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Newman PA, Dinh DA, Massaquoi N, Williams CC, Lacombe-Duncan A, Tepjan S, Nyoni T. "Going vaccine hunting": Multilevel influences on COVID-19 vaccination among racialized sexual and gender minority adults-a qualitative study. Hum Vaccin Immunother 2024; 20:2301189. [PMID: 38346919 PMCID: PMC10863362 DOI: 10.1080/21645515.2023.2301189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
High levels of COVID-19 vaccine hesitancy have been reported among Black and Latinx populations, with lower vaccination coverage among racialized versus White sexual and gender minorities. We examined multilevel contexts that influence COVID-19 vaccine uptake, barriers to vaccination, and vaccine hesitancy among predominantly racialized sexual and gender minority individuals. Semi-structured online interviews explored perspectives and experiences around COVID-19 vaccination. Interviews were recorded, transcribed, uploaded into ATLAS.ti, and reviewed using thematic analysis. Among 40 participants (mean age, 29.0 years [SD, 9.6]), all identified as sexual and/or gender minority, 82.5% of whom were racialized. COVID-19 vaccination experiences were dominated by structural barriers: systemic racism, transphobia and homophobia in healthcare and government/public health institutions; limited availability of vaccination/appointments in vulnerable neighborhoods; absence of culturally-tailored and multi-language information; lack of digital/internet access; and prohibitive indirect costs of vaccination. Vaccine hesitancy reflected in uncertainties about a novel vaccine amid conflicting information and institutional mistrust was integrally linked to structural factors. Findings suggest that the uncritical application of "vaccine hesitancy" to unilaterally explain undervaccination among marginalized populations risks conflating structural and institutional barriers with individual-level psychological factors, in effect placing the onus on those most disenfranchised to overcome societal and institutional processes of marginalization. Rather, disaggregating structural determinants of vaccination availability, access, and institutional stigma and mistrust from individual attitudes and decision-making that reflect vaccine hesitancy, may support 1) evidence-informed interventions to mitigate structural barriers in access to vaccination, and 2) culturally-informed approaches to address decisional ambivalence in the context of structural homophobia, transphobia, and racism.
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Affiliation(s)
- Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Duy Anh Dinh
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Notisha Massaquoi
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto, Scarborough, Ontario, Canada
| | - Charmaine C. Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Thabani Nyoni
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- School of Social Work, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
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Leigland A, Arnold T, Giorlando KK, Barnett AP, Sims-Gomillia CE, Bertone Z, Edet PP, Whiteley L, Brown LK. A qualitative study evaluating COVID-19 vaccine hesitancy among individuals living in Mississippi. SSM Qual Res Health 2024; 5:100377. [PMID: 38605935 PMCID: PMC11005795 DOI: 10.1016/j.ssmqr.2023.100377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Background COVID-19 vaccination rates are lower in the Southern United States compared to other regions. This study investigated COVID-19 vaccination hesitancy in Mississippi (MS) to identify preferences that may boost MS vaccination strategies in areas with poor vaccine uptake. Methods Qualitative interviews were completed between April 2021 and January 2022 with staff and patients at four Federally Qualified Health Centers in MS. Interviews included the following COVID-19 vaccine topics: willingness to be vaccinated, barriers and facilitators, and methods for providing vaccine information. Data were organized with NVivo software and analyzed using reflexive thematic analysis. Results Fifteen clinic staff and 49 patients were interviewed. Barriers to vaccine uptake included a lack of knowledge and understanding of how the vaccine worked, distrust of the government, fear of side effects, and social pressure to stay unvaccinated. Vaccination facilitators included its widespread accessibility, a desire to protect themselves and vulnerable populations, and a previous unpleasant COVID-19 illness experience. Participants stated that vaccine information should be provided by health organizations and familiar, respected community members. Conclusions Results identified barriers to vaccination, such as mistrust of the government and healthcare system, and facilitators like vaccination advocacy originating from congregations and religious leaders. These findings can inform future COVID-19 vaccination efforts to increase overall immunization rates in MS. Future research in other locations could further assess commonalities and differences in the barriers and facilitators to vaccination.
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Affiliation(s)
- Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA
| | - Trisha Arnold
- Department of Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Kayla K. Giorlando
- Department of Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA
| | - Andrew P. Barnett
- Department of Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Courtney E. Sims-Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Zoe Bertone
- Department of Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA
| | - Precious Patrick Edet
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Larry K. Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Turner S, Kranzler EC, Trigger S, Kearsley A, Luchman JN, Williams CJ, Denison B, Dahlen H, Kim JEC, Bennett M, Nighbor T, Beleche T, Hoffman L, Peck J. Benefit-Cost Analysis of the HHS COVID-19 Campaign: April 2021-March 2022. Am J Prev Med 2024:S0749-3797(24)00110-7. [PMID: 38713123 DOI: 10.1016/j.amepre.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION This study estimated the benefits and costs of the U.S. Department of Health and Human Services' We Can Do This COVID-19 public education campaign (the Campaign) and associated vaccination-related impacts. METHODS Weekly media market and national Campaign expenditures were used to estimate weekly first-dose vaccinations that would not have occurred absent the Campaign, weekly Campaign-attributed complete vaccinations, and corresponding COVID-19 cases, hospitalizations, and deaths averted. Benefits were valued using estimated morbidity and mortality reductions and associated values of a statistical life and a statistical case. Costs were estimated using Campaign paid media expenditures and corresponding vaccination costs. The net Campaign and vaccination benefit and return on investment were calculated. Analyses were conducted from 2022 to 2024. RESULTS Between April 2021 and March 2022, an estimated 55.9 million doses of COVID-19 vaccines would not have been administered absent the Campaign. Campaign-attributed vaccinations resulted in 2,576,133 fewer mild COVID-19 cases, 243,979 fewer nonfatal COVID-19 hospitalizations, and 51,675 lives saved from COVID-19. The total Campaign benefit was $740.2 billion, and Campaign and vaccination costs totaled $8.3 billion, with net benefits of approximately $732.0 billion. For every $1 spent, the Campaign and corresponding vaccination costs resulted in benefits of approximately $89.54. CONCLUSIONS The We Can Do This COVID-19 public education campaign saved more than 50,000 lives and prevented hundreds of thousands of hospitalizations and millions of COVID-19 cases, representing hundreds of billions of dollars in benefits in less than one year. Findings suggest that public education campaigns are a cost-effective approach to reducing COVID-19 morbidity and mortality.
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Affiliation(s)
| | | | - Sarah Trigger
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia
| | - Aaron Kearsley
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia
| | | | | | | | | | | | - Morgane Bennett
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia
| | - Tyler Nighbor
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia
| | - Trinidad Beleche
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia
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Byerley CO, Horne D, Gong M, Musgrave S, Valaas LA, Rickard B, Yoon H, Park MS, Mirin A, Joshua S, Lavender H, You S. An effective COVID-19 vaccine hesitancy intervention focused on the relative risks of vaccination and infection. Sci Rep 2024; 14:7419. [PMID: 38548828 PMCID: PMC10978892 DOI: 10.1038/s41598-024-57841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/22/2024] [Indexed: 04/01/2024] Open
Abstract
We designed the Relative Risk Tool (RRT) to help people assess the relative risks associated with COVID-19 vaccination and infection. In May 2022 (N = 400) and November 2022 (N = 615), U.S. residents participated in a survey that included questions about the risks of vaccination and infection. In both cohorts, we found an association between relative risk perception and vaccine hesitancy. Participants in the May cohort were randomly assigned an intervention: to see information from the RRT or the Centers for Disease Control and Prevention (CDC). After the intervention, participants answered the same questions about risk perception and vaccination intent again. The RRT was more effective than the CDC at changing risk perception and increasing vaccination intent. In November, the survey structure was the same, but the RRT was the only intervention included, and we confirmed that the RRT was effective at changing opinions in this new sample. Importantly, the RRT provided accurate information about the risks of serious adverse outcomes to vaccination and still increased vaccination intent. Our work suggests that the RRT helps people assess relative risk, which can in turn help empower them to make informed decisions and ultimately reduce vaccine hesitancy.
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Affiliation(s)
- Cameron O'Neill Byerley
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA.
| | - Dru Horne
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA
| | - Mina Gong
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA
| | - Stacy Musgrave
- Department of Mathematics and Statistics, Cal Poly Pomona, Pomona, 91768, USA
| | - Laura A Valaas
- Department of Dermatology, University of Washington, Seattle, 98195, USA
| | - Brian Rickard
- Department of Mathematical Sciences, University of Arkansas, Fayetteville, 72701, USA
| | - Hyunkyoung Yoon
- Department of Mathematics and Statistics, Cal Poly Pomona, Pomona, 91768, USA
| | - Min Sook Park
- Department of Information Studies, University of Wisconsin-Milwaukee, Milwaukee, 53201, USA
| | - Alison Mirin
- Department of Mathematics, University of Arizona, Tucson, 85721, USA
| | | | - Heather Lavender
- Department of Mathematics, Science, and Social Studies Education, University of Georgia, Athens, 30606, USA
| | - Sukjin You
- Department of Information Studies, University of Wisconsin-Milwaukee, Milwaukee, 53201, USA
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Kranzler EC, Luchman JN, Margolis KA, Ihongbe TO, Kim JEC, Denison B, Vuong V, Hoffman B, Dahlen H, Yu K, Dupervil D, Hoffman L. Association between vaccination beliefs and COVID-19 vaccine uptake in a longitudinal panel survey of adults in the United States, 2021-2022. Vaccine X 2024; 17:100458. [PMID: 38405368 PMCID: PMC10884512 DOI: 10.1016/j.jvacx.2024.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024] Open
Abstract
COVID-19 vaccine hesitancy has been a major limiting factor to the widespread uptake of COVID-19 vaccination in the United States. A range of interventions, including mass media campaigns, have been implemented to encourage COVID-19 vaccine confidence and uptake. Such interventions are often guided by theories of behavior change, which posit that behavioral factors, including beliefs, influence behaviors such as vaccination. Although previous studies have examined relationships between vaccination beliefs and COVID-19 vaccination behavior, they come with limitations, such as the use of cross-sectional study designs and, for longitudinal studies, few survey waves. To account for these limitations, we examined associations between vaccination beliefs and COVID-19 vaccine uptake using data from six waves of a nationally representative, longitudinal survey of U.S. adults (N = 3,524) administered over a nearly 2-year period (January 2021-November 2022). Survey-weighted lagged logistic regression models were used to examine the association between lagged reports of vaccination belief change and COVID-19 vaccine uptake, using five belief scales: (1) importance of COVID-19 vaccines, (2) perceived benefits of COVID-19 vaccination, (3) COVID-19 vaccine concerns and risks, (4) normative beliefs about COVID-19 vaccination, and (5) perceptions of general vaccine safety and effectiveness. Analyses controlled for confounding factors and accounted for within-respondent dependence due to repeated measures. In individual models, all vaccination belief scales were significantly associated with increased COVID-19 vaccine uptake. In a combined model, all belief scales except the benefits of COVID-19 vaccination were significant predictors of vaccine uptake. Overall, belief scales indicating the importance of COVID-19 vaccines and normative beliefs about COVID-19 vaccination were the strongest predictors of COVID-19 vaccine uptake. Findings demonstrate that changes in vaccination beliefs influence subsequent COVID-19 vaccine uptake, with implications for the development of future interventions to increase COVID-19 vaccination.
