Racial/ethnic disparities in intent to obtain a COVID-19 vaccine: A nationally representative United States survey

Understanding the determinants of vaccine hesitancy in the United States: A comparison of social surveys and social media

The COVID-19 pandemic prompted governments worldwide to implement a range of containment measures, including mass gathering restrictions, social distancing, and school closures. Despite these efforts, vaccines continue to be the safest and most effective means of combating such viruses. Yet, vaccine hesitancy persists, posing a significant public health concern, particularly with the emergence of new COVID-19 variants. To effectively address this issue, timely data is crucial for understanding the various factors contributing to vaccine hesitancy. While previous research has largely relied on traditional surveys for this information, recent sources of data, such as social media, have gained attention. However, the potential of social media data as a reliable proxy for information on population hesitancy, especially when compared with survey data, remains underexplored. This paper aims to bridge this gap. Our approach uses social, demographic, and economic data to predict vaccine hesitancy levels in the ten most populous US metropolitan areas. We employ machine learning algorithms to compare a set of baseline models that contain only these variables with models that incorporate survey data and social media data separately. Our results show that XGBoost algorithm consistently outperforms Random Forest and Linear Regression, with marginal differences between Random Forest and XGBoost. This was especially the case with models that incorporate survey or social media data, thus highlighting the promise of the latter data as a complementary information source. Results also reveal variations in influential variables across the five hesitancy classes, such as age, ethnicity, occupation, and political inclination. Further, the application of models to different MSAs yields mixed results, emphasizing the uniqueness of communities and the need for complementary data approaches. In summary, this study underscores social media data's potential for understanding vaccine hesitancy, emphasizes the importance of tailoring interventions to specific communities, and suggests the value of combining different data sources.

Perceptions of Racial-Ethnic Inequities in COVID-19 Healthcare and Willingness to Receive the COVID-19 Vaccine

BACKGROUND

Perceptions of the US healthcare system can impact individuals' healthcare utilization, including vaccination intentions. This study examined the association between perceived racial-ethnic inequities in COVID-19 healthcare and willingness to receive the COVID-19 vaccine.

METHODS

This study used data from REACH-US, a nationally representative online survey of a large, diverse sample of U.S. adults (N=5145 January 26, 2021-March 3, 2021). Confirmatory factor and regression analyses examined a latent factor of perceived racial-ethnic inequities in COVID-19 healthcare, whether the factor was associated with willingness to receive the COVID-19 vaccine, and whether associations varied across racial-ethnic groups reported as probit estimates (B) and 95% confidence intervals (CIs).

RESULTS

Perceived racial-ethnic inequities in COVID-19 healthcare were highest among Black/African American adults (mean latent factor score: 0.65 ± 0.43) and lowest among White adults (mean latent factor score: 0.04 ± 0.67). Black/African American (B = -0.08; 95% CI = -0.19, 0.03) and Native Hawaiian/Pacific Islander (B = -0.08; 95% CI = -0.23, 0.07) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were less willing than participants who perceived lower inequities. In contrast, American Indian/Alaska Native (B = 0.15; 95% CI = -0.01, 0.30), Asian (B = 0.20; 95% CI = 0.08, 0.31), Hispanic/Latino (English language preference) (B = 0.22; 95% CI = 0.01, 0.43), Multiracial (B = 0.23; 95% CI = 0.09, 0.36), and White (B = 0.31; 95% CI = 0.19, 0.43) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were more willing to receive the COVID-19 vaccine than participants perceiving higher inequities.

CONCLUSIONS

Greater perceived racial-ethnic inequities in COVID-19 healthcare were associated with less willingness to receive the COVID-19 vaccine among Black/African American and Native Hawaiian/Pacific Islander adults.

Heterogeneity in COVID-19 vaccine uptake within low-income minority communities: evidence from the watts neighborhood health study

BACKGROUND

The literature on disparities in COVID-19 vaccine uptake focuses primarily on the differences between White versus non-White individuals or differences by socioeconomic status. Much less is known about disparities in vaccine uptake within low-income, minority communities and its correlates.

METHODS

This study investigates disparities in COVID-19 vaccination uptake within racial and ethnic minoritized communities with similar socioeconomic backgrounds and built environments, specifically focusing on Black-Hispanic disparities and disparities within the Hispanic community by country of origin. Data are analyzed from the fourth wave (June 2021- May 2022) of the Watts Neighborhood Health Study, a cohort study of public housing residents in south Los Angeles, CA. Linear probability models estimated the association between vaccine uptake and participants' race/ethnicity, sequentially adding controls for sociodemographic characteristics, health care access and insurance, prior infection, and attitudes towards COVID-19 vaccines. Differences in reasons for vaccination status by race/ethnicity were also tested.

