COVID-19-Related Changes in Assistance Networks for U.S. Older Adults with and without Dementia.

OBJECTIVES: Pre-pandemic research suggests assistance networks for older adults grow over time and are larger for those living with dementia. We examined how assistance networks of older adults changed in response to the onset of the COVID-19 pandemic and whether these changes differed for those with and without dementia. METHODS: We used three rounds of the National Health and Aging Trends Study. We estimated multinomial logistic regression models to test whether changes in assistance networks during COVID-19 (2019-2020) - defined as expansion, contraction, and adaptation - differed from changes prior to COVID-19 (2018-2019). We also estimated OLS regression models to test differences in numbers of helpers assisting with one (specialist) vs. multiple (generalist) domains before and during COVID-19. For both sets of outcomes, we investigated whether pandemic-related changes differed for those with and without dementia. RESULTS: Over all activity domains, a greater proportion of assistance networks adapted during COVID-19 compared to the pre-COVID-19 period (RRR = 1.19, p < .05). Contractions in networks occurred for those without dementia. Transportation assistance contracted for those with and without dementia, and mobility/self-care assistance contracted for those with dementia. The average number of generalist helpers decreased during COVID-19 (ß = -0.09, p < .001). DISCUSSION: Early in the pandemic, assistance networks of older adults adapted by substituting helpers, by contracting to reduce exposures with more intimate tasks for recipients with dementia, and by reducing transportation assistance. Future research should explore the impact of such changes on the well-being of older adults their assistance networks.

Justice beliefs and cultural values predict support for COVID-19 vaccination and quarantine behavioral mandates: a multilevel cross-national study.

Understanding how individual beliefs and societal values influence support for measures to prevent SARS-CoV-2 transmission is vital to developing and implementing effective prevention policies. Using both Just World Theory and Cultural Dimensions Theory, the present study considered how individual-level justice beliefs and country-level social values predict support for vaccination and quarantine policy mandates to reduce SARS-CoV-2 transmission. Data from an international survey of adults from 46 countries (N = 6424) were used to evaluate how individual-level beliefs about justice for self and others, as well as national values-that is, power distance, individualism, masculinity, uncertainty avoidance, long-term orientation, and indulgence-influence support for vaccination and quarantine behavioral mandates. Multilevel modeling revealed that support for vaccination and quarantine mandates were positively associated with individual-level beliefs about justice for self, and negatively associated with country-level uncertainty avoidance. Significant cross-level interactions revealed that beliefs about justice for self were associated more strongly with support for mandatory vaccination in countries high in individualism, whereas beliefs about justice for others were more strongly associated with support for vaccination and quarantine mandates in countries high in long-term orientation. Beliefs about justice and cultural values can independently and also interactively influence support for evidence-based practices to reduce SARS-CoV-2 transmission, such as vaccination and quarantine. Understanding these multilevel influences may inform efforts to develop and implement effective prevention policies in varied national contexts.

Factors Associated With Racial/Ethnic Group-Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the US.

Importance: The impact of COVID-19 in the US has been far-reaching and devastating, especially in Black populations. Vaccination is a critical part of controlling community spread, but vaccine acceptance has varied, with some research reporting that Black individuals in the US are less willing to be vaccinated than other racial/ethnic groups. Medical mistrust informed by experiences of racism may be associated with this lower willingness. Objective: To examine the association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake and to investigate whether racial/ethnic group-based medical mistrust is a potential mediator of this association. Design, Setting, and Participants: This cross-sectional survey study was conducted from June to December 2020 using a convenience sample of 1835 adults aged 18 years or older residing in Michigan. Participants were recruited through community-based organizations and hospital-academic networks. Main Outcomes and Measures: Separate items assessed whether respondents, if asked, would agree to participate in a research study to test a COVID-19 vaccine or to receive a COVID-19 vaccine. Participants also completed the suspicion subscale of the Group-Based Medical Mistrust Scale. Results: Of the 1835 participants, 1455 (79%) were women, 361 (20%) men, and 19 (1%) other gender. The mean (SD) age was 49.4 (17.9) years, and 394 participants (21%) identified as Black individuals. Overall, 1376 participants (75%) reported low willingness to participate in vaccine trials, and 945 (52%) reported low willingness to be vaccinated. Black participants reported the highest medical mistrust scores (mean [SD], 2.35 [0.96]) compared with other racial/ethnic groups (mean [SD] for the total sample, 1.83 [0.91]). Analysis of path models revealed significantly greater vaccine trial and vaccine uptake rejection among Black participants (vaccine trial: B [SE], 0.51 [0.08]; vaccine uptake: B [SE], 0.51 [0.08]; both P < .001) compared with the overall mean rejection. The association was partially mediated by medical mistrust among Black participants (vaccine trial: B [SE], 0.04 [0.01]; P = .003; vaccine uptake: B [SE], 0.07 [0.02]; P < .001) and White participants (vaccine trial: B [SE], -0.06 [0.02]; P = .001; vaccine uptake: B [SE], -0.10 [0.02]; P < .001). Conclusions and Relevance: In this survey study of US adults, racial/ethnic group-based medical mistrust partially mediated the association between individuals identifying as Black and low rates of acceptance of COVID-19 vaccine trial participation and actual vaccination. The findings suggest that partnerships between health care and other sectors to build trust and promote vaccination may benefit from socially and culturally responsive strategies that acknowledge and address racial/ethnic health care disparities and historical and contemporary experiences of racism.