Social and behavioral impacts of the COVID-19 pandemic: validation of checkpoint travel numbers as a proxy variable in population-based studies.

BACKGROUND: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. OBJECTIVE: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. METHODS: Transportation Security Administration (TSA) checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (a) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youth and young adults (15-24 years) in the United States (N=45,080) and (b) Google's Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019 - May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week pre-pandemic baseline period (January 3 - February 6, 2020) Spearman's rank correlation coefficients were calculated for each comparison. RESULTS: Checkpoint travel data ranged from 668,719 travelers the week of April 8, 2020 to nearly 15.5 million travelers the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (week of April 15, 2020) to 70.9% (week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (ρ=.90, p<0.001) and March 2020 to May 2022 (ρ=.87, p<.001). Strong correlations were observed when analyses were restricted to age groups (15-17: ρ =.90, p<.001; 18-20: ρ=.0.87, p<.001; 21-24: 0.88, p<.001), racial/ethnic minorities (ρ=.86, p<.001) and respondents with lower socioeconomic status (ρ=.88, p<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (ρ = .92, p < .001) and retail and recreation (ρ = .89, p < .001), and moderate significant correlations for grocery and pharmacy (ρ = .68, p < .001) and parks (ρ = .62, p < .001). A strong negative correlation was observed for places of residence (ρ = -.78, p < .001), and a weak but significant positive correlation was found for workplaces (ρ = .24, p < .001). CONCLUSIONS: The TSA's travel checkpoint data provide a publicly available, flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States.

Attitudes towards COVID-19 vaccination among incarcerated persons in the Federal Bureau of Prisons, June-July 2021.

OBJECTIVE: To understand the attitudes towards COVID-19 vaccination and trusted sources of vaccination-related information among persons incarcerated in the Federal Bureau of Prisons. METHODS: From June-July 2021, persons incarcerated across 122 facilities operated by the Federal Bureau of Prisons were invited to participate in a survey asking their reasons for receiving or declining COVID-19 vaccination and the information sources they relied upon to make these decisions. Descriptive analyses were conducted. RESULTS: A total of 130,789 incarcerated persons with known vaccination status were invited to participate in the survey. At the time of survey, 78,496 (62%) were fully vaccinated; 3,128 (3%) were partially vaccinated and scheduled to complete their second dose, and 44,394 (35%) had declined either a first or second dose. 7,474 (9.5%) of the fully vaccinated group and 2,302 (4.4%) of the group declining either a first or second dose chose to participate in the survey; an overall survey return rate of 7.6% (n = 9,905). Among vaccinated respondents, the most common reason given for accepting vaccination was to protect their health (n = 5,689; 76.1%). Individuals who declined vaccination cited concerns about vaccine side effects (n = 1,304; 56.6%), mistrust of the vaccine (n = 1,256; 54.6%), and vaccine safety concerns (n = 1,252; 54.4%). Among those who declined, 21.2% (n = 489) reported that they would choose to be vaccinated if the vaccine was offered again. Those who declined also reported that additional information from outside organizations (n = 1128; 49.0%), receiving information regarding vaccine safety (n = 841; 36.5%), and/or speaking with a trusted medical advisor (n = 565; 24.5%) may influence their decision to be vaccinated in the future. CONCLUSION: As the COVID-19 pandemic continues, it is important to increase vaccine confidence in prisons, jails, and detention facilities to reduce transmission and severe health outcomes. These survey findings can inform the design of potential interventions to increase COVID-19 vaccine uptake in these settings.

COVID-19 Vaccine Acceptability Among People Experiencing Homelessness in Central Florida and Southern Nevada, March-June 2021.

CONTEXT: Understanding COVID-19 vaccine acceptability among people experiencing homelessness is critical to improve vaccine coverage during the COVID-19 pandemic. Little is known about COVID-19 vaccine acceptability people experiencing unsheltered homelessness (PEUH). OBJECTIVE: To identify and describe motivators for receiving a COVID-19 vaccine and reasons for hesitancy, information sources utilized and trusted for vaccine decision making, logistical barriers to receiving vaccination, and what might increase comfortability to receive a COVID-19 vaccination among PEUH. DESIGN: Cross-sectional survey design, implemented from March to June 2021. SETTING: Two US cities: Las Vegas and Nevada (urban), and Orlando, Florida (suburban). PARTICIPANTS: People experiencing predominantly unsheltered homelessness accessing handwashing stations and other wrap-around social services at program sites managed by Clean the World Foundation. MAIN OUTCOME MEASURES: The main outcome measures assessed included survey responses about current vaccine receipt (if participants have already received one or more doses of a COVID-19 vaccine), intention to receive a COVID-19 vaccine if not already received, motivators for receiving or wanting to receive a vaccine, reasons for hesitancy or uncertainty about receiving a vaccine, sources of information regarding COVID-19 vaccines, and actual or anticipated logistical barriers or challenges to receiving COVID-19 vaccines. RESULTS: Among 864 participants, 465 (53.8%) were classified as "vaccine accepting," and 399 were classified "vaccine hesitant or undecided." The primary motivator to be vaccinated was to protect their health (212, 45.6%). Hesitant or undecided participants reported that vaccines were too new (269, 67.4%) or they needed more information (223, 55.9%) and were more likely to receive information from social media than accepting participants (80.0% vs 58.3%, P < .001). Logistical barriers to vaccination included distance to vaccination locations (85, 21.3%), lack of transportation (79, 19.8%), and limited time (64, 16%). CONCLUSIONS: Vaccination efforts to reach PEUH should consider how information and logistical needs may be addressed.