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Willis DE, Kaholokula JK, Andersen JA, Selig JP, Bogulski CA, Scott AJ, McElfish PA. Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA. J Racial Ethn Health Disparities 2024; 11:730-738. [PMID: 36892814 PMCID: PMC9997430 DOI: 10.1007/s40615-023-01556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA). METHODS Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health. RESULTS Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results. CONCLUSIONS Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Cari A Bogulski
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Bogulski CA, Andersen JA, Eswaran S, Willis DE, Edem D, McElfish PA. Factors Associated with Online Patient Portal Utilization Experience in an Arkansas Phone Survey. Telemed J E Health 2024; 30:e1148-e1156. [PMID: 38011711 PMCID: PMC11035923 DOI: 10.1089/tmj.2023.0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
Introduction: Accessing electronic health record information through a patient portal is associated with numerous benefits to both health care providers and patients. However, patient portal utilization remains low. Little is known about the factors associated with patient portal utilization following the onset of the COVID-19 pandemic. Methods: In March 2022, we conducted a random digit dial phone survey of both cell phones and landlines of adults living in Arkansas that asked numerous demographic and health-related measures, including patient portal utilization in the past 12 months. A total of 2,201 adult Arkansans completed the survey between March 1 and March 28, 2022. Weighted estimates were generated using rank ratio estimation to approximate the 2019 American Community Survey 1-year Arkansas estimates for race/ethnicity (72% White, 15% Black/African American, 7.8% Hispanic, 4.9% other race/ethnicity), age (73% 18-39, 32% 40-59, and 31% 60+), and gender (49% male, 51% female). We fit the data to a logistic regression model. Results: We found that education, employment, prior telehealth experience, having a check-up in the past 2 years, and having a primary care provider were all positively associated with patient portal utilization. We also found that non-Hispanic Black/African-American respondents were less likely to access a patient portal relative to non-Hispanic White respondents. Discussion: Patient portal utilization is related to several demographic and health-related factors among an adult population in Arkansas. Given that the documented benefits of patient portal utilization are broad, under-utilization by groups that already experience relatively worse health outcomes could reproduce or even exacerbate existing health disparities. Additional research is needed to further investigate what barriers to patient portal utilization remain for these populations.
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Affiliation(s)
- Cari A. Bogulski
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Surabhee Eswaran
- Department of Environmental Studies, Tulane University, New Orleans, Louisiana, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
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Purvis RS, Moore R, Willis DE, Li J, Selig JP, Kraleti S, Imran T, McElfish PA. Exploring Hesitancy, Motivations, and Practical Issues for COVID-19 Vaccination Among Vaccine-Hesitant Adopter Parents Using the Increasing Vaccination Model. J Pediatr Health Care 2024:S0891-5245(24)00026-9. [PMID: 38430095 DOI: 10.1016/j.pedhc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/12/2023] [Accepted: 01/28/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION COVID-19 vaccination coverage among children remains low, and many parents report being hesitant to get their children vaccinated. This study explores factors influencing hesitancy and the facilitators that helped hesitant adopter parents choose to vaccinate their children against COVID-19 despite their hesitancy. METHOD We use a qualitative descriptive design with individual interviews (n = 20) to explore COVID-19 vaccine hesitancy and facilitators of vaccination among hesitant adopter parents. The Increasing Vaccination Model domains (thoughts and feelings, social processes, and practical issues) provided the framework for initial coding, and the research team identified nine emergent themes. RESULTS Findings document the factors influencing hesitancy and the facilitators motivating COVID-19 vaccination among hesitant adopter parents. DISCUSSION Findings fill the gap in the literature by providing hesitant adopters' lived experience, perspectives on vaccine hesitancy, and the influential factors that helped participants overcome their hesitancy and choose to vaccinate their children against COVID-19.
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Willis DE, Purvis RS, Moore R, Li J, Selig JP, Imran T, Zimmerman S, McElfish PA. Social Processes and COVID-19 Vaccination of Children of Hesitant Mothers. J Community Health 2024:10.1007/s10900-024-01340-x. [PMID: 38402520 DOI: 10.1007/s10900-024-01340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Investigate relationships between pediatric COVID-19 vaccination and social processes of healthcare provider recommendations and school encouragement to provide insights into social processes that may support pediatric COVID-19 vaccination among hesitant mothers. METHODS We analyzed survey data from a subsample (n = 509) of vaccine-hesitant mothers to child patients (ages 2 to 17) in regional clinics across Arkansas. Data were collected between September 16th and December 6th, 2022. Full information maximum likelihood multivariable logistic regression was conducted to evaluate associations with pediatric COVID-19 vaccination. RESULTS Adjusted odds of pediatric COVID-19 vaccination were more than three times greater when a child's healthcare provider recommended vaccination compared to when they did not (aOR = 3.52; 95% CI[2.06, 6.01]). Adjusted odds of pediatric COVID-19 vaccination were 85% greater when a child's school encouraged parents to vaccinate compared to when the school did not (aOR = 1.85; 95% CI[1.13, 3.03]). CONCLUSIONS For pediatric COVID-19 vaccination, having a personal healthcare provider is not significantly different from having no personal healthcare provider if they do not recommend the child be vaccinated. PRACTICE IMPLICATIONS Clinical and public health interventions should consider social processes of healthcare provider recommendations and school encouragement.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA.
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Tabasum Imran
- College of Medicine, University of Arkansas for Medical Sciences West, Fort Smith, AR, USA
| | - Stacy Zimmerman
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
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Moore R, Purvis RS, Willis DE, Li J, Langner J, Gurel-Headley M, Kraleti S, Curran GM, Macechko MD, McElfish PA. "Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine. Vaccines (Basel) 2024; 12:171. [PMID: 38400154 PMCID: PMC10892107 DOI: 10.3390/vaccines12020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Jonathan Langner
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA;
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA; (M.G.-H.); (S.K.)
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Shashank Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA; (M.G.-H.); (S.K.)
| | - Geoffrey M. Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA;
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 4300 W. 7th St., North Little Rock, AR 72114, USA
| | - Michael D. Macechko
- 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, 2708 S. 48th St., Springdale, AR 72762, USA; (R.M.); (R.S.P.); (D.E.W.)
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Andersen JA, Willis DE, Kaholokula JK, Rowland B, Council S, Riklon S, McElfish PA. Experiences of Discrimination Among Native Hawaiians and Pacific Islanders Living in the USA. J Racial Ethn Health Disparities 2024; 11:184-191. [PMID: 36626048 PMCID: PMC9838348 DOI: 10.1007/s40615-022-01509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
Experiences of racism and discrimination are stressors that adversely affect the well-being of marginalized populations, including Native Hawaiians and Pacific Islanders (NHPI). However, commonly used data aggregation methods obscure information on NHPI communities and their lived experiences. The aim of our study is to understand the types and frequency of discrimination experienced by NHPI adults in the USA. The study utilized online survey data collected from 252 NHPI adults living in the USA between September and October 2021. Younger NHPI adults, those who report constantly thinking about their race/ethnicity, and those who are socially assigned a race/ethnicity that does not match their own report experiencing more types of discrimination. NHPI who constantly think about their race/ethnicity and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. Findings indicate the need to understand the experiences of discrimination in this population.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai’i at Manoa, 651 Ilalo St, Honolulu, HI 96813 USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Sarah Council
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR 72762 USA
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Andersen JA, Willis DE, Kaholokula JK, Rowland B, Council S, Riklon S, McElfish PA. Correction to: Experiences of Discrimination Among Native Hawaiians and Pacific Islanders Living in the USA. J Racial Ethn Health Disparities 2024; 11:590. [PMID: 36877381 DOI: 10.1007/s40615-023-01547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Jennifer A Andersen
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Don E Willis
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Sarah Council
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Sheldon Riklon
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Pearl A McElfish
- College of Medicine, Sciences Northwest, University of Arkansas for Medical, 2708 S. 48th St, Springdale, AR, 72762, USA.
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Purvis RS, Moore R, Willis DE, Li J, Kraleti S, Imran T, McElfish PA. Understanding HPV Vaccine Hesitancy and What Helped Hesitant Adopter Parents Have Their Children Vaccinated Despite Their Hesitancy. J Pediatr Health Care 2023:S0891-5245(23)00353-X. [PMID: 38127043 DOI: 10.1016/j.pedhc.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION One out of four parents reported HPV vaccine hesitancy; however, little is known about HPV vaccine-hesitant parents who vaccinate their children (e.g., hesitant adopters). METHOD We use individual interviews (n = 8) to explore hesitancy and facilitators for overcoming hesitancy among hesitant adopter parents. We drew a priori codes from the Increasing Vaccination Model domains and identified seven emergent secondary themes. RESULTS Understandable information about safety, side effects, and effectiveness could address HPV vaccine hesitancy. Health care professionals, family, friends, and coworkers were trusted vaccine and vaccination information sources. The study documents the lack of access to HPV vaccines with established health care providers as a barrier to vaccination. DISCUSSION This is the first study of hesitant adopter parents that expands our understanding of factors driving HPV vaccination among them. Study insights can inform future efforts to increase HPV vaccine uptake among the hesitant.
