Medical Mistrust, COVID-19 Stress, and Intent to Vaccinate in Racial-Ethnic Minorities

Perceived Discrimination and Pandemic Attitudes on Cancer Screening Behaviors Among Asian American Women: A Sequential Explanatory Mixed-Methods Study

PURPOSE

The aim of this study was to assess how pandemic-related health concerns and discrimination affected cancer screenings among Asian American women (AAW).

METHODS

A two-phase explanatory mixed-methods study was conducted. In phase 1, a survey was distributed among AAW eligible for lung, breast, or colorectal cancer screening to assess delays during the pandemic, concerns about contracting coronavirus disease 2019 (COVID-19), barriers to care, and experiences of discrimination. In phase 2, four qualitative focus group discussions, stratified by generational status and history of delayed cancer screening, were conducted to explore a priori domains of interest on cancer screening during the pandemic and perceived discrimination. Logistic regression analyses were performed to identify factors associated with delays, followed by deductive thematic qualitative analysis.

RESULTS

In phase 1, of 225 participants recruited, 166 met the inclusion criteria (74%). Most participants were first-generation Americans (67%), were employed (65%), and had higher education (67% with a master's degree or higher). Forty percent reported delays in cancer screening. Factors associated with delays included worry about contracting COVID-19 (adjusted odds ratio, 2.57; 95% confidence interval, 1.05-6.28; P = .038) and spreading it to family or friends (adjusted odds ratio, 5.78; 95% confidence interval, 1.50-22.3; P = .011). No association between discrimination and delayed cancer screening was found. In phase 2, focus group discussions (n = 19) revealed that first-generation women who delayed screening faced barriers due to a fear of infection and perceived discrimination. Perceived discrimination affected daily behaviors and sense of safety, though less so in medical settings.

CONCLUSIONS

Delays in cancer screening among AAW were associated with patients' concerns about contracting and spreading COVID-19. Radiology practices can lead collaborative efforts on cancer screening campaigns that emphasize early detection and promote psychological safety.

Disparities in group-based medical mistrust and associations with mental health symptoms during the COVID-19 pandemic

BACKGROUND

Racial/ethnic disparities in health-related outcomes may have been exacerbated during the COVID-19 pandemic. Individuals from racial/ethnic minority groups or with a history of alcohol use disorder (AUD) may have greater medical mistrust. We examined racial/ethnic and AUD-related differences in group-based medical mistrust during the pandemic and tested whether medical mistrust dimensions were associated with mental health symptoms.

METHODS

Two hundred and fifty participants from the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study completed an online survey between April and July of 2022. Exploratory factor analysis and path analysis were conducted.

RESULTS

Group-based medical mistrust scores were elevated among participants who identified as Non-Hispanic Black and those with a history of AUD. Two medical mistrust dimensions were found: (1) Suspicion and Lack of Provider Support, and (2) Group Disparities in Health Care. Compared to Non-Hispanic White participants, Non-Hispanic Black participants reported higher scores on the Suspicion and Lack of Provider Support dimension of medical mistrust, which was associated with higher mental health symptoms. This medical mistrust dimension was also a significant mediator of the observed group differences in mental health symptoms.

LIMITATIONS

Cross-sectional data, aggregation of racial/ethnic groups with small sample sizes, and nonrepresentative sample.

CONCLUSIONS

Non-Hispanic Black individuals and individuals with AUD may be more vulnerable to mental health symptoms due to higher suspicion toward medical professionals and healthcare systems and perceived lack of support from healthcare providers. Increased awareness among healthcare providers may help address medical mistrust, encourage help-seeking behaviors, and alleviate mental health symptoms.

Proximity to COVID-19 vaccination sites and vaccine uptake: the role of gender and vaccine distrust

Objectives

Despite availability of vaccines proven to prevent severe illness, hospitalization, and death from COVID-19, a significant portion of the population remains hesitant to get vaccinated. This study examined the association between the proximity to vaccination sites and COVID-19 vaccine uptake and the role of gender and vaccine distrust in this relationship.

