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Gonzalez H, Patel MS, Pehlivanova M, Burke RV. Assessing Trust in Physician and Vaccine Hesitancy Among Hispanic/Latinx Parents. HISPANIC HEALTH CARE INTERNATIONAL 2024; 22:74-82. [PMID: 37438967 DOI: 10.1177/15404153231187379] [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: 07/14/2023]
Abstract
Introduction: Representing the USA's largest ethnic/racial group, Hispanic/Latinx (HL) experience health challenges of proportional magnitude. This study investigates the prevalence of vaccine hesitancy among HL adults and trust in their child's pediatrician. Methods: HL parents of children who receive medical care at one of the largest Federally Qualified Health Centers in the United States completed a survey examining associations between physician trust, vaccine hesitancy, and demographics. Data were subjected to ANOVA via SAS9 version 9.0 (Cary, NC) and SPSS version 27 (Chicago, IL) software. Results: With a total of 500 surveys completed (51% response rate; 81% completion rate), the prevalence of vaccine hesitancy amounted to 15.4% (n = 77). Parents with university-level education displayed higher levels of trust and perceptions in favor of routine vaccination practices (p < .01). When medical visits were conducted in Spanish, parents exhibited lower levels of trust and were more vaccine-hesitant (p < .01). Conclusions: Vaccine literacy must be prioritized in early education to reach parents who may not achieve college degrees. Ensuring language concordance within patient-physician dyads may maximize the potential for vaccine uptake and physician trust.
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Affiliation(s)
- Hector Gonzalez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mona S Patel
- Department of General Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Marieta Pehlivanova
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rita V Burke
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Castellon-Lopez YM, Klomhaus AM, Garcia C, Marquez D, Avila H, Gravette H, Lopez-Chang R, Ortega B, Norris KC, Brown AF, Blanco L. MivacunaLA (MyshotLA): A Community-Partnered Mobile Phone Intervention to Improve COVID-19 Vaccination Behaviors among Low-Income, Spanish-Speaking, and Immigrant Latino Parents or Caregivers. Vaccines (Basel) 2024; 12:511. [PMID: 38793762 PMCID: PMC11125729 DOI: 10.3390/vaccines12050511] [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: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
We developed and tested MivacunaLA/MyshotLA, a community-informed mobile phone intervention, to increase COVID-19 vaccination among Latino parents/caretakers of minors in under-resourced areas of Los Angeles by addressing misinformation and building trust. We recruited Latino parents/caregivers with at least one unvaccinated child in East and South Los Angeles in the summer of 2021 and evaluated MivacunaLA as a randomized controlled trial with a wait-list control group. A difference-in-difference analysis showed Latino parents/caregivers that participated in MivacunaLA (n = 246), in comparison to the control group, were 15 percentage points more likely (p = 0.04) to report vaccination of minors aged 12-17 years, and 12 percentage points more likely (p = 0.03) to report a positive intention to vaccinate minors aged 2-11 years (when COVID-19 vaccines became available). Mobile phone-delivered digital interventions using videos and culturally tailored educational material to promote COVID-19 vaccine confidence can be an effective way to combat misinformation and deliver timely information to marginalized communities. Community-based participatory research approaches are crucial to advance health equity among minority communities, especially immigrant Spanish-speaking underserved communities.
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Affiliation(s)
- Yelba M. Castellon-Lopez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Alexandra M. Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Cruz Garcia
- School of Public Policy, Pepperdine University, Malibu, CA 90263, USA; (C.G.); (L.B.)
| | - Denise Marquez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Hilda Avila
- Families in Schools, Los Angeles, CA 90017, USA;
| | | | | | | | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.C.N.); (A.F.B.)
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.C.N.); (A.F.B.)
- Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Luisa Blanco
- School of Public Policy, Pepperdine University, Malibu, CA 90263, USA; (C.G.); (L.B.)
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Chan IL, Schwarz K, Weinstein N, Mansergh G, Nahhas RW, Gelaude D, Alexander R, Rodriguez L, Strauss W, Repetski T, Sullivan N, Long E, Evener SL, Garbarino A, Kollar LMM. An Evaluation of Messages to Promote Parental Intent to Vaccinate Children Aged <12 Years Against COVID-19. Public Health Rep 2024; 139:230-240. [PMID: 38240243 PMCID: PMC10851906 DOI: 10.1177/00333549231218725] [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] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES Effective health communication can increase intent to vaccinate. We compared 8 messages that may influence parents' intent to vaccinate their children against COVID-19. METHODS In a cross-sectional survey of adults in the United States administered online in August 2021, 1837 parents and legal guardians were exposed to 8 messages (individual choice, gain/practical benefits, nonexpert, health care provider recommendation, altruism/community good, safety/effectiveness, safety, and effectiveness) to determine message reception and influence on intent to vaccinate their children. Parents responded to 10 questions using a Likert scale. We computed odds ratios (ORs) for each message, with an OR >1.0 indicating greater observed odds of participant agreement with the follow-up statement as compared with a reference message. We compared outcomes individually across messages with ordinal logistic regression fit using generalized estimating equations. RESULTS The individual choice message had the highest odds of agreement for understanding intent (OR = 2.10; 95% CI, 1.94-2.27), followed by the health care provider recommendation message (OR = 1.58; 95% CI, 1.46-1.71). The individual choice message had the highest odds of memorability, relatability, and trustworthiness. The altruism/community good message was at or near second best. The altruism/community good message had the highest or near-highest odds of increasing parents' intent to vaccinate their children, asking friends and family for their thoughts, and searching for additional information. The message that most motivated parents to vaccinate their children depended on parental intent to vaccinate prior to being exposed to the tested messages. CONCLUSIONS Messages with themes of individual choice, health care provider recommendation, and altruism/community good may be used in future message campaigns. Further research is needed to refine message concepts related to altruism/community good.
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Affiliation(s)
| | - Kelsey Schwarz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gordon Mansergh
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ramzi W. Nahhas
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Deborah Gelaude
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Nancy Sullivan
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | | | | | | | - Laura M. Mercer Kollar
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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McMann T, Wenzel C, Le N, Li Z, Xu Q, Cuomo RE, Mackey T. Detection and Characterization of Web-Based Pediatric COVID-19 Vaccine Discussions and Racial and Ethnic Minority Topics: Retrospective Analysis of Twitter Data. JMIR Pediatr Parent 2023; 6:e48004. [PMID: 38038663 DOI: 10.2196/48004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023] Open
Abstract
Background Despite pediatric populations representing a smaller proportion of COVID-19 cases and having a less severe prognosis, those belonging to racial and ethnic minority groups are at an increased risk of developing more severe COVID-19-related outcomes. Vaccine coverage is crucial to pandemic mitigation efforts, yet since the start of the COVID-19 pandemic, vaccine hesitancy has increased and routine pediatric immunizations have decreased. Limited research exists on how vaccine hesitancy may contribute to low pediatric COVID-19 vaccine uptake among racial and ethnic minority populations. Objective This study aimed to characterize COVID-19 vaccine-related discussion and sentiment among Twitter users, particularly among racial and ethnic minority users. Methods We used the Twitter application programming interface to collect tweets and replies. Tweets were selected by filtering for keywords associated with COVID-19 vaccines and pediatric-related terms. From this corpus of tweets, we used the Biterm Topic Model to output topics and examined the top 200 retweeted tweets that were coded for pediatric COVID-19 vaccine relevance. Relevant tweets were analyzed using an inductive coding approach to characterize pediatric COVID-19 vaccine-related themes. Replies to relevant tweets were collected and coded. User metadata were assessed for self-reporting of race or ethnic group affiliation and verified account status. Results A total of 863,007 tweets were collected from October 2020 to October 2021. After outputting Biterm Topic Model topics and reviewing the 200 most retweeted tweets, 208,666 tweets and 3905 replies were identified as being pediatric COVID-19 vaccine related. The majority (150,262/208,666, 72.01%) of tweets expressed vaccine-related concerns. Among tweets discussing vaccine confidence, user replies expressing agreement were significantly outweighed by those expressing disagreement (1016/3106, 32.71% vs 2090/3106, 67.29%; P<.001). The main themes identified in the Twitter interactions were conversations regarding vaccine-related concerns including adverse side effects, concerns that the vaccine is experimental or needs more testing and should not be tested on pediatric populations, the perception that the vaccine is unnecessary given the perceived low risk of pediatric infection, and conversations associated with vaccine-related confidence (ie, the vaccine is protective). Among signal tweets and replies, we identified 418 users who self-identified as a racial minority individual and 40 who self-identified as an ethnic minority individual. Among the subcodes identified in this study, the vaccine being protective was the most discussed topic by racial and ethnic minority groups (305/444, 68.7%). Conclusions Vaccine-related concerns can have negative consequences on vaccine uptake and participation in vaccine-related clinical trials. This can impact the uptake and development of safe and effective vaccines, especially among racial and ethnic minority populations.
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Affiliation(s)
- Tiana McMann
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | | | - Nicolette Le
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | - Qing Xu
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, United States
- Department of Anesthesiology, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Tim Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
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5
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Rabin Y, Kohler RE. COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01858-1. [PMID: 37947953 DOI: 10.1007/s40615-023-01858-1] [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: 08/16/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.
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Affiliation(s)
- Yael Rabin
- Department of Health Behavior Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Racquel E Kohler
- Department of Health Behavior Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA.
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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6
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Lyu Y, Lai X, Ma Y, Fang H. Factors associated with recommendation behaviors of four non-National Immunization Program vaccines: a cross-sectional survey among public health workers in China. Infect Dis Poverty 2023; 12:91. [PMID: 37805654 PMCID: PMC10559509 DOI: 10.1186/s40249-023-01142-8] [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: 05/01/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Immunization is a crucial preventive measure to safeguard children under five years old against a range of diseases. In China, the coverage rate of non-National Immunization Program (non-NIP) vaccines can be improved by leveraging the recommendation from public health workers. Hence, understanding the influencing factors of recommendation behaviors assume paramount importance. This study aims to investigate influencing factors of public health workers' recommendation behaviors towards non-NIP vaccines, with a particular emphasis on financial incentives. METHODS A cross-sectional survey was conducted using a multi-stage sampling method in 2019 from August to October. 627 public health workers were recruited from 148 community healthcare centers in ten provincial-level administrative divisions in China. An anonymous questionnaire was used to collect demographic information, attitudes towards vaccination, and recommendation behaviors towards non-NIP vaccines, including Haemophilus influenzae type b (Hib) vaccine, pneumococcal conjugate vaccine, varicella vaccine, and rotavirus vaccine. Descriptive analysis and multivariate logistic regression analysis were adopted in this study. RESULTS Of the 610 public health workers with complete survey data, 53.8%, 57.4%, 84.1%, and 54.1% often recommended Hib vaccine, pneumococcal pneumonia vaccine (PCV), varicella vaccine, and rotavirus vaccine, respectively. Logistic regression revealed that gender (Hib vaccine: OR = 0.4, 95% CI: 0.2-0.8; PCV: OR = 0.4, 95% CI: 0.2-0.8; rotavirus vaccine: OR = 0.3, 95% CI: 0.2-0.6), financial incentives for non-NIP vaccination (Hib vaccine: OR = 1.9, 95% CI: 1.1-3.6; PCV: OR = 2.1, 95% CI: 1.1-3.9; rotavirus vaccine: OR = 2.0, 95% CI: 1.1-3.8) and perception of vaccine safety (Hib vaccine: OR = 2.7, 95% CI: 1.1-7.0; PCV: OR = 3.2, 95% CI: 1.2-8.0; rotavirus vaccine: OR = 3.0, 95% CI: 1.2-7.7) were associated with public health workers' recommendation towards Hib vaccine, PCV and rotavirus vaccine. CONCLUSIONS The findings highlighted public health workers' recommendation behaviors of non-NIP vaccines in China and revealed strong association between vaccine recommendation and financial incentives. This highlights the importance of financial incentives in public health workers' recommendation toward non-NIP vaccines in China. Proper incentives are recommended for public health workers to encourage effective health promotion in immunization practices.