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Busch S, Andersen JA, Willis DE, McElfish PA, Reece S, DuBois D, Brown CC. Association of the COVID-19 Pandemic With Women, Infants, and Children (WIC) Receipt Among Pregnant Individuals: United States, 2016-2022. Am J Public Health 2023; 113:S240-S247. [PMID: 38118087 PMCID: PMC10733870 DOI: 10.2105/ajph.2023.307525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/22/2023]
Abstract
Objectives. To evaluate the effect of COVID-19 on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receipt among pregnant individuals overall and by race/ethnicity. Methods. We measured changes in WIC receipt among Medicaid-covered births (n = 10 484 697) from the US National Center for Health Statistics Natality Files (2016-2022). Our interrupted time series logistic model included a continuous monthly variable, a binary post-COVID variable, and a continuous slope shift variable. We additionally fit separate models for each race/ethnicity relative to White individuals, using interaction terms between the time series variables and race/ethnicity. Results. We found decreases in WIC receipt (adjusted odds ratio [AOR] = 0.899; P < .001) from before COVID (66.6%) to after COVID (57.9%). There were larger post-COVID decreases for American Indian/Alaska Native (AOR = 0.850; P < .001), Native Hawaiian/Other Pacific Islander (AOR = 0.877; P = .003), Black (AOR = 0.974; P < .001), and Hispanic (AOR = 0.972, P < .001) individuals relative to White individuals. Conclusions. The greater reductions in WIC receipt among minoritized individuals highlights a pathway through which the pandemic may have widened gaps in already disparate maternal and infant health. Public Health Implications. Continued efforts to increase WIC utilization are needed overall and among minoritized populations. (Am J Public Health. 2023;113(S3):S240-S247. https://doi.org/10.2105/AJPH.2023.307525).
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Affiliation(s)
- Savannah Busch
- Savannah Busch is with the College of Medicine and the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jennifer A. Andersen, Pearl A. McElfish, and Don E. Willis are with the College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale. Sharon Reece is with the Baylor Scott & White Health and Baylor College of Medicine, Temple, TX. Dominique DuBois is with the College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Clare C. Brown is with the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Jennifer A Andersen
- Savannah Busch is with the College of Medicine and the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jennifer A. Andersen, Pearl A. McElfish, and Don E. Willis are with the College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale. Sharon Reece is with the Baylor Scott & White Health and Baylor College of Medicine, Temple, TX. Dominique DuBois is with the College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Clare C. Brown is with the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Don E Willis
- Savannah Busch is with the College of Medicine and the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jennifer A. Andersen, Pearl A. McElfish, and Don E. Willis are with the College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale. Sharon Reece is with the Baylor Scott & White Health and Baylor College of Medicine, Temple, TX. Dominique DuBois is with the College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Clare C. Brown is with the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Pearl Anna McElfish
- Savannah Busch is with the College of Medicine and the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jennifer A. Andersen, Pearl A. McElfish, and Don E. Willis are with the College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale. Sharon Reece is with the Baylor Scott & White Health and Baylor College of Medicine, Temple, TX. Dominique DuBois is with the College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Clare C. Brown is with the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Sharon Reece
- Savannah Busch is with the College of Medicine and the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jennifer A. Andersen, Pearl A. McElfish, and Don E. Willis are with the College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale. Sharon Reece is with the Baylor Scott & White Health and Baylor College of Medicine, Temple, TX. Dominique DuBois is with the College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Clare C. Brown is with the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Dominique DuBois
- Savannah Busch is with the College of Medicine and the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jennifer A. Andersen, Pearl A. McElfish, and Don E. Willis are with the College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale. Sharon Reece is with the Baylor Scott & White Health and Baylor College of Medicine, Temple, TX. Dominique DuBois is with the College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Clare C. Brown is with the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
| | - Clare C Brown
- Savannah Busch is with the College of Medicine and the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jennifer A. Andersen, Pearl A. McElfish, and Don E. Willis are with the College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale. Sharon Reece is with the Baylor Scott & White Health and Baylor College of Medicine, Temple, TX. Dominique DuBois is with the College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Clare C. Brown is with the Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock
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Willis DE, Moore R, Andersen JA, Li J, Selig JP, McKinnon JC, Gurel-Headley M, Reece S, McElfish PA. Correlates of COVID-19 vaccine coverage in Arkansas: Results from a weighted random sample survey. Vaccine 2023; 41:6120-6126. [PMID: 37661536 PMCID: PMC10574122 DOI: 10.1016/j.vaccine.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
We assessed COVID-19 vaccination (≥1 dose) status as influenced by sociodemographic factors (i.e., age, gender, race/ethnicity, education, income, and parent or guardian status), healthcare provider recommendation, and personal vaccine hesitancy among Arkansas residents in October 2022. We asked: did the likelihood of vaccination differ across sociodemographic groups of Arkansas during this period of the pandemic? Is COVID-19 vaccination associated with recommendations from healthcare providers and/or COVID-19 vaccine hesitancy? We analyzed data from a random sample survey of adults in Arkansas (N = 2,201). Three in four adults self-reported vaccination against COVID-19 in October 2022. We found both positive and negative association between COVID-19 vaccination and age, gender, race/ethnicity, education, income, healthcare provider recommendation, and vaccine hesitancy. We highlight racial differences in COVID-19 coverage and the higher odds of COVID-19 vaccination among Black adults compared to White adults in particular, which has broad implications for the study of vaccine coverage and hesitancy. We also discuss implications of our findings regarding healthcare provider recommendations to be vaccinated against COVID-19.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Joshua C McKinnon
- College of Nursing, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA.
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Willis DE, Moore R, Selig JP, CarlLee S, Gurel-Headley MP, Cornett LE, McElfish PA. COVID-19 Booster Uptake: Are Hesitant Adopters Less Likely to Get a Booster Shot Than Nonhesitant Adopters? Behav Med 2023:1-9. [PMID: 37722699 DOI: 10.1080/08964289.2023.2249168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
The main objective of this study was to assess whether hesitancy toward receiving the initial COVID-19 vaccine was associated with uptake of the COVID-19 booster several months after it became available to all US adults. We ask whether hesitancy toward the initial COVID-19 vaccine was significantly associated with lower odds of COVID-19 booster uptake among adults. We test this association within the context of the highly rural state of Arkansas. By January 2022, the US had set a global record of nearly 1 million daily cases. The purpose of this study was to advance our understanding of vaccine hesitancy among those who have already received a dose of the COVID-19 vaccine and how that hesitancy may shape COVID-19 booster uptake. We analyzed data from a random sample survey of Arkansan adults (N = 2,201) between March 1 and March 28, 2022 and constrained our analytical sample to those who had received a vaccine (N = 1,649). Nearly two-thirds of vaccinated Arkansas residents had received a COVID-19 booster. Hesitancy was common even among vaccinated individuals and was significantly associated with reduced odds of COVID-19 booster uptake, even after controlling for other factors. Findings provide further support for conceptualizing vaccine hesitancy as an attitude related to-but separate from-the behavior of vaccination, as opposed to conflating vaccination with being nonhesitant. Public health interventions aimed at increasing COVID-19 booster uptake should pay attention to vaccine hesitancy indicated at the initiation of the series and should not ignore the vaccinated as an important population to target for intervention.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest
| | - Morgan P Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
| | | | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest
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12
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Purvis RS, Moore R, Willis DE, Kraleti SS, Gurel-Headley MP, CarlLee S, McElfish PA. Key Conversations and Trusted Information Among Hesitant Adopters of the COVID-19 Vaccine. J Health Commun 2023; 28:595-604. [PMID: 37599458 PMCID: PMC10528835 DOI: 10.1080/10810730.2023.2244458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
COVID-19 vaccines effectively protect against COVID-19-related hospitalization or death, and 67.1% of the US population is fully vaccinated. However, the disparity in COVID-19 vaccination persists among minority and rural populations who often report greater hesitancy about COVID-19 vaccines. This exploratory study aimed to understand and document trusted sources of information about the COVID-19 vaccine among a diverse sample of hesitant adopters with in-depth interviews. Participants (n = 21) described how information from trusted sources influenced their decision to get a COVID-19 vaccine despite being hesitant. Participants reported health care professionals, family members, friends, coworkers, community leaders, public health experts, government officials, and the mainstream media as trusted sources of information about the COVID-19 vaccines. Participants discussed obtaining trusted information from multiple modes, including direct conversations with trusted messengers and public health communications from public influencers who reinforced the information shared with trusted messengers. Notably, participants discussed having multiple conversations with trusted messengers during their decision-making process, and these trusted messengers often facilitated the participants' vaccination process. Study findings highlight the continued need for clear, understandable information about vaccine side effects, safety, and efficacy to address concerns that contribute to vaccine hesitancy.
