Vaccine hesitancy for COVID-19 explored in a phenomic study of 259 socio-cognitive-behavioural measures in the UK-REACH study of 12,431 UK healthcare workers

Background Vaccination is key to successful prevention of COVID-19 particularly nosocomial acquired infection in health care workers (HCWs). 'Vaccine hesitancy' is common in the population and in HCWs, and like COVID-19 itself, hesitancy is more frequent in ethnic minority groups. UK-REACH (United Kingdom Research study into Ethnicity and COVID-19 outcomes) is a large-scale study of COVID-19 in UK HCWs from diverse ethnic backgrounds, which includes measures of vaccine hesitancy. The present study explores predictors of vaccine hesitancy using a 'phenomic approach', considering several hundred questionnaire-based measures. Methods UK-REACH includes a questionnaire study encompassing 12,431 HCWs who were recruited from December 2020 to March 2021 and completed a lengthy online questionnaire (785 raw items; 392 derived measures; 260 final measures). Ethnicity was classified using the Office for National Statistics' five (ONS5) and eighteen (ONS18) categories. Missing data were handled by multiple imputation. Variable selection used the islasso package in R, which provides standard errors so that results from imputations could be combined using Rubin's rules. The data were modelled using path analysis, so that predictors, and predictors of predictors could be assessed. Significance testing used the Bayesian approach of Kass and Raftery, a 'very strong' Bayes Factor of 150, N=12,431, and a Bonferroni correction giving a criterion of p<4.02 x 10-8 for the main regression, and p<3.11 x 10-10 for variables in the path analysis. Results At the first step of the phenomic analysis, six variables were direct predictors of greater vaccine hesitancy: Lower pro-vaccination attitudes; no flu vaccination in 2019-20; pregnancy; higher COVID-19 conspiracy beliefs; younger age; and lower optimism the roll-out of population vaccination. Overall 44 lower variables in total were direct or indirect predictors of hesitancy, with the remaining 215 variables in the phenomic analysis not independently predicting vaccine hesitancy. Key variables for predicting hesitancy were belief in conspiracy theories of COVID-19 infection, and a low belief in vaccines in general. Conspiracy beliefs had two main sets of influences: i) Higher Fatalism, which was influenced a) by high external and chance locus of control and higher need for closure, which in turn were associated with neuroticism, conscientiousness, extraversion and agreeableness; and b) by religion being important in everyday life, and being Muslim. ii) receiving information via social media, not having higher education, and perceiving greater risks to self, the latter being influenced by higher concerns about spreading COVID, greater exposure to COVID-19, and financial concerns. There were indirect effects of ethnicity, mediated by religion. Religion was more important for Pakistani and African HCWs, and less important for White and Chinese groups. Lower age had a direct effect on hesitancy, and age and female sex also had several indirect effects on hesitancy. Conclusions The phenomic approach, coupled with a path analysis revealed a complex network of social, cognitive, and behavioural influences on SARS-Cov-2 vaccine hesitancy from 44 measures, 6 direct and 38 indirect, with the remaining 215 measures not having direct or indirect effects on hesitancy. It is likely that issues of trust underpin many associations with hesitancy. Understanding such a network of influences may help in tailoring interventions to address vaccine concerns and facilitate uptake in more hesistant groups.

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COVID-19 Vaccine Hesitancy Among Chinese Population: A Large-Scale National Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.781161 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jian Wu ◽

Quanman Li ◽

Clifford Silver Tarimo ◽

Meiyun Wang ◽

Jianqin Gu ◽

...

