1
|
Gonzalez VM, Stewart TJ. COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust. J Behav Med 2024; 47:123-134. [PMID: 37634151 DOI: 10.1007/s10865-023-00443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.
Collapse
Affiliation(s)
- Vivian M Gonzalez
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA.
| | - Tracy J Stewart
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA
| |
Collapse
|
2
|
Le-Morawa N, Kunkel A, Darragh J, Reede D, Chidavaenzi NZ, Lees Y, Hoffman D, Dia L, Kitcheyan T, White M, Belknap I, Agathis N, Began V, Balajee SA. Effectiveness of a COVID-19 Vaccine Rollout in a Highly Affected American Indian Community, San Carlos Apache Tribe, December 2020-February 2021. Public Health Rep 2023; 138:23S-29S. [PMID: 36017554 PMCID: PMC10515982 DOI: 10.1177/00333549221120238] [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: 11/15/2022] Open
Abstract
COVID-19 has disproportionately affected American Indian Tribes, including the San Carlos Apache Tribe, which resides on 1.8 million acres in Arizona and has 16 788 official members. High vaccination rates among American Indian/Alaska Native people in the United States have been reported, but information on how individual Tribes achieved these high rates is scarce. We describe the COVID-19 epidemiology and vaccine rollout in the San Carlos Apache Tribe using data extracted from electronic health records from the San Carlos Apache Healthcare Corporation (SCAHC). By mid-December 2020, 19% of the San Carlos Apache population had received a positive reverse transcription polymerase chain reaction test for SARS-CoV-2, the virus that causes COVID-19. The Tribe prioritized for vaccination population groups with the highest risk for severe COVID-19 outcomes (eg, those aged ≥65 years, who had a 46% risk of hospitalization if infected vs 13% overall). SCAHC achieved high early COVID-19 vaccination rates in the San Carlos community relative to the state of Arizona (47.6 vs 25.2 doses per 100 population by February 27, 2021). These vaccination rates reflected several strategies that were implemented to achieve high COVID-19 vaccine access and uptake, including advance planning, departmental vaccine education sessions within SCAHC, radio and Facebook postings featuring Tribal leaders in the Apache language, and pop-up community vaccine clinics. The San Carlos Apache Tribe's vaccine rollout strategy was an early success story and may provide a model for future vaccination campaigns in other Tribal nations and rural communities in the United States.
Collapse
Affiliation(s)
- Nam Le-Morawa
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Amber Kunkel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James Darragh
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - David Reede
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | | | - Yvonne Lees
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | - Dillene Hoffman
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Lapriel Dia
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Tara Kitcheyan
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Melinda White
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Isaiah Belknap
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Nickolas Agathis
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victoria Began
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - S Arunmozhi Balajee
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
3
|
Michels SY, Freeman RE, Williams E, Albers AN, Wehner BK, Rechlin A, Newcomer SR. Evaluating vaccination coverage and timeliness in American Indian/Alaska Native and non-Hispanic White children using state immunization information system data, 2015-2017. Prev Med Rep 2022; 27:101817. [PMID: 35656223 PMCID: PMC9152883 DOI: 10.1016/j.pmedr.2022.101817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022] Open
Abstract
Comprehensive estimates of vaccination coverage and timeliness of vaccine receipt among American Indian/Alaska Native (AI/AN) children in the United States are lacking. This study’s objectives were to quantify vaccination coverage and timeliness, as well as the proportion of children with specific undervaccination patterns, among AI/AN and non-Hispanic White (NHW) children ages 0–24 months in Montana, a large and primarily rural U.S. state. Data from Montana’s immunization information system (IIS) for children born 2015–2017 were used to calculate days undervaccinated for all doses of seven recommended vaccine series. After stratifying by race/ethnicity, up-to-date coverage at key milestone ages and the proportion of children demonstrating specific patterns of undervaccination were reported. Among n = 3,630 AI/AN children, only 23.1% received all recommended vaccine doses on-time (i.e., zero days undervaccinated), compared to 40.4% of n = 18,022 NHW children (chi-square p < 0.001). A greater proportion of AI/AN children were delayed at each milestone age, resulting in lower overall combined 7-vaccine series completion, by age 24 months (AI/AN: 56.6%, NHW: 64.3%, chi-square p < 0.001). As compared with NHW children, a higher proportion of AI/AN children had undervaccination patterns suggestive of structural barriers to accessing immunization services and delayed starts to vaccination. More than three out of four AI/AN children experienced delays in vaccination or were missing doses needed to complete recommended vaccine series. Interventions to ensure on-time initiation of vaccine series at age 2 months, as well initiatives to encourage completion of multi-dose vaccine series, are needed to reduce immunization disparities and increase vaccination coverage among AI/AN children in Montana.
