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Hsieh N. Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:38-59. [PMID: 37776198 PMCID: PMC10922600 DOI: 10.1177/00221465231199276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.
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Affiliation(s)
- Ning Hsieh
- Michigan State University, East Lansing, MI, USA
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2
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Vo AK, Cerdeña JP, Loree JM, Cairns BE, Conklin AI, Kaseweter K, Chondoma L, Cragg JJ, Kramer JLK. Race-based reporting and participation of Black individuals in registered pain clinical trials, United States, 2000 to 2019. Pain 2023; 164:1976-1984. [PMID: 37068160 DOI: 10.1097/j.pain.0000000000002893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/10/2023] [Indexed: 04/19/2023]
Abstract
ABSTRACT There are numerous, well-established racial disparities in the management of pain. The degree to which these are evident at the stage of conducting clinical trials is unknown. To address this knowledge gap, we examined race-based reporting, participation of Black individuals, and the factors associated with reporting and participation in pain clinical trials in the United States. Data were extracted from Clinicaltrials.gov and published articles. One thousand two hundred trials met our inclusion criteria; 482 (40.2%) reported participant race. More recent, publicly funded, and larger trials were more likely to report race. Of 82,468 participants included in pain clinical trials that reported race, 15,101 were Black individuals (18.3%). Participation of Black individuals was significantly associated with pain type (ß = +27% in cardiovascular disease pain compared with acute pain, P < 0.05), study population (ß = +33% and +7% in pain in minoritized populations and women, respectively, compared with general population, P < 0.05), pain intervention (ß = +7.5% for trials of opioid interventions compared with nonopioid interventions, P < 0.05), and a diverse team of investigators (ß = +8.0% for studies incorporating a visible non-White investigator compared with those that did not, P < 0.05). Our results indicate that representation of Black participants in pain clinical trials generally aligns with national demographics in the United States. Increased representation corresponds with health conditions more prevalent among Black individuals (eg, cardiovascular disease) and with a diverse study team composition. Despite these encouraging results, less than half of pain trials reported race, which introduces potential publication bias and limits external validity.
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Affiliation(s)
- Anh Khoa Vo
- Facutly of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Jessica P Cerdeña
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | | | - Brian E Cairns
- Facutly of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Annalijn I Conklin
- Facutly of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kimberley Kaseweter
- Bill Nelems Pain Research Centre, University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Lerato Chondoma
- Indigenous Research Support Initiative, VP Research and Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Jacquelyn J Cragg
- Facutly of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - John L K Kramer
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Carmona N, Trujillo M. Developing Vaccine Literacy for Urban Health Science Students, the Future Health Workforce. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2023; 24:e00038-23. [PMID: 37614881 PMCID: PMC10443395 DOI: 10.1128/jmbe.00038-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/20/2023] [Indexed: 08/25/2023]
Abstract
The 2019 coronavirus disease pandemic underlined a shift in attitudes against vaccines and a rise in hesitancy among some members of the population, despite the overwhelming evidence that vaccinations are one of the most successful and safe health interventions. Research has shown that vaccine hesitancy is complex and can result from an intersectionality of multiple factors. Research has also shown that to tackle vaccine hesitancy in the community, health care workers play a pivotal role, as they are trusted sources who can provide reliable information and can address vaccination concerns for the public. Unfortunately, health care workers are also susceptible to vaccine hesitancy. Thus, to curb these negative attitudes and doubts against vaccinations, we propose to improve vaccine competency among health science students, who are the future health workforce. Here, we propose a comprehensive pedagogical approach that aims to improve the vaccine literacy in this student population in two urban community colleges. The approach includes the use of high-impact pedagogical interventions to achieve three main objectives: (i) to teach students the nature and process of science to have them become "competent outsiders"; (ii) to enhance students' knowledge of the complex science behind emerging infectious diseases and vaccine action, adopting a learner-centered and concept-focused instructional design, and (iii) to address the social, cultural, and historical aspects of vaccine development and the historical and present inequities that characterize this health intervention.
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Affiliation(s)
- Naydu Carmona
- Biological Sciences and Geology Department, Queensborough Community College, City University of New York, Queens, New York, USA
| | - Monica Trujillo
- Biological Sciences and Geology Department, Queensborough Community College, City University of New York, Queens, New York, USA
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Willis DE, Andersen JA, Montgomery BEE, Selig JP, Shah SK, Zaller N, Bryant-Moore K, Scott AJ, Williams M, McElfish PA. COVID-19 Vaccine Hesitancy and Experiences of Discrimination Among Black Adults. J Racial Ethn Health Disparities 2023; 10:1025-1034. [PMID: 35391714 PMCID: PMC8989097 DOI: 10.1007/s40615-022-01290-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 01/12/2023]
Abstract
Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older (n = 350) between July 12th and July 30th, 2021, as part of a larger survey of Arkansans (N = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Brooke E E Montgomery
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Nickolas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Keneshia Bryant-Moore
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA.
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Abdel-Qadir H, Austin PC, Sivaswamy A, Chu A, Wijeysundera HC, Lee DS. Comorbidity-stratified estimates of 30-day mortality risk by age for unvaccinated men and women with COVID-19: a population-based cohort study. BMC Public Health 2023; 23:482. [PMID: 36915068 PMCID: PMC10010246 DOI: 10.1186/s12889-023-15386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The mortality risk following COVID-19 diagnosis in men and women with common comorbidities at different ages has been difficult to communicate to the general public. The purpose of this study was to determine the age at which unvaccinated men and women with common comorbidities have a mortality risk which exceeds that of 75- and 65-year-old individuals in the general population (Phases 1b/1c thresholds of the Centre for Disease Control Vaccine Rollout Recommendations) following COVID-19 infection during the first wave. METHODS We conducted a population-based retrospective cohort study using linked administrative datasets in Ontario, Canada. We identified all community-dwelling adults diagnosed with COVID-19 between January 1 and October 31st, 2020. Exposures of interest were age (modelled using restricted cubic splines) and the following conditions: major cardiovascular disease (recent myocardial infarction or lifetime history of heart failure); 2) diabetes; 3) hypertension; 4) recent cancer; 5) chronic obstructive pulmonary disease; 6) Stages 4/5 chronic kidney disease (CKD); 7) frailty. Logistic regression in the full cohort was used to estimate the risk of 30-day mortality for 75- and 65-year-old individuals. Analyses were repeated after stratifying by sex and medical condition to determine the age at which 30-day morality risk in strata exceed that of the general population at ages 65 and 75 years. RESULTS We studied 52,429 individuals (median age 42 years; 52.5% women) of whom 417 (0.8%) died within 30 days. The 30-day mortality risk increased with age, male sex, and comorbidities. The 65- and 75-year-old mortality risks in the general population were exceeded at the youngest age by people with CKD, cancer, and frailty. Conversely, women aged < 65 years who had diabetes or hypertension did not have higher mortality than 65-year-olds in the general population. Most people with medical conditions (except for Stage 4-5 CKD) aged < 45 years had lower predicted mortality than the general population at age 65 years. CONCLUSION The mortality risk in COVID-19 increases with age and comorbidity but the prognostic implications varied by sex and condition. These observations can support communication efforts and inform vaccine rollout in jurisdictions with limited vaccine supplies.
