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Mercado M, Lopez G, Ignacio M, Ayers S, Carver A, Hamm K, Wolfersteig W, Oesterle S. Hesitant or Confident: A Qualitative Study Examining Latinos' Perceptions of COVID-19 Vaccines in Arizona. HEALTH EDUCATION & BEHAVIOR 2024; 51:512-520. [PMID: 38804533 DOI: 10.1177/10901981241255619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
This study aimed to understand vaccine hesitancy and confidence toward the COVID-19 vaccines among Latino adults in Arizona. Latinos (n = 71) aged 18 years or older who resided in Arizona participated in 14 focus groups between February and June 2021. Theoretical thematic analysis was used to examine drivers of these two behaviors, namely, vaccine hesitancy and confidence toward the COVID-19 vaccines, using the COM-B model, comprising capability, opportunity, and motivation factors that generate a behavior. Vaccine hesitancy stemmed from the need for vaccine information (capability factor) and fear of the vaccines, religious beliefs, and perceived barriers stemming from government mistrust (motivation factors). Vaccine confidence arose from trust in science and doctors (capability factor), and a fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors). The influence of opportunity factors, such as having access to vaccinations, were not discussed as contributing to vaccine confidence or hesitancy. As predicted by the COM-B model, factors reflecting capabilities and motivations contributed to vaccine hesitancy and confidence, all of which need to be considered in public health messaging. These factors can be targeted to facilitate efforts to promote vaccine uptake and reduce the spread of COVID-19.
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Affiliation(s)
- Micaela Mercado
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Gilberto Lopez
- School of Transboarder Studies, Arizona State University, Phoenix, AZ, USA
| | - Matt Ignacio
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Stephanie Ayers
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Ann Carver
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Kathryn Hamm
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Wendy Wolfersteig
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
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Prieto-Campo Á, Vázquez-Cancela O, Roque F, Herdeiro MT, Figueiras A, Zapata-Cachafeiro M. Unmasking vaccine hesitancy and refusal: a deep dive into Anti-vaxxer perspectives on COVID-19 in Spain. BMC Public Health 2024; 24:1751. [PMID: 38951819 PMCID: PMC11218155 DOI: 10.1186/s12889-024-18864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/16/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND At the time of the emergence of COVID-19, denialist and anti-vaccine groups have also emerged and are shaking public confidence in vaccination. METHODS A qualitative study was conducted using online focus groups. Participants had not received any doses of vaccination against the disease. A total of five focus group sessions were conducted with 28 participants. They were recruited by snowball sampling and by convenience sampling. RESULTS The two major topics mentioned by the participants were adverse effects and information. The adverse effects described were severe and included sudden death. In the case of information, participants reported: (1) consultation of websites on which scientists posted anti-vaccination content; and (2) distrust. CONCLUSIONS At a time when anti-vaccine groups pose a major challenge to public health in general, and to COVID-19 vaccination campaigns in particular, this study is a first step towards gaining deeper insight into the factors that lead to COVID-19 vaccine refusal.
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Affiliation(s)
- Ángela Prieto-Campo
- Department of Public Health, Faculty of Pharmacy, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Olalla Vázquez-Cancela
- Department of Public Health, Faculty of Pharmacy, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
| | - Fátima Roque
- Research Unit for Inland Development (Unidade para o Desenvolvimento do Interior/UDI-IPG), Polytechnic of Guarda, Guarda, Portugal
- Health Sciences Research Centre (Centro de Investigação em Ciências da Saúde/CICS-UBI), University of Beira Interior, Covilhã, Portugal
- School of Health Sciences (Escola Superior de Saúde/ESS), Guarda Polytechnic Institute, Guarda, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Adolfo Figueiras
- Department of Public Health, Faculty of Pharmacy, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Carlos III Institute of Health, Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela/IDIS), A Coruña, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Public Health, Faculty of Pharmacy, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Carlos III Institute of Health, Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela/IDIS), A Coruña, Spain
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Nawaz S, Moon KJ, Anagbonu F, Trinh A, Escobedo L, Montiel GI. Evaluation of the COVID-19 Vaccination Campaign ¡Ándale! ¿Qué Esperas? in Latinx Communities in California, June 2021-May 2022. Public Health Rep 2024; 139:44S-52S. [PMID: 37957827 DOI: 10.1177/00333549231204043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVES The 12-month vaccination campaign ¡Ándale! ¿Qué Esperas? was launched to increase COVID-19 vaccination rates in Latinx populations in California by expanding community outreach. The objectives of this evaluation were to (1) determine predictors of vaccination rates and (2) identify barriers to vaccination and potential solutions. METHODS Five community partners in California serving Latinx populations with high social vulnerability participated in the ¡Ándale! ¿Qué Esperas? campaign. Community health workers were hired to deliver outreach (virtual, one-on-one, group based, and information dissemination), vaccinations, and supportive services. We collected data on outreach strategy used (method and location), number of vaccinations provided and reasons for delay, and number of times that supportive services were provided. We used regression models to assess significant predictors of vaccinations and supportive services. RESULTS Community health workers (N = 146) hired from June 1, 2021, through May 31, 2022, performed outreach engagements (n = 6297) and supportive services (n = 313 796), resulting in 130 413 vaccinations and 28 660 vaccine appointments. The number of vaccinations administered was significantly higher at events in which supportive services were provided versus not provided (coefficient = 34.02; 95% CI, 3.34-64.68; P = .03). The odds ratio of supportive services was 3.67 (95% CI, 1.76-7.55) during virtual outreach and 2.95 (95% CI, 2.37-3.69) during one-on-one outreach (P < .001 for both) as compared with information dissemination encounters. Vaccination concerns were reported among 55.0% of vaccinated survey respondents (67.7%, vaccine confidence; 51.7%, access). CONCLUSIONS Supportive services facilitate vaccinations, ease transportation and time barriers, and instill confidence among working-class racial and ethnic minority populations.
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Affiliation(s)
- Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus, OH, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus, OH, USA
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Francis Anagbonu
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Anne Trinh
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Lizette Escobedo
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
| | - Gloria Itzel Montiel
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
- Claremont Graduate University, Claremont, CA, USA
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Kim SY, Wen W, Coulter KM, Tse HW, Du Y, Chen S, Hou Y, Shen Y. Sociocultural Antecedents and Mechanisms of COVID-19 Vaccine Uptake among Mexican-Origin Youth. Behav Med 2024:1-12. [PMID: 38874131 DOI: 10.1080/08964289.2024.2355117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 05/09/2024] [Indexed: 06/15/2024]
Abstract
Mexican-origin youth, as a large and growing population among U.S. youth, have been disproportionately affected by COVID-19. Understanding what, when, and how sociocultural factors may influence their COVID-19 vaccine uptake could inform current and future pandemic-response interventions promoting vaccination behaviors among Mexican-origin youth. The current study takes a developmental approach to reveal the long-term and short-term sociocultural antecedents of 198 Mexican-origin adolescents' COVID-19 vaccination uptake behaviors and explores the underlying mechanism of these associations based on the Knowledge-Attitude-Behavior model. The current study adopted Wave 1 (2012-2015) and Wave 4 (2021-2022) self-reported data from a larger study. Analyses were conducted to examine four mediation models for four sociocultural antecedents-daily discrimination, ethnic discrimination, foreigner stress, and family economic stress-separately. Consistent indirect effects of higher levels of concurrent sociocultural risk factors on a lower probability of COVID-19 vaccine uptake were observed to occur through less knowledge about the COVID-19 vaccines and less positive attitudes toward the COVID-19 vaccines at Wave 4. Significant direct effects, but in opposite directions, were found for the associations between Wave 1 ethnic discrimination/Wave 4 daily discrimination and the probability of COVID-19 vaccine uptake. The findings highlight the importance of considering prior and concurrent sociocultural antecedents and the Knowledge-Attitude-Behavior pathway leading to COVID-19 vaccination uptake among Mexican-origin youth and suggest that the impact of discrimination on COVID-19 vaccination uptake may depend on the type (e.g., daily or ethnic) and the context (e.g., during the COVID-19 pandemic or not) of discrimination experienced.
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Affiliation(s)
- Su Yeong Kim
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Wen Wen
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Kiera M Coulter
- Population Research Center, The University of Texas at Austin, Austin, TX, USA
| | - Hin Wing Tse
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Yayu Du
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Shanting Chen
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Yang Hou
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Yishan Shen
- School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
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Keane A, Tippett A, Taylor EG, Reese O, Salazar L, De Castro K, Choi C, Ciric C, Taylor M, Mitchell A, Gibson T, Puzniak L, Hubler R, Valluri SR, Wiemken TL, Lopman BA, Kamidani S, Anderson LJ, McLaughlin JM, Rostad CA, Anderson EJ. Effectiveness of BNT162b2 Vaccine for Preventing COVID-19-Related Hospitalizations: A Test-Negative Case-Control Study. Vaccines (Basel) 2024; 12:657. [PMID: 38932386 PMCID: PMC11209557 DOI: 10.3390/vaccines12060657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
It is important to understand real-world BNT162b2 COVID-19 vaccine effectiveness (VE), especially among racial and ethnic minority groups. We performed a test-negative case-control study to measure BNT162b2 COVID-19 VE in the prevention of COVID-19-associated acute respiratory illness (ARI) hospitalizations at two Atlanta hospitals from May 2021-January 2023 and adjusted for potential confounders by multivariate analysis. Among 5139 eligible adults with ARI, 2763 (53.8%) were enrolled, and 1571 (64.5%) were included in the BNT162b2 analysis. The median age was 58 years (IQR, 44-68), 889 (56.6%) were female, 1034 (65.8%) were African American, 359 (22.9%) were White, 56 (3.6%) were Hispanic ethnicity, 645 (41.1%) were SARS-CoV-2-positive, 412 (26.2%) were vaccinated with a primary series, and 273 (17.4%) had received ≥1 booster of BNT162b2. The overall adjusted VE of the BNT162b2 primary series was 58.5% (95% CI 46.0, 68.1), while the adjusted VE of ≥1 booster was 78.9% (95% CI 70.0, 85.1). The adjusted overall VE of primary series for African American/Black individuals was 64.0% (95% CI 49.9, 74.1) and 82.7% (95% CI 71.9, 89.4) in those who received ≥1 booster. When analysis was limited to the period of Omicron predominance, overall VE of the primary series decreased with widened confidence intervals (24.5%, 95% CI -4.5, 45.4%), while VE of ≥1 booster was maintained at 60.9% (95% CI 42.0, 73.6). BNT162b2 primary series and booster vaccination provided protection against COVID-19-associated ARI hospitalization among a predominantly African American population.
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Affiliation(s)
- Amy Keane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Ashley Tippett
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Elizabeth Grace Taylor
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Olivia Reese
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Luis Salazar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Khalel De Castro
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Chris Choi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Caroline Ciric
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Meg Taylor
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Anna Mitchell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
| | - Laura Puzniak
- Pfizer, Inc., New York, NY 10017, USA; (L.P.); (R.H.); (S.R.V.); (T.L.W.); (J.M.M.)
| | - Robin Hubler
- Pfizer, Inc., New York, NY 10017, USA; (L.P.); (R.H.); (S.R.V.); (T.L.W.); (J.M.M.)
| | - Srinivas Rao Valluri
- Pfizer, Inc., New York, NY 10017, USA; (L.P.); (R.H.); (S.R.V.); (T.L.W.); (J.M.M.)
| | - Timothy L. Wiemken
- Pfizer, Inc., New York, NY 10017, USA; (L.P.); (R.H.); (S.R.V.); (T.L.W.); (J.M.M.)
| | - Ben A. Lopman
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Satoshi Kamidani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Larry J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - John M. McLaughlin
- Pfizer, Inc., New York, NY 10017, USA; (L.P.); (R.H.); (S.R.V.); (T.L.W.); (J.M.M.)
| | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.K.); (A.T.); (E.G.T.); (O.R.); (L.S.); (K.D.C.); (C.C.); (C.C.); (M.T.); (A.M.); (T.G.); (L.J.A.); (E.J.A.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
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Vázquez E, Juturu P, Burroughs M, McMullin J, Cheney AM. Continuum of Trauma: Fear and Mistrust of Institutions in Communities of Color During the COVID-19 Pandemic. Cult Med Psychiatry 2024; 48:290-309. [PMID: 37776491 PMCID: PMC11217119 DOI: 10.1007/s11013-023-09835-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/02/2023]
Abstract
Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions.
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Affiliation(s)
- Evelyn Vázquez
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, 900 University Avenue, Riverside, CA, 92521-9800, USA
| | - Preeti Juturu
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Michelle Burroughs
- Center for Healthy Communities, University of California, Riverside, USA
| | - Juliet McMullin
- Department of Family Medicine, School of Medicine, University of California, Irvine, USA
| | - Ann M Cheney
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, 900 University Avenue, Riverside, CA, 92521-9800, USA.