RESULTS

Mexican Hispanic and non-Mexican Hispanic participants were 31% points (95% CI: 0.21, 0.41, p < 0.001) and 44% points (95% CI: 0.32, 0.56, p < 0.001) more likely to be vaccinated than non-Hispanic Black participants, respectively. The disparity between Black and Hispanic participants was reduced by about 40% after controlling for attitudes towards COVID-19 vaccines. Among Hispanic participants, non-Mexican participants were 13% points (95% CI: 0.03, 0.24, p = 0.01) more likely to be vaccinated than Mexican participants, however, these differences were no longer significant after controlling for individual and household characteristics (β = 0.04, 95% CI: -0.07, 0.15, p = 0.44).

CONCLUSION

There are sizeable racial and ethnic COVID-19 vaccination disparities even within low-income and minoritized communities. Accounting for this heterogeneity and its correlates can be critically important for public health efforts to ensure vaccine equity.

Community Resilience and Cultural Responses in Crisis: Lessons Learned from Pacific Islander Responses to the COVID-19 Pandemic in the USA

Pacific Islander communities in the USA experienced some of the most severe effects of the COVID-19 pandemic. This qualitative synthesis examines the literature on Pacific Islander community responses and lessons learned from COVID-19, using a systematic search that identified 28 articles with this focus. Thematic analysis was subsequently used to classify both documented efforts by Pacific Islander communities to respond to the pandemic, as well as lessons learned and best practices from research in this area. Results revealed multiple efforts to address the pandemic, including Pacific Islander grassroots approaches, government responses, inter-sector collaboration, and research. Results further emphasized the importance of culturally and linguistically responsive outreach and messaging; partnership, engagement, and capacity building; and changes in research and policy approaches to promote health equity. Future efforts to address public health crises should make the most of Pacific Islander cultural approaches to disaster response. To achieve this, government and other organizations that work with PI communities need to support the development of the PI leadership, healthcare and research workforces, and work with Pacific Islander communities to build long-term, sustainable, and trustworthy partnerships.

County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S

Background

County-level vaccination barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, history of low vaccination) may partially explain COVID-19 vaccination intentions among U.S. adults. This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S. and were associated with willingness to receive the COVID-19 vaccine. In addition, this study assessed whether these associations differed across racial/ethnic groups.

Methods

This study used data from the REACH-US study, a large online survey of U.S. adults (N = 5,475) completed from January 2021-March 2021. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Ordinal logistic regression estimated associations between race/ethnicity and county-level vaccination barriers and between county-level vaccination barriers and willingness to receive the COVID-19 vaccine. Models adjusted for covariates (age, gender, income, education, political ideology, health insurance, high-risk chronic health condition). Multigroup analysis estimated whether associations between barriers and willingness to receive the COVID-19 vaccine differed across racial/ethnic groups.

Results

American Indian/Alaska Native, Black/African American, Hispanic/Latino ELP [English Language Preference (ELP); Spanish Language Preference (SLP)], and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers [Adjusted Odd Ratios (AORs):1.63-3.81]. Higher county-level vaccination barriers were generally associated with less willingness to receive the COVID-19 vaccine, yet associations were attenuated after adjusting for covariates. Trends differed across barriers and racial/ethnic groups. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine (AOR:0.78, 95% CI:0.64-0.94), whereas higher irregular care-seeking behavior was associated with greater willingness to receive the vaccine (AOR:1.20, 95% CI:1.04-1.39). Greater history of low vaccination was associated with less willingness to receive the COVID-19 vaccine among Black/African American adults (AOR:0.55, 95% CI:0.37-0.84), but greater willingness to receive the vaccine among American Indian/Alaska Native and Hispanic/Latino ELP adults (AOR:1.90, 95% CI:1.10-3.28; AOR:1.85, 95% CI:1.14-3.01).

Discussion

Future public health emergency vaccination programs should include planning and coverage efforts that account for structural barriers to preventive healthcare and their intersection with sociodemographic factors. Addressing structural barriers to COVID-19 treatment and preventive services is essential for reducing morbidity and mortality in future infectious disease outbreaks.

COVID-19 vaccination willingness and uptake among low-income Black/African American, Latino, and White adults living in the U.S

The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between low-income and non-low-income adults and across race-ethnicity. We utilized data from the COVID-19's Unequal Racial Burden online survey, which included baseline (12/17/2020-2/11/2021) and 6-month follow-up (8/13/2021-9/9/2021) surveys. The sample included 1,500 Black/African American, Latino, and White low-income adults living in the U.S. (N = 500 each). A non-low-income cohort was created for comparison (n = 1,188). Multinomial logistic regression was used to assess differences in vaccine willingness and uptake between low-income and non-low-income adults, as well as across race-ethnicity (low-income adults only). Only low-income White adults were less likely to be vaccinated compared to their non-low-income counterparts (extremely willing vs. not at all: OR = 0.58, 95% CI = 0.39-0.86); low-income Black/African American and Latino adults were just as willing or more willing to vaccinate. At follow-up, only 30.2% of low-income adults who reported being unwilling at baseline were vaccinated at follow-up. White low-income adults (63.6%) appeared less likely to be vaccinated, compared to non-low-income White adults (80.9%), low-income Black/African American (70.7%), and low-income Latino adults (72.4%). Distrust in the government (46.6), drug companies (44.5%), and vaccine contents (52.1%) were common among those unwilling to vaccinate. This prospective study among a diverse sample of low-income adults found that low-income White adults were less willing and less likely to vaccinate than their non-low-income counterparts, but this difference was not observed for Black/African American or Latino adults. Distrust and misinformation were prevalent among those who remained unvaccinated at follow-up.