Keyword(s):

Educational Level ◽

Large Scale ◽

Online Survey ◽

Public Health Problem ◽

Booster Vaccination ◽

Vaccine Hesitancy ◽

National Study ◽

Cross Sectional ◽

Conspiracy Beliefs ◽

And Behavior

Globally, vaccine hesitancy is a growing public health problem. It is detrimental to the consolidation of immunization program achievements and elimination of vaccine-targeted diseases. The objective of this study was to estimate the prevalence of COVID-19 vaccine hesitancy in China and explore its contributing factors. A national cross-sectional online survey among Chinese adults (≥18 years old) was conducted between August 6, 2021 and August 9 via a market research company. We collected sociodemographic information; lifestyle behavior; quality of life; the knowledge, awareness, and behavior of COVID-19; the knowledge, awareness, and behavior of COVID-19 vaccine; willingness of COVID-19 vaccination; accessibility of COVID-19 vaccination services; skepticism about COVID-19 and COVID-19 vaccine; doctor and vaccine developer scale; and so on. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the associations by using logistic regression models. A total of 29,925 residents (48.64% men) were enrolled in our study with mean age of 30.99 years. We found an overall prevalence of COVID-19 vaccine hesitancy at 8.40% (95% CI, 8.09–8.72) in primary vaccination and 8.39% (95% CI, 8.07–8.70) in booster vaccination. In addition, after adjusting for potential confounders, we found that women, higher educational level, married residents, higher score of health condition, never smoked, increased washing hands, increased wearing mask, increased social distance, lower level of vaccine conspiracy beliefs, disease risks outweigh vaccine risk, higher level of convenient vaccination, and higher level of trust in doctor and developer were more willing to vaccinate than all others (all p < 0.05). Age, sex, educational level, marital status, chronic disease condition, smoking, healthy behaviors, the curability of COVID-19, the channel of accessing information of COVID-19 vaccine, endorsement of vaccine conspiracy beliefs, weigh risks of vaccination against risks of the disease, making a positive influence on the health of others around you, and lower trust in healthcare system may affect the variation of willingness to take a COVID-19 vaccine (all p < 0.05). The prevalence of COVID-19 vaccine hesitancy was modest in China, even with the slight resulting cascade of changing vaccination rates between the primary and booster vaccination. Urgent action to address vaccine hesitancy is needed in building trust in medical personnel and vaccine producers, promoting the convenience of vaccination services, and spreading reliable information of COVID-19 vaccination via the Internet and other media.

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Determinants of self-management behaviors among pulmonary tuberculosis patients: a path analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00888-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Jin Li ◽

Jie Pu ◽

Jiaqing Liu ◽

Qingya Wang ◽

Rui Zhang ◽

...

Keyword(s):

Health Education ◽

Path Analysis ◽

Family Support ◽

Indirect Effects ◽

Pearson Correlation ◽

Self Management ◽

Directly Observed Therapy ◽

Enabling Factors ◽

Reinforcing Factors ◽

Study Sites

Abstract Background Tuberculosis (TB) is one of the top 10 causes of death in the world. Since Directly Observed Therapy (DOT) as a core strategy for the global TB control are not applicable to all types of TB patients, and self-management of TB patients (SMTP) as a patient-centered supervision type is a supplement to DOT and can improve TB case management. However, the factors related to SMTP are complex and need more study. This study aimed at identifying the determinants of SMTP and examining the direct/indirect effects of these determinants. Methods The purposive sampling technique was used to select study sites and participants were recruited from the study sites by the consecutive sampling method. The PRECEDE model was used as the framework to analyze the determinants of SMTP. The responses of TB patients were acquired via a questionnaire survey for data collection. A Pearson correlation analysis was used to define the relationship between the predisposing, enabling, reinforcing factors with SMTP behaviors. A regression-based path analysis was used to determine the action paths of the predisposing, enabling, and reinforcing factors on SMTP behaviors. Results The predisposing (TB knowledge), enabling [health education and healthcare workers (HCWs) support], reinforcing factors (family support) had significant positive correlations with SMTP behaviors (P < 0.05). The predisposing, enabling, reinforcing factors were positively correlated with each other (r = 0.123‒0.918, P < 0.05), except for family support and HCWs support. The predisposing factors (TB knowledge, β = 0.330) and the enabling factors (HCWs support, β = 0.437) had direct effects on SMTP behaviors. The enabling factors (health education and HCWs support) and the reinforcing factors (family support) had indirect effects on SMTP behaviors. Conclusions This study revealed the effects and action path of TB knowledge, health education, HCWs support, and family support on SMTP behaviors via a path analysis. Assessing patient’s needs for SMTP along with promoting effective TB health education and providing firm support from HCWs and family members are potential strategies to promote SMTP behaviors. Graphic abstract

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Global Prevalence and Drivers of Dental Students’ COVID-19 Vaccine Hesitancy

Vaccines ◽

10.3390/vaccines9060566 ◽

2021 ◽

Vol 9 (6) ◽

pp. 566

Author(s):

Abanoub Riad ◽

Huthaifa Abdulqader ◽

Mariana Morgado ◽

Silvi Domnori ◽

Michal Koščík ◽

...

