Factors Associated with Decisions of Arab Minority Parents in Israel to Vaccinate Their Children against COVID-19

Empowering Unvaccinated Youth: Feasibility, Acceptability, and Efficacy of a COVID-19 Serious Game-Based Intervention

Objective: To evaluate a serious game-based intervention's feasibility, acceptability, and efficacy in encouraging coronavirus disease (COVID-19) vaccination among 11-14-year-olds in the United States and assess participant experiences. Materials and Methods: The study, grounded in social cognitive theory and health belief model, recruited and engaged 32 English-speaking parent-child dyads with unvaccinated youths via snowball sampling and social media outreach. These dyads were randomly assigned to either the COVID-19 serious game-based intervention group (n = 16) or a usual care group (n = 16). The study measured beliefs, self-efficacy, and intentions regarding vaccination using surveys before and after the intervention, with follow-up at 2 months to evaluate vaccine uptake. Semistructured interviews provided insights into the gaming experience and study process. Results: All 32 eligible parent-youth dyads (16 in each group) completed the study with full participation. Most participants were Black or African American fathers, making up 75% and 81.3% of the intervention and control groups, respectively. The intervention impacted vaccine uptake, with 75% of the intervention group vaccinating their children compared with 37.5% of the control group [χ2(1, n = 32) = 4.57, P = 0.033]. Key factors for vaccine uptake included parents' motivation and youths' perceived susceptibility, with correlations of r(30) = 0.66, P = 0.006, and r(30) = 0.55, P = 0.029, respectively. The intervention reshaped youth perceptions about self and community protection. Participants expressed overall satisfaction with both the intervention and the study process. Conclusions: The intervention was found to be feasible and acceptable, with potential for integration into youth vaccination strategies to support COVID-19 vaccine decision-making.

Factors Associated with Israeli Arab Women Anxiety and Depression During the COVID-19 Pandemic

BACKGROUND

Reports have shown that women suffered from anxiety, stress, depression, and fatigue during the COVID-19 pandemic more than men. No study so far has examined the effect of the pandemic among the Arab minority in Israel.

OBJECTIVES

To examine the associations between levels of pandemic fatigue and stress of Israeli Arab women, and their anxiety and depression, along with their socio-demographic and socio-economic characteristics.

METHODS

A Cohen and Williamson questionnaire, which was based on a Likert scale, was distributed by the snowball method through social networks. Bivariate associations between the psycho-social and demographic characteristics and anxiety and depression were assessed using t-tests, chi-square tests, Z tests, and Pearson correlations. Multiple linear regressions were used to evaluate the associations with anxiety and depression, and the mediation model was examined with path analysis with bootstrapping.

RESULTS

Among 2294 Israeli Arab mothers who participated in the study, 63.7% were in the clinical range for anxiety, 67.4% for depression, and 57.5% for both anxiety and depression. Low economic status, pandemic fatigue, living in closed communities, and stress were related to anxiety and depression. Pandemic fatigue was positively related to stress, which was positively related to both anxiety and depression (standardized indirect effect = 0.137, SE = 0.014, 95%CI = 0.111, 0.164, p < .001; vs. 0.133, SE = 0.013, 95%CI = 0.108, 0.160, p < .001 respectively). The contribution of stress to anxiety and depression was significantly greater than that of pandemic fatigue (Z = 19.43 and Z = 18.04, p < .001, for anxiety and depression, respectively).

CONCLUSIONS

Demographic characteristics may put Arab women at a higher risk of anxiety and depression. Elevated stress alongside high fatigue may trigger mental health difficulties. The welfare of minorities should be addressed by policymakers in relation to their demographic needs.

Parents' Concerns, Behavior, Perception, and Hesitancy Regarding COVID-19 Vaccinations for Children in Central Saudi Arabia

In Saudi Arabia, the Ministry of Health (MoH) has implemented strict rules to ensure COVID-19 vaccination uptake by the general public. However, there is hesitancy about COVID-19 vaccination among parents for their children worldwide. We aimed to determine the concerns, behaviors, perceptions, and hesitancy of COVID-19 vaccination among parents for their children in Saudi Arabia. Parents of children aged 5-11 years were included in this cross-sectional study. A total of 1507 responses were obtained using the convenience sampling technique. The data were analyzed using SPSS version 25.0 by applying descriptive and inferential statistics. Of the parents who responded, 74.5% believed that the COVID-19 vaccination could affect the genes of children, and 72.8% believed that the COVID-19 vaccination could have a greater number of positive impacts on the overall health of children. In total, 87% of the parents were satisfied with the vaccination services and effective policies of the MoH, Saudi Arabia. This study concluded that there is a greater need to increase public awareness regarding the beneficial impact of COVID-19 vaccination on the overall health of children. Effective awareness campaigns are also required to provide empirical information to the public that COVID-19 vaccination for children is safe and effective.