Inability to get needed health care during the COVID-19 pandemic among a nationally representative, diverse population of U.S. adults with and without chronic conditions

BACKGROUND

Delays in health care have been observed in the U.S. during the COVID-19 pandemic; however, the prevalence of inability to get needed care and potential disparities in health care access have yet to be assessed.

METHODS

We conducted a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults between 12/2020-2/2021 (baseline) and 8/16/2021-9/9/2021 (6-month follow-up). Participants were asked "Since the start of the pandemic, was there any time when you did not get medical care that you needed?" Those who responded "Yes" were asked about the type of care and the reason for not receiving care. Poisson regression was used to estimate the association between sociodemographics and inability to receive needed care; all analyses were stratified by chronic condition status. Chronic conditions included: chronic obstructive pulmonary disease (COPD), heart conditions, type 2 diabetes, chronic kidney disease or on dialysis, sickle cell disease, cancer, and immunocompromised state (weakened immune system).

RESULTS

Overall, 20.0% of participants at baseline and 22.7% at follow-up reported not getting needed care. The most common reasons for being unable to get needed care included fear of COVID-19 (baseline: 44.1%; follow-up: 47.2%) and doctors canceled appointment (baseline: 25.3%; follow-up: 14.1%). Routine care (baseline: 59.9%; follow-up: 62.6%) and chronic care management (baseline: 31.5%; follow-up: 30.1%) were the most often reported types of delayed care. Fair/poor self-reported physical health was significantly associated with being unable to get needed care despite chronic condition status (≥ 1 chronic condition: aPR = 1.36, 95%CI = 1.04-1.78); no chronic conditions: aPR = 1.52, 95% CI = 1.28-1.80). The likelihood of inability to get needed care differed in some instances by race/ethnicity, age, and insurance status. For example, uninsured adults were more likely to not get needed care (≥ 1 chronic condition: aPR = 1.76, 95%CI = 1.17-2.66); no chronic conditions: aPR = 1.25, 95% CI = 1.00-1.56).

CONCLUSIONS

Overall, about one fifth of participants reported being unable to receive needed care at baseline and follow-up. Delays in receiving needed medical care may exacerbate existing conditions and perpetuate existing health disparities among vulnerable populations who were more likely to have not received needed health care during the pandemic.

Telehealth access, willingness, and barriers during the COVID-19 pandemic among a nationally representative diverse sample of U.S. adults with and without chronic health conditions

INTRODUCTION

During the COVID-19 pandemic, telehealth services represented a critical tool in maintaining continuity and access to care for adults in the USA. However, despite improvements in access and utilization during the pandemic, disparities in telehealth utilization have persisted. It is unclear what role access and willingness to use telehealth play in telehealth disparities.

METHODS

We used data from the nationally representative COVID-19's Unequal Racial Burden (CURB) survey, an online survey conducted between December 2020 and February 2021, n = 5500. Multivariable Poisson regression was used to estimate the prevalence of perceived telehealth access and willingness to use telehealth services among adults with and without chronic conditions.

RESULTS

Overall, 60.1% of adults with and 38.7% of adults without chronic conditions reported having access to telehealth. After adjustment, adults with chronic conditions were more likely to report telehealth access (adjusted prevalence ratio [aPR] = 1.35, 95% confidence interval [CI] = 1.21-1.50). Most adults with and without chronic conditions reported being willing to use telehealth services (85.1% and 79.8%, respectively), and no significant differences in willingness were observed across chronic condition status (aPR = 1.03, 95% CI = 0.95-1.13). Perceived telehealth access appeared to be a predictor of telehealth willingness in both groups (chronic conditions: aPR = 1.22, 95% CI = 0.97-1.54; no chronic conditions: aPR = 1.37, 95% CI = 1.22-1.54). The prevalence of perceived barriers to telehealth was low, with the majority reporting no barriers (chronic conditions = 51.4%; no chronic conditions = 61.4%).

DISCUSSION

Perceived access to telehealth was associated with telehealth willingness. Investing in approaches that increase telehealth accessibility and awareness is needed to improve access to telehealth for adults with and without chronic conditions.

COVID-19 vaccination willingness and uptake among rural Black/African American, Latino, and White adults

PURPOSE

The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between rural and nonrural adults, and within rural racial-ethnic groups.

METHODS

We utilized data from the COVID-19's Unequal Racial Burden online survey, which included 1,500 Black/African American, Latino, and White rural adults (n = 500 each). Baseline (12/2020-2/2021) and 6-month follow-up (8/2021-9/2021) surveys were administered. A cohort of nonrural Black/African American, Latino, and White adults (n = 2,277) was created to compare differences between rural and nonrural communities. Multinomial logistic regression was used to assess associations between rurality, race-ethnicity, and vaccine willingness and uptake.