Keyword(s):

International Association ◽

Cross Sectional Study ◽

Dental Students ◽

Vaccine Hesitancy ◽

Online Questionnaire ◽

Cross Sectional ◽

Middle Income ◽

Related Attitude ◽

The Media ◽

Acceptance Levels

Background: Acceleration of mass vaccination strategies is the only pathway to overcome the COVID-19 pandemic. Healthcare professionals and students have a key role in shaping public opinion about vaccines. This study aimed to evaluate the attitudes of dental students globally towards COVID-19 vaccines and explore the potential drivers for students’ acceptance levels. Methods: A global cross-sectional study was carried out in February 2021 using an online questionnaire. The study was liaised by the scientific committee of the International Association of Dental Students (IADS), and data were collected through the national and local coordinators of IADS member organizations. The dependent variable was the willingness to take the COVID-19 vaccine, and the independent variables included demographic characteristics, COVID-19-related experience, and the drivers of COVID-19 vaccine-related attitude suggested by the WHO SAGE. Results: A total of 6639 students from 22 countries, representing all world regions, responded to the questionnaire properly. Their mean age was 22.1 ± 2.8 (17–40) years, and the majority were females (70.5%), in clinical years (66.8%), and from upper-middle-income economies (45.7%). In general, 22.5% of dental students worldwide were hesitant, and 13.9% rejected COVID-19 vaccines. The students in low- and lower-middle-income (LLMI) economies had significantly higher levels of vaccine hesitancy compared to their peers in upper-middle- and high-income (UMHI) economies (30.4% vs. 19.8%; p < 0.01). Conclusions: The global acceptance level of dental students for COVID-19 vaccines was suboptimal, and their worrisome level of vaccine hesitancy was influenced by the socioeconomic context where the dental students live and study. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were barriers to vaccination. The findings of this study call for further implementation of epidemiology (infectious diseases) education within undergraduate dental curricula.

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Lack of Informations about COVID-19 Vaccine: From Implications to Intervention for Supporting Public Health Communications in COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116141 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6141

Author(s):

Silva Guljaš ◽

Zvonimir Bosnić ◽

Tamer Salha ◽

Monika Berecki ◽

Zdravka Krivdić Dupan ◽

...

Keyword(s):

Vaccine Efficacy ◽

Health Belief ◽

Ordinary Least Squares ◽

Vaccine Hesitancy ◽

Equal Proportion ◽

Least Squares Regression ◽

Online Questionnaire ◽

Demographic Groups ◽

Population Immunity ◽

Wide Range

Lack of knowledge and mistrust towards vaccines represent a challenge in achieving the vaccination coverage required for population immunity. The aim of this study is to examine the opinion that specific demographic groups have about COVID-19 vaccination, in order to detect potential fears and reasons for negative attitudes towards vaccination, and to gain knowledge on how to prepare strategies to eliminate possible misinformation that could affect vaccine hesitancy. The data collection approach was based on online questionnaire surveys, divided into three groups of questions that followed the main postulates of the health belief theory—a theory that helps understanding a behaviour of the public in some concrete surrounding in receiving preventive measures. Ordinary least squares regression analyses were used to examine the influence of individual factors on refusing the vaccine, and to provide information on the perception of participants on the danger of COVID-19 infection, and on potential barriers that could retard the vaccine utility. There was an equal proportion of participants (total number 276) who planned on receiving the COVID-19 vaccine (37%), and of those who did not (36.3%). The rest (26.7%) of participants were still indecisive. Our results indicated that attitudes on whether to receive the vaccine, on how serious consequences might be if getting the infection, as well as a suspicious towards the vaccine efficacy and the fear of the vaccine potential side effects, may depend on participants’ age (<40 vs. >40 years) and on whether they are healthcare workers or not. The barriers that make participants‘ unsure about of receiving the vaccine, such as a distrust in the vaccine efficacy and safety, may vary in different socio-demographic groups and depending on which is the point of time in the course of the pandemic development, as well as on the vaccine availability and experience in using certain vaccine formulas. There is a pressing need for health services to continuously provide information to the general population, and to address the root causes of mistrust through improved communication, using a wide range of policies, interventions and technologies.