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Kaczynski M, Vassilopoulos A, Vassilopoulos S, Sisti A, Benitez G, Tran QL, Mylona EK, Shehadeh F, Rogers R, Mylonakis E. Temporal trends and characteristics associated with racial, ethnic, and sex representation in COVID-19 clinical trials: A systematic review and meta-analysis. Contemp Clin Trials 2024; 143:107578. [PMID: 38789079 DOI: 10.1016/j.cct.2024.107578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 05/05/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Early in the pandemic, extensive attention was cast on limited inclusion of historically underrepresented patient populations in COVID-19 clinical trials. How diverse representation improved following these initial reports remains unclear. METHODS PubMed, Embase and the Cochrane Library were searched (through April 2024) for US-based COVID-19 trials. Utilizing random-effects, we compared expected proportions of trial participants from racial and ethnic groups and of female sex between trials enrolling primarily in 2020 versus primarily 2021-2022. Meta-regression was performed to assess associations between trial characteristics and group representation. RESULTS We retrieved 157 studies comprising 198,012 participants. White (2020: 63.1% [95% CI, 60.8%-67.3%]; 2021-2022: 73.8% [95% CI, 71.5%-76.0%]) and female representation (2020: 46.1% [95% CI, 44.7%-47.4%)]; 2021-2022: 51.1% [95% CI, 49.3%-52.8%) increased across enrollment periods. Industry-sponsored trials were associated with higher White (coefficient, 0.10 [95% CI, 0.03-0.18]) and Hispanic or Latinx representation (coefficient, 0.16 [95% CI, 0.08-0.25]) and lower Asian (coefficient, -0.03 [95% CI, -0.06- -0.003]) and female representation (coefficient, -0.03 [95% CI, -0.07- -0.002]). Outpatient trials were associated with higher White (coefficient, 0.20 [95% CI, 0.13-0.26]) and female representation (coefficient, 0.16 [95% CI, 0.13-0.18]), and lower Black representation (coefficient, -0.10 [95% CI, -0.10- -0.08]). CONCLUSIONS Despite improved female representation in COVID-19 trials over time, there was no clear increase in non-White representation. Trial characteristics such as primary sponsor, clinical setting, and intervention type correlate with representation of specific demographic groups and should be considered in future efforts to improve participant diversity.
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Affiliation(s)
- Matthew Kaczynski
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Athanasios Vassilopoulos
- Department of Internal Medicine, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Stephanos Vassilopoulos
- Department of Internal Medicine, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anthony Sisti
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Gregorio Benitez
- Infectious Diseases Division, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Quynh-Lam Tran
- Geisel School of Medicine at Dartmouth University, Hanover, NH, USA
| | - Evangelia K Mylona
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Fadi Shehadeh
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA; School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Ralph Rogers
- Infectious Diseases Division, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School at Brown University, Providence, RI, USA; Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
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Soto-Vásquez AD, Gonzalez AA, Garza Garza E, Shi W, Garcia N. The Cultural Influence of Familismo in Prompting Vaccination Against COVID-19 Among U.S. Latina/o/x Border Residents. HEALTH COMMUNICATION 2024:1-11. [PMID: 38744433 DOI: 10.1080/10410236.2024.2353418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This study centers on familismo as a relevant cultural construct that adds a U.S. Latina/o/x perspective to the Health Belief Model. Employing a qualitative lens, we use in-depth semi-structured focus groups and interviews with participants living, working, and attending school in a mid-size city on the U.S./Mexico border on the decision to take the COVID-19 vaccine. We find that, for many members of these communities, getting vaccinated is seen as a way to protect not only oneself but also one's family, especially those with chronic health conditions, reflecting an obligation to prioritize the collective over the individual. We highlight various approaches that families take to discuss COVID-19 vaccines, ranging from women coordinating vaccination to a non-confrontational approach to the unvaccinated. The borderlands as a place also showcase the diversity of the U.S. Latina/o/x experience during the pandemic, since the perceived disparities of vaccine access in Mexico also seemed to cue the decision to get vaccinated. We propose this helps explain the exceptionally high vaccination rate in the city under study and seen in several other border communities. By illuminating how familial ties impact health communication surrounding this important issue, this study adds an expanded Latina/o/x cultural context for aspects of the Health Belief Model such as perceived severity and susceptibility.
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Affiliation(s)
| | - Ariadne A Gonzalez
- Department of Psychology and Communication, Texas A&M International University
| | - Edith Garza Garza
- Department of Psychology and Communication, Texas A&M International University
| | - Wanzhu Shi
- Department of Political Science and Public Administration, University of North Florida
| | - Nilda Garcia
- Department of Social Sciences, Texas A&M International University
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9
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Castellon-Lopez YM, Klomhaus AM, Garcia C, Marquez D, Avila H, Gravette H, Lopez-Chang R, Ortega B, Norris KC, Brown AF, Blanco L. MivacunaLA (MyshotLA): A Community-Partnered Mobile Phone Intervention to Improve COVID-19 Vaccination Behaviors among Low-Income, Spanish-Speaking, and Immigrant Latino Parents or Caregivers. Vaccines (Basel) 2024; 12:511. [PMID: 38793762 PMCID: PMC11125729 DOI: 10.3390/vaccines12050511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
We developed and tested MivacunaLA/MyshotLA, a community-informed mobile phone intervention, to increase COVID-19 vaccination among Latino parents/caretakers of minors in under-resourced areas of Los Angeles by addressing misinformation and building trust. We recruited Latino parents/caregivers with at least one unvaccinated child in East and South Los Angeles in the summer of 2021 and evaluated MivacunaLA as a randomized controlled trial with a wait-list control group. A difference-in-difference analysis showed Latino parents/caregivers that participated in MivacunaLA (n = 246), in comparison to the control group, were 15 percentage points more likely (p = 0.04) to report vaccination of minors aged 12-17 years, and 12 percentage points more likely (p = 0.03) to report a positive intention to vaccinate minors aged 2-11 years (when COVID-19 vaccines became available). Mobile phone-delivered digital interventions using videos and culturally tailored educational material to promote COVID-19 vaccine confidence can be an effective way to combat misinformation and deliver timely information to marginalized communities. Community-based participatory research approaches are crucial to advance health equity among minority communities, especially immigrant Spanish-speaking underserved communities.
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Affiliation(s)
- Yelba M. Castellon-Lopez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Alexandra M. Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Cruz Garcia
- School of Public Policy, Pepperdine University, Malibu, CA 90263, USA; (C.G.); (L.B.)
| | - Denise Marquez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Hilda Avila
- Families in Schools, Los Angeles, CA 90017, USA;
| | | | | | | | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.C.N.); (A.F.B.)
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.C.N.); (A.F.B.)
- Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Luisa Blanco
- School of Public Policy, Pepperdine University, Malibu, CA 90263, USA; (C.G.); (L.B.)
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10
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Burrage RL, Mills KJ, Coyaso HC, Gronowski CK, Godinet MT. Community Resilience and Cultural Responses in Crisis: Lessons Learned from Pacific Islander Responses to the COVID-19 Pandemic in the USA. J Racial Ethn Health Disparities 2024; 11:560-573. [PMID: 36849862 PMCID: PMC9970122 DOI: 10.1007/s40615-023-01541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
Pacific Islander communities in the USA experienced some of the most severe effects of the COVID-19 pandemic. This qualitative synthesis examines the literature on Pacific Islander community responses and lessons learned from COVID-19, using a systematic search that identified 28 articles with this focus. Thematic analysis was subsequently used to classify both documented efforts by Pacific Islander communities to respond to the pandemic, as well as lessons learned and best practices from research in this area. Results revealed multiple efforts to address the pandemic, including Pacific Islander grassroots approaches, government responses, inter-sector collaboration, and research. Results further emphasized the importance of culturally and linguistically responsive outreach and messaging; partnership, engagement, and capacity building; and changes in research and policy approaches to promote health equity. Future efforts to address public health crises should make the most of Pacific Islander cultural approaches to disaster response. To achieve this, government and other organizations that work with PI communities need to support the development of the PI leadership, healthcare and research workforces, and work with Pacific Islander communities to build long-term, sustainable, and trustworthy partnerships.
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Affiliation(s)
- Rachel L Burrage
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA.
| | - Kelsey J Mills
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Hope C Coyaso
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Chrisovolandou K Gronowski
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
| | - Meripa T Godinet
- Department of Social Work, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, USA
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11
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Driedger SM, Maier R, Capurro G, Jardine C, Tustin J, Chartrand F, Sanguins J, Kloss O. "There's a little bit of mistrust": Red River Métis experiences of the H1N1 and COVID-19 pandemics. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024. [PMID: 38286593 DOI: 10.1111/risa.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/24/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024]
Abstract
We examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID-19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID-19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID-19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine-safety test subjects before population-wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non-prioritization of the Métis during COVID-19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign-though understandable-interpretations.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Maier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabriela Capurro
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cindy Jardine
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Frances Chartrand
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
| | - Julianne Sanguins
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
| | - Olena Kloss
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
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12
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Mensah GA, Johnson LE, Zhang X, Stinson N, Carrington K, Malla G, Land SR, Huff E, Freeman N, Stoney C, Ampey B, Paltoo D, Clark D, Rajapakse N, Ilias MR, Haase KP, Punturieri A, Kurilla MG, Archer H, Bolek M, Santos M, Wilson-Frederick S, Devaney S, Marshall V, Farhat T, Hooper MW, Wilson DR, Perez-Stable EJ, Gibbons GH. Community Engagement Alliance (CEAL): A National Institutes of Health Program to Advance Health Equity. Am J Public Health 2024; 114:S12-S17. [PMID: 37944098 PMCID: PMC10785165 DOI: 10.2105/ajph.2023.307476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Affiliation(s)
- George A Mensah
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Lenora E Johnson
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Xinzhi Zhang
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Nathan Stinson
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Kelli Carrington
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Gargya Malla
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Stephanie R Land
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Erynn Huff
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Naomi Freeman
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Catherine Stoney
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Bryan Ampey
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Dina Paltoo
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Dave Clark
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Nishadi Rajapakse
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Maliha R Ilias
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Karen Plevock Haase
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Antonello Punturieri
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Michael G Kurilla
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Hillary Archer
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Michelle Bolek
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Melanie Santos
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Shondelle Wilson-Frederick
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Stephanie Devaney
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Vanessa Marshall
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Tilda Farhat
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Monica Webb Hooper
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - David R Wilson
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Eliseo J Perez-Stable
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
| | - Gary H Gibbons
- George A. Mensah, Xinzhi Zhang, Maliha R. Ilias, and Karen Plevock Haase are with the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD. Lenora E. Johnson, Hillary Archer, Michelle Bolek, Melanie Santos, and Shondelle Wilson-Frederick are with the Office of Science Policy, Engagement, Education, and Communications, NHLBI. Nathan Stinson Jr, Kelli Carrington, Gargya Malla, Vanessa Marshall, Tilda Farhat, Monica Webb Hooper, and Eliseo J. Perez-Stable are with the National Institute on Minority Health and Health Disparities, NIH. Stephanie R. Land is with the National Cancer Institute, NIH. Erynn Huff and Naomi Freeman are with the Office of Management, Immediate Office of the Director, NHLBI. Catherine Stoney is with Stoney Consulting, Washington, DC. Bryan Ampey and Dina Paltoo are with the Immediate Office of the Director, NHLBI. Dave Clark is with the Eunice Kennedy Schriver National Institute of Child Health and Human Development, NIH. Nishadi Rajapakse is with the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Antonello Punturieri is with the Division of Lung Diseases, NHLBI. Michael G. Kurilla is with the National Center for Advancing Translational Sciences, NIH. Stephanie Devaney is with the All of Us Research Program, Office of the Director, NIH. David R. Wilson is with the Office of the Director, NIH
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13
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Al-Saudi G, Thabit AK, Jose J, Badr AF, Jad L, Kaae S, Jacobsen R. Exploring the reasons behind low COVID-19 vaccination coverage in ethnic minorities-A qualitative study among Arabic-speaking public in Denmark. Health Policy 2024; 139:104965. [PMID: 38104373 DOI: 10.1016/j.healthpol.2023.104965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
AIMS In Denmark, COVID-19 infection rates have been higher, and vaccination coverage has been lower in areas with many residents from ethnic minority backgrounds. This study aimed to explore COVID-19 vaccination perceptions among Arabic-speaking minorities in Denmark. MATERIALS AND METHODS A total of 16 individuals, varying in age, gender, education, employment, health, vaccination status, and the Arabic-speaking country of origin, were recruited and interviewed in Arabic. The interviews were transcribed verbatim, translated into English, and analyzed using directed thematic analysis. RESULTS Most interviewees had some knowledge about how vaccines work to prevent infections; however, a wide spectrum of opinions about the effectiveness and safety of COVID-19 vaccines and vaccination policies in Denmark emerged. COVID-19 vaccination issues were extensively discussed in Arabic-speaking communities, but consensus was rarely reached. Many participants felt confused and only took vaccines for practical considerations, such as travel. Due to language barriers, some participants experienced difficulties in understanding vaccination-related information in electronic invitations from the health authorities and at vaccination centers, with family members often stepping in to provide translations. CONCLUSIONS Systematic efforts to actively disseminate translated COVID-19 vaccination information are needed to support ethnic minority individuals in making informed decisions.
