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Mensah JA, Fei-Zhang DJ, Rossen JL, Rahmani B, Bentrem DJ, Stein JD, French DD. Assessment of Social Vulnerabilities of Care and Prognosis in Adult Ocular Melanomas in the US. Ann Surg Oncol 2024; 31:3302-3313. [PMID: 38418655 PMCID: PMC11003832 DOI: 10.1245/s10434-024-15038-w] [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: 09/05/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Prior works have studied the impact of social determinants on various cancers but there is limited analysis on eye-orbit cancers. Current literature tends to focus on socioeconomic status and race, with sparse analysis of interdisciplinary contributions. We examined social determinants as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), quantifying eye and orbit melanoma disparities across the United States. METHODS A retrospective review of 15,157 patients diagnosed with eye-orbit cancers in the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017 was performed, extracting 6139 ocular melanomas. SVI scores were abstracted and matched to SEER patient data, with scores generated by weighted averages per population density of county's census tracts. Primary outcome was months survived, while secondary outcomes were advanced staging, high grading, and primary surgery receipt. RESULTS With increased total SVI score, indicating more vulnerability, we observed significant decreases of 23.1% in months survival for melanoma histology (p < 0.001) and 19.6-39.7% by primary site. Increasing total SVI showed increased odds of higher grading (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02-1.43) and decreased odds of surgical intervention (OR 0.94, 95% CI 0.92-0.96). Of the four themes, higher magnitude contributions were observed with socioeconomic status (26.0%) and housing transportation (14.4%), while lesser magnitude contributions were observed with minority language status (13.5%) and household composition (9.0%). CONCLUSIONS Increasing social vulnerability, as measured by the CDC SVI and its subscores, displayed significant detrimental trends in prognostic and treatment factors for adult eye-orbit melanoma. Subscores quantified which social determinants contributed most to disparities. This lays groundwork for providers to target the highest-impact social determinant for non-clinical factors in patient care.
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Affiliation(s)
- Joshua A Mensah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David J Fei-Zhang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer L Rossen
- Division of Pediatric Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Bahram Rahmani
- Division of Pediatric Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David J Bentrem
- Division of Surgical Oncology and Medical Social Sciences, Department of Surgery, Chicago, IL, USA
| | - Joshua D Stein
- Division of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Dustin D French
- Departments of Ophthalmology and Medical Social Sciences, Feinberg School of Medicine, Chicago, IL, USA
- Health Services Research and Development Service, Veteran Health Administration, Edward Hines Jr. VA Hospital, Hines, IL, USA
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Kainth MK, Sembajwe GN, Ahn H, Qian M, Carrington M, Armellino D, Jan S. Despite mandated primary series, health care personnel still hesitant about COVID-19 vaccine and immunizing children. Vaccine 2024; 42:3122-3133. [PMID: 38604909 DOI: 10.1016/j.vaccine.2024.04.028] [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: 11/08/2023] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
IMPORTANCE Healthcare personnel (HCP) are important messengers for promoting vaccines, for both adults and children. Our investigation describes perceptions of fully vaccinated HCP about COVID-19 vaccine for themselves and primary series for their children. OBJECTIVE To determine associations between sociodemographic, employment characteristics and perceptions of COVID-19 vaccines among HCP overall and the subset of HCP with children, who were all mandated to receive a COVID-19 vaccine, in a large US metropolitan region. DESIGN Cross-sectional survey of fully vaccinated HCP from a large integrated health system. SETTING Participants were electronically enrolled within a multi-site NYS healthcare system from December 21, 2021, to January 21, 2022. PARTICIPANTS Of 78,000 employees, approximately one-third accessed promotional emails; 6,537 employees started surveys and 4165 completed them. Immunocompromised HCP (self-reported) were excluded. EXPOSURE(S) (FOR OBSERVATIONAL STUDIES) We conducted a survey with measures including demographic variables, employment history, booster status, child vaccination status; vaccine recommendation, confidence, and knowledge. MAIN OUTCOME(S) AND MEASURES The primary outcome was COVID-19 vaccine hesitancy for all dose types - primary series or booster doses - among HCP. RESULTS Findings from 4,165 completed surveys indicated that almost 17.2 % of all HCP, including administrative and clinical staff, were hesitant or unsure about receiving a COVID-19 vaccine booster, despite the NYS recommendation to do so. Depending on age group, between 20 % and 40 % of HCP were hesitant about having their children vaccinated for COVID-19, regardless of clinical versus non-clinical duties. In multivariable regression analyses, lack of booster dose, unvaccinated children, females, income less than $50,000, and residence in Manhattan remained significantly associated with vaccine hesitancy. CONCLUSIONS AND RELEVANCE Despite mandated COVID-19 vaccination, a substantial proportion of HCP remained vaccine hesitant towards adult booster doses and pediatric COVID-19 vaccination. While provider recommendation has been the mainstay of combatting COVID-19 vaccine hesitancy, a gap exists between HCP-despite clinical or administrative status-and the ability to communicate the need for vaccination in a healthcare setting. While previous studies describe the HCP vaccine mandate as a positive force to overcome vaccine hesitancy, we have found that despite a mandate, there is still substantial COVID-19 vaccine hesitancy, misinformation, and reluctance to vaccinate children.