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Intention to Be Vaccinated for COVID-19 among Italian Nurses during the Pandemic

Vaccines ◽

10.3390/vaccines9050500 ◽

2021 ◽

Vol 9 (5) ◽

pp. 500

Author(s):

Marco Trabucco Aurilio ◽

Francesco Saverio Mennini ◽

Simone Gazzillo ◽

Laura Massini ◽

Matteo Bolcato ◽

...

Keyword(s):

Vaccine Efficacy ◽

Online Survey ◽

Vaccine Development ◽

Vaccine Coverage ◽

World Health ◽

Vaccine Hesitancy ◽

Effective Vaccine ◽

Online Questionnaire ◽

Cross Sectional ◽

Female Sex

Background: While the COVID-19 pandemic has spread globally, health systems are overwhelmed by both direct and indirect mortality from other treatable conditions. COVID-19 vaccination was crucial to preventing and eliminating the disease, so vaccine development for COVID-19 was fast-tracked worldwide. Despite the fact that vaccination is commonly recognized as the most effective approach, according to the World Health Organization (WHO), vaccine hesitancy is a global health issue. Methods: We conducted a cross-sectional online survey of nurses in four different regions in Italy between 20 and 28 December 2020 to obtain data on the acceptance of the upcoming COVID-19 vaccination in order to plan specific interventions to increase the rate of vaccine coverage. Results: A total of 531 out of the 5000 nurses invited completed the online questionnaire. Most of the nurses enrolled in the study (73.4%) were female. Among the nurses, 91.5% intended to accept vaccination, whereas 2.3% were opposed and 6.2% were undecided. Female sex and confidence in vaccine efficacy represent the main predictors of vaccine intention among the study population using a logistic regression model, while other factors including vaccine safety concerns (side effects) were non-significant. Conclusions: Despite the availability of a safe and effective vaccine, intention to be vaccinated was suboptimal among nurses in our sample. We also found a significant number of people undecided as to whether to accept the vaccine. Contrary to expectations, concerns about the safety of the vaccine were not found to affect the acceptance rate; nurses’ perception of vaccine efficacy and female sex were the main influencing factors on attitudes toward vaccination in our sample. Since the success of the COVID-19 immunization plan depends on the uptake rate, these findings are of great interest for public health policies. Interventions aimed at increasing employee awareness of vaccination efficacy should be promoted among nurses in order to increase the number of vaccinated people.

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Low COVID-19 Vaccine Acceptance Is Correlated with Conspiracy Beliefs among University Students in Jordan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052407 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2407

Author(s):

Malik Sallam ◽

Deema Dababseh ◽

Huda Eid ◽

Hanan Hasan ◽

Duaa Taim ◽

...

Keyword(s):