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Affiliation(s)
- Ghuna Al-Saudi
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Abrar K Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jimmy Jose
- School of Pharmacy, University of Nizwa, Nizwa, Sultanate of Oman
| | - Aisha F Badr
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lama Jad
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Susanne Kaae
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ramune Jacobsen
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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14
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Oliver SE, Wallace M, Twentyman E, Moulia DL, Godfrey M, Link-Gelles R, Meyer S, Fleming-Dutra KE, Hall E, Wolicki J, MacNeil J, Bell BP, Lee GM, Daley MF, Cohn A, Wharton M. Development of COVID-19 vaccine policy - United States, 2020-2023. Vaccine 2023:S0264-410X(23)01466-4. [PMID: 38158297 DOI: 10.1016/j.vaccine.2023.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
COVID-19 vaccines represent a great scientific and public health achievement in the face of overwhelming pressures from a global pandemic, preventing millions of hospitalizations and deaths due to COVID-19 vaccines in the United States. Over 675 million doses of COVID-19 vaccines have been administered in the United States, and over 80% of the U.S. population has had at least 1 dose of a COVID-19 vaccine. Over the course of the COVID-19 pandemic in the United States, over one million people died from COVID-19, and over six million were hospitalized. It has been estimated that COVID-19 vaccines prevented more than 18 million additional hospitalizations and more than 3 million additional deaths due to COVID-19 in the United States. From the beginning of the COVID-19 pandemic in 2020 through June 2023, ACIP had 35 COVID-19 focused meetings and 24 votes for COVID-19 vaccine recommendations. ACIP had the critical task of rapidly and thoroughly reviewing emerging and evolving data on COVID-19 epidemiology and vaccines, as well as making comprehensive population-based recommendations for vaccine policy and considerations for implementation through a transparent and evidence-based framework. Safe and effective COVID-19 vaccines, recommended through transparent policy discussions with ACIP, remain the best tool we have to prevent serious illness, hospitalization and death from COVID-19.
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Affiliation(s)
- Sara E Oliver
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Megan Wallace
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Evelyn Twentyman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Danielle L Moulia
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Godfrey
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah Meyer
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine E Fleming-Dutra
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elisha Hall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - JoEllen Wolicki
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica MacNeil
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Grace M Lee
- Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Amanda Cohn
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melinda Wharton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Newman PA, Dinh DA, Nyoni T, Allan K, Fantus S, Williams CC, Tepjan S, Reid L, Guta A. Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01882-1. [PMID: 38117443 DOI: 10.1007/s40615-023-01882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada. METHODS Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations. RESULTS The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information. DISCUSSION We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
| | - Duy A Dinh
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thabani Nyoni
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kate Allan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Sophia Fantus
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Luke Reid
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
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16
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Eichelberger L, Hansen A, Cochran P, Hahn M, Fried R. COVID-19 vaccine decision-making in remote Alaska between November 2020 and November 2021. Int J Circumpolar Health 2023; 82:2242582. [PMID: 37535846 PMCID: PMC10402834 DOI: 10.1080/22423982.2023.2242582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
Vaccine hesitancy is an ongoing barrier to achieve sufficient COVID-19 vaccination coverage. Although there are many studies globally of vaccine hesitancy based on large survey samples, there are fewer in-depth qualitative studies that explore vaccine hesitancy and acceptance as a spectrum of decision-making. In this paper, we begin to describe vaccination decision-making among 58 adults living in remote Alaska based on three waves of online surveys and follow-up semi-structured interviews conducted between November 2020 and November 2021. The survey question of intention was not a predictor of adoption for about one third of the interviewees who were unvaccinated when they took the survey (n=12, 35%). Over half of all interviewees (n=37, 64%) had vaccine-related concerns, including 25 vaccinated individuals (representing 57% of vaccinated interviewees). Most interviewees reported that they learned about COVID-19 vaccines through interpersonal interactions (n=30, 52%) and/or a variety of media sources (n=29, 50%). The major facilitators of acceptance were trust in the information source (n=20, 48% of the 42 who responded), and learning from the experiences of family, friends, and the broader community (n=12, 29%). Further, trust and having a sense of agency appears to be important to interviewee decision-making, regardless of vaccination status and intention.
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Affiliation(s)
- Laura Eichelberger
- Tribal Water Center, Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Amanda Hansen
- Tribal Water Center, Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Micah Hahn
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK, USA
| | - Ruby Fried
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK, USA
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17
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Ezeh N, Sirek G, Ulysse SN, Williams JN, Chandler MT, Ojikutu BO, York M, Crespo-Bosque M, Jean-Jacques M, Roberson T, Mancera-Cuevas K, Milaeger H, Losina E, Dhand A, Son MB, Ramsey-Goldman R, Feldman CH. Understanding Stakeholders' Perspectives to Increase COVID-19 Vaccine and Booster Uptake Among Black Individuals With Rheumatic Conditions. Arthritis Care Res (Hoboken) 2023; 75:2508-2518. [PMID: 37309724 PMCID: PMC10716359 DOI: 10.1002/acr.25172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Disparities in COVID-19 vaccine and booster uptake persist. This study aimed to obtain perspectives from community and physician stakeholders on COVID-19 vaccine and booster hesitancy and strategies to promote vaccine uptake among Black individuals with rheumatic and musculoskeletal conditions. METHODS We invited community leaders and physicians in greater Boston and Chicago to participate in semi-structured interviews using a moderator guide developed a priori. Participants were queried about how to best address vaccine hesitancy, strategies to target high-risk populations, and factors to identify future community leaders. Interviews were audio recorded, transcribed verbatim, and analyzed thematically using Dedoose. RESULTS A total of 8 physicians and 12 community leaders participated in this study between November 2021 and October 2022. Qualitative analyses revealed misinformation/mixed messaging and mistrust, with subthemes including conspiracy theories, concerns regarding vaccine development and function, racism and historical injustices, and general mistrust of health care systems as the top cited reasons for COVID-19 vaccine hesitancy. Participants also shared demographic-specific differences, such as race, ethnicity, age, and gender that influenced the identified themes, with emphasis on COVID-19 vaccine access and apathy. Strategies for community-based vaccine-related information dissemination included personal storytelling with an iterative and empathetic approach, while recognizing the importance of protecting community leader well-being. CONCLUSION To increase vaccine uptake among Black individuals with rheumatic conditions, strategies should acknowledge and respond to racial/ethnic and socioeconomic injustices that engender vaccine hesitancy. Messaging should be compassionate, individually tailored, and recognize heterogeneity in experiences and opinions. Results from these analyses will inform a planned community-based intervention in Boston and Chicago.
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Affiliation(s)
- Nnenna Ezeh
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Greta Sirek
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Sciaska N. Ulysse
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Jessica N. Williams
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Mia T. Chandler
- The Rheumatology Program, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Bisola O. Ojikutu
- Harvard Medical School, Boston, MA
- Boston Public Health Commission, Boston, MA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA
| | - Michael York
- Department of Rheumatology, Boston Medical Center, Boston, MA
| | | | | | - Tonya Roberson
- College of Health and Human Services, Governors State University, University Park, IL
| | | | - Holly Milaeger
- Division of Rheumatology, Department of Medicine Northwestern Medicine/Feinberg School of Medicine, Chicago, IL
| | - Elena Losina
- Harvard Medical School, Boston, MA
- The Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedics, Brigham and Women’s Hospital, Boston, MA
| | - Amar Dhand
- Division of Neurology, Brigham and Women’s Hospital, Boston, MA
| | - Mary Beth Son
- The Rheumatology Program, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Department of Medicine Northwestern Medicine/Feinberg School of Medicine, Chicago, IL
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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18
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Goodwill JR, Fike KJ. Black in the pandemic: Comparing experiences of mistrust, anxiety, and the COVID-19 vaccine among Black adults in the U.S. Soc Sci Med 2023; 338:116302. [PMID: 37871396 DOI: 10.1016/j.socscimed.2023.116302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
COVID-19 vaccine decisions are shaped by many factors including historical and contemporary patterns of medical mistreatment of marginalized communities. In attending to these concerns, we measured whether fear of COVID-19, general feelings of mistrust, and race-specific mistrust of the government and healthcare providers are indirectly associated with COVID-19 vaccination status via anxiety among Black Americans. We analyzed responses from 996 Black adults who participated in the AmeriSpeak panel - a nationally representative probability-based sample recruited from the National Opinion Research Center from April-June 2022. We used multiple-group structural equation modeling to compare outcomes among those who lost a loved one to COVID-19 to those who did not. Results indicate that fear of COVID-19 was associated with a greater probability of being fully vaccinated for those who lost a family member/friend. Race-specific mistrust was positively associated with anxiety, but was negatively associated with being fully vaccinated for bereaved Black Americans. Targeted efforts are needed to specifically reach those who lost a loved one to COVID-19. More within-group evaluations are needed to identify barriers to COVID-19 vaccination that are specific to Black Americans living with loss and grief.
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Affiliation(s)
- Janelle R Goodwill
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, United States.
| | - Kayla J Fike
- Vanderbilt University, Peabody College of Education and Human Development, United States
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19
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Jiao L, Wachinger J, Dasch S, Bärnighausen T, McMahon SA, Chen S. Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100288. [PMID: 37334196 PMCID: PMC10232919 DOI: 10.1016/j.ssmqr.2023.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.
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Affiliation(s)
- Lirui Jiao
- Columbia University Mailman School of Public Health, New York, USA
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Selina Dasch
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Global Health and Population, Harvard School of Public Health, Massachusetts, USA
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Simiao Chen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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20
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Bacong AM, Haro-Ramos AY. Willingness to Receive the COVID-19 Vaccine in California: Disparities by Race and Citizenship Status. J Racial Ethn Health Disparities 2023; 10:2911-2920. [PMID: 36449129 PMCID: PMC9713137 DOI: 10.1007/s40615-022-01468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
Although it is widely acknowledged that racialized minorities may report lower COVID-19 vaccine willingness compared to non-Hispanic white individuals, what is less known, however, is whether the willingness to receive the COVID-19 vaccine also differs by citizenship. Understanding disparities in vaccine willingness by citizenship is particularly important given the misleading rhetoric of some political leaders regarding vaccine eligibility by citizenship status. This study used the 2020 California Health Interview Survey (n = 21,949) to examine disparities in vaccine willingness by race/ethnicity and citizenship among Asian, Latinx, and non-Hispanic white individuals. Overall, 77.7% of Californians indicated that they were willing to receive the COVID-19 vaccine if it was made available. However, there were distinct differences by race/ethnicity and citizenship. Asian people, regardless of citizenship, had the highest predicted probability of vaccine willingness, accounting for demographic, socioeconomic, and health factors. Non-citizen Latinx and non-citizen non-Hispanic white people had higher predicted probabilities of vaccine willingness compared to their US-born counterparts, accounting for demographic, socioeconomic, and health factors. Our results reveal that although vaccine willingness may be high among non-citizen individuals, it may not necessarily translate into actual vaccine uptake. Furthermore, while individual-level factors may account for some of the differences in vaccine willingness by race/ethnicity and citizenship, other institutional and structural barriers prevent vaccine uptake.
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Affiliation(s)
- Adrian Matias Bacong
- Stanford University Center for Asian Health Research and Education, Stanford, CA, USA.
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Alein Y Haro-Ramos
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
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21
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Rossi MM, Parisi MA, Cartmell KB, McFall D. Understanding COVID-19 vaccine hesitancy in the Hispanic adult population of South Carolina: a complex mixed-method design evaluation study. BMC Public Health 2023; 23:2359. [PMID: 38017470 PMCID: PMC10685550 DOI: 10.1186/s12889-023-16771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/16/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND In August 2021, only 47.6% of all eligible residents in South Carolina (SC) had received at least one dose of the COVID-19 vaccine, with only 41% having completed their vaccination series. Additionally, only 27% of all Hispanics in SC had completed their vaccination series compared to 34.1% of non-Hispanics. Vaccine hesitancy is a complex phenomenon that is context and vaccine-specific. Focusing on unvaccinated Hispanics living in rural areas of SC, this study aimed to identify barriers to vaccination and provide an educational intervention designed to address vaccine hesitancy. METHODS A complex mixed-methods evaluation design was used to conduct this study. First, in-person vaccine educational sessions were implemented, along with a pre-post-test survey, to assess changes in knowledge, attitudes, motivations, barriers, and intentions to receive COVID-19 vaccination. Second, in-person follow-up focus groups were held with the same participants to gather in-depth insight about participants' knowledge and attitudes about the COVID-19 vaccination. Third, an online follow-up survey was conducted to assess the effect of the training and discussion session on COVID-19 vaccination. Study outcomes were assessed among the 17 individuals who participated in the educational sessions and focus group discussions. RESULTS Findings revealed that for unvaccinated Hispanics living in South Carolina; vaccine hesitancy was primarily driven by: 1) misinformation and information coming from unverified sources and 2) negative perceptions of the safety and effectiveness of the COVID-19 vaccines. Specifically, participants were fearful that the vaccine development was rushed and that the vaccines might contain questionable ingredients that could cause strong side effects or even death. Participants were also concerned that vaccination might cause them to get sick and be hospitalized, which would have financial implications since they could not afford healthcare or take time off work. CONCLUSIONS Program implementation and mass communication campaigns should focus on COVID-19 vaccine safety and effectiveness, including side effects, what to expect after being vaccinated, and how to look for information from reputable sources. The educational session implemented proved to be effective and helped reduce vaccine hesitancy since most participants (80%) self-reported receiving a COVID-19 vaccine after program participation.