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Affiliation(s)
- Yun Lyu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Xiaozhen Lai
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yidi Ma
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China.
- Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Peking University, Beijing, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
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7
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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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8
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Xu MA, Choi J, Capasso A, DiClemente R. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. Healthcare (Basel) 2023; 11:1702. [PMID: 37372820 DOI: 10.3390/healthcare11121702] [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: 04/24/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.
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Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Ralph DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
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9
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Adjei Boakye E, Nair M, Abouelella DK, Joseph CL, Gerend MA, Subramaniam DS, Osazuwa-Peters N. Trends in Reasons for Human Papillomavirus Vaccine Hesitancy: 2010-2020. Pediatrics 2023; 151:e2022060410. [PMID: 37218460 PMCID: PMC10233736 DOI: 10.1542/peds.2022-060410] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVES We sought to identify trends in the main reasons United States parents of unvaccinated children gave for not intending to vaccinate their adolescent children against HPV from 2010 to 2020. As interventions designed to increase vaccine uptake have been implemented across the United States, we predicted that reasons for hesitancy have changed over this period. METHODS We analyzed data from the 2010 to 2020 National Immunization Survey-Teen, which included 119 695 adolescents aged 13 to 17 years. Joinpoint regression estimated yearly changes in the top five cited reasons for not intending to vaccinate using annual percentage changes. RESULTS The five most frequently cited reasons for not intending to vaccinate included "not necessary," "safety concerns," "lack of recommendation," "lack of knowledge," and "not sexually active." Overall, parental HPV vaccine hesitancy decreased by 5.5% annually between 2010 and 2012 and then remained stable for the 9-year period of 2012 through 2020. The proportion of parents citing "safety or side effects" as a reason for vaccine hesitancy increased significantly by 15.6% annually from 2010 to 2018. The proportion of parents citing "not recommended," "lack of knowledge," or "child not sexually active" as reasons for vaccine hesitancy decreased significantly by 6.8%, 9.9%, and 5.9% respectively per year between 2013 and 2020. No significant changes were observed for parents citing "not necessary." CONCLUSIONS Parents who cited vaccine safety as a reason for not intending to vaccinate their adolescent children against HPV increased over time. Findings support efforts to address parental safety concerns surrounding HPV vaccination.
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Affiliation(s)
- Eric Adjei Boakye
- Departments of Public Health Sciences
- Otolaryngology – Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | | | - Dina K Abouelella
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Mary A. Gerend
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida
| | - Divya S. Subramaniam
- Department of Health and Clinical Outcomes Research
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
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10
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Mansfield LN, Choi K, Delgado JR, Macias M, Munoz-Plaza C, Lewin B, Bronstein D, Chang J, Bruxvoort K. Decision-Making about COVID-19 Vaccines among Health Care Workers and Their Adolescent Children. West J Nurs Res 2023:1939459231170981. [PMID: 37096318 DOI: 10.1177/01939459231170981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Health care workers promote COVID-19 vaccination for adolescent patients, and as parents, may influence their own children to get vaccinated. We conducted virtual, semi-structured qualitative interviews with vaccinated health care workers and their adolescent children to explore their decision-making process for COVID-19 vaccination. In total, 21 health care workers (physicians, nurses, and medical staff) and their adolescent children (N = 17) participated in interviews. The following three themes described parent-adolescent decision-making for COVID-19 vaccination: (1) family anticipation and hesitation about COVID-19 vaccine approval; (2) parents' or adolescents' choice: the decision maker for adolescent COVID-19 vaccination; and (3) leveraging one's vaccination status to encourage others to get vaccinated. Nurses encouraged adolescent autonomy in decisions for COVID-19 vaccination while physicians viewed vaccination as the parent's decision. Health care workers and their adolescent children used role-modeling to motivate unvaccinated peers and may model their decision-making process for adolescent COVID-19 vaccination with their own children to support their patients' and parents' vaccine decisions.
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Affiliation(s)
- Lisa N Mansfield
- National Clinician Scholars Program, Division of General Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Choi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- School of Nursing, University of California, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Jeanne R Delgado
- National Clinician Scholars Program, Division of General Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Mayra Macias
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Corrine Munoz-Plaza
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Bruno Lewin
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David Bronstein
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Chang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Katia Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Hanley K, Chung TH, Nguyen LK, Amadi T, Stansberry S, Yetman RJ, Foxhall LE, Bello R, Diallo T, Le YCL. Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients. Vaccines (Basel) 2023; 11:vaccines11040872. [PMID: 37112784 PMCID: PMC10145812 DOI: 10.3390/vaccines11040872] [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: 03/27/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The COVID-19 pandemic led to delays in routine preventative primary care and declines in HPV immunization rates. Providers and healthcare organizations needed to explore new ways to engage individuals to resume preventive care behaviors. Thus, we evaluated the effectiveness of using customized electronic reminders with provider recommendations for HPV vaccination to increase HPV vaccinations among adolescents and young adults, ages 9-25. Using stratified randomization, participants were divided into two groups: usual care (control) (N = 3703) and intervention (N = 3705). The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS, email or patient portal message) at least once, and up to three times (spaced at an interval of 1 reminder per month). The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (Adjusted Odds Ratio: 1.17, 95% CI: 1.01-1.36). This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers.
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Affiliation(s)
- Kathleen Hanley
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Tong Han Chung
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Linh K Nguyen
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Tochi Amadi
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Sandra Stansberry
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Robert J Yetman
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Lewis E Foxhall
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rosalind Bello
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The HPV Vaccination Initiative, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Talhatou Diallo
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yen-Chi L Le
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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12
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Coyer L, Sogan-Ekinci A, Greutélaers B, Kuhn J, Saller FS, Hailer J, Böhm S, Brosch R, Wagner-Wiening C, Böhmer MM. Knowledge, Attitudes and Behaviors regarding Tick-Borne Encephalitis Vaccination and Prevention of Tick-Borne Diseases among Primary Care Physicians in Bavaria and Baden-Wuerttemberg, Germany, May-September 2022. Microorganisms 2023; 11:microorganisms11040961. [PMID: 37110384 PMCID: PMC10146000 DOI: 10.3390/microorganisms11040961] [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: 02/17/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
In 2020, a record number of tick-borne encephalitis (TBE) cases was reported in major endemic areas in Germany, i.e., the southern federal states of Baden-Wuerttemberg and Bavaria. Most cases were unvaccinated. Other tick-borne diseases (TBDs), including Lyme borreliosis and tularemia, are rising, too. Thus, strategies are needed to increase TBE vaccination uptake in risk areas and promote education on TBD prevention. Primary care physicians are key providers of both vaccinations and TBD education. The TBD-Prevention (TBD-Prev) study aimed to investigate the knowledge, attitudes and behaviors of primary care physicians in Baden-Wuerttemberg and Bavaria with regard to TBE vaccination and prevention of TBDs and to derive strategies for increasing vaccination rates and improving knowledge about TBE and other TBDs in the population and among primary care physicians. We invited all primary care physicians (N = 14,046) in both states to participate by mail. Using standardized, self-administered questionnaires, available both on paper and online, we asked physicians anonymously about their knowledge, attitudes and behaviors with respect to TBE vaccination and TBD prevention and their need for further information/educational materials. A total of 2321 physicians participated between May and September 2022 (response rate 17%), of whom 1222 (53%) worked in Baden-Wuerttemberg and 1067 (46%) in Bavaria. Among the participating physicians, 56% were male, 71% were >50 years and 51% worked in an individual practice. Furthermore, 91% were aware of the German national vaccination guidelines, and 98% perceived their knowledge of the risks and benefits of vaccination as adequate. A total of 97% offer TBE vaccinations, 67% provide vaccination counselling during initial consultations with new patients and 64% actively remind patients about due vaccinations. In addition, 24% expressed a need for further information materials, mainly traditional, analogue media such as flyers (82%) and posters (50%), and named timeliness, quality assurance, easy comprehensibility and independence from the pharmaceutical industry as the most important characteristics of such materials. Almost all participating physicians reported offering TBE vaccinations and feeling well-informed about TBE vaccination and TBDs. However, active offering of vaccinations and education could be further improved, and additional, low-threshold information materials are needed. Based on these results, we will develop and provide various materials on TBE vaccination and TBDs, in particular flyers and posters, for use by physicians during consultations.
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Affiliation(s)
- Liza Coyer
- Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), 16 973 Solna, Sweden
| | - Aylin Sogan-Ekinci
- Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany
| | - Benedikt Greutélaers
- Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany
| | - Julia Kuhn
- Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany
| | - Franziska S Saller
- Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany
| | - Jana Hailer
- District Health Office Reutlingen, 72764 Reutlingen, Germany
| | - Stefanie Böhm
- Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany
- Faculty of Medicine, Ludwig-Maximilians-University of Munich, 80336 Munich, Germany
| | - Rainer Brosch
- Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany
| | - Christiane Wagner-Wiening
- Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office (LGA), Ministry of Social Affairs, Health and Integration, 70191 Stuttgart, Germany
| | - Merle M Böhmer
- Infectious Disease Epidemiology and Surveillance Unit, Bavarian Health and Food Safety Authority (LGL), 80636 Munich, Germany
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, 39120 Magdeburg, Germany
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13
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Magana K, Strand L, Love M, Moore T, Peña A, Ito Ford A, Vassar M. Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review. Sex Transm Infect 2023; 99:128-136. [PMID: 36396174 DOI: 10.1136/sextrans-2022-055587] [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: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) represents the most common STI in the USA. HPV inequities in prevention, diagnostics and clinical care persist. We define inequities as systematic, avoidable and unfair differences in health outcomes. OBJECTIVES The objectives of this scoping review are to chart existing data on HPV-related inequities, identify gaps in existing literature and guide future research to reduce these inequities. METHODS We completed a scoping review following guidelines from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews extension. We performed a literature search on PubMed and Ovid Embase in July 2022 for articles pertaining to HPV and evaluating populations within the USA. We included English language publications from 2018 to 2022 evaluating at least one health inequity outlined by the National Institutes of Health. General publication characteristics and health inequity data were charted in a masked, duplicate fashion using a pilot-tested Google Form. We analysed frequencies of health inequities and summarised main findings from included studies. RESULTS Our final sample included 170 publications. The most common inequities examined were race/ethnicity (140 studies), sex or gender (97 studies), and income (69 studies). Many historically marginalised racial/ethnic groups had lower rates of HPV-related knowledge, vaccination and worse overall outcomes related to HPV. Compared with women, men had lower rates of HPV vaccination and provider recommendation, and higher rates of HPV-infection. Results regarding income were largely conflicting. CONCLUSION Findings from our review demonstrate clear gaps in HPV-related inequity research. Vaccine completion, provider recommendation and intersectionality should continue to be evaluated to implement targeted interventions.
