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Ameen K, St Jean DT, Woko C. "They Don't Really Consider Us Essential, But We Are": a Qualitative Investigation of Vaccine Acceptance and Perceived Workplace Safety Among Black Transit Workers During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2024; 11:1269-1279. [PMID: 37219734 PMCID: PMC10204654 DOI: 10.1007/s40615-023-01606-5] [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: 12/22/2022] [Revised: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 05/24/2023]
Abstract
Black Americans face a higher risk of coronavirus disease 2019 (COVID-19) morbidity and mortality due to adverse social determinants of health, including their overrepresentation in the frontline workforce. Despite these inequities, increasing vaccine acceptance among this subpopulation has been challenging. We conducted semi-structured qualitative focus groups with Black public transit workers living in the USA to explore behavioral intentions regarding COVID-19 vaccine uptake, occupational health challenges, and the perceived impact of racism on workplace health and safety during the pandemic. A thematic analysis approach was used to analyze the final transcripts. We completed three focus groups (n=10 participants) in October and November of 2021. Enabling factors for vaccination included opportunities for vaccination in the workplace, flexible hours of operation, and walk-in vaccine clinics. Disabling factors included excessive wait times. Some participants also cited lack of cleanliness, inconsistent enforcement of COVID-19 safety protocols, and unclear workplace policies regarding sick and hazard pay as major safety barriers. Perceptions regarding the role of racism in their experiences with COVID-19 as transit workers were mixed. Though occupational health and safety concerns were high, there are opportunities for transit agencies and government officials to improve both vaccine uptake and working conditions for Black transit workers.
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Affiliation(s)
- Khadijah Ameen
- Department of Health Promotion and Behavior, Georgia State University School of Public Health, 140 Decatur St SE, Atlanta, GA, 30303, USA.
| | - Denise T St Jean
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chioma Woko
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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Kyakuwa N, Abaasa A, Mpooya S, Kalutte H, Atuhairwe C, Perez L, Kikaire B. Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study. BMC Health Serv Res 2024; 24:663. [PMID: 38796411 PMCID: PMC11128104 DOI: 10.1186/s12913-024-11137-2] [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: 03/28/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Vaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers (HCWs) in Uganda. METHODS Between July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities (private and government) in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. There were no established HCWs contact registers in the municipality, and the study was conducted during a national lock down, therefore, the HCWs who were on duty at the time of the study were approached. The survey questions were based on the '3Cs' model of vaccine hesitancy and focused on confidence, convenience, and complacency factors. Non-uptake of vaccines was defined as not having received any of the available vaccines in the country. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptake of COVID-19 vaccines and to identify associated factors. RESULTS The study recruited 360 HCWs, 61.7% of whom were female, with an average age of 31 years (SD = 7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35 + years adjusted odds ratio (aOR) = 0.30, 95% CI: 0.13-0.66 compared with 18-24 years], facility ownership [government, aOR = 0.22 (0.10-0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR = 0.35 (0.19-0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR = 0.17 (0.10-0.29)]. The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services. CONCLUSION The high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence. Adequate time should be allowed to explain benefits of vaccination to the population to allay fears that might exist before actual vaccination is rolled out.
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Affiliation(s)
| | - Andrew Abaasa
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Simon Mpooya
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Laurent Perez
- Department of Medicine, Service of Immunology and Allergy, Centre for Human Immunology Lausanne, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bernard Kikaire
- Makerere University College of Health Sciences, Kampala, Uganda
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3
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Achore M. Correlates of COVID-19 vaccine uptake among the forcibly displaced: evidence from Libya. Arch Public Health 2024; 82:70. [PMID: 38741160 DOI: 10.1186/s13690-024-01306-4] [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: 11/27/2023] [Accepted: 05/04/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Vaccine hesitancy and refusal can hinder the control of infectious diseases such as coronavirus disease 2019 (COVID-19). Although forcibly displaced individuals are at high risk of contracting COVID-19, evidence shows that they are less likely to accept the COVID-19 vaccine. Given their predicament, the factors influencing vaccine uptake in the general population might differ vastly from those in displaced populations. Given the limited evidence on vaccine uptake from humanitarian settings, the current study examined the determinants of COVID-19 vaccine uptake among the forcibly displaced in Libya. METHODS Data were extracted from the World Bank/United Nations High Commissioner for Refugees (UNHCR) microdata repository. Data were collected between April and July 2021 after the rollout of the first dose of the COVID-19 vaccine in Libya. Percentages, means, and standard deviations were used to quantify the distribution of the sample population. Logistic regression models were employed to identify factors influencing COVID-19 vaccine uptake. RESULTS Odds ratios (ORs) with p values are used to present the regression analysis results. The study revealed that people unaffected by COVID-19 were less likely (OR = .71, 95%CI = 0.67-0.89) to accept the vaccine. Similarly, individuals with access to free COVID-19 vaccines were more likely to be vaccinated than those without free vaccines (OR = 38, 95%CI = 0.19-0.28). Finally, the results indicated that individuals were six times more likely to be vaccinated at mass vaccination sites ((OR = 6.31, 95%CI = 5.46- 7.94) and 1.92 times more likely to be vaccinated at local health centers (OR = 1.92, 95%CI = 0.1.72-3.11) than they were at hospitals and distant health facilities. CONCLUSION Implementing comprehensive mass vaccination venues, public education initiatives, and awareness campaigns regarding the importance of vaccination can decrease vaccine hesitancy among the forcibly displaced.
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Affiliation(s)
- Meshack Achore
- Department of Population Health, 220 Hofstra University, 101 Hofstra Dome, Hempstead, NY, 11549-2200, USA.
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Gavin RM, Countryman M, Musco J, Ricard R, Roberts A, Lees C. Reaching Diverse Communities During a Local Public Health COVID-19 Vaccination Response Through a Mobile Clinic Compared to Mass Vaccination Sites. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:411-415. [PMID: 38603747 DOI: 10.1097/phh.0000000000001905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
During the COVID-19 vaccine rollout, local public health agencies were responsible for vaccinating a wide variety of communities. Dakota County Public Health (Dakota County, Minnesota) implemented a program that offered COVID-19 vaccines in a variety of settings, such as county public health buildings, community sites, in-home, mass vaccination clinics, and a mobile clinic unit. The purpose of this analysis is to compare the demographics of vaccinations administered at Dakota County COVID-19 vaccination clinics based on clinic site. More than half (52.5%) of vaccinations administered at mobile clinic sites were administered to Hispanic or Latino clients, while at the mass vaccination clinic site, 5.4% of vaccinations were administered to Hispanic or Latino clients. In addition, 59.6% of in-home vaccinations were administered to adults 65 years and older. Offering COVID-19 vaccination clinics in a variety of clinic settings strategically throughout the community helped increase vaccine reach to diverse communities.
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Affiliation(s)
- Regina M Gavin
- Author Affiliations: Dakota County Public Health, Apple Valley, Minnesota
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Malas O, Boustani NM, Duradoni M, Omotoso D, Avşar AŞ, Shyroka A, Colombini G, Blanch A. The Vaccination Fear Scale (VFS-6): Adaptation, Cross-Cultural Validation, and Invariance among Genders and Six Different Cultures, Applying Classical Test Theory (CTT) and Item Response Theory (IRT). Eur J Investig Health Psychol Educ 2024; 14:808-822. [PMID: 38667807 PMCID: PMC11049080 DOI: 10.3390/ejihpe14040052] [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: 01/24/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had a meaningful impact on several areas of human activity. With respect to psychological assessment, the requirements to study the fear of vaccination as a means to diminish negative behaviour towards vaccination had been reported. This study aimed to evaluate the factorial invariance of the six-item Vaccination Fear Scale (VFS-6) across individuals and cultures. To achieve this goal, a sample of university students was recruited (n = 2535; mean age = 20.59, SD = 2.04; males: 26.75%, females: 73.25%) from Spain (n = 388; 15.3%), Italy (n = 376; 14.83%), Lebanon (n = 487; 19.21%), Nigeria (n = 561; 22.13%), Turkey (n = 410; 16.17%), and Ukraine (n = 313; 12.34%). The results showed that the most appropriate factorial structure, exhibiting excellent fit indices, was a model with two correlated factors (cognitive symptoms: items 1, 2, and 4; somatic symptoms: items 3, 5, and 6) for both the total sample and individual samples from each country and language (Spanish, Italian, Arabic, English, Turkish, and Ukrainian). Notably, the VFS-6 demonstrated configural, metric, scalar, and strict invariance across sex. Regarding countries and languages, configural invariance was observed between them. Also, metric invariance was observed between Spain, Italy, and Ukraine and between Lebanon, Nigeria, and Turkey, which indicates the presence of two well-differentiated groups of countries and the possibility of inferential analysis between them. Item Response Theory analysis suggested an appropriate level of discrimination and difficulty of the test. These significant findings lay the groundwork for future investigations into vaccination fear across diverse cultural backgrounds, providing valuable insights for addressing vaccination-related concerns worldwide.
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Affiliation(s)
- Olga Malas
- Department of Psychology, Sociology and Social Work, University of Lleida, Avinguda de l’Estudi General, 4, 25001 Lleida, Spain
| | - Nada Mallah Boustani
- Faculty of Business and Management, Saint Joseph University, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon
| | - Mirko Duradoni
- Department of Education, Languages, Interculture, Literatures and Psychology, University of Florence, Via di San Salvi, 12, Building 26, 50135 Florence, Italy
| | - Dayo Omotoso
- Department of Human Anatomy, Redeemer’s University, Ede 232103, Nigeria
| | - Asiye Şengül Avşar
- Department of Measurement and Evaluation in Education, Recep Tayyip Erdoğan University, 53100 Rize, Turkey
| | - Anastasiia Shyroka
- Department of Psychology and Psychotherapy, Ukrainian Catholic University, Sventsitskogo 17, 79011 Lviv, Ukraine
| | - Giulia Colombini
- Department of Education, Languages, Interculture, Literatures and Psychology, University of Florence, Via di San Salvi, 12, Building 26, 50135 Florence, Italy
| | - Angel Blanch
- Department of Psychology, Sociology and Social Work, University of Lleida, Avinguda de l’Estudi General, 4, 25001 Lleida, Spain
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Gillibrand S, Kapadia D, Watkinson R, Issa B, Kwaku-Odoi C, Sanders C. Marginalisation and distrust in the context of the COVID-19 vaccination programme: experiences of communities in a northern UK city region. BMC Public Health 2024; 24:853. [PMID: 38504230 PMCID: PMC10953068 DOI: 10.1186/s12889-024-18308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND There are clear inequalities in COVID - 19 vaccination rates amongst marginalised groups, with lower rates for some minoritised ethnic and religious groups, younger people, those living in more deprived areas, and with lower socio-economic status. Existing research focuses on psychological and socio-economic factors that influence vaccine uptake and does not explore broader social and historical contexts. Understanding inequalities in COVID-19 vaccine uptake requires a critical examination of the drivers of, and barriers to, vaccination. METHODS We present findings from a co-designed qualitative research study undertaken during the COVID-19 pandemic. Focus groups and interviews were used to examine the context underpinning responses to the COVID-19 vaccination in Greater Manchester, particularly focussing on experiences of marginalisation. Thematic framework analysis was used to analyse the data. RESULTS We found that the public's responses to the COVID-19 vaccination programme are intertwined with a longstanding history of institutional distrust and disenfranchisement, resulting from experiences of marginalisation and social inequalities. This was exacerbated further by the disproportionate impacts of the COVID-19 pandemic on minoritised ethnic groups, younger people, and those with existing health conditions. CONCLUSIONS Histories of structural inequalities experienced by minoritised groups invoked feelings of suspicion and scepticism at the motivations of the agencies behind the vaccination rollout. This highlights the need for a contextualised analysis of attitudes to vaccines, considering pre-existing inequalities, which may be especially relevant for conceptualising public responses to the vaccination programme. Finally, our study shows the important ways in which public (dis)trust can impact public health policies. We recommend this should be incorporated into responses to future public health crises.