Methods

We used data from the COVID-19 Exposure, Prevention, and Impact Study in Upstate South Carolina of the United States which was a cross-sectional survey conducted from March 2022 to August 2022 using address-based probability sampling for a mail-to-web survey. The analysis included 255 respondents (86 men and 169 women).

Results

About 75% of respondents were vaccinated. Men were more likely to be vaccinated than women (84% vs. 71%). Having 1 to 9 pharmacies nearby increased vaccination odds by 4.64 times; having 10 or more increased these odds by 3.46 times (compared to no pharmacies). Each additional kilometer to the nearest pharmacy decreased vaccination odds by 8%. Women showed weaker associations between proximity to vaccination sites and vaccine uptake compared to men. Including vaccine distrust in the model rendered the interaction term of gender and proximity to vaccination sites insignificant, highlighting distrust as a dominant factor. Further analysis showed that the effect of proximity to vaccination sites on reducing COVID-19 vaccine distrust was weaker for women.

Conclusion

These findings underscore the complex interplay between access, trust, and demographic factors in determining vaccine uptake. Addressing vaccine hesitancy requires a multifaceted approach. Strategies should focus on improving access, building trust through transparent communication, and tailoring interventions to demographic-specific barriers.

Chronic conditions, COVID-19 vaccination, and institutional trust among Hispanic/Latinx communities in San Diego, California

BACKGROUND

Hispanic/Latinx populations have been disproportionately impacted by the COVID-19 pandemic. These populations are also more likely to have chronic conditions, putting them at higher risk of severe COVID-19 outcomes. Vaccination is important to reduce the risk of severe COVID-19 outcomes, but Hispanic/Latinx populations may be less likely to vaccinate due to institutional trust related to experiences of discrimination in healthcare and community disinvestment. Project 2VIDA! is a randomized clinical trial developed to respond to the need for increased trust and vaccine access among these populations in San Diego, California. Analyzing 2VIDA! data, this article seeks to better understand the relationship between chronic health conditions, institutional trust, and vaccination behaviors among a predominantly Hispanic/Latinx sample in San Diego.

METHODS

We conducted a secondary analysis of baseline survey data collected from July 2021-June 2023 during 2VIDA! We used ordered logistic regression to understand the relationship between chronic conditions, institutional trust, and vaccination among participants.

RESULTS

Our findings show that participants aged 36 or older, women, those who indicated higher institutional trust in healthcare and health information, and those with one or more chronic conditions had higher odds of receiving more vaccinations. Participants who took the survey in Spanish had lower odds of vaccination (compared to English).

CONCLUSIONS

Our findings suggest that widespread communication on the importance of vaccination for older Hispanic/Latinx populations with chronic conditions may have supported vaccination uptake. Targeted messaging and community-based approaches to build trust, combat misinformation, and increase vaccination uptake among younger individuals and Spanish-speakers are needed.

Effects of Government Mistrust and Group-Based Medical Mistrust on COVID-19 Vaccine Hesitancy Among a Sample of African Americans

BACKGROUND

Despite the demonstrated efficacy of coronavirus disease (COVID-19) vaccines, higher rates of vaccine hesitancy among African Americans remain concerning. As determinants of vaccine hesitancy, the simultaneous roles of government mistrust and group-based medical mistrust have not been examined via from a cognitive information perspective among African Americans.

PURPOSE

We examined the direct and indirect effects of government mistrust and group-based medical mistrust on COVID-19 vaccine hesitancy in a sample of African Americans.

METHODS

We obtained data from 382 African Americans in South-East Michigan via an online survey. We assessed demographic variables, government mistrust, group-based medical mistrust, COVID risk and COVID worry, and positive and negative beliefs regarding the COVID-19 vaccine (i.e., vaccine pros and cons), and vaccine hesitancy. We examined our hypotheses with path analyses.