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Affiliation(s)
- Kimberly Magana
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Laura Strand
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Mitchell Love
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Ty Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andriana Peña
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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14
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Invasive Meningococcal Disease and Meningococcal Serogroup B Vaccination in Adults and Their Offspring: Knowledge, Attitudes, and Practices in Italy (2019). Vaccines (Basel) 2023; 11:vaccines11030508. [PMID: 36992092 DOI: 10.3390/vaccines11030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Despite its effectiveness in preventing invasive meningococcal disease (IMD), pediatric uptake of recombinant meningococcal vaccination for serogroup B meningitis (MenB) is low in Italy. This study aimed to investigate knowledge, attitudes, and practice (KAP) about IMD and the vaccine uptake for MenB from July to December 2019, in a sample collected from a series of local Facebook discussion groups from the provinces of Parma and Reggio Emilia (North-Eastern Italy; 337,104 registered users). A self-administered anonymous web-based questionnaire was used to collect demographics, knowledge status, perceived risk for contracting meningitis, attitude towards the utility of meningococcal vaccine, and willingness to receive/perform MenB vaccine in their offspring. In total, 541 parents returned a fully completed questionnaire (response rate of 1.6% of potential recipients), with a mean age of 39.2 years ± 6.3 (78.1% females). Meningococcal infection was identified as severe or highly severe by most participants (88.9%), while it was recognized as being frequent/highly frequent in the general population by 18.6% of respondents. The overall knowledge status was unsatisfactory (57.6% ± 33.6 of correct answers to the knowledge test). Even though 63.4% of participants were somewhat favorable to MenB/MenC vaccines, offspring’s vaccination towards MenB was reported by only 38.7% of participants. In a binary logistic regression model, the male gender of respondents (adjusted odds ratio [aOR] 3.184, 95% confidence interval [95%CI] 1.772 to 5.721), living in a municipality >15,000 inhabitants (aOR 1.675, 95%CI 1.051 to 2.668), reporting a favorable attitude on meningococcus B vaccine (aOR 12.472, 95%CI 3.030 to 51.338), having been vaccinated against serogroup B (aOR 5.624, 95%CI 1.936 to 16.337) and/or serogroup C (aOR 2.652, 95%CI 1.442 to 4.872), and having previously vaccinated their offspring against serogroup C meningococcus (aOR 6.585, 95%CI 3.648 to 11.888) were characterized as positive effectors of offspring’s vaccination. On the contrary, having a higher risk perception on vaccines was identified as the only negative effector (aOR 0.429, 95%CI 0.241 to 0.765). Our results hint towards extensive knowledge gaps on IMD and preventive interventions in the general population, suggesting that a positive attitude towards vaccines and vaccinations could be identified as the main effector also for MenB acceptance. Interventions in the general population aimed at improving confidence, compliance, and acknowledgment of the collective responsibility, as well as preventing actual constraints and the sharing of false beliefs on infectious diseases and their preventive measures, could therefore increase vaccination acceptance in both targeted individuals and their offspring.
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15
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Abstract
BACKGROUND COVID-19 vaccines are available for adolescents in the United States, but many parents are hesitant to have their children vaccinated. The advice of primary care professionals strongly influences vaccine uptake. OBJECTIVE We examined the willingness of primary care professionals (PCPs) to recommend COVID-19 vaccination for adolescents. METHODS Participants were a national sample of 1,047 US adolescent primary care professionals. They participated in an online survey in early 2021, after a COVID-19 vaccine had been approved for adults but before approval for adolescents. Respondents included physicians (71%), advanced practice providers (17%), and nurses (12%). We identified correlates of willingness to recommend COVID-19 vaccination for adolescents using logistic regression. RESULTS The majority (89%) of respondents were willing to recommend COVID-19 vaccination for adolescents, with advanced practice providers and nurses being less likely than paediatricians to recommend vaccination (84% vs. 94%, aOR 0.47, 95% CI 0.23-0.92). Respondents who had received at least one dose of a COVID-19 vaccine were more likely to recommend adolescent vaccination (92% vs. 69%, aOR 4.20, 95% CI 2.56-6.87) as were those with more years in practice (94% vs. 88%, aOR 2.93, 95% CI 1.79-4.99). Most respondents (96%) said they would need some measure of support in order to provide COVID-19 vaccination to adolescents, with vaccine safety and efficacy information being the most commonly cited need (80%). CONCLUSION Adolescent primary care professionals were generally willing to recommend COVID-19 vaccination. However, most indicated a need for additional resources to be able to administer COVID-19 vaccines at their clinic.
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Affiliation(s)
- Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Lauren McCormick
- Department of Biology, University of North Carolina, Chapel Hill, NC, United States
| | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
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16
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Tubaş F, Dulkadir R, Taplak AŞ, Ünlü E. Knowledge and Attitudes of Physicians and Nurses in Turkey Regarding Human Papillomavirus Vaccination of Their Children. J Community Health 2023; 48:99-103. [PMID: 36305983 DOI: 10.1007/s10900-022-01141-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 10/31/2022]
Abstract
AIM This study aimed to determine the knowledge and attitudes of physicians and nurses as parents about human papillomavirus (HPV) vaccination and their views on vaccination in children. MATERIALS AND METHODS This cross-sectional study included 72 physicians and 128 nurses who had children. Data were collected using questionnaires prepared by researchers. Descriptive statistical analysis and chi-square tests were used for data analysis. RESULTS In this study, 84.7% of physicians and 70.3% of the nurses knew that HPV is a cancer factor, and two-thirds of the healthcare professionals believed that the HPV vaccine is protective. Moreover, 62.5% of physicians and 74.2% of nurses reported that they did not intend to vaccinate their children. The reasons for vaccination hesitancy of healthcare professionals was believing it was unnecessary, thinking it was expensive, having insufficient knowledge about vaccine, thinking it may have side effects, and not trusting the vaccine. In this sample, 70.8% of physicians and 53.9% of nurses stated that they could have their children vaccinated only if the HPV vaccines were in the national vaccination schedule. DISCUSSION Further studies should be conducted to include the HPV vaccine in the childhood national vaccination program to reduce vaccine hesitancy.
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Affiliation(s)
- Filiz Tubaş
- Department Of Pediatrics, Erciyes University Faculty Of Medicine, Kayseri, Turkey.
| | - Ramazan Dulkadir
- Department of Pediatrics, K?rşehir, K?rşehir Ahi Evran Un?versity Faculty of Medicine, Kayseri, Turkey
| | | | - Erdal Ünlü
- Department of Pediatrics, K?rşehir, K?rşehir Ahi Evran Un?versity Faculty of Medicine, Kayseri, Turkey
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17
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Masaquel C, Schley K, Wright K, Mauskopf J, Parrish RA, Presa JV, Hewlett D. The Impact of Social Determinants of Health on Meningococcal Vaccination Awareness, Delivery, and Coverage in Adolescents and Young Adults in the United States: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11020256. [PMID: 36851134 PMCID: PMC9962690 DOI: 10.3390/vaccines11020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Vaccines remain a fundamental intervention for preventing illness and death. In the United States, suboptimal vaccine uptake in adolescents and young adults has been observed for meningococcal conjugate (MenACWY) and serogroup B meningococcal (MenB) vaccines, particularly among marginalized communities, despite current recommendations by the Advisory Committee on Immunization Practices. A systematic literature search was conducted in the MEDLINE and MEDLINE In-Process, Embase, Cochrane, PsychInfo, and CINAHL databases to identify both drivers of, and barriers to, MenACWY and MenB vaccine uptake in adolescents and young adults. A total of 34 of 46 eligible studies that presented outcomes stratified by race/ethnicity, geography, and socioeconomic status were selected for review. Results showed MenACWY and MenB vaccination coverage in adolescents and young adults is impacted by racial/ethnic, socioeconomic, and geographic disparities. Gaps also exist in insurance for, or access to, these vaccines in adolescents and young adults. Moreover, there was variability in the understanding and implementation of the shared decision-making recommendations for the MenB vaccine. Disease awareness campaigns, increased clarity in accessing all meningococcal vaccines, and further research on the relationships between measures of marginalization and its impact on vaccine coverage in adolescents and young adults are needed to reduce the incidence of severe infections.
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Affiliation(s)
- Catherine Masaquel
- RTI Health Solutions, 3005 Boardwalk Dr # 105, Ann Arbor, MI 48108, USA
- Correspondence: ; Tel.: +1-917-327-3884
| | | | - Kelly Wright
- RTI Health Solutions, 3005 Boardwalk Dr # 105, Ann Arbor, MI 48108, USA
| | | | | | | | - Dial Hewlett
- Medical Westchester County Department of Health, 134 Court St, White Plains, New York, NY 10601, USA
- Infectious Disease Consultant Calvary Hospital Bronx, New York, NY 10461, USA
- Microbiology & Immunology New York Medical College, New York, NY 10595, USA
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18
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Penick E, Grabert BK, Stockton E, Prentice-Dunn H, Ward M, Kirk T, Gilkey MB. Feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing for active-duty Soldiers. Hum Vaccin Immunother 2022; 18:2153536. [PMID: 36539433 PMCID: PMC9891672 DOI: 10.1080/21645515.2022.2153536] [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] [Indexed: 12/24/2022] Open
Abstract
To increase Soldiers' access to HPV vaccination, we evaluated the feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing procedures for Soldiers. We partnered with nursing staff to introduce HPV vaccine into existing vaccination services at a nurse-led clinic that serves Soldiers at Fort Bragg, North Carolina. In addition to stocking the vaccine, the intervention included training nursing staff (n = 11) strategies for recommending HPV vaccination for Soldiers ages 18-26. We conducted surveys of nursing staff to assess their perspectives on feasibility. Nursing staff tracked HPV vaccine uptake among Soldiers for 4 weeks post-training to assess adoption and again for 2 weeks at 4-month follow-up to assess sustainability. We assessed delivery cost as the cost of personnel time, vaccine doses, and other materials during the initial 4-week intervention period. Nursing staff agreed that recommending HPV vaccination fit in with medical processing procedures (mean = 4.6 of 5.0). Of the 516 Soldiers offered HPV vaccine in the 4 weeks following the training, 198 (38%) accepted and received the vaccine. Soldier ages 18-20 more often accepted HPV vaccination than older Soldier ages 21-26 (46% versus 32%, p < .01). Vaccine uptake was similar at follow-up, with 98 of 230 eligible Soldiers (43%) receiving HPV vaccine. The total delivery cost was $12,737, with an average cost per vaccine dose delivered of $64. Our findings suggest that training nursing staff to recommend and administer HPV vaccinations to Soldiers is feasible and warrants wider-scale testing as a strategy to protect soldiers from HPV-attributable cancers.