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Affiliation(s)
- Stephanie Gillibrand
- Centre for Primary Care & Health Services Research, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Greater Manchester, UK.
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, Greater Manchester, UK
| | - Ruth Watkinson
- Centre for Primary Care & Health Services Research, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Greater Manchester, UK
- NIHR Applied Research Collaboration for Greater Manchester, Greater Manchester, UK
| | - Basma Issa
- Independent public contributor, Greater Manchester, UK
| | | | - Caroline Sanders
- Centre for Primary Care & Health Services Research, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Greater Manchester, UK
- NIHR Applied Research Collaboration for Greater Manchester, Greater Manchester, UK
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Mundo Ortiz A, Nasri B. Socio-demographic determinants of COVID-19 vaccine uptake in Ontario: Exploring differences across the Health Region model. Vaccine 2024; 42:2106-2114. [PMID: 38413281 DOI: 10.1016/j.vaccine.2024.02.045] [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: 07/31/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
The COVID-19 pandemic continues to be a worldwide public health concern. Although vaccines against this disease were rapidly developed, vaccination uptake has not been equal across all the segments of the population, particularly in the case of underrepresented groups. However, there are also differences in vaccination across geographical areas, which might be important to consider in the development of future public health vaccination policies. In this study, we examined the relationship between vaccination status (having received the first dose of a COVID-19 vaccine), socio-economic strata, and the Health Regions for individuals in Ontario, Canada. Our results show that between October of 2021 and January of 2022, individuals from underrepresented communities were three times less likely to be vaccinated than White/Caucasian individuals across the province of Ontario, and that in some cases, within these groups, individuals in low-income brackets had significantly higher odds of vaccination when compared to their peers in high income brackets. Finally, we identified significantly lower odds of vaccination in the Central, East and West Health Regions of Ontario within certain underrepresented groups. This study shows that there is an ongoing need to better understand and address differences in vaccination uptake across diverse segments of the population of Ontario that the pandemic has largely impacted.
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Affiliation(s)
- Ariel Mundo Ortiz
- Centre de Recherches Mathématiques, Université de Montréal. 2920 Ch de la Tour, Montréal, QC H3T 1N8, Canada; Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada; Centre de recherche en santé publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada
| | - Bouchra Nasri
- Centre de Recherches Mathématiques, Université de Montréal. 2920 Ch de la Tour, Montréal, QC H3T 1N8, Canada; Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada; Centre de recherche en santé publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada.
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Rivers P, Porter C, LeClair LB, Jeddy Z, Fowlkes AL, Lamberte JM, Herder K, Smith M, Rai R, Grant L, Hegmann KT, Jovel K, Vaughan M, Mathenge C, Phillips AL, Khan S, Britton A, Pilishvili T, Burgess JL, Newes-Adeyi G, Gaglani M, Caban-Martinez A, Yoon S, Lutrick K. Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study. Vaccine 2024; 42:1512-1520. [PMID: 38307743 DOI: 10.1016/j.vaccine.2024.01.016] [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: 05/24/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months. METHODS The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time. RESULTS A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up. CONCLUSION The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.
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Affiliation(s)
| | | | | | - Zuha Jeddy
- Abt Associates, Rockville, MD, United States
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ramona Rai
- Abt Associates, Rockville, MD, United States
| | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | - Sana Khan
- University of Arizona, Tucson, AZ, United States
| | - Amadea Britton
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | - Sarang Yoon
- Utah University, Salt Lake City, UT, United States
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Beleites F, Adam M, Favaretti C, Hachaturyan V, Kühn T, Bärnighausen T, Barteit S. Evaluating the impact of short animated videos on COVID-19 vaccine hesitancy: An online randomized controlled trial. Internet Interv 2024; 35:100694. [PMID: 38149090 PMCID: PMC10750063 DOI: 10.1016/j.invent.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Addressing the global challenge of vaccine hesitancy, amplified during the COVID-19 pandemic due to misinformation propagated via social media, necessitates innovative health communication strategies. This investigation scrutinizes the efficacy of Short, Animated, Story-based (SAS) videos in fostering knowledge, behavioral intent, and engagement around COVID-19 vaccination. We conducted an online three-arm parallel randomized controlled trial (RCT) involving 792 adult participants (≥18 years, English-speaking) from the United States. The intervention group viewed a SAS video on COVID-19 vaccination, the attention placebo control group watched a SAS video on hope, and the control group received no intervention. Our primary objectives were to assess the influence of SAS videos on knowledge, behavioral intent, and engagement regarding COVID-19 vaccination. Participants in the intervention group displayed significantly higher mean knowledge scores (20.6, 95 % CI: 20.3-20.9) compared to both the attention placebo control (18.8, 95 % CI: 18.5-19.1, P < .001) and control groups (18.7, 95 % CI: 18.4-19.0, P < .001). However, SAS videos did not notably affect behavioral intent. Perception of COVID-19 as a significant health threat emerged as a strong predictor for engaging with the post-trial video without further incentives (OR: 0.44; 95 % CI: 0.2-0.96). The 35-44 age group exhibited the highest post-trial engagement (P = .006), whereas right-wing political inclination negatively associated with engagement (OR: 1.98; 95 % CI: 3.9-1.01). Vaccination status correlated significantly with self-efficacy (P < .001), perceived social norms (P < .001), and perceived response efficacy of the COVID-19 vaccine (P < .001), all heightened in the intervention group. These findings suggest that while SAS videos effectively amplify COVID-19 vaccination knowledge, their impact on behavioral intent is not direct. They do, however, affect determinants of vaccination status, thereby indirectly influencing vaccination behavior. The study highlights the appeal of SAS videos among younger audiences, but underscores the need for further examination of factors impeding vaccination engagement. As SAS videos closely mirror conventional social media content, they hold significant potential as a public health communication tool on these platforms. Trial Registration: Trial was registered at drks.de with the identifier DRKS00027938, on 5 January 2022.
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Affiliation(s)
- Ferdinand Beleites
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Maya Adam
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Caterina Favaretti
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
| | - Violetta Hachaturyan
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Tilman Kühn
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- University of Vienna, Department of Nutritional Sciences, Vienna, Austria
- Medical University of Vienna, Center for Public Health, Vienna, Austria
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute (AHRI), Somkhele, KwaZulu-Natal, South Africa
- Harvard Center for Population and Development Studies, T.H. Chan School of Public Health, Cambridge, MA, United States
| | - Sandra Barteit
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
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Konstantopoulos A, Dayton L, Latkin C. The politics of vaccination: a closer look at the beliefs, social norms, and prevention behaviors related to COVID-19 vaccine uptake within two US political parties. PSYCHOL HEALTH MED 2024; 29:589-602. [PMID: 37992282 PMCID: PMC10922401 DOI: 10.1080/13548506.2023.2283401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
COVID-19 vaccine hesitancy and suboptimal vaccine uptake rates are pressing public health challenges. Vaccine hesitancy has been observed for different vaccines. For COVID-19 vaccines, multiple factors influence vaccine uptake in the U.S. including political ideology. A more nuanced understanding of the factors influencing COVID-19 vaccine uptake within political parties is needed. This study assesses the relationship between known vaccine hesitancy factors and vaccine uptake within two major political parties. Data from 804 U.S. participants in an online survey from June 2021 was used to assess the association between COVID-19 vaccine uptake (no dose vs. any dose) and categories of factors thought to influence vaccine uptake (sociodemographic variables, COVID-19 disease and vaccine belief variables, belief in COVID-19 prevention behavior variables, and social network features variables) for Republicans and Democrats using bivariate and multivariate regression. 65.4% of the sample reported having received at least one dose of the COVID-19 vaccine (22.6% Republican and 52.1% Democrat). In the total sample bivariate model, Democrat participants had significantly greater odds of having received a dose of the vaccine as compared to Republican participants (OR = 2.51, 95%CI = 1.73-3.64). In adjusted models, the speed of vaccine development was negatively associated with vaccine uptake for both Republicans (aOR = 0.18, 95%CI = 0.06-0.57) and Democrats (aOR = 0.40, 95%CI = 0.19-0.86), as was concern about side effects from the vaccine (Republicans: aOR = 0.15; 95%CI = 0.05-0.47; Democrats: aOR = 0.14, 95%CI = 0.06-0.31). COVID-19 vaccine uptake among Republicans, but not Democrats, was associated with belief that the vaccine prevents COVID-19 (aOR = 3.29, 95%CI = 1.29-8.37) and belief about friends' vaccine intentions (aOR = 6.19, 95%CI = 2.39-16.05). There were no significant factors unique to Democrats. Concerns about aspects of COVID-19 vaccine safety for both political groups suggest that vaccine advocacy interventions should universally address these factors. However, Republican beliefs in vaccine efficacy and in friends' vaccine intentions suggest a need for Republican-specific messaging.
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Affiliation(s)
- Arianna Konstantopoulos
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lauren Dayton
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Ye R, Wu Y, Sun C, Wang Q, Ma Y, Chen Y, Pappas L, Feng C, Rozelle S, Zhou H. Gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural western China: A decomposition analysis. Prev Med Rep 2024; 39:102617. [PMID: 38370983 PMCID: PMC10873723 DOI: 10.1016/j.pmedr.2024.102617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/20/2024] Open
Abstract
Understanding the ethnic gap in protective behavior and its explanatory factors is a promising step for reducing pandemic-induced disparities. However, no studies have endeavored to identify the factors contributing to a gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural China. We aimed to analyze the gap in protective behaviors between Han and minority residents in rural China. We conducted cross-sectional studies in multi-ethnic rural China in 2020. A total of 1640 participants from Han and minority groups were invited to participate. The decomposition method was applied to analyze the gap in protective behaviors and its associated factors between the Han and minority groups. Participants in the Han group had a higher protective behavioral score (9.26 ± 1.20) than the minority group (8.97 ± 1.50), yielding a significant gap in protective behaviors between Han and minority ethnicities of 0.29. Socio-demographic characteristics, health status, the degree of knowledge held about COVID-19, and psychological responses to COVID-19 explained 79.3 % (0.23/0.29) of the behavioral gap between the Han and minority groups. The difference in household asset levels was the largest explained contributor to the behavioral gap (52.17 %) (0.12/0.23), followed by fear felt for COVID-19 (-21.74 %) (-0.05/0.23). Differences in educational attainment, degree of knowledge held about COVID-19, and self-efficacy in response to COVID-19 each explained 17.4 % (0.04/0.23) of the behavioral gap. In conclusion, Han group show greater protective behaviors than minority ethnic groups. To drive better protective behavior in the most vulnerable communities, targeted, group-specific COVID-19 preventative messages deployed in public health communication strategies is suggested to enhance individual confidence in coping with the pandemic while creating a healthy amount of fear for public health crisis.