Pandemic Fatigue and Vaccine Hesitancy among People Who Have Recovered from COVID-19 Infection in the Post-Pandemic Era: Cross-Sectional Study in China

At present, the COVID-19 pandemic is still ongoing globally and the virus is constantly mutating. The herd immunity barrier established by past infections or vaccinations is gradually weakening and reinfections are occurring. To evaluate the pandemic fatigue and vaccine hesitancy among people who have recovered from COVID-19 in the post-pandemic era, we conducted an anonymous cross-sectional survey study in China from 4 July to 11 August 2023, nearly 6 months after the last large-scale nationwide infection. Basic sociodemographic characteristics, health-related factors (smoking, drinking, and chronic disease history), COVID-19 vaccination history, and self-reported long COVID were obtained as potential covariates. A series of logistic regression models were performed to examine the association between pandemic fatigue and vaccine hesitancy toward the next dose of COVID-19 vaccines via crude relative risks (cORs) and adjusted relative risks (aORs) with 95% CIs. According to our results, of the 2942 participants, 1242 (42.2%) were hesitant (unwilling or not sure) to receive the next dose of COVID-19 vaccines. The average score on the Pandemic Fatigue Scale was 21.67 ± 8.86, in which the scores of all items in the vaccine-hesitant group were significantly higher than those in the vaccine-accepting group. Additionally, the higher the pandemic fatigue level among people who have recovered from COVID-19, the more likely they were to be hesitant to receive the next dose of the COVID-19 vaccines (moderate: aOR = 2.94, 95% CI: 2.46-3.53; high: aOR = 6.88, 95% CI: 5.49-8.64). Overall, more than 40% of the recovered participants were unwilling or uncertain about the next vaccine dose, with varying degrees of pandemic fatigue. Pandemic fatigue is a potentially relevant factor for vaccine hesitancy and may hinder the translation of vaccination intention into behavior. Considering the ongoing reinfection situation, implementing a health education plan to reduce pandemic fatigue and prioritizing vaccination issues for people who have recovered from COVID-19 may be key to promoting the reduction of the COVID-19 disease burden and ensuring the health and well-being of the population.

Factors Related to the Compliance of Arab Parents in Israel to the Vaccination of Children and Adolescents against COVID-19

The Arab minority consists of 20% of the Israeli population. Most of the Arab minority live in rural villages, mostly in closed communities, with specific psycho-social and sociodemographic characteristics. Previous studies showed different attitudes to COVID-19 vaccination among Arab adults.

OBJECTIVES

To examine the influence of factors on the willingness of parents to vaccinate their young and adolescent children and if there is a difference between parents' attitudes to both groups.

METHODS AND MATERIALS

The survey examined correlations between variables and attitudes toward the vaccine and the pandemic and was disseminated anonymously to parents of children between the ages of 5 and 18 in the Arab population of Israel through social media networks, using the snowball method. Statistical analyses included the Pearson correlation, MANCOVA, and logistic regression tests.

RESULTS

In total, 361 Arab Israeli parents participated. As mentioned above, 130 parents had both children and adolescents. Overall, 48 parents (36.9%) chose not to vaccinate both their children and adolescents, 52 parents (40.0%) chose to vaccinate only their adolescents, only 1 parent (0.8%) chose to vaccinate only the child, and 29 parents (22.3%) vaccinated both their children and adolescents. Significant correlations were found among a higher age of parents and socioeconomic status, attitudes toward COVID vaccination, subjective norms, perceived severity of the disease, perceived benefits of vaccination, and trust in formal sources.

DISCUSSION

There is a difference between parents' decision to be vaccinated and their willingness to vaccinate their children. There is a difference between their decision to vaccinate their adolescents and their young children. Different factors positively or negatively influenced parents' decisions. Addressing these factors by authorities may increase compliance of Arab minorities with instructions in the future.

Compliance with Ministry of Health Regulations among Israeli Nurses during the COVID-19 Pandemic: The Mediating Role of Risk Perception

The COVID-19 pandemic has created a sustained state of emergency, causing uncertainty and risk taking. Israeli nurses were required to follow new regulations and safety measures issued by the Israeli Ministry of Health (MOH). This study aimed to examine nurses' compliance with MOH regulations and its association with their risk and threat perceptions and their positive and negative emotions. A cross-sectional online survey was conducted among 346 Israeli nurses. The study model was examined with path analysis. Most nurses reported complying with MOH regulations either fully (49%) or very often (30%). Negative emotions were positively associated with perceptions of both threat and risk, yet only risk perception was positively associated with nurses' compliance. A significant mediated relationship was found between negative emotions and nurses' compliance, with the possible mediator being risk perception. Hence, higher negative emotions were associated with a greater risk perception, which was associated with higher compliance. Health systems leaders must strategize to deal with the wave-like character of the pandemic. Solutions to nursing teams' negative emotions must be provided to keep the balance between feelings of complacency and a situation of high-level, intense negative feelings, which might lead to abstention, burnout, or emotional injury.