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Affiliation(s)
- Emily Penick
- Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC, USA,CONTACT Emily Penick Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC28310, USA
| | - Brigid K. Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA,Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emma Stockton
- Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah Prentice-Dunn
- Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marion Ward
- Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Trinita Kirk
- Medical One Stop, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Melissa B. Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA,Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Richman AR, Torres E, Wu Q, Eldridge D, Lawson L. The Evaluation of a Digital Health Intervention to Improve Human Papillomavirus Vaccine Recommendation Practices of Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022:10.1007/s13187-022-02250-z. [PMID: 36526919 DOI: 10.1007/s13187-022-02250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
We investigated what is being taught about HPV in US medical schools and evaluated a digital health intervention for medical students to increase their intention to provide a high-quality HPV vaccine recommendation. An online survey was emailed to Academic Deans at the 124 accredited US Schools of Medicine and Osteopathic Medicine between February and April 2018. A digital educational module was emailed to medical students in June 2020. A single-subject longitudinal study design was employed. Pre- post-survey administration measured change in knowledge, attitudes, subjective norms, perceived behavioral control, and intention to recommend HPV vaccine. Gaps in medical school curricula were found. Very few schools (~ 9%) reported teaching content on HPV prevention strategies or patient education. For the digital intervention, independent and dependent variables increased positively. Perceived behavioral control improved at significant levels as participants felt more confident addressing parents' concerns about the vaccine (p < 0.001) and more confident recommending the vaccine for patients (p < 0.05) post module. On the pre-survey, only 6% of the sample knew the most effective HPV vaccine communication style and on the post-survey 81% correctly identified it (p < 0.001). The intervention increased HPV and HPV vaccine knowledge, self-efficacy, and intention to provide a high-quality HPV vaccine recommendation to patients.
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Affiliation(s)
- Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 300 Curry Court, Carol Belk Building, Greenville, NC, 27858, USA.
| | - Essie Torres
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 300 Curry Court, Carol Belk Building, Greenville, NC, 27858, USA
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, 2150 West 5th Street, Greenville, NC, 27858, USA
| | - David Eldridge
- Department of Pediatrics, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Luan Lawson
- Department of Emergency Medicine, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
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Taddio A, McMurtry CM, Logeman C, Gudzak V, de Boer A, Constantin K, Lee S, Moline R, Uleryk E, Chera T, MacDonald NE, Pham B. Prevalence of pain and fear as barriers to vaccination in children - Systematic review and meta-analysis. Vaccine 2022; 40:7526-7537. [PMID: 36283899 DOI: 10.1016/j.vaccine.2022.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Injection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injection pain or fear of needles as barriers to childhood (i.e., 0-18 years) vaccination. METHODS Four databases were searched from inception for relevant English and French articles until August 2021. In addition, the references of recent systematic reviews and all articles included in the review were hand searched. Article screening and data extractions were performed in duplicate. Studies were included if they reported on injection-related pain or fear of needles in children (0-18 years) using a checklist/closed-ended question(s). Results were stratified by respondent (parents or children), type of pediatric population (general or under-vaccinated), and relative importance of barrier (pain or needle fear as primary reason or any reason for under-vaccination). Prevalence rates of pain or needle fear were combined using a random effects model. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence data. Quality across studies was assessed using GRADE. RESULTS There were 26 studies with 45 prevalence estimates published between 1995 and 2021. For parent reports (of children) and children self-reported reasons for non-compliance, prevalence rates of pain or needle fear ranged from 5 to 13% in a general population and 8 to 28% in an under-vaccinated population, with a substantial variation in the prevalence estimates. There was no difference between category of respondent or relative importance on pain or needle fear prevalence rate. A regression model demonstrated an overall prevalence rate of pain or needle fear as an obstacle to vaccination of 8% in the general population and 18.3% in the under-vaccinated population. All evidence was very low in quality. CONCLUSION This is the first review to systematically quantify the prevalence and therefore, importance, of pain and needle fear as obstacles to vaccination in children around the world. Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention. Addressing pain and fear has the potential to significantly improve vaccination acceptance.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, and Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids), Toronto, Canada.
| | | | | | - Victoria Gudzak
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Adrian de Boer
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Soeun Lee
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Rachel Moline
- Department of Psychology, University of Guelph, Guelph, Canada
| | | | | | | | - Ba' Pham
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
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21
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Ghiani M, Hagemann C, Friedrich J, Maywald U, Wilke T, von Eiff C, Malerczyk C. Can risk area designation help increase vaccination coverage for Tick-Borne Encephalitis? Evidence from German claims data. Vaccine 2022; 40:7335-7342. [PMID: 36347722 DOI: 10.1016/j.vaccine.2022.10.075] [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: 07/15/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Although vaccine preventable, the incidence of tick-borne encephalitis (TBE) increased in Germany from 2001 to 2021 by on average 2% each year, with a peak of more than 700 TBE infections documented in 2020. TBE-risk areas, as designated by district based on incidence of human cases, expanded north- and northeastward, present in 11 of the 16 Federal States as of 2022. Using claims data from a German statutory health insurance in the Federal States of Saxony and Thuringia (AOK PLUS), we aimed to assess whether official assignment of a district to a risk area had an impact on vaccination rates in Germany. METHODS The data covered the period from 01/01/2010 to 31/12/2018 and included information on vaccine administrations from outpatient physicians. Yearly incident vaccination rates were reported overall and by district. To investigate the association between a new designation of an incident TBE-risk area and vaccination rates, a difference-in-difference analysis was conducted. RESULTS Overall, the incident vaccination rates increased from 6.2 to 9.5 per 1,000 person-years between 2012 and 2018, with a peak of 12.2 in 2015. While districts that had been risk-areas for the whole study period had always a higher vaccination rate compared to districts that were never categorized as risk areas, the increase between 2012 and 2018 was comparable in the two groups (3.0 and 3.2 per 1,000 person-years, respectively). In contrast, districts that were newly designated risk districts during the study period experienced a significantly larger increase in vaccination rates, going from 5.8 to 14.7 per 1,000 person-years between 2012 and 2018, with a peak of 19.6 in 2015. CONCLUSION The results suggest that the new designation of a district as risk area has a significant positive impact on vaccination rates, which is strongest immediately after designation of risk area.
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Affiliation(s)
- M Ghiani
- IPAM e.V, Alter Holzhafen 19, 23966 Wismar, Germany.
| | - C Hagemann
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | - J Friedrich
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | | | - T Wilke
- Ingress-Health HWM GmbH, Wismar, Germany
| | - C von Eiff
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | - C Malerczyk
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
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22
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A Protocol of a Pilot Experimental Study Using Social Network Interventions to Examine the Social Contagion of Attitudes Towards Childhood Vaccination in Parental Social Networks. HEALTH PSYCHOLOGY BULLETIN 2022. [DOI: 10.5334/hpb.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Williamson LD, Tarfa A. Examining the relationships between trust in providers and information, mistrust, and COVID-19 vaccine concerns, necessity, and intentions. BMC Public Health 2022; 22:2033. [PMCID: PMC9639262 DOI: 10.1186/s12889-022-14399-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
To facilitate maximum uptake of the COVID-19 vaccine, the roles of medical trust and mistrust of healthcare professionals must be examined. Previous work suggests that trust and mistrust may have differential impacts on vaccination intention via vaccine necessity and concerns. Multigroup structural equation modeling was utilized to test whether vaccine necessity and concerns mediated the associations between trust in providers and health information, mistrust of providers, and willingness to get the COVID-19 vaccine. The model was found to be invariant across Black and White respondents. Trust in providers and trust in healthcare information exerted indirect effects on intentions through vaccine necessity, while mistrust of providers exerted indirect effects through vaccine concerns. Unlike previous work, the forms of trust did not influence vaccine concerns. The findings have implications for future communication efforts from healthcare professionals and health messengers.
