for improving vaccine uptake in this high-risk population. STUDY DESIGN Longitudinal observational study. SETTING & PARTICIPANTS 3,692 Chronic Renal Insufficiency Cohort Study (CRIC) participants. EXPOSURE Demographic factors, social determinants of health, clinical conditions, and health behaviors. OUTCOME Influenza non-vaccination, which was assessed based on a receipt of influenza vaccine ascertained during annual clinic visits in a subset of participants who were under nephrology care. ANALYTICAL APPROACH Mixed-effects Poisson models to estimate adjusted prevalence ratios (APRs). RESULTS Between 2009 and 2020, the pooled mean vaccine uptake was 72% (mean age, 66 years; 44% female; 44% Black race). In multivariable models, factors significantly associated with influenza non-vaccination were younger age (APR, 2.16 [95% CI, 1.85-2.52] for<50 vs≥75 years), Black race (APR, 1.58 [95% CI, 1.43-1.75] vs White race), lower education (APR, 1.20 [95% CI, 1.04-1.39 for less than high school vs college graduate]), lower annual household income (APR, 1.26 [95% CI, 1.06-1.49] for <$20,000 vs >$100,000), formerly married status (APR, 1.22 [95% CI, 1.09-1.35] vs currently married), and nonemployed status (APR, 1.13 [95% CI, 1.02-1.24] vs employed). In contrast, participants with diabetes (APR, 0.80 [95% CI, 0.73-0.87] vs no diabetes), chronic obstructive pulmonary disease (COPD) (APR, 0.80 [95% CI, 0.70-0.92] vs no COPD), end-stage kidney disease (APR, 0.64 [0.56 to 0.76] vs estimated glomerular filtration rate≥60mL/min/1.73m2), frailty (APR, 0.86 [95% CI, 0.74-0.99] vs no frailty), and ideal physical activity (APR, 0.90 [95% CI, 0.82-0.99] vs. physically inactive) were less likely to have non-vaccination status. LIMITATIONS Possible residual confounding. CONCLUSIONS Among adults with CKD receiving nephrology care, younger adults, Black individuals, and those with adverse social determinants of health were more likely to have the influenza non-vaccination status. Strategies are needed to address these disparities and reduce barriers to vaccination. PLAIN-LANGUAGE SUMMARY Identifying risk factors for not receiving an influenza vaccine ("non-vaccination") in people living with kidney disease, who are at risk of influenza and its complications, could inform strategies for improving vaccine uptake. In this study, we examined whether demographic factors, social determinants of health, and clinical conditions were linked to the status of not receiving an influenza vaccine among people living with kidney disease and receiving nephrology care. We found that younger adults, Black individuals, and those with adverse social determinants of health were more likely to not receive the influenza vaccine. These findings suggest the need for strategies to address these disparities and reduce barriers to vaccination in people living with kidney disease.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jeanne B Charleston
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James P Lash
- Division of Nephrology, College of Medicine, University of Illinois, Chicago, Illinois
| | - Julia Brown
- Division of Nephrology, College of Medicine, University of Illinois, Chicago, Illinois
| | - Jing Chen
- Division of Nephrology, School of Medicine, Tulane University New Orleans, Louisiana
| | - Katherine T Mills
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University New Orleans, Louisiana
| | | | - Sheru Kansal
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David W Dowdy
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Huang L, Huschka TR, Barwise AK, Allen JSP, Wolfersteig W, Hamm K, Cardenas LD, Phelan SM, Allyse MA. Psychological reactance, misinformation, and distrust: A mixed methods analysis of COVID-19 vaccine uptake. J Clin Transl Sci 2024; 8:e48. [PMID: 38510694 PMCID: PMC10951926 DOI: 10.1017/cts.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 03/22/2024] Open
Abstract
Background Assessing perceptions of the COVID-19 vaccines is essential for understanding vaccine hesitancy and for improving uptake during public health emergencies. In the complicated landscape of COVID-19 vaccine mandates and rampant misinformation, many individuals faced challenges during vaccination decision-making. The purpose of our mixed methods study is to elucidate factors affecting vaccine decision-making and to highlight the discourse surrounding the COVID-19 vaccines in diverse and underserved communities. Methods This mixed methods study was conducted in Arizona, Florida, Minnesota, and Wisconsin between March and November 2021, combining a cross-sectional survey (n = 3593) and focus groups (n = 47). Results The groups least likely to report receiving a vaccination were non-Hispanic Whites, Indigenous people, males, and those with moderate socioeconomic status (SES). Those indicating high and low SES reported similar vaccination uptake. Focus group data highlighted resistance to mandates, distrust, misinformation, and concerns about the rapid development surrounding the COVID-19 vaccines. Psychological reactance theory posits that strongly persuasive messaging and social pressure can be perceived as a threat to freedom, encouraging an individual to take action to restore that freedom. Conclusion Our findings indicate that a subsection of participants felt pressured to get the vaccine, which led to weaker intentions to vaccinate. These results suggest that vaccine rollout strategies should be reevaluated to improve and facilitate informed decision-making.
