An Ecological Theory Application and Expansion to the COVID-19 Pandemic’s Impact on African Americans and Contributors to Vaccine Hesitancy

BACKGROUND COVID-19 vaccination rates have waned across the country since the rollout in early 2021, especially among African American neighborhoods. Vaccine hesitancy is a recurring theme challenging the world’s public health. Yet, months after efforts to vaccinate the world’s population, we still do not have a good understanding of consumer insights about those who choose to be vaccinated and those who refuse. This also suggests that many vaccination campaigns are running on assumptions, not evidence-informed by consumer insights. OBJECTIVE The purpose of this study is to understand consumer insight of COVID-19 vaccines in Kansas City, a city with higher percentages of African Americans, to contextualize the insight and further compare data from Kansas City with insights from three other similar-sized towns (Long Beach, California; Omaha, Nebraska; Raleigh, North Carolina) that also have higher percentages of people of color. METHODS The researchers collected and analyzed 180,128 tweets from four cities. Triangulated methods were used to look at the breadth and depth of data to provide validity to the findings. In addition, health communication experts, informed by machine learning/deep learning topic and emotion models, conducted a textual analysis of the tweets. The strength of this study is the compilation of methods and the ways in which the data was analyzed and visualized. RESULTS Four major themes about COVID were discovered from the mass of tweets: “COVID Vaccines,” “Politics,” “Mitigation Measures,” and “Community/Local Issues.” The tweets per topic and emotion category were visualized to show regional differences and longitudinal changes. Critical moments of emotional changes were detected. Textual analysis based upon data partitioned by the models identified national and local themes. Insights into strategies of appealing to residents are discussed. CONCLUSIONS This project’s data reveal wavering relationships of trust among residents and the government and its entities. While long-term initiatives should be used to rebuild and strengthen relationships among residents in cities with higher percentages of people of color, additional attention should be given to the health messaging directed at this audience. Practical implications are offered to inform local vaccination campaigns.

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A Theory-Based Analysis of COVID-19 Vaccine Hesitancy among African Americans in the United States: A Recent Evidence

Healthcare ◽

10.3390/healthcare9101273 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1273

Author(s):

Manoj Sharma ◽

Kavita Batra ◽

Ravi Batra

Keyword(s):

African Americans ◽

Behavioral Interventions ◽

Health Behavior Change ◽

The United States ◽

Theory Model ◽

T Test ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Fourth Generation ◽

North East

African Americans have been disproportionately vaccinated at lower rates, which warrants the development of theory-based interventions to reduce vaccine hesitancy in this group. The fourth-generation theories, e.g., multi-theory model (MTM) of health behavior change, are vital in developing behavioral interventions. Therefore, the current study aims to determine recent trends in COVID-19 vaccination rates and to test the MTM model in predicting the initiation of COVID-19 vaccines among vaccine-hesitant Blacks. A sample of 428 unvaccinated African Americans were recruited through a web-based survey using a 28-item psychometric valid questionnaire. Chi-square, independent-samples-t-test or Welch’s t test, and Pearson’s correlation tests were utilized for the analyses. Hierarchical regression modelling was performed to determine the increment in variation accounted for through addition of predictors over a set of models. Nearly 48% of unvaccinated Blacks reported being vaccine-hesitant. The vaccine-hesitant group was relatively younger (40.5 years ± 15.8 vs. 46.2 years ± 17.4, p < 0.001), were Republicans (22.1% vs. 10.0%, p < 0.001), lived in the North-East region (26.0% vs. 11.4%, p < 0.001) and had religious affiliations other than Christianity (21.2% vs. 13.6%, p = 0.04). The mean scores of perceived advantages ((9.01 ± 3.10 vs. 7.07 ± 3.60, p < 0.001) and behavioral confidence (8.84 ± 3.76 vs. 5.67 ± 4.09, p < 0.001) were higher among vaccine non-hesitant group as opposed to the hesitant ones. In a final regression model, all MTM constructs) predicted nearly 65% of variance in initiating COVID-19 vaccination behavior among the vaccine-hesitant group (adjusted R2 = 0.649, F = 32.944, p < 0.001). With each unit increment in MTM constructs (e.g., participatory dialogue and behavior confidence), the initiation of COVID-19 vaccination among vaccine-hesitant Blacks increased by 0.106 and 0.166 units, respectively. Based on the findings of this study a m-health educational intervention to promote COVID-19 vaccine uptake behavior among Blacks is proposed.