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Affiliation(s)
- Lillie D. Williamson
- grid.14003.360000 0001 2167 3675Department of Communication Arts, University of Wisconsin-Madison, 6050 Vilas Hall, 821 University Ave, Madison, WI 53706 USA
| | - Adati Tarfa
- grid.14003.360000 0001 2167 3675School of Pharmacy, University of Wisconsin-Madison, Madison, WI USA
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24
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Askarian M, Fu LY, Taghrir MH, Borazjani R, Shayan Z, Taherifard E, Taherifard E, Akbarialiabad H, Longtin Y, Askarian A, Kavousi S. COVID-19 Vaccination Acceptance in Iran, a Nationwide Survey on Factors Associated with the Willingness toward Getting Vaccinated. Int J Prev Med 2022; 13:130. [PMID: 36452471 PMCID: PMC9704476 DOI: 10.4103/ijpvm.ijpvm_261_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/28/2021] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In the name of extensive vaccine uptake, understanding the public's attitude, perception, and intent toward COVID-19 vaccination is a significant challenge for public health officials. METHODS A cross-sectional survey via an online questionnaire rooted in the Health Belief Model and Integrated Behavioral Model was conducted to evaluate COVID-19 vaccination intent and its associated factors. Factor analysis and multivariate logistic regression were operated to be satisfactory. RESULTS Among the 4,933 respondents, 24.7% were health care workers, and 64.2% intended to accept COVID-19 vaccination. The adjusted odds (aOR) of COVID-19 vaccination intent was higher for individuals with greater exposure to social norms supportive of COVID-19 vaccination (aOR = 3.07, 95% Confidence Interval (CI) = 2.71, 3.47) and higher perceived benefits of COVID-19 vaccination (aOR = 2.9, 95% CI = 2.49, 3.38). The adjusted odds of vaccination intent were lower for individuals with greater COVID-19 vaccine safety concerns (aOR = 0.28, 95%CI = 0.25, 0.31). Lower vaccination intent was also associated with increasing age ((aOR = 0.99, 95% CI = 0.98, 0.999), female sex (aOR = 0.76, 95% CI = 0.65, 0.88), and working in the health care field (aOR = 0.75, 95% CI = 0.63, 0.9). CONCLUSIONS The odds of COVID-19 vaccination intent were higher three or more times among those with a greater belief in vaccine effectiveness, lower concerns about vaccine safety, and greater exposure to cues to vaccinate, including from doctors. This last finding is concerning as vaccine acceptance was surprisingly lower among health care workers compared to others. The remarkable results of factor analysis and reliability of the questionnaire may encourage local health authorities to apply it to their regional population.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, School of Medicine, Shiraz, Iran
- Health Behavior Science Research Center, Shiraz, Iran
| | - Linda Y. Fu
- General and Community Pediatrics, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - Mohammad Hossein Taghrir
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences and Health Services, Shiraz, Iran
| | - Roham Borazjani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Biostatistics, School of Medicine, Shiraz, Iran
| | - Ehsan Taherifard
- Medical Student, School of Medicine, Shiraz University of Medical Sciences and Health Services, Shiraz, Iran
| | - Erfan Taherifard
- Medical Student, School of Medicine, Shiraz University of Medical Sciences and Health Services, Shiraz, Iran
| | - Hossein Akbarialiabad
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences and Health Services, Shiraz, Iran
| | - Yves Longtin
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Ardalan Askarian
- Student, College of Arts & Science, University of Saskatchewan, Saskatoon, Canada
| | - Shahin Kavousi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences and Health Services, Shiraz, Iran
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25
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Bester JC. A Clinician's Obligation to be Vaccinated: Four Arguments that Establish a Duty for Healthcare Professionals to be Vaccinated Against COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:451-465. [PMID: 35362931 PMCID: PMC8972764 DOI: 10.1007/s11673-022-10182-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 05/14/2023]
Abstract
This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are:(1) The obligation to protect patients against COVID-19 spread;(2) The obligation to maintain professional competence and remain available for patients;(3) Clinicians' role and place in society in relation to COVID-19;(4) The obligation to encourage societal vaccination uptake.These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional's ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians.
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Affiliation(s)
- Johan Christiaan Bester
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas 2040 W Charleston Blvd, Las Vegas, NV, 89102, USA.
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26
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Understanding parental vaccine refusal: Implicit and explicit associations about vaccines as potential building blocks of vaccine beliefs and behavior. Soc Sci Med 2022; 310:115275. [PMID: 36037608 PMCID: PMC9374490 DOI: 10.1016/j.socscimed.2022.115275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/29/2022] [Accepted: 08/06/2022] [Indexed: 11/22/2022]
Abstract
Objective A movement of parents refusing vaccines for their children has contributed to increasingly large outbreaks of diseases that are preventable by vaccines. Research has identified multiple factors that relate to parents' vaccination behaviors (i.e., whether not they vaccinate their children), including their beliefs about vaccines' safety and utility and their trust in those who recommend vaccines. Here we examine the role of more fundamental psychological processes that may contribute to multiple vaccine-related beliefs and behaviors: cognitive associations. Methods Using a large sample of U.S. parents (pre-COVID-19), we investigated parents' associations between vaccines and helpfulness/harmfulness, as well as between the self and vaccines (vaccine identity), and their relation to parents' beliefs about vaccine safety and utility, trust in authorities' vaccine recommendations, and prior vaccination refusal for their children. To capture a more complete understanding of people's associations, we examined both explicit associations (measured via self-report) and implicit associations (measured by the Implicit Association Test). Results Both implicit and explicit associations correlated with beliefs, trust, and vaccination refusal. Results from structural equation models indicated that explicit vaccine-identity and vaccine-helpfulness associations and implicit vaccine helpfulness associations were indirectly related to vaccination refusal via their relation with vaccine beliefs. Conclusions Collectively, study findings suggest that vaccine associations—especially those related to helpfulness/harmfulness—may serve as psychological building blocks for parental vaccine beliefs and behaviors.
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27
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Richman AR, Torres E, Wu Q, Eldridge D, Lawson L. HPV vaccine recommendation practices of current and future physicians in North Carolina: an exploratory study. HEALTH EDUCATION RESEARCH 2022; 37:213-226. [PMID: 35788319 DOI: 10.1093/her/cyac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
We assessed human papillomavirus (HPV) prevention practices and HPV literacy of pediatricians, family physicians and medical students in North Carolina. An online survey was distributed to physicians in 2018, and paper surveys were collected among medical students in 2019. Surveys measured HPV literacy, HPV prevention practices and HPV prevention self-efficacy. In terms of comfort, 27% of medical students and 24% of physicians anticipated having an uncomfortable conversion when recommending the vaccine to patients. Most physicians (76%, n = 230) followed the HPV vaccine age recommendation guidelines; however, those with higher HPV vaccine knowledge were more compliant with the guidelines (P < 0.01). Female physicians were more likely to start routinely recommending the HPV vaccine to women (84%, n = 134 versus 72%, n = 92) and men (81%, n = 127 versus 71%, n = 84) between the ages of 9 and 12 years (P < 0.05). Only 27%, n = 73 of physicians and 18%, n = 19 of medical students followed/knew the 'provider-driven' HPV-recommended style. Female physicians were more likely to use this communication style (32%, n = 48 versus 20%, n = 23, P = 0.03). HPV prevention curriculum should be incorporated into medical programs. The gender-related practice patterns found indicate a need for training of male providers specifically. Quality improvement efforts are needed for all physicians to strengthen vaccine communication, recommendation practices and guideline adherence.
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Affiliation(s)
- Alice R Richman
- Department of Health Education and Promotion, East Carolina University, College of Health and Human Performance, 238 Rivers West, Greenville, NC 27858, USA
| | - Essie Torres
- Department of Health Education and Promotion, East Carolina University, College of Health and Human Performance, 238 Rivers West, Greenville, NC 27858, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, College of Allied Health Sciences, 2150 West 5th Street, Greenville, NC 27858, USA
| | - David Eldridge
- Department of Pediatrics, East Carolina University, Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27858, USA
| | - Luan Lawson
- Department of Emergency Medicine, East Carolina University, Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27858, USA
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28
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Hecht ML, BeLue R, Ray A, Hopfer S, Miller-Day M, Mckee F. HPV Vaccine Intent among Adult Women Receiving Care at Community Health Centers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1186-1193. [PMID: 33400206 DOI: 10.1007/s13187-020-01937-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Human papillomavirus (HPV) is a disease that exacts substantial costs in human life and public health expenditures. Fortunately, a vaccine exists that can mitigate these costs. This study reports the development and evaluation of the intervention designed to overcome these barriers by using culturally grounded narratives to promote HPV vaccination. Women's Stories (WS) targets women over the age of 18 and was originally successfully validated for use among college students resulting in NCI recognition. WS was adapted for touch pad delivery in Planned Parenthood clinics where a randomized clinical trial was conducted in 8 clinics in 3 cities. Two hundred seventeen women were randomly assigned to treatment and control, completing pretest and posttest surveys. This study examined data from the immediate posttest. An intent to treat analysis was conducted using a generalized linear mixed modeling approach using a multinomial link and accounting for repeated measures by site. Results demonstrate significant short-term effects on vaccine intentions and vaccine self-efficacy. When compared to control group participants, women in the treatment condition more likely to intend to get the shot today/the day of interview (p < 0.01), as well as in 1 (p < 0.01) and 6 (p < 0.01) months and had greater self-efficacy to receive the HPV vaccination (B = 0.54; p = 0.0002). These results are promising for the potential impact of the intervention in clinical settings as well as providing a model for overcoming lack of awareness and vaccine resistance in other segments of the population.
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Affiliation(s)
- M L Hecht
- REAL Prevention LLC, Clifton, NJ, USA
| | - R BeLue
- Health Management and Policy, Saint Louis University, St Louis, MO, USA.
| | - A Ray
- Public Health, University of Kentucky, Lexington, KY, USA
| | - S Hopfer
- Public Health, UC Irvine, Irvine, CA, USA
| | - M Miller-Day
- Communication Studies, Chapman University, Orange, CA, USA
| | - F Mckee
- St. Andrew Development, Inc., Philadelphia, PA, USA
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29
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Sobierajski T, Bulińska-Stangrecka H, Wanke-Rytt M, Stefanoff P, Augustynowicz E. Behavioural and Cognitive Attitudes of Paediatricians towards Influenza Self-Vaccination-Partial Mediation Model. Vaccines (Basel) 2022; 10:vaccines10081206. [PMID: 36016094 PMCID: PMC9416341 DOI: 10.3390/vaccines10081206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: This study aims to analyse the attitudinal components influencing paediatricians’ self-vaccination. (2) Methods: The national-cross survey was conducted among paediatricians involved in childhood vaccination within the immunisation program. (3) Results: A hypothetical model indicating the influence of cognitive and behavioural factors on influenza vaccination among paediatricians was verified based on a survey of Polish paediatricians. A simple mediation model, based on Triandis’ Theory of Interpersonal Behaviour, reflects a relationship in which knowledge and beliefs about outcomes contribute to whether paediatricians vaccinate against influenza. (4) Conclusions: The presented research shows that the pro-vaccination behaviours of paediatricians are not only influenced by cognitive factors but also the behavioural components of attitudes, which are equally important. The conclusions point to the pivotal role of shaping both knowledge and understanding of the effectiveness of immunisation programmes in building the pro-vaccination attitudes of paediatricians. (5) Practical Implications: This is the first representative study of Polish paediatricians to demonstrate how their attitudes and behaviour are related to self-vaccination. Its conclusions allow policymakers to develop programmes to support effective measures against the spread of infectious diseases through the self-vaccination of medical professionals.