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Affiliation(s)
- Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Todd R. Huschka
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Amelia K. Barwise
- Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay-Sheree P. Allen
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wendy Wolfersteig
- Southwest Interdisciplinary Research Center, Arizona State University, Tempe, AZ, USA
| | - Kathryn Hamm
- Southwest Interdisciplinary Research Center, Arizona State University, Tempe, AZ, USA
| | | | - Sean M. Phelan
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Megan A. Allyse
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
- Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
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Henderson C, Scott T, Schinder B, Hager E, Friedman FS, Miller E, Ragavan MI. Shifting the Paradigm From Participant Mistrust to Researcher & Institutional Trustworthiness: A Qualitative Study of Researchers' Perspectives on Building Trustworthiness With Black Communities. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:127-136. [PMID: 36125424 DOI: 10.1177/0272684x221117710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Black communities are deeply underrepresented in research, due, in large part, to research mistrust. It is critical to shift the burden of trust building from communities to researchers and research institutions, which have perpetrated harm against Black communities for centuries. In this study, we examine researchers' perspectives on how to become trustworthy to Black-identifying participants and communities. METHODS We conducted semi-structured interviews with researchers affiliated with our institution's Clinical and Translational Science Institute. Participants were recruited through email and responded to the study team if they wished to participate. Interviews occurred through Zoom, took 60 minutes, and were audio recorded. We used an inductive thematic data analysis approach. RESULTS Sixteen researchers, who were affiliated with medicine, public health, psychology, education, and nursing, participated in this study. Participants agreed that researchers bear the responsibility for building trust and noted how critical it is to address the underrepresentation of Black participants in research through equitable recruitment and that researchers must be transparent and engage in reciprocal research practices. Community-partnered research was highlighted as a way to develop trustworthiness. Finally, participants noted that trustworthiness must also be built at the institutional level, rather than just by individual researchers. DISCUSSION To our knowledge, this is one of the first studies to examine researchers' perspectives on how to build their own trustworthiness, with a specific focus on trust-building with Black communities. Explicit training and resources are needed to build trustworthiness into academic centers.
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Affiliation(s)
| | | | | | - Erricka Hager
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth Miller
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Fitri FI, Lage C, Mollayeva T, Santamaria-Garcia H, Chan M, Cominetti MR, Daria T, Fallon G, Gately D, Gichu M, Giménez S, Zuniga RG, Hadad R, Hill-Jarrett T, O’Kelly M, Martinez L, Modjaji P, Ngcobo N, Nowak R, Ogbuagu C, Roche M, Aguzzoli CS, Shin SY, Smith E, Yoseph SA, Zewde Y, Ayhan Y. Empathy as a crucial skill in disrupting disparities in global brain health. Front Neurol 2023; 14:1189143. [PMID: 38162446 PMCID: PMC10756064 DOI: 10.3389/fneur.2023.1189143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/26/2023] [Indexed: 01/03/2024] Open
Abstract
Brain health refers to the state of a person's brain function across various domains, including cognitive, behavioral and motor functions. Healthy brains are associated with better individual health, increased creativity, and enhanced productivity. A person's brain health is intricately connected to personal, social and environmental factors. Racial, ethnic, and social disparities affect brain health and on the global scale these disparities within and between regions present a hurdle to brain health. To overcome global disparities, greater collaboration between practitioners and healthcare providers and the people they serve is essential. This requires cultural humility driven by empathy. Empathy is a core prosocial value, a cognitive-emotional skill that helps us understand ourselves and others. This position paper aims to provide an overview of the vital roles of empathy, cooperation, and interdisciplinary partnerships. By consciously integrating this understanding in practice, leaders can better position themselves to address the diverse challenges faced by communities, promote inclusivity in policies and practices, and further more equitable solutions to the problem of global brain health.