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Affiliation(s)
| | | | - Katherine A. Margolis
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, United States
| | | | | | | | | | | | | | - Kathleen Yu
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, United States
| | - Daphney Dupervil
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, United States
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Ben-Umeh KC, Kim J. Income disparities in COVID-19 vaccine and booster uptake in the United States: An analysis of cross-sectional data from the Medical Expenditure Panel Survey. PLoS One 2024; 19:e0298825. [PMID: 38377073 PMCID: PMC10878507 DOI: 10.1371/journal.pone.0298825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
COVID-19 vaccination has significantly decreased morbidity, hospitalizations, and death during the pandemic. However, disparities in vaccination uptake threatens to stymie the progress made in safeguarding the health of Americans. Using a nationally representative adult (≥18 years old) sample from the 2021 Medical Expenditure Panel Survey (MEPS), we aimed to explore disparities in COVID-19 vaccine and booster uptake by income levels. To reflect the nature of the survey, a weighted logistic regression analysis was used to explore factors associated with COVID-19 vaccine and booster uptake. A total of 241,645,704 (unweighted n = 21,554) adults were included in the analysis. Average (SD) age of the population was 49 (18) years old, and 51% were female. There were disparities in COVID-19 vaccine and booster uptake by income groups. All other income groups were less likely to receive COVID-19 vaccines and booster shot than those in the high-income group. Those in the poor income group had 55% lower odds of being vaccinated for COVID-19 (aOR = 0.45, p<0.01). Considering the female population only, women with lower incomes may have greater disparities in access to COVID-19 vaccines than do males with lower incomes. Disparities in COVID-19 vaccination by income may have even greater implications as the updated vaccines are rolled out in the US without the government covering the cost as before.
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Affiliation(s)
- Kenechukwu C. Ben-Umeh
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, United States of America
| | - Jaewhan Kim
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, United States of America
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Wong E, Liu Y, Shier V, Datar A. Heterogeneity in COVID-19 vaccine uptake within low-income minority communities: evidence from the watts neighborhood health study. BMC Public Health 2024; 24:503. [PMID: 38365658 PMCID: PMC10873997 DOI: 10.1186/s12889-024-17968-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The literature on disparities in COVID-19 vaccine uptake focuses primarily on the differences between White versus non-White individuals or differences by socioeconomic status. Much less is known about disparities in vaccine uptake within low-income, minority communities and its correlates. METHODS This study investigates disparities in COVID-19 vaccination uptake within racial and ethnic minoritized communities with similar socioeconomic backgrounds and built environments, specifically focusing on Black-Hispanic disparities and disparities within the Hispanic community by country of origin. Data are analyzed from the fourth wave (June 2021- May 2022) of the Watts Neighborhood Health Study, a cohort study of public housing residents in south Los Angeles, CA. Linear probability models estimated the association between vaccine uptake and participants' race/ethnicity, sequentially adding controls for sociodemographic characteristics, health care access and insurance, prior infection, and attitudes towards COVID-19 vaccines. Differences in reasons for vaccination status by race/ethnicity were also tested. RESULTS Mexican Hispanic and non-Mexican Hispanic participants were 31% points (95% CI: 0.21, 0.41, p < 0.001) and 44% points (95% CI: 0.32, 0.56, p < 0.001) more likely to be vaccinated than non-Hispanic Black participants, respectively. The disparity between Black and Hispanic participants was reduced by about 40% after controlling for attitudes towards COVID-19 vaccines. Among Hispanic participants, non-Mexican participants were 13% points (95% CI: 0.03, 0.24, p = 0.01) more likely to be vaccinated than Mexican participants, however, these differences were no longer significant after controlling for individual and household characteristics (β = 0.04, 95% CI: -0.07, 0.15, p = 0.44). CONCLUSION There are sizeable racial and ethnic COVID-19 vaccination disparities even within low-income and minoritized communities. Accounting for this heterogeneity and its correlates can be critically important for public health efforts to ensure vaccine equity.
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Affiliation(s)
- Elizabeth Wong
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, VPD, Los Angeles, CA, 90089, USA
| | - Ying Liu
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, VPD, Los Angeles, CA, 90089, USA
| | - Victoria Shier
- Sol Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, VPD, Los Angeles, CA, 90089, USA
| | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, VPD, Los Angeles, CA, 90089, USA.
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Smith JD, Li DH, Merle JL, Keiser B, Mustanski B, Benbow ND. Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations. Implement Sci 2024; 19:10. [PMID: 38331832 PMCID: PMC10854146 DOI: 10.1186/s13012-024-01345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Implementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient's health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term-adjunctive interventions-to classify change methods that are distinct from the common intervention/strategy taxonomy. MAIN TEXT Adjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients' motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention ("the thing"), as an adjunctive intervention, or an implementation strategy in different studies-further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients' attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients' utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided. CONCLUSION Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Dennis H Li
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brennan Keiser
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Third Coast Center for AIDS Research, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nanette D Benbow
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Liu J, Kassas B, Lai J, Kropp J, Gao Z. Understanding the role of risk preferences and perceptions in vaccination decisions and post-vaccination behaviors among U.S. households. Sci Rep 2024; 14:3190. [PMID: 38326338 PMCID: PMC10850518 DOI: 10.1038/s41598-024-52408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
COVID-19 vaccines play a critical role in protecting against infection and transmission of the virus. Therefore, understanding public perceptions of COVID-19 vaccines is essential for successful vaccine promotion. Previous literature reported strong associations between vaccination decisions and several sociodemographic variables. However, knowledge about how behavioral factors, including risk perceptions and preferences, impact individuals' attitudes towards receiving COVID-19 vaccination is currently lacking. Using data from a nationally representative survey of 1050 US adults, this study investigates the correlation between individuals' decisions to receive COVID-19 vaccination and both their risk perceptions and preferences. Additionally, we investigate post-vaccination behavior by measuring individuals' participation in three different groups of activities that vary by their degree of social exposure. We find strong correlations between vaccination decisions and four measures of risk preference and risk perception. We also find associations between the four risk measures and individuals' behaviors post-vaccination. We shed light on the main factors discouraging the uptake of COVID-19 vaccines, as well as public opinions regarding the performance of different organizations in addressing the COVID-19 pandemic, and grocery store policies to prevent COVID-19 infections. Our study provides critical information that can help policymakers communicate more effectively with the public and promote vaccine uptake among population groups and geographic areas with higher anti-vaccine sentiments.
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Affiliation(s)
- Jianhui Liu
- Food and Resource Economics Department, Institute of Food and Agricultural Sciences, University of Florida, 2120 McCarty B, Gainesville, FL, 32611, USA
| | - Bachir Kassas
- Food and Resource Economics Department, Institute of Food and Agricultural Sciences, University of Florida, 1099 McCarty B, Gainesville, FL, 32611, USA.
| | - John Lai
- Food and Resource Economics Department, Institute of Food and Agricultural Sciences, University of Florida, 1109 McCarty B, Gainesville, FL, 32611, USA
| | - Jaclyn Kropp
- Food and Resource Economics Department, Institute of Food and Agricultural Sciences, University of Florida, 1157 McCarty B, Gainesville, FL, 32611, USA
| | - Zhifeng Gao
- Food and Resource Economics Department, Institute of Food and Agricultural Sciences, University of Florida, 1155 McCarty A, Gainesville, FL, 32611, USA
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Krasner H, Harmon N, Martin J, Olaco CA, Netski DM, Batra K. Community Level Correlates of COVID-19 Booster Vaccine Hesitancy in the United States: A Cross-Sectional Analysis. Vaccines (Basel) 2024; 12:167. [PMID: 38400150 PMCID: PMC10892894 DOI: 10.3390/vaccines12020167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Introduction: Evidence exists that individual-level sociodemographic factors contribute to vaccine hesitancy, but it is unknown how community-level factors affect COVID-19 booster dose hesitancy. The current study aims to fill this knowledge gap by comparing data from a nationwide survey on COVID-19 vaccine hesitancy with a community-level indicator, i.e., the Distressed Communities Index (DCI). Methods: Attitudes toward vaccinations, vaccine literacy, COVID-19 vaccine confidence index, and trust were measured using a 48-item, psychometrically valid and reliable survey tool. In this study, 2138 survey participants residing in the United States were divided into quintiles of varying community distress levels based on their zip codes using the DCI. Data were analyzed through Chi-square, one-way ANOVA, and post hoc analysis with Tukey's test. Results: A significantly higher proportion of participants from the distressed communities had lower trust than their prosperous counterparts (26.6% vs. 37.6%, p < 0.001). On the contrary, participants from the prosperous communities had significantly higher vaccine confidence index scores than those in distressed communities (2.22 ± 1.13 vs. 1.70 ± 1.01, p < 0.001). Conclusions: These findings affirm the importance of developing community-level interventions to promote trust in COVID-19 vaccinations and increase booster dose uptake. From these results, future studies can examine the efficacy of various community-level interventions.
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Affiliation(s)
- Henry Krasner
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA; (J.M.); (C.-A.O.)
| | - Nicolette Harmon
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
| | - Jeffrey Martin
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA; (J.M.); (C.-A.O.)
| | - Crysty-Ann Olaco
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA; (J.M.); (C.-A.O.)
| | - Dale M. Netski
- Office of Faculty Affairs, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA;
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
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Foster TB, Fernandez L, Porter SR, Pharris-Ciurej N. Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic. Demography 2024; 61:59-85. [PMID: 38197462 DOI: 10.1215/00703370-11133943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.
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12
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Irizar P, Pan D, Taylor H, Martin CA, Katikireddi SV, Kannangarage NW, Gomez S, La Parra Casado D, Srinivas PN, Diderichsen F, Baggaley RF, Nellums LB, Koller TS, Pareek M. Disproportionate infection, hospitalisation and death from COVID-19 in ethnic minority groups and Indigenous Peoples: an application of the Priority Public Health Conditions analytical framework. EClinicalMedicine 2024; 68:102360. [PMID: 38545088 PMCID: PMC10965404 DOI: 10.1016/j.eclinm.2023.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 04/21/2024] Open
Abstract
The COVID-19 pandemic has resulted in disproportionate consequences for ethnic minority groups and Indigenous Peoples. We present an application of the Priority Public Health Conditions (PPHC) framework from the World Health Organisation (WHO), to explicitly address COVID-19 and other respiratory viruses of pandemic potential. This application is supported by evidence that ethnic minority groups were more likely to be infected, implying differential exposure (PPHC level two), be more vulnerable to severe disease once infected (PPHC level three) and have poorer health outcomes following infection (PPHC level four). These inequities are driven by various interconnected dimensions of racism, that compounds with socioeconomic context and position (PPHC level one). We show that, for respiratory viruses, it is important to stratify levels of the PPHC framework by infection status and by societal, community, and individual factors to develop optimal interventions to reduce inequity from COVID-19 and future infectious diseases outbreaks.
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Affiliation(s)
- Patricia Irizar
- Faculty of Humanities, School of Social Sciences, University of Manchester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, UK
| | - Harry Taylor
- Department of Global Health and Social Medicine, King’s College London, UK
| | - Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
| | | | | | | | | | | | | | - Rebecca F. Baggaley
- Leicester NIHR Biomedical Research Centre, UK
- Development Centre for Population Health, University of Leicester, UK
- Department of Population Health Sciences, University of Leicester, UK
| | - Laura B. Nellums
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
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13
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Martin MA, Cook S, Spring B, Echeverria Garcia JC, Moskowitz D, Delaughter-Young J, Silva A, Hartstein M, De Pablo M, Peek M, Lynch E, Battalio S, Vu M. Delivering COVID-19 Vaccine via Trusted Social Services: Program Evaluation Results from the Chicagoland CEAL Program. J Community Health 2024; 49:61-69. [PMID: 37438456 PMCID: PMC10996394 DOI: 10.1007/s10900-023-01242-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/14/2023]
Abstract
To describe the reach, implementation, and sustainability of COVID-19 vaccination programs delivered by social service community organizations. Five academic institutions in the Chicagoland CEAL (Community Engagement Alliance) program partnered with 17 community organizations from September 2021-April 2022. Interviews, community organizations program implementation tracking documents, and health department vaccination data were used to conduct the evaluation. A total of 269 events were held and 5,432 COVID-19 vaccines delivered from May 2021-April 2022. Strategies that worked best included offering vaccinations in community settings with flexible and reliable hours; pairing vaccinations with ongoing social services; giving community organizations flexibility to adjust programs; offering incentives; and vaccinating staff first. These strategies and partnership structures supported vaccine uptake, community organization alignment with their missions and communities' needs, and trust. Community organizations delivering social services are local community experts and trusted messengers. Pairing social service delivery with COVID-19 vaccination built individual and community agency. Giving COs creative control over program implementation enhanced trust and vaccine delivery. When given appropriate resources and control, community organizations can quickly deliver urgently needed health services in a public health crisis.
