Socioeconomic privilege and political ideology are associated with racial disparity in COVID-19 vaccination

Vaccine uptake is critical for mitigating the impact of COVID-19 in the United States, but structural inequities pose a serious threat to progress. Racial disparities in vaccination persist despite the increased availability of vaccines. We ask what factors are associated with such disparities. We combine data from state, federal, and other sources to estimate the relationship between social determinants of health and racial disparities in COVID-19 vaccinations at the county level. Analyzing vaccination data from 19 April 2021, when nearly half of the US adult population was at least partially vaccinated, we find associations between racial disparities in COVID-19 vaccination and median income (negative), disparity in high school education (positive), and vote share for the Republican party in the 2020 presidential election (negative), while vaccine hesitancy is not related to disparities. We examine differences in associations for COVID-19 vaccine uptake as compared with influenza vaccine. Key differences include an amplified role for socioeconomic privilege factors and political ideology, reflective of the unique societal context in which the pandemic has unfolded.

Download Full-text

COVID-19 Vaccine Intentions in the United States, December 2020 to March 2021

10.1101/2021.05.16.21257290 ◽

2021 ◽

Author(s):

Mark É Czeisler ◽

Shantha M.W. Rajaratnam ◽

Mark E Howard ◽

Charles A Czeisler

Keyword(s):

Post Infection ◽

Political Ideology ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Efficacy Data ◽

Post Vaccination ◽

Safety And Efficacy ◽

Vaccine Refusal ◽

The Us

Importance SARS-CoV-2 containment is estimated to require attainment of high (>80%) post-infection and post-vaccination population immunity. Objective To assess COVID-19 vaccine intentions among US adults and their children, and reasons for vaccine hesitancy among potential refusers. Design Internet-based surveys were administered cross-sectionally to US adults during December 2020 and February to March 2021 (March-2021). Setting Surveys were administered through Qualtrics using demographic quota sampling. Participants A large, demographically diverse sample of 10,444 US adults (response rate, 63.9%). Main Outcomes and Measures COVID-19 vaccine uptake, intentions, and reasons for potential refusal. Adults living with or caring for children aged 2 to 18 years were asked about their intent to have their children vaccinated. Multivariable weighted logistic regression models were used to estimate adjusted odds ratios for vaccine refusal. Results Of 5256 March-2021 respondents, 3467 (66.0%) reported they would definitely or most likely obtain a COVID-19 vaccine as soon as possible (ASAP Obtainers), and an additional 478 (9.1%) reported they were waiting for more safety and efficacy data before obtaining the vaccine. Intentions for children and willingness to receive a booster shot largely matched personal COVID-19 vaccination intentions. Vaccine refusal (ie, neither ASAP Obtainers nor waiting for more safety and efficacy data) was most strongly associated with not having obtained an influenza vaccine in 2020 (adjusted odds ratio, 4.11 [95% CI, 3.05-5.54]), less frequent mask usage (eg, rarely or never versus always or often, 3.92 [2.52-6.10]) or social gathering avoidance (eg, rarely or never versus always or often, 2.65 [1.95-3.60]), younger age (eg, aged 18-24 versus over 65 years, 3.88 [2.02-7.46]), and more conservative political ideology (eg, very conservative versus very liberal, 3.58 [2.16-5.94]); all P<.001. Conclusions and Relevance Three-quarters of March-2021 respondents in our large, demographically diverse sample of US adults reported they would likely obtain a COVID-19 vaccine, and 60% of adults living with or caring for children plan to have them vaccinated as soon as possible. With an estimated 27% of the US population having been infected with SARS-CoV-2, once vaccines are available to children and they have been vaccinated, combined post-infection and post-vaccination immunity will approach 80% of the US population in 2021, even without further infections.

Download Full-text

Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189904 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9904

Author(s):

Anuli Njoku ◽

Marcelin Joseph ◽

Rochelle Felix

Keyword(s):

Minority Groups ◽

Ethnic Disparities ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Structural Barriers ◽

Structural Racism ◽

Vaccination Rates ◽

Promising Solution ◽

The Impact

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.

Download Full-text

COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users

Tobacco Use Insights ◽

10.1177/1179173x211068027 ◽

2021 ◽

Vol 14 ◽

pp. 1179173X2110680

Author(s):

Nicolle M Krebs ◽

Gail D’Souza ◽

Candace Bordner ◽

Sophia I Allen ◽

Andrea L Hobkirk ◽

...