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Affiliation(s)
- Mundeep K Kainth
- Northwell, New Hyde Park, NY, USA; Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA; Department of Molecular Medicine, Feinstein Institutes of Medical Research, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA.
| | - Grace N Sembajwe
- Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes of Medical Research, Manhasset, NY, USA; Department of Occupational Medicine, Epidemiology, and Prevention, Northwell Health, New York, NY, USA
| | - Heejoon Ahn
- Institute of Health System Science, Feinstein Institutes of Medical Research, Manhasset, NY, USA
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Maxine Carrington
- Center for Learning & Innovation, Human Resources, Northwell Health, USA
| | | | - Sophia Jan
- Northwell, New Hyde Park, NY, USA; Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
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Russ S, Myers C, Licherdell E, Bowden A, Chinchilli E, Dahhan R, Van Wijngaarden E, Plumb ID, Dumyati G. Sociodemographic and Occupational Characteristics Associated with Early and Continued COVID-19 Vaccine Uptake Among Healthcare Personnel: Monroe County, NY. Vaccine 2024; 42:2585-2591. [PMID: 38480100 DOI: 10.1016/j.vaccine.2024.03.019] [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: 10/24/2023] [Revised: 01/15/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Identify characteristics of healthcare personnel (HCP) who did not have timely initiation of the COVID-19 primary series, as well as HCP who did not receive a booster vaccine. METHODS Characteristics of HCP enrolled in a COVID-19 vaccine effectiveness study between 12/28/2020-12/01/2022 were compared by timing of receipt of 1st mRNA dose, and by receipt of a booster dose. Data for this retrospective cohort analysis came from HCP working at a large healthcare system in Monroe County, New York, and included standardized questionnaires and verified vaccination status. HCP were categorized by whether they received their 1stmRNA COVID-19 vaccine between 12/14/2020-03/30/2021 (earlier) or 04/01/2021-09/28/2021 (later) based on timing of local vaccine eligibility and mandates, and by whether they received a 3rdmRNA booster dose by 12/01/22. Logistic regression models were run to identify characteristics of HCP who had later 1stdose receipt or did not receive a booster. RESULTS 3,375 HCP were enrolled. Of these, 86.8 % had early initiation of their 1stCOVID-19 vaccine, and 85.0 % received a booster dose. Low education, low household income, younger age (<50), non-White race and public health insurance were all significant predictors of later receipt of 1stdose and lack of uptake of a booster. However, advanced professional role was only found to be a significant predictor of early 1stdose receipt. CONCLUSIONS Continual monitoring of COVID-19 vaccine uptake among HCP to identify those less likely to receive new booster doses will be crucial to support targeted vaccine campaigns in this important population.
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Affiliation(s)
- Savanah Russ
- Rochester, NY Emerging Infections Program, Center for Community Health & Prevention at the University of Rochester Medical Center, 46 Prince Street, Suite 1001, Rochester, NY 14607, United States; Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Blvd, Rochester, NY 14642, United States.
| | - Christopher Myers
- Rochester, NY Emerging Infections Program, Center for Community Health & Prevention at the University of Rochester Medical Center, 46 Prince Street, Suite 1001, Rochester, NY 14607, United States
| | - Erin Licherdell
- Rochester, NY Emerging Infections Program, Center for Community Health & Prevention at the University of Rochester Medical Center, 46 Prince Street, Suite 1001, Rochester, NY 14607, United States
| | - Acacia Bowden
- Rochester, NY Emerging Infections Program, Center for Community Health & Prevention at the University of Rochester Medical Center, 46 Prince Street, Suite 1001, Rochester, NY 14607, United States
| | - Ellen Chinchilli
- Rochester, NY Emerging Infections Program, Center for Community Health & Prevention at the University of Rochester Medical Center, 46 Prince Street, Suite 1001, Rochester, NY 14607, United States
| | - Runda Dahhan
- Rochester, NY Emerging Infections Program, Center for Community Health & Prevention at the University of Rochester Medical Center, 46 Prince Street, Suite 1001, Rochester, NY 14607, United States
| | - Edwin Van Wijngaarden
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Blvd, Rochester, NY 14642, United States
| | - Ian D Plumb
- National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control & Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States
| | - Ghinwa Dumyati
- Rochester, NY Emerging Infections Program, Center for Community Health & Prevention at the University of Rochester Medical Center, 46 Prince Street, Suite 1001, Rochester, NY 14607, United States
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Baymon DE, Vakkalanka JP, Krishnadasan A, Mohr NM, Talan DA, Hagen MB, Wallace K, Harland KK, Aisiku IP, Hou PC. Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers. JAMA Netw Open 2024; 7:e245697. [PMID: 38598239 PMCID: PMC11007575 DOI: 10.1001/jamanetworkopen.2024.5697] [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: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear. Objectives To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023. Exposure Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred. Main Outcomes and Measures Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs. Results A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing. Conclusions and Relevance In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.
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Affiliation(s)
- DaMarcus E. Baymon
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Anusha Krishnadasan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
| | - Nicholas M. Mohr
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Department of Anesthesia Critical Care, Carver College of Medicine, University of Iowa, Iowa City
| | - David A. Talan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
- David Geffen School of Medicine, University of California, Los Angeles
| | - Melissa Briggs Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Kelli Wallace
- University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City
| | - Karisa K. Harland
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Imoigele P. Aisiku
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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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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Zlotorzynska M, Chea N, Eure T, Alkis Ramirez R, Blazek GT, Czaja CA, Johnston H, Barter D, Kellogg M, Emanuel C, Lynfield R, Fell A, Lim S, Lovett S, Phipps EC, Shrum Davis S, Sievers M, Dumyati G, Concannon C, Myers C, McCullough K, Woods A, Hurley C, Licherdell E, Pierce R, Ocampo VL, Hall E, Magill SS, Grigg CT. Residential social vulnerability among healthcare personnel with and without severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in Five US states, May-December 2020. Infect Control Hosp Epidemiol 2024; 45:82-88. [PMID: 37462106 PMCID: PMC10782193 DOI: 10.1017/ice.2023.131] [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: 03/29/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection. DESIGN Case-control study. SETTING This study analyzed data collected in May-December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon. PARTICIPANTS Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed. METHODS HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase- polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression. RESULTS Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37-2.26). CONCLUSIONS These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.