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Affiliation(s)
- Husam Abdel-Qadir
- Women's College Hospital, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter C Austin
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Atul Sivaswamy
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Anna Chu
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Harindra C Wijeysundera
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Douglas S Lee
- University Health Network, Toronto, ON, Canada. .,ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Cardiovascular Research Program, Program Lead, ICES, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada.
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McElfish PA, Selig JP, Scott AJ, Rowland B, Willis DE, Reece S, CarlLee S, Macechko MD, Shah SK. Associations Between General Vaccine Hesitancy and Healthcare Access Among Arkansans. J Gen Intern Med 2023; 38:841-847. [PMID: 36323819 PMCID: PMC9629763 DOI: 10.1007/s11606-022-07859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Vaccines provide protection against numerous diseases that can cause serious illness and death. However, vaccine hesitancy threatens to undermine progress in reducing preventable diseases and illness. Vaccine hesitancy has been shown to vary by sociodemographic characteristics. However, studies examining associations between healthcare access and vaccine hesitancy are lacking. OBJECTIVE Using a statewide random sample of Arkansas adults, we examined the relationship between general vaccine hesitancy and healthcare access. DESIGN From July 12 to 30, 2021, participants were contacted by landlines and cellular phones using random digit dialing. PARTICIPANTS A total of 1500 Arkansas adults were surveyed. Black/African American and Hispanic/Latinx adults were oversampled to ensure adequate representation. The survey had a cooperation rate of 20%. MAIN MEASURES The dependent variable was an ordinal measure of general vaccine hesitancy. Age, gender, race, education, relationship status, and rural/urban residence were included in the model. Healthcare access was measured across four domains: (1) health insurance coverage; (2) having a primary care provider (PCP); (3) forgoing care due to cost; and (4) time since last routine checkup. The relationship between general vaccine hesitancy and healthcare access was modeled using ordinal logistic regression, controlling for sociodemographic characteristics. KEY RESULTS Mean age was 48.5 years, 51.1% were women, 28% reported a race other than White, and 36.3% held a bachelor's degree or higher. Those with a PCP and those with health insurance had approximately two-thirds the odds of being more hesitant ([OR=0.63, CI=0.47, 0.84] and [OR=0.68; CI=0.49, 0.94]) than those without a PCP and those without health insurance. Participants reporting a routine checkup in the last 2 years were almost half as likely to be more hesitant than those reporting a checkup more than 2 years prior (OR=0.58; CI=0.43, 0.79). CONCLUSIONS Results suggest improving access to health insurance, PCPs, and routine preventative care services may be critical to reducing vaccine hesitancy.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Michael D Macechko
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Associations between Influenza Vaccination and Health Care Access among Adults in the United States. Vaccines (Basel) 2023; 11:vaccines11020416. [PMID: 36851292 PMCID: PMC9958667 DOI: 10.3390/vaccines11020416] [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: 12/07/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Few studies have investigated the relationship between influenza vaccination and health care access. Furthermore, despite the well-documented disparities in vaccine coverage for communities of color, few studies have examined how experiences of discrimination may influence vaccine uptake. To fill this gap in the literature, this study examined associations between 5-year influenza vaccination rates and sociodemographic characteristics, health care access, and racial discrimination. Age, race/ethnicity, education, health care coverage, primary care provider, no medical care due to cost, and routine doctor checkups were significant correlates of 5-year influenza vaccination. In contrast to previous studies, discrimination scores were not a significant correlate of regular influenza vaccination. Respondents who reported forgoing care due to cost were less likely to report vaccination every year out of the last 5 years compared to all of the less frequent categories combined, demonstrating a more complex association between sometimes not being able to afford medical care and influenza vaccination. Future research should examine the relationship between influenza vaccination uptake, racial discrimination, and forgone care due to cost to enhance resources and messaging for influenza vaccination uptake.
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Healthcare Access and Experiences of Racial Discrimination as Predictors of General Vaccine Hesitancy. Vaccines (Basel) 2023; 11:vaccines11020409. [PMID: 36851286 PMCID: PMC9963783 DOI: 10.3390/vaccines11020409] [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: 12/16/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
The literature regarding vaccine hesitancy is limited to specific vaccines rather than general vaccine hesitancy. No studies have examined the relationship of general vaccine hesitancy to healthcare access and experiences of racial discrimination. This study fills gaps by examining: (1) socio-demographic factors; (2) associations between healthcare access; and (3) experiences with racial discrimination and general vaccine hesitancy. Survey data were obtained from 2022 US adults from 7 September to 3 October 2021. Racial and ethnic minority populations were oversampled. Age, gender, race, and education were predictors of vaccine hesitancy. Asian respondents had less than two-thirds the odds of being vaccine hesitant. Healthcare access was associated with vaccine hesitancy. Not having health insurance coverage, not having a primary care provider, and not seeing a provider for a routine check-up in the past two years were associated with higher vaccine hesitancy. For every one-point increase in racial discrimination score (0-45), the odds of being more vaccine hesitant increased by a factor of 1.03. The findings demonstrate that policy, systems, and environmental factors are critical to addressing vaccine hesitancy. Given the associations between vaccine hesitancy and racial discrimination and healthcare access, more attention should be given to inequities in the healthcare systems in order to address vaccine hesitancy.