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Affiliation(s)
| | - Sara Cook
- University of Illinois Chicago, Chicago, USA
| | | | | | | | | | | | | | | | | | | | | | - Milkie Vu
- Northwestern University, Chicago, USA
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14
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Binswanger IA, Narwaney KJ, Barrow JC, Albers KB, Bechtel L, Steiner CA, Ann Shoup J, Glanz JM. Association between severe acute respiratory syndrome coronavirus 2 antibody status and reinfection: A case-control study nested in a Colorado-based prospective cohort study. Prev Med Rep 2024; 37:102530. [PMID: 38205171 PMCID: PMC10776776 DOI: 10.1016/j.pmedr.2023.102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
The association between the presence of detectable antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 reinfection is not well established. The objective of this study was to determine the association between antibody seronegativity and reinfection. METHODS Participants in Colorado, USA, were recruited between June 15, 2020, and March 28, 2021, and encouraged to complete SARS-CoV-2 molecular ribonucleic acid (RNA) and serology testing for antibodies every 28 days for 10 months. Participants with reinfections (positive SARS-CoV-2 RNA test ≥ 90 days after the first positive RNA test) were matched to controls without reinfections by age, sex, date of the first positive RNA test, date of the last serology test, and serology test type. Using conditional logistic regression, case patients were compared to control patients on the last serologic test result, with adjustment for demographic and clinical confounders. RESULTS The cohort (n = 4,235) included 2,033 participants with ≥ 1 positive RNA test, of whom 120 had reinfection. Among the 80 case patients who could be matched, the last serologic test was negative in 12 of the cases (15.0 %) whereas the last serologic test was negative in 77 of 1,034 (7.5 %) controls. Seronegativity (adjusted OR [aOR] 2.24; 95 % CI 1.07, 4.68), Hispanic ethnicity (aOR 1.87; 95 % 1.10, 3.18), and larger household size (aOR 1.15; 95 % 1.01, 1.30 for each additional household member) were associated with reinfection. CONCLUSIONS Seronegative status, Hispanic ethnicity, and increasing household size were associated with reinfection. Serologic testing could be considered to reduce vaccine hesitancy in higher risk populations.
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Affiliation(s)
- Ingrid A. Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
- Colorado Permanente Medical Group, Denver, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, USA
- Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, USA
| | - Komal J. Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
| | | | | | - Laura Bechtel
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
- Siemens-Healthineers, USA
| | - Claudia A. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
- Colorado Permanente Medical Group, Denver, USA
- Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, USA
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, USA
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15
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Sulaiman SK, Musa MS, Tsiga-Ahmed FI, Sulaiman AK, Bako AT. A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV. Nat Hum Behav 2024; 8:100-114. [PMID: 37904021 PMCID: PMC10810755 DOI: 10.1038/s41562-023-01733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.
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Affiliation(s)
| | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Abdulwahab Kabir Sulaiman
- Department of Medicine, Murtala Muhammad Specialist Hospital, Kano, Nigeria
- Kwanar Dawaki COVID-19 Isolation Center, Kano, Nigeria
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16
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Luchman JN, Nighbor T, Kranzler EC, Denison B, Dahlen H, Kim JEC, Williams C, Trigger S, Bennett M, Hoffman L, Peck J. Association Between the United States Department of Health and Human Services' COVID-19 Public Education Campaign and Initial Adult COVID-19 Vaccination Uptake by Race and Ethnicity in the United States, 2020-2022. Health Promot Pract 2023:15248399231221159. [PMID: 38158812 DOI: 10.1177/15248399231221159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Non-Hispanic Black (Black) and Hispanic/Latino (Latino) populations face an increased risk of COVID-19 infection, hospitalization, and death from COVID-19 relative to non-Hispanic White (White) populations. When COVID-19 vaccines became available in December 2020, Black and Latino adults were less likely than White adults to get vaccinated due to factors such as racial discrimination and structural barriers to uptake. In April 2021, the U.S. HHS COVID-19 public education campaign (the Campaign) was launched to promote vaccination through general and audience-tailored messaging. As of March 2022, Black and Latino adults had reached parity with White adults in COVID-19 vaccine uptake. This study evaluated the relationship between Campaign exposure and subsequent vaccine uptake among Black, Latino, and White adults in the United States and assessed whether participant race/ethnicity moderated the relationship between Campaign exposure and vaccine uptake. Campaign media delivery data was merged with survey data collected from a sample of U.S. adults (n = 2,923) over four waves from January 2021 to March 2022. Logistic regression analysis showed that cumulative Campaign digital impressions had a positive, statistically significant association with COVID-19 vaccine uptake, and that participant race/ethnicity moderated this association. Compared with White adults, the magnitude of the relationship between cumulative impressions and vaccination was greater among Black and Latino adults. Results from a simulation model suggested that the Campaign may have been responsible for closing 5.0% of the gap in COVID-19 vaccination by race/ethnicity from April to mid-September 2021. We discuss implications for future public education campaigns that aim to reduce health disparities.
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Affiliation(s)
| | - Tyler Nighbor
- U.S. Department of Health and Human Services, Washington, DC, USA
| | | | | | | | | | | | - Sarah Trigger
- U.S. Department of Health and Human Services, Washington, DC, USA
| | - Morgane Bennett
- U.S. Department of Health and Human Services, Washington, DC, USA
| | | | - Joshua Peck
- U.S. Department of Health and Human Services, Washington, DC, USA
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17
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Munoz-Lavanderos C, Oluyomi A, Rosales O, Hernandez N, Mensah-Bonsu N, Badr H. Development, Implementation, and Evaluation of Three Outreach Events to Improve COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Communities in Houston, Texas, 2022. Public Health Rep 2023:333549231213848. [PMID: 38140821 DOI: 10.1177/00333549231213848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities. METHODS Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored to the needs of these communities in January-March 2022. We used program evaluation surveys to assess attendee characteristics and satisfaction with the events. Vaccinated attendees also completed surveys on what motivated them to get vaccinated. RESULTS Two communities were predominantly Hispanic, and the third had an equal number of Black and Hispanic residents. Based on community stakeholder input, the study team organized 2 health fairs and 1 community festival featuring dialogue-based COVID-19 vaccine engagement in January and March 2022. Across the 3 events, a total of 865 attendees received COVID-19 education and 205 (24.0%) attendees received a COVID-19 vaccine or booster. Of 90 attendees who completed program evaluation surveys, 81 (90%) rated the outreach event as good or excellent. Of 145 attendees who completed postvaccination surveys, 132 (91%) endorsed ≥1 key program feature as motivating them to either get vaccinated or vaccinate their child that day. CONCLUSION Community outreach events are important strategies for disseminating information, building trust, and facilitating COVID-19 vaccine uptake.
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Affiliation(s)
| | - Abiodun Oluyomi
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Omar Rosales
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Norvin Hernandez
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nana Mensah-Bonsu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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18
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Kondo A, Abuliezi R, Ota E, Oki T, Naruse K. Cross-sectional study of factors related to COVID-19 vaccination uptake among university healthcare students. Front Public Health 2023; 11:1325942. [PMID: 38155882 PMCID: PMC10752956 DOI: 10.3389/fpubh.2023.1325942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Healthcare students are more likely to become infected than other university students as they may encounter patients with COVID-19 during clinical training. Vaccination uptake is essential to prevent infection. This study explored factors related to COVID-19 vaccination uptake among healthcare students. Methods This cross-sectional study conducted online surveys of undergraduate and graduate nursing and healthcare graduate students from four medical universities in the Tokyo Metropolitan Area of Japan. Data were collected from June to August 2022, when the fourth vaccination program was initiated. Results Data from 1,169 students were analyzed (response rate = 37.3%). The mean age was 25.1 ± 7.6 years, and most were female (82.3%). Academic majors included nursing (68.0%), medicine (16.3%), dentistry (9.3%), and others (6.4%). Thirty students (2.6%) were not vaccinated, one student (0.1%) had received one vaccination, 997 (85.3%) had received three, and 27 (2.3%) had received four. The major reason for not being vaccinated was insufficient confirmation of its safety (n = 25). Students who had received at least one vaccination (n = 1,139), 965 (84.7%) reported experiencing adverse side effects, the most frequent being pain at the injection site (76.2%), followed by fever (68.3%). In the logistic regression, a greater number of vaccinations (3-4 times) was associated with older age (odds ratio, OR = 1.53), working (OR = 1.67), and more frequent infection-preventive behaviors (OR = 1.05). Significantly fewer students were vaccinated at University B than at University A (OR = 0.46). Additionally, those majoring in subjects other than nursing (OR = 0.28), and students from non-Asian countries (OR = 0.30) were less likely to be vaccinated. Discussion It is necessary to pay attention to and encourage the vaccination of students who engage in low levels of preventive behavior, students who are young, international, or unemployed, and those in non-healthcare professional majors.
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Affiliation(s)
- Akiko Kondo
- International Nursing Development, Graduate School of Healthcare Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Erika Ota
- Global Health Nursing, St. Lukes International University, Tokyo, Japan
- The Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Tomomi Oki
- School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Kazuko Naruse
- School of Nursing, Tokyo Medical University, Tokyo, Japan
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19
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Xu Q, McMann TJ, Li J, Wenzel C, Mackey TK. Characterization of COVID-19 vaccine clinical trial discussions on the social question-and-answer site Quora. Trials 2023; 24:790. [PMID: 38053216 DOI: 10.1186/s13063-023-07837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Throughout the COVID-19 pandemic, underserved populations, such as racial and ethnic minorities, were disproportionately impacted by illness, hospitalization, and death. Equity in clinical trials means that the participants in clinical trials represent the people who are most likely to have the health condition and need the treatment that the trial is testing. Infodemiology approaches examining user conversations on social media platforms have the potential to elucidate specific barriers and challenges related to clinical trial participation, including among racial and ethnic minority populations. MATERIALS AND METHODS The study retrospectively collected and analyzed user question and answer posts from Quora in October 2021 using an inductive content coding approach. We also examined user's publicly available profile metadata to identify racial and ethnic minority users to capture their experiences, attitudes, topics, and discussions of barriers to COVID-19 vaccine trials. RESULTS A total of 1073 questions and 7479 answers were collected. A total of 763 questions and 2548 answers were identified as related to COVID-19 vaccine clinical trials. The majority of these online interactions focused on asking questions and sharing knowledge and opinions about COVID-19 vaccine trials, including major topics related to: (a) interpreting whether clinical trial results could be trusted; (b) questions about vaccine efficacy and safety; (c) understanding trial design, regulatory considerations, and vaccine platforms; and (d) questions about trial enrollment, length, and adequate representation. Additionally, four major barriers discussed included: (i) disagreement from users regarding whether clinical trials require representation from different racial and ethnic minorities; (ii) concerns regarding the safety of trials when participating; (iii) lack of knowledge on how to participate in a trial; and (iv) questions of whether participants could withdraw from a trial to access an approved COVID-19 vaccine. CONCLUSIONS Our study found active user discussions related to COVID-19 vaccine clinical trials on Quora, including those specific to minority health topics and those posted by a smaller group of self-identified racial and ethnic minority online users. Results from this study can help identify barriers to participation among the general public and underrepresented groups while also supporting the design of future outreach strategies to help with recruitment and inclusive trial participation.
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Affiliation(s)
- Qing Xu
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, LLC, San Diego, CA, USA
| | - Tiana J McMann
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, LLC, San Diego, CA, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, CA, USA
- S-3 Research, LLC, San Diego, CA, USA
| | | | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, USA.
- S-3 Research, LLC, San Diego, CA, USA.
- Global Health Program, Department of Anthropology, University of California, San Diego, CA, USA.