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Affiliation(s)
- Maria Zlotorzynska
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taniece Eure
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Alkis Ramirez
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory T. Blazek
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Chenega Enterprise Systems & Solutions, LLC, Chesapeake, Virginia
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Melissa Kellogg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Catherine Emanuel
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Ashley Fell
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Sarah Lim
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Sara Lovett
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Erin C. Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Marla Sievers
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Ghinwa Dumyati
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Cathleen Concannon
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Christopher Myers
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Kathryn McCullough
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Amy Woods
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Christine Hurley
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Erin Licherdell
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | | | - Eric Hall
- School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Shelley S. Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheri T. Grigg
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Boschung K, Gill MJ, Krentz HB, Dalere J, Beckthold B, Fonseca K, Bakal JA, McMillan JM, Kanji J, Lang R. COVID-19 vaccine uptake among people with HIV: identifying characteristics associated with vaccine hesitancy. Sci Rep 2023; 13:20610. [PMID: 37996521 PMCID: PMC10667522 DOI: 10.1038/s41598-023-47106-8] [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: 07/21/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
People with HIV (PWH) are at increased risk of COVID-19 infection. Both Canadian (NACI) and US (CDC) guidelines recommend that all PWH receive at least 2 doses of COVID-19 vaccine, and a booster. We examined vaccination uptake among PWH in Southern Alberta, Canada. Among adult PWH, we evaluated COVID-19 vaccination uptake between December 2020 and August 2022. Poisson regression models with robust variance (approximating log binomial models) estimated crude and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for receiving (1) any vs. no vaccine, and (2) primary series with booster (≥ 3 vaccines) versus primary series without booster. Among 1885 PWH, 10% received no COVID-19 vaccinations, 37% < 3 vaccines and 54% received ≥ 3 vaccines. Females (vs. males) were less likely to receive a vaccine booster. Receiving no COVID-19 vaccines was associated with White ethnicity, unsuppressed HIV viral load (> 200 copies/mL), and using illegal substances. Factors associated with decreased booster uptake included being younger, Black (vs. White) ethnicity, substance use, lower educational attainment, and having an unsuppressed HIV viral load. COVID-19 booster uptake among PWH does not meet vaccine guidelines, and receipt of vaccines is unevenly distributed. Booster uptake is lowest among young females and marginalized individuals. Focused outreach is necessary to close this gap.
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Affiliation(s)
- Karol Boschung
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
| | - Hartmut B Krentz
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
| | | | | | - Kevin Fonseca
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Jeffrey A Bakal
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Provincial Research Data Services, Alberta Health Services, Calgary, AB, Canada
| | - Jacqueline M McMillan
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jamil Kanji
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
- Section of Medical Microbiology, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Southern Alberta Clinic, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Solak-Grassie S, Baş F, Ünal E. COVID-19 Vaccine Hesitancy in Healthcare Workers and Attitude Changes During the Pandemic. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:198-204. [PMID: 38633554 PMCID: PMC10986699 DOI: 10.36519/idcm.2023.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/21/2023] [Indexed: 04/19/2024]
Abstract
Objective Many healthcare workers (HCWs) hesitated or refused to receive the COVID-19 vaccines during the pandemic. The attitudes of HCWs toward vaccines have an impact on society and patients. In this study, we aimed to investigate the reasons for vaccine hesitancy and refusal among HCWs during the COVID pandemic. Materials and Methods We planned a two-step descriptive survey study. In the first step, we surveyed the unvaccinated HCWs in our hospital face-to-face after the first vaccination program. After eight months, we conducted another survey with the unvaccinated HCWs over the phone. We investigated the changes in their attitudes between the two surveys and the relationship of vaccine hesitation with their occupation and COVID-19 history. Results After the first vaccine program, 325 (21.2%) HCWs out of 1532 did not get vaccinated in our hospital. We found that there was a significant relationship between vaccine hesitancy and occupation. In our study, the group of "non-HCWs" had the highest vaccine hesitancy rate at the beginning. The most common reasons for vaccine hesitancy were breastfeeding and pregnancy (29.5%) and side effects, especially allergic reactions (18.0%). After eight months, in the second survey, vaccine hesitancy dropped to 5.6%. We found that 80.1% of the HCWs who stated they were planning to get vaccinated in the first survey were vaccinated, and 62.4% of those who were not planning it were vaccinated. In the second survey, 1.8% of HCWs were still planning the vaccination, but 3.8% of HCWs refused the COVID-19 vaccine. Not believing in the efficacy of the vaccine in the first survey was associated with vaccine refusal in the second survey (p=0.001). Conclusion The overall rate of vaccine refusal was low among HCWs. Nevertheless, vaccine refusal among HCWs having more information about the vaccine and disease than the community may be related to cultural, psychological, and political reasons other than efficacy and safety. Future studies on the cultural, psychological, and political reasons for vaccine refusal will contribute to understanding vaccine refusal and increasing vaccine acceptance.