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Characteristics of U.S. older adult medicare beneficiaries receiving the influenza vaccination at retail pharmacies. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100220. [PMID: 36691454 PMCID: PMC9860398 DOI: 10.1016/j.rcsop.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/04/2022] [Accepted: 01/01/2023] [Indexed: 01/06/2023] Open
Abstract
Background Pharmacy-provided influenza vaccination services have become more prevalent among the older adult population. However, little is known about the characteristics of older adults associated with receiving the influenza vaccination at retail pharmacies and how these associated characteristics have changed. Objective To examine characteristics of older adults associated with use of retail pharmacy-provided influenza vaccination services and how the characteristics changed between 2009 and 2015. Methods The study used a retrospective, cross-sectional design with data from the 2009 and 2015 Medicare Current Beneficiary Survey. Older adults aged 65 and older who completed a community questionnaire and received the influenza vaccination during the previous winter were identified. Andersen's Behavioral Model of Health Services Use was the conceptual framework for inclusion of the population characteristics. A multivariable log-binomial regression was performed to estimate the association between the population characteristics and use of pharmacy-provided vaccination service, and the relative change in associations between 2009 and 2015. Survey weights were applied in all analyses. Results The results showed older adults who were non-Hispanic black (compared to non-Hispanic white), who did not have secondary private insurance (compared to those who had), who did not have physician office visit (compared to those who had) and who lived in non-metro area (compared to those who lived in metro area) had become more likely to use pharmacy-provided influenza vaccination services in 2015 than in 2009. Conclusions Pharmacy-provided influenza vaccination services appear to reduce access barriers for racially and socioeconomically disadvantaged older adults. Findings could help inform not only the retail pharmacies that provide vaccination services to better outreach to potential target populations but also policy makers about the disadvantaged populations that would benefit from the vaccination services provided by retail pharmacies.
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Delays and declines in seasonal influenza vaccinations due to Hurricane Harvey narrow annual gaps in vaccination by race, income and rurality. Infect Control Hosp Epidemiol 2022; 43:1833-1839. [PMID: 35292125 PMCID: PMC9753087 DOI: 10.1017/ice.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Temporal overlap of the Atlantic hurricane season and seasonal influenza vaccine rollout has the potential to result in delays or disruptions of vaccination campaigns. We documented seasonal influenza vaccination behavior over a 5-year period and explored associations between flooding following Hurricane Harvey and timing and uptake of vaccines, as well as how the impacts of Hurricane Harvey on vaccination vary by race, wealth, and rurality. DESIGN Retrospective cohort analysis. SETTING Texas counties affected by Hurricane Harvey. PATIENTS Active users of the Veterans' Health Administration in 2017. METHODS We used geocoded residential address data to assess flood exposure status following Hurricane Harvey. Days to receipt of seasonal influenza vaccines were calculated for each year from 2014 to 2019. Proportional hazards models were used to determine how likelihood of vaccination varied according to flood status as well as the race, wealth, and rural-urban residence of patients. RESULTS The year of Hurricane Harvey was associated with a median delay of 2 weeks to vaccination and lower overall vaccination than in prior years. Residential status in flooded areas was associated with lower hazards of influenza vaccination in all years. White patients had higher proportional hazards of influenza vaccination than non-White patients, though this attenuated to 6.39% (hazard ratio [HR], 1.0639; 95% confidence interval [CI], 1.034-1.095) in the hurricane. year. CONCLUSIONS Receipt of seasonal influenza vaccination following regional exposure to the effects of Hurricane Harvey was delayed among US veterans. White, non-low-income, and rural patients had higher likelihood of vaccination in all years of the study, but these gaps narrowed during the hurricane year.
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Willis DE, Montgomery BE, Selig JP, Andersen JA, Shah SK, Li J, Reece S, Alik D, McElfish PA. COVID-19 vaccine hesitancy and racial discrimination among US adults. Prev Med Rep 2022; 31:102074. [PMID: 36466305 PMCID: PMC9703864 DOI: 10.1016/j.pmedr.2022.102074] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Vaccination is a critical preventive measure to reduce COVID-19 health risks. We utilize full information maximum likelihood (FIML) logistic regression to analyze COVID-19 vaccine hesitancy in a national sample of United States (US) adults (N = 2,022). Online survey data was collected between September 7th and October 3rd, 2021. Before weighting, the racial composition of the sample was as follows: Asian American (15.0 %), Black/African American (20.0 %), Hispanic/Latino (20.0 %), American Indian or Alaska Native (12.6 %), Native Hawaiian or Pacific Islander (12.5 %), and White (20.0 %). Informed by the Increasing Vaccination Model (IVM), we assessed the relationship between COVID-19 vaccine hesitancy and experiences of racial discrimination (Krieger's 9-item measure). Odds of COVID-19 vaccine hesitancy were greater for most younger age groups, women (OR = 1.96; 95 % CI[1.54, 2.49]), Black/African American respondents (OR = 1.68; 95 % CI[1.18, 2.39]), those with a high school education or less (OR = 1.46; 95 % CI[1.08, 1.98]), Independent (OR = 1.77; 95 % CI[1.34, 2.35]) or Republican political affiliation (OR = 2.69; 95 % CI[1.92, 3.79]), and prior COVID-19 infection (OR = 1.78; 95 % CI[1.29, 2.45]). Odds of COVID-19 vaccine hesitancy were 1.04 greater for every-one unit increase in lifetime experiences of racial discrimination (95 % CI[1.02, 1.05]). Odds of COVID-19 vaccine hesitancy were lower for Asian American respondents (OR = 0.682; 95 % CI[0.480, 0.969]), and those who had a primary care doctor had reduced odds of COVID-19 vaccine hesitancy (OR = 0.735; 95 % CI[0.542, 0.998). Our primary finding provides support for a link between experiences of racial discrimination and hesitancy towards a COVID-19 vaccine among US adults. We discuss implications for public health officials and future research.
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Affiliation(s)
- Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Brooke E.E. Montgomery
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA,Corresponding author.