Keyword(s):

Adult Population ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

P Value ◽

Current Cigarette Smoking ◽

Chi Square ◽

Convenience Sample ◽

Increased Risk ◽

Current Tobacco

Novel mRNA vaccines have been developed and were first distributed to high-risk individuals (including smokers) in the United States starting in December 2020 to combat the coronavirus (COVID-19) pandemic. Over one-half of the U.S. adult population has received at least 1 dose of a COVID-19 vaccine, but many others have reported hesitation about becoming vaccinated. We examined COVID-19 vaccine uptake and hesitancy from a convenience sample of Pennsylvanian adult smokers in April 2021, approximately 3 months after tobacco users were eligible to receive vaccination in the state. Participants (n = 231) were 23.4% male, 90.5% white, and had a mean age of 48.1 (SD = 11.9) years. All participants were current tobacco users, with the majority reporting current cigarette smoking (90.9%) with an average of 16 (SD = 8.1) cigarettes smoked per day. Nearly 60% (n = 137) reported receiving at least 1 dose of the vaccine and of those who did not (n = 94), 84% (n = 79) said they were somewhat or very unlikely to get a vaccine. Those who were unvaccinated were more likely to not consume news about COVID-19 (chi-square P-value < .01) and less likely to believe government news sources as reliable information for COVID-19 (chi-square P-value < .01). Qualitative responses among those who were vaccine hesitant expressed concerns about the lack of research on the vaccine, distrust of the safety of the vaccine, and fears about side effects. Understanding vaccine hesitancy among tobacco users can help develop targeted communication strategies and directly address concerns to promote vaccination among this population who may be at an increased risk of severe complications from COVID-19.

Download Full-text

Improving older adults’ vaccination uptake: are existing measures of vaccine hesitancy valid and reliable for older people?

10.1101/2021.09.29.21263161 ◽

2021 ◽

Author(s):

Nicola Cogan ◽

Allyson J. Gallant ◽

Louise A. Brown Nicholls ◽

Susan Rasmussen ◽

David Young ◽

...

Keyword(s):

Older Adults ◽

Older Adult ◽

Discriminant Validity ◽

Adult Population ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Future Research ◽

Vaccination Uptake ◽

Older Adult Population ◽

The Impact

ABSTRACTOlder adults are particularly vulnerable to vaccine-preventable diseases (VDU), due to decreased immunity and increased comorbidity. Vaccination can support healthy ageing and help reduce morbidity, mortality, and loss of quality of life associated with VPDs. Despite the availability of effective vaccines, many countries, including the UK, fail to reach recommended coverage levels. Psychosocial factors are recognised as providing important insights into the determinants of vaccination uptake. Little research has sought to establish psychometrically sound scales of vaccine attitudes with older adults. In the present study, a total of 372 UK-based participants (65-92 years, M = 70.5 yrs, SD = 4.6) completed a cross-sectional, online survey measuring health and socio-demographic characteristics in relation to vaccination uptake for influenza, pneumococcal and shingles. Two recently developed vaccination attitude scales, the 5C scale and the Vaccination Attitudes Examination (VAX) scale, were also administered to test their reliability and validity for use with an older adult population. Additional scales used to examine convergent and discriminant validity, the Beliefs about Medicines Questionnaire, the Perceived Sensitivity to Medicines Scale, the Medical Mistrust Index, the Perceived Stress Scale, and the Interpersonal Support Evaluation List, were included. The factor structure of the 5C and VAX scales was confirmed. Both scales showed good internal reliability, convergent, discriminant and concurrent validity, supporting their use with older adult populations. The 5C and VAX scales were found to be reliable and valid psychosocial measures of vaccine hesitancy and acceptance within a UK-based, older adult population. Future research could use these scales to evaluate the impact of psychological antecedents of vaccine uptake, and how concerns about vaccination may be understood and addressed among older adults.Ethics approval & informed consentEthical approval (34/26/11/2019/Staff Williams) was granted by the School of Psychological Sciences and Health Ethics Committee, University of Strathclyde. (SEC19/20: Williams, Nicholls, Rasmussen, Young & Gallant). Approved on 8th January 2020.

Download Full-text

A Community-Based Management of COVID-19 in a Mobile Container Unit

Vaccines ◽

10.3390/vaccines9111362 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1362

Author(s):

Elena Petrova ◽

Timothy Farinholt ◽

Tejas P. Joshi ◽

Hannah Moreno ◽

Mayar Al Mohajer ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Coverage ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Air Filtration ◽

Clinical Environment ◽

Mobile Clinic ◽

Community Based ◽

Community Healthcare

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.