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Affiliation(s)
- Semiha Solak-Grassie
- Infectious Diseases Clinic, Ankara Yıldırım Beyazıt University
Yenimahalle Training and Research Hospital, Ankara, Türkiye
| | - Ferhat Baş
- Department of Health Management, Ankara Yıldırım Beyazıt
University, Ankara, Türkiye
| | - Egemen Ünal
- Department of Public Health, Ankara Yıldırım Beyazıt University
School of Medicine, Ankara, Türkiye
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9
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Green-McKenzie J, Shofer FS, Kruse G, Momplaisir F, Brennan PJ, Kuter BJ. COVID-19 vaccine uptake before and after a vaccine mandate at a major academic hospital: Trends by race/ethnicity and level of patient contact. Vaccine 2023; 41:5441-5446. [PMID: 37517911 DOI: 10.1016/j.vaccine.2023.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To assess vaccine coverage rates before and after implementation of a COVID-19 vaccine mandate among Health care Personnel (HCP) and demographic characteristics associated with vaccine uptake Design, Setting, and Participants: Cohort study conducted among 10,889 hospital employees followed from Dec 16, 2020 - October 31, 2021, at a large academic hospital in Philadelphia. MAIN OUTCOME AND MEASURES Time to COVID-19 vaccination and vaccine series completion rates before and after implementation of a COVID-19 vaccine mandate based on age, gender, race/ethnicity, and level of patient contact/occupational group. RESULTS The vaccination series completion rate was 86.0% prior to mandate announcement, and increased to 98.7% after mandate implementation. Rates before mandate announcement were highest among Asians (96.2%), Whites (94.0%), males (89.7%), employees ≥ 65 years of age (95.2%), and employees with direct patient care (physicians, 99.0%, and nurses, 93.3%). Hospital educational initiatives (including Town Halls and discussions with Black and Hispanic employees with the lowest vaccination rates) appeared to improve uptake. The largest increase in series completion after mandate announcement occurred among Blacks, those of other/multiracial backgrounds, and Hispanics (35.6%, 22.4%, and 10.8%, respectively) as well as those with some or no direct patient contact (24.5% and 18.3%, respectively). Medical or religious exemptions were approved for 64 (<0.6%) employees and 38 (<0.4%) left their positions (8 voluntary, 30 involuntary) specifically due to the COVID-19 vaccine mandate. No clinically meaningful differences by age, gender, or race/ethnicity for those who were vaccinated under the mandate versus those who left their positions were noted. CONCLUSIONS AND RELEVANCE These results suggest that while mandates may be challenging to institutions and enforcement unpopular, they play an important role in reducing hesitancy and securing high vaccination rates among HCP, a group at high risk of COVID-19 given their employment and who can be a source of disease transmission to patients.
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Affiliation(s)
- Judith Green-McKenzie
- Professor & Chief, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, United States; Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, United States.
| | - Frances S Shofer
- Director & Adjunct Professor of Epidemiology & Biostatistics, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, United States
| | - Gregory Kruse
- Associate Vice President of Strategic Operations, University of Pennsylvania Perelman School of Medicine, United States
| | - Florence Momplaisir
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, United States; Assistant Professor, University of Pennsylvania, Perelman School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Patrick J Brennan
- Chief Medical Officer and Senior Vice President, University of Pennsylvania Health System, United States
| | - Barbara J Kuter
- Visiting Research Scientist, Vaccine Education Center, Children's Hospital of Philadelphia, United States
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10
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Green-McKenzie J, Field-Flowers C, Peairs K, Barnes K, Shofer F, Kuter BJ. Best Practices for Implementation of an Employee Health COVID-19 Vaccine Clinic-A Model for Future Pandemic Preparedness. J Occup Environ Med 2023; 65:621-626. [PMID: 37043395 PMCID: PMC10417232 DOI: 10.1097/jom.0000000000002860] [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] [Indexed: 04/13/2023]
Abstract
OBJECTIVES The aims of the study are to determine best practices from two large-scale, academic medical centers' employee coronavirus 2019 (COVID-19) vaccination clinics and to apply them to create scalable modules for rapid administration of 10,000 vaccinations. METHODS The weekly number of COVID-19 vaccine doses administered was captured. Processes were compared to determine best practices, which informed the scalable financial model. RESULTS Within the first 3 months, more than 60,000 COVID-19 vaccine doses were administered, and 70% of employees were fully vaccinated in 4 months with more than 95% by the vaccine mandate deadline. The estimated cost of delivering one dose was $29.95 ($299,505/10,000) compared with $35-$39 per dose when delivered by an on-site retail pharmacy. CONCLUSIONS Successful, safe, and rapid delivery of more than 60,000 COVID-19 vaccine doses in 3 months is practical and scalable. Learnings go beyond COVID-19 and can be applied to future outbreaks/pandemics.
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11
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Russell D, Onorato N, Stern A, Vergez S, Oberlink M, Luebke M, Feldman PH, McDonald MV, Sterling MR. A Qualitative Study of Home Health Aides' Perspectives towards COVID-19 Vaccination. J Appl Gerontol 2023; 42:660-669. [PMID: 36210760 PMCID: PMC9548484 DOI: 10.1177/07334648221130677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Home health aides provide care to homebound older adults and those with chronic conditions. Aides were less likely to receive COVID-19 vaccines when they became available. We examined aides' perspectives towards COVID-19 vaccination. Qualitative interviews were conducted with 56 home health aides at a large not-for-profit home care agency in New York City. Results suggested that aides' vaccination decisions were shaped by (1) information sources, beliefs, their health, and experiences providing care during COVID-19; (2) perceived susceptibility and severity of COVID-19; (3) perceived benefits of vaccination including protection from COVID-19, respect from colleagues and patients, and fulfillment of work-related requirements; (4) perceived barriers to vaccination including concerns about safety, efficacy, and side effects; and (5) cues to action including access to vaccination sites/appointments, vaccination mandates, question and answer sessions from trusted sources, and testimonials. Providing tailored information with support to address vaccination barriers could lead to improved vaccine uptake.