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Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States

Vaccines ◽

10.3390/vaccines9080879 ◽

2021 ◽

Vol 9 (8) ◽

pp. 879

Author(s):

Justin Xavier Moore ◽

Keon L. Gilbert ◽

Katie L. Lively ◽

Christian Laurent ◽

Rishab Chawla ◽

...

Keyword(s):

United States ◽

African Americans ◽

Community Sample ◽

The United States ◽

Community Dwelling ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Convenience Sample ◽

Logistic Regression Models ◽

Sectional Analysis

In the United States, African Americans (AAs) have been disproportionately affected by COVID-19 mortality. However, AAs are more likely to be hesitant in receiving COVID-19 vaccinations when compared to non-Hispanic Whites. We examined factors associated with vaccine hesitancy among a predominant AA community sample. We performed a cross-sectional analysis on data collected from a convenience sample of 257 community-dwelling participants in the Central Savannah River Area from 5 December 2020, through 17 April 2021. Vaccine hesitancy was categorized as resistant, hesitant, and acceptant. We estimated relative odds of vaccine resistance and vaccine hesitancy using polytomous logistic regression models. Nearly one-third of the participants were either hesitant (n = 40, 15.6%) or resistant (n = 42, 16.3%) to receiving a COVID-19 vaccination. Vaccine-resistant participants were more likely to be younger and were more likely to have experienced housing insecurity due to COVID-19 when compared to both acceptant and hesitant participants, respectively. Age accounted for nearly 25% of the variation in vaccine resistance, with 21-fold increased odds (OR: 21.93, 95% CI: 8.97–5.26–91.43) of vaccine resistance in participants aged 18 to 29 compared to 50 and older adults. Housing insecurity accounted for 8% of the variation in vaccine resistance and was associated with 7-fold increased odds of vaccine resistance (AOR: 7.35, 95% CI: 1.99–27.10). In this sample, AAs under the age of 30 and those experiencing housing insecurity because of the COVID-19 pandemic were more likely to be resistant to receiving a free COVID-19 vaccination.

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COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Frontiers in Public Health ◽

10.3389/fpubh.2021.770985 ◽

2021 ◽

Vol 9 ◽

Author(s):

Farah Yasmin ◽

Hala Najeeb ◽

Abdul Moeed ◽

Unaiza Naeem ◽

Muhammad Sohaib Asghar ◽

...

Keyword(s):

Systematic Review ◽

African Americans ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Vaccine Acceptance ◽

Black African ◽

Income Status ◽

Pubmed Database ◽

The Us

Vaccine hesitancy in the US throughout the pandemic has revealed inconsistent results. This systematic review has compared COVID-19 vaccine uptake across US and investigated predictors of vaccine hesitancy and acceptance across different groups. A search of PUBMED database was conducted till 17th July, 2021. Articles that met the inclusion criteria were screened and 65 studies were selected for a quantitative analysis. The overall vaccine acceptance rate ranged from 12 to 91.4%, the willingness of studies using the 10-point scale ranged from 3.58 to 5.12. Increased unwillingness toward COVID-19 vaccine and Black/African Americans were found to be correlated. Sex, race, age, education level, and income status were identified as determining factors of having a low or high COVID-19 vaccine uptake. A change in vaccine acceptance in the US population was observed in two studies, an increase of 10.8 and 7.4%, respectively, between 2020 and 2021. Our results confirm that hesitancy exists in the US population, highest in Black/African Americans, pregnant or breastfeeding women, and low in the male sex. It is imperative for regulatory bodies to acknowledge these statistics and consequently, exert efforts to mitigate the burden of unvaccinated individuals and revise vaccine delivery plans, according to different vulnerable subgroups, across the country.

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