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Affiliation(s)
- Fasihah Irfani Fitri
- Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Carmen Lage
- Department of Neurology, Marques de Valdecilla University Hospital - Valdecilla Research Institute (IDIVAL), Santander, Spain
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
| | - Tatyana Mollayeva
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Canada Research Chairs, Ottawa, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Acquired Brain Injury Research Lab, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hernando Santamaria-Garcia
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio Bogotá, Bogotá, Colombia
- Pontificia Universidad Javeriana (PhD Program in Neuroscience) Bogotá, Bogotá, Colombia
| | - Melissa Chan
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Social Sciences, University of Luxembourg, Luxembourg, Luxembourg
| | - Marcia R. Cominetti
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | - Tselmen Daria
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Gladstone Institutes, San Francisco, CA, United States
| | - Gillian Fallon
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
| | - Dominic Gately
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Muthoni Gichu
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Division of Geriatric Medicine at the Ministry of Health, Nairobi, Kenya
| | - Sandra Giménez
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Multidisciplinary Sleep Unit, Memory Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Gutierrez Zuniga
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Hospital Quirónsalud Valle del Henares, Madrid, Spain
| | - Rafi Hadad
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Rambam Health Care Campus, Haifa, Israel
| | - Tanisha Hill-Jarrett
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Memory and Aging Center, Medical Center, University of California, San Francisco, CA, United States
| | - Mick O’Kelly
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- National College of Art and Design, Dublin, Ireland
| | - Luis Martinez
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Memory and Aging Center, Medical Center, University of California, San Francisco, CA, United States
| | - Paul Modjaji
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Ntkozo Ngcobo
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Rafal Nowak
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Neuroelectrics (Spain), Barcelona, Spain
| | - Chukwuanugo Ogbuagu
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Faculty of Basic Clinical Sciences, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Moïse Roche
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Division of Psychiatry, UCL, London, United Kingdom
| | - Cristiano Schaffer Aguzzoli
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - So Young Shin
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Nursing, Inje University, Busan, Republic of Korea
| | - Erin Smith
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Stanford University, Stanford, CA, United States
| | - Selam Aberra Yoseph
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Zewde
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yavuz Ayhan
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Perkins JR, Jaqua EE, Nguyen VT, Franz DA, Elkins J, Morton KR. Optimizing Education to Improve COVID-19 Vaccination Rates in a Federally Qualified Health Center. Perm J 2023; 27:143-150. [PMID: 37908131 PMCID: PMC10723104 DOI: 10.7812/tpp/23.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION COVID-19 vaccination hesitancy is prevalent in underserved communities, and family medicine clinics can combat hesitancy with vaccine education. However, due to general misinformation, physicians hesitate to educate patients because doing so can create conflict. METHODS A series of resident-run, team-based quality improvement projects were conducted at a federally qualified health center every 4 months between June 2021 and May 2022. First, staff documentation of vaccine status was addressed. Second, physician and staff education about COVID-19 vaccines was completed along with motivational interview training to avoid conflict with patients. Third, patient COVID-19 vaccine education was addressed. RESULTS After Cycle 1, COVID-19 vaccine documentation status increased the number of patients who completed the vaccination series from 1% to 22%. Cycle 2 showed an increase in COVID-19 vaccination rate after health care team education. This reflected an increase from 35% to 76% of residents reporting that they discussed COVID-19 vaccines with unvaccinated patients after the intervention. Cycle 3 fought vaccine misinformation by educating patients. Most patients heard information about COVID-19 vaccines from friends and family (95%), social media (90%), and the news (80%). Physician confidence in providing COVID-19 vaccine education to patients increased from 2.8 (< somewhat confident) to 4.3 (moderately confident) out of 5 over 3 plan-do-study-act cycles. DISCUSSION Vaccination rates were tracked alongside physician surveys regarding the experience of offering the vaccine to patients. Vaccination rates steadily increased over time, and physicians became more confident in COVID-19 vaccine discussions with patients. CONCLUSION Primary care physicians are needed to approach public health concerns, such as vaccination completion, but ongoing education is also needed to promote confidence in health care pathways.
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Affiliation(s)
- Joshua R Perkins
- Family Medicine Department, Loma Linda University Health, Loma Linda, CA, USA
| | - Ecler E Jaqua
- Family Medicine Department, Loma Linda University Health, Loma Linda, CA, USA
| | - Van T Nguyen
- Family Medicine Department, Loma Linda University Health, Loma Linda, CA, USA
| | - Daniel A Franz
- Psychology Department, Loma Linda University Health, Loma Linda, CA, USA
| | - Joseph Elkins
- School of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Kelly R Morton
- Family Medicine Department, Loma Linda University Health, Loma Linda, CA, USA
- Psychology Department, Loma Linda University Health, Loma Linda, CA, USA
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Paetznick C, Okoro O. The Intersection between Pharmacogenomics and Health Equity: A Case Example. PHARMACY 2023; 11:186. [PMID: 38133461 PMCID: PMC10747429 DOI: 10.3390/pharmacy11060186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/25/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Pharmacogenomics (PGx) and the study of precision medicine has substantial power to either uplift health equity efforts or further widen the gap of our already existing health disparities. In either occurrence, the medication experience plays an integral role within this intersection on an individual and population level. Examples of this intertwined web are highlighted through a case discussion. With these perspectives in mind, several recommendations for the research and clinical communities are highlighted to promote equitable healthcare with PGx integrated.