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20
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Boschung K, Gill MJ, Krentz HB, Dalere J, Beckthold B, Fonseca K, Bakal JA, McMillan JM, Kanji J, Lang R. COVID-19 vaccine uptake among people with HIV: identifying characteristics associated with vaccine hesitancy. Sci Rep 2023; 13:20610. [PMID: 37996521 PMCID: PMC10667522 DOI: 10.1038/s41598-023-47106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
People with HIV (PWH) are at increased risk of COVID-19 infection. Both Canadian (NACI) and US (CDC) guidelines recommend that all PWH receive at least 2 doses of COVID-19 vaccine, and a booster. We examined vaccination uptake among PWH in Southern Alberta, Canada. Among adult PWH, we evaluated COVID-19 vaccination uptake between December 2020 and August 2022. Poisson regression models with robust variance (approximating log binomial models) estimated crude and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for receiving (1) any vs. no vaccine, and (2) primary series with booster (≥ 3 vaccines) versus primary series without booster. Among 1885 PWH, 10% received no COVID-19 vaccinations, 37% < 3 vaccines and 54% received ≥ 3 vaccines. Females (vs. males) were less likely to receive a vaccine booster. Receiving no COVID-19 vaccines was associated with White ethnicity, unsuppressed HIV viral load (> 200 copies/mL), and using illegal substances. Factors associated with decreased booster uptake included being younger, Black (vs. White) ethnicity, substance use, lower educational attainment, and having an unsuppressed HIV viral load. COVID-19 booster uptake among PWH does not meet vaccine guidelines, and receipt of vaccines is unevenly distributed. Booster uptake is lowest among young females and marginalized individuals. Focused outreach is necessary to close this gap.
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Affiliation(s)
- Karol Boschung
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
| | - Hartmut B Krentz
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
| | | | | | - Kevin Fonseca
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Jeffrey A Bakal
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Provincial Research Data Services, Alberta Health Services, Calgary, AB, Canada
| | - Jacqueline M McMillan
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jamil Kanji
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
- Section of Medical Microbiology, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Southern Alberta Clinic, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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21
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Aggarwal J, Nguyen KT, Campbell ML, Shiau S, Shendell DG. Factors Associated with COVID-19 Vaccine Hesitancy and Case Status among New Jersey Secondary Educational Professionals. Vaccines (Basel) 2023; 11:1667. [PMID: 38005999 PMCID: PMC10674534 DOI: 10.3390/vaccines11111667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Vaccine hesitancy remains a societal problem, including during the COVID-19 pandemic. New Jersey (NJ) Safe Schools Program provides work-based learning training to supervisory-level career-technical-vocational education teachers and administrators who have to consider varied state and local mandates concerning COVID-19 vaccination and exemptions. METHODS In early 2022, we distributed an online survey via PsychData to individuals trained between 2014 and 2022 to understand NJ teachers' practices and concerns regarding COVID-19 vaccines. Overall, 269 completed the survey. We stratified data by vaccination status, number of doses, booster status, age, teaching experience, gender, race, county of work, and COVID-19 diagnosis status. RESULTS Overall, results suggested differences in COVID-19-related concerns, including access to, perceptions of, and confidence in COVID-19 vaccines and COVID-19-related practices. About 90.7% received the initial vaccine; 77.7% received the booster. About half the participants had received a positive COVID-19 diagnosis by the time of the survey; they were less likely to get the vaccine or booster if they had received the initial vaccine. CONCLUSIONS Data suggested differences in levels of COVID-19-related concerns and confidence in, or importance of, vaccines when comparing different demographic factors and vaccination practices. The data informs efforts to understand factors affecting vaccine hesitancy among educational professionals.
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Affiliation(s)
- Juhi Aggarwal
- NJ Safe Schools Program, Rutgers School of Public Health (SPH), Rutgers University, Piscataway, NJ 08854, USA (M.L.C.); (D.G.S.)
| | - Kimberly T. Nguyen
- NJ Safe Schools Program, Rutgers School of Public Health (SPH), Rutgers University, Piscataway, NJ 08854, USA (M.L.C.); (D.G.S.)
| | - Maryanne L. Campbell
- NJ Safe Schools Program, Rutgers School of Public Health (SPH), Rutgers University, Piscataway, NJ 08854, USA (M.L.C.); (D.G.S.)
| | - Stephanie Shiau
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health (SPH), Piscataway, NJ 08854, USA;
| | - Derek G. Shendell
- NJ Safe Schools Program, Rutgers School of Public Health (SPH), Rutgers University, Piscataway, NJ 08854, USA (M.L.C.); (D.G.S.)
- Department of Environmental and Occupational Health and Justice, Rutgers School of Public Health (SPH), Piscataway, NJ 08854, USA
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Koskan AM, Sivanandam S, Roschke K, Irby J, Helitzer DL, Doebbeling B. Sharing Reliable COVID-19 Information and Countering Misinformation: In-Depth Interviews With Information Advocates. JMIR Infodemiology 2023; 3:e47677. [PMID: 37862066 PMCID: PMC10625073 DOI: 10.2196/47677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The rampant spread of misinformation about COVID-19 has been linked to a lower uptake of preventive behaviors such as vaccination. Some individuals, however, have been able to resist believing in COVID-19 misinformation. Further, some have acted as information advocates, spreading accurate information and combating misinformation about the pandemic. OBJECTIVE This work explores highly knowledgeable information advocates' perspectives, behaviors, and information-related practices. METHODS To identify participants for this study, we used outcomes of survey research of a national sample of 1498 adults to find individuals who scored a perfect or near-perfect score on COVID-19 knowledge questions and who also self-reported actively sharing or responding to news information within the past week. Among this subsample, we selected a diverse sample of 25 individuals to participate in a 1-time, phone-based, semistructured interview. Interviews were recorded and transcribed, and the team conducted an inductive thematic analysis. RESULTS Participants reported trusting in science, data-driven sources, public health, medical experts, and organizations. They had mixed levels of trust in various social media sites to find reliable health information, noting distrust in particular sites such as Facebook (Meta Platforms) and more trust in specific accounts on Twitter (X Corp) and Reddit (Advance Publications). They reported relying on multiple sources of information to find facts instead of depending on their intuition and emotions to inform their perspectives about COVID-19. Participants determined the credibility of information by cross-referencing it, identifying information sources and their potential biases, clarifying information they were unclear about with health care providers, and using fact-checking sites to verify information. Most participants reported ignoring misinformation. Others, however, responded to misinformation by flagging, reporting, and responding to it on social media sites. Some described feeling more comfortable responding to misinformation in person than online. Participants' responses to misinformation posted on the internet depended on various factors, including their relationship to the individual posting the misinformation, their level of outrage in response to it, and how dangerous they perceived it could be if others acted on such information. CONCLUSIONS This research illustrates how well-informed US adults assess the credibility of COVID-19 information, how they share it, and how they respond to misinformation. It illustrates web-based and offline information practices and describes how the role of interpersonal relationships contributes to their preferences for acting on such information. Implications of our findings could help inform future training in health information literacy, interpersonal information advocacy, and organizational information advocacy. It is critical to continue working to share reliable health information and debunk misinformation, particularly since this information informs health behaviors.
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Affiliation(s)
- Alexis M Koskan
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Shalini Sivanandam
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Kristy Roschke
- Walter Cronkite School of Journalism and Mass Communication, Arizona State University, Phoenix, AZ, United States
| | - Jonathan Irby
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Deborah L Helitzer
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Bradley Doebbeling
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Crawshaw AF, Kitoko LM, Nkembi SL, Lutumba LM, Hickey C, Deal A, Carter J, Knights F, Vandrevala T, Forster AS, Hargreaves S. Co-designing a theory-informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community-based participatory research study (LISOLO MALAMU). Health Expect 2023; 27:e13884. [PMID: 37831054 PMCID: PMC10726157 DOI: 10.1111/hex.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Disparities in the uptake of routine and COVID-19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. METHODS This study used a theory-informed, community-based participatory research approach to co-design a culturally tailored behaviour change intervention aimed at increasing COVID-19 vaccine uptake among Congolese migrants in London, United Kingdom (2021-2022). It was designed and led by a community-academic partnership in response to unmet needs in the Congolese community as the COVID-19 pandemic started. Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co-designed and tailored in workshops involving Congolese migrants. RESULTS Thirty-two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. Fourteen barriers and 10 facilitators to COVID-19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. CONCLUSIONS Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co-producing all stages of the study and co-authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.
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Affiliation(s)
- Alison F. Crawshaw
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | | | | | | | | | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineLondonUK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and EducationKingston University LondonLondonUK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
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Green AL, Stewart AL, Nápoles AM, Strassle PD. COVID-19 vaccination willingness and uptake among low-income Black/African American, Latino, and White adults living in the U.S. Prev Med Rep 2023; 35:102367. [PMID: 37638353 PMCID: PMC10458284 DOI: 10.1016/j.pmedr.2023.102367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between low-income and non-low-income adults and across race-ethnicity. We utilized data from the COVID-19's Unequal Racial Burden online survey, which included baseline (12/17/2020-2/11/2021) and 6-month follow-up (8/13/2021-9/9/2021) surveys. The sample included 1,500 Black/African American, Latino, and White low-income adults living in the U.S. (N = 500 each). A non-low-income cohort was created for comparison (n = 1,188). Multinomial logistic regression was used to assess differences in vaccine willingness and uptake between low-income and non-low-income adults, as well as across race-ethnicity (low-income adults only). Only low-income White adults were less likely to be vaccinated compared to their non-low-income counterparts (extremely willing vs. not at all: OR = 0.58, 95% CI = 0.39-0.86); low-income Black/African American and Latino adults were just as willing or more willing to vaccinate. At follow-up, only 30.2% of low-income adults who reported being unwilling at baseline were vaccinated at follow-up. White low-income adults (63.6%) appeared less likely to be vaccinated, compared to non-low-income White adults (80.9%), low-income Black/African American (70.7%), and low-income Latino adults (72.4%). Distrust in the government (46.6), drug companies (44.5%), and vaccine contents (52.1%) were common among those unwilling to vaccinate. This prospective study among a diverse sample of low-income adults found that low-income White adults were less willing and less likely to vaccinate than their non-low-income counterparts, but this difference was not observed for Black/African American or Latino adults. Distrust and misinformation were prevalent among those who remained unvaccinated at follow-up.
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Affiliation(s)
- Alexis L. Green
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, San Francisco, CA, USA
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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25
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Mantina NM, Contreras J, Yellowhair M, Miranti C, Hatcher J. Building capacity for collaborative research between basic scientists and underrepresented communities in cancer research. Cancer Causes Control 2023; 34:845-853. [PMID: 37269404 PMCID: PMC10239042 DOI: 10.1007/s10552-023-01726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Basic science research is critical for understanding biological mechanisms essential to advances in cancer prevention, diagnoses and treatment. However, most of this research is conducted outside of the purview of community observation or input, leaving these research processes mysterious and subsequent findings disconnected from the communities they intend to benefit. This paper discusses strategies to build capacity for collaborations between basic scientists and Hispanic community members at the University of Arizona Cancer Center (UACC). METHODS Through partnership of the Cancer Biology Program and Office of Community Outreach and Engagement both at UACC, the Research Outreach for Southern Arizona (ROSA) program was developed as a way to forward the following strategies to build capacity for collaboration: forming a community working group, launching a community and student ambassador program, hosting scientific cafés and developing a community-based survey. RESULTS The strategies underpinning the ROSA program have been integral in bridging dialogue between basic scientists and the community and fostering bidirectional learning opportunities. Each of the strategies presented have documented successes and based on the lessons learned, they have evolved into productive and integral parts of UACC's overall strategy of bridging scientific research and communities. CONCLUSION While the strategies discussed are evolving, they help foster dialogue and exchange between basic scientists and community members that demystifies basic science research and facilitates culturally tailored approaches to address health disparities of vulnerable communities. These strategies also have the potential to shift cancer research into a paradigm that is more collaborative and transformative.