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Sanford K, Pizzuto AE. The Healthcare Discrimination Experience Scale: Assessing a Variable Crucial for Explaining Racial/Ethnic Inequities in Patient Activation and Health. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01350-2. [PMID: 35731463 DOI: 10.1007/s40615-022-01350-2] [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: 04/01/2022] [Revised: 05/23/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
Healthcare discrimination experience is expected to be a consequential variable that explains racial/ethnic inequities in patient activation and health; however, existing scales assessing healthcare discrimination experience are limited by insufficient psychometric development and overly narrow construct definitions. A new Healthcare Discrimination Experience Scale was developed, validated, compared to an existing scale, and used to estimate effects in explaining racial/ethnic health inequities. Across two studies, 975 patients with hypertension or diabetes (43% Black, 10% other Persons of Color, 47% White, 53% having household incomes < 40 thousand dollars) were recruited through marketing research panels to complete online questionnaires. Compared to an existing measure, the new scale better detected differences between People of Color and White people. It produced good results in confirmatory factor analysis and item response theory analysis, and it mediated the effects of racial/ethnic identity on eight variables regarding patient-practitioner relationships, treatment adherence, general health, blood pressure, and life stress. The new scale is valid for assessing a broadly defined healthcare discrimination experience construct in diverse patients with chronic medical conditions, and it is more sensitive to group differences than the best existing alternative scale. Compared to research using unvalidated scales, the results of this study demonstrate that healthcare discrimination experience plays a larger role in explaining racial/ethnic inequities in patient activation and health.
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Affiliation(s)
- Keith Sanford
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA.
| | - Alexandra E Pizzuto
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA
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13
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Anderson-Carpenter KD, Neal ZP. Racial Disparities in COVID-19 Impacts in Michigan, USA. J Racial Ethn Health Disparities 2022; 9:156-164. [PMID: 33620712 PMCID: PMC7901513 DOI: 10.1007/s40615-020-00939-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
Racial disparities have been observed in the impacts of COVID-19 in the USA. In the present paper, we used a representative sample of adults in Michigan to examine differences in COVID-19 impacts on Blacks and Whites in four domains: direct, perceived, political, and behavioral. We found that in the initial wave of the outbreak in May 2020, Blacks experienced more severe direct impacts: they were more likely to be diagnosed or know someone who was diagnosed, and more likely to lose their job compared to Whites. In addition, Blacks differed significantly from Whites in their assessment of COVID-19's threat to public health and the economy, the adequacy of government responses to COVID-19, and the appropriateness of behavioral changes to mitigate COVID-19's spread. Although in many cases these views of COVID-19 were also associated with political ideology, this association was significantly stronger for Whites than Blacks. Continued investigation of racial disparities in COVID-19's impact is necessary; however, these preliminary findings of a race-by-ideology interaction are important because they suggest some racial disparities are restricted to conservatives, while more liberal Whites and Blacks exhibit few differences.
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14
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MALONEY PATRICK, TIETJE LAUREN, RUNG ARIANE, BROYLES STEPHANIE, COUK JOHN, PETERS EDWARD, STRAIF-BOURGEOIS SUSANNE. The mediating effects of barriers to vaccination on the relationship between race/ethnicity and influenza vaccination status in a rural Southeastern Louisiana medical center. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E482-E491. [PMID: 36415290 PMCID: PMC9648542 DOI: 10.15167/2421-4248/jpmh2022.63.3.2687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/21/2022] [Indexed: 04/26/2023]
Abstract
Introduction Persistent disparities in influenza vaccination rates exist between racial/ethnic minorities and Whites. The mechanisms that define this relationship are under-researched. Methods Surveys assessing barriers to vaccination were administered to outpatients in a rural medical center in Southeastern Louisiana. Survey responses were matched to patient medical records. Likert-style statements were used to measure barriers to vaccination. A mediation analysis assessing the relationship between race and influenza vaccination mediated by vaccination barriers was conducted. Results The self-reported influenza vaccination rate in those surveyed was 40.4%. Whites (45.5%) were more likely than racial/ethnic minorities (36.3%) to report receipt of an influenza vaccination (p = 0.02). Racial/ethnic minorities reported significantly higher vaccination barrier scores (p < 0.01). The relationship between race/ethnicity and vaccination was mediated by vaccination barriers, when controlling for provider recommendation and having at least one comorbid medical condition (natural indirect effect [NIE] p-value = 0.02, proportion mediated = 0.71). Conclusions Barriers to vaccination mediates the relationship between race/ethnicity and vaccination status. Providers should focus on minimizing fears that the vaccine will cause illness and emphasize that the vaccine is safe and effective at preventing severe influenza-associated illness. Additional efforts should be made to improve accessibility of the influenza vaccine, including addressing costs of vaccination and expanding the number and types of settings where the vaccine is offered.
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Affiliation(s)
- PATRICK MALONEY
- University of Nebraska Medical Center, School of Public Health, Omaha, NE
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
- Correspondence: Patrick Maloney, 984375 Nebraska Medical Center, MCPH Room 3031, Omaha, NE 68198-4375. - E-mail:
| | - LAUREN TIETJE
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | - ARIANE RUNG
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | - STEPHANIE BROYLES
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, LA
| | - JOHN COUK
- Louisiana State University Health Care Services Division, New Orleans, LA
| | - EDWARD PETERS
- University of Nebraska Medical Center, School of Public Health, Omaha, NE
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
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15
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McElfish PA, Narcisse MR, Felix HC, Cascante DC, Nagarsheth N, Teeter B, Faramawi MF. Race, Nativity, and Sex Disparities in Human Papillomavirus Vaccination Among Young Adults in the USA. J Racial Ethn Health Disparities 2021; 8:1260-1266. [PMID: 33033889 PMCID: PMC9753349 DOI: 10.1007/s40615-020-00886-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
Research has demonstrated that the human papillomavirus (HPV) vaccine is a safe and effective way to decrease HPV-related cervical cancers; however, the vaccination rate in the USA is suboptimal. The current study examined racial and ethnic disparities in HPV vaccination among a nationally representative sample, including Native Hawaiian and Pacific Islanders (NHPI). This study also investigated the associations between nativity and vaccination, and sex differences between race/ethnicity and vaccination and nativity and vaccination. A cross-sectional study was conducted with a sample of adults aged 18-26 years drawn from the 2014 NHPI National Health Interview Survey (n = 2590) and the general 2014 National Health Interview Survey (n = 36,697). Log-binomial models were fitted to examine differences in vaccination. There was a statistically significant racial/ethnic difference in HPV vaccination (p = 0.003). More women than men were vaccinated (41.8% vs. 10.1%) (p < 0.001). There was a significant difference in HPV vaccination based on nativity: 27.4% of adults aged 18 to 26 years who were born in the USA and 27.7% born in a US territory received the HPV vaccine compared with 14.3% among those not born in the USA or a US territory (p < 0.001). The association of HPV vaccination with nativity and race/ethnicity differed by sex and showed several nuanced differences. Overall, the prevalence of HPV vaccination was low. The study's findings demonstrate the need for public health strategies to increase vaccination rates among all populations, with the critical need to identify strategies that are effective for men, racial/ethnic minorities, and immigrant women born outside the USA.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA.