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Affiliation(s)
- Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
| | - Shashank S. Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Morgan P. Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR
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Yeary KHK, Willis DE, Yu H, Johnson B, McElfish PA. Self-reported Racial Discrimination and Healthy Behaviors in Black Adults Residing in Rural Persistent Poverty Areas. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01738-8. [PMID: 37555914 DOI: 10.1007/s40615-023-01738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Racism is a social determinant of health inequities and associated with poorer health and health behaviors. As a domain of racism, self-reported racial discrimination affects health through unhealthy behaviors (e.g., smoking) but the understudied impact of self-reported racial discrimination's relationship with healthy behaviors (e.g., cancer screening) precludes a comprehensive understanding of racism's impact on health inequities. Understanding how self-reported racial discrimination impacts healthy behaviors is even more important for those living in rural persistent poverty areas (poverty rates of 20% or more of a population since 1980), who have a higher disease burden due to poverty's interaction with racism. The distinct sociocultural context of rural persistent poverty areas may result in differential responses to self-reported racial discrimination compared to those in non-persistent poverty areas. METHODS A community-engaged process was used to administer a survey to a convenience sample of 251 Black adults residing in 11 rural persistent poverty counties in the state of Arkansas. Self-reported racial discrimination, fruit and vegetable intake, colorectal cancer screening, cervical cancer screening, and screening mammography were assessed. Stress and religion/spirituality were also assessed as potential mediators or moderators in the relationship between self-reported racial discrimination and healthy behaviors. RESULTS In adjusted models, those reporting more self-reported racial discrimination had a higher probability of having had a test to check for cervical cancer (situation discrimination: OR = 1.23, 95% CI: 1.04-1.5; frequency discrimination: OR = 1.06, 95% CI: 1.02-1.12). Stress and religion/spirituality were not significant mediators/moderators. DISCUSSION Greater self-reported racial discrimination was associated with a higher odds of cervical cancer screening. Black adults residing in rural persistent poverty areas may have greater self-reported racial discrimination-specific coping and racial identity attitudes.
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Affiliation(s)
| | - Don E Willis
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Han Yu
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Beverly Johnson
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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14
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Willis DE, Reece S, Gurel-Headley M, Selig JP, Li J, Zimmerman S, Cornett LE, McElfish PA. Social processes, practical issues, and COVID-19 vaccination among hesitant adults. Vaccine 2023; 41:5150-5158. [PMID: 37423799 PMCID: PMC11045247 DOI: 10.1016/j.vaccine.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION The purpose of this study is to examine relationships between COVID-19 vaccination, social processes, and the practical issues of healthcare coverage and workplace requirements. We examine these relationships among individuals who expressed some degree of hesitancy towards receiving the vaccine. Assessing relationships between COVID-19 vaccination, social processes, and practical issues among vaccine-hesitant individuals has implications for public health policy and intervention. METHODS We analyzed weighted data from a random sample phone survey of Arkansas adults (N = 2,201) between March 1st and March 28th, 2022 and constrained our analytical sample to those who had reported some degree of vaccine hesitancy (N = 1,251). Statistical analyses included weighted and unweighted descriptive statistics, weighted bivariate logistic regressions, and a weighted multivariate logistic regression to obtain adjusted odds ratios for COVID-19 vaccination. RESULTS More than two-thirds (62.5 %) of respondents were vaccinated, despite their hesitancy. Adjusted odds of COVID-19 vaccination were greater among Black (OR = 2.55; 95 % CI[1.63, 3.97]) and Hispanic respondents (OR = 2.46; 95 % CI[1.53, 3.95]), respondents whose healthcare provider recommended vaccination (OR = 2.50; 95 % CI[1.66, 3.77]), and as perceptions of vaccination coverage (OR = 2.04; 95 % CI[1.71, 2.43]) and subjective social status increased (OR = 1.10; 95 % CI[1.01, 1.19]). Adjusted odds of COVID-19 vaccination were greater among respondents with a workplace that recommended (OR = 1.96; 95 % CI[1.03, 3.72]) or required vaccination (OR = 12.62; 95 % CI[4.76, 33.45]) and among respondents who were not employed (OR = 1.82; 95 % CI[1.10, 3.01]) compared to those whose workplace did not recommend or require COVID-19 vaccination. CONCLUSIONS Some hesitant individuals become vaccinated despite their hesitancy-a group we refer to as "hesitant adopters." Social processes and practical issues are important correlates of vaccination among those who are hesitant. Workplace requirements appear to be of particular importance for vaccination among hesitant individuals. Provider recommendations, norms, social status, and workplace policies may be effective points of intervention among those who express vaccine hesitancy.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA.
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Morgan Gurel-Headley
- College of Medicine, 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, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Stacy Zimmerman
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Lawrence E Cornett
- College of Medicine, 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, 2708 S. 48(th) St., Springdale, AR 72762, USA
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15
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Hallgren E, Narcisse MR, Andersen JA, Willis DE, Thompson T, Bryant-Smith G, McElfish PA. Medical Financial Hardship and Food Security among Cancer Survivors in the United States. Cancer Epidemiol Biomarkers Prev 2023; 32:1038-1047. [PMID: 37255367 PMCID: PMC10524473 DOI: 10.1158/1055-9965.epi-22-1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/21/2022] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Some cancer survivors experience medical financial hardship, which may reduce their food security. The purpose of this study was to explore whether medical financial hardship is related to food security among cancer survivors. METHODS The study was based on cross-sectional data from the 2020 National Health Interview Survey. We used ordinal logistic regression to examine the relationship between material, psychological, and behavioral medical financial hardships and household food security (i.e., high, marginal, low, or very low) among individuals ages ≥18 years who reported a cancer diagnosis from a health professional (N = 4,130). RESULTS The majority of the sample reported high household food security (88.5%), with 4.8% reporting marginal, 3.6% reporting low, and 3.1% reporting very low household food security. In the adjusted model, the odds of being in a lower food security category were higher for cancer survivors who had problems paying or were unable to pay their medical bills compared with those who did not [OR, 1.73; 95% confidence interval (CI), 1.06-2.82, P = 0.027], who were very worried about paying their medical bills compared with those who were not at all worried (OR, 2.88; 95% CI, 1.64-5.07; P < 0.001), and who delayed medical care due to cost compared with those who did not (OR, 2.56; 95% CI, 1.29-5.09; P = 0.007). CONCLUSIONS Food insecurity is rare among cancer survivors. However, medical financial hardship is associated with an increased risk of lower household food security among cancer survivors. IMPACT A minority of cancer survivors experience medical financial hardship and food insecurity; social needs screenings should be conducted.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Tess Thompson
- Brown School, Washington University, One Brookings Drive, St. Louis, MO 63130, USA
| | - Gwendolyn Bryant-Smith
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St. – Slot 556, Little Rock, AR 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
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Reece S, McElfish PA, Andersen JA, Ayers BL, Tiwari T, Willis DE, Rowland B, Norris JD, Beasley K, Mendoza Kabua P, Brown CC. Application Status Among Women Enrolled in a Healthy Start Program in Arkansas for the Special Nutrition Program for Women and Children. J Community Health 2023; 48:724-730. [PMID: 37000375 PMCID: PMC10063932 DOI: 10.1007/s10900-023-01215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
This study aimed to examine the demographic characteristics of pregnant women in a Healthy Start program who are presumed eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but who have not yet applied for WIC benefits. We used a cross sectional evaluation of data collected from pregnant women (n=203) participating in a Healthy Start program. Data came from surveys administered at enrollment in the Healthy Start program from July 15th, 2019 until January 14th, 2022. The primary outcome was WIC application status, which was determined by whether the woman had applied or was receiving benefits at the time of enrollment. Covariates included race/ethnicity, marital status, insurance, education, income, age, employment, and having previous children/pregnancies. Fisher exact tests and logistic regression were used to examine associations. Approximately 65% of women had not yet applied for WIC benefits. Marshallese women (80.9%) and other NHPI women (80.0%) had the highest need for assistance. In adjusted analyses, White women (p = 0.040) and Hispanic women (p = 0.005) had lower rates of needing assistance applying for WIC than Marshallese women. There were higher rates of needing assistance in applying for women with private insurance or with no insurance and for those with higher incomes. Nearly two out of every three pregnant women who were eligible for WIC had not yet applied for benefits. The findings highlight the need for outreach for all populations that may be eligible, particularly among racial/ethnic minorities and those with higher incomes.
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Affiliation(s)
- Sharon Reece
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703 USA
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Tanvangi Tiwari
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Don E. Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Jacqueline D. Norris
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Kristen Beasley
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Philmar Mendoza Kabua
- College of Nursing, University of Arkasnas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Clare C. Brown
- University of Arkansas for Medical Sciences Fay W Boozman College of Public Health, 4301 W. Markham St, Little Rock, AR 72205 USA
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17
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Moore R, Purvis RS, CarlLee S, Hallgren E, Kraleti S, Willis DE, McElfish PA. Understanding Vaccination Among Hesitant Adopters of the COVID-19 Vaccine Using the Increasing Vaccination Model. J Health Commun 2023; 28:458-476. [PMID: 37394866 PMCID: PMC10443235 DOI: 10.1080/10810730.2023.2224265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The coronavirus disease (COVID-19) was the third leading cause of death in 2021 in the United States and has led to historic declines in life expectancy for Americans. While vaccination is an effective mitigation strategy for COVID-19, vaccine hesitancy remains a major barrier to individual and population-level protection. An emerging literature on hesitant adopters of COVID-19 vaccines highlights co-occurrence of hesitancy and vaccine uptake as an understudied phenomenon, with the potential to provide insight into factors that lead hesitant individuals to become vaccinated despite their hesitancy. We use qualitative interviews among hesitant adopters in Arkansas to examine vaccine hesitancy among this understudied group. Drawing on the Increasing Vaccination Model, we find that the most frequently reported motivations of hesitant adopters were within the domain of social processes, pointing to a critical focal point for targeted health communications intervening in this domain (e.g. social norms, social networks, and altruistic behavior). We find that recommendations from health care workers (HCWs) other than physicians/providers may serve as an effective influence to vaccinate. We also demonstrate negative effects of low provider and HCW confidence and weak recommendations on motivations to vaccinate among individuals expressing vaccine hesitancy. Additionally, we find individual information-seeking behaviors among hesitant adopters bolstered confidence in the efficacy of the COVID-19 vaccine. Based on these findings, clear, accessible, and authoritative health communication has a role in combatting the COVID-19 misinformation/disinformation infodemic.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Shashank Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
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18
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Long CR, Narcisse MR, Selig JP, Willis DE, Gannon M, Rowland B, English ES, McElfish PA. Prevalence and associations between food insecurity and overweight/obesity among native Hawaiian and Pacific Islander adolescents. Public Health Nutr 2023; 26:1338-1344. [PMID: 37069046 PMCID: PMC10346012 DOI: 10.1017/s1368980023000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/20/2023] [Accepted: 04/01/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association. DESIGN Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria. SETTING The USA, including all 50 states and the District of Columbia. PARTICIPANTS 383 NHPI adolescents aged 12-17 in the USA. RESULTS A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families. CONCLUSIONS The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.