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Affiliation(s)
- Namoonga M. Mantina
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85724 USA
- Cancer Center, University of Arizona, 1515 N Campbell Avenue, Tucson, AZ 85724 USA
| | - Juan Contreras
- Cancer Center, University of Arizona, 1515 N Campbell Avenue, Tucson, AZ 85724 USA
| | - Monica Yellowhair
- Cancer Center, University of Arizona, 1515 N Campbell Avenue, Tucson, AZ 85724 USA
| | - Cynthia Miranti
- Cancer Center, University of Arizona, 1515 N Campbell Avenue, Tucson, AZ 85724 USA
- Department of Cellular and Molecular Medicine, College of Medicine, University of Arizona, 1501 N Campbell Avenue, Tucson, AZ 85724 USA
| | - Jennifer Hatcher
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85724 USA
- Cancer Center, University of Arizona, 1515 N Campbell Avenue, Tucson, AZ 85724 USA
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26
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Bacon E, An L, Yang P, Hawley S, Van Horn ML, Resnicow K. Novel Psychosocial Correlates of COVID-19 Vaccine Hesitancy: Cross-Sectional Survey. JMIR Form Res 2023; 7:e45980. [PMID: 37756115 PMCID: PMC10538360 DOI: 10.2196/45980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/23/2023] [Accepted: 08/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Effective COVID-19 vaccines have been available since early 2021 yet many Americans refuse or delayed uptake. As of mid-2022, still around 30% of US adults remain unvaccinated against COVID-19. The majority (81%) of these unvaccinated adults say they will "definitely not" be getting the COVID-19 vaccine. Understanding the determinants of COVID-19 vaccine uptake is critical to reducing death and illness from the virus, as well as to inform future vaccine efforts, such as the more recent bivalent (omicron) booster. OBJECTIVE This study aimed to expand our understanding of psychosocial determinants of COVID-19 vaccine uptake. We focus on both COVID-19-specific factors, such as COVID-19 conspiracy beliefs, as well as more global personality attributes such as dogmatism, reactance, gender roles, political beliefs, and religiosity. METHODS We conducted a web-based survey in mid-2021 of a representative sample of 1376 adults measuring both COVID-19-specific beliefs and attitudes, as well as global personality attributes. COVID-19 vaccination status is reported at 3 levels: vaccinated; unvaccinated-may-get-it; unvaccinated-hard-no. RESULTS Our analyses focused on the correlation of COVID-19 vaccination status with 10 psychosocial attributes: COVID-19-specific conspiracy theory beliefs; COVID-19 vaccine misinformation; COVID-19-related Rapture beliefs; general antivaccination beliefs; trait reactance; trait dogmatism; belief in 2020 election fraud; belief in a QAnon conspiracy; health care system distrust; and identification with traditional gender roles. We used a multivariate analysis of covariance to examine mean differences across vaccine status groups for each of the correlates while holding constant the effects of age, gender, race, income, education, political party, and Evangelicalism. Across the 10 psychosocial correlates, several different response scales were used. To allow for comparison of effects across correlates, measures of effect size were computed by converting correlates to z scores and then examining adjusted mean differences in z scores between the groups. We found that all 10 psychosocial variables were significantly associated with vaccination status. After general antivaccination beliefs, COVID-19 misinformation beliefs and COVID-19 conspiracy beliefs had the largest effect on vaccine uptake. CONCLUSIONS The association of these psychosocial factors with COVID-19 vaccine hesitancy may help explain why vaccine uptake has not shifted much among the unvaccinated-hard-no group since vaccines became available. These findings deepen our understanding of those who remain resistant to getting vaccinated and can guide more effective tailored communications to reach them. Health communication professionals may apply lessons learned from countering related beliefs and personality attributes around issues such as climate change and other forms of vaccine hesitancy. For example, using motivational interviewing strategies that are equipped to handle resistance and provide correct information in a delicate manner that avoids reactance.
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Affiliation(s)
- Elizabeth Bacon
- Center for Health Communications Research, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Lawrence An
- Center for Health Communications Research, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Division of General Medicine, School of Medicine University of Michigan, Ann Arbor, MI, United States
| | - Penny Yang
- Center for Health Communications Research, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Hawley
- Center for Health Communications Research, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Division of General Medicine, School of Medicine University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - M Lee Van Horn
- Department of Individual, Family, and Community, University of New Mexico, Albuquerque, NM, United States
| | - Ken Resnicow
- Center for Health Communications Research, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
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27
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Strassle PD, Green AL, Colbert CA, Stewart AL, Nápoles AM. COVID-19 vaccination willingness and uptake among rural Black/African American, Latino, and White adults. J Rural Health 2023; 39:756-764. [PMID: 36863851 PMCID: PMC10474244 DOI: 10.1111/jrh.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between rural and nonrural adults, and within rural racial-ethnic groups. METHODS We utilized data from the COVID-19's Unequal Racial Burden online survey, which included 1,500 Black/African American, Latino, and White rural adults (n = 500 each). Baseline (12/2020-2/2021) and 6-month follow-up (8/2021-9/2021) surveys were administered. A cohort of nonrural Black/African American, Latino, and White adults (n = 2,277) was created to compare differences between rural and nonrural communities. Multinomial logistic regression was used to assess associations between rurality, race-ethnicity, and vaccine willingness and uptake. FINDINGS At baseline, only 24.9% of rural adults were extremely willing to be vaccinated and 28.4% were not at all willing. Rural White adults were least willing to be vaccinated, compared to nonrural White adults (extremely willing: aOR = 0.44, 95% CI = 0.30-0.64). At follow-up, 69.3% of rural adults were vaccinated; however, only 25.3% of rural adults who reported being unwilling to vaccinate were vaccinated at follow-up, compared to 95.6% of adults who were extremely willing to be vaccinated and 76.3% who were unsure. Among those unwilling to vaccinate at follow-up, almost half reported distrust in the government (52.3%) and drug companies (46.2%); 80% reported that nothing would change their minds regarding vaccination. CONCLUSIONS By August 2021, almost 70% of rural adults were vaccinated. However, distrust and misinformation were prevalent among those unwilling to vaccinate at follow-up. To continue to effectively combat COVID-19 in rural communities, we need to address misinformation to increase COVID-19 vaccination rates.
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Affiliation(s)
- Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Alexis L. Green
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Caleb A. Colbert
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, San Francisco, CA
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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McKinnon B, Abalovi K, Fortin G, Parvez M, Dalal S, Bouabid R, Jasmin D, Zéphrin M, Gupta N, Hasan AT, Andog-Naba Sebastien A, Taheem B, Dubé È, Tuong Nguyen C, Quach C, Vandermorris A, Zinszer K. Perspectives on COVID-19 Vaccination and Vaccine Passports in a Diverse Urban Adolescent Population: A Youth Participatory Mixed Methods Study. J Adolesc Health 2023; 73:527-535. [PMID: 37294252 PMCID: PMC10150197 DOI: 10.1016/j.jadohealth.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/02/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Disparities in youth COVID-19 vaccine acceptance and uptake have been documented in several countries, yet few studies have explored the attitudes and perceptions underlying vaccine-related decision-making among adolescent populations with unique sociocultural, environmental, and/or structural contexts that may influence vaccine uptake. METHODS This study used data from surveys and semistructured interviews collected between January and March 2022 as part of an ongoing community-based research project in two ethnoculturally diverse, lower income neighborhoods of Montreal, Canada. Youth researchers designed and conducted interviews with unvaccinated adolescents, and thematic analysis was employed to explore attitudes and perceptions underlying vaccine-related decisions and opinions about vaccine passports. Survey data were used to describe sociodemographic and psychological determinants of COVID-19 vaccination. RESULTS Among 315 survey participants aged 14-17 years, most (74%) were fully vaccinated against COVID-19. Prevalence ranged from 57% among Black adolescents to 91% among South and/or Southeast Asian adolescents (34% difference, 95% confidence interval: 20-49). Qualitative and quantitative findings highlighted several misconceptions about the safety, effectiveness, and necessity of COVID-19 vaccines and adolescents' desire for trusted sources of information to address their concerns. Vaccine passports likely increased uptake, yet adolescents were strongly resistant to the policy, and for some, it may have fueled distrust of government and scientific institutions. DISCUSSION Strategies that increase the trustworthiness of institutions and foster genuine partnership with underserved youth may improve vaccine confidence and help ensure an effective, proequity recovery from COVID-19.
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Affiliation(s)
- Britt McKinnon
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Krystelle Abalovi
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada
| | - Geneviève Fortin
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Maryam Parvez
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Sanya Dalal
- School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Rania Bouabid
- Calixa-Lavallée Secondary School, Montréal-Nord, Québec, Canada
| | - Djunah Jasmin
- Henri-Bourassa Secondary School, Montréal-Nord, Québec, Canada
| | | | - Nandini Gupta
- Lucien-Pagé Secondary School, Montréal, Québec, Canada
| | | | | | - Binal Taheem
- Lucien-Pagé Secondary School, Montréal, Québec, Canada
| | - Ève Dubé
- Research Centre of the CHU of Québec, Laval University, Québec, Québec, Canada
| | - Cat Tuong Nguyen
- School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Caroline Quach
- Department of Microbiology, Infectiology and Immunology, University of Montreal, Montréal, Québec, Canada
| | - Ashley Vandermorris
- Division of Adolescent Medicine, Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Kate Zinszer
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Public Health, University of Montreal, Montréal, Québec, Canada
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Nordyke K, Kressin A, Holtz ML, Robinson R. The Impact of Racism on Healthcare Experiences and Well-Being: a Qualitative Study Based on Focus Group Discussions with Communities of Color. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01603-8. [PMID: 37615901 DOI: 10.1007/s40615-023-01603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Connections between race and health are discussed, and racism has been called out as a root cause of health disparities. The impacts of systemic racism are not fully understood and should be considered in order to advance health equity. The aim of the study is to explore the impact of racism on healthcare experiences and well-being for communities of color. METHODS Individuals from a Northeast region of Wisconsin, who self-identified as Somali, Hmong, Black/African American, Hispanic/Latino/a, and First Nations/Native American/Indigenous, were invited to participate in focus group discussions, and informed consent was obtained from all participants (25 adults, 17 females, and 8 males). Focus groups were planned so participants from the same self-identified communities were together, and five virtual focus group discussions were carried out. A qualitative content analysis approach was used to gain a deeper understanding of the content. RESULTS There was a range of experiences; however, everyone experienced the negative impacts of racism. Three categories, representing areas impacted by racism, and a final theme, describing the overall impact on healthcare experiences and well-being, were created. Dealing with systemic racism means that "backgrounds and values," "resources," and "prejudices" (categories) require constant attention, maneuvering, and "juggling the impacts of racism diminishes access to healthcare and well-being for communities of color" (theme). DISCUSSION Systemic racism negatively impacts access to healthcare and well-being for communities of color perpetuating health disparities. Planning and policy should include a focus on health equity and target systemic racism in order to diminish health disparities.