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Diana C Cascante
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Nirav Nagarsheth
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Ben Teeter
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Mohammed F Faramawi
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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16
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Savoia E, Piltch-Loeb R, Goldberg B, Miller-Idriss C, Hughes B, Montrond A, Kayyem J, Testa MA. Predictors of COVID-19 Vaccine Hesitancy: Socio-Demographics, Co-Morbidity, and Past Experience of Racial Discrimination. Vaccines (Basel) 2021; 9:vaccines9070767. [PMID: 34358184 PMCID: PMC8310049 DOI: 10.3390/vaccines9070767] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/16/2022] Open
Abstract
The goal of this study is to explore predictors of COVID-19 vaccine hesitancy, including socio-demographic factors, comorbidity, risk perception, and experience of discrimination, in a sample of the U.S. population. We used a cross-sectional online survey study design, implemented between 13-23 December 2020. The survey was limited to respondents residing in the USA, belonging to priority groups for vaccine distribution. Responses were received from 2650 individuals (response rate 84%) from all 50 states and Puerto Rico, American Samoa, and Guam. The five most represented states were California (13%), New York (10%), Texas (7%), Florida (6%), and Pennsylvania (4%). The majority of respondents were in the age category 25-44 years (66%), male (53%), and working in the healthcare sector (61%). Most were White and non-Hispanic (66%), followed by Black and non-Hispanic (14%) and Hispanic (8%) respondents. Experience with racial discrimination was a predictor of vaccine hesitancy. Those reporting racial discrimination had 21% increased odds of being at a higher level of hesitancy compared to those who did not report such experience (OR = 1.21, 95% C.I. 1.01-1.45). Communication and logistical aspects during the COVID-19 vaccination campaign need to be sensitive to individuals' past-experience of racial discrimination in order to increase vaccine coverage.
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Affiliation(s)
- Elena Savoia
- Emergency Preparedness Research Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA 02115, USA; (R.P.-L.); (A.M.); (M.A.T.)
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Correspondence:
| | - Rachael Piltch-Loeb
- Emergency Preparedness Research Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA 02115, USA; (R.P.-L.); (A.M.); (M.A.T.)
| | - Beth Goldberg
- Jigsaw, Google LLC, 82th 10th Ave, New York, NY 10024, USA;
| | - Cynthia Miller-Idriss
- Center for University Excellence (CUE) and Polarization and Extremism Research and Innovation Lab (PERIL), American University, 4400 Massachusetts Avenue NW, Washington, DC 20016, USA; (C.M.-I.); (B.H.)
| | - Brian Hughes
- Center for University Excellence (CUE) and Polarization and Extremism Research and Innovation Lab (PERIL), American University, 4400 Massachusetts Avenue NW, Washington, DC 20016, USA; (C.M.-I.); (B.H.)
| | - Alberto Montrond
- Emergency Preparedness Research Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA 02115, USA; (R.P.-L.); (A.M.); (M.A.T.)
| | - Juliette Kayyem
- Belfer Center for Science and International Affairs, Harvard Kennedy School, Harvard University, 79 John F. Kennedy Street, Cambridge, MA 02138, USA;
| | - Marcia A. Testa
- Emergency Preparedness Research Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA 02115, USA; (R.P.-L.); (A.M.); (M.A.T.)
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Massachusetts Association of Health Boards, 20 Walnut Street, Suite 110, Wellesley, MA 02481, USA
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17
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Lwowski B, Rios A. The risk of racial bias while tracking influenza-related content on social media using machine learning. J Am Med Inform Assoc 2021; 28:839-849. [PMID: 33484133 PMCID: PMC7973478 DOI: 10.1093/jamia/ocaa326] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Machine learning is used to understand and track influenza-related content on social media. Because these systems are used at scale, they have the potential to adversely impact the people they are built to help. In this study, we explore the biases of different machine learning methods for the specific task of detecting influenza-related content. We compare the performance of each model on tweets written in Standard American English (SAE) vs African American English (AAE). MATERIALS AND METHODS Two influenza-related datasets are used to train 3 text classification models (support vector machine, convolutional neural network, bidirectional long short-term memory) with different feature sets. The datasets match real-world scenarios in which there is a large imbalance between SAE and AAE examples. The number of AAE examples for each class ranges from 2% to 5% in both datasets. We also evaluate each model's performance using a balanced dataset via undersampling. RESULTS We find that all of the tested machine learning methods are biased on both datasets. The difference in false positive rates between SAE and AAE examples ranges from 0.01 to 0.35. The difference in the false negative rates ranges from 0.01 to 0.23. We also find that the neural network methods generally has more unfair results than the linear support vector machine on the chosen datasets. CONCLUSIONS The models that result in the most unfair predictions may vary from dataset to dataset. Practitioners should be aware of the potential harms related to applying machine learning to health-related social media data. At a minimum, we recommend evaluating fairness along with traditional evaluation metrics.