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Affiliation(s)
- Ruixue Ye
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuju Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingzhi Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Ma
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lucy Pappas
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Cindy Feng
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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12
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Cénat JM, Moshirian Farahi SMM, Broussard C, Dalexis RD. The state of COVID-19 vaccine confidence and need in Black individuals in Canada: Understanding the role of sociodemographic factors, health literacy, conspiracy theories, traumatic stressors and racial discrimination. Vaccine 2024; 42:960-968. [PMID: 37891050 DOI: 10.1016/j.vaccine.2023.10.048] [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: 07/06/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Black communities in Canada have been among the most affected by the COVID-19 pandemic, in terms of number of infections and deaths. They are also among those most hesitant about vaccination against COVID-19. However, while a few studies have documented the factors associated with COVID-19 vaccine hesitancy, those related to vaccine confidence remain unknown. To respond to this gap, this study aims to investigate factors associated to vaccine confidence in Black individuals in Canada. METHODS A total of 2002 participants (1034 women) aged 14 to 89 years old (Mean age = 29.34, SD = 10.13) completed questionnaires assessing sociodemographic information, COVID-19 vaccine confidence and need, health literacy, conspiracy beliefs, major racial discrimination, and traumatic stressors related to COVID-19. RESULTS Results showed an average score of COVID-19 vaccine confidence and need of 33.27 (SD = 7.24), with no significant difference between men (33.48; SD = 7.24) and women (33.08; SD = 7.91), t (1999) = 1.19, p = 0.234. However, there were significant differences according to employment status, migration status, age, inhabited province, spoken language, education, marital status, religion, and income. The linear regression model explained 25.8 % of the variance and showed that health literacy (B = 0.12, p < 0.001) and traumatic stressors related to COVID-19 (B = 0.21, p < .001) predicted COVID-19 vaccine confidence and need positively, while conspiracy beliefs (B = -1.14, p < 0.001) and major racial discrimination (B = -0.20, p = 0.044) predicted it negatively. CONCLUSIONS This study showed that building the confidence of Black communities in vaccines requires health education, elimination of racial discrimination in the Canadian society and a focus on certain groups (e.g., young people, those living in Quebec and Ontario). The results also argue in favor of involving community leaders and organizations in the development and implementation of vaccination-related tools, strategies and programs by city, provincial and federal public health agencies.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | | | - Cathy Broussard
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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13
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Morales DX, Paat YF. Hesitancy or Resistance? Differential Changes in COVID-19 Vaccination Intention Between Black and White Americans. J Racial Ethn Health Disparities 2024; 11:23-35. [PMID: 36547772 PMCID: PMC9774084 DOI: 10.1007/s40615-022-01494-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
The literature on COVID-19 vaccination has rarely taken a macro and longitudinal approach to investigate the nuanced racial and ethnic differences in vaccine hesitancy and refusal. To fill this gap, this study examines the relationships between race, time, and COVID-19 vaccine hesitancy and refusal using state-level data from the US Census Household Pulse Survey, 2020 US Decennial Census, and other sources (i.e., American Community Survey, Human Development Index database, and Centers for Disease Control and Prevention). Four longitudinal Generalized Estimating Equations (GEEs) were estimated to analyze how time-variant and time-invariant measures, and time itself influenced COVID-19 vaccine hesitancy and refusal rates, controlling for the effect of other relevant covariates. The results provide descriptive evidence that COVID-19 vaccine hesitancy had decreased in the USA, but vaccine refusal remained stable between January and October 2021. The GEEs further indicated that the proportion of the Black population was positively associated with both vaccine hesitancy and refusal rates, while the proportion of the White population was positively associated with the vaccine refusal rate but not associated with the vaccine hesitancy rate. In addition, over the 10-month period, COVID-19 vaccine hesitancy and refusal in the Black population declined rapidly, but vaccine refusal in the White population stayed fairly stable. More research and practical efforts are needed to understand and inform the public about these important but overlooked trends.
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Affiliation(s)
- Danielle Xiaodan Morales
- Department of Urban Studies, Worcester State University, 486 Chandler St, Worcester, MA, 01602, USA.
| | - Yok-Fong Paat
- Department of Social Work, The University of Texas at El Paso, El Paso, USA
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14
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Kocoglu-Tanyer D, Dengiz KS, Sacikara Z. Modification of the Public Attitude Towards Vaccination Scale for use in adult vaccines. Int J Nurs Pract 2024; 30:e13201. [PMID: 37671727 DOI: 10.1111/ijn.13201] [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: 08/13/2022] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Vaccination is a crucial protective intervention to prevent adult mortality and morbidity. Personal perceptions and resources have an important place in the vaccination decision. AIM This study aimed to modify the Public Attitude Towards Vaccination-Health Belief Model scale for adult vaccines and evaluate its psychometric properties. METHODS Overall, 626 people participated in this methodological study. Content validity index, confirmatory factor analysis, internal consistency and item-total score correlation were used for validity and reliability. The independent samples t test, logistic regression analysis and ROC analysis were used for criterion and concurrent validity. RESULTS In confirmatory factor analysis, values of fit indices were excellent or acceptable. The Cronbach alpha value was between 0.83 and 0.92. According to criterion validity, the susceptibility, severity, benefit, and health motivation scores of those with the vaccine were higher than those without, whereas their barrier score was lower. The barrier subscale was a risk factor, whereas the benefit score was a protective factor that increased the likelihood of vaccination. The concurrent validity of the scale was tested with the COVID-19 vaccine. While the barrier subscale's ability to distinguish between vaccinated (specificity) and unvaccinated (sensitivity) individuals is excellent, it is acceptable for the other subscales. CONCLUSION Modified PAVS-HBM is valid and reliable for adult vaccines. This scale was associated with vaccination behaviour and distinguished between vaccinated and unvaccinated individuals.
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Affiliation(s)
- Deniz Kocoglu-Tanyer
- Faculty of Nursing, Department of Public Health Nursing, Selcuk University, Konya, Turkey
| | - Kubra Sultan Dengiz
- Faculty of Nursing, Department of Public Health Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Zeynep Sacikara
- Faculty of Nursing, Department of Public Health Nursing, Necmettin Erbakan University, Konya, Turkey
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15
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Saaka SA, Mohammed K, K. A. Pienaah C, Luginaah I. Child malaria vaccine uptake in Ghana: Factors influencing parents' willingness to allow vaccination of their children under five (5) years. PLoS One 2024; 19:e0296934. [PMID: 38241404 PMCID: PMC10798622 DOI: 10.1371/journal.pone.0296934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Malaria is a substantial health burden in Ghana, particularly among children. Despite the availability of malaria vaccines, uptake remains low. Notwithstanding, there is a paucity of nationally representative studies on the factors driving hesitance towards the new malaria vaccine. In response, this study, guided by the Theory of Planned Behaviors (TPB), seeks to understand the determinants of child malaria vaccine uptake in Ghana to inform strategies for improving coverage. MATERIALS AND METHODS We employed multiple regression model to examine the association between maternal awareness, socioeconomic status, ethnicity, geographical location, and vaccine uptake using data from the 2019 Ghana Malaria Indicator Survey (MIS). RESULTS Maternal awareness of vaccine (OR = 2.200; P<0.01) significantly predicted higher likelihood of vaccine uptake. Household wealth was associated with child vaccination as parents in middle-income households (OR = 9.342; P<0.01), and those in poorest households (OR = 9.409; P<0.05) recorded higher likelihood of allowing their children to be vaccinated. With regards to ethnicity, parents from the Mande ethnic group (OR = 0.106; P<0.05) were less likely to allow their children to be vaccinated when compared to parents from the Akan ethnic group. Knowing that malaria is covered by National Health Insurance (OR = 2.407; P<0.05) was associated with higher likelihood of allowing child vaccination compared to not knowing. More so, geographical variations were observed as parents who lived in rural areas (OR = 0.254; P<0.05) were significantly less likely to allow vaccination of their children compared to those in urban areas. CONCLUSIONS Enhancing awareness through education campaigns can improve child malaria vaccine coverage. Observing socioeconomic disparities in uptake and ensuring equitable access to vaccines are vital. Tailored strategies considering ethnic background and geographical location, can as well enhance acceptance of the vaccine. This study provides valuable insights for developing effective strategies to reduce the burden of malaria in children and improve coverage of uptake. This study underscores the need to improve parental awareness and the relevance of the vaccine in preventing child mortality.
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Affiliation(s)
- Sulemana Ansumah Saaka
- Department of Geography and Environment, Faculty of Social Science, University of Western, London, Ontario, Canada
| | - Kamaldeen Mohammed
- Department of Geography and Environment, Faculty of Social Science, University of Western, London, Ontario, Canada
| | - Cornelius K. A. Pienaah
- Department of Geography and Environment, Faculty of Social Science, University of Western, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, Faculty of Social Science, University of Western, London, Ontario, Canada
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16
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Biasio LR, Zanobini P, Lorini C, Monaci P, Fanfani A, Gallinoro V, Cerini G, Albora G, Del Riccio M, Pecorelli S, Bonaccorsi G. COVID-19 vaccine literacy: A scoping review. Hum Vaccin Immunother 2023; 19:2176083. [PMID: 36794338 PMCID: PMC10026896 DOI: 10.1080/21645515.2023.2176083] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
To address vaccine hesitancy, specific self-rated tools have been developed to assess vaccine literacy (VL) related to COVID-19, including additional variables, such as beliefs, behavior, and willingness to be vaccinated. To explore the recent literature a search was performed selecting articles published between January 2020 and October 2022: 26 papers were identified using these tools in the context of COVID-19. Descriptive analysis showed that the levels of VL observed in the studies were generally in agreement, with functional VL score often lower than the interactive-critical dimension, as if the latter was stimulated by the COVID-19-related infodemic. Factors associated with VL included vaccination status, age, educational level, and, possibly, gender. Effective communication based on VL when promoting vaccination is critical to sustaining immunization against COVID-19 and other communicable diseases. The VL scales developed to date have shown good consistency. However, further research is needed to improve these tools and develop new ones.
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Affiliation(s)
| | - Patrizio Zanobini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Pietro Monaci
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Alice Fanfani
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Veronica Gallinoro
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Giuseppe Albora
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Marco Del Riccio
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sergio Pecorelli
- Scientific Advisory Committee, Giovanni Lorenzini Foundation, Milan, Italy
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17
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Curtis MG, Whalen CC, Pjesivac I, Kogan SM. Contextual Pathways Linking Cumulative Experiences of Racial Discrimination to Black American Men's COVID Vaccine Hesitancy. J Racial Ethn Health Disparities 2023; 10:2944-2956. [PMID: 36445684 PMCID: PMC9707415 DOI: 10.1007/s40615-022-01471-8] [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: 08/10/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has revealed and widened racialized health disparities, underscoring the impact of structural inequities and racial discrimination on COVID-19 vaccination uptake. A sizable proportion of Black American men report that they either do not plan to or are unsure about becoming vaccinated against COVID-19. The present study investigated hypotheses regarding the mechanisms by which experiences of racial discrimination are associated with Black American men's COVID-19 vaccine hesitancy. Hypotheses were tested using structural equation modeling with 4 waves of data from 242 Black American men (aged ~ 27) living in resource-poor communities in the rural South. Study findings revealed that racial discrimination was indirectly associated with COVID-19 vaccine hesitancy via increased endorsement of COVID-19 conspiratorial beliefs. Findings also demonstrated that increased levels of ethnic identity strengthen the association between experiences of racial discrimination and COVID-19 conspiratorial beliefs. In contrast, increased levels of social support weakened the association between cumulative experiences of racial discrimination and COVID conspiratorial beliefs. Taken together, these results suggest that racial discrimination may promote conspiratorial beliefs which undermine Black American men's willingness to be vaccinated. Future interventions aimed towards promoting vaccine uptake among Black American men may benefit from the inclusion of targeted efforts to rebuild cultural trust and increase social support.