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Affiliation(s)
- David Russell
- Department of Sociology, 1801Appalachian State University, Boone, NC, USA
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Nicole Onorato
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Alexis Stern
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Mia Oberlink
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | | | - Penny H Feldman
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | | | - Madeline R Sterling
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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12
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Thaivalappil A, Young I, MacKay M, Pearl DL, Papadopoulos A. A qualitative study exploring healthcare providers’ and trainees’ barriers to COVID-19 and influenza vaccine uptake. Health Psychol Behav Med 2022; 10:695-712. [PMID: 35957955 PMCID: PMC9359157 DOI: 10.1080/21642850.2022.2106231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Vaccines are effective biological interventions which reduce health burdens and protect healthcare providers from vaccine-preventable diseases. However, there are concerns about varying levels of vaccination coverage of influenza and COVID-19 vaccines among those working in healthcare. The aim of this study was to identify barriers and facilitators to COVID-19 and influenza vaccinations among healthcare providers and trainees using the Theoretical Domains Framework (TDF). Methods Semi-structured interviews (n = 18) were carried out with healthcare providers and trainees in Canada. A thematic analysis approach was used to code interview transcripts and match findings to TDF domains and broader categories. Results Three overarching themes were generated from six TDF domains and three inductively generated categories: (1) making informed health decisions with an added responsibility to protect oneself and patients; (2) a pro-vaccine social network, widespread accessibility, and pursuing a sense of normalcy; and (3) seeking a more nuanced, respectful, and calculated approach to vaccine communication and policy implementation. Conclusion These findings help to identify factors associated with influenza and COVID-19 vaccine uptake among individuals in the healthcare field. Addressing these factors may improve healthcare provider sentiments surrounding vaccines, lead to better patient education, and increased uptake of vaccinations with the potential for seasonal booster doses.
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Affiliation(s)
| | - Ian Young
- School of Occupational and Public Health, Ryerson University, Toronto, Canada
| | - Melissa MacKay
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - David L. Pearl
- Department of Population Medicine, University of Guelph, Guelph, Canada
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13
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Burrowes SAB, Casey SM, Dobbins S, Hall T, Ma M, Bano R, Drainoni ML, Schechter-Perkins EM, Garofalo C, Perkins RB, Pierre-Joseph N. Healthcare workers' perspectives on the COVID-19 vaccine and boosters for themselves, their patients, and their communities: a mixed methods study. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 32:1-14. [PMID: 36588660 PMCID: PMC9790765 DOI: 10.1007/s10389-022-01793-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022]
Abstract
Aim To examine experiences and attitudes of a diverse sample of clinical and non-clinical healthcare workers regarding COVID-19 vaccines and boosters for themselves, their patients, and their communities. Subject and methods We conducted a sequential exploratory mixed methods study; 52 healthcare workers participated in qualitative interviews between April 22 and September 7, 2021, and 209 healthcare workers completed surveys between February 17 and March 23, 2022. Interviews and survey questions asked about personal attitudes toward COVID-19 vaccination and boosters and experiences discussing vaccination with patients. Results Participants were predominantly White (56% and 73%, respectively) and female (79% and 81%, respectively). Factors motivating healthcare workers to take the vaccine were the belief that vaccination would protect themselves, their families, patients, and communities. Healthcare workers were accepting of and had high receipt of the booster, though some had diminished belief in its effectiveness after becoming infected with SARS-CoV-2 after initial vaccination. Race related mistrust, misinformation related to vaccine safety, and concerns about vaccine effects during pregnancy were the most common barriers that providers encountered among their patients and communities. Conclusions Healthcare workers' primary motivation to receive COVID-19 vaccines was the desire to protect themselves and others. Healthcare workers' perception was that concerns about safety and misinformation were more important barriers for their patients than themselves. Race-related medical mistrust amplified concerns about vaccine safety and hindered communication efforts.
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Affiliation(s)
- Shana A. B. Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA USA
| | - Sharon M. Casey
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA 02118 USA
| | - Sidney Dobbins
- Boston University School of Public Health, Boston, MA USA
| | - Taylor Hall
- Graduate of Medical Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, MA USA
| | - Mengyu Ma
- Boston University School of Public Health, Boston, MA USA
| | - Ruqiyya Bano
- Boston University School of Public Health, Boston, MA USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA USA
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA USA
| | - Elissa M. Schechter-Perkins
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA USA
| | - Christopher Garofalo
- Department of Family Medicine and Department of Obstetrics and Gynecology, Sturdy Memorial Hospital, Attleboro, MA USA
- Family Medicine Associates of South Attleboro, South Attleboro, MA USA
| | - Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA 02118 USA
| | - Natalie Pierre-Joseph
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, MA USA
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14
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Viskupič F, Wiltse DL. Drivers of COVID-19 booster uptake among nurses. Am J Infect Control 2022:S0196-6553(22)00815-X. [PMID: 36427700 PMCID: PMC9683517 DOI: 10.1016/j.ajic.2022.11.014] [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: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nurses are at the forefront of efforts to contain COVID-19 and are thus at greater risk of infection from the virus than the general population. Unlike the initial vaccination, booster vaccinations are not always required, and some nurses have not received a booster shot. We investigate the predictors of booster uptake among nurses. METHODS We developed an original survey to study booster uptake among nurses. Using contact information from the South Dakota Board of Nursing, we contacted nurses in South Dakota in June and July of 2022. We conducted a multivariate logistic regression to analyze the data. RESULTS One thousand eighty-four nurses participated in our study. We found booster uptake among nurses was associated with their partisan self-identification (OR 0.40, 95% CI 0.31-0.52), age (OR 1.04, 95% CI 1.02-1.05), flu vaccination last season (OR 5.61, 95% CI 2.6-12.1), and positive COVID-19 test in last 12 months (OR 0.51, 95% CI 0.35-0.74). DISCUSSION/CONCLUSIONS Our results show that COVID-19 booster uptake has been politicized even among nurses. As public health officials continue devising interventions to increase booster uptake among healthcare workers, they should be mindful that they would be viewed through the partisan lens.