Download Full-text

The Political Impact of Immigration: Evidence from the United States

American Economic Journal Applied Economics ◽

10.1257/app.20190081 ◽

2022 ◽

Vol 14 (1) ◽

pp. 358-389

Author(s):

Anna Maria Mayda ◽

Giovanni Peri ◽

Walter Steingress

Keyword(s):

United States ◽

Republican Party ◽

The United States ◽

The Political ◽

Skilled Immigrants ◽

Level Data ◽

Political Impact ◽

Indirect Impact ◽

Political Effect ◽

The Impact

This paper studies the impact of immigration to the United States on the vote share for the Republican Party using county-level data from 1990 to 2016. Our main contribution is to show that an increase in high-skilled immigrants decreases the share of Republican votes, while an inflow of low-skilled immigrants increases it. These effects are mainly due to the indirect impact on existing citizens’ votes, and this is independent of the origin country and race of immigrants. We find that the political effect of immigration is heterogeneous across counties and depends on their skill level, public spending, and noneconomic characteristics. (JEL D72, J15, J24, J61, R23)

Download Full-text

The Policy Opinions of British Political Activists

Political Studies ◽

10.1111/j.1467-9248.1983.tb01356.x ◽

1983 ◽

Vol 31 (4) ◽

pp. 604-619 ◽

Cited By ~ 5

Author(s):

Susan Welch ◽

Donley T. Studlar

Keyword(s):

United States ◽

Political Ideology ◽

The United States ◽

Election Study ◽

Political Behaviour ◽

Socioeconomic Characteristics ◽

Activist Group ◽

Policy Attitudes ◽

Demographic Attributes ◽

The Impact

This article employs the October 1974 British Election Study to examine the level and nature of political ideology among British political activists, the effects of socioeconomic characteristics on these attitudes, and the impact of the attitudes on political behaviour. On balance, the activist group closely resembles the nonactivist population. Activists are somewhat more ideological in their thinking than nonactivists, but the differences are quite small. Demographic attributes affect the policy attitudes of the élite slightly more than the nonactivists, but again differences are small. The influence of issue attitudes on voting is about the same for activists and nonactivists. These results stand in contrast to studies showing large élite-mass policy differences in the United States and other work documenting ideological orientations in higher levels of the Labour Party.

Download Full-text

OR30-01 Real-World Minimed™ 670G System Use and Glycemic Outcomes of Pediatric and Adult Individuals Living with Type 1 Diabetes (T1D) in the United States

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1708 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Robert Alan Vigersky ◽

Michael Stone ◽

Pratik Agrawal ◽

Alex Zhong ◽

Kevin Velado ◽

...

Keyword(s):

Glycemic Control ◽

Real World ◽

Adult Population ◽

Age Groups ◽

The United States ◽

System Use ◽

System Data ◽

The Mean ◽

The Impact ◽

The U.S

Abstract Introduction: The MiniMed™ 670G system was FDA-approved in 2016 for adults and adolescents ≥14yrs, and in 2018 for children ages 7-13yrs with T1D. Since then, use of the system has grown to over 180,000 people in the U.S. The glycemic control benefits of real-world MiniMed™ 670G system Auto Mode use in the U.S. were assessed. Methods: System data (aggregated five-minute instances of sensor glucose [SG]) uploaded from March 2017 to July 2019 by individuals (N=118,737) with T1D and ≥7yrs of age who enabled Auto Mode were analyzed to determine the mean % of overall time spent <54mg/dL/<70mg/dL (TBR); between 70-180mg/dL (TIR); and >180mg/dL/>250mg/dL (TAR). The impact of Auto Mode was further assessed in a sub-group of individuals (N=51,254) with, at least, 7 days of SG data for both Auto Mode turned ON and turned OFF. The % of TIR, TBR and TAR, and the associated glucose management indicator (GMI) were evaluated for the overall OFF (2,524,570 days) and ON (6,308,806 days) periods, and across different age groups. Results: System data TIR was 71.3%; TBR was 0.4% and 1.9%, respectively; and TAR was 26.8% and 6.2%, respectively. User-wise data of Auto Mode OFF versus ON showed a mean of 70.3% of the time spent in Auto Mode, that TIR increased from 60.9% to 69.9%; and that both TBR and TAR decreased. For those 7-13yrs (N=1,417), TIR increased from 48.7% to 61.5%; TBR increased from 0.5% to 0.6% and from 2.0% to 2.2%, respectively; and TAR decreased from 49.3% to 36.3% and from 20.5% to 13.0%, respectively. For those 14-21yrs (N=4,194), TIR increased from 51.0% to 61.5%; TBR decreased from 0.7% to 0.6% and from 2.3% to 2.0%, respectively; and TAR decreased from 46.7% to 36.5% and from 18.5% to 12.5%, respectively. For those ≥22yrs (N=45,643), TIR increased from 62.2% to 70.9%; TBR decreased from 0.7% to 0.5% and from 2.6% to 1.9%, respectively; and TAR decreased from 35.2% to 27.3% and from 9.9% to 6.3%, respectively. The mean GMI decreased by 0.23% (overall), 0.48% (7-13yrs), 0.35% (14-21yrs), and 0.22% (≥22yrs), respectively, with Auto Mode ON versus OFF. Discussion: In over 6 million days of real-world MiniMed™ 670G system Auto Mode use in the U.S., TIR of a large pediatric and adult population with T1D improved by 9% compared to when Auto Mode was OFF, which was comparable to or exceeded the TIR observed in the smaller pivotal trials. These results further support outcomes of the pivotal trials and increased glycemic control with system use.

