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Lin YJ, Chang YP, Yen CF. Predicting the Influences of Depression and Sexual Stigma on Motivation to Get Vaccinated against COVID-19 in Lesbian, Gay, and Bisexual Young Adults: A 4-Year Follow-Up Study. Vaccines (Basel) 2023; 11:1430. [PMID: 37766107 PMCID: PMC10536742 DOI: 10.3390/vaccines11091430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Vaccination is a crucial preventive measure against COVID-19. However, limited research has focused on identifying the factors predicting motivation to get vaccinated against COVID-19 (MoVAC-19) among lesbian, gay, and bisexual (LGB) individuals. This study examined the predictive effects of depression and sexual stigma (i.e., perceived sexual stigma from family members, perceived sexual orientation microaggression, and internalized sexual stigma) before the COVID-19 pandemic on MoVAC-19 among LGB individuals 4 years later during the COVID-19 pandemic in Taiwan. Baseline data related to depression and sexual stigma were collected in 2018 and 2019. Depression was assessed using the 20-item Mandarin Chinese version of the Center for Epidemiologic Studies Depression Scale. Perceived sexual stigma from family members was assessed using the Homosexuality-Related Stigma Scale. Internalized sexual stigma was assessed using the Measure of Internalized Sexual Stigma for Lesbians and Gay Men. Perceived sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory. Participant MoVAC-19 during the pandemic was assessed using the nine-item Motors of COVID-19 Vaccination Acceptance Scale. The associations of depression and sexual stigma at baseline with MoVAC-19 at follow-up were examined through multivariate linear regression analysis. Internalized sexual stigma was negatively associated with MoVAC-19, whereas perceived sexual orientation microaggression was positively associated with MoVAC-19. Depression and perceived sexual stigma from family members were not significantly associated with MoVAC-19. Although male sex and older age were positively associated with increased MoVAC-19, sex and age did not moderate the relationship between sexual stigma and motivation to get vaccinated. Among LGB individuals, sexual stigma experiences should be considered when developing intervention strategies aimed at enhancing MoVAC-19.
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Affiliation(s)
- Yen-Ju Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, NY 14214-8013, USA
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal. Healthcare (Basel) 2023; 11:healthcare11020245. [PMID: 36673613 PMCID: PMC9859126 DOI: 10.3390/healthcare11020245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard. OBJECTIVE The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population. METHODS We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews. RESULT The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population. CONCLUSION The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.
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Yu Y, Ling RHY, Ip TKM, Luo S, Lau JTF. Factors of COVID-19 Vaccination among Hong Kong Chinese Men Who Have Sex with Men during Months 5–8 since the Vaccine Rollout—General Factors and Factors Specific to This Population. Vaccines (Basel) 2022; 10:vaccines10101763. [PMID: 36298627 PMCID: PMC9609851 DOI: 10.3390/vaccines10101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of planned behaviors (TPB). A total of 400 Chinese MSM were recruited from multiple sources (site recruitment, online recruitment, and peer referral) in Hong Kong from July to October 2021, who then participated in a structured telephone interview. Of all the participants, the prevalence of COVID-19 vaccination (i.e., taking at least one dose of COVID-19 vaccination) was 78.3%. Multivariable logistic regression analyses showed that, after adjusting for background factors, (1) the general and MSM-specific HBM variables of perceived benefits and self-efficacy were positively associated with COVID-19 vaccination behavior; (2) the items or scale of general/MSM-specific perceived barriers and social norms were negatively associated with COVID-19 vaccination behavior; (3) the general perceived severity and MSM-specific perceived susceptibility, perceived severity, and cue to action were not significantly associated with COVID-19 vaccination behavior. The findings suggest that the HBM and social norm construct of the TPB only partially explained the participant’s COVID-19 vaccination behavior. Health promotion may need to focus more on modifying perceptions related to COVID-19 vaccination rather than COVID-19.