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Affiliation(s)
- Michael G Curtis
- Department of Human Development and Family Science, University of Georgia, 1095 College Station Road, Athens, Georgia, 30602-4527, USA.
| | | | - Ivanka Pjesivac
- Grady College of Journalism & Mass Communication, University of Georgia, Athens, Georgia, USA
| | - Steven M Kogan
- Department of Human Development and Family Science, University of Georgia, 1095 College Station Road, Athens, Georgia, 30602-4527, USA
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18
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Weierbach FM, Adkins Fletcher R, Luffman IE, Meyer C, Keener JM, Ahuja M, Mamudu HM. Factors Associated with COVID-19 Vaccine Hesitancy in South Central Appalachia. JOURNAL OF APPALACHIAN HEALTH 2023; 5:71-84. [PMID: 38784140 PMCID: PMC11110903 DOI: 10.13023/jah.0503.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Introduction The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall medical mistrust, few of these studies focus on Appalachia. Purpose This study identifies barriers and facilitators to adherence with COVID-19 mitigation, focusing specifically on vaccine hesitancy in South Central Appalachia. Methods A secondary data study was conducted with a subset of Appalachian residents from the COVID-19 Public Health survey. Participants were grouped by county using ARC economic county designations for analysis. The dependent variable, vaccine hesitancy, was explored in relation to five categories of independent variable: (1) demographics (with four conceptual areas); (2) belief; (3) action; (4) medical mistrust; and (5) health literacy. Results Findings indicate vaccine hesitancy attributes include beliefs addressing COVID-19 threat, overstatement of severity of illness, risk of vaccines, vaccine safety information not present from manufacturer, and independent decision to vaccinate. Findings from this study are comparable to HPV vaccine studies in Appalachia. Implications As interventions are developed for Appalachia, it is paramount to focus vaccine administration at the individual and population level.
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19
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Jiao L, Wachinger J, Dasch S, Bärnighausen T, McMahon SA, Chen S. Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100288. [PMID: 37334196 PMCID: PMC10232919 DOI: 10.1016/j.ssmqr.2023.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.
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Affiliation(s)
- Lirui Jiao
- Columbia University Mailman School of Public Health, New York, USA
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Selina Dasch
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Global Health and Population, Harvard School of Public Health, Massachusetts, USA
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Simiao Chen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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20
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Chen X, Winterowd C, Li M, Kreps GL. Identifying Mental Health Literacy as a Key Predictor of COVID-19 Vaccination Acceptance among American Indian/Alaska Native/Native American People. Vaccines (Basel) 2023; 11:1793. [PMID: 38140196 PMCID: PMC10748283 DOI: 10.3390/vaccines11121793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND This study examines how health literacy and mental health literacy associate with the willingness to receive a COVID-19 vaccination among American Indian/Alaska Native/Native American (AI/AN) people. METHODS The data were collected with an online Qualtrics survey in February 2021 (n = 563). A purposive snowball sampling strategy was used by sending recruitment flyers to colleagues and organizations who work with AI/AN communities to share with appropriate potential respondents. We performed linear regression analyses examining the relationships between the willingness to receive a COVID-19 vaccination and socio-demographic characteristics such as age, gender, education, health literacy, mental health literacy, self-rated physical and mental health status, worry about getting COVID-19, perceived COVID-19 susceptibility, and perceived COVID-19 severity. RESULTS Mental health literacy and health literacy predicted 30.90% and 4.65% of the variance (R2adjusted) in the willingness to receive a COVID-19 vaccine, respectively. After holding the self-rated physical/mental health status, worry about getting COVID-19, perceived susceptibility, perceived severity, health literacy, and socio-demographics constant, mental health literacy was still a strong predictor (b = 0.03, p < 0.001) for the willingness to receive a COVID-19 vaccine (model R2adjusted = 40.14%). CONCLUSIONS We identified mental health literacy as a substantial factor associated with the willingness to receive a COVID-19 vaccination among AI/AN respondents.
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Affiliation(s)
- Xuewei Chen
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Carrie Winterowd
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Ming Li
- Department of Health Sciences, College of Health Professions, Towson University, Towson, MD 21252, USA;
| | - Gary L. Kreps
- Center for Health and Risk Communication, George Mason University, Fairfax, VA 22030, USA;
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21
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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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Rodriguez VJ, Kozlova S, LaBarrie DL, Liu Q. Parental anxiety and pediatric vaccine refusal in a US national sample of parents. Vaccine 2023; 41:7072-7075. [PMID: 37833125 PMCID: PMC10841520 DOI: 10.1016/j.vaccine.2023.10.015] [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: 07/06/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES Understanding vaccine hesitancy among parents is of emerging interest and of rising importance for promoting vaccine uptake to prevent pediatric illness. Here, we examine associations between pediatric vaccine refusal and parental symptoms of anxiety. METHODS Our cross-sectional survey assessed pediatric vaccine refusal in 1699 parents in a US national sample. Participants completed a sociodemographic questionnaire, the Vaccine Hesitancy Scale, and symptoms of anxiety (GAD-7). RESULTS The prevalence of pediatric vaccine refusal was 15.5 %. Parent symptoms of anxiety were related to vaccine refusal (OR = 1.07 [1.03, 1.10]). Mild (1.88 [1.39, 2.54], p <.001) and clinically significant (2.14 [1.39, 3.31], p <.001) symptoms of anxiety were also related to pediatric vaccine refusal. Parental anxiety was also associated with perceived risks of vaccines and reduced confidence. CONCLUSIONS Findings highlight the need to consider parental anxiety in the development of public health interventions that address substandard pediatric vaccine uptake.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychology, University of Illinois at Urbana-Champaign, United States.
| | - Sofia Kozlova
- Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine, United States
| | | | - Qimin Liu
- Department of Psychological and Brain Sciences, Boston University, United States
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23
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Peacock E, Craig LS, Wilson M, Williams L, Dahir SA, Tang W, Cyprian A, Dery M, Gilliam D, Nguyen D, Smith K, Valliere M, Williams S, Wiltz G, Winfrey K, Davis T, Arnold C, Theall K, Sarpong D, Krousel-Wood M. COVID-19 vaccination likelihood among federally qualified health center patients: Lessons learned for future health crises. Am J Med Sci 2023; 366:321-329. [PMID: 37619894 PMCID: PMC10962256 DOI: 10.1016/j.amjms.2023.07.013] [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: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND To prepare for rollout of a COVID-19 vaccine in fall 2020, there was an urgent need to understand barriers to ensuring equitable access and addressing vaccine skepticism and resistance. This study aimed to understand the association between trusted sources of COVID-19 information and likelihood of vaccination during that time, focusing on lessons learned to prepare for future public health crises. METHODS From December 2020-March 2021, we surveyed a probability-based, cross-sectional sample of 955 patients across seven federally qualified health centers (FQHCs) serving predominantly low-income, Black and White populations in southeastern Louisiana. Vaccination likelihood was measured on a 7-point scale; "very likely to vaccinate" was defined as score=7. Trust in healthcare provider was measured with a single survey item. High trust in personal contacts, government, and media, respectively, were defined as the highest tertiles of summative scores of trust items. Weighted multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for being very likely to vaccinate. RESULTS Participants were 56% Black, 64% women, mean age 44.6 years; 33% were very likely to vaccinate. High trust in healthcare provider (aOR=4.14, 95% CI 2.26-7.57) and government sources (aOR=3.23, 95% CI 1.98-5.28) were associated with being very likely to vaccinate. CONCLUSIONS During initial COVID-19 vaccination rollout, trust in healthcare providers and government sources of COVID-19 information was associated with likelihood to vaccinate in FQHC patients. To inform public health planning for future crises, we highlight lessons learned for translating community-relevant insights into direct action to reach those most impacted.
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Affiliation(s)
- Erin Peacock
- Tulane University, School of Medicine, New Orleans, LA, USA.
| | - Leslie S Craig
- Tulane University, School of Medicine, New Orleans, LA, USA
| | | | - LaKeisha Williams
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | - Sara Al Dahir
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | - Wan Tang
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | | | - Diem Nguyen
- NOELA Community Health Center, New Orleans, LA, USA
| | | | | | | | | | | | - Terry Davis
- Louisiana State University Health - Shreveport, Shreveport, LA, USA
| | - Connie Arnold
- Louisiana State University Health - Shreveport, Shreveport, LA, USA
| | - Katherine Theall
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Daniel Sarpong
- Yale University, School of Medicine, Office of Health Equity Research, New Haven, CT, USA
| | - Marie Krousel-Wood
- Tulane University, School of Medicine, New Orleans, LA, USA; Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
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24
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Koong A, McDermott R, Kaplan R. Examining American attitudes toward vaccination during the COVID-19 pandemic from the perspective of negative and positive rights. Politics Life Sci 2023; 42:291-305. [PMID: 37987573 DOI: 10.1017/pls.2023.17] [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: 11/22/2023]
Abstract
We examine the likely acceptance of the COVID-19 vaccine in the period prior to political polarization around vaccine mandates. Two representative cross-sectional surveys of 1,000 respondents were fielded in August and December 2020. The surveys included items about the COVID-19 vaccine and vaccine mandates. Respondents self-identifying as liberal were the least likely to believe the vaccine had undisclosed harmful effects (p< .001), conservatives were the most likely (p < .001), and moderates fell in between. Individuals with a bachelor's degree were less likely to think the vaccine had undisclosed harmful effects than individuals without a bachelor's degree (p < .001), and 60.5% of those individuals did not support a government vaccine mandate. Political ideology was more often strongly associated with avoiding government involvement compared to education level. In summary, both liberal political ideology and higher education were significantly associated with endorsing intended vaccine uptake. We discuss these results in terms of positive versus negative rights.
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Affiliation(s)
- Amanda Koong
- McGovern Medical School at UTHealth Houston, Houston, TX, USA, Watson Institute of International & Public Affairs at Brown University, Providence, RI, USA and Clinical Excellence Research Center at Stanford University, Stanford, CA, USA
| | - Rose McDermott
- McGovern Medical School at UTHealth Houston, Houston, TX, USA, Watson Institute of International & Public Affairs at Brown University, Providence, RI, USA and Clinical Excellence Research Center at Stanford University, Stanford, CA, USA,
| | - Robert Kaplan
- McGovern Medical School at UTHealth Houston, Houston, TX, USA, Watson Institute of International & Public Affairs at Brown University, Providence, RI, USA and Clinical Excellence Research Center at Stanford University, Stanford, CA, USA
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25
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Cooper D, Harmon D, Alemayehu C, Levy J, Gastañaduy M, Birdsall Fort L, McCoin N. Survey of Vaccine Hesitancy in Patients Visiting Three Tertiary-care Emergency Departments in Southeast Louisiana. West J Emerg Med 2023; 24:1073-1084. [PMID: 38165190 PMCID: PMC10754190 DOI: 10.5811/westjem.57449] [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: 05/16/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives Vaccine hesitancy has been a barrier to achieving herd immunity during the coronavirus 2019 (COVID-19) pandemic. Having low socioeconomic status and education levels, and being a person of color, are associated with higher COVID-19 infection risk and worse outcomes. These same groups are associated with higher vaccine hesitancy. The state of Louisiana has one of the lowest vaccination rates in the country. In this study we aimed to identify demographic, perspective, and health behavior factors associated with vaccine hesitancy in emergency departments (ED) in Southeast Louisiana. Methods A cross-sectional survey was distributed at three tertiary-care hospital EDs. Patients >18 years old and not in acute distress were recruited between April-July 2021. The 37-item questionnaire addressed socioeconomic demographics, social determinants of health, COVID-19 safety practices, thoughts and perceptions on COVID-19 and vaccines, sources of COVID-19 and vaccine information, and trust in the healthcare system. Results Overall, 247 patients completed our survey. Of those, 29.6% reported they were vaccine hesitant. These respondents were significantly more likely, when compared to vaccine-acceptant respondents, to never have married, to have some college education, make less than <$25,000 in household earnings yearly, be unsure whether vaccines prevent disease, not have discussed the COVID-19 vaccine with their primary care doctor, and to prefer to do their own research for COVID-19 vaccine information. We observed no statistically significant differences based on gender, race/ethnicity, parental status, area of living, or their perceived risk of needing hospitalization for treatment or dying from the virus. Conclusion Vaccine hesitancy was associated with multiple socioeconomic factors, perspectives, and beliefs. Vaccine-hesitant individuals were more uncertain about the safety of the COVID-19 vaccine, the feasibility of obtaining the vaccine, and its efficacy. Public health interventions aimed at these findings and improving public trust in healthcare systems are needed to increase vaccine acceptance.
