1
|
O’Bryan SE, Muñoz F, Smith D, Bearse A, Melendrez B, Kamdar B, James-Price C, Ramirez D, Servin AE. Community based participatory research as a promising practice for addressing vaccine hesitancy, rebuilding trust and addressing health disparities among racial and ethnic minority communities. Hum Vaccin Immunother 2024; 20:2326781. [PMID: 38497273 PMCID: PMC10950264 DOI: 10.1080/21645515.2024.2326781] [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: 01/13/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
The COVID-19 pandemic disproportionately affected racial and ethnic minority communities across the United States (U.S.). Despite the disproportionate burden of COVID-19 faced by communities of color, Black and Hispanic communities are less likely to be fully vaccinated than White non-Hispanic Persons. Health inequity and vaccine hesitancy are complex phenomena that require multilevel responses tailored to the unique needs of each community, a process that inherently necessitates a high level of community engagement in order to develop the most effective health interventions. Building on the principles of community based participatory research (CBPR) and with the support of the National Institutes of Health (NIH), Project 2VIDA! was born. A multidisciplinary collaborative of academic researchers, community members, and clinicians whose aim is to foster sustainable partnerships to reduce the burden of COVID-19 in Hispanic and Black communities across Southern California. Our model was designed to meet our community members where they were - whether on their lunch break or picking their children from school. This CBPR model has been well received by community members. Future health interventions focused on reducing health disparities should prioritize the role of the community, leverage the voices of key community partners, and be grounded in equitable power sharing.
Collapse
Affiliation(s)
- Sophie E. O’Bryan
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Fatima Muñoz
- Health Support Services, San Ysidro Health, San Ysidro, CA, USA
| | - David Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Adriana Bearse
- UC San Diego, Center for Community Health, University of California, San Diego, La Jolla, CA, USA
| | - Blanca Melendrez
- UC San Diego, Center for Community Health, University of California, San Diego, La Jolla, CA, USA
| | - Biren Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Daniel Ramirez
- Health Support Services, San Ysidro Health, San Ysidro, CA, USA
| | - Argentina E. Servin
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
2
|
James D, Horne L. Examining barriers to dental, medical, mental, and vision healthcare access, attitudes towards seeking healthcare, and internalized racism among Black Americans. Soc Sci Med 2024; 357:117193. [PMID: 39127001 DOI: 10.1016/j.socscimed.2024.117193] [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: 05/16/2024] [Revised: 07/16/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
Structural barriers, which impede access to healthcare, are often seen as tangible expressions of structural racism. Those who experience more structural barriers to healthcare access are likely to experience poor health. Expanding on this notion, our research integrated the Internalized Racism Framework (James, 2022) with the Structural Vulnerability Framework (Bourgois et al., 2017; Metzl and Hansen, 2014) to explore how encountering barriers to healthcare access influences healthcare seeking attitudes across four health domains: mental, medical, dental, and vision. Our study included a sample of 780 Black American adults (average age = 37.68) who were recruited to participate in an anonymous web-based cross-sectional survey. Our findings revealed that internalized racism explained the direct effect of healthcare access structural barriers on healthcare attitudes in the mental, medical, and vision health domains, but not in the dental health domain. Specifically, the experience of more structural barriers in accessing healthcare (mental, medical, and vision) correlated with heightened internalized racism, which, in turn, was associated with more negative attitudes towards seeking (mental, medical, and vision) healthcare. Notably, our results also showed variations in the frequency and types of structural barriers encountered across the four health domains, along with differences in participants' positive healthcare seeking attitudes. Our findings underscore an urgent need for targeted interventions addressing both structural and internalized racism. Removing healthcare access barriers is crucial for fostering equitable healthcare access for Black Americans. Future research should explore additional factors influencing healthcare seeking attitudes, as well as strategies that mitigate the negative effects of racism on said attitudes.
Collapse
Affiliation(s)
- Drexler James
- Department of Psychology, University of Minnesota, USA.
| | - Lisette Horne
- Department of Psychology, University of Minnesota, USA
| |
Collapse
|
3
|
Nwachukwu G, Rihan A, Nwachukwu E, Uduma N, Elliott KS, Tiruneh YM. Understanding COVID-19 Vaccine Hesitancy in the United States: A Systematic Review. Vaccines (Basel) 2024; 12:747. [PMID: 39066385 PMCID: PMC11281578 DOI: 10.3390/vaccines12070747] [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: 06/01/2024] [Revised: 06/21/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
The COVID-19 pandemic has presented the importance of vaccination as a pivotal strategy for controlling its spread. However, vaccine hesitancy poses a significant barrier to achieving widespread immunization in the United States. This systematic review utilizes the 5C model to examine the factors contributing to hesitancy, which include confidence in vaccines, complacency about disease risk, calculations of individual benefit, convenience of vaccination, and collective responsibility for the protection of others. METHODS We conducted a comprehensive search across several relevant databases and the gray literature, identifying 544 studies that used quantitative and qualitative methods to explore COVID-19 vaccine hesitancy in the general U.S. POPULATION RESULTS This review identifies a complex interplay of factors affecting hesitancy, such as concerns over vaccine safety and efficacy, misinformation and conspiracy theories, demographic variables, and socioeconomic conditions. Key strategies for increasing vaccine uptake include transparent and effective communication along with proactive community engagement. CONCLUSIONS To effectively mitigate vaccine hesitancy, it is crucial to understand its multifaceted causes. Tailored interventions that consider socioeconomic and cultural contexts and prioritize clear communication, community involvement, and specific strategies to address unique concerns can enhance vaccine acceptance.