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Affiliation(s)
- Filip Viskupič
- Address correspondence to Filip Viskupič, PhD, 219 West Hall, South Dakota State University, Brookings, SD 57006
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15
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Roel E, Raventós B, Burn E, Pistillo A, Prieto-Alhambra D, Duarte-Salles T. Socioeconomic Inequalities in COVID-19 Vaccination and Infection in Adults, Catalonia, Spain. Emerg Infect Dis 2022; 28:2243-2252. [PMID: 36220130 PMCID: PMC9622244 DOI: 10.3201/eid2811.220614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Evidence on the impact of the COVID-19 vaccine rollout on socioeconomic COVID-19-related inequalities is scarce. We analyzed associations between socioeconomic deprivation index (SDI) and COVID-19 vaccination, infection, and hospitalization before and after vaccine rollout in Catalonia, Spain. We conducted a population-based cohort study during September 2020-June 2021 that comprised 2,297,146 adults >40 years of age. We estimated odds ratio of nonvaccination and hazard ratios (HRs) of infection and hospitalization by SDI quintile relative to the least deprived quintile, Q1. Six months after rollout, vaccination coverage differed by SDI quintile in working-age (40-64 years) persons: 81% for Q1, 71% for Q5. Before rollout, we found a pattern of increased HR of infection and hospitalization with deprivation among working-age and retirement-age (>65 years) persons. After rollout, infection inequalities decreased in both age groups, whereas hospitalization inequalities decreased among retirement-age persons. Our findings suggest that mass vaccination reduced socioeconomic COVID-19-related inequalities.
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16
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Toure AA, Traore FA, Camara G, Magassouba AS, Barry I, Kourouma ML, Sylla Y, Conte NY, Cisse D, Dioubaté N, Sidibe S, Beavogui AH, Delamou A. Facilitators and barriers to COVID-19 vaccination among healthcare workers and the general population in Guinea. BMC Infect Dis 2022; 22:752. [PMID: 36167578 PMCID: PMC9514191 DOI: 10.1186/s12879-022-07742-3] [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: 05/15/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The advent of the effective COVID-19 vaccine was the most eagerly expected worldwide. However, this hope quickly became hesitation and denial in many countries, including Guinea. Understanding the reasons for low vaccine coverage is essential to achieving herd immunity leading to disease control. This study aimed to comprehend the facilitators and barriers to the acceptance COVID-19 vaccine in Guinea. Methods The survey focused on healthcare workers (HCWs) and the general population (GP) in 4 natural regions in Guinea from 23 March 2021 to 25 August 2021. We used the Fishbein integration model to study the behaviours of HWCs and GP regarding vaccination. A mixed cross-sectional study collected knowledge, attitudes, norms, and perceptions. Regression and thematic content analysis identified the main facilitators and barriers to vaccination. Results We surveyed 3547 HCWs and 3663 GP. The proportion of people vaccinated was 65% among HCWs and 31% among the GP. For HCWs: the main factors associated with vaccination against COVID-19 were as follows: absence of pregnancy AOR = 4.65 [3.23–6.78], being supportive of vaccination AOR = 1.94 [1.66–2.27] and being an adult AOR = 1.64 [1.26–2.16]. Regarding the GP, the following factors increased the odds of vaccination: absence of pregnancy AOR = 1.93 [CI 1.01–3.91], being favourable for vaccination AOR = 3.48 [CI 2.91–4.17], being an adult AOR = 1.72 [CI 1.38–2.14] and being able to get the vaccine AOR = 4.67 [CI 3.76–5.84]. Semi-interviews revealed fear, lack of trust, and hesitant perception of the government as potential barriers to vaccination. Conclusion This study suggests that beliefs and negative perceptions are potential barriers to vaccination against COVID-19 among HCWs and the GP. Policies should emphasise practical strategies to mitigate these barriers among young people and pregnant women. Lastly, there is a need to improve access to vaccines in the GP. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07742-3.
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Affiliation(s)
- Almamy Amara Toure
- National Centre of Training and Recherche in Rural Health of Mafèrinyah, BP 2649, Forécariah, Guinea. .,Department of Public Health, Kofi Annan University of Guinea, Conakry, Guinea.
| | - Fodé Amara Traore
- Faculté des Sciences et Techniques de la Santé, Centre Hospitalo-Universitaire de Conakry, Service de Maladies Infectieuses, Université Gamal Abdel Nasser, Conakry, Guinea.,Agence Nationale de Sécurité Sanitaire, Conakry, Guinea
| | - Gnoume Camara
- Department of Public Health, Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Guinea
| | - Aboubacar Sidiki Magassouba
- Department of Public Health, Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Guinea
| | - Ibrahima Barry
- National Centre of Training and Recherche in Rural Health of Mafèrinyah, BP 2649, Forécariah, Guinea
| | | | - Younoussa Sylla
- National Centre of Training and Recherche in Rural Health of Mafèrinyah, BP 2649, Forécariah, Guinea
| | - Naby Yaya Conte
- National Centre of Training and Recherche in Rural Health of Mafèrinyah, BP 2649, Forécariah, Guinea.,Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | - Diao Cisse
- Department of Public Health, Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Guinea
| | - Nafissatou Dioubaté
- National Centre of Training and Recherche in Rural Health of Mafèrinyah, BP 2649, Forécariah, Guinea
| | - Sidikiba Sidibe
- Department of Public Health, Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Guinea.,African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Conakry, Guinea
| | - Abdoul Habib Beavogui
- National Centre of Training and Recherche in Rural Health of Mafèrinyah, BP 2649, Forécariah, Guinea
| | - Alexandre Delamou
- Department of Public Health, Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Guinea.,African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Conakry, Guinea
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17
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Bilal U, Mullachery PH, Schnake-Mahl A, Rollins H, McCulley E, Kolker J, Barber S, Diez Roux AV. Heterogeneity in Spatial Inequities in COVID-19 Vaccination Across 16 Large US Cities. Am J Epidemiol 2022; 191:1546-1556. [PMID: 35452081 PMCID: PMC9047229 DOI: 10.1093/aje/kwac076] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/02/2022] [Accepted: 04/14/2022] [Indexed: 01/29/2023] Open
Abstract
Differences in vaccination coverage can perpetuate coronavirus disease 2019 (COVID-19) disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTAs) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose, all in California; Chicago, Illinois; Indianapolis, Indiana; Minneapolis, Minnesota; New York, New York; Philadelphia, Pennsylvania; and Austin, Dallas, Fort Worth, Houston, and San Antonio, all in Texas. We computed absolute and relative total and Social Vulnerability Index-related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% confidence interval: 0.69, 0.81) or 16 percentage points (95% confidence interval: 12.1, 20.3) lower in neighborhoods with the highest social vulnerability as compared with those with the lowest. These inequities were heterogeneous, with cities in the West generally displaying narrower inequities in both the absolute and relative scales. The Social Vulnerability Index domains of socioeconomic status and of household composition and disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.
