Associations Between General Vaccine Hesitancy and Healthcare Access Among Arkansans

Social Determinants of Health Associated With SARS-CoV-2 Testing and Vaccine Attitudes in a Cross-Sectional Study of Latinx Individuals in Oregon

Introduction

Latinx communities have reported higher barriers to SARS-CoV-2 testing and vaccination and experienced disproportionate COVID-19 burden, especially compared with non-Latinx Whites. Social determinants of health models explain health inequities; however, it is unknown how each social determinant of health is associated with SARS-CoV-2 testing and vaccination attitudes among Latinx Americans. This study determined the relative importance of social determinants of health indicators on testing and vaccine attitudes among Latinxs and whether English proficiency and parental nativity moderate associations.

Methods

Cross-sectional survey data were collected between January and December 2022. Multilevel structural equation path modeling addressed the nonindependence of respondents nested within 52 SARS-CoV-2 testing sites across Oregon, U.S. Equality constraints were used to test for differences in the magnitudes of the associations.

Results

Latinx respondents (n=1,247) predominantly spoke Spanish at home (94%) and had no U.S.-born parents (92%). Pandemic vulnerability (β=0.95, p<0.001), economic insecurity (β=0.17, p<0.001), and discrimination (β=0.16, p<0.001) were associated with testing hesitancy; education was associated with vaccine hesitancy (β=0.15, p<0.001); and education (β=0.13, p<0.001) and discrimination (β=0.08, p<0.01) were associated with vaccine safety acceptance. Social determinants of health associations were statistically equal in magnitude. English proficiency moderated the associations from discrimination (β=0.07, p<0.01) and economic insecurity (β= -0.09, p<0.05) to vaccine hesitancy. Parental nativity moderated the associations from economic insecurity to testing hesitancy (β= -0.21, p<0.001) and lack of healthcare access to vaccine hesitancy (β=0.37, p<0.01).

Conclusions

Findings from this study identified distinct social determinants of health paths to testing and vaccine attitudes among Latinxs as well as by English proficiency and parental nativity. These results inform culturally responsive disease prevention for Latinx subgroups.

Perceptions of non-needle-based vaccination devices in the state of Georgia

BACKGROUND

Vaccination is important for controlling infectious disease; however, there are logistical barriers associated with needle and syringe-based vaccination. Non-needle-based vaccination methods could address many of these barriers and are in pre-clinical and clinical development. New technology is sometimes followed by hesitancy, affecting acceptance and uptake, highlighting the importance of understanding the perceptions of vaccine delivery methods by potential vaccine recipients.

METHODS

To understand perceptions of non-needle-based vaccination methods in the state of Georgia, we surveyed 427 Georgia residents. Respondents were asked about their perceptions of vaccines and new medical technology, willingness to accept a non-needle-based vaccine, and whether they would recommend specific vaccination devices.

RESULTS

Race and ethnicity were found to impact vaccine hesitancy and trust in new medical developments hesitancy. Of 427 participants, 29.3 % were more likely to accept non-needle-based devices over needle/syringe, 35.1 % were just as likely to accept, 14.4 % were unsure, and 20.6 % indicated that non-needle-based methods would not make them more likely to receive a vaccine. Race, urbanization, insurance status, vaccine hesitancy, and trust in new medical developments affected willingness to accept a non-needle-based vaccine. Needle/syringe vaccine devices were the most accepted method based on a picture and short description (77.6 %), inhaled vaccine devices were the least recommended (46.8 %); nasal spray (64.3 %), jet injector (60.0 %), skin patch (57.3 %), and oral delivery (54.0 %) were between these values.

CONCLUSIONS

While needle/syringe is the preferred method of vaccination, there are clear preferences among non-needle-based vaccine delivery methods; however, demographic factors that are associated should be considered as these devices move through clinical testing. Our future work will involve in-depth interviews to further identify important themes affecting vaccine acceptance in Georgia. Due to potential hesitancy, we need to strengthen our understanding of themes associated with vaccine perceptions to enable design of accurate and persuasive materials for physicians and patients.