Collapse
Affiliation(s)
- Godspower Nwachukwu
- Department of Public Health, School of Health Professions, University of Texas at Tyler Health Science Center, Tyler, TX 75708, USA;
| | - Alaa Rihan
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas at Tyler Health Science Center, Tyler, TX 75708, USA;
| | - Esther Nwachukwu
- Department of Biology, University of Texas at Tyler, Tyler, TX 75799, USA; (E.N.); (N.U.)
| | - Ndukwe Uduma
- Department of Biology, University of Texas at Tyler, Tyler, TX 75799, USA; (E.N.); (N.U.)
| | - Kimberly S. Elliott
- Department of Health Policy, Economics and Management, School of Health Professions, University of Texas at Tyler Health Science Center, Tyler, TX 75708, USA;
| | - Yordanos M. Tiruneh
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas at Tyler Health Science Center, Tyler, TX 75708, USA;
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| |
Collapse
|
4
|
Blake N, Siddiq H, Brecht ML, Warda U, Villacorte F, Banawa J. Social Determinants of Health and Satisfaction With Sources of Information About COVID-19 Related to Vaccine Uptake in a Safety Net Healthcare System. Nurs Res 2024; 73:261-269. [PMID: 38498855 DOI: 10.1097/nnr.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Vaccination is a critical tool to combat the COVID-19 pandemic. Yet, vaccine uptake varies across communities and is often affected by sociodemographic factors and accessibility. OBJECTIVES This article outlines a pilot study aimed to examine factors associated with COVID-19 patients within one of the nation's largest safety net healthcare systems. METHODS A cross-sectional survey design was conducted with adults over 18 years of age eligible to receive the COVID-19 vaccine. Descriptive analysis of survey data collected in 2021-2022 was employed. Unconditional and multivariate logistic regression analyses were conducted to examine associations between sociodemographics, social factors, and COVID-19 vaccine uptake. RESULTS Study participants ( N = 280) were a diverse patient population, primarily low-income and majority Hispanic/Latinx, with low education levels, but with a high level of COVID-19 vaccine uptake and a high rate of intent to vaccinate again. Approximately 22% report having unstable housing, and 46% experiencing food insecurity. Most trusted sources for COVID-19 data included mainstream media, including TV, radio, and newspapers, and friends, family, or other informal networks. We found that respondents who were satisfied or very satisfied with COVID-19 information received from healthcare providers or the government had higher odds of vaccine uptake rates. DISCUSSION These findings highlight the critical role of access to the COVID-19 vaccine and sources of information as an independent factor in COVID-19 vaccine uptake among patients within a safety net healthcare system. This study expands the literature on COVID-19 vaccine uptake, particularly in an underresourced region of the South Los Angeles community. Future research is needed to better understand the mechanisms between social determinants of health, perceived discrimination, and vaccine uptake.
Collapse
|
5
|
Üsküp DK, Castellon-Lopez YM, Jolayemi O, Branch CA, Adeyiga O, Shoptaw S. Racial (In)Equity in South Los Angeles-Community Centered Experiences with COVID-19 Syndemics. Health Equity 2024; 8:446-454. [PMID: 39011070 PMCID: PMC11249122 DOI: 10.1089/heq.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 07/17/2024] Open
Abstract
Objectives To analyze community experiences involving COVID-19 vaccination access and equity in Black and Latina/o/x communities within South Los Angeles, using a socioecological framework. Methods We conducted four virtual focus groups (n = 33 total participants) in 2021, with Black and Latina/o/x community members, community leaders, and community-based providers in South Los Angeles, a region highly impacted by the COVID-19 pandemic. We used a grounded theory approach to guide the analysis and generate data shaped by participant perspectives. Results Participants across groups consistently emphasized medical mistrust, fear/skepticism, misinformation, accessibility, and feelings of pressure and blame as factors influencing COVID-19 vaccination decisions. The need to address pandemic-related socioeconomic hardships in underresourced communities was equally highlighted. Conclusions Findings show that building trust, providing tailored information, and continued investment into diversity and equity initiatives can support Black and Latino/a/x communities in making informed health decisions. Community-centered support services should address the economic, social, and structural impact of the pandemic on vulnerable communities. Furthermore, public health and policy efforts must prioritize funding to equip social and health care systems with infrastructure investment in racial and ethnic minority communities.