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Affiliation(s)
- Maria Mercedes Rossi
- Department of Food, Nutrition, and Packaging Sciences, C228 Pool Agricultural Center, Clemson University, Clemson, SC, 29631, USA.
| | - Michelle A Parisi
- Department Nutritional Sciences, University of Georgia, 206 Hoke Smith Annex, Athens, GA, 30602, USA
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, 534 Edwards Hall, Clemson, SC, 29634, USA
| | - Danielle McFall
- Rural Health and Nutrition Program Team, Clemson University, 120 Lehotsky Hall, Clemson, SC, 29634, USA
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22
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Guay M, Maquiling A, Chen R, Lavergne V, Baysac DJ, Dubé È, MacDonald SE, Driedger SM, Gilbert NL. Racial disparities in COVID-19 vaccination in Canada: results from the cross-sectional Canadian Community Health Survey. CMAJ Open 2023; 11:E1075-E1082. [PMID: 37989513 PMCID: PMC10681669 DOI: 10.9778/cmajo.20230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in COVID-19 vaccination coverage have been observed in Canada and in other countries. We aimed to compare vaccination coverage for at least 1 dose of a COVID-19 vaccine between First Nations people living off reserve and Métis, Black, Arab, Chinese, South Asian and White people. METHODS We used data collected between June 2021 and June 2022 by Statistics Canada's Canadian Community Health Survey, a large, nationally representative cross-sectional study. The analysis included 64 722 participants aged 18 years or older from the 10 provinces. We used a multiple logistic regression model to determine associations between vaccination status and race, controlling for collection period, region of residence, age, gender and education. RESULTS Nonvaccination against COVID-19 was more frequent in off-reserve First Nations people (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.7) and Black people (adjusted OR 1.7, 95% CI 1.1-2.6), and less frequent among South Asian people (adjusted OR 0.3, 95% CI 0.1-0.7) compared to White people. INTERPRETATION This analysis showed significant inequalities in COVID-19 vaccine uptake between racial/ethnic populations in Canada. Further research is needed to understand the sociocultural, structural and systemic facilitators of and barriers to vaccination across racial groups, and to identify strategies that may improve vaccination uptake among First Nations and Black people.
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Affiliation(s)
- Mireille Guay
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que.
| | - Aubrey Maquiling
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Ruoke Chen
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Valérie Lavergne
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Donalyne-Joy Baysac
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Ève Dubé
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Shannon E MacDonald
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - S Michelle Driedger
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Nicolas L Gilbert
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
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23
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Eichelberger L, Hansen A, Cochran P, Fried R, Hahn M. "In the beginning, I said I wouldn't get it.": Hesitant adoption of the COVID-19 vaccine in remote Alaska between November 2020 and 2021. Soc Sci Med 2023; 334:116197. [PMID: 37666096 DOI: 10.1016/j.socscimed.2023.116197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by 'hesitant adopters', defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context.
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Affiliation(s)
- Laura Eichelberger
- Alaska Native Tribal Health Consortium, Tribal Water Center. 4000 Ambassador Drive Anchorage, Alaska, 99508, USA.
| | - Amanda Hansen
- Alaska Native Tribal Health Consortium, Tribal Water Center. 4000 Ambassador Drive Anchorage, Alaska, 99508, USA.
| | - Patricia Cochran
- Alaska Native Science Commission. 429 L Street, Anchorage, AK 99501, USA.
| | - Ruby Fried
- University of Alaska Anchorage (UAA), Institute for Circumpolar Health Studies (ICHS), 1901 Bragaw, Suite 220, Anchorage, Alaska, 99508, USA.
| | - Micah Hahn
- University of Alaska Anchorage (UAA), Institute for Circumpolar Health Studies (ICHS), 1901 Bragaw, Suite 220, Anchorage, Alaska, 99508, USA.
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Winters M, Christie S, Lepage C, Malik AA, Bokemper S, Abeyesekera S, Boye B, Moini M, Jamil Z, Tariq T, Beresh T, Kazymyrova G, Palamar L, Paintsil E, Faller A, Seusan A, Bonnevie E, Smyser J, Khan K, Gulaid M, Francis S, Warren JL, Thomson A, Omer SB. Persuasive COVID-19 vaccination campaigns on Facebook and nationwide vaccination coverage in Ukraine, India, and Pakistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002357. [PMID: 37756298 PMCID: PMC10529538 DOI: 10.1371/journal.pgph.0002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023]
Abstract
Social media platforms have a wide and influential reach, and as such provide an opportunity to increase vaccine uptake. To date, there is no large-scale, robust evidence on the offline effects of online messaging campaigns. We aimed to test whether pre-tested, persuasive messaging campaigns from UNICEF, disseminated on Facebook, influenced COVID-19 vaccine uptake in Ukraine, India, and Pakistan. In Ukraine, we deployed a stepped-wedge randomized controlled trial (RCT). Half of the 24 oblasts (provinces) received five weeks of the intervention, the other half ten weeks of the intervention. In India, an RCT with an augmented synthetic control was conducted in five states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan), whereby 40 out of 174 districts were randomized to receive six weeks of intervention. In Pakistan we deployed a pre-post design, whereby 25 city districts received six weeks of the intervention. Weekly COVID-19 vaccination data was sourced through government databases. Using Poisson regression models, the association between the intervention and vaccine uptake was estimated. In Ukraine we conducted a survey among Facebook users at three time points during the RCT, to ascertain vaccination intentions and trust in vaccines. The campaigns reached more than 110 million Facebook users and garnered 2.9 million clicks. In Ukraine, we found that the intervention did not affect oblast-level vaccination coverage (Relative Risk (RR): 0.93, 95% Confidence Interval (CI) 0.86-1.01). Similarly, in India and Pakistan we found no effect of our intervention (India: RR 0.85, 95% CI 0.70-1.04; Pakistan: RR 0.64, 95% CI 0.01-29.9). The survey among Facebook users in Ukraine showed that trust in vaccines and information sources was an important predictor of vaccination status and intention to get vaccinated. Our campaigns on Facebook had a wide reach, which did not translate in shifting behaviours. Timing and external events may have limited the effectiveness of our interventions.
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Affiliation(s)
- Maike Winters
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Sarah Christie
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | | | - Amyn A. Malik
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Scott Bokemper
- Institution for Social and Policy Studies, Yale University, New Haven, Connecticut, United States of America
- Center for the Study of American Politics, Yale University, New Haven, Connecticut, United States of America
| | | | - Brian Boye
- UNICEF Country Office India, New Delhi, India
| | | | - Zara Jamil
- UNICEF Country Office, Karachi, Pakistan
| | - Taha Tariq
- UNICEF Country Office, Karachi, Pakistan
| | | | | | | | - Elliott Paintsil
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
| | - Alexandra Faller
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Andreea Seusan
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Erika Bonnevie
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Joe Smyser
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Kadeem Khan
- Meta Platforms Inc., Menlo Park, California, United States of America
| | - Mohamed Gulaid
- Meta Platforms Inc., Menlo Park, California, United States of America
| | - Sarah Francis
- Team Upswell, Seattle, Washington, United States of America
| | - Joshua L. Warren
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, Texas, United States of America
| | | | - Saad B. Omer
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, Texas, United States of America
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25
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Mondera F, Cammalleri V, Forestiero FM, Turatto F, Direnzo GFM, Napoli A, Pirelli F, Razafimpanana N, Rossi E, Baccolini V, Cinti L, Marzuillo C, Barra M, Antonelli G, Badiani A, Villari P. Adherence to SARS-CoV-2 Vaccination Recommendations among Patients with Substance Use Disorders: A Cross-Sectional Study in Rome, Italy. Vaccines (Basel) 2023; 11:1434. [PMID: 37766111 PMCID: PMC10538200 DOI: 10.3390/vaccines11091434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Adherence to vaccination recommendations is a challenge for national immunization programs. We quantified adherence to COVID-19 vaccination recommendations in people with substance use disorders (SUDs) attending an outpatient addiction center in Rome, Italy; we investigated the determinants of adherence, and also analyzed patient risk perception and compliance with preventive measures. A multivariable logistic regression model identified predictors of adherence to vaccination recommendations, with statistical validity tested by estimating adjusted odds ratios (aORs) and 95% confidence intervals (CIs). From December 2021 to January 2022, 200 SUD patients completed a questionnaire, 80% of whom reported being vaccinated against SARS-CoV-2 (minimum one dose). Negative predictors of vaccine uptake included being non-Italian (aOR: 0.36, 95% CI: 0.13-0.97), having coexisting comorbidities (aOR: 0.35, 95% CI: 0.13-0.95), and previous use of heroin (aOR: 0.24, 95% CI: 0.08-0.71). No difference was found for cocaine use, demographic characteristics, previous COVID-19 infection, methadone therapy, or compliance with preventive measures. Major reasons for non-adherence to vaccination recommendations were fear of side effects, insufficient recognition of the importance of vaccination, bureaucratic issues, and lack of trust in the authorities. Given their vulnerability, additional efforts are needed to facilitate access to vaccination for people with SUDs, and to limit disinformation around vaccines..
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Affiliation(s)
- Francesco Mondera
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Vincenzo Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Francesca Maria Forestiero
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | | | - Anna Napoli
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (A.N.); (L.C.); (G.A.)
| | - Francesca Pirelli
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; (F.P.); (N.R.)
| | - Nirinalisera Razafimpanana
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; (F.P.); (N.R.)
| | - Ettore Rossi
- Villa Maraini Foundation, 00151 Rome, Italy; (G.F.M.D.); (E.R.); (M.B.); (A.B.)
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Lilia Cinti
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (A.N.); (L.C.); (G.A.)
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Massimo Barra
- Villa Maraini Foundation, 00151 Rome, Italy; (G.F.M.D.); (E.R.); (M.B.); (A.B.)
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (A.N.); (L.C.); (G.A.)
| | - Aldo Badiani
- Villa Maraini Foundation, 00151 Rome, Italy; (G.F.M.D.); (E.R.); (M.B.); (A.B.)
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; (F.P.); (N.R.)
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
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Stephenson-Hunter C, Yusuf Y, Larson R, Campanella J, Gutnick DN. What matters to us: Bridging research and accurate information through dialogue (BRAID) to build community trust and cultivate vaccine confidence. Prev Med Rep 2023; 34:102253. [PMID: 37252070 PMCID: PMC10199752 DOI: 10.1016/j.pmedr.2023.102253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/27/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Despite higher rates of SARS-CoV-2 infections and mortality, vaccine uptake in Black and Latinx populations remained disproportionately low, including in the Bronx, New York. In response, we used the Bridging Research, Accurate Information, and Dialogue (BRAID) model to elicit community members' COViD-19 vaccine-related perspectives and informational needs and inform strategies to improve vaccine acceptance. We conducted a longitudinal qualitative study over 13 months (May 2021-June 2022), with 25 community experts from the Bronx including community health workers, and representatives from community-based organizations. Each expert participated in 1-5 of the 12 conversation circles conducted via Zoom. Clinicians and scientists, attended circles to provide additional information in content areas identified by the experts. Inductive thematic analysis was used to analyze the conversations. Five overarching themes, related to trust, emerged: (1) disparate and unjust treatment from institutions; (2) the impact of rapidly changing COVID messages in the lay press (a different story every day); (3) influencers of vaccine intention; (4) strategies to build community trust; and (5) what matters to community experts [us]. Our findings highlighted the influence of factors, such as health communication, on trust (or lack thereof) and vaccine intention. They also reinforce that creating safe spaces for dialogue and listening and responding to community concerns in real time are effective trust-building strategies. The BRAID model fostered open discussion about the factors that influence vaccine uptake and empowered participants to share accurate information with their community. Our experience suggests that the model can be adapted to address many public health issues.