Difference between Minorities and Majorities in the Association between COVID-19-Related Stress and Psychological Distress: A Socio-Ecological Perspective and the Moderating Role of Parenthood

This study introduces a socio-ecological perspective of differences in psychological distress between the Palestinian minority and Jewish majority citizens of Israel during lockdown due to COVID-19. The study examines the association between COVID-19-related stress and psychological distress, and the moderating effect of parenthood. Online questionnaires, completed by 1934 participants (1391 Jews, 552 Palestinians; 1306 parents, 637 without children; 54.86% female, 45.13% male; M age = 40.38, SD = 13.77) assessed COVID-19-related stressors and depression, anxiety, and stress. The Palestinian minority showed a higher level of COVID-19-related stress and psychological distress than the Jewish majority. Parenthood showed a moderating effect on the association between COVID-19-related stress and distress for the Jewish majority but not the Palestinian minority. The results emphasize the significance of considering social status when seeking to understand the differences between minorities and majorities in terms of distress and resilience during pandemic events, and the need for cultural sensitivity and awareness when issuing instructions in such circumstances. Additionally, the results highlight the potential role of parenthood as a resilience factor, depending upon social status.

The Mediating Role of the Perceived COVID-19 Vaccine Benefits: Examining Israeli Parents' Perceptions Regarding Their Adolescents' Vaccination

Israel was among the first countries to initiate adolescent COVID-19 vaccination. As adolescent vaccination requires parental consent, we evaluated the factors associated with parents’ willingness to vaccinate their adolescents and their point of view regarding adolescents’ involvement in this decision. An online survey was completed by 581 parents of adolescents aged 16–18. The main independent variables included trust in the healthcare system, components of the Health Belief Model (HBM) and adolescents’ involvement in the decision, as well as background data, including demographics. Analysis included a multiple logistic regression and mediation examination. Parents reported that 446 adolescents (76.8%) have been or will soon be vaccinated against COVID-19, 12.2% chose not to vaccinate their child and 11% have not yet decided. Vaccination was significantly associated with HBM components and with adolescents’ involvement in the decision. The perceived vaccination benefits acted as a mediator in the association between parents’ COVID-19 perceived threat and adolescent vaccination, as well as between parents’ trust in the healthcare system and adolescent vaccination. Addressing vaccination benefits and barriers is pivotal in the attempt to enhance adolescents’ vaccination adherence. Considering the importance of adolescents’ involvement in the decision, addressing them directly may also be beneficial in improving vaccination rates.

How to increase COVID-19 vaccine uptake among children? determinants associated with vaccine compliance

OBJECTIVE

Three aims: to elucidate determinants associated with COVID-19 vaccine uptake in children and the association with parental vaccination; to compare rates of PCR-positive SARS-CoV-2 results between vaccinated and unvaccinated children; to estimate the rate of parental COVID-19 vaccination and its association with the vaccination rate of their children.

METHODS

We performed a retrospective chart review of all children aged 5-11 years registered at a central district in Israel from November 21st, 2021 to April 30th, 2022, and characterized COVID-19 vaccinated vs. unvaccinated individuals. Data retrieved from the electronic medical files included: demographics [age, gender, sector, socioeconomic status (SES)]; COVID-19 vaccination (first and second doses) and influenza vaccination status; co-morbidities; and parental vaccinations for COVID-19. We divided the population into three distinct demographic groups: non-ultra-orthodox Jews (43,889 children), ultra-orthodox Jews (13,858 children), and Arabs (4,029 children).

RESULTS

Of the 61,776 children included in the study, 20,355 (32.9%) received at least one dose of the COVID-19 vaccine. Vaccination rates were similar amongst males and females and were higher in children aged 9-11 years compared to children aged 5-6 years. Multivariate analysis identified five independent determinants that were significantly (p < 0.001) associated with low vaccination rates: Arab and ultra-orthodox sectors (odds ratios: 0.235 and 0.617, respectively); children aged 5-8 years; children of low SES; and children who had not received previous seasonal influenza vaccination. Relatively high vaccination rates were noted amongst children with the following medical co-morbidities: treatment with biological agents (42.9%); solid tumor transplantation (42.9%); type 1 diabetes mellitus (38.5%), asthma (38.2%), and attention deficit and hyperactivity disorder (ADHD) (37.6%). Regarding the uptake of two vaccine doses among children with co-morbidities, it was highest in those with type 1 diabetes mellitus, heart failure, treatment with biological agents, asthma and obesity.

CONCLUSION

This study highlights several pediatric sub-populations with low and high vaccine uptake. It is essential to focus on determinants associated with low vaccination rates.