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Affiliation(s)
- Yanqiu Yu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Shanghai 200032, China
| | - Rachel Hau Yin Ling
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tsun Kwan Mary Ip
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Joseph T. F. Lau
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, China
- School of Mental Health, Wenzhou Medical University, Wenzhou 325000, China
- School of Public Health, Zhejiang University, Hangzhou 310058, China
- Correspondence:
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Ousseine YM, Vaux S, Vandentorren S, Bonmarin I, Champenois K, Lydié N, Velter A. Predictors of Uncertainty and Unwillingness to Receive the COVID-19 Vaccine in Men Who Have Sex with Men in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5372. [PMID: 35564769 PMCID: PMC9101119 DOI: 10.3390/ijerph19095372] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 12/23/2022]
Abstract
The development of vaccines against COVID-19 has given hope to populations. Public acceptability of vaccination is a major driver in containing the disease. However, in marginalized and stigmatized populations, uncertainty and unwillingness may be a challenge. This study aimed to analyze the factors associated with uncertainty and unwillingness to vaccinate against COVID-19 in men who have sex with men (MSM) living in France. The data used came from Rapport au Sexe (ERAS) 2021, a voluntary, cross-sectional, anonymous, self-administered, online survey conducted from 26 February to 11 April 2021. Among the 15,426 respondents included in the analysis, 60.5% were willing to vaccinate (these included persons already vaccinated), 17.5% were not, and 22% were uncertain. Factors independently associated with uncertainty and unwillingness were lower education level, low health literacy level, financial hardship, being under 30 years of age, and living in a rural area. HIV-positive MSM were less likely to report vaccination uncertainty and unwillingness than HIV-negative MSM and those with unknown serostatus. Although more impacted by COVID-19, socioeconomically vulnerable MSM were the sub-group most unwilling to vaccinate. To improve acceptability of COVID-19 vaccination in MSM, policy makers and researchers must increase access to and understanding of medical information by considering the general public's health literacy when developing information sources. Moreover, a dedicated global care approach, which ensures these populations can be reached, is necessary.
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Affiliation(s)
- Youssoufa M. Ousseine
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
| | - Sophie Vaux
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
- Université de Bordeaux, INSERM UMR 1219, PHAreS Team, 33000 Bordeaux, France
| | - Isabelle Bonmarin
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
| | | | - Nathalie Lydié
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
| | - Annie Velter
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
- Aix Marseille Univ., INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L’Information Médicale, ISSPAM, 13005 Marseille, France
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Zhang K, Chan PSF, Chen S, Fang Y, Cao H, Chen H, Hu T, Chen Y, Zhou X, Wang Z. Factors Predicting COVID-19 Vaccination Uptake Among Men Who Have Sex With Men in China: An Observational Prospective Cohort Study. Front Med (Lausanne) 2022; 9:838973. [PMID: 35360721 PMCID: PMC8963419 DOI: 10.3389/fmed.2022.838973] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/17/2022] [Indexed: 01/15/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected sexual minorities including men who have sex with men (MSM). This study investigated factors associated with the uptake of COVID-19 vaccination among MSM in China. Methods Inclusion criteria were: (1) born biologically male, (2) had oral or anal sex with men in the past year, (3) aged at least 18 years, and (4) lived in Shenzhen, China. Prospective participants were recruited through outreach in gay bars and saunas, online recruitment, and peer referrals. Participants completed a baseline online survey between August and September 2020 and a follow-up online survey between April and May 2021. Logistic regression models were fitted for data analysis. Results Among 420 participants who completed the baseline survey, 303 completed the follow-up survey. Among participants being followed up, 113 (37%) received at least one dose of COVID-19 vaccination during the study period. After adjusting for significant sociodemographic characteristics, five baseline predisposing factors predicted COVID-19 vaccination uptake during the follow-up period, including asking whether their partners had COVID-19 symptoms [adjusted odds ratio (AOR): 1.17, 95% confidence interval (CI): 1.00-1.38], washing hands before and after sex (AOR: 1.23, 95% CI: 1.03-1.46), sanitizing before and after sex (AOR: 1.17, 95% CI: 1.00-1.37), perceived higher risk of COVID-19 transmission through sexual behaviors (AOR: 1.28, 95% CI: 1.04-1.58), and panic about COVID-19 (AOR: 1.48, 95% CI: 1.16-1.89). Regarding enabling factors, receiving testing for sexually transmitted infections (STI) (AOR: 2.19, 95% CI: 1.25-3.85) and other prevention measures for human immunodeficiency virus (HIV)/STI (AOR: 2.61, 95% CI: 1.56-4.37) 6 months prior to the baseline survey were associated with higher uptake of COVID-19 vaccination. Conclusion MSM's uptake rate of COVID-19 vaccination was comparable to that of the general population in Shenzhen, China. This study offered an overview for us to identify tapping points that can encourage COVID-19 vaccination uptake among Chinese MSM.