Collapse
Affiliation(s)
- Dilara K Üsküp
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Internal Medicine, Charles R. Drew University of Medicine, and Science, Los Angeles, California, USA
| | | | - Oluwadamilola Jolayemi
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Cheryl A Branch
- The Community Response System of South Los Angeles (CRSSLA), Los Angeles, California, USA
| | - Oladunni Adeyiga
- Department of Medicine, Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Steve Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
6
|
Tiruneh YM, Cuccaro PM, Elliott KS, Xie J, Martinez J, Owens M, Alvarado CR, Yamal JM. Vaccine Uptake and Intentions: Insights from a Texas Survey on Factors Influencing COVID-19 Vaccination Decisions. Vaccines (Basel) 2024; 12:601. [PMID: 38932330 PMCID: PMC11209159 DOI: 10.3390/vaccines12060601] [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: 04/19/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The effectiveness of COVID-19 vaccines depends on widespread vaccine uptake. Employing a telephone-administered weighted survey with 19,502 participants, we examined the determinants of COVID-19 vaccine acceptance among adults in Texas. We used multiple regression analysis with LASSO-selected variables to identify factors associated with COVID-19 vaccine uptake and intentions to receive the vaccine among the unvaccinated. The prevalence of unvaccinated individuals (22%) was higher among those aged 18-39, males, White respondents, English speakers, uninsured individuals, those facing financial challenges, and individuals expressing no concern about contracting the illness. In a fully adjusted regression model, higher odds of being unvaccinated were observed among males (aOR 1.11), the uninsured (aOR 1.38), smokers (aOR 1.56), and those facing financial struggles (aOR 1.62). Conversely, Asians, Blacks, and Hispanics were less likely to be unvaccinated compared to Whites. Among the unvaccinated, factors associated with stronger intent to receive the vaccine included age (over 65 years), Black and Hispanic ethnicity, and perceived risk of infection. Hispanic individuals, the uninsured, those covered by public insurance, and those facing financial challenges were more likely to encounter barriers to vaccine receipt. These findings underscore the importance of devising tailored strategies, emphasizing nuanced approaches that account for demographic, socioeconomic, and attitudinal factors in vaccine distribution and public health interventions.
Collapse
Affiliation(s)
- Yordanos M. Tiruneh
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA
- Department of Internal Medicine, School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Paula M. Cuccaro
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 78701, USA;
| | - Kimberly S. Elliott
- Department of Health Policy, Economics, and Management, School of Professions, University of Texas at Tyler, Tyler, TX 75708, USA;
| | - Jing Xie
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (J.X.); (J.M.); (J.-M.Y.)
| | - Journey Martinez
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (J.X.); (J.M.); (J.-M.Y.)
| | - Mark Owens
- Department of Political Science, School of Humanities and Social Sciences, The Citadel, Charleston, SC 29409, USA;
| | - Christian R. Alvarado
- Department of Epidemiology and Biostatistics, School of Medicine, University of Texas at Tyler, Tyler, TX 75708, USA;
| | - Jose-Miguel Yamal
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (J.X.); (J.M.); (J.-M.Y.)
| |
Collapse
|
7
|
Park YW, Bragard E, Madhivanan P, Fisher CB. A Latent Profile Analysis of COVID-19 and Influenza Vaccine Hesitancy among Economically Marginalized Hispanic Mothers of Children under Five Years of Age in the US. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02012-1. [PMID: 38713370 DOI: 10.1007/s40615-024-02012-1] [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: 12/18/2023] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
Rates of COVID-19 and influenza vaccine coverage among Hispanic young children continue to be low in comparison to other racial and ethnic groups in the United States. This study utilized a person-centered approach to understand COVID-19 and influenza vaccination hesitancy for young children under the age of five among 309 economically marginalized Hispanic mothers. Drawing on the cultural health belief model, in 2022, following FDA approval of the COVID-19 vaccine for young children, a latent profile analysis was conducted from which three profiles emerged. The Low Acculturation group (Profile 1), was notable for lower acculturation, moderate cultural medical mistrust, lower access to vaccines, and higher financial security. Compared to Profile 1, the two remaining profiles had higher acculturation and lower levels of financial security, but differed in that the High Acculturation group (Profile 2) had higher vaccine accessibility and the Moderate Acculturation group (Profile 3) had higher cultural medical mistrust. Relative to other profiles, Low Acculturation mothers were more likely to plan to vaccinate their child against current and seasonal COVID-19 and seasonal influenza, report that their child's health provider recommended the COVID-19 shot and reported lower COVID-19 and influenza vaccine mistrust. However, they also reported lower vaccine accessibility and moderate levels of cultural medical mistrust. The study highlights the importance of developing person-centered public health strategies that draw on Hispanic cultural values and consider diversity within lower income Hispanic populations to increase future pediatric COVID-19 and flu vaccination coverage among young Hispanic children.