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Affiliation(s)
| | - Olihe Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN 55812, USA
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Michaelson NM, Watsula A, Bakare-Okpala A, Mohamadpour M, Chukwueke UN, Budhu JA. Disparities in Neuro-Oncology. Curr Neurol Neurosci Rep 2023; 23:815-825. [PMID: 37889427 DOI: 10.1007/s11910-023-01314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
PURPOSEOF REVIEW Health disparities are preventable differences in the diagnosis, treatment, and outcomes of many diseases, including central nervous system (CNS) tumors. This review will summarize and compile the existing literature on health disparities in neuro-oncology and provide directions for future research and interventions. RECENT FINDINGS Patients from historically marginalized groups are more likely to receive inadequate treatment, develop complications, and experience a shorter life expectancy. Financial toxicity can be particularly severe for patients with CNS tumors due to the high costs of treatment. Additionally, CNS clinical trials and research lack diverse representation.
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Affiliation(s)
| | - Amanda Watsula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Maliheh Mohamadpour
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, C719, USA
| | - Ugonma N Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joshua A Budhu
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, C719, USA.
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Adedinsewo D, Eberly L, Sokumbi O, Rodriguez JA, Patten CA, Brewer LC. Health Disparities, Clinical Trials, and the Digital Divide. Mayo Clin Proc 2023; 98:1875-1887. [PMID: 38044003 PMCID: PMC10825871 DOI: 10.1016/j.mayocp.2023.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/03/2023] [Indexed: 12/05/2023]
Abstract
In the past few years, there have been rapid advances in technology and the use of digital tools in health care and clinical research. Although these innovations have immense potential to improve health care delivery and outcomes, there are genuine concerns related to inadvertent widening of the digital gap consequentially exacerbating health disparities. As such, it is important that we critically evaluate the impact of expansive digital transformation in medicine and clinical research on health equity. For digital solutions to truly improve the landscape of health care and clinical trial participation for all persons in an equitable way, targeted interventions to address historic injustices, structural racism, and social and digital determinants of health are essential. The urgent need to focus on interventions to promote health equity was made abundantly clear with the coronavirus disease 2019 pandemic, which magnified long-standing social and racial health disparities. Novel digital technologies present a unique opportunity to embed equity ideals into the ecosystem of health care and clinical research. In this review, we examine racial and ethnic diversity in clinical trials, historic instances of unethical research practices in biomedical research and its impact on clinical trial participation, and the digital divide in health care and clinical research, and we propose suggestions to achieve digital health equity in clinical trials. We also highlight key digital health opportunities in cardiovascular medicine and dermatology as exemplars, and we offer future directions for development and adoption of patient-centric interventions aimed at narrowing the digital divide and mitigating health inequities.
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Affiliation(s)
| | - Lauren Eberly
- Division of Cardiovascular Medicine, Perelman School of Medicine, Center for Cardiovascular Outcomes, Quality, and Evaluative Research, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | - Jorge Alberto Rodriguez
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN.
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Grisdela P, Liu C, Model Z, Steele A, Liu D, Earp B, Blazar P, Zhang D. Do Socioeconomic Factors Affect Symptom Duration and Disease Severity at Presentation for Cubital Tunnel Syndrome? Hand (N Y) 2023:15589447231213386. [PMID: 38014540 DOI: 10.1177/15589447231213386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Socioeconomic factors have been implicated in delayed presentation for compressive neuropathies of the upper extremity. Our article seeks to elucidate the effect of socioeconomic factors on self-reported symptom duration and objective disease severity at presentation for cubital tunnel syndrome. METHODS This retrospective cohort study included 207 patients with surgical management of cubital tunnel syndrome at 2 institutions between June 1, 2015, and March 1, 2020. Exclusion criteria included age under 18 years, revision surgery, lack of preoperative electrodiagnostic studies, and concurrent additional surgeries. Response variables were self-reported symptom duration, time from presentation to surgery, McGowan grade, and electrodiagnostic measures. Explanatory variables included age, sex, white race, diabetes mellitus, depression, anxiety, and the Distressed Communities Index. RESULTS Symptom duration was associated with nonwhite race, and time from presentation to surgery was associated with insurance provider. More clinically severe disease was associated with older age, male sex, and not having carpal tunnel syndrome. Nonrecordable sensory nerve action potential latency was associated with older age, higher body mass index, male sex, diabetes mellitus, and unemployment. Nonrecordable conduction velocities were associated with older age, and having fibrillations at presentation was associated with older age, male sex, and unemployment. CONCLUSIONS Economic distress is not associated with self-reported symptom duration, time from presentation to surgery, or presenting severity of cubital tunnel syndrome. White patients presented with shorter self-reported symptom duration. Insurance type was associated with delay from presentation to surgery. Older age and male sex were risk factors for more clinically severe disease at presentation.
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Affiliation(s)
| | - Christina Liu
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Zina Model
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Amy Steele
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - David Liu
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
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