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Affiliation(s)
- Kechun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Paul Shing-fong Chan
- Jockey Club (JC) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Siyu Chen
- Jockey Club (JC) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - He Cao
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Hongbiao Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Yaqi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Xiaofeng Zhou
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Zixin Wang
- Jockey Club (JC) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Jaffe AE, Graupensperger S, Blayney JA, Duckworth JC, Stappenbeck CA. The Role of Perceived Social Norms in College Student Vaccine Hesitancy: Implications for COVID-19 Prevention Strategies. Vaccine 2022; 40:1888-1895. [PMID: 35190209 PMCID: PMC8789646 DOI: 10.1016/j.vaccine.2022.01.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Among US adults, the highest rates of hesitancy to receive the COVID-19 vaccine are among young adults aged 18 to 25. Vaccine hesitancy is particularly concerning among young adults in college, where social interactions on densely populated campuses can lead to substantial community spread. Given that many colleges have opted not to mandate vaccines, identification of modifiable predictors of vaccine hesitancy – such as perceived social norms – is key to informing interventions to promote vaccine uptake. To address this need, we examined predictors of and explicit reasons for vaccine hesitancy among 989 students aged 18 to 25 recruited from four geographically diverse US universities in the spring of 2021. At the time of the survey, 57.3% had been vaccinated, 13.7% intended to be vaccinated as soon as possible, and 29.0% were vaccine hesitant. Common reasons for hesitancy were wanting to see how it affected others first (75.2%), not believing it was necessary (30.0%), and other reasons (17.4%), which were examined via content analysis and revealed prominent safety concerns. Despite these varied explicit reasons, logistic regressions revealed that, when controlling for demographics and pandemic-related experiences, perceived descriptive and injunctive social norms for vaccine uptake were each significant predictors of vaccine hesitancy (ORs = 0.35 and 0.78, respectively). When both norms were entered into the same model, only perceived descriptive norms uniquely predicted vaccine hesitancy (OR = 0.37; 95% CI: 0.29 – 0.46). Findings suggest perceived social norms are strongly associated with vaccine-related behavior among young adult college students. Correcting normative misperceptions may be a promising approach to increase vaccine uptake and slow the spread of COVID-19 among young adults.
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Affiliation(s)
- Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States.
| | - Scott Graupensperger
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jennifer C Duckworth
- Department of Human Development, Washington State University, Pullman, WA, United States
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Garg I, Hanif H, Javed N, Abbas R, Mirza S, Javaid MA, Pal S, Shekhar R, Sheikh AB. COVID-19 Vaccine Hesitancy in the LGBTQ+ Population: A Systematic Review. Infect Dis Rep 2021; 13:872-887. [PMID: 34698208 PMCID: PMC8544378 DOI: 10.3390/idr13040079] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has disproportionately impacted lesbian, gay, bisexual, transgender, queer (LGBTQ+) people. Despite developing safe and effective COVID-19 vaccines, LGBTQ+ communities still faces challenges due to inequitable access and vaccine hesitancy. Vaccine hesitancy is a delay in the acceptance or refusal of vaccines despite the availability of vaccination services. Various studies have explored and tried to address factors influencing vaccine hesitancy. However, the LGBTQ+ population remains under- and misrepresented in many of these studies. According to the few studies that have focused on the LGBTQ+ population, several factors influencing vaccine hesitancy have been identified, with the most common factors in studies being concern about vaccine safety, vaccine efficacy, and history of bad experiences with healthcare providers. In order to rebuild the confidence of LGBTQ+ people in vaccines, governments, healthcare policymakers, and healthcare providers need to start by acknowledging, and then resolving, these disparities; building trust; dismantling systemic suppression and discrimination; and prioritizing the inclusion of LGBTQ+ people in research studies and public health policies.
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Affiliation(s)
- Ishan Garg
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York, NY 11219, USA;
| | - Hamza Hanif
- Department of General Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA;
| | - Nismat Javed
- Department of Medicine, Shifa International Hospital, Islamabad 44000, Pakistan;
| | - Ramsha Abbas
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad 44000, Pakistan;
| | - Samir Mirza
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (S.M.); (M.A.J.)
| | - Muhammad Ali Javaid
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (S.M.); (M.A.J.)
| | - Suman Pal
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (S.P.); (R.S.)
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (S.P.); (R.S.)
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (S.P.); (R.S.)
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