University Students ◽

Online Survey ◽

Vaccine Hesitancy ◽

Negative Consequences ◽

Vaccine Acceptance ◽

Awareness Campaigns ◽

High Prevalence ◽

Conspiracy Beliefs ◽

Social Media Platforms ◽

A Chain

Vaccination to prevent coronavirus disease 2019 (COVID-19) emerged as a promising measure to overcome the negative consequences of the pandemic. Since university students could be considered a knowledgeable group, this study aimed to evaluate COVID-19 vaccine acceptance among this group in Jordan. Additionally, we aimed to examine the association between vaccine conspiracy beliefs and vaccine hesitancy. We used an online survey conducted in January 2021 with a chain-referral sampling approach. Conspiracy beliefs were evaluated using the validated Vaccine Conspiracy Belief Scale (VCBS), with higher scores implying embrace of conspiracies. A total of 1106 respondents completed the survey with female predominance (n = 802, 72.5%). The intention to get COVID-19 vaccines was low: 34.9% (yes) compared to 39.6% (no) and 25.5% (maybe). Higher rates of COVID-19 vaccine acceptance were seen among males (42.1%) and students at Health Schools (43.5%). A Low rate of influenza vaccine acceptance was seen as well (28.8%), in addition to 18.6% of respondents being anti-vaccination altogether. A significantly higher VCBS score was correlated with reluctance to get the vaccine (p < 0.001). Dependence on social media platforms was significantly associated with lower intention to get COVID-19 vaccines (19.8%) compared to dependence on medical doctors, scientists, and scientific journals (47.2%, p < 0.001). The results of this study showed the high prevalence of COVID-19 vaccine hesitancy and its association with conspiracy beliefs among university students in Jordan. The implementation of targeted actions to increase the awareness of such a group is highly recommended. This includes educational programs to dismantle vaccine conspiracy beliefs and awareness campaigns to build recognition of the safety and efficacy of COVID-19 vaccines.

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Ethnic Discrimination in the Dutch Labor Market: Differences Between Ethnic Minority Groups and the Role of Personal Information About Job Applicants—Evidence from a Field Experiment

Journal of International Migration and Integration / Revue de l integration et de la migration internationale ◽

10.1007/s12134-020-00795-w ◽

2020 ◽

Author(s):

Lex Thijssen ◽

Marcel Coenders ◽

Bram Lancee

Keyword(s):

Labor Market ◽

Field Experiment ◽

Ethnic Minority ◽

Large Scale ◽

Minority Groups ◽

Personal Information ◽

Empirical Support ◽

Ethnic Discrimination ◽

Ethnic Minority Groups ◽

Large Scale Field

AbstractIn this study, we present the results of a large-scale field experiment on ethnic discrimination in the Dutch labor market. We sent fictitious job applications (N = 4211) to vacancies for jobs in ten different occupations in the Netherlands. By examining 35 different ethnic minority groups, we detect considerable differences in discrimination rates, predominantly between Western and non-Western minorities. Furthermore, we find little systematic variation in discrimination patterns with regard to gender, regions, and occupations, pointing to the existence of an ethnic hierarchy that is widely shared among employers. Finally, we do not find empirical support for the hypothesis that adding personal information in job applications reduces discrimination.

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From Victims to Perpetrators of Bullying: The Role of Irrational Cognitions, Externalizing Problems, and Parental Attachment

Journal of Interpersonal Violence ◽

10.1177/08862605211043583 ◽

2021 ◽

pp. 088626052110435

Author(s):

Raluca Balan ◽

Anca Dobrean ◽

Robert Balazsi

Keyword(s):

Public Schools ◽

Path Analysis ◽

Indirect Effects ◽

Externalizing Problems ◽

Parental Attachment ◽

Bullying Victimization ◽

Indirect Pathway ◽

Bullying Perpetration ◽

Interaction Terms

The transition from bullying victimization to bullying perpetration is well documented in the literature. However, the mechanisms linking bullying victimization to perpetration are not fully understood. The main aim of the current study was to conduct a preliminary research investigating the indirect effects of youths bullying victimization on bullying perpetration through irrational cognitions and externalizing problems. The second aim of the study was to explore the moderating role of the type of parental attachment (secure vs. insecure) in the proposed model in explaining the association of bullying victimization and bullying perpetration. Data were collected from 269 adolescents (11-15 years; M = 11.98, SD = .68), enrolled in middle public schools from Romania. Path analysis and moderated path analysis were conducted to explore the direct and indirect effects and moderating effects, respectively. Study findings indicate that bullying victimization was indirectly related to bullying perpetration separately through youths’ irrational cognition as well as through externalizing problems. The serial indirect pathway from victimization to perpetration through irrational cognitions leading further to externalizing problems was also significant. However, the type of attachment that adolescents reported having toward their parents failed to moderate the indirect pathways, since all the interaction terms were nonsignificant. These findings advance the field prevention and intervention by identifying irrational cognitions and externalizing problems as important targets that anti-bullying programs should address to stop the transition from victims of bullying to perpetrators.

