Orange County, California COVID-19 Vaccine Equity Best Practices Checklist: A Community-Centered Call to Action for Equitable Vaccination Practices

Talents, Tears, Stories of Our Identities, and Community Building: Toward Community-Based Ecosystems of Latiné Health Driven by Promotores

This essay describes a process for integrating US Latiné communities as drivers of a grassroots vision for healthy Latiné communities and health equity planning that addresses racial injustices. Transforming structural conditions to promote Latiné community health happens alongside creating conditions for community-level self-determination to foster community-based ecosystems of health. Integrating a life course perspective, we describe a vision for community-based ecosystems of Latiné health that is rooted in forging connections and cultivating community; building community power to address structural drivers of health; leveraging the expertise and assets of promotores to reach, engage, and mobilize communities; scaling solutions through policy, system, and environment changes; and grounding research processes in community-driven priorities. Such processes must affirm the expertise of promotores and Latiné communities and recognize the interconnectedness of communities and systems (e.g., food, housing, living wages) to nurture health at local levels. Research can advance the science and evidence-based models that support community-based ecosystems of Latiné health. (Am J Public Health. 2024;114(S6):S525-S533. https://doi.org/10.2105/AJPH.2024.307763) [Formula: see text].

Important Barriers to COVID-19 Vaccination Among African Americans in Black Belt Region

BACKGROUND

To identify important barriers to COVID-19 vaccination among African Americans living in the Black Belt region.

METHODS

A cross-sectional, web-based questionnaire survey was conducted using best-worst scaling case 1 (the object case). Thirty-two potential barriers to COVID-19 vaccination were identified from the literature and confirmed by an expert. A nested balanced incomplete block design was used to generate 62 sets of 16 choice tasks. Each choice task included six barriers. Participants were asked to choose the most and least important barriers to their COVID-19 vaccination in each choice task of one set. The natural logarithm of the square root of best counts divided by the worst counts of each barrier was calculated to rank the importance of barriers.

RESULTS

Responses from a total of 808 participants were included. Among 32 barriers to COVID-19 vaccination, the five most important barriers were "safety concern of COVID-19 vaccines," "rapid mutation of COVID-19," "ingredients of COVID-19 vaccines," "Emergency Use Authorization (Fast-track approval) of COVID-19 vaccines," and "inconsistent information of COVID-19 vaccines." On the other hand, the five least important barriers were "religious reasons," "lack of time to get COVID-19 vaccine," "no support from my family and friends," "political reasons," and "fear of the needle."

CONCLUSIONS

Important barriers to the COVID-19 vaccination for African Americans living in the Black Belt region centered around the issues that could be resolved by communication strategies.

Neighborhood-level factors associated with COVID-19 vaccination rates: a case study in Chicago

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.

An Examination of US COVID-19 Vaccine Distribution in New Jersey, Pennsylvania, and New York

COVID-19 quickly spread across the United States (US) while communications and policies at all government levels suffered from inconsistency, misinformation, and lack of coordination. In order to explain the discrepancy between availability and population uptake, a case study was conducted analyzing vaccine rollout plans, social media, and Health Officer/Other Key Informant interviews in New Jersey, New York, and Pennsylvania. Key research questions included, "What were the barriers and facilitators of early COVID vaccine distribution?" and "What mechanisms in the community emerged to alleviate strains in early vaccination?" Findings from this study revealed that pre-existing emergency preparedness infrastructures and plans developed since the 9/11 tragedy were seemingly abandoned. This caused health departments at all levels of government to make impromptu, non-uniform decisions leading to confusion, vaccine hesitancy, and ultimately low uptake. The results indicate that future vaccine rollout best practices must include evidence-based decision-making, coordinated communications, and outreach to high-priority and vulnerable communities.

Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey

Background

The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States.

Objective

We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available. 

Methods

Participants aged ≥18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx.

Results

Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1% (n=191) were female, 77% (n=204) had at most a high school degree, 34.7% (n=92) had an annual income <US $25,000, and 11.7% (n=31) had previously tested positive for COVID-19. We found high knowledge regarding transmission and spread; moderate knowledge regarding symptoms awareness; overall negative attitudes, which included high pessimism in government public health efforts and high amounts of fear, anxiety, and frustration due to COVID-19 pandemic; and moderate participation in preventive practices. A college education was positively associated with a higher knowledge score than those without a college education (β=0.14, 95% CI 0.01-1.60; P=.04) when adjusted for covariates. Male gender had a positive association with COVID-19 attitude scores compared to female gender (β=1.61, 95% CI 0.50-2.72; P=.05), and male gender was negatively associated with the COVID-19 practices score compared to female gender (β=–0.16, 95% CI –0.56 to –0.06; P=.03), when both were adjusted for covariates. Among a subset of 203 patients, 26.6% (n=54) indicated that if the vaccine was available, they would not take a COVID-19 vaccine, and 18.7% (n=38) were unsure.

Conclusions

Good knowledge and preventative practices in the population may have reflected effective public health messaging and the implementation of public health laws during the first wave of the pandemic; however, the overall fear and anxiety may have reflected the negative impact that the pandemic had on vulnerable populations such as the Latinx community. Although our data are a reflection of a previous time in the pandemic, we believe it captures a critical time that can be used to provide unique insights regarding potential avenues to better protect the Latinx communities against future vaccine-resistant COVID-19 strains.

International Registered Report Identifier (IRRID)

RR2-10.2196/25265