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Affiliation(s)
- Christopher R Long
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Marie-Rachelle Narcisse
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - James P Selig
- University of Arkansas for Medical Sciences Northwest, Fay W. Boozman College of Public Health, Fayetteville, AR, USA
| | - Don E Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Matthew Gannon
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, Fayetteville, AR, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, Fayetteville, AR, USA
| | - Emily S English
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
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19
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Andersen JA, Scott AJ, Rowland B, Willis DE, McElfish PA. Associations between COVID-19 Death Exposure and COVID-19 Vaccine Hesitancy and Vaccine Uptake. South Med J 2023; 116:519-523. [PMID: 37400094 DOI: 10.14423/smj.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVES The aim of the study was to determine the relation between coronavirus disease 2019 (COVID-19) death exposure and COVID-19 vaccine hesitancy and vaccine uptake among Arkansans, controlling for sociodemographic factors. METHODS Data were collected from a telephone survey administered in Arkansas between July 12 and July 30, 2021 (N = 1500) via random digit dialing of telephone landlines and cellular telephones. Weighted data were used to estimate regressions. RESULTS Controlling for sociodemographic variables, COVID-19 death exposure was not a significant predictor of COVID-19 vaccine hesitancy (P = 0.423) or COVID-19 vaccine uptake (P = 0.318). Younger individuals, those with lower levels of education, and those who live in rural counties were more likely to be COVID-19 vaccine hesitant. Older individuals, Hispanic/Latinx individuals, those who reported higher levels of education, and those who reported living in urban counties were more likely to have reported receiving the COVID-19 vaccine. CONCLUSIONS Many efforts to promote COVID-19 vaccines have focused on prosocial norms, including encouraging vaccination to protect the community from COVID-19 infection and death; however, COVID-19 death exposure was not related to COVID-19 vaccine hesitancy or uptake in the present study. Future research should examine whether prosocial messaging is effective in decreasing hesitancy or motivating some individuals to receive the vaccine among those who have been exposed to COVID-19 deaths.
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Affiliation(s)
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale
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Reece S, CarlLee S, Scott AJ, Willis DE, Rowland B, Larsen K, Holman-Allgood I, McElfish PA. Hesitant adopters: COVID-19 vaccine hesitancy among diverse vaccinated adults in the United States. Infect Med (Beijing) 2023; 2:89-95. [PMID: 38013742 PMCID: PMC10038887 DOI: 10.1016/j.imj.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 07/11/2023]
Abstract
Background Despite the United States (US) having an abundant supply of COVID-19 vaccines, vaccination rates lag behind other high-income countries, suggesting that vaccine hesitancy and attitudes play a greater role in public health measures than pure supply and access. With the acknowledgment that vaccination attitudes and status may or may not be correlated, this study examined COVID-19 vaccine hesitancy among vaccinated US adults by asking: 1) What is the prevalence of COVID-19 vaccine hesitancy among the vaccinated? 2) Does COVID-19 vaccine hesitancy vary across sociodemographic characteristics? 3) Does COVID-19 vaccine hesitancy vary by healthcare access and influenza vaccination over the past 5 years? Methods Data were collected through an online survey of 2022 US adults with a final analytic sample of 1383 vaccinated respondents. Results Overall, 48.8% of vaccinated adults reported some level of hesitancy, while a slight majority reported they were "not at all hesitant". Younger respondents, women, and Black and American Indian or Alaska Native participants had greater adjusted odds of being more hesitant towards receiving the COVID-19 vaccine. Respondents who had a primary care physician had greater adjusted odds than those who did not have a primary care physician of being more hesitant towards receiving the COVID-19 vaccine. Conclusions This is the first population-based national sample study examining COVID-19 vaccine hesitancy among vaccinated individuals from subgroups of distinctive backgrounds in order to inform targeted strategies for reducing vaccine hesitancy. Findings can assist in efforts to increase vaccination rates and also decrease vaccine hesitancy at the national level.
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Affiliation(s)
- Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
| | - Kristin Larsen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Ijanae Holman-Allgood
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72703, USA
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Willis DE, Selig JP, Andersen JA, Hall S, Hallgren E, Williams M, Bryant-Moore K, McElfish PA. Hesitant but vaccinated: assessing COVID-19 vaccine hesitancy among the recently vaccinated. J Behav Med 2023; 46:15-24. [PMID: 35032254 PMCID: PMC8760868 DOI: 10.1007/s10865-021-00270-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/04/2021] [Indexed: 11/06/2022]
Abstract
We administered a survey during the fifteen-minute wait time after the COVID-19 vaccine was given (N = 1475) to examine attitudes towards COVID-19 vaccines among adults who were vaccinated in Arkansas between April 22nd and July 6th, 2021. We found 60% of those who had just been vaccinated reported some level of hesitancy, including 10% who reported being "very hesitant." Hesitancy was not evenly distributed across sociodemographic groups (age, sex, race/ethnicity, and education) and was associated with whether a non-English language is spoken in the home, health care coverage, and flu vaccination over the past five years in bivariate analysis. Generalized ordered logistic regression results reveal associations between the log-ordered odds of COVID-19 vaccine hesitancy and age, sex, race/ethnicity, health care coverage, health literacy, and flu vaccination over the past five years. Surprisingly, a prior COVID-19 diagnosis was not significantly associated with COVID-19 vaccine hesitancy. These results can inform health care and communication strategies. Further attention to "hesitant adopters" can provide insights into the process of overcoming vaccine hesitancy that are critical to vaccine uptake.
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Affiliation(s)
- Don E Willis
- 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, Little Rock, AR, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Spencer Hall
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Keneshia Bryant-Moore
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Moore R, Purvis RS, Willis DE, Worley KC, Hervey D, Reece S, Yeates A, McElfish PA. The vaccine hesitancy continuum among hesitant adopters of the COVID-19 vaccine. Clin Transl Sci 2022; 15:2844-2857. [PMID: 36330587 PMCID: PMC9747130 DOI: 10.1111/cts.13385] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022] Open
Abstract
Vaccination is a strategy for mitigating the impact of coronavirus disease 2019 (COVID-19) at both the individual and population levels. Vaccine hesitancy is identified as a significant threat to global health by the World Health Organization (WHO). Vaccine hesitancy has been theorized as a continuum encompassing a range of attitudes, beliefs, emotional orientations, ideologies, and health-seeking behaviors. Individuals who received the COVID-19 vaccine but also indicated some level of hesitancy about vaccination, or "hesitant adopters," remain an understudied group. This study uses a qualitative descriptive design to understand motivations to receive the COVID-19 vaccine among hesitant adopters at various self-reported levels of hesitancy. We conducted interviews with hesitant adopters (n = 49) to analyze the elements of vaccine hesitancy corresponding to reported levels of COVID-19 vaccine hesitancy (i.e., "little hesitant," "somewhat hesitant," and "very hesitant"). Concerns about side effects are shared across the continuum but are articulated differently at each level of hesitancy. The "little hesitant" relate fears of side effects to their health and a lack of clear information to inform their health decision making, whereas the "very hesitant" articulate the risks of side effects within the frame of conspiracies related to the development, approval, and economics of the COVID-19 vaccine. Additionally, conspiracy theories generally increase in salience across the continuum, with the "very hesitant" reporting conspiracy theories as the most salient element of vaccine hesitancy. This research presents opportunities for developing targeted interventions for different levels of vaccine hesitancy.