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Affiliation(s)
- Brandon Lwowski
- Department of Information Systems and Cyber Security, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anthony Rios
- Department of Information Systems and Cyber Security, University of Texas at San Antonio, San Antonio, Texas, USA
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18
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Jungquist RM, Abuelezam NN. Disparities in influenza vaccination: Arab Americans in California. BMC Public Health 2021; 21:443. [PMID: 33663444 PMCID: PMC7932900 DOI: 10.1186/s12889-021-10476-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/18/2021] [Indexed: 01/24/2023] Open
Abstract
Background Influenza vaccination among minoritized groups remains below federal benchmarks in the United States (US). We used data from the 2004–2016 California Health Interview Surveys (CHIS) to characterize influenza vaccination patterns among Arab Americans in California. Methods Influenza vaccination was self-reported by Arab American adults (N = 1163) and non-Hispanic Whites (NHW, N = 166,955). Differences in influenza vaccination prevalence and odds were compared using chi-squared tests and survey-weighted logistic regression, respectively. Results Across all years, 30.3% of Arab Americans self-reported receiving an influenza vaccine (vs. 40.5% for NHW, p < 0.05). After sequential adjustment by sociodemographic, health behavior, and acculturation variables no differences in odds of self-reported influenza vaccination were observed between Arab Americans and NHW (odds ratio: 1.02, 95% confidence interval: 0.76–1.38). Male and unemployed Arab Americans had higher odds of reporting influenza vaccination than female and employed Arab Americans. Conclusions Future work should consider specific barriers to influenza vaccination in Arab American communities.
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Affiliation(s)
| | - Nadia N Abuelezam
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
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19
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Grandhi GR, Mszar R, Vahidy F, Valero-Elizondo J, Blankstein R, Blaha MJ, Virani SS, Andrieni JD, Omer SB, Nasir K. Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States. JAMA Cardiol 2020; 6:87-91. [PMID: 32902562 DOI: 10.1001/jamacardio.2020.3978] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death and disability in the US and worldwide. Influenza vaccination has shown to decrease overall morbidity, mortality, severity of infection, and hospital readmissions among these individuals. However, national estimates of influenza vaccination among individuals with ASCVD in the US are not well studied. Objective To evaluate the prevalence of and sociodemographic disparities in influenza vaccination among a nationally representative sample of individuals with ASCVD. Design, Setting, and Participants Pooled Medical Expenditure Panel Survey data from 2008 to 2016 were used and included adults 40 years or older with ASCVD. Participants' ASCVD status was ascertained via self-report and/or International Classification of Diseases, Ninth Revision diagnosis of coronary heart disease, peripheral artery disease, and/or cerebrovascular disease. Analysis began April 2020. Main Outcomes and Measures Prevalence and characteristics of adults with ASCVD who lacked influenza vaccination during the past year. Covariates including age, sex, race/ethnicity, family income, insurance status, education level, and usual source of care were assessed. Results Of 131 881 adults, 19 793 (15.7%) had ASCVD, corresponding to 22.8 million US adults annually. A total of 7028 adults with ASCVD (32.7%), representing 7.4 million adults, lacked influenza vaccination. The highest odds of lacking vaccination were observed among individuals aged 40 to 64 years (odds ratio [OR], 2.32; 95% CI, 2.06-2.62), without a usual source of care (OR, 2.00; 95% CI, 1.71-2.33), without insurance (OR, 2.05; 95% CI, 1.63-2.58), with a lower education level (OR, 1. 25; 95% CI, 1.12-1.40), with a lower income level (OR, 1.14; 95% CI, 1.01-1.27), and of non-Hispanic Black race/ethnicity (OR, 1.24, 95% CI, 1.10-1.41). A stepwise increase was found in the prevalence and odds of lacking influenza vaccination among individuals with increase in high-risk characteristics. Overall, 1171 individuals (59.7%; 95% CI, 55.8%-63.5%) with 4 or more high-risk characteristics and ASCVD (representing 732 524 US adults annually) reported lack of influenza vaccination (OR, 6.06; 95% CI, 4.88-7.53). Conclusion and Relevance Despite current recommendations, a large proportion of US adults with established ASCVD lack influenza vaccination, with several sociodemographic subgroups having greater risk. Focused public health initiatives are needed to increase access to influenza vaccinations for high-risk and underserved populations.
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Affiliation(s)
- Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Farhaan Vahidy
- Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas.,Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Julia D Andrieni
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Saad B Omer
- Yale Institute of Global Health, New Haven, Connecticut.,Yale School of Nursing, New Haven, Connecticut.,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Division of Cardiology, Yale University, New Haven, Connecticut
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20
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Martinez ML, Coles S. Addressing Immunization Health Disparities. Prim Care 2020; 47:483-495. [DOI: 10.1016/j.pop.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Su Z, Chengbo Z, Mackert M. Understanding the influenza vaccine as a consumer health technology: a structural equation model of motivation, behavioral expectation, and vaccine adoption. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/17538068.2019.1680038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Zhaohui Su
- Department of Mass Communication, College of Liberal Arts and Social Sciences, East Central University, Ada, OK, USA
| | - Zeng Chengbo
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael Mackert
- Stan Richards School of Advertising & Public Relations, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
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22
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Lu PJ, Hung MC, O'Halloran AC, Ding H, Srivastav A, Williams WW, Singleton JA. Seasonal Influenza Vaccination Coverage Trends Among Adult Populations, U.S., 2010-2016. Am J Prev Med 2019; 57:458-469. [PMID: 31473066 PMCID: PMC6755034 DOI: 10.1016/j.amepre.2019.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Influenza is a major cause of morbidity and mortality among adults. The most effective strategy for preventing influenza is annual vaccination. However, vaccination coverage has been suboptimal among adult populations. The purpose of this study is to assess trends in influenza vaccination among adult populations. METHODS Data from the 2010-2016 National Health Interview Survey were analyzed in 2018 to estimate vaccination coverage during the 2010-2011 through 2015-2016 seasons. Trends of vaccination in recent years were assessed. Vaccination coverage by race/ethnicity within each group was examined. Multivariable logistic regression and predictive marginal models were conducted to identify factors associated with vaccination, and interactions between race/ethnicity and other demographic and access-to-care characteristics were assessed. RESULTS Vaccination coverage among adults aged ≥18 years increased from 38.3% in the 2010-2011 season to 43.4% in the 2015-2016 season, with an average increase of 1.3 percentage points annually. From the 2010-2011 through 2015-2016 seasons, coverage was stable for adults aged ≥65 years and changed by -0.1 to 9.9 percentage points for all other examined subgroups. Coverage in 2015-2016 was 70.4% for adults aged ≥65 years, 46.4% for those aged 50-64 years, and 32.3% for those aged 18-49 years; 47.9% for people aged 18-64 years with high-risk conditions; 64.8% for healthcare personnel; and 50.3% for pregnant women. Among adults aged ≥18 years for the 2015-2016 season, coverage was significantly lower among non-Hispanic blacks and Hispanics compared with non-Hispanic whites. CONCLUSIONS Overall, influenza vaccination coverage among adults aged ≥18 years increased during 2010-2016, but it remained below the national target of 70%. Vaccination coverage varied by age, risk status, race/ethnicity, healthcare personnel, and pregnancy status. Targeted efforts are needed to improve coverage and reduce disparities.