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Affiliation(s)
- Denrick Cooper
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
| | - David Harmon
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
- Ochsner Health, Department of Clinical Research, New Orleans, Louisiana
| | - Carmel Alemayehu
- Ochsner Health, Department of Clinical Research, New Orleans, Louisiana
- Georgetown University, School of Medicine, Washington D.C
| | - Julia Levy
- Oregon Health & Sciences University, Department of Internal Medicine, Portland, Oregon
| | - Mariella Gastañaduy
- Ochsner Health, Department of Clinical Research, New Orleans, Louisiana
- Ochsner Health, Office of Epidemiology and Biostatistics, New Orleans, Louisiana
| | - Lisa Birdsall Fort
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
| | - Nicole McCoin
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
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26
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Nicolo M, Kawaguchi E, Ghanem-Uzqueda A, Soto D, Deva S, Shanker K, Lee R, Gilliland F, Klausner JD, Baezconde-Garbanati L, Kovacs A, Van Orman S, Hu H, Unger JB. Characteristics associated with attitudes and behaviors towards mask wearing during the COVID-19 pandemic: The Trojan Pandemic Response Initiative. BMC Public Health 2023; 23:1968. [PMID: 37821836 PMCID: PMC10566076 DOI: 10.1186/s12889-023-16915-x] [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: 02/23/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Attitudes and behaviors towards mask wearing may influence the ability to reduce transmission of COVID-19 and other diseases. METHODS University students, staff, and faculty (N = 9653) responded to an email invitation to complete electronic surveys (November 2021 and April 2022). Surveys included 19 items measuring attitudes and behaviors towards mask wearing from the Understanding America Study. Linear mixed models including variables for sex, age group, division, race and ethnicity, political affiliation, and history of COVID-19, were used to estimate the mean difference of the mean score for attitudes and behavior between Time 1 (November 2021) and Time 2 (April 2022). RESULTS Participants were mostly female (62.1%), students (70.6%), White (39.5%) and Asian (34.7%). More than half identified their political affiliation as Democrat (65.5%). Characteristic variable-by-time interactions for difference in mean mask attitude scores difference were significant at Time 1 (T1) and Time 2 (T2) between Black and White participants (B = 0.18 (0.05), 95% CI: 0.07, 0.28, p = 0.001), Asian and White participants (B = 0.07 (0.02), 95% CI: 0.03-0.12, p = 0.001), participants with self-reported history of COVID-19 and no history of COVID-19 (B= -0.13 (0.02), 95% CI: -0.07, -0.18, p < 0.0001), females and males (B = 0.07 (0.02), 95% CI: 0.03, 0.11, p = 0.001), Republicans and Democrats (B= -0.18 (0.04), 95%CI: -0.26, -0.10, p < 0.0001) and Independents and Democrats (B= -0.10 (0.03), 95%CI: -0.15, -0.05, p < 0.0001). Mean difference in mean scores for mask behaviors at Time and Time 2 were significant between participants with COVID-19 and participants who did not have COVID-19 (B= -0.12 (0.04), 95% CI: -0.19, -0.04, p = 0.004), students compared to faculty and staff (B=-0.22 (0.05), -0.32, -0.12, p < 0.0001), between Republicans and Democrats (B-= -0.16 (0.07), 95% CI: -0.28, -0.03, p = 0.020, and between Independents and Democrats (B=-0.08 (0.04), 95% CI: -0.16, -0.002, p = 0.04). CONCLUSION Race and ethnicity, political affiliation, and division may affect attitudes and behaviors in mask wearing. Further investigation into how characteristics influence public health measures such as mask wearing is needed to contain the spread of the COVID-19 virus, other infectious diseases, and future pandemics.
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Affiliation(s)
- Michele Nicolo
- Department of Nutrition and Food Science, California State University Los Angeles, Los Angeles, CA, USA.
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Eric Kawaguchi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Angie Ghanem-Uzqueda
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Family Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sohini Deva
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kush Shanker
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Andrea Kovacs
- Keck School Medicine of USC, University of Southern California, Los Angeles, USA
| | - Sarah Van Orman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Family Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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27
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Zhuang J. Whose Norms to Follow? Effects of Social Norm Specificity on Black Americans' Intention to Receive COVID-19 Vaccines. HEALTH COMMUNICATION 2023; 38:2350-2358. [PMID: 35491862 DOI: 10.1080/10410236.2022.2069212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
COVID-19 has caused tremendous disruptions to public health and social stability. While the record-breaking speed of vaccine development brings a beam of light to put this global pandemic under control, public health professionals struggle to motivate certain population segments to be vaccinated. This research examined how social norms varying in reference group specificity influenced the intention to be vaccinated against COVID-19 among unvaccinated Black Americans. This report documented findings yielded from the first wave of data collection of a longitudinal study conducted in June 2021, with a total of 1,278 Black Americans who had not received COVID-19 vaccines. The results showed that participants' perceived norms among important others, Black Americans, and all Americans differed in their effects on vaccination intention. Moreover, perceived norms among Black Americans strengthened the effect of perceived norms in important others on vaccination intention, whereas perceived norms among all Americans attenuated the relationship between perceived norms among Black Americans and vaccination intention. The findings suggest the importance of considering norm specificity in future theoretical advancements and practical applications of social norms.
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Affiliation(s)
- Jie Zhuang
- Department of Communication Studies, Texas Christian University
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28
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Castel AD, Barth S, Wilbourn BC, Horberg M, Monroe AK, Greenberg AE. Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC. J Acquir Immune Defic Syndr 2023; 94:124-134. [PMID: 37368934 PMCID: PMC10529778 DOI: 10.1097/qai.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC. METHODS We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed. RESULTS Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001). CONCLUSIONS This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.
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Affiliation(s)
- Amanda D Castel
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Shannon Barth
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Brittany C Wilbourn
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | | | - Anne K Monroe
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
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29
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Montiel Ishino FA, Villalobos K, Williams F. A multivariable model of barriers to COVID-19 vaccination: Using cross sectional data from a nationally distributed survey in the United States. Prev Med 2023; 175:107709. [PMID: 37739183 PMCID: PMC10662532 DOI: 10.1016/j.ypmed.2023.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Discrimination has had longstanding effects on mental and physiological health, which became more evident and synergized during the COVID-19 pandemic. The role of discrimination on vaccination for COVID-19 during the pandemic, however, is not well understood. As such, we examined the relationship of everyday discrimination on COVID-19 vaccination. METHODS Using a multivariate logistic regression on data collected from a nationally distributed survey in the United States (US), we examined the relationship of discrimination measured by the Everyday Discrimination Scale on self-reported COVID-19 vaccination while adjusting for US nativity, as well as sociodemographic (i.e., age; gender; sexual orientation; race, and ethnicity) and socioeconomic (i.e., educational attainment; employment status; household income) factors. RESULTS We found that participants reporting monthly to weekly discrimination and multiple times a week to daily discrimination had decreased odds of reporting COVID-19 vaccination (adjusted odds ratio [AOR] = 0.78, 95% confidence interval [CI]:0.68-0.90; and AOR = 0.75, 95% CI = 0.62-0.91, respectively) compared to those that reported no discrimination experienced. Educational attainment of high school equivalent or above, employment as an essential worker, and household-annual income of $50,000 or greater were significant socioeconomic factors. Age, sexual orientation, and race/ethnicity had mixed associations with COVID-19 vaccination. CONCLUSIONS Discrimination overall remained a significant barrier to vaccination, while nativity was not significant when accounting for socioeconomic and sociodemographic factors. Discrimination must become a public health priority in addressing disparities in health and access and barriers that may affect preventive behaviors.
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Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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30
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Ryan GW, Askelson NM, Woodworth KR, Lindley MC, Gedlinske A, Parker AM, Gidengil CA, Petersen CA, Scherer AM. Unvaccinated Adolescents' COVID-19 Vaccine Intentions: Implications for Public Health Messaging. J Adolesc Health 2023; 73:679-685. [PMID: 37395695 PMCID: PMC10529916 DOI: 10.1016/j.jadohealth.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE COVID-19 vaccine uptake remains low for US adolescents and contributes to excess morbidity and mortality. Most research has assessed parental intention to vaccinate their children. We explored differences between vaccine-acceptant and vaccine-hesitant unvaccinated US adolescents using national survey data. METHODS A nonprobability, quota-based sample of adolescents, aged 13-17 years, was recruited through an online survey panel in April 2021. One thousand nine hundred twenty seven adolescents were screened for participation and the final sample included 985 responses. We assessed responses from unvaccinated adolescents (n = 831). Our primary measure was COVID-19 vaccination intent ("vaccine-acceptant" defined as "definitely will" get a COVID-19 vaccine and any other response classified as "vaccine-hesitant") and secondary measures included reasons for intending or not intending to get vaccinated and trusted sources of COVID-19 vaccine information. We calculated descriptive statistics and chi-square tests to explore differences between vaccine-acceptant and vaccine-hesitant adolescents. RESULTS Most (n = 831; 70.9%) adolescents were hesitant, with more hesitancy observed among adolescents with low levels of concern about COVID-19 and high levels of concern about side effects of COVID-19 vaccination. Among vaccine-hesitant adolescents, reasons for not intending to get vaccinated included waiting for safety data and having parents who would make the vaccination decision. Vaccine-hesitant adolescents had a lower number of trusted information sources than vaccine-acceptant adolescents. DISCUSSION Differences identified between vaccine-acceptant and vaccine-hesitant adolescents can inform message content and dissemination. Messages should include accurate, age-appropriate information about side effects and risks of COVID-19 infection. Prioritizing dissemination of these messages through family members, state and local government officials, and healthcare providers may be most effective.
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Affiliation(s)
- Grace W Ryan
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa
| | | | | | - Amber Gedlinske
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | | | - Courtney A Gidengil
- RAND Corporation, Boston, Massachusetts; Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christine A Petersen
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa; Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
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31
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Soklaridis S, Zaheer R, Scully M, Shier R, Williams B, Dang L, Daniel SJ, Sockalingam S, Tremblay M. 'We are in for a culture change': continuing professional development leaders' perspectives on COVID-19, burn-out and structural inequities. BMJ LEADER 2023:leader-2023-000837. [PMID: 37739772 DOI: 10.1136/leader-2023-000837] [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: 04/25/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges. METHODS In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed. RESULTS This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD. DISCUSSION The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.