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Affiliation(s)
- Cara Stephenson-Hunter
- Harold and Muriel Block Institute for Clinical and Translational Research, Albert Einstein College of Medicine, Bronx, NY 10461, United States
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Yousra Yusuf
- Section for Health Equity, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Rita Larson
- Section for Health Equity, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - James Campanella
- Department of Epidemiology & Population Health, The Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Damara N. Gutnick
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, United States
- Department of Epidemiology & Population Health, The Albert Einstein College of Medicine, Bronx, NY 10461, United States
- Department of Psychiatry & Behavioral Sciences, The Albert Einstein College of Medicine, Bronx, NY 10461, United States
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27
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Lazard AJ, Nicolla S, Vereen RN, Pendleton S, Charlot M, Tan HJ, DiFranzo D, Pulido M, Dasgupta N. Exposure and Reactions to Cancer Treatment Misinformation and Advice: Survey Study. JMIR Cancer 2023; 9:e43749. [PMID: 37505790 PMCID: PMC10422174 DOI: 10.2196/43749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Cancer treatment misinformation, or false claims about alternative cures, often spreads faster and farther than true information on social media. Cancer treatment misinformation can harm the psychosocial and physical health of individuals with cancer and their cancer care networks by causing distress and encouraging people to abandon support, potentially leading to deviations from evidence-based care. There is a pressing need to understand how cancer treatment misinformation is shared and uncover ways to reduce misinformation. OBJECTIVE We aimed to better understand exposure and reactions to cancer treatment misinformation, including the willingness of study participants to prosocially intervene and their intentions to share Instagram posts with cancer treatment misinformation. METHODS We conducted a survey on cancer treatment misinformation among US adults in December 2021. Participants reported their exposure and reactions to cancer treatment misinformation generally (saw or heard, source, type of advice, and curiosity) and specifically on social media (platform, believability). Participants were then randomly assigned to view 1 of 3 cancer treatment misinformation posts or an information post and asked to report their willingness to prosocially intervene and their intentions to share. RESULTS Among US adult participants (N=603; mean age 46, SD 18.83 years), including those with cancer and cancer caregivers, almost 1 in 4 (142/603, 23.5%) received advice about alternative ways to treat or cure cancer. Advice was primarily shared through family (39.4%) and friends (37.3%) for digestive (30.3%) and natural (14.1%) alternative cancer treatments, which generated curiosity among most recipients (106/142, 74.6%). More than half of participants (337/603, 55.9%) saw any cancer treatment misinformation on social media, with significantly higher exposure for those with cancer (53/109, 70.6%) than for those without cancer (89/494, 52.6%; P<.001). Participants saw cancer misinformation on Facebook (39.8%), YouTube (27%), Instagram (22.1%), and TikTok (14.1%), among other platforms. Participants (429/603, 71.1%) thought cancer treatment misinformation was true, at least sometimes, on social media. More than half (357/603, 59.2%) were likely to share any cancer misinformation posts shown. Many participants (412/603, 68.3%) were willing to prosocially intervene for any cancer misinformation posts, including flagging the cancer treatment misinformation posts as false (49.7%-51.4%) or reporting them to the platform (48.1%-51.4%). Among the participants, individuals with cancer and those who identified as Black or Hispanic reported greater willingness to intervene to reduce cancer misinformation but also higher intentions to share misinformation. CONCLUSIONS Cancer treatment misinformation reaches US adults through social media, including on widely used platforms for support. Many believe that social media posts about alternative cancer treatment are true at least some of the time. The willingness of US adults, including those with cancer and members of susceptible populations, to prosocially intervene could initiate the necessary community action to reduce cancer treatment misinformation if coupled with strategies to help individuals discern false claims.
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Affiliation(s)
- Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sydney Nicolla
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hll, Chapel Hill, NC, United States
| | - Rhyan N Vereen
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hll, Chapel Hill, NC, United States
| | - Shanetta Pendleton
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hll, Chapel Hill, NC, United States
| | - Marjory Charlot
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Medicine, Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hung-Jui Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dominic DiFranzo
- P.C. Rossin College of Engineering and Applied Science, Lehigh University, Bethlehem, PA, United States
| | - Marlyn Pulido
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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28
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Mansfield LN, Carson SL, Sunku N, Troutt A, Jackson S, Santillan D, Vassar SD, Slaughter D, Kim G, Norris KC, Brown AF. Community-based organization perspectives on participating in state-wide community canvassing program aimed to reduce COVID-19 vaccine disparities in California. BMC Public Health 2023; 23:1356. [PMID: 37452299 PMCID: PMC10349443 DOI: 10.1186/s12889-023-16210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Inequities in COVID-19 vaccine accessibility and reliable COVID-related information disproportionately affected marginalized racial and ethnic communities in the U.S. The Get Out the Vaccine (GOTVax) program, an innovative statewide government-funded COVID-19 vaccine canvassing program in California, aimed to reduce structural barriers to COVID-19 vaccination in high-risk communities with low vaccination rates. GOTVax consisted of a community-academic-government partnership with 34 local trusted community-based organizations' (CBOs) to conduct COVID-19 vaccine outreach, education, and vaccine registration. The purpose of this qualitative evaluation study was to explore the barriers and facilitators of using local CBOs to deploy a geographically, racially, and ethnically diverse state-wide COVID-19 vaccine outreach program. METHODS Semi-structured online interviews were conducted with participating GOTVax CBO leaders from November 2021 to January 2022. Transcripts were analyzed using reflexive thematic analysis. RESULTS Thirty-one of 34 CBOs participated (91% response rate). Identified themes encompassed both facilitators and barriers to program participation. Key facilitators included leveraging trust through recognized entities; promoting empathetic, tailored outreach; and flexibility of milestone-based CBO funding contracts for rapid program implementation. Barriers included navigating community sociopolitical, geographic, and cultural factors; managing canvassers' safety; desiring metrics for self-evaluation of outreach success; mitigating canvassing technology challenges; and concerns of program infrastructure initially limiting outreach. CBOs problem-solved barriers with academic and government partners. CONCLUSIONS Between May and December 2021, the GOTVax program reached over 2 million California residents and registered over 60,000 residents for COVID-19 vaccination. Public health campaigns may improve benefits from leveraging the expertise of community-trusted CBOs and universities by providing flexible infrastructure and funding, allowing CBOs to seamlessly tailor outreach most applicable to local minoritized communities.
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Affiliation(s)
- Lisa N Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Savanna L Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nisha Sunku
- Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Alana Troutt
- California Government Operations Agency, State of California, Sacramento, CA, USA
- San Francisco Health Plan, San Francisco, California, United States
| | | | | | - Stefanie D Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Dale Slaughter
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gloria Kim
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Olive View-UCLA Medical Center, Sylmar, CA, USA
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29
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Chaudhary M, Kosyluk K, Thomas S, Neal T. On the use of aspect-based sentiment analysis of Twitter data to explore the experiences of African Americans during COVID-19. Sci Rep 2023; 13:10694. [PMID: 37394523 DOI: 10.1038/s41598-023-37592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/23/2023] [Indexed: 07/04/2023] Open
Abstract
According to data from the U.S. Center for Disease Control and Prevention, as of June 2020, a significant number of African Americans had been infected with the coronavirus disease, experiencing disproportionately higher death rates compared to other demographic groups. These disparities highlight the urgent need to examine the experiences, behaviors, and opinions of the African American population in relation to the COVID-19 pandemic. By understanding their unique challenges in navigating matters of health and well-being, we can work towards promoting health equity, eliminating disparities, and addressing persistent barriers to care. Since Twitter data has shown significant promise as a representation of human behavior and for opinion mining, this study leverages Twitter data published in 2020 to characterize the pandemic-related experiences of the United States' African American population using aspect-based sentiment analysis. Sentiment analysis is a common task in natural language processing that identifies the emotional tone (i.e., positive, negative, or neutral) of a text sample. Aspect-based sentiment analysis increases the granularity of sentiment analysis by also extracting the aspect for which sentiment is expressed. We developed a machine learning pipeline consisting of image and language-based classification models to filter out tweets not related to COVID-19 and those unlikely published by African American Twitter subscribers, leading to an analysis of nearly 4 million tweets. Overall, our results show that the majority of tweets had a negative tone, and that the days with larger numbers of published tweets often coincided with major U.S. events related to the pandemic as suggested by major news headlines (e.g., vaccine rollout). We also show how word usage evolved throughout the year (e.g., outbreak to pandemic and coronavirus to covid). This work also points to important issues like food insecurity and vaccine hesitation, along with exposing semantic relationships between words, such as covid and exhausted. As such, this work furthers understanding of how the nationwide progression of the pandemic may have impacted the narratives of African American Twitter users.
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Affiliation(s)
- Meghna Chaudhary
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Kristin Kosyluk
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Sylvia Thomas
- Department of Electrical Engineering, University of South Florida, Tampa, FL, USA
| | - Tempestt Neal
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA.
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Zaildo T, Santino TA, Chaves G, da Silva BAK, Alchieri JC, Patino CM, Leite S, Luz KG, Guerra RO, da Penha THS, da Silva GR, Jácome AC, Monteiro KS, de Mendonça KMPP. Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis. Eur Respir Rev 2023; 32:220238. [PMID: 37343960 DOI: 10.1183/16000617.0238-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/03/2023] [Indexed: 06/23/2023] Open
Abstract
AIMS To summarise the evidence on barriers to and facilitators of population adherence to prevention and control measures for coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases. METHODS A qualitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. We performed an electronic search on MEDLINE, Embase and PsycINFO from their inception to March 2023. RESULTS We included 71 studies regarding COVID-19, pneumonia, tuberculosis, influenza, pertussis and H1N1, representing 5966 participants. The measures reported were vaccinations, physical distancing, stay-at-home policy, quarantine, self-isolation, facemasks, hand hygiene, contact investigation, lockdown, infection prevention and control guidelines, and treatment. Tuberculosis-related measures were access to care, diagnosis and treatment completion. Analysis of the included studies yielded 37 barriers and 23 facilitators. CONCLUSIONS This review suggests that financial and social support, assertive communication, trust in political authorities and greater regulation of social media enhance adherence to prevention and control measures for COVID-19 and infectious respiratory diseases. Designing and implementing effective educational public health interventions targeting the findings of barriers and facilitators highlighted in this review are key to reducing the impact of infectious respiratory diseases at the population level.
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Affiliation(s)
- Tácito Zaildo
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Thayla Amorim Santino
- Department of Physical Therapy, State University of Paraiba, Campina Grande, PB, Brazil
| | | | | | - João Carlos Alchieri
- Department of Psychology, Graduate Program in Science, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Cecilia M Patino
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sarah Leite
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Kleber Giovanni Luz
- Department of Infectious Diseases, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ricardo Oliveira Guerra
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Tito Hugo Soares da Penha
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Gabriel Rodrigues da Silva
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ada Cristina Jácome
- Public Health Department of the State of Rio Grande do Norte, Natal, RN, Brazil
| | - Karolinne Souza Monteiro
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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31
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Avorgbedor F, Gondwe KW, Aljarrah A, Bankole AO. COVID-19 Vaccine Decision-Making Among Black Pregnant and Postpartum Women. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01675-6. [PMID: 37335424 DOI: 10.1007/s40615-023-01675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The history of biomedical research is marred by racially discriminatory and abusive practices that impacted Black/African Americans. Medical racism impacts the trust and utilization of new medical interventions, such as the COVID-19 vaccine. This study aimed to understand Black pregnant and postpartum women's perspectives and decision-making about the COVID-19 vaccine. METHODS We used a qualitative descriptive design and recruited 23 pregnant and postpartum Black women aged 18 years and above. Data was collected using a semi-structured interview guide. Data were analyzed using content analysis. FINDINGS The participants described factors influencing their decision to receive or not receive the COVID-19 vaccines. These factors included individual, cultural, ethnicity, religious, and family-related factors (individual-personal beliefs influenced decisions about the vaccine; ethnicity, culture, and religion influenced vaccine decision-making; group-family and friends played a role in decision-making), vaccine or vaccination-related issues (concerns about vaccination and pregnancy outcomes and mistrust in the vaccine information), and contextual influence (sources of vaccine information influenced decision-making and healthcare providers influenced decision-making). CONCLUSION Understanding the vaccine decision-making process of underserved populations likely to decline vaccination due to pregnancy, postpartum, and breastfeeding status will help design tailored interventions to improve vaccine acceptance in minority communities, especially for pregnant and postpartum women.
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Affiliation(s)
- Forgive Avorgbedor
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA.
| | | | - Ahmad Aljarrah
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
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Chen JC, Gutierrez G, Kamran R, Terry J, Telliyan A, Zaks C, Carson SL, Brown A, Kim K. Evaluation of COVID-19 vaccine implementation in a large safety net health system. FRONTIERS IN HEALTH SERVICES 2023; 3:1152523. [PMID: 37342796 PMCID: PMC10277563 DOI: 10.3389/frhs.2023.1152523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023]
Abstract
Objectives To evaluate rapid COVID-19 vaccine clinic implementation from January-April 2021 in the Los Angeles County Department of Health Services (LACDHS), the second-largest US safety net health system. During initial vaccine clinic implementation, LACDHS vaccinated 59,898 outpatients, 69% of whom were Latinx (exceeding the LA County Latinx population of 46%). LACDHS is a unique safety net setting to evaluate rapid vaccine implementation due to system size, geographic breadth, language/racial/ethnic diversity, limited health staffing resources, and socioeconomic complexity of patients. Methods Implementation factors were assessed through semi-structured interviews of staff from all twelve LACDHS vaccine clinics from August-November 2021 using the Consolidated Framework for Implementation Research (CFIR) and themes analyzed using rapid qualitative analysis. Results Of 40 potential participants, 25 health professionals completed an interview (27% clinical providers/medical directors, 23% pharmacist, 15% nursing staff, and 35% other). Qualitative analysis of participant interviews yielded ten narrative themes. Implementation facilitators included bidirectional communication between system leadership and clinics, multidisciplinary leadership and operations teams, expanded use of standing orders, teamwork culture, use of active and passive communication structures, and development of patient-centered engagement strategies. Barriers to implementation included vaccine scarcity, underestimation of resources needed for patient outreach, and numerous process challenges encountered. Conclusion Previous studies focused on robust advance planning as a facilitator and understaffing and high staff turnover as barriers to implementation in safety net health systems. This study found facilitators that can mitigate lack of advance planning and staffing challenges present during public health emergencies such as the COVID-19 pandemic. The ten identified themes may inform future implementations in safety net health systems.