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Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Mei-Chuan Hung
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Leidos, Inc., Atlanta, Georgia
| | - Alissa C O'Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Helen Ding
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; CFD Research Corporation, Huntsville, Alabama
| | - Anup Srivastav
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Leidos, Inc., Atlanta, Georgia
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Budhwani H, De P. Perceived Stigma in Health Care Settings and the Physical and Mental Health of People of Color in the United States. Health Equity 2019; 3:73-80. [PMID: 30915422 PMCID: PMC6434589 DOI: 10.1089/heq.2018.0079] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Addressing perceived and enacted stigma in clinical settings is critical to ensuring delivery of high-quality patient-centered care, reducing health disparities, and improving population health outcomes. Methods: Data from the Behavioral Risk Factor Surveillance System's (2012–2014) Reaction to Race module were analyzed to test the hypothesis that perceived stigma in health care settings would be associated with poorer physical and mental health. Poor health was measured by (1) the number of days the respondent was physically or mentally ill over the past month and (2) depressive disorder diagnosis. Multivariate linear and logistic regression models were employed. Results: Effects of stigma on physical and mental health were significant. Perceived stigma was associated with additional 2.79 poor physical health days (β=2.79, confidence interval [CI]=1.84–3.75) and 2.92 more days of poor mental health (β=2.92, CI=1.97–3.86). Moreover, perceived stigma in health care settings was associated with 61% higher odds of reporting a depressive disorder (adjusted odds ratio=1.61, CI=1.29–2.00). Among other findings, individuals who were married, younger, had higher income, had college degrees, and were employed reported significantly fewer poor physical and mental health days and had lower odds of self-reported depressive disorder. Conclusions: Reducing stigma against people of color in health care settings (environments that should be pro-patient) must be a top priority for population health scholars and clinicians. Reducing perceived stigma in clinical settings may produce better mental and physical health outcomes in minority patients thereby reducing health disparities. In addition, fewer days lost to poor health could positively influence the health care system by decreasing utilization and may improve economic productivity through increasing days of good health.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Prabal De
- Department of Economics, Colin Powell School, City College, New York, New York.,Department of Economics, The Graduate Center, CUNY, New York, New York
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Bleser WK, Miranda PY, Salmon DA. Child Influenza Vaccination and Adult Work Loss: Reduced Sick Leave Use Only in Adults With Paid Sick Leave. Am J Prev Med 2019; 56:251-261. [PMID: 30573337 DOI: 10.1016/j.amepre.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Children are a population of interest for influenza. They are at increased risk for severe influenza, comprise a substantial portion of influenza morbidity, and significantly contribute to its transmission in the household and subsequent parental work loss. The association between influenza vaccination and work loss prevention, however, has rarely been studied, and the sparse existing literature has very limited generalizability to U.S. adults, thus requiring better characterization. METHODS Using pooled National Health Interview Survey data (2013-2015, analyses conducted in 2018) nationally representative of working U.S. adults with household children (n=23,014), zero-inflated negative binomial regression examined the association of child influenza vaccination (exposure) with sick days (outcome) stratified by paid sick leave (no: n=10,741, yes: n=12,273). RESULTS Child influenza vaccination was associated with significantly lower sick day usage, but only among adults with paid sick leave (prevalence rate ratio=0.79, 95% CI=0.67, 0.93), equating to average annual sick days of 4.07 vs 3.29 in adults with unvaccinated versus vaccinated household children (difference=0.78 fewer days annually). CONCLUSIONS Influenza vaccination of children is associated with reduced sick leave in household adults, helping to keep the workforce healthy and reduce influenza's costly annual economic burden. This only occurred among adults with paid sick leave, however, which is distributed inequitably by income, education, gender, occupation, and race/ethnicity. Health in All Policies considers downstream health effects of social and economic policy; the failure of federal policy to ensure paid sick leave likely contributes to propagating influenza and health inequities.
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Affiliation(s)
- William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, District of Columbia.
| | - Patricia Y Miranda
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Hughes MM, Saiyed NS, Chen TS. Local-Level Adult Influenza and Pneumococcal Vaccination Disparities: Chicago, Illinois, 2015-2016. Am J Public Health 2018; 108:517-523. [PMID: 29470113 DOI: 10.2105/ajph.2017.304257] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate local-level adult influenza and pneumococcal vaccination disparities to inform targeted interventions. METHODS Questions on influenza and pneumococcal vaccination uptake were included in a door-to-door community-based representative survey conducted in 10 Chicago, Illinois, neighborhoods in 2015 and 2016. A total of 1543 adults completed the survey, including 172 adults aged 65 years or older. We calculated adult influenza (≥ 18 years) and pneumococcal (≥ 65 years) vaccination coverage by community area and respondent characteristics. RESULTS We observed significant differences in pneumococcal vaccination coverage between community areas (range = 18%-91%). Influenza vaccination coverage differed by gender, age, insurance coverage, acculturation, and confidence or trust in physician. Non-Hispanic Blacks were more likely to be vaccinated when they had higher confidence or trust in their physician (45% vs 20%; P < .01). Mexicans who reported less acculturation were more likely to be vaccinated than were Mexicans who were more acculturated (41% vs 27%; P = .02). CONCLUSIONS Striking disparities between neighborhoods and racial/ethnic groups in adult influenza and pneumococcal vaccination coverage highlight the need for improved local-level immunization coverage data.