FINDINGS

At baseline, only 24.9% of rural adults were extremely willing to be vaccinated and 28.4% were not at all willing. Rural White adults were least willing to be vaccinated, compared to nonrural White adults (extremely willing: aOR = 0.44, 95% CI = 0.30-0.64). At follow-up, 69.3% of rural adults were vaccinated; however, only 25.3% of rural adults who reported being unwilling to vaccinate were vaccinated at follow-up, compared to 95.6% of adults who were extremely willing to be vaccinated and 76.3% who were unsure. Among those unwilling to vaccinate at follow-up, almost half reported distrust in the government (52.3%) and drug companies (46.2%); 80% reported that nothing would change their minds regarding vaccination.

CONCLUSIONS

By August 2021, almost 70% of rural adults were vaccinated. However, distrust and misinformation were prevalent among those unwilling to vaccinate at follow-up. To continue to effectively combat COVID-19 in rural communities, we need to address misinformation to increase COVID-19 vaccination rates.

Perceived Role, Identity and Experiences of Pharmacists and the Potential Impact on COVID-19 Vaccine Uptake per Louisiana Region: A Prospective Cohort Study

Some of the lowest COVID-19 community vaccination rates in America are found in Louisiana. This study investigated: (1) barriers that Louisiana pharmacists encountered during the pandemic; and (2) the effect of pharmacists' role and identity confidence on willingness to enforce vaccine mandates, and COVID-19 vaccine uptake. Fifty-four community pharmacists from nine regions of Louisiana participated in the study. Pharmacists completed questionnaires about: personal demographics, patient population, vaccination encouragement, COVID-19 concerns, and vaccination administration rates. The importance of feeling like a trusted voice in the community, as well as professional perception and self-assurance, were measured using Likert scale questions. During focus groups, participants discussed experiences with the COVID-19 vaccination rollout and vaccination-related obstacles. As the pandemic progressed, pharmacists reported being overworked, understaffed, and overburdened with new responsibilities. In regions with lower vaccination rates, pharmacists were less likely to feel at ease enforcing vaccine mandates. Independent pharmacists were less comfortable enforcing vaccine mandates than chain pharmacists but had more positive perceptions of their role and identity. This study contributes to further understanding of pharmacy workflow obstacles and pharmacists' perceptions of their professional roles and identities in the community.

Depression Symptoms, Perceived Stress, and Loneliness During the COVID-19 Pandemic Among Diverse US Racial-Ethnic Groups

Introduction

Studies have reported increases in psychological distress during the COVID-19 pandemic. This study aimed to estimate associations between race-ethnicity and psychological distress during the COVID-19 pandemic among nationally representative samples of all major racial-ethnic groups in the United States.

Methods

We conducted a nationally representative cross-sectional survey between December 2020 and February 2021 of Asian, black/African American, Latino (English and Spanish speaking), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, white, and multiracial adults (n=5500). Distress measures included: anxiety-depression (Patient Health Questionnaire-4 [PHQ-4]), stress (modified Perceived Stress Scale), and loneliness-isolation (frequency felt lonely and isolated). Multinomial logistic regression models estimated associations between race-ethnicity and psychological distress, adjusting for demographic and health characteristics.

Results

Overall, 23.7% reported moderate/severe anxiety-depression symptoms, 34.3% reported moderate/severe stress, and 21.3% reported feeling lonely-isolated fairly/very often. Compared with white adults and adjusting for covariates, the prevalence of moderate/severe anxiety-depression was significantly lower among Asian (adjusted odds ratio [aOR]=0.44, 95% confidence interval [CI]=0.34-0.58), black (aOR=0.49, 95% CI=0.38-0.63), English-speaking Latino (aOR=0.62, 95% CI=0.45-0.85), Spanish-speaking Latino (aOR=0.31, 95% CI=0.22-0.44), and Native Hawaiian/Pacific Islander (aOR=0.66, 95% CI=0.49-0.90) adults. Similar trends were seen for moderate/severe stress and feeling lonely-isolated fairly/very often. Worse distress profiles of American Indian/Alaska Native and multiracial adults were attenuated after adjustment.

Conclusions

Minoritized groups tended to have less distress than white adults. Collective experiences of cumulative disadvantage could engender shared resiliency/normalization among these groups.

Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities

PURPOSE

Although telehealth access and utilization have increased during the pandemic, rural and low-income disparities persist. We sought to assess whether access or willingness to use telehealth differed between rural and non-rural and low-income and non-low-income adults and measure the prevalence of perceived barriers.

METHODS

We conducted a cross-sectional study using COVID-19's Unequal Racial Burden (CURB) online survey (December 17, 2020-February 17, 2021), which included 2 nationally representative cohorts of rural and low-income Black/African American, Latino, and White adults. Non-rural and non-low-income participants from the main, nationally representative sample were matched for rural versus non-rural and low-income versus non-low-income comparisons. We measured perceived telehealth access, willingness to use telehealth, and perceived telehealth barriers.