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Affiliation(s)
- Ramey Moore
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Rachel S. Purvis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Don E. Willis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | | | | | - Sharon Reece
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Aimee Yeates
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Pearl A. McElfish
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
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McElfish PA, Purvis RS, Riklon S, Willis DE. Complicity in sociology and community-based participatory research with Marshallese. Sociol Health Illn 2022; 44 Suppl 1:142-157. [PMID: 35213055 DOI: 10.1111/1467-9566.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Complicity with colonialism can be reflected in a particular approach to research, whose interests it serves, and who has power or ownership over the research process. It can also be reflected in neglect, inaction or methodological erasure of groups historically subjected to domination by colonial empires. Social scientists have often failed to account for colonialism's role or the complicit role they have played. We provide a brief historical overview of colonialism in the Marshall Islands and the role social scientists-and their methodological and epistemological approaches-played in the US empire's expansion into the region. We discuss the tenets of Community Based Participatory Research (CBPR), setting the research agenda, co-direction of the research process, research team membership, collaboration challenges, and the action and outputs which have come from our team's health disparities research among the largest Marshallese population in the continental US. We argue CBPR is a promising but imperfect approach to guarding against complicity within medical sociology and situate our methodological approach within ongoing debates regarding objectivity and advocacy within sociology. We reflect on successes and shortcomings of our CBPR efforts to address health disparities among Marshallese, as well as how those successes and shortcomings overlap with questions of complicity.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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25
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Willis DE, Long CR, Rowland B, Tidwell C, Andersen JA, McElfish PA. COVID-19 and food insecurity in a vulnerable rural state. Dialogues Health 2022; 1:100013. [PMID: 36636611 PMCID: PMC9098512 DOI: 10.1016/j.dialog.2022.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/16/2023]
Abstract
Objective This study explored variations in food insecurity across sociodemographic groups and changes specific to the COVID-19 pandemic, including income loss, stimulus check receipt, and changes in household size. Design A cross-sectional online survey was conducted using a 2-item food insecurity screener. COVID-19 related factors and sociodemographic data were collected. Setting Data were collected in Arkansas, United States, during July and August 2020. Participants A sample of 1205 adults was recruited using ARresearch, a volunteer research registry. Participants were over the age of 18 and living, working, or receiving health care in Arkansas. Results The prevalence of food insecurity was 24.9% during the COVID-19 pandemic. Food insecurity was elevated even after the majority of respondents received a stimulus check. Chi-square and t-tests revealed that food insecurity was more prevalent among those who are younger, Black, Hispanic/Latinx, lower-income, less educated, and living in households with children. Multivariate logistic regression revealed that odds of food insecurity were greater for individuals who reported income loss due to the pandemic (OR = 3.29; p < .001), Black respondents (OR = 2.06, p = .014), Hispanic respondents (OR = 3.34, p = .001), those earning less than $25,000 annually (OR = 4.92; p < .001) or between $25,000 to $49,999 (OR = 2.04; p = .023), respondents with a high school degree or less (OR = 4.21; p < .001) or some college (OR = 2.55; p < .001), and those living in households with children (OR = 1.62; p = .021). Odds of food insecurity were lower for those who had received a stimulus check (OR = 0.60; p = .026). Conclusion Food insecurity prevalence was high in Arkansas in July and August 2020. The risk of food insecurity was uneven across sociodemographic groups. Several factors related to the COVID-19 pandemic were indicators for increased risk of food insecurity. Interventions to address food insecurity that recognize social factors unique to the pandemic are needed to reduce levels of food insecurity.
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Affiliation(s)
- Don E. Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Christopher R. Long
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Caitlin Tidwell
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA,Corresponding author
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26
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Purvis RS, Moore R, Willis DE, Hallgren E, McElfish PA. Factors influencing COVID-19 vaccine decision-making among hesitant adopters in the United States. Hum Vaccin Immunother 2022; 18:2114701. [PMID: 36070518 PMCID: PMC9746519 DOI: 10.1080/21645515.2022.2114701] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Increasing COVID-19 vaccine uptake is crucial to managing the endemic. In this qualitative study, we examine factors influencing the decision-making process of COVID-19 hesitant adopters - those who reported some level of hesitancy and are vaccinated. Using interviews with 49 participants, we documented multiple factors influencing the decision-making process to get the COVID-19 vaccine among a racially and ethnically diverse sample of hesitant adopters in the US. Participants described influences related to sociocultural context and personal and group influences, which affected their decision to get the COVID-19 vaccine despite being hesitant. We find politics, culture, healthcare professionals, employment, vaccine attitudes and beliefs, social networks, and the media influence the decision to get vaccinated. Our findings provide nuanced and in-depth information in their own words. This study expands on prior literature on COVID-19 vaccine hesitancy, especially among hesitant adopters. These findings can inform future interventions and research targeting vaccine-hesitant populations to increase vaccine uptake.
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Affiliation(s)
- Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Ramey Moore
- College of Medicine, 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
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA,CONTACT Pearl A. McElfish College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR72703, USA
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27
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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: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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28
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Andersen JA, Willis DE, Hallgren E, McElfish PA, Felix HC. Physical activity and fruit and vegetable consumption during the COVID-19 pandemic for people with type 2 diabetes mellitus. Prim Care Diabetes 2022; 16:640-643. [PMID: 35909071 PMCID: PMC9300581 DOI: 10.1016/j.pcd.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
AIMS To understand the associations between sociodemographic factors, self-rated health, and COVID-19-related changes in physical activity and diet and the reported number of days per week participants engaged in physical activity and consumed fruits and vegetables for people with type 2 diabetes mellitus (T2DM). METHODS Respondents from Arkansas primary care clinics completed a survey between October 2020 and January 2021. Multivariable regression determined associations between sociodemographic factors, self-rated health, and COVID-19-related changes in physical activity and diet and the reported number of days per week participants engaged in physical activity and consumed fruits and vegetables. RESULTS Respondents exercised for at least 30 min on a mean of 2.09 days and consumed five or more fruit and vegetable servings on a mean of 3.57 days. Males engaged in one additional day of physical activity compared to women. Respondents with a college degree or higher ate 5 or more fruit and vegetable servings on fewer days per week than those with a high school education or less. CONCLUSIONS Results reaffirm a need for diabetes education programs and health care providers to provide information on the importance of maintaining physical activity and a healthy diet as part of a self-care plan for T2DM, especially during public health emergencies like the COVID-19 pandemic.
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Affiliation(s)
- Jennifer A Andersen
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Don E Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Emily Hallgren
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Ave., Fayetteville, AR 72703, USA.
| | - Holly C Felix
- University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, 4301 W. Markham St., Little Rock, AR 72205, USA
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29
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McElfish PA, Rowland B, Scott AJ, Andersen JA, CarlLee S, McKinnon JC, Reece S, Meredith‐Neve SM, Macechko MD, Gurel‐Headley M, Willis DE. Hesitant adopters: An examination of hesitancy among adults in Arkansas who have taken the COVID-19 vaccine. Clin Transl Sci 2022; 15:2316-2322. [PMID: 36004689 PMCID: PMC9538052 DOI: 10.1111/cts.13367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Abstract
Recent research suggests people who report vaccine hesitancy may still get vaccinated; however, little is known about hesitancy among those who chose to vaccinate. The current study focused on individuals who received the coronavirus disease 2019 (COVID-19) vaccine despite their hesitancy, whom we refer to as "hesitant adopters." With the understanding that vaccine attitudes and vaccine behaviors may or may not be correlated, we examined the prevalence of COVID-19 vaccine hesitancy among those who have been vaccinated, how COVID-19 vaccine hesitancy varies across sociodemographic groups, and how COVID-19 vaccine hesitancy relates to other factors (prior health care access and influenza vaccination behavior over the past 5 years). Random digit dialing of telephone landlines and cell phones was used to contact potential survey respondents, rendering a sample of 1500 Arkansan adults. Approximately one-third of those who received a COVID-19 vaccine also reported some level of hesitancy. Among hesitant adopters, 5.3% said they were "very hesitant," 8.8% said they were "somewhat hesitant," and 17.1% said they were "a little hesitant." Black/African American and Hispanic/Latinx respondents reported more hesitancy than White respondents, and female respondents reported greater hesitancy compared to male respondents. Greater hesitancy was associated with non-metro/rural residence, forgoing health care due to cost, and lower influenza vaccination rates over the past 5 years. Findings suggest those who are hesitant may get vaccinated despite their hesitancy, illustrating the complexity of vaccination behaviors. Prevalence of hesitancy among the vaccinated has implications for communication strategies in vaccine outreach programs and may help to reduce stigmatization of hesitant adopters.
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Affiliation(s)
- Pearl A. McElfish
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Brett Rowland
- Office of Community Health and ResearchUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Aaron J. Scott
- Office of Community Health and ResearchUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Jennifer A. Andersen
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sheena CarlLee
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Joshua C. McKinnon
- College of NursingUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sharon Reece
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Sandra M. Meredith‐Neve
- Integrated Medicine Service LineUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Michael D. Macechko
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Morgan Gurel‐Headley
- College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
- Fay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Don E. Willis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
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30
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Andersen JA, Willis DE, Malhis JR, Long CR, McElfish PA. The Association Between Education and Basic Needs Insecurity for Marshallese During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022; 9:1882-1887. [PMID: 34403123 PMCID: PMC8370049 DOI: 10.1007/s40615-021-01125-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to explore the prevalence of basic needs insecurity and to examine the association between education and basic needs insecurity during the COVID-19 pandemic for Marshallese living in the USA. METHODS Survey data describing Marshallese experiences during the pandemic were analyzed using descriptive statistics and complementary log-log regression to test the association between education and basic needs insecurity. RESULTS Marshallese respondents reported no usual source of care (46%), less healthcare (22.3%), and difficulty obtaining medication (34.8%). Nearly 80% reported being food insecure, and 47.5% reported being housing insecure. Marshallese with a high school education or less had higher odds of reporting being food and housing insecure. DISCUSSION Basic needs insecurities are a serious threat to the health of Marshallese during the pandemic. Results from this study can inform interventions addressing food and housing insecurity, access to healthcare, and medication access for Marshallese communities.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Joseph R Malhis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA.