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Affiliation(s)
- Sophie Soklaridis
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Rabia Zaheer
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michelle Scully
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen Shier
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Betsy Williams
- Department of Psychiatry, University of Kansas School of Medicine, Kansas City, Kansas, USA
- Professional Renewal Centre, Lawrence, Kansas, USA
| | - Linda Dang
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sam J Daniel
- Department of Pediatric Surgery, McGill University, Montreal, Québec, Canada
| | - Sanjeev Sockalingam
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Martin Tremblay
- Continuing Professional Development Department, Fédération des médecins spécialistes du Québec, Montreal, Québec, Canada
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Willis DE, Moore R, Andersen JA, Li J, Selig JP, McKinnon JC, Gurel-Headley M, Reece S, McElfish PA. Correlates of COVID-19 vaccine coverage in Arkansas: Results from a weighted random sample survey. Vaccine 2023; 41:6120-6126. [PMID: 37661536 PMCID: PMC10574122 DOI: 10.1016/j.vaccine.2023.08.075] [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: 02/03/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
We assessed COVID-19 vaccination (≥1 dose) status as influenced by sociodemographic factors (i.e., age, gender, race/ethnicity, education, income, and parent or guardian status), healthcare provider recommendation, and personal vaccine hesitancy among Arkansas residents in October 2022. We asked: did the likelihood of vaccination differ across sociodemographic groups of Arkansas during this period of the pandemic? Is COVID-19 vaccination associated with recommendations from healthcare providers and/or COVID-19 vaccine hesitancy? We analyzed data from a random sample survey of adults in Arkansas (N = 2,201). Three in four adults self-reported vaccination against COVID-19 in October 2022. We found both positive and negative association between COVID-19 vaccination and age, gender, race/ethnicity, education, income, healthcare provider recommendation, and vaccine hesitancy. We highlight racial differences in COVID-19 coverage and the higher odds of COVID-19 vaccination among Black adults compared to White adults in particular, which has broad implications for the study of vaccine coverage and hesitancy. We also discuss implications of our findings regarding healthcare provider recommendations to be vaccinated against COVID-19.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Joshua C McKinnon
- College of Nursing, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA.
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Anino CO, Wandera I, Masimba ZO, Kirui CK, Makero CS, Omari PK, Sanga P. Determinants of Covid-19 vaccine uptake among the elderly aged 58 years and above in Kericho County, Kenya: Institution based cross sectional survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001562. [PMID: 37698989 PMCID: PMC10497123 DOI: 10.1371/journal.pgph.0001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
Hesitancy to Covid-19 vaccine is a global challenge despite the compelling evidence of the value of vaccine in preventing disease and saving lives. It is suggested that context-specific strategies can enhance acceptability and decrease hesitancy to Covid-19 vaccine. Hence, the study determined uptake and determinants of Covid-19 vaccine following a sustained voluntary vaccination drive by Kenyan government. We conducted institution based cross-sectional survey of 1244 elderly persons aged 58 to 98 years in the months of January, February and March, 2022. A multinomial logistic regression analysis was used to investigate determinants of Covid 19 vaccine uptake. The predictor variables included socioeconomic and demographic characteristics, convenience and ease of access of the vaccine, collective responsibility, complacency and the three dimensions of confidence; trust in safety, trust in decision makers and delivery system. The findings are reported as the adjusted odd ratio (AOR) at 95% confidence interval (CI). Significant level was considered at p <0.05. The results from the multinomial logistic regression analysis indicated that advanced age and presence of chronic disease were associated with increased odds of doubt on Covid 19 vaccine, while long distance from vaccination centers was associated with increased odds of delay in vaccination. Overall, the findings of this study provided valuable insights into the factors influencing vaccine hesitancy among the elderly population in Kenya and will inform the development of targeted interventions to increase vaccine acceptance and uptake in this population.
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Purvis RS, Moore R, Willis DE, Kraleti SS, Gurel-Headley MP, CarlLee S, McElfish PA. Key Conversations and Trusted Information Among Hesitant Adopters of the COVID-19 Vaccine. JOURNAL OF HEALTH COMMUNICATION 2023; 28:595-604. [PMID: 37599458 PMCID: PMC10528835 DOI: 10.1080/10810730.2023.2244458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
COVID-19 vaccines effectively protect against COVID-19-related hospitalization or death, and 67.1% of the US population is fully vaccinated. However, the disparity in COVID-19 vaccination persists among minority and rural populations who often report greater hesitancy about COVID-19 vaccines. This exploratory study aimed to understand and document trusted sources of information about the COVID-19 vaccine among a diverse sample of hesitant adopters with in-depth interviews. Participants (n = 21) described how information from trusted sources influenced their decision to get a COVID-19 vaccine despite being hesitant. Participants reported health care professionals, family members, friends, coworkers, community leaders, public health experts, government officials, and the mainstream media as trusted sources of information about the COVID-19 vaccines. Participants discussed obtaining trusted information from multiple modes, including direct conversations with trusted messengers and public health communications from public influencers who reinforced the information shared with trusted messengers. Notably, participants discussed having multiple conversations with trusted messengers during their decision-making process, and these trusted messengers often facilitated the participants' vaccination process. Study findings highlight the continued need for clear, understandable information about vaccine side effects, safety, and efficacy to address concerns that contribute to vaccine hesitancy.
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Affiliation(s)
- Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
| | - Shashank S. Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Morgan P. Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
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Hill AV, Dyer HP, Gianakas J, Howze R, King A, Gary-Webb TL, Méndez DD. Correlates of COVID-19 Vaccine Uptake in Black Adults Residing in Allegheny County, PA. Health Equity 2023; 7:419-429. [PMID: 37638118 PMCID: PMC10457607 DOI: 10.1089/heq.2022.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Efforts to address vaccine uptake and access among black adults will be relevant for continued coronavirus disease 2019 (COVID-19) eradication efforts and can be transferable to other prevention efforts in future pandemics. This study investigated factors related to COVID-19 vaccine uptake and access among black residents in Allegheny County, PA. Methods Surveys were administered electronically from October 2021 to January 2022 to black Allegheny County residents aged 18 and older. Questions included thoughts on COVID mitigation strategies (e.g., masking, social distancing), vaccination status, intention to vaccinate children, trust of COVID-19 information sources and vaccines, family needs, access to support services, and social media use to access information. Descriptive statistics and significant correlates of being vaccinated using adjusted logistic regression models are reported. Results Of the overall sample (N=397), the majority were fully vaccinated (n=306, 77%). Fully vaccinated participants were more likely to be female (62.5%, p=0.010), age 60 years or older (34.3%, p=0.0002), have some college education (23.2%, p<0.0001), and be employed full time (50.0%, p=0.0001) compared with nonvaccinated individuals. Among the unvaccinated participants (n=91), the primary reason was fear of illness (8.9%), long-term effects (6.5%), mistrust in the vaccine (6.3%), and needing more information (4.5%). Vaccine-hesitant participants were more likely to be unvaccinated (adjusted odds ratio=2.3, 95% confidence interval 1.25-4.14) after adjusting for age, education, employment, insurance, health status, and income. Conclusion Vaccine hesitancy may be improved by directly addressing fear of illness resulting from vaccines and improving clarity in the vaccine development and approval process to improve uptake among black adults.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Harika P. Dyer
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - John Gianakas
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruth Howze
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Ayanna King
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Tiffany L. Gary-Webb
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Dara D. Méndez
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
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Foy CG, Lloyd SL, Williams KL, Gwathmey TM, Caban-Holt A, Starks TD, Fortune DR, Ingram LR, Byrd GS. Gender, Age and COVID-19 Vaccination Status in African American Adult Faith-Based Congregants in the Southeastern United States. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01744-w. [PMID: 37580437 DOI: 10.1007/s40615-023-01744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has revealed significant differences in COVID-19 vaccination rates, with African Americans reporting lower rates compared to other racial and ethnic groups. The purpose of these analyses was to assess whether COVID-19 vaccination status differed according to age in a sample of 1,240 African American adult congregants of faith-based organizations ages 18 years or older, and to examine whether this association was moderated by gender. DESIGN We developed and administered a 75-item cross-sectional survey, the Triad Pastor's Network COVID-19 and COVID-19 Vaccination survey, to assess experiences and perceptions regarding the COVID-19 virus and vaccines. We assessed the association between age and having received > 1 dose of a COVID-19 vaccine using unadjusted and multivariable binary logistic regression models, and the interaction of age and gender with COVID-19 vaccination status in a multivariable model. RESULTS Approximately 86% of participants reported having received ≥ 1 dose of a COVID-19 vaccine. The mean age (standard deviation) of the sample was 51.33 (16.62) years, and 70.9% of the sample was comprised of women. The age by gender interaction term in the multivariable model was significant (p = 0.005), prompting additional analyses stratified by gender. In women, increased age was significantly associated with higher odds of COVID-19 vaccination (odds ratio = 1.09; 95% Confidence Interval 1.06, 1.11; p < 0.001). In men, the association was not significant (p = 0.44). CONCLUSIONS Older age was positively associated with COVID-19 vaccination in African American women, but not African American men, which may inform strategies to increase vaccination rates.
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Affiliation(s)
- Capri G Foy
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Shawnta L Lloyd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kelvin L Williams
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
- Wake Forest University School of Medicine, Claude D. Pepper Older Adults Independence Center, Winston-Salem, NC, 27157, USA
| | - TanYa M Gwathmey
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
- Hypertension and Vascular Research, Cardiovascular Sciences Center, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Doreen R Fortune
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - LaDrea R Ingram
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
- Yale School of Public Health, Social Behavioral Sciences, Winston-Salem, NC, 27157, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
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Harris M, Sherrod D, Walsh JL, Hunt BR, Jacobs J, Valencia J, Baumer-Mouradian S, Quinn KG. The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01708-0. [PMID: 37531019 DOI: 10.1007/s40615-023-01708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023]
Abstract
Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.
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Affiliation(s)
- Melissa Harris
- Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Darielle Sherrod
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bijou R Hunt
- Sinai Health System, Sinai Infectious Disease Center, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jesus Valencia
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
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Sayar MS, Akça MÖ, Hakyemez İN, Asan A. The impact of health literacy on COVID-19 immunization. Hum Vaccin Immunother 2023; 19:2254539. [PMID: 37814493 PMCID: PMC10566376 DOI: 10.1080/21645515.2023.2254539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023] Open
Abstract
The COVID-19 pandemic can be controlled by vaccination in addition to public health measures. This study investigate the impact of Health Literacy (HL) on vaccination and COVID-19. 334 patients and patient's relatives aged 18 to 65 years who were followed up at the Infectious Diseases Clinic between March and July 2022 for reasons other than COVID-19 disease were included in the study. The COVID-19 vaccination status of each participant was queried and the preferred vaccination was recorded on the case form. The mean age was 40.9 years, and 52.4% (n:175) of participants were women. It was found that 82.3% (n:275) of participants had received at least one dose of the vaccine COVID-19. It was found that 17.6% of participants had not been COVID-19 vaccinated. It was found that 60.7% (n:203) of participants received ≥ 2 doses of the mRNA-based viral vaccine. Vaccination rates were found to be significantly lower in patients with 'inadequate' HL (p = .047). In addition, the vaccination rate was lower in people aged 39 years and younger and in the presence of one or more chronic diseases. When chronic diseases are present, COVID-19 becomes more severe. On the other hand, the disease shows a moderate clinical picture and plays a significant role in transmission to risk groups in the young population, where vaccination rates are low. This situation in the context of COVID-19 demonstrates once again the importance of informing at-risk groups and the healthy young population about vaccine-preventable diseases.