FINDINGS

Rural (38.6% vs 44.9%) and low-income adults (42.0% vs 47.4%) were less likely to report telehealth access, compared to non-rural and non-low-income counterparts. After adjustment, rural adults were still less likely to report telehealth access (adjusted prevalence ratio [aPR] = 0.89, 95% CI = 0.79-0.99); no differences were seen between low-income and non-low-income adults (aPR = 1.02, 95% CI = 0.88-1.17). The majority of adults reported willingness to use telehealth (rural = 78.4%; low-income = 79.0%), with no differences between rural and non-rural (aPR = 0.99, 95% CI = 0.92-1.08) or low-income versus non-low-income (aPR = 1.01, 95% CI = 0.91-1.13). No racial/ethnic differences were observed in willingness to use telehealth. The prevalence of perceived telehealth barriers was low, with the majority reporting no barriers (rural = 57.4%; low-income = 56.9%).

CONCLUSIONS

Lack of access (and awareness of access) is likely a primary driver of disparities in rural telehealth use. Race/ethnicity was not associated with telehealth willingness, suggesting that equal utilization is possible once granted access.

Trust in science and scientists among university students, staff, and faculty of a large, diverse university in Los Angeles during the COVID-19 pandemic, the Trojan Pandemic Response Initiative

BACKGROUND

Mistrust in science and scientists may adversely influence the rate of COVID-19 vaccination and undermine public health initiatives to reduce virus transmission.

METHODS

Students, staff and faculty responded to an email invitation to complete an electronic survey. Surveys included 21-items from the Trust in Science and Scientists Inventory questionnaire. Responses were coded so higher scores indicated a higher trust in science and scientists, A linear regression model including sex, age group, division, race and ethnicity, political affiliation, and history of COVID-19, was used to determine variables significantly associated with trust in science and scientists scores at the p < 0.05 level.

RESULTS

Participants were mostly female (62.1%), Asian (34.7%) and White (39.5%) and students (70.6%). More than half identified their political affiliation as Democrat (65%). In the final regression model, all races and ethnicities had significantly lower mean trust in science and scientists scores than White participants [Black ([Formula: see text]= -0.42, 95% CI: -0.55, -0.43, p < 0.001); Asian ([Formula: see text]= -0.20, 95% CI: -0.24, -0.17, p < 0.001); Latinx ([Formula: see text]= -0.22, 95% CI: -0.27, -0.18, p < 0.001); Other ([Formula: see text]= -0.19, 95% CI: -0.26, -0.11, p < 0.001)]. Compared to those identifying as Democrat, all other political affiliations had significantly lower mean scores. [Republican ([Formula: see text] =-0.49, 95% CI: -0.55, -0.43, p < 0.0001); Independent ([Formula: see text] =-0.29, 95% CI: -0.33, -0.25, p < 0.0001); something else ([Formula: see text] =-0.19, 95% CI: -0.25, -0.12, p < 0.0001)]. Having had COVID-19 ([Formula: see text]= -0.10, 95% CI: -0.15, -0.06, p < 0.001) had significantly lower scores compared to those who did not have COVID-19.

CONCLUSION

Despite the setting of a major research University, trust in science is highly variable. This study identifies characteristics that could be used to target and curate educational campaigns and university policies to address the COVID19 and future pandemics.

Correlates of COVID-19 vaccination status among college students

Objectives: Despite the widespread availability of COVID-19 vaccines in the United States, vaccine hesitancy remains high among certain groups. This study examined the correlates of being unvaccinated among a sample of students attending a single university (N = 2900) during the spring and summer of 2021, when the campus had been closed for over a year and students were preparing to return to in-person learning. Methods: Students responded to an email invitation and completed electronic surveys. Results: In multivariable logistic regression analyses, students were more likely to be unvaccinated if they were African American, identified with any political affiliation other than Democrat, were undergraduates or international students, had not traveled outside the Los Angeles during the pandemic, and/or had previously been ill with COVID-19. Conclusion: Findings indicate that culturally resonant educational interventions, and possibly vaccine requirements, are needed to promote vaccination among university students.

Assessing the Impact of COVID-19 Phased Vaccine Eligibility on COVID-19 Vaccine Intent among African Americans in Southeastern Louisiana: A Community-Based, Cohort Study

The purpose of this study was to explore the impact of eligibility for the coronavirus 2019 (COVID-19) vaccine at the time of the vaccine rollout as a predictor of vaccine intent within the African American community.

METHODS

Four hundred eighty-seven African American participants in southeastern Louisiana were surveyed from January-April of 2021, with follow-up surveys occurring in Fall 2021. Survey domains included demographics, vaccine hesitancy, discrimination in the healthcare setting, and knowledge and experiences with COVID-19. Descriptive statistics, Chi-square tests, and binary logistic regression were performed.

