ABSTRACT
BACKGROUND: Despite COVID-19 vaccines' demonstrated effectiveness in mitigating COVID-related hospitalizations and death, large numbers of Americans, including U.S. veterans, have not completed the primary vaccine series or the third/booster dose. The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S. Identifying subgroups of veterans that have not completed COVID-19 vaccination and booster/third doses may inform targeted interventions to decrease disparities and promote vaccine completion. METHODS: We included veterans enrolled at VHA facilities from Jan 1, 2021 (first COVID-19 vaccinations available for highest risk veterans per CDC guidelines) through December 22, 2021. The VA COVID-19 Shared Data Resource was linked to the Corporate Data Warehouse to provide vaccination and other COVID-related clinical information, as well as demographic and social determinants data. The main study outcome was completion of the COVID-19 primary vaccine series (two doses of either mRNA vaccine or one dose of the viral vector vaccine). Secondary outcome was completion of the booster or third dose among eligible veterans. Univariate descriptive statistics determined the proportion of veterans completing vaccination by subgroup of interest;relative risks calculated statistical significance. RESULTS: Of 6,235,555 veterans, 9.5% were women;mean age was 62.9 years (+/-16.8 years);31.2% were of non-White racial/ethnic minority groups;6.7% were Hispanic. Of these, 61.7% completed primary vaccination series. Primary vaccination rates were significantly lower in younger veterans ≤ 49 years (47.2%) compared to those >50 years (67.7%). In addition, lower primary vaccination rates were found in women vs. men (57.1% vs. 62.5%);those residing in highly rural vs. urban locations (53.9% vs. 64.5%);Native Americans (56%) compared to Black/African American (64.8%), Hispanic (63.9%) or White (61.6%) veterans;those reporting food insecurity vs. not (54.9% vs. 64.3%);housing insecurity vs. not (51.6% vs. 65.1%);having had a positive vs. negative COVID-19 test prior to vaccination (45.5% vs. 71.6%);and not assigned a primary care team vs. assigned (45.2% vs. 64.5%), (all pvalues < 0.001). Of 3,672,322 eligible veterans, 33.5% received their booster/ third doses as of 12/22/21. Subgroups at risk for not having received booster/ third doses were the same as for the primary series, with the youngest veterans (18-49 years) having the lowest rates of booster/third doses compared to veterans > 50 years (16.1% vs. 36.9%). CONCLUSIONS: Based on VA data, substantial proportions of veterans remain unvaccinated-or under-vaccinated, especially younger veterans, women, Native Americans, those with food or housing insecurity, prior COVID-19, and those not assigned to primary care. Impactful interventions, including health care staff encouraging vaccine completion among more vulnerable subgroups, are needed to avoid further disparities related to adverse COVID19 outcomes.
ABSTRACT
Objective: The Veterans Health Administration is implementing Whole Health cultural transformation to equip Veterans with tools to take charge of their health. The onset of COVID-19 created a need for innovation in virtual care delivery of Whole Health education. Methods: The San Francisco VA adapted a Whole Health Passport Group from an in-person workshop series to a drop-in workshop series on a Web-Ex platform cofacilitated by a veteran peer support specialist and clinician. Veterans learned about the eight dimensions of Whole Health: Working the Body, Surroundings, Personal Development, Food & Drink, Recharge, Family, Friends & Co-workers, Spirit & Soul, Power of the Mind. Each virtual workshop began with a mindful moment and meet-&-greet to foster community and included Whole Health education. Each workshop culminated in group members creating a personalized health plan comprised of SMART (specific, measurable, actionable, realistic, time-bound) goals based on each veteran's personal values. To pilot the Whole Health Passport Group, two veterans were recruited from the Whole Health coaching program. Qualitative feedback was solicited from participating veterans through brief, informal interviews at the last workshop. Results: The two enrolled veterans successfully participated in the pilot via phone and video, respectively. One completed all eight workshops via phone;the other completed 7 workshops via video. The veteran attending the full cycle described the program as something that helps with our humanity and everything that we have to do in our personal lives. He added: It's important that we continue to grow, and this is helping us do that. Tools discussed enhance skills of the individual personally, socially and professionally. Conclusion: Based on limited but positive observations, the Whole Health Passport Groups will leverage the virtual platform to expand and to serve veterans across Northern California. Future steps include further Quality Improvement evaluation and diversification of referral pathways to reach more veterans.
ABSTRACT
In recognition of the increasing health burden of cardiovascular disease, the Dutch CardioVascular Alliance (DCVA) was founded with the ambition to lower the cardiovascular disease burden by 25% in 2030. To achieve this, the DCVA is a platform for all stakeholders in the cardiovascular field to align policies, agendas and research. An important goal of the DCVA is to guide and encourage young researchers at an early stage of their careers in order to help them overcome challenges and reach their full potential. Young@Heart is part of the DCVA that supports the young cardiovascular research community. This article illustrates the challenges and opportunities encountered by young cardiovascular researchers in the Netherlands and highlights Young@Heart's vision to benefit from these opportunities and optimise collaborations to contribute to lowering the cardiovascular disease burden together as soon as possible.