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Uyghurs

Chinese Studies ◽

10.1093/obo/9780199920082-0187 ◽

2021 ◽

Author(s):

David O'Brien

Keyword(s):

Ethnic Group ◽

Cultural History ◽

Communist Party ◽

Large Scale ◽

Minority Groups ◽

Group Living ◽

The United States ◽

Early Years ◽

Chinese Government ◽

Complete Control

The Uyghur (alternatively spelled Uighur) are the largest and titular ethnic group living in the Xinjiang Uyghur Autonomous Region, a vast area in northwestern China of over 1.6 million sq. km. According to the 2010 census Uyghurs make up 45.21 percent of the population of Xinjiang, numbering 8,345,622 people. The Han, the largest ethnic group in China, make up 40.58 percent in the region with 7,489,919. A Turkic-speaking largely Muslim ethnic group, the Uyghurs traditionally inhabited a series of oases around the Taklamakan desert. Their complex origin is evidenced by a rich cultural history that can be traced back to various groups that emerged across the steppes of Mongolia and Central Asia. Uyghur communities are also found in Uzbekistan, Kyrgyzstan, and Kazakhstan, with significant diaspora groups in Australia, the United States, Germany, and Turkey. In the first half of the 20th century, Uyghurs briefly declared two short-lived East Turkestan Republics in 1933 and again in 1944, but the region was brought under the complete control of the Chinese state after the Communist Party (CCP) came to power in 1949. Within China they are considered one of the fifty-five officially recognized ethnic minority groups, who, along with the Han who constitute 92 percent of the population, make up the Chinese nation or Zhonghua Minzu中华民族. However, for many Uyghurs the name “Xinjiang,” which literally translates as “New Territory,” indicates that their homeland is a colony of China, and they prefer the term “East Turkestan.” Nevertheless, many scholars use Xinjiang as a natural term even when they are critical of the position of the Communist Party. In this article both terms are used. In the early years of the People’s Republic of China (PRC) Uyghurs numbered about 80 percent of the population of Xinjiang, but large-scale government-sponsored migration has seen the number of Han in the region rise to almost the same as that of the Uyghur. This has led to an increase in ethnic tensions often caused by competition for scarce resources and a perception that the ruling Communist Party favors the Han. In 2009, a major outbreak of violence in the capital Ürümchi saw hundreds die and many more imprisoned. The years 2013 and 2014 were also crucial turning points with deadly attacks on passengers in train stations in Kunming and Yunnan, bombings in Ürümchi, and a suicide attack in Tiananmen Square in Beijing, all blamed on Uyghur terrorists. Since then the Chinese government has introduced a harsh regime of security clampdowns and mass surveillance, which has significantly increased from 2017 and which, by some accounts, has seen over one million Uyghurs and other Muslim ethnic minorities imprisoned without trial in “reeducation” camps. The Chinese government insist these camps form part of an education and vocational training program designed to improve the lives of Uyghurs and root out “wrong thinking.” Many Uyghurs believe it is part of a long-term project of assimilation of Uyghur identity and culture.

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The Role of English Songs in Saudi Students’ Self-Learning of English

Theory and Practice in Language Studies ◽

10.17507/tpls.1111.07 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1405-1415

Author(s):

Omar Jabak

Keyword(s):

Foreign Language ◽

Large Scale ◽

Online Questionnaire ◽

King Saud University ◽

Saudi Students ◽

Self Study ◽

Speaking Skill ◽

Self Learning ◽

Academic Year

The present study aimed to explore the role of English songs in Saudi students’ self-learning of English as a foreign language. The study employed one data collection tool which was an online questionnaire. The questionnaire was completed by 38 Saudi students at the Community College of King Saud University in the second semester of the academic year 2020. The examination and analysis of the data showed that listening to English songs motivated the Saudi students to learn English in a self-study mode, augmented their English vocabulary, improved their speaking skill and developed their spelling or writing skill to a considerable extent. It is, therefore, recommended that more large-scale quantitative or qualitative studies on the role of English songs in Saudi students’ self-learning of English as a foreign language be conducted to confirm the findings of the present study, challenge them or yield new ones.

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