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Affiliation(s)
- Usama Bilal
- Correspondence to Dr. Usama Bilal, 3600 Market Street, Suite 730, Philadelphia, PA, 19104 (e-mail: )
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18
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Garcia L, Firek A, Freund D, Massai D, Khurana D, Lee JE, Zamarripa S, Sasaninia B, Michaels K, Nightingale J, Gatto NM. Decisions to Choose COVID-19 Vaccination by Health Care Workers in a Southern California Safety Net Medical Center Vary by Sociodemographic Factors. Vaccines (Basel) 2022; 10:1247. [PMID: 36016135 PMCID: PMC9412623 DOI: 10.3390/vaccines10081247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Limited information exists regarding COVID-19 vaccine hesitancy among healthcare workers (HCWs). Our previous survey analyzed the reasons for HCWs' decisions to accept vaccination, suggesting that a "one-size fits all" approach may not suffice to increase vaccine uptake. METHODS Based on the vaccination acceptance group (acceptor, hesitant, refuser), we examined differences by sociodemographic factors (race/ethnicity, household income, education) from Likert Scale responses to fourteen influences affecting a decision to be vaccinated using the Kruskal-Wallis test and multinomial logistic regression with mutual adjustment for these sociodemographic factors, age, and sex. RESULTS Non-Hispanic White vaccine acceptors ranked lower confidence in preventing, withstanding, or treating COVID-19, while Non-Hispanic Blacks more highly regarded the motivation of a religious leader, colleague, or family member. Social media was ranked more influential among Non-Hispanic Asians. Acceptors with lower incomes ranked a job requirement influential; conversely, higher income vaccine hesitant HCWs highly rated this reason. More highly educated acceptors ranked being motivated by colleagues, family, and other HCWs higher. Adjustment weakened some but not all the differences between groups. CONCLUSIONS Sociodemographic factors affect HCWs' decisions to be vaccinated against COVID-19. Our findings may help develop more focused and tailored strategies to improve vaccination acceptance.
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Affiliation(s)
- Lauren Garcia
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA 91711, USA; (L.G.); (D.F.); (D.M.)
| | - Anthony Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA; (A.F.); (D.K.); (S.Z.); (B.S.); (K.M.); (J.N.)
| | - Deborah Freund
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA 91711, USA; (L.G.); (D.F.); (D.M.)
- Department of Economic Sciences, Claremont Graduate University, 150 E 10th St, Claremont, CA 91711, USA;
| | - Donatella Massai
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA 91711, USA; (L.G.); (D.F.); (D.M.)
| | - Dhruv Khurana
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA; (A.F.); (D.K.); (S.Z.); (B.S.); (K.M.); (J.N.)
- Division of Addiction Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Jerusha E. Lee
- Department of Economic Sciences, Claremont Graduate University, 150 E 10th St, Claremont, CA 91711, USA;
| | - Susanna Zamarripa
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA; (A.F.); (D.K.); (S.Z.); (B.S.); (K.M.); (J.N.)
| | - Bijan Sasaninia
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA; (A.F.); (D.K.); (S.Z.); (B.S.); (K.M.); (J.N.)
| | - Kelsey Michaels
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA; (A.F.); (D.K.); (S.Z.); (B.S.); (K.M.); (J.N.)
| | - Judi Nightingale
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA; (A.F.); (D.K.); (S.Z.); (B.S.); (K.M.); (J.N.)
| | - Nicole M. Gatto
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA; (A.F.); (D.K.); (S.Z.); (B.S.); (K.M.); (J.N.)
- School of Public Health, Loma Linda University, 24951 Circle Dr, Loma Linda, CA 92354, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90089, USA
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Vaccine hesitancy and health care providers: Using the preferred cognitive styles and decision- making model and empathy tool to make progress. Vaccine X 2022; 11:100174. [PMID: 35782719 PMCID: PMC9241108 DOI: 10.1016/j.jvacx.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/09/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Low vaccination rates among health care providers (HCPs) pose a risk to themselves, their colleagues, their patients, and the general public. This paper seeks to frame the issues surrounding health care provider vaccine hesitancy and vaccination rates, as well as explore factors influencing respective decision-making, including health care occupation and demographic characteristics. This paper will then propose the use of the Preferred Cognitive Style and Decision-Making (PCSDM) Model and the Empathy Tool to increase health care provider vaccination rates, and will end by discussing several recommendations. It is important while discussing HCP vaccination rates to not view them as a monolithic group or apply “one-size-fits-all” approaches, and thus it is essential to present information and engage in conversations in ways that align with how the HCP takes in and processes information and decisions. Furthermore, it is vital to increase health literacy across the spectrum of HCP programs and professions. To this end, it is important to teach and incorporate the PCSDM Model and Empathy Tool, along with information about how individuals think and make decisions, into vaccine education programs and training sessions.