RESULTS

Participants eligible for the vaccine were 1.61 times as likely to express positive vaccine intent versus ineligible participants. Additional predictors of vaccine intent were age, insurance status and coverage, and female sex at birth. In the multivariable logistic analysis, eligible individuals were 2.07 times as likely to receive the vaccine versus ineligible individuals.

CONCLUSIONS

Vaccine eligibility for the COVID-19 vaccine was a significant predictor of intent to vaccinate in the African American community. Younger individuals were less likely to have a positive intent, correlating with the eligibility of ages 16+ occurring 5 months post-vaccine approval.

Examining the barriers, facilitators and attitudes towards COVID-19 vaccine and public health measures for black communities in Canada: a qualitative study protocol

INTRODUCTION

Black communities claim the highest number of cases and deaths due to COVID-19 in Canada. Generating culturally/contextually appropriate public health measures and strategies for vaccine uptake in black communities within Canada can better support the disproportionate impact of this pandemic. This study explores the barriers and enablers to public health measures limited to mask-wearing, disinfection, sanitation, social distancing and handwashing, as well as the barriers and attitudes towards COVID-19 vaccines among the black community.

METHODS AND ANALYSIS

We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid our investigation. We will conduct 120 semistructured interviews and five focus groups with black populations across the major provinces of Canada to understand the barriers and facilitators to public health measures, including barriers and attitudes towards COVID-19 vaccines. Data will be organised and analysed based on the CFIR. Facilitators and barriers to COVID-19 preventative measures and the barriers, facilitators and attitudes towards COVID-19 vaccines will be organised to explore relationships across the data.

ETHICS AND DISSEMINATION

This study was approved by the Social Sciences, Humanities and Education Research Ethics Board at the University of Toronto (41585). All participants are given information about the study and will sign a consent form in order to be included; participants are informed of their right to withdraw from the study. Research material will be accessible to all researchers involved in this study as no personal identifiable information will be collected during the key informant semistructured interviews and focus groups. The study results will be provided to participants and published in peer-reviewed journals.

A meta-analysis of COVID-19 vaccines acceptance among black/African American

The COVID-19 pandemic had harmed Black/African Americans disproportionately. Mortality and morbidity can reduce by increasing vaccination acceptability and availability. We conducted a meta-analysis of 20 studies that show the prevalence of Black/African Americans who embrace COVID-19 vaccination between 2020 and September, 2022. Investigations conducted before and after the availability of COVID-19 vaccines found the vaccinations effective. The heterogeneity was examined using stratified analyses, the meta-regression approach, and sensitivity analysis in R programming language. This meta-analysis showed that the overall COVID-19 vaccine hesitancy among Black/African Americans is 35% (95% CI: 26%-45%). That means 65% of Black African Americans received vaccines without any hesitancy. According to correlation analysis, there was a negative relationship (r = -0.392, P = 0.021) between the prevalence of vaccine hesitancy and the survey year. Evidence suggests ethnic health disparities in Black/African Americans were for lower socioeconomic status. Some initiatives had to address health disparities, while ethnicity had not consistently been a focus. Only vaccines can prevent COVID-19 like infectious diseases. Policy makers and health educators should concern on vaccine acceptance or hesitancy related programs among Black/African American.

Assessment of Practices Affecting Racial and Ethnic COVID-19 Vaccination Equity in 10 Large US Cities

CONTEXT

In the United States, COVID-19 vaccines have been unequally distributed between different racial and ethnic groups. Public reporting of race and ethnicity data for COVID-19 vaccination has the potential to help guide public health responses aimed at promoting vaccination equity. However, there is evidence that such data are not readily available.

OBJECTIVES

This study sought to assess gaps and discrepancies in COVID-19 vaccination reporting in 10 large US cities in July 2021.

DESIGN, SETTING, AND PARTICIPANTS

For the 10 cities selected, we collected COVID-19 vaccination and population data using publicly available resources, such as state health department Web sites and the US Census Bureau American Community Survey. We examined vaccination plans and news sources to identify initial proposals and evidence of implementation of COVID-19 vaccination best practices.

MAIN OUTCOME MEASURE

We performed quantitative assessment of associations of the number of vaccination best practices implemented with COVID-19 racial and ethnic vaccination equity. We additionally assessed gaps and discrepancies in COVID-19 vaccination reporting between states.

RESULTS

Our analysis did not show that COVID-19 vaccination inequity was associated with the number of vaccination best practices implemented. However, gaps and variation in reporting of racial and ethnic demographic vaccination data inhibited our ability to effectively assess whether vaccination programs were reaching minority populations.

CONCLUSIONS

Lack of consistent public reporting and transparency of COVID-19 vaccination data has likely hindered public health responses by impeding the ability to track the effectiveness of strategies that target vaccine equity.

Factors Associated With COVID-19 Non-vaccination in Adolescents Hospitalized Without COVID-19

BACKGROUND

Pfizer-BioNTech COVID-19 vaccine received emergency use authorization for persons ≥ 16 years in December 2020 and for adolescents 12-15 years in May 2021. Despite the clear benefits and favorable safety profile, vaccine uptake in adolescents has been suboptimal. We sought to assess factors associated with COVID-19 non-vaccination in adolescents 12-18 years of age.