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Affiliation(s)
- Michelle M Hughes
- Michelle M. Hughes conducted this research at the Sinai Urban Health Institute, Sinai Health System, Chicago, IL, and Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL. Nazia S. Saiyed is with the Sinai Urban Health Institute. Tiffany S. Chen is with Chicago Medical School, Rosalind Franklin University of Medicine and Science
| | - Nazia S Saiyed
- Michelle M. Hughes conducted this research at the Sinai Urban Health Institute, Sinai Health System, Chicago, IL, and Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL. Nazia S. Saiyed is with the Sinai Urban Health Institute. Tiffany S. Chen is with Chicago Medical School, Rosalind Franklin University of Medicine and Science
| | - Tiffany S Chen
- Michelle M. Hughes conducted this research at the Sinai Urban Health Institute, Sinai Health System, Chicago, IL, and Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL. Nazia S. Saiyed is with the Sinai Urban Health Institute. Tiffany S. Chen is with Chicago Medical School, Rosalind Franklin University of Medicine and Science
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Crouse Quinn S, Jamison AM, Freimuth VS, An J, Hancock GR. Determinants of influenza vaccination among high-risk Black and White adults. Vaccine 2017; 35:7154-7159. [PMID: 29126805 PMCID: PMC5712242 DOI: 10.1016/j.vaccine.2017.10.083] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adults with chronic conditions are at much greater risk of influenza-related morbidity and mortality, yet flu vaccine uptake remains suboptimal. Research focused on the high-risk population has been limited, particularly related to racial disparities in vaccination. We explore a broad range of demographic, racial, and psychosocial factors to identify predictors of vaccination among high-risk adults, with a focus on identify differences between Black and White adults. METHODS We conducted an online survey in March 2015, utilizing international research firm GfK's KnowledgePanel, for a nationally representative sample of Black and White adults (≥18, USA) and limited analysis adults with high-risk of influenza-related complications. Using two-way ANOVA, we assessed demographic, racial, and psychosocial predictors across vaccine uptake in the past five years and across racial group. RESULTS 424 (52.2%) Black and 388 (47.8%) White respondents with high-risk complications completed the survey. 383 (47.3%) reported vaccination annually, 99 (12.2%) most years, 104 (12.9%) once/twice, and 223 (27.6%) never.ANOVA confirmed significant differences in vaccine behavior for most demographic predictors (except education), all racial factors (including racial fairness, experiences of discrimination, etc.), and most psychosocial factors (including vaccine attitudes, trust in the vaccine, etc.). ANOVA confirmed significant differences for most factors by race. We observed significant interaction effects between race and vaccine behavior for subjective social status, access to medical care, knowledge of vaccine recommendations, vaccine attitudes, perceived side effect risks, descriptive norms, subjective norms, flu vaccine hesitancy, and flu vaccine confidence, thus implying racial differences in the connection between vaccine uptake and key demographic, racial, and psychosocial factors. CONCLUSIONS This study provides a novel examination of flu vaccine behavior among high-risk Blacks and Whites that identified factors influencing vaccine uptake.We found significant differences by race. Health care professionals can use this information to more effectively target high-risk adults during flu season.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742-2611, United States.
| | - Amelia M Jamison
- Maryland Center for Health Equity, University of Maryland, College Park, MD, United States
| | - Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, United States
| | - Ji An
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
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Quinn SC, Jamison A, An J, Freimuth VS, Hancock GR, Musa D. Breaking down the monolith: Understanding flu vaccine uptake among African Americans. SSM Popul Health 2017; 4:25-36. [PMID: 29349270 PMCID: PMC5769118 DOI: 10.1016/j.ssmph.2017.11.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 11/30/2022] Open
Abstract
Black adults are significantly less likely to be immunized for seasonal influenza when compared to Whites. This persistent disparity contributes to increased influenza-related morbidity and mortality in the African American population. Most scholarship on vaccine disparities has compared Whites and Blacks. Employing Public Health Critical Race Praxis, this study seeks to shift the focus to explore differences within the Black population. Utilizing a nationally-representative 2015 survey of US Black adults (n = 806), we explore differences by gender, age, income, and education across vaccine-related measures (e.g., perceived risk, knowledge, attitudes) and racial factors (e.g. racial salience, racial fairness, perceived discrimination). We also explore differences by vaccine behavior in the past five years among those who vaccinate every year, most years but not all, once or twice, and never. Greater frequency of flu vaccine uptake was associated with better self-reported vaccine knowledge, more positive vaccine attitudes, more trust in the flu vaccine and the vaccine process, higher perceived disease risk, lower perceived risk of vaccine side effects, stronger subjective and moral norms, lower general vaccine hesitancy, higher confidence in the flu vaccine, and lower perceived barriers. Logistic regression results highlighted other significant differences among the groups, emphasizing areas to target for improved vaccination rates. We find great diversity within the Black community related to influenza immunization decisions, highlighting the need to “break down the monolith” in future research. Empirically tested differences within the Black population for flu vaccine behavior. Detected significant differences in past vaccine behavior by age, gender, income, and education. Focus on past behavior to move adults along the continuum to increase vaccination. Highlights diversity within the Black population, often missing from comparative studies.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, Suite 1142, College Park, MD 20742, USA.,Maryland Center for Health Equity, School of Public Health, University of Maryland, 4200 Valley Drive, Suite 1304, College Park, MD 20742, USA
| | - Amelia Jamison
- Maryland Center for Health Equity, School of Public Health, University of Maryland, 4200 Valley Drive, Suite 1304, College Park, MD 20742, USA
| | - Ji An
- Department of Human Development and Quantitative Methods, University of Maryland,1230 Benjamin Building, College Park, MD 20742, USA
| | - Vicki S Freimuth
- Department of Health Promotion and Behavior, University of Georgia, 100 Foster Road, Athens, GA 30602, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methods, University of Maryland,1230 Benjamin Building, College Park, MD 20742, USA
| | - Donald Musa
- University Center for Social and Urban Research, University of Pittsburgh, 3343 Forbes Avenue, Pittsburgh, PA 15260, USA
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Moving beyond the individual: Community-level prejudice and health. Soc Sci Med 2017; 183:169-172. [DOI: 10.1016/j.socscimed.2017.04.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 01/01/2023]
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Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults. Vaccine 2017; 35:1167-1174. [PMID: 28126202 DOI: 10.1016/j.vaccine.2016.12.046] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Racial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors. METHODS We contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior. RESULTS There were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge. CONCLUSIONS Racial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.
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Racial/Ethnic Disparities in Influenza Vaccination of Chronically-ill US Adults: The Mediating Role of Perceived Discrimination in Healthcare: Erratum. Med Care 2016. [DOI: 10.1097/mlr.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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