The impact of politics, religion, and rurality on COVID-19 vaccine hesitancy in Oregon: a cross-sectional study.

INTRODUCTION: Vaccine hesitancy has been a major barrier to mitigating the effects of COVID-19, especially in rural Oregon, USA. This study assessed the influence of political affiliation, religious identity, and rurality on vaccine hesitancy in counties across Oregon. METHODS: Cross-sectional association analysis was performed using public data on US President Trump votership in the 2020 election, White Christian identity, population density, and COVID-19 vaccination data for adults as of 29 August 2021. RESULTS: By 29 August 2021, 68.0% of adults had been fully vaccinated in Oregon. Trump votership was the strongest independent association with vaccination status in Oregon (r=0.90, p<0.01), followed by White Christian identity (r= -0.69, p<0.01), and population density (r=0.55, p<0.01). In multivariate analysis, White Christian identity and political affiliation with Trump in the 2020 election explained 84.1% of the variability in COVID-19 vaccination status in Oregon counties. CONCLUSION: White Christian identity, Trump affiliation, and rurality were identified as factors in vaccine hesitancy among counties in Oregon. Without addressing these factors in public health outreach, vaccine hesitancy is likely to continue unabated.

Shared Decision-making in Dermatology: A Scoping Review.

Importance: Shared decision-making (SDM) can improve the quality of care for patients. The extent to which this tool has been used and the evidence supporting its use in dermatology have not been systematically examined. Objective: To perform a scoping review of the literature regarding SDM in dermatology. Evidence Review: Searches of Ovid MEDLINE, PsycINFO, PsycARTICLES, Sciverse Scopus, and EBM Reviews were conduced on July 11, 2019, and March 6, 2020. There were no limits on date, type of article, language, or subject for the initial search. A total of 1673 titles and abstracts were screened by 2 independent reviewers in the Covidence mixed-methods platform. Forty-one full-text studies were assessed for eligibility. For inclusion, articles needed to include a dermatologic diagnosis as well as discussion of SDM or patient decision aids. Two independent reviewers screened 29 full-text articles for inclusion and extracted qualitative data using a set of 26 predefined codes. Qualitative coding was applied to excerpts to categorize the article, define and describe advantages and disadvantages of SDM, understand patient and physician requests for SDM, and discuss methods of implementation. Findings: Despite a small number of articles on SDM (n = 29) in dermatology, the selected literature provided consistent messages regarding the importance of SDM for dermatology and a number of strategies and tools for implementation. Medical dermatology was the most common subspecialty studied, with melanoma, psoriasis, and connective tissue diseases most examined. Only 5 publications introduced SDM tools specifically for dermatologic conditions; of these, only 2 tools were validated. Barriers to implementation that were cited included time and a lack of training for clinicians, although the literature also provided potential solutions to these issues. All articles emphasized the value of SDM for both patients and physicians. Conclusions and Relevance: The literature regarding SDM in dermatology consistently suggests that it is a useful tool for providing patient-centered care. Established tools have been proposed since 2012. More research is needed to implement better practices, especially in dermatologic subspecialties. However, there are substantial suggestions from the literature for strategies and tools with which to begin a shared decision-making practice.