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McElfish PA, Bogulski C, Langston K, Carleton A, Semingson J, Gurel L, Willis DE. Bilingual care navigation and enhanced case management during COVID-19. Fam Syst Health 2022; 40:403-407. [PMID: 35549491 DOI: 10.1037/fsh0000682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
COVID-19 disparities exposed health inequity across socioeconomic status, with community members of color experiencing higher rates of COVID-19 infections, hospitalizations, and death. Racial/ethnic differences were especially disparate in Benton and Washington counties in northwest Arkansas, a region in the United States that experienced high COVID-19 infection rates. To address these disparities and support families with COVID-19, the University of Arkansas for Medical Sciences and Community Clinic (a federally qualified health center) worked with the Arkansas Department of Health and community partners to develop systematic Care Navigation and Enhanced Case Management. During an initial screening process, contact tracers offered Care Navigation and Enhanced Case Management services to individuals who tested positive for COVID-19 within Washington and Benton counties. Bilingual community health navigators, social workers, and nurses began providing enhanced case management to households that accepted services. Between September 9, 2020 and June 19, 2021, 3,502 households representing ∼13,000 individuals were offered services, and 1,511 (43.1%) households requested/accepted services. Based on our experience, we provide four recommendations for practice: (a) provide contact tracing in community members' preferred language, (b) incorporate assessments into the contact tracing process to ensure community members have necessary resources for quarantine, (c) implement comprehensive care navigation and case management services for those who need additional support, and (d) integrate bilingual health navigators who are part of the target community into the process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest
| | - Krista Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest
| | - Ayoola Carleton
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest
| | | | | | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest
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Abstract
As of May 17, 2022, more than a million deaths due to COVID-19 have been recorded in the US. For each COVID-19 death, there are an estimated nine bereaved family members and an unknown number of bereaved friends. This study aimed to assess the correlates of self-reported COVID-19 death exposure (i.e., loss of a close friend or family member) among US adults using online survey data (n = 1,869) collected between September 17, 2021 and October 3, 2021. One in four US adults in this national sample reported the loss of a close friend or family member due to COVID-19. The odds of losing a close friend or family member due to COVID-19 death were greater for those age 60 or older, all minoritized racial/ethnic groups except for Asian American respondents, married/coupled respondents, those who had foregone care due to cost in the past year, and those who reported a COVID-19 infection.
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Affiliation(s)
- Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Shashank S. Kraleti
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Kendrick A, Fantasia HC, Morse B, Willis DE. Food insecurity in college students: A concept analysis. Nurs Forum 2022; 57:898-904. [PMID: 35616363 DOI: 10.1111/nuf.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
AIM This concept analysis provides an analysis of the concept of food insecurity among college students. The purpose was to support improved identification of the population and allow for targeted assessment and intervention strategies. BACKGROUND Food insecurity is a problem among college students. College students experience this more than the general population and have a unique set of risk factors and consequences. This requires a comprehensive understanding of this concept to design effective interventions. DESIGN Concept analysis using Walker and Avant. DATA SOURCES Databases were searched for articles in English related to food insecurity among college students. Government reports and gray literature were also reviewed. No date limit was set. REVIEW METHODS Articles and reports were read and reviewed. Thirty-nine sources were included in the analysis. RESULTS Five defining attributes were identified: Lack of sufficient food, negative academic implications, negative physical health impacts, negative psychosocial health impacts, learning to identify, and use food resources. Definitions, antecedents, consequences, and empirical referents are described. Cases are presented. CONCLUSIONS The proposed definition expounds upon current definitions and identifies the unique experiences and needs of college students who experience the phenomenon. This allows for early identification and support of college students' needs regarding food.
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Affiliation(s)
- Amy Kendrick
- Department of Nursing, Fitchburg, Massachusetts, USA
| | | | - Brenna Morse
- Solomont School of Nursing, Lowell, Massachusetts, USA
| | - Don E Willis
- Division of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
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Bogulski CA, Willis DE, Williams CA, Ayers BL, Andersen JA, McElfish PA. Stressful life events and social support among pregnant Marshallese women. Matern Child Health J 2022; 26:1194-1202. [PMID: 35551586 PMCID: PMC9095441 DOI: 10.1007/s10995-022-03404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/12/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
Introduction Women from racial and ethnic minority groups in the United States are disproportionately likely to experience adverse perinatal outcomes such as preterm birth, low birthweight infants, and infant mortality. Previous research has demonstrated that exposure to stressful life events and social support may influence perinatal outcomes. Although studies have documented stressful life events and social support for the general United States population and minority groups, less is known about the experiences of Pacific Islander women in the United States, and no prior studies have documented these experiences in Marshallese Pacific Islander women. Methods The present study examined data collected from pregnant Marshallese women (n = 67) in northwest Arkansas participating in a women’s health program using descriptive analyses (means, standard deviations, proportions). Results Results indicated a high prevalence of three stressful life events: experiencing a family member going into the hospital (35.8%), someone close to them dying (29.9%), and being unable to pay bills (53.7%). Food insecurity was higher than previously reported for pregnant women or Pacific Islanders (83.7%). Social support was high among the sample. A majority of women reported receiving help with daily chores (86.6%), help when sick (88.1%), and support on how to deal with personal problems (85.1%). Discussion This study is the first to document the prevalence of stressful life events and social support in a sample of pregnant Marshallese women living in the United States. The findings provide important information to guide efforts to reduce adverse perinatal outcomes in a Pacific Islander population.
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Affiliation(s)
- Cari A. Bogulski
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Don E. Willis
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Christina A. Williams
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, 72703-1908 Fayetteville, AR United States
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Willis DE, Schootman M, Shah SK, Reece S, Selig JP, Andersen JA, McElfish PA. Parent/guardian intentions to vaccinate children against COVID-19 in the United States. Hum Vaccin Immunother 2022; 18:2071078. [PMID: 35506876 PMCID: PMC9302502 DOI: 10.1080/21645515.2022.2071078] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Vaccination is critical for protecting adults and children from COVID-19 infection, hospitalization, and death. Analyzing subsamples of parent/guardians of children age 0–11 (n = 343) and 12–17 (n = 322) from a larger national survey of US adults (n = 2,022), we aimed to assess intentions to vaccinate children and how intentions might vary across parent/guardian sociodemographic characteristics, healthcare coverage, vaccination status, political affiliation, prior COVID-19 infection, exposure to COVID-19 death(s) of family or friends, perceived norms of vaccination, and COVID-19 vaccine hesitancy. We also report the prevalence of vaccinated children for parents whose oldest child was eligible for vaccination at the time of the survey. More than one third of parents whose oldest child was not yet eligible for vaccination (11 or younger) planned to get them vaccinated right away when a vaccine became available to them. Among parents whose child was eligible to be vaccinated (age 12–17 years), approximately a third reported their child had already been vaccinated and approximately a third planned to do so right away. Intentions to vaccinate children age 0 to 11 were significantly associated with age, gender, race/ethnicity, education, COVID-19 vaccination, political affiliation, social norms, and COVID-19 vaccine hesitancy. Intentions to vaccinate children age 12 to 17 were significantly associated with age, education, healthcare coverage, COVID-19 vaccination, political affiliation, social norms, and COVID-19 vaccine hesitancy. We discuss implications for public health officials and for future research.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Mario Schootman
- 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
| | - Sharon Reece
- 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
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 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 2022; 10:1025-1034. [PMID: 35391714 PMCID: PMC8989097 DOI: 10.1007/s40615-022-01290-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Andersen JA, Rowland B, Gloster E, Willis DE, Hernandez N, Felix HC, Long CR, McElfish PA. Associations among Self-Reported Mental Health, Physical Activity, and Diet during the COVID-19 Pandemic. Nutr Health 2022; 28:711-719. [PMID: 35234099 PMCID: PMC8891903 DOI: 10.1177/02601060221082362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Understanding the relationship between physical activity, diet, and mental health during the COVID-19 pandemic may help inform resources encouraging healthy lifestyle choices during the time of an increased threat to health and wellbeing. Aim: Our objective was to examine how self-rated mental health was associated with engagement in physical activity and consumption of fruits and vegetables during the COVID-19 pandemic. Methods: The study utilized cross-sectional survey data from adults (≥18 years of age) living, working, and/or receiving healthcare in Arkansas (n = 754). Multivariable regression models were used to examine the associations between self-rated mental health and the number of days respondents engaged in 30 min of physical activity and the number of days respondents consumed five or more servings of fruits and vegetables. Results: Respondents who reported somewhat poor/poor mental health reported engaging in at least 30 min of physical activity fewer days per week (β = -.77, p = .018) compared with those reporting excellent mental health, after controlling for sociodemographic factors and self-rated health. The significant association observed in the first two models between mental health and number of days consuming five or more servings of fruits and vegetables became non-significant after inclusion of self-rated health. Conclusion: The relationship between mental health and physical activity and diet reaffirms a need for healthcare providers to promote the importance of maintaining both a healthy physical activity level and a nutrient-rich diet in the face of challenging circumstances, such as a global pandemic.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, 37323University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Brett Rowland
- Office of Community Health and Research, 12215University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Erin Gloster
- Office of Community Health and Research, 12215University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Don E Willis
- College of Medicine, 37323University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Nestor Hernandez
- Department of Sociology, 14719University of Nebraska-Lincoln, Lincoln, NE
| | - Holly C Felix
- Fay W. Boozman College of Public Health, 12215University of Arkansas for Medical Sciences, Little Rock, AR
| | - Christopher R Long
- College of Medicine, 37323University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Pearl A McElfish
- College of Medicine, 37323University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
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Purvis RS, Willis DE, Moore R, Bogulski C, McElfish PA. Perceptions of adult Arkansans regarding trusted sources of information about the COVID-19 pandemic. BMC Public Health 2021; 21:2306. [PMID: 34930208 PMCID: PMC8685165 DOI: 10.1186/s12889-021-12385-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The United States leads the world in confirmed COVID-19 cases; Arkansas ranks fifth in average daily cases per 100,000. Historically, Americans relied on health communications from governmental sources and the news media. However, there has been a documented decline of trust in these sources. The present study seeks to understand trusted sources of information about COVID-19 to improve health messaging because research shows the level of trust is associated with adherence to recommendations. METHODS Data were collected using an online survey from participants (N = 1221) who were 18 years of age or older and residing, employed, or accessing health care in Arkansas. A qualitative descriptive design was used to summarize participants' experiences and perceptions related to trusted sources of COVID-19 information. RESULTS Two primary themes related to participants' perceptions of sources of information about COVID-19 are reported: 1) trusted sources of information and 2) distrust or lack of trust in sources of information. Several subthemes emerged within each primary theme. Results showed high trust in the academic medical center, federal and state public health agencies, and local health care providers. The study also documents diverging voices of distrust and uncertainty in making sense of contradictory information. Participants reported the main reason for their lack of trust was the rapidly changing information and the lack of consistency in information provided across sources. CONCLUSIONS This finding provides insight into the importance of coordination between national, state, and local communications to bolster trust. Personal recommendations and testimonies from trusted health care providers and professionals could inform public health messaging interventions to increase vaccine uptake.