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Affiliation(s)
- Tomasz Sobierajski
- Faculty of Applied Social Sciences and Resocialization, University of Warsaw, Krakowskie Przedmieście 26/28, 00-927 Warsaw, Poland
- Correspondence: ; Tel.: +48-503-456-234
| | - Helena Bulińska-Stangrecka
- Faculty of Administration and Social Sciences, Warsaw University of Technology, Plac Politechniki Street 1, 00-661 Warsaw, Poland;
| | - Monika Wanke-Rytt
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland;
| | - Paweł Stefanoff
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway;
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health-National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland;
| | - Ewa Augustynowicz
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health-National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland;
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30
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Abuduxike G, Asut O, Cali S, Vaizoglu S. Knowledge and Awareness of Parents Towards Human Papillomavirus (HPV) and HPV Vaccines, and Vaccine Acceptability in Northern Cyprus. JOURNAL OF PREVENTION (2022) 2022; 43:225-240. [PMID: 35286543 DOI: 10.1007/s10935-021-00657-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
The human papillomavirus (HPV) vaccine is one of the most cost-effective public health measures for preventing cervical cancer and other HPV-related diseases. However, the vaccine uptake in many countries remains suboptimal. This cross-sectional study aimed to assess the knowledge and awareness of parents towards HPV, related diseases, and HPV vaccines, as well as to examine the effect of brief educational information on parents' vaccine acceptability. We used a structured interviewer-administered questionnaire to collect information from 227 outpatient visitors to a healthcare center who had children under the age of 19 years. We asked parents again about their acceptance of HPV vaccines after being provided brief educational information. Of all the parents, 43% were aware of HPV and related diseases, and 59% of those had sufficient knowledge regarding HPV while 45% of them reported that they were aware of HPV vaccines. Being Northern Cypriot was a predictor of having good knowledge, whilst being a female, having a higher education level, being 35 years or older, and being employed were the significant predictors of having greater awareness of HPV and related diseases. The HPV vaccine acceptance of the parents increased substantially in all sociodemographic groups after the provision of the educational information. The findings demonstrated that the vaccination rates of children of parents who have insufficient knowledge and awareness of HPV and vaccines are also very low. Effective educational interventions based on the specific sociodemographic characteristics of the patients should be given a stronger focus to improve vaccine acceptability among this population.
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Affiliation(s)
- Gulifeiya Abuduxike
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus.
| | - Ozen Asut
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus
| | - Sanda Cali
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus
| | - Songul Vaizoglu
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus
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31
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Phan TLT, Enlow PT, Wong MK, Lewis AM, Kazak AE, Miller JM. Medical factors associated with caregiver intention to vaccinate their children against COVID-19. Vaccine X 2022; 10:100144. [PMID: 35128377 PMCID: PMC8802490 DOI: 10.1016/j.jvacx.2022.100144] [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: 08/30/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe medical factors that are associated with caregiver intention to vaccinate their children against COVID-19. METHODS We conducted a cross-sectional study of families receiving primary care in a mid-Atlantic pediatric healthcare system, linking caregiver-reported data from a survey completed March 19 to April 16, 2021 to comprehensive data from the child's EHR. RESULTS 513 families were included (28% Black, 16% Hispanic, 44% public insurance, 21% rural, child age range 0-21 years). 44% of caregivers intended to vaccinate their children against COVID-19, while 41% were not sure and 15% would not. After adjusting for socio-demographics, the only medical factors that were associated with caregiver COVID-19 vaccine hesitancy were caregiver COVID-19 vaccination status at the time of the survey (aOR 3.0 if the caregiver did not receive the vaccine compared to those who did, 95% CI 1.7-5.3) and child seasonal influenza immunization history (aOR 3.3 if the child had not received the influenza vaccine in the 2020-2021 season compared to those who did, 95% CI 2.0-5.4). Other medical factors, including family medical experiences with COVID-19, other child immunization history, child health conditions like obesity and asthma, and family engagement with the healthcare system were not associated with caregiver intention to vaccinate their children against COVID-19. CONCLUSIONS This study highlights important factors, such as general attitudes towards vaccines and understanding of COVID-19 morbidity risk factors, that healthcare providers should address when having conversations with families about the COVID-19 vaccine.
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Affiliation(s)
- Thao-Ly T Phan
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Paul T Enlow
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Michael K Wong
- Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Amanda M Lewis
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Anne E Kazak
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Jonathan M Miller
- Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA.,Nemours Value-Based Services Organization, 1600 Rockland Rd, Wilmington, DE 19803, USA
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32
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Kuru O, Chan MPS, Lu H, Stecula DA, Jamieson KH, Albarracín D. Religious affiliation and philosophical and moral beliefs about vaccines: A longitudinal study. J Health Psychol 2022; 27:3059-3081. [PMID: 35289216 PMCID: PMC9580036 DOI: 10.1177/13591053221082770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
How do religious affiliation and beliefs shape vaccine attitudes and behaviors? This study examined the associations of attitudes and behaviors relevant to the flu, measles-mumps-rubella (MMR), and human-papillomavirus (HPV) vaccines with religious affiliations, as well as philosophical, spiritual, and moral beliefs. Respondents were 3005 adults from a probability-based, four-wave panel survey in the United States. Longitudinal structural equation modeling examined how religious affiliations and philosophical/moral beliefs shaped attitudes toward vaccines and actual vaccination. Stronger philosophical beliefs predicted more negative attitudes toward each vaccine and stronger moral beliefs more negative attitudes toward the HPV vaccine. Negative vaccine attitudes then predicted weaker intentions to encourage others to vaccinate and lower probability of receiving a vaccine. Theoretical and public health messaging implications are discussed.
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Affiliation(s)
- Ozan Kuru
- National University of Singapore, Singapore
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Suess C, Maddock J, Dogru T, Mody M, Lee S. Using the Health Belief Model to examine travelers' willingness to vaccinate and support for vaccination requirements prior to travel. TOURISM MANAGEMENT 2022; 88:104405. [PMID: 34456412 PMCID: PMC8380459 DOI: 10.1016/j.tourman.2021.104405] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/08/2021] [Accepted: 07/26/2021] [Indexed: 05/08/2023]
Abstract
Data from a survey of 1478 travelers and multistep group structural equation model analysis revealed that the Health Belief Model constructs of cues to action (trust in third-party information sources), perceived severity of and susceptibility to COVID-19, and beliefs about the protection benefits of a COVID-19 vaccine, subsequently elicited willingness to vaccinate and beliefs that others should vaccinate prior to travel and enhanced support for pre-travel vaccination mandates. Also, significant differences in the perceived protection benefits of the vaccine and willingness to vaccinate were found across groups of travelers who travel more or less frequently and those with and without a prior positive test for COVID-19. The study provides a theoretically informed understanding of the dynamics that may enable the success of important health-related travel policy in the wake of COVID-19 and future pandemics and identifies the communication mechanisms that must be leveraged by governments and travel authorities in enforcing policy.
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Affiliation(s)
- Courtney Suess
- Department of Park, Recreation and Tourism Sciences, Texas A & M University, College Station, TX, 77840, USA
- Cornell Institute for Healthy Futures, Cornell University, Ithaca, NY, 14853 USA
| | - Jason Maddock
- School of Public Health, Texas A & M University, College Station, TX, 77840, USA
| | - Tarik Dogru
- Dedman School of Hospitality, Florida State University, Tallahassee, FL, 32306, USA
| | - Makarand Mody
- School of Hospitality Administration, Boston University, Boston, MA, 02215, USA
| | - Seunghoon Lee
- Department of Park, Recreation and Tourism Sciences, Texas A & M University, College Station, TX, 77840, USA
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Cole JW, M.H. Chen A, McGuire K, Berman S, Gardner J, Teegala Y. Motivational interviewing and vaccine acceptance in children: The MOTIVE study. Vaccine 2022; 40:1846-1854. [DOI: 10.1016/j.vaccine.2022.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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Devchand R, Koehler L, Hook S, Marx GE, Hooks H, Schwartz A, Hinckley A. Understanding consumer and clinician perceptions of a potential Lyme disease vaccine. HEALTH EDUCATION RESEARCH 2022; 36:494-504. [PMID: 34529775 PMCID: PMC10911045 DOI: 10.1093/her/cyab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
Each year, over 450 000 Lyme disease diagnoses are estimated to occur in the United States, and current preventive measures have been insufficient to stem the rising incidence. An effective human Lyme disease vaccine could be a powerful intervention for population-level impact. In advance of new Lyme disease vaccines coming to market, this study explored barriers to acceptability and motivations for the uptake of a new Lyme disease vaccine. Researchers conducted 9 online focus groups among consumers who may potentially benefit from the vaccine and 30 in-depth interviews among clinician groups who may provide the vaccine. All participants were recruited from three US regions of high Lyme disease incidence. Researchers found that participants shared common motivators to either recommend (clinicians) or accept (consumers) a Lyme disease vaccine, largely driven by perceived benefits of the vaccine, the lack of current effective preventive measures and a greater peace of mind. The concern about the challenges associated with diagnosing and treating Lyme disease is a primary motivator for clinicians to recommend the vaccine, while the concern about getting Lyme disease is a primary motivator for consumers to desire the vaccine.
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Affiliation(s)
| | - Laura Koehler
- Hager Sharp, 1030 15th Street NW, Washington, DC 20005, USA
| | - Sarah Hook
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Grace E. Marx
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Holley Hooks
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Amy Schwartz
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Alison Hinckley
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
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ÖZNUR MUZ FN, ÖNSÜZ MF, METİNTAS S, ARSLANTAS D, ÜNSAL A, OKTAR D, YÜCEL E, TEPETAŞ M. Assesment of Physicians’ Attitudes Towards COVID-19 Vaccine. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1005495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The aim of this study is to physicians attitudes towards the COVID-19 vaccine.
Methods: Our research is a cross-sectional study, which was conducted between January 4th and February 26th, 2021. A Google Forms questionnaire was prepared according to the literature. The first part of the two-part questionnaire included the sociodemographic characteristics of the physicians and some variables thought to be related to COVID-19. In the second part, questions from the “Attitudes Towards COVID-19 Vaccine Scale (ATCVS)” were included. Multiple linear regression analysis with variables that were significant in univariate analysis was used for further analysis.
Results: Three hundred fifteen (71.9%) of a total of 438 participants stated that they were assigned to units related to COVID-19 during the pandemic. With more than 10 years of work in the profession, physicians had a more positive attitude towards vaccination than those with 1 – 5 years’ experience. Most of the physicians reported that there were insufficient studies on these newly developed vaccines. Possible adverse effects, uncertainty about the efficacy and safety of the vaccine, and beliefs that people are not at risk for severe disease were prominent.
Conclusions: Despite all the uncertainties about the efficacy, safety, and long-term adverse effects of newly developed COVID vaccines, it was determined that 79% of the physicians approached the vaccine positively. The most important reason for vaccine hesitation was the insufficient studies about COVID-19 vaccines.
