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Epperson AE, Carson SL, Garcia AN, Casillas A, Castellon-Lopez Y, Brown AF, Garrison NA. A qualitative study of COVID-19 vaccine decision making among urban Native Americans. Vaccine X 2022; 12:100212. [PMID: 36059599 PMCID: PMC9423870 DOI: 10.1016/j.jvacx.2022.100212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Significant disparities in COVID-19 morbidity and mortality exist for Native American (NA) people, the majority of whom live in urban areas. COVID-19 vaccination is a key strategy for mitigating these disparities; however, vaccination disparities affect NA communities. The current study investigated COVID-19 vaccine decision-making before widespread vaccine rollout occurred, among urban NA communities. We aimed to understand vaccine decision-making factors to develop recommendations about COVID-19 vaccine outreach. Methods We conducted three in-depth virtual focus groups with 17 NA adults living in an urban community (Los Angeles County) between December 2020 and January 2021. Participants were recruited through NA community-based organizations and community stakeholders. Reflexive thematic analysis was conducted using Atlas.ti. Findings Participants in this study identified two overarching themes with implications for health vaccination campaigns. First, participants described a need for tailored information and outreach, including NA vaccine outreach that addresses misconceptions about vaccine development to calm fears of experimentation and support communication of vaccine evidence specific to NA people. Second, participants suggested strategies to improve public health resources in the urban NA community, such as the need for unified, proactive communication across trusted NA entities, navigation support to improve vaccine accessibility, and adequately resourcing health partnerships with and among trusted NA community agencies for improved reach. Conclusion In this qualitative study, we found that urban NA participants reported several factors that affected their vaccine decision-making, including a lack of tailored information for their communities. Our findings also underscore the need to work with tribes, tribal leadership, and urban NA serving organizations to coordinate vaccine communication and distribution to urban communities where the majority of NAs now reside. Further, these findings have implications for COVID-19 vaccine outreach among urban NA communities and demonstrate the need for clear and tailored engagement about the COVID-19 vaccine.
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Affiliation(s)
- Anna E. Epperson
- Department of Psychological Sciences, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 95343, USA
- Corresponding author at: Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, 5200 N. Lake Road, Merced, CA 95343, USA.
| | - Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Andrea N. Garcia
- Los Angeles County Department of Mental Health, Los Angeles, CA 90020, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Yelba Castellon-Lopez
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Nanibaa' A. Garrison
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Warren BR, Grandis JR, Johnson DE, Villa A. Head and Neck Cancer among American Indian and Alaska Native Populations in California, 2009-2018. Cancers (Basel) 2021; 13:cancers13205195. [PMID: 34680342 PMCID: PMC8534223 DOI: 10.3390/cancers13205195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary In the United States, it is estimated there will be 54,000 new cases of oral cavity and pharyngeal cancer in 2021. Tobacco exposure and drinking alcohol are the main causes of head and neck cancer (HNC). Human Papilloma Virus (HPV) is now increasing in prevalence and is the most common cause of oropharyngeal cancer in the United States. This study assessed the incidence of HNC and HPV status in American Indian/Alaska Native (AI/AN) populations in California and determined if incidence was higher among AI/ANs compared to other ethnicities. We found that AI/AN and White patients had the highest burden of late-stage HNC and HPV+ lip, oral cavity, and pharynx cancer compared to other ethnicities. In addition, AI/ANs had a decreased survival rate compared to White patients. These findings reveal ethnic or racial differences in incidence, presentation, and survival, and should inform future preventative care measures for the AI/AN population. Abstract The purpose of this study was to determine the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) head and neck cancer (HNC) in the American Indian/Alaska Native (AI/AN) population in California to assess whether incidence is higher among AI/ANs compared to other ethnicities. We analyzed data from the California Cancer Registry, which contains data reported to the Cancer Surveillance Section of the Department of Public Health. A total of 51,289 HNC patients were identified for the years 2009–2018. Outcomes of interest included sex, stage at presentation, 5-year survival rate, tobacco use, and HPV status. AI/AN and White patients had the highest burden of late stage HNC (AI/AN 6.3:100,000; 95% CI 5.3–7.4, White 5.8:100,000; 95% CI 5.7–5.9) compared to all ethnicities or races (Black: 5.2; 95% CI 4.9–5.5; Asian/Pacific Islander: 3.2; 95% CI 3–3.3; and Hispanic: 3.1; 95% CI 3–3.2 per 100,000). Additionally, AI/AN and White patients had the highest burden of HPV+ lip, oral cavity, and pharynx HNC (AI/AN 0.9:100,000; 95% CI 0.6–1.4, White 1.1:100,000; 95% CI 1–1.1) compared to all ethnicities or races (Black: 0.8:100,000; 95% CI 0.7–0.9; Asian/Pacific Islander: 0.4; 95% CI 0.4–0.5; and Hispanic: 0.6; 95% CI 0.5–0.6). AI/ANs had a decreased 5-year survival rate compared to White patients (AI/AN 59.9%; 95% CI 51.9–67.0% and White 67.7%; 95% CI 67.00–68.50%) and a higher incidence of HNC in former and current tobacco users. These findings underscore the disparities that exist in HNC for California AI/AN populations. Future studies should aim to elucidate why the unequal burden of HNC outcomes exists, how to address increased tobacco usage, and HPV vaccination patterns to create culturally and community-based interventions.
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Affiliation(s)
- Brooke R. Warren
- School of Medicine, University of California, San Francisco, CA 94143, USA;
| | - Jennifer R. Grandis
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; (J.R.G.); (D.E.J.)
| | - Daniel E. Johnson
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; (J.R.G.); (D.E.J.)
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-415-476-2431
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