Collapse
Affiliation(s)
- Yea Won Park
- Department of Psychology. Dealy Hall, Fordham University, 441 E Fordham Rd, Bronx, NY, 10458, USA
| | - Elise Bragard
- Health Department of Public Health Sciences, University of Connecticut, 195 Farmington Avenue, Farmington, CT, 06032, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave. Tucson, Tucson, AZ, 85721, USA
| | - Celia B Fisher
- Department of Psychology. Dealy Hall, Fordham University, 441 E Fordham Rd, Bronx, NY, 10458, USA.
| |
Collapse
|
8
|
Keegan G, Zhu M, Paz M, Kang H, Patel A, Baig AA. Neighborhood-level factors associated with COVID-19 vaccination rates: a case study in Chicago. BMC Public Health 2024; 24:889. [PMID: 38528490 PMCID: PMC10962191 DOI: 10.1186/s12889-024-18352-w] [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: 07/25/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Chicago's deeply-rooted racial and socioeconomic residential segregation is a pattern mirrored in other major cities, making it a prototype for studying the uptake of public health interventions across the US. Residential segregation is related to availability of primary care, sense of community, and trust in the healthcare system, components which are essential in the response to crises like Covid-19 in which vaccine rollout was primarily community-based. We aimed to evaluate the association between rates of access to primary care and community-belonging with Covid-19 vaccination within Chicago's neighborhoods. METHODS Data from Chicago Department of Public Health (12/2020-6/2022) on Covid-19 vaccination rates, race/ethnicity (% Black and % Hispanic/Latinx residents), age (% >65), gender (% female), socioeconomic status (% below the federal poverty line), access to needed care rate, and rate of self-reported sense of community-belonging on the neighborhood level were analyzed. Linear mixed models (LMMs) were used to study the impact of variables on vaccination; each neighborhood was added as a random effect to account for with-community association. RESULTS The average Covid-19 vaccination rates across Chicago's neighborhoods was 79%, ranging from 37 to 100%, with median 81%. We found that Covid-19 vaccination rates were positively correlated with access to needed care (p < 0.001) and community-belonging (p < 0.001). Community areas that had lower vaccination rates had greater percentage of Black residents (p < 0.0001) and greater poverty rates (p < 0.0001). After adjusting for poverty, race, gender and age in the models, the association between vaccination rates and access to care or community-belonging were no longer significant, but % Black residents and poverty remained significant. CONCLUSIONS Though access to needed primary care and community-belonging are correlated with vaccination rates, this association was not significant when controlling for demographic factors. The association between poverty, race and vaccination status remained significant, indicating that socioeconomic and racial disparities across Chicago drive Covid-19 vaccine recommendation adherence regardless of care access. Understanding how poverty, and its intersectional relation to race and primary care access, affects vaccination should be a priority for public health efforts broadly.
Collapse
Affiliation(s)
- Grace Keegan
- Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Ave. MC 2007, 60637, Chicago, IL, USA.
| | - Mengqi Zhu
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, USA
| | - Maria Paz
- Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Ave. MC 2007, 60637, Chicago, IL, USA
| | - Hyojung Kang
- Department of Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Ajanta Patel
- Chicago Department of Public Health, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, USA
| |
Collapse
|
9
|
Hwang J, Ding Y, Wang C, Chen E, Wu Y, Hu X. Asian American University Students' Experiences during the COVID-19 Pandemic: A Qualitative Study. Behav Sci (Basel) 2024; 14:34. [PMID: 38247686 PMCID: PMC10813077 DOI: 10.3390/bs14010034] [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: 09/28/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
In addition to the unprecedented challenges and stressors that university students faced during the COVID-19 pandemic, Asian American students experienced specific hardships due to COVID-19-associated xenophobic attitudes, harassment, and assault against people of Asian complexions. This qualitative study aimed to explore the ways in which Asian American university students' experiences during the pandemic changed their views of their identities as Asian Americans by analyzing in-depth interviews of four case study participants. Secondary analysis of two waves of interviews, which were conducted during the initial outbreak of the COVID-19 pandemic and during a six-month follow-up, and primary analysis of a newly conducted third wave one year after the initial outbreak yielded 12 themes that captured the essence of the Asian American university students' experience and redefining of their identity during the pandemic. The four participants identified these themes across four categories: Experiences and Events during the Pandemic; Categorization of Asians in America; Confronting Asian Discrimination; and Renewed Sense of Identity. The longitudinal findings revealed direct experiences and perspectives regarding the influence of the COVID-19 pandemic on Asian communities, as well as the impact of the various social and political events during this time period, such as the Black Lives Matter Movement (2020) and the 2020 US presidential election. The implications, limitations, and future directions are discussed.