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COVID-19 Vaccination Hesitancy among Healthcare Workers-A Review. Vaccines (Basel) 2022; 10:vaccines10060948. [PMID: 35746556 PMCID: PMC9227837 DOI: 10.3390/vaccines10060948] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic and its associated vaccine have highlighted vaccine hesitancy among healthcare workers (HCWs). Vaccine hesitancy among this group existed prior to the pandemic and particularly centered around influenza vaccination. Being a physician, having more advanced education, and previous vaccination habits are frequently associated with vaccine acceptance. The relationship between age and caring for patients on COVID-19 vaccination is unclear, with studies providing opposing results. Reasons for hesitancy include concerns about safety and efficacy, mistrust of government and institutions, waiting for more data, and feeling that personal rights are being infringed upon. Many of these reasons reflect previous attitudes about influenza vaccination as well as political beliefs and views of personal autonomy. Finally, several interventions to encourage vaccination have been studied, including education programs and non-monetary incentives with the most effective studies using a combination of methods.
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Rich JA, Miech EJ, Bilal U, Corbin TJ. How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia. BMC Public Health 2022; 22:1044. [PMID: 35614426 PMCID: PMC9130689 DOI: 10.1186/s12889-022-13414-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COVID-19 infection has disproportionately affected socially disadvantaged neighborhoods. Despite this disproportionate burden of infection, these neighborhoods have also lagged in COVID-19 vaccinations. To date, we have little understanding of the ways that various types of social conditions intersect to explain the complex causes of lower COVID-19 vaccination rates in neighborhoods. METHODS We used configurational comparative methods (CCMs) to study COVID-19 vaccination rates in Philadelphia by neighborhood (proxied by zip code tabulation areas). Specifically, we identified neighborhoods where COVID-19 vaccination rates (per 10,000) were persistently low from March 2021 - May 2021. We then assessed how different combinations of social conditions (pathways) uniquely distinguished neighborhoods with persistently low vaccination rates from the other neighborhoods in the city. Social conditions included measures of economic inequities, racial segregation, education, overcrowding, service employment, public transit use, health insurance and limited English proficiency. RESULTS Two factors consistently distinguished neighborhoods with persistently low COVID-19 vaccination rates from the others: college education and concentrated racial privilege. Two factor values together - low college education AND low/medium concentrated racial privilege - identified persistently low COVID-19 vaccination rates in neighborhoods, with high consistency (0.92) and high coverage (0.86). Different values for education and concentrated racial privilege - medium/high college education OR high concentrated racial privilege - were each sufficient by themselves to explain neighborhoods where COVID-19 vaccination rates were not persistently low, likewise with high consistency (0.93) and high coverage (0.97). CONCLUSIONS Pairing CCMs with geospatial mapping can help identify complex relationships between social conditions linked to low COVID-19 vaccination rates. Understanding how neighborhood conditions combine to create inequities in communities could inform the design of interventions tailored to address COVID-19 vaccination disparities.
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Affiliation(s)
- John A Rich
- Department of Health Management and Policy, Center for Nonviolence and Social Justice, Dornsife School of Public Health, Drexel University, 1505 Race Street, MS 1047, 6th floor, Philadelphia, PA, 19102, USA.
| | - Edward J Miech
- Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
| | - Theodore J Corbin
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Suite 108 Kellogg, Chicago, IL, 60612, USA
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22
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Attributes of Long Duration COVID-19 Workers’ Compensation Claims. J Occup Environ Med 2022; 64:e327-e332. [DOI: 10.1097/jom.0000000000002523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thomas CM, Searle K, Galván A, Liebman AK, Mann EM, Kirsch JD, Stauffer WM. Healthcare Worker Perspectives on COVID-19 Vaccines: Implications for Increasing Vaccine Acceptance among Healthcare Workers and Patients. Vaccine 2022; 40:2612-2618. [PMID: 35315322 PMCID: PMC8904141 DOI: 10.1016/j.vaccine.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
Objective To understand COVID-19 vaccine perspectives among healthcare workers serving diverse communities. Methods A dual English/Spanish survey was distributed to healthcare workers in the United States from 3/12/2021–4/22/2021 by the Migrant Clinicians Network, Society of Refugee Healthcare Providers, a Federally Qualified Healthcare Center, and social media advertisement to general primary care workers. Results 517 responses were at least 50% complete and included in the analysis. Among these, 88% (457/517) indicated vaccine acceptance. Factors associated with acceptance included not reporting any vaccine concerns, identifying as male, ≥65 years of age, being a physician or advanced practice provider, and interacting directly with patients from refugee, immigrant, and migrant (RIM) communities. Participants identified educational information as most helpful for themselves when making a vaccine decision, but a healthcare provider’s recommendation as most helpful for their patients. Conclusion Healthcare workers, especially those serving RIM communities, are vaccine accepting. Tailoring vaccine-related information to healthcare workers may improve vaccine confidence for both themselves and patients who rely on them for information.
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Affiliation(s)
- Christine M Thomas
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States.
| | - Kelly Searle
- School of Public Health, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Alma Galván
- Migrant Clinicians Network, Austin, TX, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Amy K Liebman
- Migrant Clinicians Network, Austin, TX, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Erin M Mann
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan D Kirsch
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States; Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - William M Stauffer
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States; Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
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Error in Author's Name. JAMA Netw Open 2022; 5:e2147879. [PMID: 35072725 PMCID: PMC8787592 DOI: 10.1001/jamanetworkopen.2021.47879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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