RESULTS

Results indicated significant direct effects of government mistrust on vaccine hesitancy; however, despite a significant correlation, there was no direct effect of group-based medical mistrust on vaccine hesitancy. The effect of group-based medical mistrust was fully mediated by both vaccine pros and cons, whereas the effect of government mistrust was partially mediated by vaccine pros. COVID risk and COVID worry did not mediate the effects of mistrust to vaccine hesitancy.

CONCLUSION

Negative effects of group-based medical mistrust on COVID-19 vaccine hesitancy among African Americans may be amenable to interventions that focus on beliefs about the vaccine rather than beliefs about vulnerability to the virus. However, given its direct effect, it may be necessary to focus directly on government mistrust to diminish its effects on COVID-19 vaccine hesitancy.

Medical mistrust in racial minorities during the COVID-19 pandemic: Attitudes, actions and mental health outcomes

Numerous studies have demonstrated that minority groups had a higher level of medical mistrust than non-minority groups, and minority communities were criticized for noncompliance with the public health guidelines during the COVID-19 pandemic. This study explores racial minorities' attitudes and actual behavioral responses to the COVID-19 pandemic public health guidelines. A total of 221 adults responded to an online survey (mean age = 41.5; 48.0% female; 24.4% non-White). Study results indicate that racial minorities have lower trust in public health guidelines compared to non-minority groups but have taken more actions according to the public health guidelines. Analysis also uncovers the mediating roles of perceived pandemic severity and perceived public health action benefits, on the relation between minority status and public health compliance. This study contextualizes how racial minorities respond to public health crises in action, and the dissonance between that and their historical mistrust of medical authorities. This work highlights the importance of recognizing the minority's historical burden and fostering trust in government and professionals during public health crisis.

Validation of a Modified Group-Based Medical Mistrust Scale Among Young Latinx Adults in the United States

Medical mistrust is an important barrier to accessing health care among Latinx populations in the United States (US). However, research on the validity and reliability of medical mistrust scales is limited. We examined the validity and reliability of a modified bilingual version of the Group-Based Medical Mistrust scale (mGBMMS) among a sample of Latinx adults. Participants included 308 Latinx adults (ages 18-25), who responded in Spanish (n = 134) or English (n = 174). Following feedback from bilingual/bicultural staff during the English-Spanish translation process, we made three changes to the original GBMMS. Validation testing of our 12-item mGBMMS scale included: split-half and internal consistency reliability; discriminant, convergent, and predictive validity; and both exploratory and confirmatory factor analyses. The mGBMMS had good internal consistency (overall sample: Cronbach's α = 0.79; Spanish: Cronbach's α = 0.73; English: Cronbach's α = 0.83). The mGBMMS showed good convergent (moderately correlated with the experiences of discrimination scale, r = 0.46, p < 0.001) and discriminant (weakly correlated with the acculturation scale, r = 0.11, p = 0.06) validity. Split-half reliability was 0.71 (p < 0.001). Exploratory and confirmatory factor analyses found a two-factor solution. The mGBMMS was associated with satisfaction with care (OR = 0.60, 95%CI: 0.42-0.87), a sign of good predictive validity. Findings suggest that the mGBMMS is a valid and reliable scale to utilize among bilingual (Spanish/English) populations in the US. Further validation studies should be considered among Latinx respondents of different ages, backgrounds, languages, and US regions.

Influence of Medical Mistrust on Prevention Behavior and Decision-Making Among Minoritized Youth and Young Adults During the COVID-19 Pandemic

BACKGROUND

Medical mistrust (MM) is seen as a barrier to assessing healthcare needs and addressing health disparities; however, limited literature has focused on assessing MM for vulnerable populations, especially racial/ethnic minority and sexual/gender minority youth and young adults (YYA).

METHODS

Between February 2021 and March 2022, we conducted the Youth and Young Adults COVID-19 Study, a prospective cohort of minoritized YYA aged 14 to 24 years (n = 1027), within the United States and its territories. Participants were recruited through a combination of paid social media ads, outreach with organizations serving marginalized youth, and an existing registry, targeting racial and ethnic minority and LGBTQ + youth for a study on COVID-19 health behaviors. Multiple multinomial logistic regression models were developed to examine associations between demographics and three dimensions of MM including healthcare experience, government information, and scientific information.