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Hayes KN, Harris DA, Zullo AR, Chachlani P, Wen KJ, Smith-Ray RL, Djibo DA, McCarthy EP, Pralea A, Singh TG, McMahill-Walraven C, Taitel MS, Deng Y, Gravenstein S, Mor V. Racial and ethnic disparities in COVID-19 booster vaccination among U.S. older adults differ by geographic region and Medicare enrollment. Front Public Health 2023; 11:1243958. [PMID: 37637796 PMCID: PMC10456997 DOI: 10.3389/fpubh.2023.1243958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction COVID-19 booster vaccines are highly effective at reducing severe illness and death from COVID-19. Research is needed to identify whether racial and ethnic disparities observed for the primary series of the COVID-19 vaccines persist for booster vaccinations and how those disparities may vary by other characteristics. We aimed to measure racial and ethnic differences in booster vaccine receipt among U.S. Medicare beneficiaries and characterize potential variation by demographic characteristics. Methods We conducted a cohort study using CVS Health and Walgreens pharmacy data linked to Medicare claims. We included community-dwelling Medicare beneficiaries aged ≥66 years who received two mRNA vaccine doses (BNT162b2 and mRNA-1273) as of 8/1/2021. We followed beneficiaries from 8/1/2021 until booster vaccine receipt, death, Medicare disenrollment, or end of follow-up (12/31/2021). Adjusted Poisson regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) comparing vaccine uptake between groups. Results We identified 11,339,103 eligible beneficiaries (mean age 76 years, 60% female, 78% White). Overall, 67% received a booster vaccine (White = 68.5%; Asian = 67.0%; Black = 57.0%; Hispanic = 53.3%). Compared to White individuals, Black (RR = 0.78 [95%CI = 0.78-0.78]) and Hispanic individuals (RR = 0.72 [95% = CI 0.72-0.72]) had lower rates of booster vaccination. Disparities varied by geographic region, urbanicity, and Medicare plan/Medicaid eligibility. The relative magnitude of disparities was lesser in areas where vaccine uptake was lower in White individuals. Discussion Racial and ethnic disparities in COVID-19 vaccination have persisted for booster vaccines. These findings highlight that interventions to improve vaccine uptake should be designed at the intersection of race and ethnicity and geographic location.
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Affiliation(s)
- Kaleen N. Hayes
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Daniel A. Harris
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Andrew R. Zullo
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States
| | - Preeti Chachlani
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Katherine J. Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, United States
| | - Renae L. Smith-Ray
- Walgreens Center for Health and Wellbeing Research, Walgreen Company, Deerfield, IL, United States
| | | | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alexander Pralea
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
| | - Tanya G. Singh
- Walgreens Center for Health and Wellbeing Research, Walgreen Company, Deerfield, IL, United States
| | | | - Michael S. Taitel
- Walgreens Center for Health and Wellbeing Research, Walgreen Company, Deerfield, IL, United States
| | - Yalin Deng
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Stefan Gravenstein
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States
- Division of Geriatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States
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Gardiner FW, Schofield Z, Hendry M, Jones K, Smallacombe M, Steere M, Beach J, MacIsaac M, Greenberg R, Crawford C, Trivett M, Morris J, Spring B, Quinlan F, Churilov L, Rallah-Baker K, Gardiner E, O’Donnell J. A novel COVID-19 program, delivering vaccines throughout rural and remote Australia. Front Public Health 2023; 11:1019536. [PMID: 37529430 PMCID: PMC10390067 DOI: 10.3389/fpubh.2023.1019536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background The Royal Flying Doctor Service of Australia (RFDS) established a unique SARS-CoV-2 vaccination program for vaccinating Australians that live in rural and remote areas. This paper describes the preparation and response phases of the RFDS response. Methods This study includes vaccinations conducted by the RFDS from 01 January 2021 until 31 December 2021 when vaccines were mandatory for work and social activities. Prior to each clinic, we conducted community consultation to determine site requirements, patient characteristics, expected vaccination numbers, and community transmission rates. Findings Ninety-five organizations requested support. The majority (n = 60; 63.2%) came from Aboriginal Community Controlled Health Organizations. Following consultation, 360 communities were approved for support. Actual vaccinations exceeded expectations (n = 70,827 vs. 49,407), with a concordance correlation coefficient of 0.88 (95% CI, 0.83, 0.93). Areas that reported healthcare workforce shortages during the preparation phase had the highest population proportion difference between expected and actual vaccinations. Areas that reported high vaccine hesitancy during the preparation phase had fewer than expected vaccines. There was a noticeable increase in vaccination rates in line with community outbreaks and positive polymerase chain reaction cases [r (41) = 0.35, p = 0.021]. Engagement with community leaders prior to clinic deployment was essential to provide a tailored response based on community expectations.
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Affiliation(s)
- Fergus W. Gardiner
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, WA, Australia
| | - Zoe Schofield
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
- CDU Menzies School of Medicine, Darwin, NT, Australia
| | - Miranda Hendry
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Kate Jones
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | | | - Mardi Steere
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Jenny Beach
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | | | | | - Candice Crawford
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Melanie Trivett
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Judah Morris
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Breeanna Spring
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
- Molly Wardagua Research Centre, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Frank Quinlan
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - Leonid Churilov
- Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Elli Gardiner
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
| | - John O’Donnell
- Royal Flying Doctor Service of Australia, Canberra, ACT, Australia
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Jindal M, Hua MJ, Hartstein M, Martin M. Trustworthiness, Not Trust: How Systemic Racism Impacts COVID-19 Vaccine Receipt. Health Equity 2023; 7:380-383. [PMID: 37476706 PMCID: PMC10354722 DOI: 10.1089/heq.2022.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
To illuminate the forces of structural racism influencing COVID-19 vaccine receipt, we developed a conceptual model that recontextualizes trust and presents potential pathways to address structural racism. Our model emerged from Chicagoland CEAL, a partnership of community and academic experts collaborating to encourage COVID-19 vaccine uptake for communities of color. We concluded that systemic factors influenced by racism contribute to an overall lack of trustworthiness in vaccine-affiliated institutions. We highlight the need to recenter discussions of COVID-19 vaccination on our system's trustworthiness rather than mistrust and suggest using the model to test pathways to close racial gaps in COVID-19 vaccination.
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Affiliation(s)
- Monique Jindal
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Miao Jenny Hua
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine & Cook County Health, Chicago, Illinois, USA
| | - Madison Hartstein
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Molly Martin
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA
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Bacong AM, Yellow Horse AJ, Lee E, Ðoàn LN, Saw A. Modes of COVID-19 Information and Vaccine Hesitancy Among Asian Americans: The Moderating Role of Exposure to Cyberbullying. AJPM Focus 2023; 2:100130. [PMID: 37362393 PMCID: PMC10285202 DOI: 10.1016/j.focus.2023.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction : COVID-19 vaccination is an important public health intervention to curb the pandemic's magnitude and spread, and racial discrimination is a key predictor of COVID-19 preventive behavior, vaccine hesitancy, and uptake. This study evaluated the association of vaccine hesitancy with various modes of information on COVID-19 (i.e., online, social media) and the moderating role of cyberbullying among Asian Americans. Methods : We used population-weighted data from the nationwide Asian American & Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Survey, which was conducted from January to April 2021 (unweighted n=3,127). We examined the association of various modes of COVID-19 information and vaccine hesitancy, moderated by exposure to cyberbullying. Results : In general, 16% of Asian Americans reported vaccine hesitancy; 26% reported experiencing cyberbullying. Asian Americans reported receiving the majority of COVID-19 information from online sources (75%) and social media (52%). In unadjusted models, receiving information online (OR=0.46, 95%CI=0.33, 0.62, p<.001), via social media (OR=0.80, 95%CI=0.52, 0.93, p<.05), and via broadcast (OR=0.60, 95%CI=0.44, 0.81, p<.001) were significantly associated with a lower vaccine hesitancy. However, reporting any cyberbullying was associated with increased vaccine hesitancy (OR=1.39, 95%CI=1.02, 1.90, p<.05). The protective effects for COVID-19 information modes remained when accounting for health and sociodemographic factors, while the effect of cyberbullying was no longer statistically significant. Cyberbullying moderated the protective effect of broadcast information only, so those who received information via broadcast and reported experiencing cyberbullying had similar odds of vaccine hesitancy compared to those who did not receive information via broadcast. Conclusions : Online, social media, and broadcast remain important sources of information about COVID-19 for Asian Americans; however, experiencing cyberbullying can reduce the effectiveness of these sources in the uptake of the vaccine. COVID-19 information promotion strategies for Asian Americans must account for the role of cyberbullying in social media campaigns.
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Affiliation(s)
- Adrian M. Bacong
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford University Center for Asian Health Research and Education, Stanford, California
| | | | - Eunhye Lee
- Department of Community Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Lan N. Ðoàn
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, New York, New York
| | - Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois
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Sujarwoto S, Maharani A. Is knowledge about COVID-19 associated with willingness to receive vaccine, vaccine uptake, and vaccine booster uptake in rural Malang, Indonesia? Front Public Health 2023; 11:1203550. [PMID: 37351094 PMCID: PMC10282756 DOI: 10.3389/fpubh.2023.1203550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
Background Lack of knowledge regarding the coronavirus disease (COVID-19) and COVID-19 vaccines is a key barrier to COVID-19 vaccine uptake in low- and middle-income countries (LMICs). Aims To examine factors associated with knowledge about COVID-19 and the association between knowledge of COVID-19, willingness to receive a COVID-19 vaccine, and vaccine uptake in Malang, East Java, Indonesia. Method A cross-sectional study among individuals aged 15-99 years was conducted in Malang, Java Timur, Indonesia between November 2022 and January 2023. Of 10,050 potential respondents, 10,007 were able to complete the survey. The main independent variable was knowledge about COVID-19, which was assessed using a six-item questionnaire. The dependent variables were COVID-19 vaccine uptake and COVID-19 booster vaccine uptake. The mediating variable was respondent's willingness to receive a COVID-19 vaccine. Linear regression was used to examine factors associated with knowledge about COVID-19. Logistic regression was employed to examine the association of knowledge about COVID-19 with vaccine uptake. Generalized structural equation modeling (GSEM) was performed to examine whether willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccination uptake. Findings The percentage of respondents who reported having received at least one dose of a COVID-19 vaccine was 94.8%, while the percentage of those who reported having received at least three doses was 88.5%. These numbers are higher than the national average for COVID-19 vaccine and booster vaccine uptake. Most respondents answered about four of six knowledge items correctly (M = 4.60, SD = 1.1). Among respondents who had not received a vaccine, 83.1% expressed willingness to receive a vaccine when it became available to them. Older, more educated, employed respondents, and those with higher economic status, demonstrated more accurate knowledge about COVID-19 than younger, less educated, unemployed respondents and those with lower economic status. Respondents who demonstrated more accurate knowledge about COVID-19 were more likely to have received a vaccine (OR = 1.528, 95% CI = 1.428-1.634) and a booster vaccine (OR = 1.260, 95% CI = 1.196-1.328). Willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccine uptake (coef. = 0.426, 95% CI = 0.379-0.473). Implications Interventions and public health programs aiming to improve knowledge about COVID-19 can be implemented to improve individual willingness to receive COVID-19 vaccination and to improve COVID-19 vaccine uptake among the general population.
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Affiliation(s)
- Sujarwoto Sujarwoto
- Department of Public Administration, Faculty of Administrative Science, Brawijaya University, Malang, Indonesia
| | - Asri Maharani
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
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Diaz AA, Thakur N, Celedón JC. Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States. Clin Chest Med 2023; 44:425-434. [PMID: 37085230 PMCID: PMC9678822 DOI: 10.1016/j.ccm.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Neeta Thakur
- Department of Medicine, University of California at San Francisco, 505 Parnassus Avenue, Box 0841, San Francisco, CA 94143, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Suite 9130, Rangos Building, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Abduljalil JM, Elghareib AM, Samir A, Ezat AA, Elfiky AA. How helpful were molecular dynamics simulations in shaping our understanding of SARS-CoV-2 spike protein dynamics? Int J Biol Macromol 2023:125153. [PMID: 37268078 DOI: 10.1016/j.ijbiomac.2023.125153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/22/2023] [Accepted: 05/27/2023] [Indexed: 06/04/2023]
Abstract
The SARS-CoV-2 spike protein (S) represents an important viral component that is required for successful viral infection in humans owing to its essential role in recognition of and entry to host cells. The spike is also an appealing target for drug designers who develop vaccines and antivirals. This article is important as it summarizes how molecular simulations successfully shaped our understanding of spike conformational behavior and its role in viral infection. MD simulations found that the higher affinity of SARS-CoV-2-S to ACE2 is linked to its unique residues that add extra electrostatic and van der Waal interactions in comparison to the SARS-CoV S. This illustrates the spread potential of the pandemic SARS-CoV-2 relative to the epidemic SARS-CoV. Different mutations at the S-ACE2 interface, which is believed to increase the transmission of the new variants, affected the behavior and binding interactions in different simulations. The contributions of glycans to the opening of S were revealed via simulations. The immune evasion of S was linked to the spatial distribution of glycans. This help the virus to escape the immune system recognition. This article is important as it summarizes how molecular simulations successfully shaped our understanding of spike conformational behavior and its role in viral infection. This will pave the way to us preparing for the next pandemic as the computational tools are tailored to help fight new challenges.