Collapse
Affiliation(s)
- Jacqueline Hwang
- Graduate School of Education, Fordham University, New York, NY 10023, USA; (J.H.); (E.C.); (Y.W.); (X.H.)
| | - Yi Ding
- Graduate School of Education, Fordham University, New York, NY 10023, USA; (J.H.); (E.C.); (Y.W.); (X.H.)
| | - Cixin Wang
- College of Education, University of Maryland, College Park, MD 20742, USA;
| | - Eric Chen
- Graduate School of Education, Fordham University, New York, NY 10023, USA; (J.H.); (E.C.); (Y.W.); (X.H.)
| | - Ying Wu
- Graduate School of Education, Fordham University, New York, NY 10023, USA; (J.H.); (E.C.); (Y.W.); (X.H.)
| | - Xiaoyan Hu
- Graduate School of Education, Fordham University, New York, NY 10023, USA; (J.H.); (E.C.); (Y.W.); (X.H.)
| |
Collapse
|
10
|
Yakusheva O, Lee KA, Keller A, Weiss ME. Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients. Med Care 2024; 62:21-29. [PMID: 38060342 DOI: 10.1097/mlr.0000000000001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. OBJECTIVE To examine how the association of nurse assessments of patients' readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. RESEARCH DESIGN Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014-03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. SUBJECTS All Medicare patients in the study's intervention arm (n=14,684). MEASURES Patient's race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient's Readiness for Hospital Discharge Scale (RHDS) score (0-10 scale) assessed by the discharging nurse on the day of discharge. RESULTS Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18-8.24), non-Hispanic Black (8.20; 95% CI: 8.12-8.28), Hispanic (7.92; 95% CI: 7.81-8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01-8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3-30.3; White: 32.6%, 95% CI: 31.1-34.1). CONCLUSIONS Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.
Collapse
Affiliation(s)
- Olga Yakusheva
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kathryn A Lee
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Abiola Keller
- Marquette University College of Nursing, Milwaukee, WI
| | | |
Collapse
|
11
|
Miller HN, Stevens SC, Young D, Lacanienta CT, Tomiwa T, Vazquez MG, Olawole W, Zhu T, Lewis-Land C, Clark R, Peeler A, Byiringiro S, Cook B, Weston C, Bronner Y, Rich T, Himmelfarb CR. Grassroots and Digital Outreach Strategies Raise Awareness of COVID-19 Information and Research in Baltimore City. Am J Public Health 2024; 114:S69-S73. [PMID: 38207261 PMCID: PMC10785161 DOI: 10.2105/ajph.2023.307492] [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] [Accepted: 10/04/2023] [Indexed: 01/13/2024]
Abstract
We aimed to disseminate reliable COVID-19 information to the Black and Latino communities of Baltimore City, Maryland, between July 2020 and December 2022. With community partners, we disseminated evidence-based COVID-19 information via grassroots and digital strategies, including Hopkins Opportunity for Participant Engagement, and connected volunteers to COVID-19 research. Using a multimodal approach facilitated dissemination of reliable information and raised awareness of research; evaluation of trust is ongoing. Robust, multimodal strategies are needed to foster trust and equity among diverse communities. (Am J Public Health. 2024;114(S1):S69-S73. https://doi.org/10.2105/AJPH.2023.307492).