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Grabert BK, Kurtzman R, Heisler-MacKinnon J, Leeman J, Bjork A, Kameny M, Liu A, Todd K, Alton Dailey S, Smith K, Brewer NT, Gilkey MB. Implementation of quality improvement coaching versus physician communication training for improving human papillomavirus vaccination in primary care: a randomized implementation trial. Transl Behav Med 2022; 12:ibab071. [PMID: 34244807 PMCID: PMC8919808 DOI: 10.1093/tbm/ibab071] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Many US health departments (HDs) conduct in-person quality improvement (QI) coaching to help primary care clinics improve their HPV vaccine delivery systems and communication. Some HDs additionally conduct remote communication training to help vaccine prescribers recommend HPV vaccination more effectively. Our aim was to compare QI coaching and communication training on key implementation outcomes. In a cluster randomized trial, we offered 855 primary care clinics: 1) QI coaching; 2) communication training; or 3) both interventions combined. In each trial arm, we assessed adoption (proportion of clinics receiving the intervention), contacts per clinic (mean number of contacts needed for one clinic to adopt intervention), reach (median number of participants per clinic), and delivery cost (mean cost per clinic) from the HD perspective. More clinics adopted QI coaching than communication training or the combined intervention (63% vs 16% and 12%, both p < .05). QI coaching required fewer contacts per clinic than communication training or the combined intervention (mean = 4.7 vs 29.0 and 40.4, both p < .05). Communication training and the combined intervention reached more total staff per clinic than QI coaching (median= 5 and 5 vs 2, both p < .05), including more prescribers (2 and 2 vs 0, both p < .05). QI coaching cost $439 per adopting clinic on average, including follow up ($129/clinic), preparation ($73/clinic), and travel ($69/clinic). Communication training cost $1,287 per adopting clinic, with most cost incurred from recruitment ($653/clinic). QI coaching was lower cost and had higher adoption, but communication training achieved higher reach, including to influential vaccine prescribers.
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Affiliation(s)
- Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Kurtzman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Heisler-MacKinnon
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam Bjork
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- United States Public Health Service, Commissioned Corps, Rockville, MD, USA
| | - Maddy Kameny
- Delaware Valley Community Health, Philadelphia, PA, USA
| | - Amy Liu
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, USA
| | - Karen Todd
- WakeMed Health and Hospitals, WakeMed Physician Practices, Raleigh, NC, USA
| | - Susan Alton Dailey
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Smith
- Immunization Action & Lead Poisoning Prevention Programs, Westchester County Department of Health, Mt Kisco, NY, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hook SA, Hansen AP, Niesobecki SA, Meek JI, Bjork JKH, Kough EM, Peterson MS, Schiffman EK, Rutz HJ, Rowe AJ, White JL, Peel JL, Biggerstaff BJ, Hinckley AF. Evaluating public acceptability of a potential Lyme disease vaccine using a population-based, cross-sectional survey in high incidence areas of the United States. Vaccine 2021; 40:298-305. [PMID: 34895785 DOI: 10.1016/j.vaccine.2021.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lyme disease incidence is increasing, despite current prevention options. New Lyme disease vaccine candidates are in development, however, investigation of the acceptability of a Lyme disease vaccine among potential consumers is needed prior to any vaccine coming to market. We conducted a population-based, cross-sectional study to estimate willingness to receive a potential Lyme disease vaccine and factors associated with willingness. METHODS The web-based survey was administered to a random sample of Connecticut, Maryland, Minnesota, and New York residents June-July 2018. Survey-weighted descriptive statistics were conducted to estimate the proportion willing to receive a potential Lyme disease vaccine. Multivariable multinomial logistic regression models were used to quantify the association of sociodemographic characteristics and Lyme disease vaccine attitudes with willingness to be vaccinated. RESULTS Surveys were completed by 3313 respondents (6% response rate). We estimated that 64% of residents were willing to receive a Lyme disease vaccine, while 30% were uncertain and 7% were unwilling. Compared to those who were willing, those who were uncertain were more likely to be parents, adults 45-65 years old, non-White, have less than a bachelor's degree, or have safety concerns about a potential Lyme disease vaccine. Those who were unwilling were also more likely to be non-White, have less than a bachelor's degree, or have safety concerns about a potential Lyme disease vaccine. In addition, the unwilling had low confidence in vaccines in general, had low perceived risk of contracting Lyme disease, and said they would not be influenced by a positive recommendation from a healthcare provider. DISCUSSION Overall, willingness to receive a Lyme disease vaccine was high. Effective communication by clinicians regarding safety and other vaccine parameters to those groups who are uncertain will be critical for increasing vaccine uptake and reducing Lyme disease incidence.
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Affiliation(s)
- Sarah A Hook
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
| | - AmberJean P Hansen
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - Sara A Niesobecki
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - James I Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - Jenna K H Bjork
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | - Erin M Kough
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | - Molly S Peterson
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | | | - Heather J Rutz
- Maryland Department of Health, 201 W. Preston Street, 3rd Floor, Baltimore, MD 21201, USA.
| | - Adam J Rowe
- New York State Department of Health, Empire Plaza, Corning Tower, State St, Albany, NY 12203, USA.
| | - Jennifer L White
- New York State Department of Health, Empire Plaza, Corning Tower, State St, Albany, NY 12203, USA.
| | - Jennifer L Peel
- Colorado State University, Environmental Health Building, 350 W. Lake St., Fort Collins, CO 80523, USA.
| | - Brad J Biggerstaff
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
| | - Alison F Hinckley
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
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Li H, Zhang H, Jiang H. Combining power of different methods to detect associations in large data sets. Brief Bioinform 2021; 23:6447432. [PMID: 34864853 DOI: 10.1093/bib/bbab488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/08/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Exploring the relationship between factors of interest is a fundamental step for further analysis on various scientific problems such as understanding the genetic mechanism underlying specific disease, brain functional connectivity analysis. There are many methods proposed for association analysis and each has its own advantages, but none of them is suitable for all kinds of situations. This brings difficulties and confusions to practitioner on which one to use when facing a real problem. In this paper, we propose to combine power of different methods to detect associations in large data sets. It goes as combining the weaker to be stronger. Numerical results from simulation study and real data applications show that our new framework is powerful. Importantly, the framework can also be applied to other problems. Availability: The R script is available at https://jiangdata.github.io/resources/DM.zip.
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Affiliation(s)
- He Li
- Polytechnic Institute of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Hangxiao Zhang
- Basic Forestry and Proteomics Research Center, College of Forestry, Fujian Provincial Key Laboratory of Haixia Applied Plant Systems Biology, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Hangjin Jiang
- Center for Data Science, Zhejiang University, Hangzhou, China
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Huynh HP, Zsila Á, Martinez-Berman L. Psychosocial Predictors of Intention to Vaccinate Against the Coronavirus (COVID-19). Behav Med 2021; 49:115-129. [PMID: 34702134 DOI: 10.1080/08964289.2021.1990006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The COVID-19 pandemic has wreaked havoc across the world. Public health efforts to combat the disease and return life to normalcy largely rests upon COVID-19 vaccination distribution and uptake. Thus, it is critical to examine factors that predict people's intentions to vaccinate. This study explored predictors of intention to vaccinate against COVID-19 among demographic and personal factors, health behaviors and beliefs, COVID-19-specific beliefs, and trust in physicians, using a sample of U.S. adults. We employed bivariate correlations and hierarchical regression to analyze the data. We found that the strongest predictors are political orientation, trust in physicians, subjective norms, and prior flu shot uptake. These associations suggest that individuals who held more liberal political views, expressed higher levels of trust in their primary care provider, perceived stronger social pressure to vaccinate against COVID-19, and received a flu shot during the previous flu season, had a stronger intention to vaccinate against COVID-19. Based on our results, we suggest that public health efforts to increase vaccination uptake for COVID-19 vaccines focus on addressing political orientation (conservatism), involve primary care providers, emphasize vaccination as the norm (and not the exception), and use information about previous flu vaccinations to target vaccination campaigns.
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Affiliation(s)
- Ho Phi Huynh
- Life Sciences, Texas A&M University - San Antonio, San Antonio, TX, USA
| | - Ágnes Zsila
- Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary
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Tharmaraj D, Dendle C, Polkinghorne KR, Mulley WR. Kidney transplant recipients' attitudes toward COVID-19 vaccination and barriers and enablers to vaccine acceptance. Transpl Infect Dis 2021; 24:e13749. [PMID: 34694682 PMCID: PMC8646313 DOI: 10.1111/tid.13749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To identify barriers and enablers to COVID-19 vaccination in renal transplant recipients who are undecided about vaccination. METHODS An online survey was distributed to 876 adult kidney transplant recipients at a tertiary referral service, who had not been vaccinated against COVID-19. The survey assessed willingness to be vaccinated, attitudes toward COVID-19 vaccines, and barriers and enablers to proceeding with vaccination. RESULTS The survey response rate was 54% (473/876). Three hundred and forty-six (73.1%) participants planned to receive vaccination (yes group), 105 (22.2%) were undecided, and 22 (4.7%) refused vaccination. The undecided group were younger but were not different in other demographic characteristics to the yes group. The undecided group were less positive toward (34.29% vs. 91.3%, p < .001) and more concerned about (93.3% vs. 25.1%, p < .001) vaccination than the yes group. Their concerns related to vaccine safety (including harm to their transplant), poor efficacy, and a lack of rigorous testing in transplant recipients. Undecided recipients had received less vaccine-specific information from medical specialists than the yes group. Most undecided participants (95.1%) were willing to proceed with vaccination with appropriate supports. The most desired supports were information and a recommendation to proceed with vaccination from their treating transplant specialist and team. CONCLUSION(S) Concerns about vaccine safety (including harm to transplant), poor vaccine efficacy, and lack of rigorous testing were barriers to vaccine uptake. Most undecided recipients would proceed with vaccination with specific recommendations and vaccine information provided by their transplant specialist/team. These simple interventions can be readily implemented to optimize vaccine uptake.
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Affiliation(s)
- Dhakshayini Tharmaraj
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Claire Dendle
- Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - William R Mulley
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
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Wick JA, Henneman A. Pharmacy student perceptions of their preparedness to address vaccine hesitancy and refusal. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1324-1331. [PMID: 34521527 DOI: 10.1016/j.cptl.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/15/2021] [Accepted: 07/15/2021] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Vaccine hesitancy/refusal is a growing issue worldwide. Pharmacists are well suited to address vaccine hesitancy; however, the extent to which they feel trained to do so may vary. The objective of this study was to determine pharmacy student confidence in addressing vaccine hesitancy/refusal. METHODS Students in their penultimate didactic and experiential years at United States schools of pharmacy were invited to participate in a 30-item electronic survey concerning perceptions of preparedness to address vaccine hesitancy/refusal. The primary outcome was pharmacy students' perception of their ability to address vaccine hesitancy/refusal. Secondary outcomes included student confidence in their knowledge of and ability to speak to vaccine controversies and support for pharmacist/patient vaccine responsibilities. Outcomes were addressed using five-point Likert-type items. Median values and interquartile ranges were reported, with chi-square analysis accounting for possible heterogeneity between groups. RESULTS A total of 1433 students (estimated response rate = 20%) completed the survey. Respondents indicated confidence in their preparedness to address patient immunization concerns, hesitancy, and refusal with a median score of 4 (scale of 5, with 1 = the least confident and 5 = the most confident). Secondary outcome analysis revealed varying degrees of confidence regarding specific vaccine hesitancy controversies. CONCLUSIONS Pharmacy students were confident in their ability to address vaccine hesitancy/refusal. Students held beliefs of responsibility for limiting non-vaccination, but felt less confident in addressing concerns regarding specific vaccine components and immune system overload.