METHODS

Between June 1, 2021 and April 29, 2022, we assessed factors associated with COVID-19 non-vaccination in hospitalized adolescents ages 12-18 years enrolled in the Overcoming COVID-19 vaccine effectiveness network. Demographic characteristics and clinical information were captured through parent interviews and/or electronic medical record abstraction; COVID-19 vaccination was assessed through documented sources. We assessed associations between receipt of the COVID-19 vaccine and demographic and clinical factors using univariate and multivariable logistic regression and estimated adjusted odds ratios (aOR) for each factor associated with non-vaccination.

RESULTS

Among 1665 hospitalized adolescents without COVID-19, 56% were unvaccinated. Unvaccinated adolescents were younger (median age 15.1 years vs. 15.4 years, p < .01) and resided in areas with higher social vulnerability index (SVI) scores (median 0.6 vs 0.5, p < .001) than vaccinated adolescents. Residence in the Midwest [aOR 2.60 (95% CI: 1.80, 3.79)] or South [aOR 2.49 (95% CI: 1.77, 3.54)] US census regions, rarely or never receiving influenza vaccine [aOR 5.31 (95% CI: 3.81, 7.47)], and rarely or never taking precautions against COVID-19 [aOR 3.17 (95% CI: 1.94, 5.31)] were associated with non-vaccination against COVID-19.

CONCLUSIONS

Efforts to increase COVID-19 vaccination of adolescents should focus on persons with geographic, socioeconomic, and medical risk factors associated with non-vaccination.

Leveraging 13 million responses to the U.S. COVID-19 Trends and Impact Survey to examine vaccine hesitancy, vaccination, and mask wearing, January 2021-February 2022

BACKGROUND

The urgency of the COVID-19 pandemic called upon the joint efforts from the scientific and private sectors to work together to track vaccine acceptance and prevention behaviors.

METHODS

Our study utilized individual responses to the Delphi Group at Carnegie Mellon University U.S. COVID-19 Trends and Impact Survey, in partnership with Facebook. We retrieved survey data from January 2021 to February 2022 (n = 13,426,245) to examine contextual and individual-level predictors of COVID-19 vaccine hesitancy, vaccination, and mask wearing in the United States. Adjusted logistic regression models were developed to examine individual and ZIP code predictors of COVID-19 vaccine hesitancy and vaccination status. Given the COVID-19 vaccine was rolled out in phases in the U.S. we conducted analyses stratified by time, January 2021-May 2021 (Time 1) and June 2021-February 2022 (Time 2).

RESULTS

In January 2021 only 9% of U.S. Facebook respondents reported receiving the COVID-19 vaccine, and 45% were vaccine hesitant. By February 2022, 80% of U.S. Facebook respondents were vaccinated and only 18% were vaccine hesitant. Individuals who were older, held higher educational degrees, worked in white collar jobs, wore a mask most or all the time, and identified as white and Asian had higher COVID-19 vaccination rates and lower vaccine hesitancy across Time 1 and Time 2. Essential workers and blue-collar occupations had lower COVID vaccinations and higher vaccine hesitancy. By Time 2, all adults were eligible for the COVID-19 vaccine, but blacks and multiracial individuals had lower vaccination and higher vaccine hesitancy compared to whites. Those 55 years and older and females had higher odds of wearing masks most or all the time. Protective service, construction, and installation and repair occupations had lower odds of wearing masks. ZIP Code level percentage of the population with a bachelors' which was associated with mask wearing, higher vaccination, and lower vaccine hesitancy.

CONCLUSION

Associations found in earlier phases of the pandemic were generally found to also be present later in the pandemic, indicating stability in inequities. Additionally, inequities in these important outcomes suggests more work is needed to bridge gaps to ensure that the burden of COVID-19 risk does not disproportionately fall upon subgroups of the population.

Perceptions of COVID-19 Vaccine, Racism, and Social Vulnerability: An Examination among East Asian Americans, Southeast Asian Americans, South Asian Americans, and Others

As COVID-19 vaccines are readily available and most U.S. adults who are enthusiastic about the vaccine have received it, motivating those who have not been vaccinated to accept it has become a challenge. The purpose of this study was to understand the mechanisms behind COVID-19 vaccine acceptance in Asian American ethnic groups, including how sociodemographic characteristics and racism predict COVID-19 and vaccine perceptions. The study also examined associations between social vulnerability and COVID-19 and vaccine perceptions. Social vulnerability is defined as the degree to which a community is able to prepare and respond to a natural or man-made disaster. This cross-sectional study used community-based survey data collected from April to September 2021. Study measures included demographics, perceptions of COVID-19 and COVID-19 vaccines, and racism-related experiences. The results showed that, compared to Non-Asians, East Asians reported that they had significantly more challenges accessing COVID-19 vaccines, and South Asians reported significantly higher safety concerns about COVID-19 vaccines. Our study also found that racism experience mediates the association between race/ethnicity and safety concerns about COVID-19 vaccines. Three Asian subgroups (East Asians, South Asians, and Southeast Asians) experienced more racism (compared to Non-Asians), and more experience of racism was related to greater safety concerns. Geographical Information System (GIS) maps revealed that residents of lower social vulnerability index (SVI) areas reported fewer unfairness perceptions and that higher SVI areas had lower vaccine accessibility and trust in public health agencies. Our study advances the understanding of racism, social vulnerability, and COVID-19 vaccine-related perceptions among Asian Americans. The findings have implications for policymakers and community leaders with respect to tailoring COVID-19 program efforts for socially vulnerable populations and Asian American groups that experience greater challenges regarding vaccine safety concerns and accessibility.