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Affiliation(s)
- Jameel M Abduljalil
- Department of Biological Sciences, Faculty of Applied Sciences, Thamar University, Dhamar, Yemen; Department of Botany and Microbiology, College of Science, Cairo University, Giza, Egypt
| | - Ahmed M Elghareib
- Department of Biophysics, Faculty of Science, Cairo University, Giza, Egypt
| | - Ahmed Samir
- Department of Biophysics, Faculty of Science, Cairo University, Giza, Egypt
| | - Ahmed A Ezat
- Department of Biophysics, Faculty of Science, Cairo University, Giza, Egypt
| | - Abdo A Elfiky
- Department of Biophysics, Faculty of Science, Cairo University, Giza, Egypt.
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Vernon-Wilson E, Tetui M, Nanyonjo A, Adil M, Bala A, Nelson D, Sayers E, Waite N, Grindrod K. Unintended consequences of communicating rapid COVID-19 vaccine policy changes- a qualitative study of health policy communication in Ontario, Canada. BMC Public Health 2023; 23:932. [PMID: 37221519 DOI: 10.1186/s12889-023-15861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. METHODS Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. RESULTS Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. CONCLUSIONS Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.
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Affiliation(s)
- Elizabeth Vernon-Wilson
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada.
| | - Moses Tetui
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Agnes Nanyonjo
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, Lincolnshire, UK
| | - Maisha Adil
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
| | - Arthi Bala
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
| | - David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, Lincolnshire, UK
| | - Emma Sayers
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, Lincolnshire, UK
| | - Nancy Waite
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
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Datar RS, Fette LM, Hinkelman AN, Hammershaimb EA, Friedman-Klabanoff DJ, Mongraw-Chaffin M, Weintraub WS, Ahmed N, Gibbs MA, Runyon MS, Plumb ID, Thompson W, Saydah S, Edelstein SL, Berry AA. Factors associated with COVID-19 vaccination during June-October 2021: A multi-site prospective study. Vaccine 2023; 41:3204-3214. [PMID: 37069033 PMCID: PMC10063571 DOI: 10.1016/j.vaccine.2023.03.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Vaccine hesitancy presents a challenge to COVID-19 control efforts. To identify beliefs associated with delayed vaccine uptake, we developed and implemented a vaccine hesitancy survey for the COVID-19 Community Research Partnership. METHODS In June 2021, we assessed attitudes and beliefs associated with COVID-19 vaccination using an online survey. Self-reported vaccination data were requested daily through October 2021. We compared responses between vaccinated and unvaccinated respondents using absolute standardized mean differences (ASMD). We assessed validity and reliability using exploratory factor analysis and identified latent factors associated with a subset of survey items. Cox proportional hazards models and mediation analyses assessed predictors of subsequent vaccination among those initially unvaccinated. RESULTS In June 2021, 29,522 vaccinated and 1,272 unvaccinated participants completed surveys. Among those unvaccinated in June 2021, 559 (43.9 %) became vaccinated by October 31, 2021. In June, unvaccinated participants were less likely to feel "very concerned" about getting COVID-19 than vaccinated participants (10.6 % vs. 43.3 %, ASMD 0.792). Among those initially unvaccinated, greater intent to become vaccinated was associated with getting vaccinated and shorter time to vaccination. However, even among participants who reported no intention to become vaccinated, 28.5 % reported vaccination before study end. Two latent factors predicted subsequent vaccination-being 'more receptive' was derived from motivation to protect one's own or others' health and resume usual activities; being 'less receptive' was derived from concerns about COVID-19 vaccines. In a Cox model, both factors were partially mediated by vaccination intention. CONCLUSION This study characterizes vaccine hesitant individuals and identifies predictors of eventual COVID-19 vaccination through October 31, 2021. Even individuals with no intention to be vaccinated can shift to vaccine uptake. Our data suggest factors of perceived severity of COVID-19 disease, vaccine safety, and trust in the vaccine development process are predictive of vaccination and may be important opportunities for ongoing interventions.
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Affiliation(s)
- Reva S Datar
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lida M Fette
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Amy N Hinkelman
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, NC, USA
| | - E Adrianne Hammershaimb
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - DeAnna J Friedman-Klabanoff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - William S Weintraub
- MedStar Health Research Institute, Georgetown University, Washington, DC, USA
| | - Naheed Ahmed
- Center for Health Equity Research, MedStar Health Research Institute, Hyattsville, MD, USA
| | | | | | - Ian D Plumb
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - William Thompson
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sharon Saydah
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sharon L Edelstein
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Andrea A Berry
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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Lundberg DJ, Wrigley-Field E, Cho A, Raquib R, Nsoesie EO, Paglino E, Chen R, Kiang MV, Riley AR, Chen YH, Charpignon ML, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022. JAMA Netw Open 2023; 6:e2311098. [PMID: 37129894 PMCID: PMC10155069 DOI: 10.1001/jamanetworkopen.2023.11098] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
Importance Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. Design, Setting, and Participants This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures Age-standardized death rates. Results There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.
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Affiliation(s)
- Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Elizabeth Wrigley-Field
- Department of Sociology, University of Minnesota, Minneapolis
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University, Boston, Massachusetts
- Department of Political Science, Boston University, Boston, Massachusetts
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Center for Antiracist Research, Boston University, Boston, Massachusetts
| | - Eugenio Paglino
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge
| | | | - Samuel H. Preston
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Irma T. Elo
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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Park JK, Davies B. Rationing, Responsibility, and Vaccination during COVID-19: A Conceptual Map. Am J Bioeth 2023:1-14. [PMID: 37104661 DOI: 10.1080/15265161.2023.2201188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics.
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Affiliation(s)
- Jin K Park
- Harvard Medical School
- University of Oxford
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Datta BK, Jaremski JE, Ansa BE, Odhiambo LA, Islam KMM, Johnson JA. Role of perceived social support in COVID-19 vaccine uptake among U.S. adults. AJPM Focus 2023:100104. [PMID: 37362394 PMCID: PMC10133023 DOI: 10.1016/j.focus.2023.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Vaccine uptake concerns in the Unites States were at the forefront of public health discussions during the COVID-19 pandemic. By the end of 2022, approximately 80% of the U.S. population was vaccinated against the virus. This study examined the relationship between perceived social support and COVID-19 vaccine uptake among U.S. adults. Methods Using nationally representative cross-sectional data on 21,107 adults from the 2021 National Health Interview Survey, we assessed the COVID-19 vaccination rates across individuals with strong, some, and weak levels of social support. Multivariable logistic regression models were estimated to obtain the odds of being vaccinated in adults with different levels of perceived social support for the full sample and sub-samples of age groups. Results We found that compared to adults with perceived strong social support, adults with weak social support were 21.1% less likely to be vaccinated against COVID-19. Apart from the age 18-24 years group, the lower likelihood of being vaccinated for adults with weak social support was evident in age 24-49 years (AOR=0.66, 95% CI: 0.52-0.85), age 50-64 years (AOR=0.67, 95% CI: 0.50-0.90), and age 65+ years (AOR=0.56, 95% CI: 0.41-0.75) groups. Conclusions These findings are consistent with a broader literature indicating that social support increases the likelihood of healthy behaviors and decreases risky behaviors. Interventions designed to improve the perception of social support, particularly among those at high risk of mortality from COVID-19 may be a promising tactic for increasing COVID-19 vaccine uptake.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jennifer E Jaremski
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Benjamin E Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Lorriane A Odhiambo
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - K M Monirul Islam
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - J Aaron Johnson
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
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Wang H, Li Y, Hutch MR, Kline AS, Otero S, Mithal LB, Miller ES, Naidech A, Luo Y. Patterns of diverse and changing sentiments towards COVID-19 vaccines: a sentiment analysis study integrating 11 million tweets and surveillance data across over 180 countries. J Am Med Inform Assoc 2023; 30:923-931. [PMID: 36821435 PMCID: PMC10114113 DOI: 10.1093/jamia/ocad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/25/2023] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES Vaccines are crucial components of pandemic responses. Over 12 billion coronavirus disease 2019 (COVID-19) vaccines were administered at the time of writing. However, public perceptions of vaccines have been complex. We integrated social media and surveillance data to unravel the evolving perceptions of COVID-19 vaccines. MATERIALS AND METHODS Applying human-in-the-loop deep learning models, we analyzed sentiments towards COVID-19 vaccines in 11 211 672 tweets of 2 203 681 users from 2020 to 2022. The diverse sentiment patterns were juxtaposed against user demographics, public health surveillance data of over 180 countries, and worldwide event timelines. A subanalysis was performed targeting the subpopulation of pregnant people. Additional feature analyses based on user-generated content suggested possible sources of vaccine hesitancy. RESULTS Our trained deep learning model demonstrated performances comparable to educated humans, yielding an accuracy of 0.92 in sentiment analysis against our manually curated dataset. Albeit fluctuations, sentiments were found more positive over time, followed by a subsequence upswing in population-level vaccine uptake. Distinguishable patterns were revealed among subgroups stratified by demographic variables. Encouraging news or events were detected surrounding positive sentiments crests. Sentiments in pregnancy-related tweets demonstrated a lagged pattern compared with the general population, with delayed vaccine uptake trends. Feature analysis detected hesitancies stemmed from clinical trial logics, risks and complications, and urgency of scientific evidence. DISCUSSION Integrating social media and public health surveillance data, we associated the sentiments at individual level with observed populational-level vaccination patterns. By unraveling the distinctive patterns across subpopulations, the findings provided evidence-based strategies for improving vaccine promotion during pandemics.
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Affiliation(s)
- Hanyin Wang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Yikuan Li
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Meghan R Hutch
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adrienne S Kline
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sebastian Otero
- Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Leena B Mithal
- Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Emily S Miller
- Department of Obstetrics & Gynecology, Northwestern Medicine, Chicago, Illinois, USA
| | - Andrew Naidech
- Department of Neurology, Northwestern Medicine, Chicago, Illinois, USA
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Payne JR, Bose S, Kubiak RW, Nolen LD. Evaluation of mortality risk after COVID-19 vaccination, Utah 2021. Vaccine 2023; 41:2996-3002. [PMID: 37037710 PMCID: PMC10073592 DOI: 10.1016/j.vaccine.2023.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
Introduction In order to evaluate trends in death after COVID-19 vaccination we analyzed the timing of death relative to vaccination date and the causes of death in vaccinated Utahns in 2021. Methods We matched people in the Utah immunization registry with documented COVID-19 vaccinations between December 18, 2020 and December 31, 2021 to Utah’s 2021 vital statistics death records. Vaccinated people were categorized as having one, two, or ≥three COVID-19 vaccine doses in a time-updated metric. We examined crude mortality rates by dosing groups in two-week intervals for all deaths, and by COVID-19 versus non-COVID-19 causes, within the 44 weeks following receipt of the most recent vaccine. Results We identified 2,072,908 individuals who received at least one dose of COVID-19 vaccine of whom 10,997 died in 2021. Only 17.5% of the total vaccinated population was age 65+, while 80.9% of those who died were over 65. In the four weeks following the first or second vaccination, all-cause mortality was low and then stabilized for the remainder of the evaluation period at a bi-weekly average of 33.0 and 39.0 deaths/100,000 people for one and two doses, respectively. Typical seasonal variation in death was observed among those with two doses. Small sample size precluded analysis of those with ≥three doses, but trends were similar. Conclusions Mortality rates in the 44 weeks following the COVID-19 vaccination did not show trends suggesting an increase in mortality related to COVID-19 vaccination, reinforcing the safety of COVID-19 vaccines. This represents an accessible approach for local evaluation.