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Affiliation(s)
- Merve Sefa Sayar
- Infectious Disease and Clinical Microbiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mustafa Özgür Akça
- Infectious Disease and Clinical Microbiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - İ̇smail Necati Hakyemez
- Infectious Disease and Clinical Microbiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ali Asan
- Infectious Disease and Clinical Microbiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Bonilla E, Fogel J, Hubley R, Anand R, Liu PC. Survey of COVID-19 Vaccine Attitudes in Predominately Minority Pregnant Women. South Med J 2023; 116:677-682. [PMID: 37536694 PMCID: PMC10417252 DOI: 10.14423/smj.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Despite recommendations for coronavirus disease (COVID-19) vaccination during pregnancy, some pregnant women are concerned about COVID-19 vaccines and decline to be vaccinated. This study focuses on attitudes in a sample of mostly minority pregnant Hispanic and Black women that may influence vaccine hesitancy. METHODS This was a cross-sectional survey of 400 pregnant women. Participants were provided with a one-page information sheet on pregnancy health, COVID-19 health, and COVID-19 vaccines. They were then asked to complete a survey on attitudes about these topics. RESULTS We found that attitudes for knowing about the health topics were in the range from agree to strongly agree, whereas attitudes for knowing about topics pertaining to COVID-19 messenger RNA (mRNA) vaccines were in a lower-level range from neutral to agree. Negative vaccine attitudes were significantly associated with decreased agreement for knowing about health attitudes, but not significantly associated with COVID-19 mRNA vaccine attitudes. CONCLUSIONS COVID-19 vaccine mRNA technology was a lesser understood topic than attitudes for knowing about other health topics. This finding suggests the need for physician intervention and that further education about COVID-19 vaccine mRNA technology may influence patient attitudes toward acceptance of the COVID-19 mRNA vaccine in pregnancy.
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Affiliation(s)
- Engelbert Bonilla
- From the Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, New York
| | - Joshua Fogel
- From the Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, New York
- Department of Business Management, Brooklyn College of the City University of New York, Brooklyn
| | - Robert Hubley
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury
| | - Rahul Anand
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury
| | - Paul C. Liu
- From the Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, New York
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Tzeng R, Huang FY, Lee J. Compliance, procrastination and refusal: American COVID-19 vaccination trust and value orientation. Vaccine 2023; 41:4950-4957. [PMID: 37394373 PMCID: PMC10277854 DOI: 10.1016/j.vaccine.2023.06.060] [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: 02/17/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION COVID-19 vaccine hesitancy studies, most of which were completed prior to the release of the vaccine, speculated on factors that might influence inoculation intention when a vaccine was introduced. This paper examines actual vaccination decisions among US residents after COVID-19 vaccines were approved, with a focus on trust in vaccine effectiveness, increased trust in government pandemic response, and individual-versus-collective value orientation. METHOD The data set was from the Kaiser Family Foundation COVID-19 Vaccine Monitor, a nationally representative sample reflecting the opinions of 1519 American adults aged 18 and above. Data were collected in September 2021-approximately nine months after the first COVID-19 vaccines were approved for distribution. Indicators of trust in vaccine effectiveness included individual opinions regarding breakthrough infections and vaccine boosters. Increased trust in government indicated approval of official COVID-19 responses, and value orientation denoted respondent emphasis on personal choice versus protecting the health of others. We established three categories of a vaccine hesitancy dependent variable: none, some, and full rejection. A multinomial regression analysis was employed to compare vaccine hesitancy in three pairs of contrasting groups. RESULTS While we noted distinct patterns in decision-making factors for each of the contrasting pairs, we also observed strong effects for trust in vaccine effectiveness and value orientation on vaccine decisions across all three. Both effects were more substantial than those associated with three control variables-social-demographic characteristics, political party affiliation, and health risk. CONCLUSION Our findings suggest that in order to increase vaccination rates, policymakers and influencers should focus on reducing individual scepticism over breakthrough infections and vaccine boosters, and on influencing a value orientation shift from personal choice to social responsibility.
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Affiliation(s)
- Rueyling Tzeng
- Institute of European and American Studies, Academia Sinica, 128, Academia Road, Section 2, Nankang, Taipei 115, Taiwan.
| | - Fang-Yi Huang
- Department of Sociology, Soochow University, No. 70, Linxi Rd., Shilin Dist., Taipei 111002, Taiwan.
| | - Jaein Lee
- Department of Sociology and Criminology, Arkansas State University, Jonesboro, AR, United States.
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Tolley AJ, Scott VC, Mitsdarffer ML, Scaccia JP. The Moderating Effect of Vaccine Hesitancy on the Relationship between the COVID-19 Vaccine Coverage Index and Vaccine Coverage. Vaccines (Basel) 2023; 11:1231. [PMID: 37515046 PMCID: PMC10386611 DOI: 10.3390/vaccines11071231] [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: 05/26/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
To examine COVID-19 vaccination barriers in the US, this study drew on publicly available county-level data (n = 3130) to investigate the impact of vaccine hesitancy on the relationship between county-level social/structural barriers and vaccine coverage. A hierarchical regression was performed to establish the relationship between the COVID-19 Vaccine Coverage Index (CVAC) and vaccine coverage, assess the moderating effect of vaccine hesitancy on this relationship, and explore the influence of ethno-racial composition on vaccine coverage. A significant, negative relationship (r2 = 0.11, f2 = 0.12) between CVAC and vaccine coverage by county was established (step 1). When vaccine hesitancy was introduced as a moderator (step 2), the model significantly explained additional variance in vaccine coverage (r2 = 0.21, f2 = 0.27). Simple slopes analysis indicated a significant interaction effect, whereby the CVAC-vaccine coverage relationship was stronger in low hesitancy counties as compared with high hesitancy counties. Counties with low social/structural barriers (CVAC) but high hesitancy were projected to have 14% lower vaccine coverage. When county-level ethno-racial composition was introduced (step 3), higher proportions of white residents in a county predicted decreased vaccination rates (p < 0.05). Findings indicate that CVAC should be paired with vaccine hesitancy measures to better predict vaccine uptake. Moreover, counties with higher proportions of white residents led to decreases in vaccine uptake, suggesting that future intervention strategies should also target whites to reach herd immunity. We conclude that public health leaders and practitioners should address both social/structural and psychological barriers to vaccination to maximize vaccine coverage, with a particular focus on vaccine hesitancy in communities with minimal social/structural barriers.
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Affiliation(s)
- Annalise Julia Tolley
- Department of Psychology, Health Psychology, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Victoria C Scott
- Department of Psychology, Health Psychology, Faculty of Psychological Science and Public Health Science, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Mary Louise Mitsdarffer
- Biden School of Public Policy & Administration, Research Faculty in the Center for Community Research and Service, University of Delaware, Newark, DE 19716, USA
| | - Jonathan P Scaccia
- Dawn Chorus Group, 342 N. Queen Street, Candy Factory Warehouse D, Lancaster, PA 17603, USA
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Kaliba AR, Andrews DR. The Impact of Meso-Level Factors on SARS-CoV-2 Vaccine Early Hesitancy in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6313. [PMID: 37444159 PMCID: PMC10341526 DOI: 10.3390/ijerph20136313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
The extant literature on the U.S. SARS-CoV-2 virus indicates that the vaccination campaign was lagging, insufficient, and uncoordinated. This study uses the spatial model to identify the drivers of vaccine hesitancy (in the middle of the pandemic), one of the critical steps in creating impactful and effective interventions to influence behavioral changes now and in the future. The applied technique accounted for observed and unobserved homogeneity and heterogeneity among counties. The results indicated that political and religious beliefs, quantified by Cook's political bipartisan index and the percentage of the population affiliated with the main Christian groups, were the main drivers of the SARS-CoV-2 vaccine hesitancy. The past vaccination experience and other variables determining the demand and supply of vaccines were also crucial in influencing hesitancy. The results imply that vaccination campaigns require engaging community leaders at all levels rather than depending on politicians alone and eliminating barriers to the supply and demand of vaccines at all levels. Coordination among religious and community leaders would build a practical institutional arrangement to facilitate (rather than frustrate) the vaccination drives.
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Affiliation(s)
- Aloyce R. Kaliba
- College of Business, Southern University and A&M, Baton Rouge, LA 70813, USA
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43
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Moore R, Purvis RS, CarlLee S, Hallgren E, Kraleti S, Willis DE, McElfish PA. Understanding Vaccination Among Hesitant Adopters of the COVID-19 Vaccine Using the Increasing Vaccination Model. JOURNAL OF HEALTH COMMUNICATION 2023; 28:458-476. [PMID: 37394866 PMCID: PMC10443235 DOI: 10.1080/10810730.2023.2224265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The coronavirus disease (COVID-19) was the third leading cause of death in 2021 in the United States and has led to historic declines in life expectancy for Americans. While vaccination is an effective mitigation strategy for COVID-19, vaccine hesitancy remains a major barrier to individual and population-level protection. An emerging literature on hesitant adopters of COVID-19 vaccines highlights co-occurrence of hesitancy and vaccine uptake as an understudied phenomenon, with the potential to provide insight into factors that lead hesitant individuals to become vaccinated despite their hesitancy. We use qualitative interviews among hesitant adopters in Arkansas to examine vaccine hesitancy among this understudied group. Drawing on the Increasing Vaccination Model, we find that the most frequently reported motivations of hesitant adopters were within the domain of social processes, pointing to a critical focal point for targeted health communications intervening in this domain (e.g. social norms, social networks, and altruistic behavior). We find that recommendations from health care workers (HCWs) other than physicians/providers may serve as an effective influence to vaccinate. We also demonstrate negative effects of low provider and HCW confidence and weak recommendations on motivations to vaccinate among individuals expressing vaccine hesitancy. Additionally, we find individual information-seeking behaviors among hesitant adopters bolstered confidence in the efficacy of the COVID-19 vaccine. Based on these findings, clear, accessible, and authoritative health communication has a role in combatting the COVID-19 misinformation/disinformation infodemic.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Shashank Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
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Andersen JA, Scott AJ, Rowland B, Willis DE, McElfish PA. Associations between COVID-19 Death Exposure and COVID-19 Vaccine Hesitancy and Vaccine Uptake. South Med J 2023; 116:519-523. [PMID: 37400094 DOI: 10.14423/smj.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVES The aim of the study was to determine the relation between coronavirus disease 2019 (COVID-19) death exposure and COVID-19 vaccine hesitancy and vaccine uptake among Arkansans, controlling for sociodemographic factors. METHODS Data were collected from a telephone survey administered in Arkansas between July 12 and July 30, 2021 (N = 1500) via random digit dialing of telephone landlines and cellular telephones. Weighted data were used to estimate regressions. RESULTS Controlling for sociodemographic variables, COVID-19 death exposure was not a significant predictor of COVID-19 vaccine hesitancy (P = 0.423) or COVID-19 vaccine uptake (P = 0.318). Younger individuals, those with lower levels of education, and those who live in rural counties were more likely to be COVID-19 vaccine hesitant. Older individuals, Hispanic/Latinx individuals, those who reported higher levels of education, and those who reported living in urban counties were more likely to have reported receiving the COVID-19 vaccine. CONCLUSIONS Many efforts to promote COVID-19 vaccines have focused on prosocial norms, including encouraging vaccination to protect the community from COVID-19 infection and death; however, COVID-19 death exposure was not related to COVID-19 vaccine hesitancy or uptake in the present study. Future research should examine whether prosocial messaging is effective in decreasing hesitancy or motivating some individuals to receive the vaccine among those who have been exposed to COVID-19 deaths.