Vaccine hesitancy or hesitancies? A latent class analysis of pediatric patients' parents

Vaccine hesitancy is an attitude of indecision toward vaccination that is related to but not determinative of vaccination behaviors. Although theories of vaccine hesitancy emphasize it is often vaccine-specific, we do not know the extent to which this is true across sociodemographic groups. In this study, we asked: What latent classes of vaccine hesitancy might exist when examining parents' attitudes toward vaccines in general and COVID-19 and human papillomavirus (HPV) vaccination specifically? Which sociodemographic, health access, and health-related variables are predictive of membership in those classes? To answer those questions, we analyze online survey data from parents of pediatric patients recruited through eight clinics within the University of Arkansas for Medical Sciences Rural Research Network. Data were collected between September 16, 2022 and December 6, 2022. Latent class analysis revealed three underlying classes of vaccine hesitancy, or hesitancies: The "Selectively Hesitant," the "COVID-Centric Hesitant," and the "Pervasively Hesitant." Significant predictors of class membership were age, education, health insurance status, and usual source of care. Vaccine hesitancy may be specific to certain vaccines for some parents and more generalized for others. The distinct classes of vaccine hesitancy revealed in this study suggest the need for distinct approaches to addressing vaccine hesitancy depending on the population.

Vaccine Confidence and Coverage among Medical Students at a Federal University in Brazil

BACKGROUND

Declining vaccination coverage (VC) and vaccine hesitancy among medical students are global challenges. These challenges reflect individual and logistical barriers to a sufficient adherence toward essential vaccines for healthcare professionals, as well as presenting a need for educational strategies during undergraduate training.

METHODS

This is a prospective study for evaluating VC rates, sociodemographic associations, and the vaccine confidence among medical students at a federal university in Brazil. The data collection included questionnaires and individual analyses of the participants' vaccination records.

RESULTS

A total of 237 medical students from all six years of an undergraduate program participated, of whom 124 (52.3%) had a vaccination record. Although the majority considered the vaccines to be "Completely Safe" (86.9%), the VC rates for complete vaccination schedules were relatively low, ranging from 87.9% (hepatitis B vaccine) to 3.2% (meningococcal B vaccine), including the vaccines from the National Immunization Program (NIP) and the private sector. Higher VC rates were found to occur among students in the final years of their undergraduate studies, in those from families with higher monthly incomes, and those from private secondary schools.

CONCLUSIONS

Given the low VC rates among medical students, other factors in addition to vaccine confidence may be determinants, thus highlighting the importance of reviewing policies for the inclusion of priority groups in the NIP and in implementing educational interventions during undergraduate training.

Trust in federal COVID-19 vaccine oversight and parents' willingness to vaccinate their children against COVID-19: a cross-sectional study

BACKGROUND

Over half of the youth population in the United States, aged 6 months to 17 years, have not received the Coronavirus Disease 2019 (COVID-19) vaccine. Given parents' central role in vaccinating their children, we examined associations between parents' trust of the federal oversight of COVID-19 vaccine safety and their willingness to vaccinate their children against COVID-19.

METHODS

This cross-sectional study included 975 parents of minor children residing in Philadelphia who completed the online survey between September 2021 and February 2022. Trust was measured using a four-point Likert scale ranging from 'do not trust' to 'fully trust' for two variables: (1) trust in federal oversight of COVID-19 vaccine safety for children and (2) trust in federal oversight of COVID-19 vaccine safety for the general public. A multiple logistic regression evaluated associations between trust and parents' willingness to vaccinate their children, which was measured on a five-point Likert scale ranging from 'strongly disagree' to 'strongly agree.' The analysis was adjusted for race/ethnicity, age, sexual orientation, gender, education, insurance, and parents' vaccination status.