RESULTS

Most participants were between the ages of 18 and 21 years (48.3%), identified as Hispanic (33.3%) or white (22.5%), and bisexual or pansexual (34.3%). Queer YYA had higher odds of reporting worse personal healthcare experiences than their straight peers. The odds of gay/lesbian YYA that reported somewhat or extreme trust in doctor's sources were two times higher than their straight peers. Except for those who identified as Asian, racial/ethnic minority YYA were less likely to report somewhat or extreme trust in the CDC's general information or its COVID-19 data than white YYA. Transgender and gender diverse YYA were more than twice as likely to report being very or extremely influenced by statistics of the dangers of COVID-19 than cisgender YYA.

CONCLUSIONS

Our study indicated the importance of incorporating marginalized identities into the assessment of medical mistrust to better understand YYA's health prevention and treatment behaviors and to develop public health prevention and treatment strategies, especially for minoritized communities.

Direct and vicarious exposure to healthcare discrimination and erasure among transgender and gender independent individuals: Testing the indirect effect of mistrust in healthcare on utilization behaviors

RATIONALE

Direct exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, exposure to such harm vicariously (i.e., through observation or report) is underexplored.

OBJECTIVE

The present study examined the relationships among direct and vicarious gender identity-related healthcare discrimination and erasure exposure and past-year healthcare utilization.

METHOD

Gender identity-based mistrust in healthcare was also assessed, as a mechanism through which direct and vicarious gender identity-related healthcare discrimination and erasure predict healthcare utilization behaviors among a sample (N = 385) of TGI adults in the U.S., aged 18 to 71 recruited online.

RESULTS

Results indicated direct lifetime and vicarious healthcare discrimination and erasure exposure significantly predicted past-year healthcare underutilization when participants anticipated encountering gender identity-related healthcare discrimination. Mediational analyses indicated that higher levels of exposure to direct lifetime and vicarious healthcare discrimination and erasure were related to higher levels of mistrust in healthcare, through which past-year underutilization was significantly related.

CONCLUSIONS

These findings are vital to informing healthcare practice and policy initiatives aimed at ensuring the barriers that deleteriously influence the accessibility of healthcare among TGI individuals are ameliorated.

Addressing the Impact of Race and Ethnicity on Musculoskeletal Spine Care in the United States

➤ Despite being a social construct, race has an impact on outcomes in musculoskeletal spine care.➤ Race is associated with other social determinants of health that may predispose patients to worse outcomes.➤ The musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends.➤ Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Factors Associated with COVID-19 Vaccination Promptness after Eligibility in a North Carolina Longitudinal Cohort Study

Many studies identified factors associated with vaccination intention and hesitancy, but factors associated with vaccination promptness and the effect of vaccination intention on vaccination promptness are unknown. This study identified factors associated with COVID-19 vaccination promptness and evaluated the role of vaccination intention on vaccination promptness in 1223 participants in a community-based longitudinal cohort study (June 2020 to December 2021). Participants answered questions regarding COVID-19 vaccination intention, vaccination status, and reasons for not receiving a vaccine. The association of baseline vaccine hesitancy with vaccination was assessed by the Kaplan-Meier survival analysis. Follow-up analyses tested the importance of other variables predicting vaccination using the Cox proportional hazards model. Older age was associated with shorter time to vaccination (HR = 1.76 [1.37-2.25] 85-year-old versus 65-year-old). Lower education levels (HR = 0.80 [0.69-0.92]), household incomes (HR = 0.84 [0.72-0.98]), and baseline vaccination intention of 'No' (HR = 0.16 [0.11-0.23]) were associated with longer times to vaccination. The most common reasons for not being vaccinated (N = 58) were vaccine safety concerns (n = 33), side effects (n = 28), and vaccine effectiveness (n = 25). Vaccination campaigns that target populations prone to hesitancy and address vaccine safety and effectiveness could be helpful in future vaccination rollouts.