Download Full-text

Mental Distress in the United States at the Beginning of the COVID-19 Pandemic

American Journal of Public Health ◽

10.2105/ajph.2020.305857 ◽

2020 ◽

Vol 110 (11) ◽

pp. 1628-1634 ◽

Cited By ~ 5

Author(s):

Calliope Holingue ◽

Luther G. Kalb ◽

Kira E. Riehm ◽

Daniel Bennett ◽

Arie Kapteyn ◽

...

Keyword(s):

Depressive Symptoms ◽

Odds Ratio ◽

Mental Distress ◽

Adult Population ◽

The United States ◽

The Us ◽

Patient Health ◽

Completion Date ◽

History Of ◽

The Impact

Objectives. To assess the impact of the COVID-19 pandemic on mental distress in US adults. Methods. Participants were 5065 adults from the Understanding America Study, a probability-based Internet panel representative of the US adult population. The main exposure was survey completion date (March 10–16, 2020). The outcome was mental distress measured via the 4-item version of the Patient Health Questionnaire. Results. Among states with 50 or more COVID-19 cases as of March 10, each additional day was significantly associated with an 11% increase in the odds of moving up a category of distress (odds ratio = 1.11; 95% confidence interval = 1.01, 1.21; P = .02). Perceptions about the likelihood of getting infected, death from the virus, and steps taken to avoid infecting others were associated with increased mental distress in the model that included all states. Individuals with higher consumption of alcohol or cannabis or with history of depressive symptoms were at significantly higher risk for mental distress. Conclusions. These data suggest that as the COVID-19 pandemic continues, mental distress may continue to increase and should be regularly monitored. Specific populations are at high risk for mental distress, particularly those with preexisting depressive symptoms.

Download Full-text

Spatial Modeling of COVID-19 Vaccine Hesitancy in the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189488 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9488

Author(s):

Abolfazl Mollalo ◽

Moosa Tatar

Keyword(s):

United States ◽

Healthcare Providers ◽

Vulnerability Index ◽

The United States ◽

Vaccine Hesitancy ◽

Social Vulnerability Index ◽

Vaccination Programs ◽

Public Health Decision ◽

Vaccination Rates ◽

The Impact

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite the availability of vaccine services. Despite the efforts of United States healthcare providers to vaccinate the bulk of its population, vaccine hesitancy is still a severe challenge that has led to the resurgence of COVID-19 cases to over 100,000 people during early August 2021. To our knowledge, there are limited nationwide studies that examined the spatial distribution of vaccination rates, mainly based on the social vulnerability index (SVI). In this study, we compiled a database of the percentage of fully vaccinated people at the county scale across the continental United States as of 29 July 2021, along with SVI data as potential significant covariates. We further employed multiscale geographically weighted regression to model spatial nonstationarity of vaccination rates. Our findings indicated that the model could explain over 79% of the variance of vaccination rate based on Per capita income and Minority (%) (with positive impacts), and Age 17 and younger (%), Mobile homes (%), and Uninsured people (%) (with negative effects). However, the impact of each covariate varied for different counties due to using separate optimal bandwidths. This timely study can serve as a geospatial reference to support public health decision-makers in forming region-specific policies in monitoring vaccination programs from a geographic perspective.

Download Full-text