RESULTS

Analyses included 975 parents whose children had not previously been vaccinated against COVID-19 (mean age 36.79, standard deviation 6.4; 42.1% racial/ethnic minorities; 93.2% heterosexual; and 73.7% with a college degree). Greater trust regarding federal oversight of COVID-19 vaccine safety for children [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.13-2.04] and for the public (aOR = 1.58, 95% CI: 1.17-2.14) were each associated with increased willingness to have their child vaccinated against COVID-19. Unvaccinated parents had decreased willingness compared to parents who had received at least one dose of the vaccine (aOR = 0.14, 95% CI: 0.04-0.41). College-graduate parents exhibited increased willingness compared to those without a college degree (aOR = 2.07, 95% CI: 1.52-2.81). Non-heterosexual parents showed increased willingness compared to heterosexual parents (aOR = 2.30, 95% CI: 1.20-4.76).

CONCLUSIONS

Trust in federal COVID-19 vaccine oversight was associated with parental willingness to vaccinate their children against COVID-19 among parents whose children have not yet been vaccinated. Identifying and addressing causes of mistrust are crucial next steps to promote child vaccination. Intervention efforts to address trust gaps should remain a public health priority.

Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy

OBJECTIVES

Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries.

STUDY DESIGN

A cross-sectional study was conducted from November 1 to December 15, 2022.

METHODS

Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed.

RESULTS

Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10-1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19-1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69-2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19-0.32), and had a healthcare facility-based delivery (AOR = 0.55, 95% CI: 0.44-0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68-16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10-0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95-0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44-0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166-0.00168).

CONCLUSIONS

Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage.

Socioeconomic Inequalities in COVID-19 Vaccine Hesitancy and Uptake in Greece and Cyprus during the Pandemic

Despite the rigorous investigation of the phenomenon of vaccine hesitancy and refusal during the COVID-19 pandemic, the socioeconomic determinants of this phenomenon remain poorly investigated on a global scale. Following proportional quota sampling, we conducted a population-based cross-sectional study. We recruited participants on-site and online from different settings, regions, and socioeconomic strata in two Eastern Mediterranean populations, Greece and Cyprus. Our approach provided a nationwide sample (n = 576) approaching the adult population structure of the two countries, with a slight underrepresentation of men and older people. Our results indicate clear socioeconomic differences in vaccine hesitancy and vaccination coverage, consistent with wider social inequalities in health. In particular, we reveal a clear socioeconomic gradient characterized by lower vaccine hesitancy and higher vaccination coverage, with increasing educational attainment and income. Additionally, participants residing in semi-urban areas show higher vaccine hesitancy and have lower vaccination coverage than those residing in urban and rural areas. Our results could inform Public Health approaches aiming to tackle the alarming phenomenon of vaccine hesitancy by enabling the targeting of population groups who are particularly vaccine-hesitant, rendering such approaches more targeted and effective while at the same time reducing inequalities in the control and prevention of infectious diseases.

Healthcare Access and Experiences of Racial Discrimination as Predictors of General Vaccine Hesitancy

The literature regarding vaccine hesitancy is limited to specific vaccines rather than general vaccine hesitancy. No studies have examined the relationship of general vaccine hesitancy to healthcare access and experiences of racial discrimination. This study fills gaps by examining: (1) socio-demographic factors; (2) associations between healthcare access; and (3) experiences with racial discrimination and general vaccine hesitancy. Survey data were obtained from 2022 US adults from 7 September to 3 October 2021. Racial and ethnic minority populations were oversampled. Age, gender, race, and education were predictors of vaccine hesitancy. Asian respondents had less than two-thirds the odds of being vaccine hesitant. Healthcare access was associated with vaccine hesitancy. Not having health insurance coverage, not having a primary care provider, and not seeing a provider for a routine check-up in the past two years were associated with higher vaccine hesitancy. For every one-point increase in racial discrimination score (0-45), the odds of being more vaccine hesitant increased by a factor of 1.03. The findings demonstrate that policy, systems, and environmental factors are critical to addressing vaccine hesitancy. Given the associations between vaccine hesitancy and racial discrimination and healthcare access, more attention should be given to inequities in the healthcare systems in order to address vaccine hesitancy.