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Affiliation(s)
- Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA.
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Hallgren E, Moore R, Purvis RS, Hall S, Willis DE, Reece S, CarlLee S, Gurel-Headley M, McElfish PA. Facilitators to vaccination among hesitant adopters. Hum Vaccin Immunother 2021; 17:5168-5175. [PMID: 34893018 PMCID: PMC8903968 DOI: 10.1080/21645515.2021.2010427] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/22/2021] [Indexed: 12/30/2022] Open
Abstract
To end the COVID-19 pandemic, it is essential to increase vaccine coverage in the United States (U.S.). In this study, we examine the facilitators that helped hesitant adopters - those who are both vaccinated and report some degree of hesitancy - overcome barriers to vaccination. Drawing on a sample of 867 hesitant adopters in Arkansas, we find social networks, individual actions, health care organizations and professionals, employers, religious communities and leaders, and the media all play a role in helping the vaccine hesitant overcome barriers to vaccination. Our findings demonstrate vaccine hesitancy and uptake occur simultaneously, and overcoming hesitancy in the U.S. population requires multifaceted strategies from multiple entities. We provide recommendations for overcoming barriers, including hesitancy, based on our findings.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Spencer Hall
- 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
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Purvis RS, Hallgren E, Moore RA, Willis DE, Hall S, Gurel-Headley M, McElfish PA. Trusted Sources of COVID-19 Vaccine Information among Hesitant Adopters in the United States. Vaccines (Basel) 2021; 9:1418. [PMID: 34960164 PMCID: PMC8706404 DOI: 10.3390/vaccines9121418] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
The World Health Organization has identified vaccine hesitancy as a top health concern. Emerging research shows that those who are hesitant may still get vaccinated; however, little is known about those who say they are hesitant but still get vaccinated. Most people have high trust in several sources of COVID-19 information, and trust in certain information sources such as the Centers for Disease Control and Prevention and health care providers was associated with being vaccinated. This study explored trusted information sources among hesitant adopters in the United States with a survey respondents completed while waiting after receiving a COVID-19 vaccine dose. The study included (n = 867) respondents. The majority of respondents were female (60.21%); were between the ages of 18 and 44 years old (71.97%); and were diverse, with most identifying as White (44.54%) or Hispanic/Latinx (32.55%). Hesitant adopters reported multiple trusted sources of COVID-19 vaccine information, which can be grouped into four emergent subthemes: (1) Health care/Medical science, (2) Personal relationships, (3) News and social media, and (4) Individual/Myself. Some respondents expressed a distrust of all sources of COVID-19 vaccine information, despite receiving the vaccine, describing a lack of trust in traditional sources of information such as the mainstream media or government. This study contributes to the literature by documenting trusted sources of COVID-19 vaccine information among hesitant adopters in the United States. Findings provide important insights about respondents' trusted sources of COVID-19 vaccine information that can inform future public health messaging campaigns intended to increase vaccine uptake among hesitant adopters.
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Affiliation(s)
- Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.S.P.); (E.H.); (R.A.M.); (D.E.W.)
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.S.P.); (E.H.); (R.A.M.); (D.E.W.)
| | - Ramey A. Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.S.P.); (E.H.); (R.A.M.); (D.E.W.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.S.P.); (E.H.); (R.A.M.); (D.E.W.)
| | - Spencer Hall
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA;
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA;
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.S.P.); (E.H.); (R.A.M.); (D.E.W.)
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McElfish PA, Willis DE, Bogulski C, Kelen M, Riklon S, Alik E, Laelan M, Brown AL, Sinclair KA, Andersen JA, Amick BC, Williams M. COVID-19 Vaccine Willingness and Hesitancy Among Marshallese Pacific Islanders. J Patient Exp 2021; 8:23743735211056428. [PMID: 34825050 PMCID: PMC8609098 DOI: 10.1177/23743735211056428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders': willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, 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
| | - Cari Bogulski
- Office of Community Health and Research, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Meetu Kelen
- West Hawaii Community Health
Center, Kailua, HI, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Eldon Alik
- Consul General – Arkansas, Republic of the Marshall Islands,
Springdale, AR, USA
| | - Melisa Laelan
- Arkansas Coalition of
Marshallese, Springdale, AR, USA
| | | | - Ka’imi A. Sinclair
- Institute for Research and Education to Advance Community Health
(IREACH), Washington State University, Pullman, WA, USA
- College of Nursing, Washington State University, Pullman, WA, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical
Sciences Northwest, Fayetteville, AR, USA
| | - Benjamin C. Amick
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
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Rowland B, Bogulski CA, Willis DE, Scott AJ, Gloster EE, Andersen JA. Experiences of Marshallese Food Processing Workers during the COVID-19 Pandemic. J Agromedicine 2021; 27:292-302. [PMID: 34736373 DOI: 10.1080/1059924x.2021.2002222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of this study was to conduct an exploratory assessment of COVID-19 mitigation steps and compare workplace experiences during the COVID-19 pandemic with Marshallese workers in other occupations. Marshallese adults residing in the continental United States (US) and Hawaii took part in an online survey. The sample was divided into two categories: food processing workers and workers in all other occupations. To examine differences between food processing workers and workers from all other occupations, we used Wilcoxon-Mann-Whitney U tests and Fisher's Exact tests. Of those employed at the time of the survey (n = 113), 31 were employed in food processing plants, and 82 were employed in another occupation. Food processing workers and workers in other occupations differed significantly on level of education, length of residence in the US, English-speaking ability, and health literacy. More food processing workers reported that their employers installed barriers or provided shields (45%), provided temperature screenings (71%), and tested for COVID-19 (61%) compared with those in other occupations. A larger proportion of food processing workers reported having no sick leave compared with workers in other occupations, although they reported COVID-19 testing and being insured at similar rates. This is the first study to examine Marshallese food processing workers' experiences during the COVID-19 pandemic. Our findings show that while some food processing employers implemented government-recommended guidelines to prevent the spread of COVID-19, preventative and protective measures were not comprehensively applied across the food processing industry, despite efforts by public health agencies and community partners.
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Affiliation(s)
- Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Cari A Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Erin E Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
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Willis DE, Andersen JA, Bryant‐Moore K, Selig JP, Long CR, Felix HC, Curran GM, McElfish PA. COVID-19 vaccine hesitancy: Race/ethnicity, trust, and fear. Clin Transl Sci 2021; 14:2200-2207. [PMID: 34213073 PMCID: PMC8444681 DOI: 10.1111/cts.13077] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/02/2021] [Accepted: 04/30/2021] [Indexed: 01/25/2023] Open
Abstract
Understanding and minimizing coronavirus disease 2019 (COVID-19) vaccine hesitancy is critical to population health and minimizing health inequities, which continue to be brought into stark relief by the pandemic. We investigate questions regarding vaccine hesitancy in a sample (n = 1205) of Arkansas adults surveyed online in July/August of 2020. We examine relationships among sociodemographics, COVID-19 health literacy, fear of COVID-19 infection, general trust in vaccines, and COVID-19 vaccine hesitancy using bivariate analysis and a full information maximum likelihood (FIML) logistic regression model. One in five people (21,21.86%) reported hesitancy to take a COVID-19 vaccine. Prevalence of COVID-19 vaccine hesitancy was highest among Black/African Americans (50.00%), respondents with household income less than $25K (30.68%), some college (32.17%), little to no fear of infection from COVID-19 (62.50%), and low trust in vaccines in general (55.84%). Odds of COVID-19 vaccine hesitancy were 2.42 greater for Black/African American respondents compared to White respondents (p < 0.001), 1.67 greater for respondents with some college/technical degree compared to respondents with a 4-year degree (p < 0.05), 5.48 greater for respondents with no fear of COVID-19 infection compared to those who fear infection to a great extent (p < 0.001), and 11.32 greater for respondents with low trust in vaccines (p < 0.001). Sociodemographic differences in COVID-19 vaccine hesitancy raise concerns about the potential of vaccine implementation to widen existing health disparities in COVID-19 related infections, particularly among Black/African Americans. Fear of infection and general mistrust in vaccines are significantly associated with vaccine hesitancy.