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Affiliation(s)
- Jennifer A Wick
- Clinical Pharmacy Specialist, Primary Care, The Christ Hospital, 2123 Auburn Ave., Ste 520, Cincinnati, OH 45219, United States
| | - Amy Henneman
- Associate Professor of Pharmacy Practice, Belmont University, 1900 Belmont Blvd., Nashville, TN 37212, 615-460-8129, United States.
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Adeyanju GC, Engel E, Koch L, Ranzinger T, Shahid IBM, Head MG, Eitze S, Betsch C. Determinants of influenza vaccine hesitancy among pregnant women in Europe: a systematic review. Eur J Med Res 2021; 26:116. [PMID: 34583779 PMCID: PMC8477621 DOI: 10.1186/s40001-021-00584-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pregnant women are at high risk for severe influenza. However, maternal influenza vaccination uptake in most World Health Organization (WHO) European Region countries remains low, despite the presence of widespread national recommendations. An influenza vaccination reduces influenza-associated morbidity and mortality in pregnancy, as well as providing newborns with protection in their first months. Potential determinants of vaccine hesitancy need to be identified to develop strategies that can increase vaccine acceptance and uptake among pregnant women. The primary objective of the systematic review is to identify the individual determinants of influenza vaccine hesitancy among pregnant women in Europe, and how to overcome the hesitancy. METHODS Databases were searched for peer-reviewed qualitative and quantitative studies published between 2009 and 2019 inclusive. Databases included PubMed via MEDLINE, Cochrane Central Register for Controlled Trials, PsycINFO, SAGE Journals, Taylor and Francis and Springer nature. These covered themes including psychology, medicine, and public health. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, 11 studies were eligible and analyzed for significant determinants of influenza vaccine hesitancy among pregnant women in Europe. RESULTS The most commonly reported factors were psychological aspects, for example concerns about safety and risks to mother and child, or general low risk perception of becoming ill from influenza. Doubts about the effectiveness of the vaccine and a lack of knowledge about this topic were further factors. There was also influence of contextual factors, such as healthcare workers not providing adequate knowledge about the influenza vaccine or the pregnant lady stating their antivaccine sentiment. CONCLUSION Health promotion that specifically increases knowledge among pregnant women about influenza and vaccination is important, supporting a valid risk judgment by the pregnant lady. The development of new information strategies for dialogue between healthcare providers and pregnant women should form part of this strategy.
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Affiliation(s)
- Gbadebo Collins Adeyanju
- Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of Erfurt, Erfurt, Germany.
- Media and Communication Science, University of Erfurt, Erfurt, Germany.
| | - Elena Engel
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Laura Koch
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Tabea Ranzinger
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | | | - Micheal G Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sarah Eitze
- Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Cornelia Betsch
- Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
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Berenson AB, Hirth JM, Chang M, Kuo YF, Richard P, Jones DL. A brief educational intervention can improve nursing students' knowledge of the human papillomavirus vaccine and readiness to counsel. Hum Vaccin Immunother 2021; 17:1952-1960. [PMID: 33517843 DOI: 10.1080/21645515.2020.1852871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Provider recommendation is a primary reason for patient uptake of the human papillomavirus (HPV) vaccine. Most provider-focused educational interventions are focused on physicians, even though nurses are also important sources of vaccine-related information for their patients. This study examined whether a HPV educational intervention could improve nursing students' HPV knowledge, beliefs, and comfort with counseling. The same lecture on HPV and HPV vaccination was given to both medical and nursing students. To determine the effects of the lecture, students were asked to complete identical pre- and post-lecture tests with questions on demographics, knowledge, attitudes, and comfort with counseling on the HPV vaccine. Pre- and post-lecture test scores were compared between nursing and medical students to assess whether there were differences in pre-lecture test scores and/or changes in post-lecture test scores. On the pre-lecture tests, fewer nursing students responded correctly to knowledge questions, indicated positive attitudes or comfort with counseling about the HPV vaccine compared to medical students. However, similar frequencies of nursing and medical students responded correctly to knowledge questions and indicated a positive attitude, as well as a high comfort level with counseling on the post-lecture tests. Study results show that integrating lectures in a nursing program curriculum could be a feasible way to increase students' HPV knowledge. Having health-care providers with similar levels of knowledge, attitudes, and comfort with counseling on HPV vaccination is ideal, as all share the responsibility of recommending the vaccine to patients.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Patricia Richard
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Deborah L Jones
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
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Oh NL, Biddell CB, Rhodes BE, Brewer NT. Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Prev Med 2021; 148:106554. [PMID: 33857561 DOI: 10.1016/j.ypmed.2021.106554] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3-24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.
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Affiliation(s)
- N Loren Oh
- University of North Carolina School of Medicine, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Blythe E Rhodes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America.
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Tsai Y, Lindley MC, Zhou F, Stokley S. Urban-Rural Disparities in Vaccination Service Use Among Low-Income Adolescents. J Adolesc Health 2021; 69:114-120. [PMID: 33288460 PMCID: PMC8175462 DOI: 10.1016/j.jadohealth.2020.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To access urban-rural disparities in vaccination service use among Medicaid-enrolled adolescents and examine its association with residence county characteristics. STUDY DESIGN We used the 2016 Medicaid T-MSIS Analytic File to estimate adolescents' use of vaccination services, defined as the proportion of adolescents aged 11-18 years with ≥ 1 vaccination visit in a county. We used linear regression and the Oaxaca-Blinder decomposition method to examine the association between county characteristics and urban-rural disparities in vaccination service use. RESULTS The analysis included 2,473 counties located in 38 states. The mean proportion of adolescents making ≥ 1 vaccination visit at the county level was low (36.09%) and was lower in rural than in urban counties (31.99% vs. 36.85%, p < .01). The number of primary care physicians (PCPs) was positively associated with vaccination service use in rural counties; in urban counties, % of households without a vehicle was negatively associated with vaccination service use. The decomposition results showed that 66.78% (3.24 percentage points) of the urban-rural disparities in vaccination service use could be attributed to urban-rural differences in the county characteristics included in the study. Characteristics measuring access to care (number of PCPs), social and economic factors (% adults with at least a bachelor's degree and % children in poverty), quality of care (influenza vaccination rates and preventable hospital stays), and demographics (% non-Hispanic black, % Hispanic, and % females) played a role in urban-rural disparities. CONCLUSIONS Differences in county characteristics could partly explain the observed urban-rural disparities in vaccination service use among low-income adolescents.
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Affiliation(s)
- Yuping Tsai
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Lin C, Mullen J, Smith D, Kotarba M, Kaplan SJ, Tu P. Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review. Vaccines (Basel) 2021; 9:vaccines9070713. [PMID: 34358132 PMCID: PMC8310254 DOI: 10.3390/vaccines9070713] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Jewel Mullen
- Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Danielle Smith
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Michaela Kotarba
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Samantha J. Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC 27710, USA;
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
- Correspondence:
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Plutzer E, Warner SB. A potential new front in health communication to encourage vaccination: Health education teachers. Vaccine 2021; 39:4671-4677. [PMID: 34215451 DOI: 10.1016/j.vaccine.2021.06.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the potential for a new channel for effective vaccine health communication in the United States: the nation's health education teachers. METHODS Content analysis of current curricular standards governing health education in the fifty states and the District of Columbia, and a 2019 nationally representative survey of middle and high school health education teachers in the United States. RESULTS Only 12 states require any discussion of vaccines or immunization, and none provide detailed guidance to teachers on critical knowledge that might help young adults make wise immunization decisions. Only 42% of teachers discuss benefits of vaccination and immunization in their classes. In contrast to the teaching of evolution and climate change, only a small minority (2.4%) are classified as vaccine skeptics. CONCLUSIONS Public school health education classes are an under-utilized health communication channel with the unrealized potential to convey medically accurate information to millions of young Americans. Low levels of vaccine skepticism among teachers suggest that this channel can be effectively utilized to improve vaccination uptake and thereby improve collective health outcomes.
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Affiliation(s)
- Eric Plutzer
- Penn State University, University Park, PA 16802, United States.
| | - Seth B Warner
- Penn State University, University Park, PA 16802, United States.
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Kidney Transplant Recipient Attitudes Toward a SARS-CoV-2 Vaccine. Transplant Direct 2021; 7:e713. [PMID: 34131585 PMCID: PMC8196090 DOI: 10.1097/txd.0000000000001171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022] Open
Abstract
A widely accepted severe acute respiratory syndrome 2 (SARS-CoV-2) vaccine could protect vulnerable populations, but the willingness of solid organ transplant recipients (SOTRs) to accept a potential vaccine remains unknown. Methods We conducted a national survey of 1308 SOTRs and 1617 non-SOTRs between November 11 and December 2, 2020 through the network of the National Kidney Foundation. Results Respondents were largely White (73.2%), female (61.1%), and college graduates (56.2%). Among SOTRs, half (49.5%) were unsure or would be unwilling to receive a SARS-CoV-2 vaccine once available. Major concerns included potential side effects (85.2%), lack of rigor in the testing and development process (69.7%), and fear of incompatibility with organ transplants (75.4%). Even after the announcement of the high efficacy of the mRNA-1273 vaccine (Moderna Inc.) at the time of survey distribution, likeliness to receive a vaccine only slightly increased (53.5% before announcement versus 57.8% after the announcement). However, 86.8% of SOTRs would accept a vaccine if recommended by a transplant provider. Conclusions SOTRs reported skepticism in receiving a potential SARS-CoV-2 vaccine, even after announcements of high vaccine efficacy. Reassuringly, transplant providers may be the defining influence in vaccine acceptance and will likely have a critical role to play in promoting vaccine adherence.
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Berenson AB, Chang M, Hirth JM, Kanukurthy M. Intent to get vaccinated against COVID-19 among reproductive-aged women in Texas. Hum Vaccin Immunother 2021; 17:2914-2918. [PMID: 34081572 DOI: 10.1080/21645515.2021.1918994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Data are needed on the acceptability of Covid-19 vaccination among young, low-income, diverse populations. To assess this, we surveyed 18-45-year-old women on their intent to be vaccinated, experiences with Covid-19, and uptake of other vaccines. Among the 342 who completed the survey, only one-third were likely to accept the Covid-19 vaccine as soon as it was available. Less than half would accept it even if recommended by their doctor. Most (69%) wanted more information on its safety and 48% wanted proof it works. Likelihood of accepting the vaccine with a doctor's recommendation was associated with fear of catching Covid-19 and exposure to social media as well as HPV and annual flu vaccination. This demonstrates it will be necessary to help vaccine-hesitant individuals overcome their concerns to reach herd immunity in the US. Physician recommendation and social media may play important roles.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Manasa Kanukurthy
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
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