Collapse
Affiliation(s)
- Hailey N Miller
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Sarah C Stevens
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Donald Young
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Cyd T Lacanienta
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Tosin Tomiwa
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Monica Guerrero Vazquez
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Wura Olawole
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Trinity Zhu
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Cassie Lewis-Land
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Roger Clark
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Anna Peeler
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Samuel Byiringiro
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Brittany Cook
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Christine Weston
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Yvonne Bronner
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Tim Rich
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Cheryl R Himmelfarb
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| |
Collapse
|
12
|
Gully BJ, Padovano HT, Clark SE, Muro GJ, Monnig MA. Exposure to the Death of Others during the COVID-19 Pandemic: Growing Mistrust in Medical Institutions as a Result of Personal Loss. Behav Sci (Basel) 2023; 13:999. [PMID: 38131855 PMCID: PMC10741189 DOI: 10.3390/bs13120999] [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: 10/17/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND AND AIMS The prominence of death during the COVID-19 pandemic was heightened by the potential of personally knowing someone who lost their life to the virus. The terror management theory (TMT) suggests that the salient presence of death has a pronounced effect on behavior and may result in the ossification of beliefs and actions aligned with one's worldview (i.e., the mortality salience hypothesis). In this study, we evaluated how death exposure early in the COVID-19 pandemic could enact the process of firming up held beliefs and attitudes related to health and safety. Specifically, we tested the hypothesis that exposure to a personal loss during the pandemic would strengthen participants' baseline attitudes and behaviors regarding COVID-19 safety guidelines. METHOD Data were analyzed from a prospective, regional survey administered at two time points during the pandemic, June-July 2020 and May 2021, in five United States northeastern states. Baseline and follow-up surveys were administered approximately 12 months apart, with adherence to public guidance and death exposure measured at both timepoints and other safety measures at follow-up only. FINDINGS Our results indicated that there were significant main effects of death exposure on guideline adherence and support for COVID-related public policy. Contrary to the mortality salience hypothesis, death exposures after baseline were related to higher medical mistrust at follow-up for those high in adherence at baseline, rather than those with low adherence. CONCLUSION Our results offer some conflicting evidence to the mortality salience hypothesis. Rather than entrench people in their worldviews, death in the context of the COVID-19 pandemic appeared to sway people away from their initial stances. This finding has important implications for TMT literature and for the COVID-19 pandemic response.
Collapse
Affiliation(s)
- Brian J. Gully
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02903, USA; (H.T.P.); (S.E.C.); (G.J.M.); (M.A.M.)
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02903, USA
| | - Hayley Treloar Padovano
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02903, USA; (H.T.P.); (S.E.C.); (G.J.M.); (M.A.M.)
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02903, USA
- Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02903, USA
| | - Samantha E. Clark
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02903, USA; (H.T.P.); (S.E.C.); (G.J.M.); (M.A.M.)
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02903, USA
| | - Gabriel J. Muro
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02903, USA; (H.T.P.); (S.E.C.); (G.J.M.); (M.A.M.)
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02903, USA
| | - Mollie A. Monnig
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02903, USA; (H.T.P.); (S.E.C.); (G.J.M.); (M.A.M.)
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02903, USA
| |
Collapse
|
13
|
Rich KM, Pandya A, Chiosi JJ, Reddy KP, Shebl FM, Ciaranello AL, Neilan AM, Pinkney JA, Losina E, Freedberg KA, Ahonkhai AA, Hyle EP. Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men. JAMA Netw Open 2023; 6:e2344385. [PMID: 38015507 PMCID: PMC10685884 DOI: 10.1001/jamanetworkopen.2023.44385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Substantial racial inequities exist across the HIV care continuum between non-Hispanic Black and White men who have sex with men (MSM) in the US. Objectives To project years of life gained (YLG) with improving the HIV care continuum among Black MSM and White MSM in the US and to determine the outcomes of achieving health equity goals. Design, Setting, and Participants The Cost-Effectiveness of Preventing AIDS Complications microsimulation model was used and populated with 2021 race-specific data to simulate HIV care among Black MSM and White MSM in the US who have acquired HIV. Analyses were completed from July 2021 to October 2023. Intervention The study simulated status quo care using race-specific estimates: age at infection, time to diagnosis, receipt of care, and virologic suppression. The study next projected the outcomes of attaining equity-centered vs non-equity-centered goals by simulating 2 equal improvements in care goals: (10-point increased receipt of care and 5-point increased virologic suppression), 3 equity-centered goals (annual HIV testing, 95% receiving HIV care, and 95% virologic suppression) and lastly, an equitable care continuum that achieves annual HIV testing, 95% receiving care, and 95% virologic suppression in Black MSM and White MSM. One-way and multiway sensitivity and scenario analyses were conducted. Main Outcomes and Measures Mean age at death and YLG. Results In the simulated cohort, the mean (SD) age at HIV infection was 27.0 (10.8) years for Black MSM and 35.5 (13.6) years for White MSM. In status quo, mean age at death would be 68.8 years for Black MSM and 75.6 years for White MSM. The equal improvements in care goals would result in 0.5 YLG for Black MSM and 0.5 to 0.9 YLG for White MSM. Achieving any 1 equity-centered goal would result in 0.5 to 1.7 YLG for Black MSM and 0.4 to 1.3 YLG for White MSM. With an equitable care continuum compared with the nationally reported status quo, Black MSM and White MSM would gain 3.5 and 2.1 life-years, respectively. If the status quo HIV testing was every 6 years with 75% retained in care and 75% virologically suppressed, Black MSM would gain 4.2 life-years with an equitable care continuum. Conclusions and Relevance In this simulation modeling study of HIV care goals, equal improvements in HIV care for Black and White MSM maintained or worsened inequities. These results suggest that equity-centered goals for the HIV care continuum are critical to mitigate long-standing inequities in HIV outcomes.