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Affiliation(s)
- Don E. Willis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Jennifer A. Andersen
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Keneshia Bryant‐Moore
- Fay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - James P. Selig
- Fay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Christopher R. Long
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Holly C. Felix
- Fay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Geoffrey M. Curran
- College of PharmacyUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Pearl A. McElfish
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
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Abstract
The purpose of this evaluation is to describe COVID-19 vaccine hesitancy among a sample of youth aged 12-15 and inform efforts to increase vaccination uptake among youth populations. We used data collected in May 2021 through a health education program for 9th graders (N = 345). We used Spearman correlations and chi-square tests to assess the statistical significance of bivariate relationships. Less than half of students (42%) reported they are not hesitant at all about getting a COVID-19 vaccine. The remainder reported they were "a little hesitant" (22%), "somewhat hesitant" (21%), or "very hesitant" (15%). There were no statistically significant differences across age, gender, race/ethnicity, parental education, self-reported grades, or hours playing video games during school days. There was a statistically significant relationship between COVID-19 vaccine hesitancy and hours of TV watched during school days. The prevalence of COVID-19 vaccine hesitancy in this sample is high, but more research is needed to estimate its prevalence for youth at the state or national level. Correlates of COVID-19 vaccine hesitancy among adult populations may not match those found in youth populations. Research which recognizes youth as agentic rather than passive participants in decision-making opens opportunities for developing age-appropriate health communication and interventions for vaccination.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Jessica Presley
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nickolas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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McElfish PA, Rowland B, Porter A, Felix HC, Selig JP, Semingson J, Willis DE, Smith M, Riklon S, Alik E, Padilla-Ramos A, Jasso EY, Zohoori N. Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020. Prev Chronic Dis 2021; 18:E91. [PMID: 34618667 PMCID: PMC8522500 DOI: 10.5888/pcd18.210124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas.,1125 N College Ave, Fayetteville, AR 72703.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Austin Porter
- Arkansas Department of Health, Little Rock, Arkansas
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | | | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, Arkansas
| | - Alan Padilla-Ramos
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Erika Y Jasso
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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Felix HC, Andersen JA, Willis DE, Malhis JR, Selig JP, McElfish PA. Control of type 2 diabetes mellitus during the COVID-19 pandemic. Prim Care Diabetes 2021; 15:786-792. [PMID: 34246614 PMCID: PMC8449252 DOI: 10.1016/j.pcd.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
AIMS Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic condition that can lead to significant complications if not well controlled. The COVID-19 pandemic created disruptions in daily life; however, it is unknown whether the pandemic's disruptions affected the ability for adults with T2DM to control their condition. This study aims to fill the knowledge gap with the experiences of adults with T2DM in Arkansas, U.S. during the COVID-19 pandemic. METHODS This study analyzed cross-sectional, observational survey data collected from adults (≥18 years) who live, work, or receive healthcare in Arkansas; self-reported a diagnosis of T2DM; and completed the diabetes module of the Impact of COVID-19 online survey (n = 131) fielded in July-August 2020. Descriptive statistics were used to characterize the sample and survey responses, and multivariate regression was used to identify demographics, self-care behaviors, and access issues associated with uncontrolled T2DM (HbA1c ≥ 9% or 74.9 mmol/mol) or with an increase in HbA1c. RESULTS 28.2% reported an increase in their HbA1c since the pandemic began, and 18.2% had uncontrolled T2DM. Educational level, eating healthily, and weight gain were negatively associated with uncontrolled T2DM. Eating less healthily and having difficulty accessing diabetes related medication were positively associated with an increase in HbA1c. CONCLUSIONS Adults with T2DM in Arkansas were reasonably able to maintain control of their T2DM during the five months post the first case of COVD-19 diagnosed in the state. However, T2DM self-management interventions targeting those with lower educational levels that are focused on eating habits and/or that improve access to diabetes medication should be considered for future public health emergencies.
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Affiliation(s)
- Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, United States
| | - Jennifer A Andersen
- Division of Community Health & Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703-1908, United States
| | - Don E Willis
- Division of Community Health & Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703-1908, United States
| | - Joseph R Malhis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, United States
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, United States
| | - Pearl A McElfish
- Division of Community Health & Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703-1908, United States.
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Willis DE, McElfish PA. Racial disparities in the COVID-19 response affecting the Marshall Islands diaspora, United States of America. Bull World Health Organ 2021; 99:680-681. [PMID: 34475605 PMCID: PMC8381097 DOI: 10.2471/blt.20.277855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Don E Willis
- College of Medicine, Division of Community Health and Research, University of Arkansas for Medical Sciences, 1125 N. College Ave., Fayetteville, AR 72703, United States of America (USA)
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, USA
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Moore R, Willis DE, Shah SK, Purvis RS, Shields X, McElfish PA. "The Risk Seems Too High": Thoughts and Feelings about COVID-19 Vaccination. Int J Environ Res Public Health 2021; 18:8690. [PMID: 34444438 PMCID: PMC8394920 DOI: 10.3390/ijerph18168690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/31/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to describe the thoughts and feelings of individuals expressing concerns about the COVID-19 vaccine. A qualitative descriptive study was conducted in order to examine the thoughts and feelings of participants who are hesitant about the COVID-19 vaccine. Data were collected from 754 participants using an online instrument. Emergent themes included a lack of knowledge about the safety of the COVID-19 vaccine; concerns over the speed of development, testing, and approval of these vaccines; reluctance to be among the first vaccinated; concerns about the motivations of government actors, pharmaceutical companies, and others involved in producing the COVID-19 vaccine; and hesitancy about vaccines generally.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (S.K.S.); (X.S.)
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Xochitl Shields
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (S.K.S.); (X.S.)
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
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Moore R, Zielinski MJ, Thompson RG, Willis DE, Purvis RS, McElfish PA. "This Pandemic Is Making Me More Anxious about My Welfare and the Welfare of Others:" COVID-19 Stressors and Mental Health. Int J Environ Res Public Health 2021; 18:5680. [PMID: 34073187 PMCID: PMC8197875 DOI: 10.3390/ijerph18115680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/19/2022]
Abstract
COVID-19 and subsequent social distancing guidelines have changed many aspects of people's daily lives including the way that they interact within their social environment. Pandemics are inherently social phenomena, and public health measures intended to curtail transmission of COVID-19 (e.g., quarantine and social distancing) have consequences for individuals with anxiety and depression. Using qualitative methods, respondents with previously diagnosed anxiety or depression identified ways in which COVID-19 affected their symptoms at multiple levels of the social ecological model (SEM). Key themes reported were organized following the SEM. Emergent themes at the individual level are isolation/loneliness, fear of contracting COVID-19, and uncertainty about the future. Themes at the interpersonal level are: fears of family contracting COVID-19, separation from family members, and domestic relationships. Themes at the level of community and societal stressors are: employment, community and societal systems, media, and the COVID-19 pandemic. Our findings demonstrate the ways that mental health, physical health/safety, and social environments are interrelated in the experience of COVID-19 for individuals diagnosed with anxiety or depression. These findings make a significant contribution to the literature as this is the first article to document mental health stressors related to the COVID-19 pandemic among individuals with diagnosed anxiety and depressive disorders.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Melissa J. Zielinski
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.J.Z.); (R.G.T.J.)
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72703, USA
| | - Ronald G. Thompson
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.J.Z.); (R.G.T.J.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
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McElfish PA, Willis DE, Bryant-Moore K, Rojo MO, Andersen JA, Kaminicki KF, James LP. Arkansans' Preferred COVID-19 Testing Locations. J Prim Care Community Health 2021; 12:21501327211004289. [PMID: 33771056 PMCID: PMC8767652 DOI: 10.1177/21501327211004289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: A contributing factor to racial and ethnic disparities during the COVID-19 pandemic may be the accessibility and acceptability of COVID-19 testing. Previous studies found that access to testing has not been equitable across several sociodemographic indicators. This study documents the preferred testing locations and examines differences across sociodemographic factors with a specific focus on race and ethnicity. Methods: This study includes a primary analysis of cross-sectional data using a self-administered digital survey distributed to Arkansas residents using ARresearch, a volunteer research participant registry. The survey had 1288 responses, and 1221 met eligibility criteria for inclusion in the survey. Participants provided sociodemographic information and were asked to select up to 3 preferred testing locations from 12 options. Chi-square tests assessed differences in testing site preference across relevant sociodemographic groups. Results: Participants preferred drive-through clinics as their top location for COVID-19 testing, with 55% reporting this was their preferred method of testing. This pattern was consistent across all comparison groups (ie, age, sex, race/ethnicity, education, insurance status). Significant differences in testing location preference were observed across age, race and ethnicity, and education, with the most differences observed across race and ethnicity. Conclusion: This study reveals that race and ethnicity are important to consider when deciding where to offer COVID-19 testing. The preferences for testing locations among the most vulnerable demographics will be used to develop targeted responses aimed at eliminating disparities in COVID-19 in Arkansas.
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Affiliation(s)
- Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Don E Willis
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | | | - Martha O Rojo
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer A Andersen
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Kyle F Kaminicki
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Laura P James
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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