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Affiliation(s)
- Jennifer C. Chen
- Ambulatory Care Network, Los Angeles County Department of Health Services, Los Angeles, CA, United States
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Griselda Gutierrez
- Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, CA, United States
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Rachel Kamran
- Fielding School of Public Health Graduate Program, University of California, Los Angeles, CA, United States
| | - Jill Terry
- Pharmacy Affairs, Los Angeles County Department of Health Services, Los Angeles, CA, United States
- Adjunct Faculty, USC School of Pharmacy, Los Angeles, CA, United States
| | - Armenui Telliyan
- Adjunct Nursing Faculty, Glendale Community College, Glendale, CA, United States
- Adjunct Nursing Faculty, West Coast University, Los Angeles, CA, United States
| | - Camilo Zaks
- Division of Street Medicine, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Savanna L. Carson
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Arleen Brown
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Karen Kim
- Population Health Management, Los Angeles County Department of Health Services, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Shearn C, Krockow EM. Reasons for COVID-19 vaccine hesitancy in ethnic minority groups: A systematic review and thematic synthesis of initial attitudes in qualitative research. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100210. [PMID: 36573229 PMCID: PMC9771578 DOI: 10.1016/j.ssmqr.2022.100210] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/11/2022] [Accepted: 12/16/2022] [Indexed: 04/22/2023]
Abstract
Despite being disproportionately affected by the COVID-19 pandemic, ethnic and racial minority groups show widespread vaccine hesitancy. Adherence to ongoing booster vaccine campaigns is required to contain future spread of the virus and protect health systems. This review aims to appraise and synthesise qualitative studies published from December 2021 to February 2022 addressing the issue for an in-depth exploration of initial COVID-19 vaccine hesitancy in minorities, including refugee, asylum seeker and migrant populations. A systematic literature search of five databases identified 15 eligible studies. Thematic synthesis identified three main themes of "institutional mistrust", "lack of confidence in vaccine and vaccine development process", and "lack of reliable information or messengers". Two minor themes included "complacency/perceived lack of need" and "structural barriers to vaccine access". "Institutional mistrust" permeated several other themes, demonstrating the need for culturally sensitive approaches. Applying our findings to the World Health Organisation's Three C Model of vaccine hesitancy, the "confidence" dimension appears to represent a disproportionately large barrier to vaccine uptake in ethnic minority groups. Indeed, nuanced adaptations of the model may be necessary to explain vaccine hesitancy in those groups. Further research is required to explore factors facilitating vaccine uptake to monitor changes in hesitancy over time.
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Affiliation(s)
- Christina Shearn
- School of Psychology and Vision Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
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Sharma E, Mondal S, Das S, Vrana VG. Scale Development for COVID-19 Vaccine Hesitancy by Integration of Socio-Demographic and Psychological Factors. Vaccines (Basel) 2023; 11:1052. [PMID: 37376441 DOI: 10.3390/vaccines11061052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Vaccination is the most cost-effective way to maintain population health. However, it can only be effective if widespread acceptance is held. The efficacy of COVID-19 vaccines depends on their favor. When countries start to vaccinate their citizens, there is a certain level of skepticism about the effectiveness of the vaccines. The hesitancy study on vaccines has gained momentum following the pandemic. However, few studies have examined the link between the psychological and sociodemographic factors influencing the fit. This paper proposes integrating the concepts of the information systems success and stimulus-organism-response into a cognitive fit theory framework to explore the integration of psychological and sociodemographic factors in the receivers' reactions (n = 1510). This study analyses the factors that influence the hesitancy of vaccines and the public's refusal in Asia and Europe. Receivers' reactions were assessed to various stimuli and we explored the link between psychological and sociodemographic elements and the concept of fit. Two surveys were conducted following the scale development of Mackenzie. The first was to develop the fit scale, while the second was to validate the fit scale. The results of the second survey were analyzed using structural equation modelling. The results indicate that the scale's fit development is valid and reliable. The quality of the vaccine information, the psychological characteristics of the vaccine system, and vaccine receivers' satisfaction are also beneficial factors for emotional and cognitive fit. Maintaining the vaccines' quality and efficiency can help improve the fit between sociodemographic and psychological characteristics. It can also enhance receivers' satisfaction and encourage continued vaccine administration. This study is regarded as one of the first to examine and develop an emotional and cognitive fit scale for practitioners and researchers.
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Affiliation(s)
- Eliza Sharma
- Symbiosis Institute of Business Management Bengaluru, Symbiosis International (Deemed University), Karnataka 560100, India
| | - Subhra Mondal
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Subhankar Das
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Vasiliki G Vrana
- Department of Business Administration, School of Economics and Administration, The Campus of Serres, International Hellenic University, 62124 Serres, Greece
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Panameno M, Blanco LR, Hernandez AM, Escobar R, Zendejas B, Rafaela S, Castellon-Lopez YM. Using Digital Technology to Build COVID-19 Vaccine Confidence: A Qualitative Study among Latinx Parents of Children Aged 5-11 in Under-Resourced Communities across Los Angeles County. Vaccines (Basel) 2023; 11:1042. [PMID: 37376431 DOI: 10.3390/vaccines11061042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Latinx school-aged children are more than twice as likely to be infected with and die from COVID-19 as non-Latinx White children in Los Angeles. Although COVID-19 vaccination has the potential to mitigate health disparities exacerbated by the pandemic, vaccination uptake among Latinx children remains limited. MiVacunaLA (MVLA) is a mobile-phone-delivered digital intervention that improved vaccination rates in 12- to 17-year-old Latinx children and parental intention to vaccinate 2- to 11-year-old children. Since piloting MVLA, the COVID-19 vaccine became available to children aged 5-11. We sought to understand parental experiences with the MVLA intervention and their attitudes and beliefs about vaccinating their young children to improve vaccination confidence in the Latinx community. Methods: We conducted six virtual focus groups with 47 parents/caregivers of children aged 5-11 who participated in the MVLA intervention. We used standard qualitative content analysis methods and rigid and accelerated data reduction to identify and analyze major themes discussed in the sessions. Results: Each salient theme from our focus groups was mapped to one of the 5Cs constructs. The themes included the parents' need for more contemplation about vaccinating their children than about vaccinating themselves; the parents' need for trusted sources of vaccine information; the parents' motivations to vaccinate their children against COVID-19; parental concern about short- and long-term effects of the vaccine in children; digital technology and videos as useful engagement tools; and age and health stratification as an approach to parental vaccination decision-making. Conclusions: The results of this study clarify the key factors that influence the decision of Latinx parents and caregivers to vaccinate their children against COVID-19. Our findings can inform efforts to increase COVID-19 vaccination rates among children in underserved Latinx communities, especially regarding the use of digital technologies for promoting vaccine confidence.
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Affiliation(s)
- Michael Panameno
- David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90069, USA
| | - Luisa R Blanco
- Pepperdine School of Public Policy, Pepperdine University, Malibu, CA 90069, USA
| | - Ann Marie Hernandez
- David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Renato Escobar
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Brittney Zendejas
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Susana Rafaela
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Yelba M Castellon-Lopez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, PDC Green, G500, West Hollywood, CA 90069, USA
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Kim C, Aminawung JA, Brinkley-Rubinstein L, Wang EA, Puglisi LB. COVID-19 vaccine deliberation in individuals directly impacted by incarceration. Vaccine 2023; 41:3475-3480. [PMID: 37127524 PMCID: PMC10130327 DOI: 10.1016/j.vaccine.2023.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
Delays in vaccinating communities of color to COVID-19 have signaled a need to investigate structural barriers to vaccine uptake, with mass incarceration demanding greater characterization as a potential factor. In a nationally representative survey from February-March 2021 (N = 1,157), exposure to the criminal legal system, defined as having been incarcerated in prison or jail or having had a family member or close friend incarcerated, was associated with higher odds for COVID-19 vaccine deliberation. Individuals with criminal legal system exposure reported lower confidence in physician recommendation as a reason to get vaccinated. They were also more likely to decline vaccination out of fear it would cause COVID-19 infection, and that the vaccine might be promoted as a political tool. Our analysis suggests that populations impacted by the criminal legal system would benefit from targeted vaccine outreach by trusted community members who can address distrust during current and future pandemics.
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Affiliation(s)
- Charlotte Kim
- Yale School of Medicine, 129 York Street Apt #2M, New Haven, CT 06511, USA.
| | - Jenerius A Aminawung
- Department of Medicine, Yale School of Medicine, 330 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA; SEICHE Center for Health and Justice, 300 George Street, Suite G05, New Haven, CT 06510, USA
| | - Lauren Brinkley-Rubinstein
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701, USA
| | - Emily A Wang
- Department of Medicine, Yale School of Medicine, 330 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA; SEICHE Center for Health and Justice, 300 George Street, Suite G05, New Haven, CT 06510, USA
| | - Lisa B Puglisi
- Department of Medicine, Yale School of Medicine, 330 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA; SEICHE Center for Health and Justice, 300 George Street, Suite G05, New Haven, CT 06510, USA
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Bruckhaus AA, Khan A, Pickering TA, Abedi A, Salehi S, Duncan D. COVID-19 vaccination dynamics in the US: coverage velocity and carrying capacity based on socio-demographic vulnerability indices in California's pediatric population. Front Public Health 2023; 11:1148200. [PMID: 37228717 PMCID: PMC10203576 DOI: 10.3389/fpubh.2023.1148200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/03/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction COVID-19 vaccine inequities have been widespread across California, the United States, and globally. As COVID-19 vaccine inequities have not been fully understood in the youth population, it is vital to determine possible factors that drive inequities to enable actionable change that promotes vaccine equity among vulnerable minor populations. Methods The present study used the social vulnerability index (SVI) and daily vaccination numbers within the age groups of 12-17, 5-11, and under 5 years old across all 58 California counties to model the growth velocity and the anticipated maximum proportion of population vaccinated. Results Overall, highly vulnerable counties, when compared to low and moderately vulnerable counties, experienced a lower vaccination rate in the 12-17 and 5-11 year-old age groups. For age groups 5-11 and under 5 years old, highly vulnerable counties are expected to achieve a lower overall total proportion of residents vaccinated. In highly vulnerable counties in terms of socioeconomic status and household composition and disability, the 12-17 and 5-11 year-old age groups experienced lower vaccination rates. Additionally, in the 12-17 age group, high vulnerability counties are expected to achieve a higher proportion of residents vaccinated compared to less vulnerable counterparts. Discussion These findings elucidate shortcomings in vaccine uptake in certain pediatric populations across California and may help guide health policies and future allocation of vaccines, with special emphasis placed on vulnerable populations, especially with respect to socioeconomic status and household composition and disability.
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Affiliation(s)
- Alexander A. Bruckhaus
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Azrin Khan
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Trevor A. Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Aidin Abedi
- USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Sana Salehi
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Dominique Duncan
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
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Naidoo D, Meyer-Weitz A, Govender K. Factors Influencing the Intention and Uptake of COVID-19 Vaccines on the African Continent: A Scoping Review. Vaccines (Basel) 2023; 11:vaccines11040873. [PMID: 37112785 PMCID: PMC10146577 DOI: 10.3390/vaccines11040873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The COVID-19 pandemic is a severe concern worldwide, particularly in Africa. Vaccines are crucial in the fight against the COVID-19 pandemic. This scoping review examined existing literature from 2020 to 2022 on individual, interpersonal, and structural barriers and facilitators to COVID-19 vaccination within Africa to facilitate more informed health promotion interventions to improve vaccine uptake. This review was conducted using Arksey and O'Malley's five-stage methodological framework. A comprehensive search was undertaken from 2021 to 2022 using six electronic databases: EBSCOhost, PubMed, Web of Science, ProQuest, WorldCat Discovery, and Google Scholar. Data was collected, charted into themes, and summarized using a standard data extraction sheet in Microsoft Excel. A total of forty (n = 40) published academic articles were reviewed, with many conducted in Nigeria (n = 10), followed by Ethiopia (n = 5) and Ghana (n = 4) and the rest elsewhere in Africa. Thematic narratives were used to report data into six themes: attitudes and perceptions about COVID-19 vaccines, intention to uptake COVID-19 vaccines; factors and barriers associated with COVID-19 vaccine uptake; socio-demographic determinants affecting the intention and uptake; and information sources for COVID-19 vaccines. The intention for uptake ranged from 25% to 80.9%, resulting in a suboptimal uptake intention rate (54.2%) on the African continent. Factors that promoted vaccine acceptance included confidence in the COVID-19 vaccines and the desire to protect people. Age, education, and gender were the most common factors significantly associated with vaccine acceptance. Most studies revealed that considerable barriers to vaccine uptake exist in Africa. Concerns about potential side effects, vaccine ineffectiveness, a perceived lack of information, and inaccessibility were among the individual, interpersonal, and structural barriers to COVID-19 vaccine uptake. The unwillingness to receive the COVID-19 vaccine was strongly correlated with being female. Mass and social media were the main sources of information regarding COVID-19 vaccines. To encourage vaccine uptake, governments should pay attention to refuting misinformation through integrated community-based approaches, such as creating messages that convey more than just information.