Collapse
Affiliation(s)
- Katherine M. Rich
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John J. Chiosi
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Krishna P. Reddy
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
| | - Fatma M. Shebl
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Andrea L. Ciaranello
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Anne M. Neilan
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston
| | - Jodian A. Pinkney
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Elena Losina
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Policy and Innovation Evaluation in Orthopedic Treatments (PIVOT) Center, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kenneth A. Freedberg
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
| | - Aima A. Ahonkhai
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily P. Hyle
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
| |
Collapse
|
14
|
Neighbors CE, Faldowski RA, Pieper CF, Taylor J, Gaines M, Sloane R, Wixted D, Woods CW, Newby LK. Factors Associated with COVID-19 Vaccination Promptness after Eligibility in a North Carolina Longitudinal Cohort Study. Vaccines (Basel) 2023; 11:1639. [PMID: 38005971 PMCID: PMC10674190 DOI: 10.3390/vaccines11111639] [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: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Many studies identified factors associated with vaccination intention and hesitancy, but factors associated with vaccination promptness and the effect of vaccination intention on vaccination promptness are unknown. This study identified factors associated with COVID-19 vaccination promptness and evaluated the role of vaccination intention on vaccination promptness in 1223 participants in a community-based longitudinal cohort study (June 2020 to December 2021). Participants answered questions regarding COVID-19 vaccination intention, vaccination status, and reasons for not receiving a vaccine. The association of baseline vaccine hesitancy with vaccination was assessed by the Kaplan-Meier survival analysis. Follow-up analyses tested the importance of other variables predicting vaccination using the Cox proportional hazards model. Older age was associated with shorter time to vaccination (HR = 1.76 [1.37-2.25] 85-year-old versus 65-year-old). Lower education levels (HR = 0.80 [0.69-0.92]), household incomes (HR = 0.84 [0.72-0.98]), and baseline vaccination intention of 'No' (HR = 0.16 [0.11-0.23]) were associated with longer times to vaccination. The most common reasons for not being vaccinated (N = 58) were vaccine safety concerns (n = 33), side effects (n = 28), and vaccine effectiveness (n = 25). Vaccination campaigns that target populations prone to hesitancy and address vaccine safety and effectiveness could be helpful in future vaccination rollouts.
Collapse
Affiliation(s)
- Coralei E. Neighbors
- Department of Population Health, Duke University, Durham, NC 27701, USA
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC 27710, USA
| | - Richard A. Faldowski
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA
| | - Carl F. Pieper
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - Joshua Taylor
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC 27701, USA (L.K.N.)
| | - Megan Gaines
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC 27701, USA (L.K.N.)
| | - Richard Sloane
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA
| | - Douglas Wixted
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC 27701, USA (L.K.N.)
| | - Christopher W. Woods
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC 27710, USA
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - L. Kristin Newby
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC 27701, USA (L.K.N.)
- Duke Clinical Research Institute, Duke University, Durham, NC 27701, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| |
Collapse
|
15
|
Kalita N, Corr PG, Ward MC, Xavier J, McDonald PL. Identifying facilitators and barriers to culturally responsive communication for racial, ethnic, sexual, and gender minoritized patients when screened for COVID-19 vaccinations: A scoping review protocol. PLoS One 2023; 18:e0290514. [PMID: 37796975 PMCID: PMC10553356 DOI: 10.1371/journal.pone.0290514] [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: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Racial, ethnic, sexual, and gender minoritized groups are considered historically excluded groups and have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. The influence of social determinants of health (SDOH), including access to screening and treatment, and other systemic and structural factors are largely responsible for these disparities. Primary care practitioner (PCP) competence in culturally responsive screening practices will be critical to reducing the impact of systemic and structural factors serving as barriers to screening and treatment. Correspondingly, improving the capacity of PCPs to communicate with patients in a culturally responsive manner may influence improved screening and treatment outcomes for minoritized groups related to COVID-19. This scoping literature review aims to determine the current breadth of literature on culturally responsive communication (CRC) in regard to COVID-19 vaccination screening for historically excluded, or minoritized groups. Results from this review will inform the development of a training series and social marketing campaign to improve PCPs capacity in CRC. This manuscript provides details on our study protocol. OBJECTIVES This scoping literature review aims to analyze existing literature on culturally responsive COVID-19 vaccinations between PCPs and patients in the U.S., specifically for racial, ethnic, sexual, and gender minoritized groups. Results of this scoping review will inform the development of a training series and social marketing campaign to improve capacity of PCPs in this area. Additionally, the review will inform recommendations for future research. MATERIALS AND METHODS This scoping review will be performed following the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Relevant studies between the years 2019-2022 were identified using a rigorous search strategy across four databases: MEDLINE (via PubMed), Scopus, Cochrane (CENTRAL; via Wiley), and CINAHL (via EBSCO), using Boolean and Medical Subject Headings (MeSH) search terms. Studies will be uploaded to the data extraction tool, Covidence, to remove duplicates and perform a title/abstract screening, followed by a full-text screening. RESULTS The data extraction and analysis phases of the scoping review are in progress. Data will be analyzed for themes related to culturally responsive COVID-19 screening practices in clinical encounters with the identified study populations. Results will be reported by theme and align to PRISMA-ScR guidelines. DISCUSSION To our knowledge, this is the first study to use scoping methods to investigate the barriers and facilitators to CRC of COVID-19 vaccine screening for historically excluded communities in the U.S. The work and results from this research will be directly utilized for the development of nationally-accessible, continuing medical education materials to teach PCPs about CRC, as well as other materials to influence relevant policy changes within the healthcare landscape.