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Affiliation(s)
- Jessica R Payne
- Utah Department of Health and Human Services, Salt Lake City, UT, USA.
| | - Srimoyee Bose
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | - Rachel W Kubiak
- Utah Department of Health and Human Services, Salt Lake City, UT, USA; CDC Foundation, Atlanta, GA, USA
| | - Leisha D Nolen
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
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Duncan DT, Park SH, Chen YT, Dolotina B, Worrall WR, Hanson H, Durrell M, Franco GA, Morse SS, Schneider JA. HIV Care Engagement Is Not Associated with COVID-19 Vaccination Hesitancy during the Initial Peak of the COVID-19 Pandemic among Black Cisgender Sexual Minority Men and Transgender Women in the N2 COVID Study. Vaccines (Basel) 2023; 11:vaccines11040787. [PMID: 37112699 PMCID: PMC10146179 DOI: 10.3390/vaccines11040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Although there is limited literature on medication adherence (including HIV care engagement) and COVID-19 vaccine hesitancy in general populations (i.e., non-sexual or gender minority populations), even less is known about whether HIV care engagement correlates with COVID-19 vaccine hesitancy among sexual and gender minorities, especially those from intersectional backgrounds. The objective of the current study was to examine if an association exists between HIV status neutral care (i.e., current pre-exposure prophylaxis [PrEP] or antiretroviral therapy [ART] use) and COVID-19 vaccination hesitancy among Black cisgender sexual minority men and transgender women at the initial peak of the pandemic. Methods: We conducted the N2 COVID Study in Chicago from 20 April 2020 to 31 July 2020 (analytic n = 222), including Black cisgender sexual minority men and transgender women who were vulnerable to HIV as well as those who were living with HIV. The survey included questions regarding HIV care engagement, COVID-19 vaccination hesitancy and COVID-19 related socio-economic hardships. Multivariable associations estimated adjusted risk ratios (ARRs) using modified Poisson regressions for COVID vaccine hesitancy adjusting for baseline socio-demographic characteristics and survey assessment time period. Results: Approximately 45% of participants reported COVID-19 vaccine hesitancy. PrEP and ART use were not associated with COVID-19 vaccine hesitancy when examined separately or combined (p > 0.05). There were no significant multiplicative effects of COVID-19 related socio-economic hardships and HIV care engagement on COVID-19 vaccine hesitancy. Conclusions: Findings suggest no association between HIV care engagement and COVID-19 vaccine hesitancy among Black cisgender sexual minority men and transgender women at the initial peak of the pandemic. It is therefore essential that COVID-19 vaccine promotion interventions focus on all Black sexual and gender minorities regardless of HIV care engagement and COVID-19 vaccine uptake is likely related to factors other than engagement in HIV status neutral care.
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Affiliation(s)
- Dustin T. Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Su Hyun Park
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Yen-Tyng Chen
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ 08901, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Brett Dolotina
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Wilder R. Worrall
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, IL 60637, USA
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | | | - Stephen S. Morse
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - John A. Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
- Crown Family School of Social Work, Policy and Practice, University of Chicago, Chicago, IL 60637, USA
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Brandt S, Demmer RT, Walsh S, Mulcahy JF, Zepeda E, Yendell S, Hedberg C, Ulrich AK, Beebe T. COVID-19 Vaccine Hesitancy in a Population-Based Study of Minnesota Residents. Vaccines (Basel) 2023; 11:vaccines11040766. [PMID: 37112678 PMCID: PMC10143128 DOI: 10.3390/vaccines11040766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
COVID-19 continues to be a public health concern in the United States. Although safe and effective vaccines have been developed, a significant proportion of the US population has not received a COVID-19 vaccine. This cross-sectional study aimed to describe the demographics and behaviors of Minnesota adults who have not received the primary series of the COVID-19 vaccine, or the booster shot using data from the Minnesota COVID-19 Antibody Study (MCAS) collected through a population-based sample between September and December 2021. Data were collected using a web-based survey sent to individuals that responded to a similar survey in 2020 and their adult household members. The sample was 51% female and 86% White/Non-Hispanic. A total of 9% of vaccine-eligible participants had not received the primary series and 23% of those eligible to receive a booster had not received it. Older age, higher education, better self-reported health, $75,000 to $100,000 annual household income, mask-wearing, and social distancing were associated with lower odds of hesitancy. Gender, race, and previous COVID-19 infection were not associated with hesitancy. The most frequently reported reason for not receiving a COVID-19 vaccination was safety concerns. Mask-wearing and being age 65 or older were the only strong predictors of lower odds of vaccine hesitancy for both the primary series and booster analyses.
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Cohen DB, Saling LL, Lee E, Zagura A. Moral, self-interested, and social motivation each predict compliance with social distancing rules: utilitarianism is an indirect positive predictor. BMC Psychol 2023; 11:85. [PMID: 36991517 PMCID: PMC10054198 DOI: 10.1186/s40359-023-01093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 02/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Social distancing rules have proven to be essential in reducing the spread of COVID-19. However, we can optimise these rules if we identify factors which predict compliance. Thus, in this study we investigated whether compliance with distancing rules is predicted by whether an individual is motivated by moral, self-interested, or social reasons. We also investigated the impact of an individual's utilitarian orientation both on compliance itself and on reasons for compliance. METHODS Our sample consisted of 301 participants recruited from four US states - California, Oregon, Mississippi, and Alabama - who completed an anonymous online survey. Six vignettes describing hypothetical social distancing rules were developed for the study. Participants indicated (i) how likely they were to violate each hypothetical distancing rule, (ii) how morally wrong violating each rule would be, (iii) how much risk of contracting COVID-19 they would tolerate in order to violate each rule, and (iv) how much social condemnation they would tolerate in order to violate each rule. Based on these responses, we gauged each participant's overall degree of compliance with social distancing rules as well as the extent to which each participant's compliance is motivated by moral, self-interested, and social reasons. We also measured other variables that could affect compliance including personality, level of religiosity, and inclination to engage in utilitarian reasoning. Multiple regression and exploratory structural equation modelling were used to determine predictors of compliance with social distancing rules. RESULTS We found that moral, self-interested, and social motivation each positively predicted compliance, with self-interested motivation being the strongest predictor. Furthermore, utilitarian orientation indirectly predicted compliance, with moral, self-interested, and social motivation as positive mediating factors. No controlled covariates (personality factors, religiosity, political orientation, or other background variables) predicted compliance. CONCLUSION These findings have implications not only for the design of social distancing rules but also for efforts to ensure vaccine uptake. Governments need to consider how to harness moral, self-interested, and social motivation to promote compliance, perhaps by co-opting utilitarian reasoning, which positively influences these motivational forces.
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Affiliation(s)
- Daniel B Cohen
- School of Social Work and Arts, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia.
| | - Lauren L Saling
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Eunro Lee
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Anabella Zagura
- School of Social Work and Arts, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia
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Campman SL, van Rossem G, Boyd A, Coyer L, Schinkel J, Agyemang C, Galenkamp H, Koopman ADM, Leenstra T, Schim van der Loeff M, Moll van Charante EP, van den Born BH, Lok A, Verhoeff A, Zwinderman AH, Jurriaans S, Stronks K, Prins M. Intent to vaccinate against SARS-CoV-2 and its determinants across six ethnic groups living in Amsterdam, the Netherlands: A cross-sectional analysis of the HELIUS study. Vaccine 2023; 41:2035-45. [PMID: 36803902 DOI: 10.1016/j.vaccine.2023.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/19/2022] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Ethnic minority groups experience a disproportionately high burden of infections, hospitalizations and mortality due to COVID-19, and therefore should be especially encouraged to receive SARS-CoV-2 vaccination. This study aimed to investigate the intent to vaccinate against SARS-CoV-2, along with its determinants, in six ethnic groups residing in Amsterdam, the Netherlands. METHODS We analyzed data of participants enrolled in the population-based multi-ethnic HELIUS cohort, aged 24 to 79 years, who were tested for SARS-CoV-2 antibodies and answered questions on vaccination intent from November 23, 2020 to March 31, 2021. During the study period, SARS-CoV-2 vaccination in the Netherlands became available to individuals working in healthcare or > 75 years old. Vaccination intent was measured by two statements on a 7-point Likert scale and categorized into low, medium, and high. Using ordinal logistic regression, we examined the association between ethnicity and lower vaccination intent. We also assessed determinants of lower vaccination intent per ethnic group. RESULTS A total of 2,068 participants were included (median age 56 years, interquartile range 46-63). High intent to vaccinate was most common in the Dutch ethnic origin group (369/466, 79.2%), followed by the Ghanaian (111/213, 52.1%), South-Asian Surinamese (186/391, 47.6%), Turkish (153/325, 47.1%), African Surinamese (156/362, 43.1%), and Moroccan ethnic groups (92/311, 29.6%). Lower intent to vaccinate was more common in all groups other than the Dutch group (P < 0.001). Being female, believing that COVID-19 is exaggerated in the media, and being < 45 years of age were common determinants of lower SARS-CoV-2 vaccination intent across most ethnic groups. Other identified determinants were specific to certain ethnic groups. CONCLUSIONS Lower intent to vaccinate against SARS-CoV-2 in the largest ethnic minority groups of Amsterdam is a major public health concern. The ethnic-specific and general determinants of lower vaccination intent observed in this study could help shape vaccination interventions and campaigns.
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Kranzler EC, Luchman JN, Williams CJ, Model TA, Ostby R, Vines M, Weinberg J, Petrun Sayers EL, Kurti AN, Trigger S, Hoffman L, Peck J. Recalled Exposure to COVID-19 Public Education Campaign Advertisements Predicts COVID-19 Vaccine Confidence. J Health Commun 2023; 28:144-155. [PMID: 37050887 DOI: 10.1080/10810730.2023.2181891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This study examined the relationship between recalled exposure to the We Can Do This COVID-19 Public Education Campaign (the Campaign) and COVID-19 vaccine confidence (the likelihood of vaccination or vaccine uptake) in the general population, including vaccine-hesitant adults (the "Movable Middle"). Analyses used three waves of a triannual, nationally representative panel survey of adults in the U.S. fielded from January to November 2021 (n = 3,446). Proportional odds regression results demonstrated a positive, statistically significant relationship between past 4-month Campaign recall and vaccine confidence, controlling for lagged reports of Campaign recall and vaccine confidence; concurrent and lagged fictional campaign recall; survey wave; and sociodemographics. Results indicated that as one moves from no Campaign recall to infrequent recall, there is a 29% increase in the odds of being in a higher vaccine confidence category. Findings offer evidence of the impact of a COVID-19 public education campaign on increasing vaccine confidence.
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Affiliation(s)
- Elissa C Kranzler
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
| | | | | | | | - Ronne Ostby
- Insights & Strategy, Fors Marsh, Arlington, Virginia, USA
| | - Monica Vines
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, USA
| | - Jessica Weinberg
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, USA
| | - Elizabeth L Petrun Sayers
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, USA
| | - Allison N Kurti
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, USA
| | - Sarah Trigger
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, USA
| | - Leah Hoffman
- Communication Campaign Research & Evaluation, Fors Marsh, Arlington, Virginia, USA
| | - Joshua Peck
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Public Affairs, Washington, District of Columbia, USA
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Hurstak EE, Paasche-Orlow MK, Hahn EA, Henault LE, Taddeo MA, Moreno PI, Weaver C, Marquez M, Serrano E, Thomas J, Griffith JW. The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago. Vaccine 2023:S0264-410X(23)00202-5. [PMID: 36907736 DOI: 10.1016/j.vaccine.2023.02.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas. METHODS Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI). RESULTS Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree). CONCLUSIONS Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity. CLINICAL TRIALS NUMBER NCT03584490.
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Cawley JF. The Antivaccination Movement and Vaccine Hesitancy. Physician Assistant Clinics 2023. [DOI: 10.1016/j.cpha.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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