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Affiliation(s)
- Damian Naidoo
- Discipline of Psychology, School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, Durban 4041, South Africa
- Health Promotion Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, Private Bag X9051, Pietermaritzburg 3200, South Africa
| | - Anna Meyer-Weitz
- Discipline of Psychology, School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Kaymarlin Govender
- HEARD, College of Law and Management Studies, University of KwaZulu-Natal, Durban 4041, South Africa
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Jalilian H, Amraei M, Javanshir E, Jamebozorgi K, Faraji-Khiavi F. Ethical considerations of the vaccine development process and vaccination: a scoping review. BMC Health Serv Res 2023; 23:255. [PMID: 36918888 PMCID: PMC10013982 DOI: 10.1186/s12913-023-09237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Various vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes. METHODS A scoping review of the literature was conducted based on the Arkesy and O'Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis. RESULTS In total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes). CONCLUSION Due to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Amraei
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Farzad Faraji-Khiavi
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Adkins-Jackson PB, Vázquez E, Henry-Ala FK, Ison JM, Cheney A, Akingbulu J, Starks C, Slay L, Dorsey A, Marmolejo C, Stafford A, Wen J, McCauley MH, Summers L, Bermudez L, Cruz-Roman ZL, Castillo I, Kipke MD, Brown AF. The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic. Health Promot Pract 2023; 24:232-243. [PMID: 36419256 PMCID: PMC9703012 DOI: 10.1177/15248399221132581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The Share, Trust, Organize, and Partner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community-institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community-institutional partnership and to live up to the vision of community-based participatory research.
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Affiliation(s)
| | | | | | | | - Ann Cheney
- University of California, Riverside, Riverside, CA, USA
| | | | | | - Lindsay Slay
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander Dorsey
- Mending Minds Professional Clinical Counseling, Inc, Los Angeles, CA, USA
| | | | | | - James Wen
- St. John's Cathedral, Los Angeles, CA, USA
| | | | - Latrese Summers
- St. John's Well Child and Family Center, Inc., Los Angeles, CA, USA
| | | | | | | | | | - Arleen F Brown
- University of California, Los Angeles, Los Angeles, CA, USA
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Kipke MD, Karimipour N, Wolfe N, Orechwa A, Stoddard L, Rubio-Diaz M, North G, Dezfuli G, Murphy S, Phelps A, Kagan J, De La Haye K, Perry C, Baezconde-Garbanati L. Community-Based Public Health Vaccination Campaign (VaccinateLA) in Los Angeles' Black and Latino Communities: Protocol for a Participatory Study. JMIR Res Protoc 2023; 12:e40161. [PMID: 36757953 PMCID: PMC9989912 DOI: 10.2196/40161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly affected Los Angeles County and disproportionately impacted Black and Latino populations who experienced disparities in rates of infection, hospitalizations, morbidity, and mortality. The University of Southern California (USC), USC Keck School of Medicine, Southern California Clinical and Translational Science Institute, USC Mann School of Pharmacy and Pharmaceutical Sciences, Annenberg School for Journalism and Communication, and Children's Hospital Los Angeles will launch a collaborative public health campaign called VaccinateLA. OBJECTIVE VaccinateLA will implement a community-based, community-partnered public health campaign that (1) delivers culturally tailored information about COVID-19 and available vaccines; and (2) addresses misinformation and disinformation, which serves as a barrier to vaccine uptake. The campaign will be targeted to communities in Los Angeles with the highest rates of COVID-19 infection and the lowest vaccination rates. Using these criteria, the campaign will be targeted to neighborhoods located in 34 zip codes in the Eastside and South Los Angeles. The primary aim of VaccinateLA will be to design and deliver an evidence-based multimedia public health campaign tailored for Black and Latino populations. A secondary aim will be to train and deploy community vaccine navigators to deliver COVID-19 education, help individuals overcome barriers to getting vaccinated (eg, transportation and challenges registering), and assist with delivering vaccinations in our targeted communities. METHODS We will use a community-based, participatory research approach to shape VaccinateLA's public health campaign to address community members' attitudes and concerns in developing campaign content. We will conduct focus groups, establish a community advisory board, and engage local leaders and stakeholders to develop and implement a broad array of educational, multimedia, and field-based activities. RESULTS As of February 2023, target communities have been identified. The activities will be initiated and evaluated over the course of this year-long initiative, and dissemination will occur following the completion of the project. CONCLUSIONS Engaging the community is vital to developing culturally tailored public health messages that will resonate with intended audiences. VaccinateLA will serve as a model for how an academic institution can quickly mobilize to address a pressing public health crisis, particularly in underrepresented and underresourced communities. Our work has important implications for future public health campaigns. By leveraging community partnerships and deploying community health workers or promotores into the community, we hope to demonstrate that urban universities can successfully partner with local communities to develop and deliver a range of culturally tailored educational, multimedia, and field-based activities, which in turn may change the course of an urgent public health crisis, such as the COVID-19 pandemic. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40161.
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Affiliation(s)
- Michele D Kipke
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Office of the Senior Vice President of Health Affairs, University of Southern California, Los Angeles, CA, United States
| | - Nicki Karimipour
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Nicole Wolfe
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Allison Orechwa
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Laura Stoddard
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Mayra Rubio-Diaz
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Gemma North
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Ghazal Dezfuli
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Sheila Murphy
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, United States
| | - Ashley Phelps
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, United States
| | - Jeremy Kagan
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, United States
| | - Kayla De La Haye
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Christina Perry
- Department of Population and Public Health Science, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Science, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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Tjilos M, Tamlyn AL, Ragan EJ, Assoumou SA, Barnett KG, Martin P, Perkins RB, Linas BP, Drainoni ML. "Community members have more impact on their neighbors than celebrities": leveraging community partnerships to build COVID-19 vaccine confidence. BMC Public Health 2023; 23:350. [PMID: 36797724 PMCID: PMC9933023 DOI: 10.1186/s12889-023-15198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. This paper describes the themes which resulted from these community-engaged conversations and proposes next steps for healthcare leaders. METHODS We accessed nine publicly available recordings of the community-engaged conversations which were held between March 2021 and September 2021 and ranged from 8 to 122 attendees. Six conversations prioritized specific groups: the Haitian-Creole community, the Cape Verdean community, the Latino community, the Black Christian Faith community, guardians who care for children living with disabilities, and individuals affected by systemic lupus erythematosus. Remaining conversations targeted the general public of the Greater Boston Area. We employed a Consolidated Framework for Implementation Research-driven codebook to code our data. Our analysis utilized a modified version of qualitative rapid analysis methods. RESULTS Five main themes emerged from these community-engaged conversations: (1) Structural factors are important barriers to COVID-19 vaccination; (2) Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government; (3) There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine as well as the practical implications of being vaccinated; (4) Community leaders emphasize community engagement for delivering COVID-19 information and education and; (5) Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic. CONCLUSION This study illustrates a need for community-engaged COVID-19 vaccine messaging which reflects the nuances of the COVID-19 vaccine and pandemic without oversimplifying information. In highlighting common concerns of the Greater Boston Area which contribute to a lack of confidence in the COVID-19 vaccine, we underscore important considerations for public health and healthcare leadership in the development of initiatives which work to advance health equity.
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Affiliation(s)
- Maria Tjilos
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118, Boston, MA, US.
| | - Autumn L. Tamlyn
- grid.239424.a0000 0001 2183 6745Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US
| | - Elizabeth J. Ragan
- grid.239424.a0000 0001 2183 6745Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US
| | - Sabrina A. Assoumou
- grid.239424.a0000 0001 2183 6745Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US ,grid.239424.a0000 0001 2183 6745 Section of Infectious Diseases, Boston University Chobanian & Edward Avedisian School of Medicine, Boston Medical Center, 72 E Concord St, 02118 Boston, MA US
| | - Katherine Gergen Barnett
- grid.239424.a0000 0001 2183 6745Department of Family Medicine, Boston Medical Center, 1 Boston Medical Center Place, 02118 Boston, MA US ,grid.189504.10000 0004 1936 7558 Department of Family Medicine, Boston University Chobanian & Edward Avedisian School of Medicine, 72 E Concord St, MA 02118 Boston, United States ,grid.38142.3c000000041936754X Harvard Center for Primary Care, Harvard Medical School, 25 Shattuck St, MA 02115 Boston, US
| | - Petrina Martin
- grid.239424.a0000 0001 2183 6745Boston Medical Center, Boston Medical Center Health System, 85 East Concord Street, 02118 Boston, MA US
| | - Rebecca B. Perkins
- grid.189504.10000 0004 1936 7558Department of Obstetrics and Gynecology, Boston University Chobanian & Edward Avedisian School of Medicine, 72 E Concord St, 02118 Boston, MA US ,grid.239424.a0000 0001 2183 6745 Department of Obstetrics and Gynecology, Boston Medical Center, 775 Albany St, MA 02118 Boston, US
| | - Benjamin P. Linas
- grid.239424.a0000 0001 2183 6745Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US ,grid.239424.a0000 0001 2183 6745 Section of Infectious Diseases, Boston University Chobanian & Edward Avedisian School of Medicine, Boston Medical Center, 72 E Concord St, 02118 Boston, MA US ,grid.189504.10000 0004 1936 7558 Department of Epidemiology, Boston University School of Public Health, 715 Albany St, 02118 Boston, MA US
| | - Mari-Lynn Drainoni
- grid.239424.a0000 0001 2183 6745 Section of Infectious Diseases, Boston University Chobanian & Edward Avedisian School of Medicine, Boston Medical Center, 72 E Concord St, 02118 Boston, MA US ,grid.189504.10000 0004 1936 7558 Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany St, MA 02118 Boston, US
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Chebli P, McBryde-Redzovic A, Al-Amin N, Gutierrez-Kapheim M, Molina Y, Mitchell UA. Understanding COVID-19 Risk Perceptions and Precautionary Behaviors in Black Chicagoans: A Grounded Theory Approach. HEALTH EDUCATION & BEHAVIOR 2023; 50:7-17. [PMID: 36510857 PMCID: PMC9749057 DOI: 10.1177/10901981221139168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine whether actual community-level risk for COVID-19 in the Black community influenced individual perceptions of community-level and personal risk and how self-assessment of personal risk was reflected in the adoption of COVID-19 precautionary behaviors. METHODS Semistructured interviews were conducted with 20 Black Chicago adults from February to July 2021. A grounded theory approach was used for the qualitative analysis and initial, focused, and theoretical coding were performed. RESULTS We developed a grounded model consisting of four major themes: (a) Pre-Existing Health Conditions; (b) Presence of COVID-19 Infection in Participant Social Network; (c) COVID-19-Related Information, Participant Trust, and Perceived Personal Risk; and (d) Perceived Higher Burden of COVID-19 in the Black Community. CONCLUSIONS Higher perceptions of personal risk were shaped by pre-existing health conditions and experiences with COVID-19 in one's social network but were not influenced by perceived higher burden of COVID-19 in the Black community. POLICY IMPLICATIONS Black adults' perceptions of their individual risk and precautionary behaviors were not congruent with public health data and recommendations. Therefore, COVID-19 messaging and mitigation should be informed by local community engagement and transparent communication.
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Affiliation(s)
- Perla Chebli
- New York University Grossman School of
Medicine, New York, NY, USA,Perla Chebli, Section for Health Equity,
Department of Population Health, New York University Grossman School of
Medicine, 180 Madison Ave., 8th Fl, New York, NY 10016, USA.
| | | | | | | | - Yamilé Molina
- University of Illinois Chicago,
Chicago, IL, USA,University of Illinois Cancer Center,
Chicago, IL, USA
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Bonner KE, Vashist K, Abad NS, Kriss JL, Meng L, Lee JT, Wilhelm E, Lu PJ, Carter RJ, Boone K, Baack B, Masters NB, Weiss D, Black C, Huang Q, Vangala S, Albertin C, Szilagyi PG, Brewer NT, Singleton JA. Behavioral and Social Drivers of COVID-19 Vaccination in the United States, August-November 2021. Am J Prev Med 2023; 64:865-876. [PMID: 36775756 PMCID: PMC9874048 DOI: 10.1016/j.amepre.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION COVID-19 vaccines are safe, effective, and widely available, but many adults in the U.S. have not been vaccinated for COVID-19. This study examined the associations between behavioral and social drivers of vaccination with COVID-19 vaccine uptake in the U.S. adults and their prevalence by region. METHODS A nationally representative sample of U.S. adults participated in a cross-sectional telephone survey in August-November 2021; the analysis was conducted in January 2022. Survey questions assessed self-reported COVID-19 vaccine initiation, demographics, and behavioral and social drivers of vaccination. RESULTS Among the 255,763 respondents, 76% received their first dose of COVID-19 vaccine. Vaccine uptake was higher among respondents aged ≥75 years (94%), females (78%), and Asian non-Hispanic people (94%). The drivers of vaccination most strongly associated with uptake included higher anticipated regret from nonvaccination, risk perception, and confidence in vaccine safety and importance, followed by work- or school-related vaccination requirements, social norms, and provider recommendation (all p<0.05). The direction of association with uptake varied by reported level of difficulty in accessing vaccines. The prevalence of all of these behavioral and social drivers of vaccination was highest in the Northeast region and lowest in the Midwest and South. CONCLUSIONS This nationally representative survey found that COVID-19 vaccine uptake was most strongly associated with greater anticipated regret, risk perception, and confidence in vaccine safety and importance, followed by vaccination requirements and social norms. Interventions that leverage these social and behavioral drivers of vaccination have the potential to increase COVID-19 vaccine uptake and could be considered for other vaccine introductions.