Collapse
Affiliation(s)
- Sarah Y. Michels
- Yale School of Public Health, New Haven, CT, United States
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- Corresponding author at: University of Montana, Center for Population Health Research, 32 Campus Drive, Skaggs 173, Missoula, MT 59804, United States.
| | - Rain E. Freeman
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
| | - Elizabeth Williams
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
- All Nations Health Center, Missoula, MT, United States
| | - Alexandria N. Albers
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
| | - Bekki K. Wehner
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, United States
| | - Annie Rechlin
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, United States
| | - Sophia R. Newcomer
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
| |
Collapse
|
4
|
Gilbert RM, Mersky JP, Lee CTP. Prevalence and correlates of vaccine attitudes and behaviors in a cohort of low-income mothers. Prev Med Rep 2021; 21:101292. [PMID: 33489723 PMCID: PMC7804978 DOI: 10.1016/j.pmedr.2020.101292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/22/2020] [Accepted: 12/13/2020] [Indexed: 12/02/2022] Open
Abstract
The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%–21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization.
Collapse
Affiliation(s)
- Ross M Gilbert
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Joshua P Mersky
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Chien-Ti Plummer Lee
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| |
Collapse
|
5
|
Cooper DM, Afghani B, Byington CL, Cunningham CK, Golub S, Lu KD, Radom-Aizik S, Ross LF, Singh J, Smoyer WE, Lucas CT, Tunney J, Zaldivar F, Ulloa ER. SARS-CoV-2 vaccine testing and trials in the pediatric population: biologic, ethical, research, and implementation challenges. Pediatr Res 2021; 90:966-970. [PMID: 33627824 PMCID: PMC7903864 DOI: 10.1038/s41390-021-01402-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023]
Abstract
As the nation implements SARS-CoV-2 vaccination in adults at an unprecedented scale, it is now essential to focus on the prospect of SARS-CoV-2 vaccinations in pediatric populations. To date, no children younger than 12 years have been enrolled in clinical trials. Key challenges and knowledge gaps that must be addressed include (1) rationale for vaccines in children, (2) possible effects of immune maturation during childhood, (3) ethical concerns, (4) unique needs of children with developmental disorders and chronic conditions, (5) health inequities, and (6) vaccine hesitancy. Because COVID-19 is minimally symptomatic in the vast majority of children, a higher acceptable risk threshold is required when evaluating pediatric clinical trials. Profound differences in innate and adaptive immunity during childhood and adolescence are known to affect vaccine responsiveness for a variety of childhood diseases. COVID-19 and the accompanying social disruption, such as the school shutdowns, has been disproportionately damaging to minority and low-income children. In this commentary, we briefly address each of these key issues, specify research gaps, and suggest a broader learning health system approach to accelerate testing and clinical trial development for an ethical and effective strategy to implement a pediatric SARS-CoV-2 vaccine as rapidly and safely as possible. IMPACT: As the US begins an unprecedented implementation of SARS-CoV-2 vaccination, substantial knowledge gaps have yet to be addressed regarding vaccinations in the pediatric population. Maturational changes in the immune system during childhood have influenced the effectiveness of pediatric vaccines for other diseases and conditions, and could affect SARS-CoV-2 vaccine responsiveness in children. Given that COVID-19 disease is far milder in the majority of children than in adults, the risk-benefit of a pediatric SARS-CoV-2 vaccine must be carefully weighed. The needs of children with developmental disabilities and with chronic disease must be addressed. Minority and low-income children have been disproportionately adversely affected by the COVID-19 pandemic; care must be taken to address issues of health equity regarding pediatric SARS-CoV-2 vaccine trials and allocation. Research and strategies to address general vaccine hesitancy in communities must be addressed in the context of pediatric SARS-CoV-2 vaccines.
Collapse
Affiliation(s)
- Dan M. Cooper
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | - Behnoush Afghani
- grid.266093.80000 0001 0668 7243Department of Pediatrics, UC Irvine School of Medicine, Irvine, CA USA
| | | | - Coleen K. Cunningham
- grid.26009.3d0000 0004 1936 7961Department of Pediatrics, Duke University School of Medicine, Durham, NC USA
| | - Sidney Golub
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | - Kim D. Lu
- grid.266093.80000 0001 0668 7243Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA USA
| | - Shlomit Radom-Aizik
- grid.266093.80000 0001 0668 7243Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA USA
| | - Lainie Friedman Ross
- grid.170205.10000 0004 1936 7822Department of Pediatrics, University of Chicago, Chicago, IL USA
| | - Jasjit Singh
- grid.414164.20000 0004 0442 4003Division of Infectious Diseases, CHOC Children’s Hospital, Orange, CA USA
| | - William E. Smoyer
- grid.261331.40000 0001 2285 7943Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
| | - Candice Taylor Lucas
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | | | | | - Erlinda R. Ulloa
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA ,grid.414164.20000 0004 0442 4003Division of Infectious Diseases, CHOC Children’s Hospital, Orange, CA USA
| |
Collapse
|