Collapse
Affiliation(s)
- Nikhil Kalita
- Department of Epidemiology, The George Washington University Milken School of Public Health, Washington, D.C., United States of America
| | - Patrick G. Corr
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Maranda C. Ward
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Julia Xavier
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Paige L. McDonald
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| |
Collapse
|
16
|
Cénat JM, Moshirian Farahi SMM, Bakombo SM, Dalexis RD, Pongou R, Caulley L, Yaya S, Etowa J, Venkatesh V. Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system. J Med Virol 2023; 95:e28738. [PMID: 37185858 DOI: 10.1002/jmv.28738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic disproportionately affected Black communities in Canada in terms of infection and mortality rates compared to the general population. Despite these facts, Black communities are among those with the highest level of COVID-19 vaccine mistrust (COVID-19 VM). We collected novel data to analyze the sociodemographic characteristics and factors associated with COVID-19 VM among Black communities in Canada. A survey was conducted among a representative sample of 2002 Black individuals (51.66% women) aged 14-94 years (M = 29.34; SD = 10.13) across Canada. Vaccine mistrust was assessed as the dependent variable and conspiracy theories, health literacy, major racial discrimination in healthcare settings, and sociodemographic characteristics of participants were assessed as independent variables. Those with a history of COVID-19 infection had higher COVID-19 VM score (M = 11.92, SD = 3.88) compared to those with no history of infection (M = 11.25, SD = 3.83), t (1999) = -3.85, p < 0.001. Participants who reported having experienced major racial discrimination in healthcare settings were more likely to report COVID-19 VM (M = 11.92, SD = 4.03) than those who were not (M = 11.36, SD = 3.77), t (1999) = -3.05, p = 0.002. Results also showed significant differences for age, education level, income, marital status, provinces, language, employment status, and religion. The final hierarchical linear regression showed that conspiracy beliefs (B = 0.69, p < 0.001) were positively associated with COVID-19 VM, while health literacy (B = -0.05, p = 0.002) was negatively associated with it. The mediated moderation model showed that conspiracy theories completely mediated the association between racial discrimination and vaccine mistrust (B = 1.71, p < 0.001). This association was also completely moderated by the interaction between racial discrimination and health literacy (B = 0.42, p = 0.008), indicating that despite having a high level of health literacy, those who experienced major racial discrimination in health services developed vaccine mistrust. This first study on COVID-19 VM exclusively among Black individuals in Canada provides data that can significantly impact the development of tools, trainings, strategies, and programs to make the health systems free of racism and increase their confidence in vaccination for COVID-19 and other infectious diseases.
Collapse
Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada
| | | | - Schwab Mulopo Bakombo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Roland Pongou
- Department of Economics, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Caulley
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Josephine Etowa
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ontario, Canada
| | - Vivek Venkatesh
- Department of Art Education, Concordia University, Quebec, Montreal, Canada
| |
Collapse
|
17
|
Regan AK, Fiddian-Green A. Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion. Hum Vaccin Immunother 2022; 18:2156229. [PMID: 36535646 PMCID: PMC10019833 DOI: 10.1080/21645515.2022.2156229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Before COVID-19, influenza vaccines were the most widely recommended vaccine during pregnancy worldwide. In response to immunization during pregnancy, maternal antibodies offer protection against potentially life-threatening disease in both pregnant people and their infants up to six months of age. Despite this, influenza vaccine hesitancy is common, with few countries reporting immunization rates in pregnant people above 50%. In this review, we highlight individual, institutional, and social factors associated with influenza vaccine hesitancy during pregnancy. In addition, we present an overview of the evidence evaluating interventions to address influenza vaccine hesitancy during pregnancy. While some studies have indicated promising results, no single intervention has consistently effectively increased influenza vaccine uptake during pregnancy. Using a social-ecological model of health framework, future strategies addressing multiple levels of vaccine hesitancy will be needed to realize the potential health benefits of prenatal immunization programs.
Collapse
Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA.,Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| |
Collapse
|