Embracing the Diversity of Latinx Communities to Promote Vaccinations

While vaccine hesitancy is well documented in the literature among the Latinx community, little attention or effort is given to the nuances among the members of individual communities, such as country of origin, immigration status, generational status, primary language, race, age, sex, gender, or rural residence and how these complexities affect vaccine messaging and uptake. We have evidence that this heterogeneity causes differences in access to healthcare, attitudes towards vaccines, and degree of health disparities. In this review we will describe their impact on vaccination rates in the Latinx community, highlighting missed opportunities for public health outreach, and how targeted messaging could improve vaccine uptake.

COVID-19 Vaccination Status, Attitudes, and Values among US Adults in September 2021

Background: The Delta COVID-19 variant caused a resurgence in cases and deaths during the summer of 2021, particularly among the unvaccinated, highlighting the need to increase vaccine coverage. We describe a survey conducted in September 2021, in the midst of the Delta variant surge, after the FDA fully approved Pfizer-BioNTech’s vaccine for ages 16+ and issued an emergency use authorization for ages 12−15. Methods and Findings: US adults were surveyed to measure COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities. More than three-quarters (77%) reported receiving at least one dose of COVID-19 vaccination. Of the unvaccinated, 6% intended to vaccinate, 40% were unlikely to ever vaccinate, and 55% remained uncertain. Most of the unvaccinated were <45 years old (62%), without a bachelor’s degree (83%), earning less than $85,000 annually (74%), and Republican/Independent (66%). Concerns among the unvaccinated-yet-still-uncertain included the vaccines’ safety (86%), speed of development (86%), and suspicion of government (79%) and pharmaceutical companies (69%). Most (86%) of the unvaccinated reported they would not vaccinate if mandated by their employer. About one third (34%) of the unvaccinated reported facing at least one barrier to vaccination. Conclusion: More than half of unvaccinated adults remained uncertain about COVID-19 vaccination, indicating an opportunity to support their decision making. Public health must increase easy and equitable access to vaccination and renew efforts to provide unvaccinated populations access to information from trusted sources.

Leveraging 13 million responses to the Facebook COVID-19 Trends and Impact Survey to examine vaccine hesitancy, vaccination, and mask wearing, January 2021-February 2022

Background: The urgency of the COVID-19 global pandemic called upon the joint efforts from the scientific and private sectors to work together to track vaccine acceptance, prevention behaviors, and symptoms. Methods: Our study utilized individual responses to the Facebook’s COVID-19 Trends and Impact Survey from January 2021 to February 2022 (n=13,426,245) to examine contextual and individual-level predictors of COVID-19 vaccine hesitancy, vaccination, and mask wearing. Adjusted logistic regression models were developed to examine individual and zip code predictors of COVID-19 vaccine hesitancy and vaccination status. Given the COVID vaccine was rolled out in phases in the U.S. we conducted analyses stratified by time, January 2021-May 2021 (Time 1) and June 2021-February 2022 (Time 2). Results: On January 2021 only 9% of Facebook respondents reported receiving the COVID-19 vaccine, and 45% were vaccine hesitant. By February 2022, 80% of respondents were vaccinated and only 18% were vaccine hesitant. Individuals who were older, held higher educational degrees, worked in white collar jobs, wore a mask most of the time or some of the time, and identified as white and Asian had higher COVID-19 vaccination rates and lower vaccine hesitancy across Time 1 and Time 2. COVID vaccinations were lower among essential workers and blue-collar occupations (OR=0.31-0.40) including those in food preparation and serving, construction, installation and repair, transportation, and production in Time 1. In Time 2, these disparities attenuated but were still present (OR-0.36-0.64). For these same occupation groups, vaccine hesitancy was higher (OR=1.88-2.30 in Time 1) and (OR=2.05-2.80 in Time 2). By Time 2, all adults were eligible for the COVID-19 vaccine, but blacks (OR=0.71; 95% CI: 0.70-0.72) and multiracial (OR=0.47; 95% CI: 0.47-0.48) individuals had lower vaccination and higher vaccine hesitancy compared to whites. Conclusions: Associations found in earlier phases of the pandemic were generally found to also be present later in the pandemic, indicating stability in inequities. Additionally, inequities in these important outcomes suggests more work is needed to bridge gaps to ensure that the burden of COVID-19 risk does not disproportionately fall upon subgroups of the population.