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Affiliation(s)
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale
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Parameswaran L, Jaysing A, Ding H, Wilkenfeld M, Dean R, Wilson KK, Frank O, Duerr R, Mulligan MJ. Vaccine Equity: Lessons Learned Exploring Facilitators and Barriers to COVID-19 Vaccination in Urban Black Communities. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01680-9. [PMID: 37391605 DOI: 10.1007/s40615-023-01680-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023]
Abstract
COVID-19 vaccines were developed at unparalleled speed, but racial disparities persist in vaccine uptake. This is a cross-sectional survey that was conducted in mid-2021 in ambulatory clinics across Brooklyn, New York. The objectives of the study were to assess: knowledge of COVID-19, healthcare communication and access, attitudes including trust in the process of vaccine development and mistrust due to racial discrimination, and to determine the relationship of the above to vaccine receipt. 58 respondents self-identified as Black non-Hispanic and completed the survey: the majority were women (79%), <50 years old (65%), employed (66%), and had annual household income <$75,000 (59%). The majority reported having some health insurance (97%) and a regular place of healthcare (95%). 60% of respondents reported COVID-19 vaccination receipt. A significant percentage of the vaccinated group compared to the unvaccinated group scored higher on knowledge questions (91% vs. 65%; p = 0.018), felt it was important that others in the community get vaccinated (89% vs. 65%, p = 0.04), and trusted vaccine safety (86% vs. 35%; p < 0.0001) and effectiveness (88% vs. 48%; p < 0.001). The unvaccinated group reported a lower annual household income of <$75,000 (72% vs. 50%; p = 0.0002) and also differed by employment status (p = 0.04). Majority in both groups agreed that racial discrimination interferes with healthcare (78%). In summary, unvaccinated Black non-Hispanic respondents report significant concerns about vaccine safety and efficacy and have greater mistrust in the vaccine development process. The relationship between racial discrimination, mistrust, and vaccine hesitancy needs further study in order to improve vaccine uptake in this population.
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Affiliation(s)
- Lalitha Parameswaran
- New York University (NYU) Langone Vaccine Center, New York, NY, USA.
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
| | - Anna Jaysing
- NYU Long Island School of Medicine, New York, NY, USA
| | - Helen Ding
- NYU Long Island School of Medicine, New York, NY, USA
| | - Marc Wilkenfeld
- Division of Occupational/Environmental Medicine, Department of Medicine, NYU Long Island School of Medicine, New York, NY, USA
| | - Ranekka Dean
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Kesi K Wilson
- New York University (NYU) Langone Vaccine Center, New York, NY, USA
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Olivia Frank
- New York University (NYU) Langone Vaccine Center, New York, NY, USA
| | - Ralf Duerr
- New York University (NYU) Langone Vaccine Center, New York, NY, USA
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark J Mulligan
- New York University (NYU) Langone Vaccine Center, New York, NY, USA
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Reece S, CarlLee S, Scott AJ, Willis DE, Rowland B, Larsen K, Holman-Allgood I, McElfish PA. Hesitant adopters: COVID-19 vaccine hesitancy among diverse vaccinated adults in the United States. INFECTIOUS MEDICINE 2023; 2:89-95. [PMID: 38013742 PMCID: PMC10038887 DOI: 10.1016/j.imj.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 07/11/2023]
Abstract
Background Despite the United States (US) having an abundant supply of COVID-19 vaccines, vaccination rates lag behind other high-income countries, suggesting that vaccine hesitancy and attitudes play a greater role in public health measures than pure supply and access. With the acknowledgment that vaccination attitudes and status may or may not be correlated, this study examined COVID-19 vaccine hesitancy among vaccinated US adults by asking: 1) What is the prevalence of COVID-19 vaccine hesitancy among the vaccinated? 2) Does COVID-19 vaccine hesitancy vary across sociodemographic characteristics? 3) Does COVID-19 vaccine hesitancy vary by healthcare access and influenza vaccination over the past 5 years? Methods Data were collected through an online survey of 2022 US adults with a final analytic sample of 1383 vaccinated respondents. Results Overall, 48.8% of vaccinated adults reported some level of hesitancy, while a slight majority reported they were "not at all hesitant". Younger respondents, women, and Black and American Indian or Alaska Native participants had greater adjusted odds of being more hesitant towards receiving the COVID-19 vaccine. Respondents who had a primary care physician had greater adjusted odds than those who did not have a primary care physician of being more hesitant towards receiving the COVID-19 vaccine. Conclusions This is the first population-based national sample study examining COVID-19 vaccine hesitancy among vaccinated individuals from subgroups of distinctive backgrounds in order to inform targeted strategies for reducing vaccine hesitancy. Findings can assist in efforts to increase vaccination rates and also decrease vaccine hesitancy at the national level.
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Affiliation(s)
- Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Kristin Larsen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Ijanae Holman-Allgood
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
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Ma MZ, Ye S. Coronavirus-Related Searches on the Internet Predict COVID-19 Vaccination Rates in the Real World: A Behavioral Immune System Perspective. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2023; 14:572-587. [PMID: 37220501 PMCID: PMC10195687 DOI: 10.1177/19485506221106012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
According to the smoke detector and functional flexibility principles of human behavioral immune system (BIS), the exposure to COVID-19 cues could motivate vaccine uptake. Using the tool of Google Trends, we tested that coronavirus-related searches-which assessed natural exposure to COVID-19 cues-would positively predict actual vaccination rates. As expected, coronavirus-related searches positively and significantly predicted vaccination rates in the United States (Study 1a) and across the globe (Study 2a) after accounting for a range of covariates. The stationary time series analyses with covariates and autocorrelation structure of the dependent variable confirmed that more coronavirus-related searches compared with last week indicated increases in vaccination rates compared with last week in the United States (Study 1b) and across the globe (Study 2b). With real-time web search data, psychological scientists could test their research questions in real-life settings and at a large scale to expand the ecological validity and generalizability of the findings.
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Affiliation(s)
- Mac Zewei Ma
- City University of Hong Kong, Kowloon, Hong Kong
| | - Shengquan Ye
- City University of Hong Kong, Kowloon, Hong Kong
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Kowalski KJ, Bhat S, Fedje M, Stahl G, Beyersdorfer N, Goade DS, Johnson K, Arnce R, Hillard R. COVID-19 and Kidney Disease (KD): A Retrospective Investigation in a Rural Southwestern Missouri Region Patient Population. Cureus 2023; 15:e41043. [PMID: 37519535 PMCID: PMC10374171 DOI: 10.7759/cureus.41043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Studies have linked pre-existing kidney disease (KD) to higher rates of mortality due to coronavirus disease 2019 (COVID-19) infection. In the rural Midwest, where KD is prevalent, the impact of COVID-19 has been significant in a population that includes many patients on Medicare or Medicaid. METHODS A retrospective cohort study was performed assessing patients with acute kidney injury (AKI), chronic kidney disease (CKD) and end stage renal disease (ESRD), with and without COVID-19. International Classification of Diseases 10th Revision codes were submitted by physicians into Freeman Health System's Electronic Medical Records and gathered from April 2020 to January 2021. The data were analyzed and compared to determine whether the mortality rate in patients with varying stages of KD and COVID-19 was higher than the mortality rate in patients with KD alone, excluding variables such as sex and age. RESULTS The 95% confidence interval (CI) of the mortality rate of patients with COVID-19 and any degree of KD, encompassing both AKI and CKD, was between 30.21% and 37.63%. This metric was significantly higher than the 95% CI of COVID-19 infection (6.70%-9.96%, p<0.0001) or KD alone (10.89%-13.01%, p<0.0001). Within those with COVID-19 and KD, the highest rate of mortality was in patients with AKI (38.13% and 49.02%). There was not sufficient statistical support in our sample to assert that COVID-19 increased mortality in ESRD patients. CONCLUSIONS Based on our results, patients with KD and COVID-19 are at higher risk for mortality when compared to patients with KD alone. Further studies are warranted into individual comorbidities affecting KD patient outcomes with COVID-19.
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Affiliation(s)
| | - Shilpa Bhat
- College of Medicine, Kansas City University, Joplin, USA
| | - Mariah Fedje
- College of Medicine, Kansas City University, Joplin, USA
| | - Greg Stahl
- Quality Improvement, Freeman Health System, Joplin, USA
| | | | - Darrin S Goade
- Pharmacy, Freeman Health System, Joplin, USA
- Mathematics, Missouri Southern State University, Joplin, USA
| | - Kerry Johnson
- Mathematics, Missouri Southern State University, Joplin, USA
| | - Robert Arnce
- Primary Care, Kansas City University, Joplin, USA
- Emergency Medicine, Freeman Health System, Joplin, USA
| | - Robert Hillard
- Pathology and Anatomical Sciences, Kansas City University, Joplin, USA
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Chu H, Liu S. Risk-efficacy framework - a new perspective on threat and efficacy appraisal and the role of disparity. CURRENT PSYCHOLOGY 2023:1-14. [PMID: 37359691 PMCID: PMC10231283 DOI: 10.1007/s12144-023-04813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023]
Abstract
The current study aims to provide a more nuanced understanding of threat and efficacy appraisal and account for the influence of disparity in the accessibility to risk prevention resources in predicting attitudes and behaviors. We propose a Risk-Efficacy Framework by integrating theories, including the extended parallel process model, health belief model, social cognitive theory, and construal level theory of psychological distance to achieve such a goal. An online survey targeting the U.S. population was conducted to empirically test the model (N = 729). The survey measured people's threat and efficacy appraisals related to COVID-19 and its vaccines and their attitudes and behavioral intention. The results of the survey supported the model's propositions. Specifically, perceived susceptibility moderated perceived severity's effects on attitudes and behaviors, such that perceived severity's influence attenuated as perceived susceptibility increased. Perceived accessibility to risk prevention resources moderated the influence of self and response efficacy. The former's effects on attitudes and behaviors increased, and the latter's effects decreased when perceived accessibility was high. The proposed framework provides a new perspective to examine the psychological determinants of prevention adoption and contributes to designing and implementing campaigns distributing prevention to underserved populations. The framework offers insights for risk managers such as public health authorities by articulating the dynamic nature of risks. When communicating early-stage lesser-known risks to the public, campaigns should highlight their severity and the response efficacy of risk solutions. Differently, more resources should be devoted to cultivating self-efficacy for widespread risks with more mitigation resources.
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Affiliation(s)
- Haoran Chu
- Department of Public Relations, College of Journalism and Communications, University of Florida, 2066A Weimer Hall, PO Box 118400, Gainesville, FL 32611 USA
| | - Sixiao Liu
- Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104 USA
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Meador JE, James W, Branson J, Bennett J, Matthews K. COVID-19 pandemic and the social determinants of health. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1139371. [PMID: 38516332 PMCID: PMC10956357 DOI: 10.3389/fepid.2023.1139371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 03/23/2024]
Abstract
Hesitancy to receive a COVID-19 vaccination across sub-groups within the US population contributed to higher illness rates and deaths. Specifically, minority groups and those living in rural and remote areas are more vaccine-hesitant populations known to suffer from higher disparities in health. Identifying successful and replicable approaches to promoting vaccination within these subpopulations is critical to ensuring vaccination rates can be maximized in these vulnerable groups. In this paper, we present findings from the Mississippi Recognizing Important Vaccine & Education Resources (RIVERs) project, a multi-state effort to spread accurate information related to COVID-19 vaccinations using a variety of community and media-based methods as well as provide vaccinations. Vaccination rates for Black people in Mississippi exceeded those of White people, likely due to the concerted effort of regional health and community organizations. Propensity score matching is performed to test intervention styles using spatial and temporal data related to approximately 7,000 events across Mississippi and parts of Tennessee and publicly available data on vaccination rates and socio-economic data. We demonstrate that vaccination rates within the vulnerable groups may be closely related to misinformation being spread through local social networks and that interventions carried out by local leaders with high levels of local social capital are best at quashing misinformation at the local level. We recommend that policymakers consider the importance of local efforts as an effective tool in increasing vaccination rates in future pandemics.
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Affiliation(s)
| | - Wesley James
- Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States
| | - Joseph Branson
- Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States
| | - Jonathan Bennett
- Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States
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