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Affiliation(s)
- Kimberly E Bonner
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Oregon Health Authority Public Health Division, Oregon Health Authority, Portland, Oregon; COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Kushagra Vashist
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennesse; Immunization Services Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neetu S Abad
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L Kriss
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Immunization Services Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lu Meng
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; General Dynamics Information Technology Inc, Falls Church, Virginia
| | - James T Lee
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Immunization Services Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elisabeth Wilhelm
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peng-Jun Lu
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Immunization Services Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rosalind J Carter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of the Director, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kwanza Boone
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Goldbelt, Inc., Juneau, Alaska
| | - Brittney Baack
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nina B Masters
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debora Weiss
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Preparedness and Response (CPR), Division of State and Local Readiness (DSLR), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carla Black
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Immunization Services Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Caroline
| | - Sitaram Vangala
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, New York
| | - Christina Albertin
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, New York
| | - Peter G Szilagyi
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, New York
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Caroline; Lineberger Comprehensive Cancer Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James A Singleton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Immunization Services Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
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Valero-Martínez C, Martínez-Rivera C, Zhen-Duan J, Fukuda M, Alegría M. Attitudes toward COVID-19 Vaccine Uptake: A Qualitative Study of Mostly Immigrant Racial/Ethnic Minority Older Adults. Geriatrics (Basel) 2023; 8:17. [PMID: 36826359 PMCID: PMC9956127 DOI: 10.3390/geriatrics8010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
(1) Background: Few qualitative studies address diverse older adults' perceptions of COVID-19 vaccination in the United States, including non-English speakers and immigrant populations. This study aims to understand the attitudes of diverse, primarily immigrant older adults in the U.S. toward the COVID-19 vaccine and its influences on their vaccination decision-making. (2) Methods: The research team conducted semi-structured interviews (N = 100) in 2021 focused on understanding ethnically/racially diverse older adults' perceptions of the COVID-19 vaccine. Interviews were recorded, coded, and analyzed using a thematic analysis approach. (3) Results: Thematic analyses identified three themes. (1) Older adults showed mixed attitudes toward the COVID-19 vaccine associated with information consumed and trust in healthcare systems; (2) health concerns and underlying medical conditions were the most influential factors of vaccine uptake; and (3) systemic barriers and trusted figures impacted vaccination decision-making of older adults. (4) Conclusions: Accessible information in diverse languages tailored to the community's fears is needed to combat vaccine mistrust. Vaccine rollout programs need to tackle the fear of vaccine side effects. Attitudes of religious leaders, family members, and physicians considerably influenced vaccine uptake, suggesting their role as trusted members for vaccine messaging for older, primarily immigrant adults. Systemic barriers, namely lack of transportation and inaccessible vaccination sites, contributed to vaccine deterrence.
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Affiliation(s)
- Carla Valero-Martínez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychology, Faculty of Social Sciences, Río Piedras Campus, University of Puerto Rico, San Juan, PR 00925, USA
| | - Christopher Martínez-Rivera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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Abascal Miguel L, Christian C, Accurso EC, Najmabadi A, Athavale P, Diala JA, Sachdev D, Philip S, Reid MJ, Handley MA. Barriers and Enablers to COVID-19 Vaccination in San Francisco's Spanish-Speaking Population. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:56-66. [PMID: 36647398 PMCID: PMC9833024 DOI: 10.1007/s43477-023-00071-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.
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Affiliation(s)
- Lucía Abascal Miguel
- Institute for Global Health Sciences, University of California, 550 16th St, San Francisco, CA 94158 USA
| | - Canice Christian
- Institute for Global Health Sciences, University of California, 550 16th St, San Francisco, CA 94158 USA ,Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA USA
| | | | - Priyanka Athavale
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Jody A. Diala
- Institute for Global Health Sciences, University of California, 550 16th St, San Francisco, CA 94158 USA
| | - Darpun Sachdev
- San Francisco Department of Public Health, San Francisco, CA USA
| | - Susan Philip
- San Francisco Department of Public Health, San Francisco, CA USA
| | - Michael J. Reid
- Institute for Global Health Sciences, University of California, 550 16th St, San Francisco, CA 94158 USA ,School of Medicine, University of California, San Francisco, CA USA ,Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA USA
| | - Margaret A. Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA ,PRISE Center (Partnerships in Research in Implementation Science for Equity), University of California, San Francisco, CA USA
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Evaluation of the Community Health Worker Model for COVID-19 Response and Recovery. J Community Health 2023; 48:430-445. [PMID: 36604393 PMCID: PMC9816010 DOI: 10.1007/s10900-022-01183-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
Community health workers (CHWs), or promotores de salud, have long played a role in health promotion, but the COVID-19 pandemic has brought renewed attention to the functions, sustainability, and financing of CHW models. ¡Andale! ¿Que Esperas? was a 12-month (June 2021-May 2022) campaign that expanded the CHW workforce to increase COVID-19 vaccination rates in structurally vulnerable, Latinx communities across California. This mixed-methods evaluation aims to elucidate (1) the role of CHWs in COVID-19 response, recovery, and rebuilding and (2) the importance, needs, and perils of CHW models in the COVID-19 era and beyond. CHWs facilitated 159,074 vaccinations and vaccine appointments by countering mis/disinformation, addressing mental health and social needs, building digital competencies, and meeting people where they are, all of which expanded access and instilled confidence in the COVID-19 vaccine. CHWs' success in engaging the community lies in their shared lived experience as well as their accessibility and recognition in the community, enabling their role in both immediate response and long-term recovery. Funding instability imperils the advances made by CHWs, and efforts are needed to institutionalize the CHW workforce with sustainable funding models. While Medicaid reimbursement models exist in some states, these models are often limited to healthcare services, overlooking a critical function of the CHW model: building community resilience and mobilizing the community for social change.
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Woodard L, Gilbert L, King B, Adepoju OE, Bruce MA, McDougle L, Moultry AM, Beech BM. Examining Black and Hispanic physicians and other healthcare providers' attitudes toward the COVID-19 vaccine. J Natl Med Assoc 2023; 115:53-65. [PMID: 36610827 PMCID: PMC9815487 DOI: 10.1016/j.jnma.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/11/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Recognizing that the voice delivering the message is as important as the information being shared, we examined vaccine perceptions and willingness to encourage patients to obtain COVID-19 vaccinations among Black and Hispanic healthcare providers. METHODS We conducted a cross-sectional, online survey of Black and Hispanic healthcare providers who were members of the National Medical Association (NMA), National Hispanic Medical Association (NHMA), and National Pharmaceutical Association (NPhA) between January 11 - March 3, 2021, shortly after emergency use authorization (EUA) for the Pfizer and Moderna COVID-19 vaccines. Three multivariable logistic regression models were used to determine factors associated with the willingness to encourage COVID-19 vaccination. RESULTS The analytic sample consisted of 542 fully completed surveys. Pharmacists reported intent to take the vaccine (75.0% "as soon as you can" vs 91.4% for MD/DOs; p<0.001) and encouraged patients to get vaccinated (78.6% vs 91.0% for MD/DOs; p = 0.01). Providers in a suburban practice location were less likely to recommend vaccines to patients (OR=0.43, 95%CI: 0.22-0.87) and personal family (OR=0.45, 95%CI: 0.22-0.92) compared to those practicing in urban areas. Providers over age 45 were also more likely to report intent to take the vaccine themselves as soon as it was available (OR=3.72, 95%CI: 1.30-10.64). CONCLUSIONS This is likely the first cross-sectional study in the United States demonstrating the substantial vaccine confidence among Black and Hispanic healthcare providers who serve minoritized communities that have borne the greatest risk of adverse COVID-related outcomes.
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Affiliation(s)
- LeChauncy Woodard
- Tilman J. Fertitta Family College of Medicine, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US; Humana Integrated Health System Sciences Institute, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US
| | - Lauren Gilbert
- Tilman J. Fertitta Family College of Medicine, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US; Humana Integrated Health System Sciences Institute, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US.
| | - Ben King
- Tilman J. Fertitta Family College of Medicine, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US; Humana Integrated Health System Sciences Institute, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US
| | - Omolola E Adepoju
- Tilman J. Fertitta Family College of Medicine, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US; Humana Integrated Health System Sciences Institute, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US
| | - Marino A Bruce
- Tilman J. Fertitta Family College of Medicine, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US
| | - Leon McDougle
- The Ohio State University Wexner Medical Center, 410W. 10th Ave., Columbus, Ohio 43210 US
| | | | - Bettina M Beech
- Tilman J. Fertitta Family College of Medicine, University of Houston, Health 2 Building, 4849 Martin Luther King Blvd, Houston, TX 77004 US
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Lu PJ, Srivastav A, Vashist K, Black CL, Kriss JL, Hung MC, Meng L, Zhou T, Yankey D, Masters NB, Fast HE, Razzaghi H, Singleton JA. COVID-19 Booster Dose Vaccination Coverage and Factors Associated with Booster Vaccination among Adults, United States, March 2022. Emerg Infect Dis 2023; 29:133-140. [PMID: 36480674 PMCID: PMC9796208 DOI: 10.3201/eid2901.221151] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Centers for Disease Control and Prevention recommends a COVID-19 vaccine booster dose for all persons >18 years of age. We analyzed data from the National Immunization Survey-Adult COVID Module collected during February 27-March 26, 2022 to assess COVID-19 booster dose vaccination coverage among adults. We used multivariable logistic regression analysis to assess factors associated with vaccination. COVID-19 booster dose coverage among fully vaccinated adults increased from 25.7% in November 2021 to 63.4% in March 2022. Coverage was lower among non-Hispanic Black (52.7%), and Hispanic (55.5%) than non-Hispanic White adults (67.7%). Coverage was 67.4% among essential healthcare personnel, 62.2% among adults who had a disability, and 69.9% among adults who had medical conditions. Booster dose coverage was not optimal, and disparities by race/ethnicity and other factors are apparent in coverage uptake. Tailored strategies are needed to educate the public and reduce disparities in COVID-19 vaccination coverage.
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Adkins-Jackson PB, Burke NJ, Espinosa PR, Ison JM, Goold SD, Rosas LG, Doubeni CA, Brown AF. Inclusionary Trials: A Review of Lessons Not Learned. Epidemiol Rev 2022; 44:78-86. [PMID: 36124656 PMCID: PMC9494445 DOI: 10.1093/epirev/mxac007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/22/2021] [Accepted: 09/07/2022] [Indexed: 12/29/2022] Open
Abstract
The COVID-19 pandemic revealed weaknesses in the public health infrastructure of the United States, including persistent barriers to engaging marginalized communities toward inclusion in clinical research, including trials. Inclusive participation in clinical trials is crucial for promoting vaccine confidence, public trust, and addressing disparate health outcomes. A long-standing body of literature describes the value of community-based participatory research in increasing marginalized community participation in research. Community-based participatory research emphasizes shared leadership with community members in all phases of the research process, including in the planning and implementation, interpretation, and dissemination. Shared leadership between academic and industry with marginalized communities can assist with inclusive participation in vaccine trials and increase public trust in the development of the vaccines and other therapies used during public emergencies. Nevertheless, epidemiologic and clinical research do not yet have a strong culture of community partnership in the scientific process, which takes time to build and therefore may be difficult to develop and rapidly scale to respond to the pandemic. We outline practices that contribute to a lack of inclusive participation and suggest steps that trialists and other researchers can take to increase marginalized communities' participation in research. Practices include planning for community engagement during the planning and recruitment phases, having regular dialogues with communities about their priorities, supporting them throughout a study, and navigating complex structural determinants of health. Additionally, we discuss how research institutions can support inclusive practices by reexamining their policies to increase participation in clinical trials and instilling institutional trustworthiness.
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Affiliation(s)
- Paris B Adkins-Jackson
- Correspondence to Dr. Paris Adkins-Jackson, Department of Epidemiology, Mailman School of Public Health, 722 W. 168th Street, New York, NY 10032 (e-mail: )
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