COVID-19 Vaccine Hesitancy and Health Literacy in US Southern States

The following are the highlights of our study: * Vaccine hesitancy in Southern states is complex and extends beyond health literacy. * Vaccine hesitancy in Southern states transcends many sociodemographic differences. * Effective public health communication should be unambiguous about negative externalities of COVID-19 beyond individual threats. _____ The COVID-19 pandemic caused by SARS-CoV-2 remains a public health crisis, accounting for more than 100 million confirmed cases with more than 1,121,800 deaths in the United States as of April 26, 2023.1 Despite widespread vaccination efforts by the US government and public health leadership, the rate of vaccine uptake is still far from desirable, as researchers estimate that about 70% to 85% of the country will need to be immunized before SARS-CoV-2 can be fully contained through herd immunity.2 As of April 19, 2023, about 81% of the US population had received at least 1 dose, whereas 69.4% had completed a full primary vaccine series and only 16.7% had received an updated bivalent booster, with variations in the rate of vaccination across states and regions.3 The Southern states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, and West Virginia) have relatively lower rates of full vaccination (primary series) compared with other states (mean of 61.3%, ranging from 53.2% in Alabama to 79.9% in Maryland);6 Southern states rank among the 10 states with the lowest fully vaccinated rates in the nation.3 The predominant barrier to uptake has been vaccine hesitancy,4-9 defined as the intention to delay or refuse taking vaccinations despite availability and accessibility.10,11 It may be influenced by complex contextual factors, ranging from individual and group factors to vaccine-specific characteristics.10 In particular, individual factors may be related to health literacy (HL),12 which is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.13 HL is a phenomenon that involves individuals, families, communities, and systems, and it could be implicated in the level of COVID-19 vaccine hesitancy.5 Although HL is a major determinant of individuals' health behaviors,14 a systematic review study reported that HL's relationship with vaccination uptake prior to the COVID-19 pandemic was unclear because of variations in assessment tools, target populations, and outcome measures across available limited studies.15 Evidence suggests a relationship between HL and COVID-19 vaccine hesitancy.12,16,17 In the United States, a study among women recently released from jails found that low HL is related to COVID-19 vaccine hesitancy.16 Similarly, a study in Turkey found that low HL and a high perception of health care system distrust are associated with higher vaccine hesitancy.17 A study in China found that higher HL is associated with low likelihood of COVID-19 vaccine hesitancy, and the effect was moderated by stress.12 Overall, to the best of our knowledge, no study has examined the association between HL and COVID-19 vaccine hesitancy in populations with low vaccine uptake within the United States, including those residing in the Southern states, which served as the impetus for this study.18,19 This study aimed to estimate the level of HL among a population residing in Southern states and its association with vaccine hesitancy. Nearly 20% of the United States population had still not received a single dose of COVID-19 vaccine as of April 26, 2023, despite increases in both vaccine availability and individual eligibility over the previous 2 years.20 The observed trends in overall and region-specific COVID-19 cases and rates of vaccination in the United States demonstrate the need to examine the impact of HL on vaccine hesitancy in the Southern states, especially with the release of simplified eligibility guidelines and expanded booster recommendations.21 METHODS Participants This study included adults 18 years and older. Upon receiving institutional review board (IRB) approval from East Tennessee State University (IRB No. c0221.22e), a cross-sectional study was initiated. Race/ethnicity was collected as: (1) Asian or Pacific Islander, (2) Black or African American, (3) Hispanic/Latino, (4) Native American or Alaskan Native, (5) non-Hispanic White, (6) biracial or multicultural, and (7) race/ethnicity not listed here. Because of small sample sizes for non-White racial/ethnic groups in the study population, race/ethnicity was recoded as non-Hispanic White and other.

End-of-Life Care and Advanced Directives in Hispanic/Latinx Patients: Challenges and Solutions for the Practicing Oncologist.

Advanced end-of-life care (EOL) comprises a group of strategies to provide comfort to patients at the end of life. These are associated with better quality of life, better satisfaction, and a lower rate of hospitalizations and aggressive medical treatment. Advanced EOL care, including advanced directives completion and hospice enrollment, is suboptimal among Hispanic/Latinx patients with cancer due to personal, socio-cultural, financial, and health system-related barriers, as well as due to a lack of studies specifically designed for this population. In addition, the extrapolation of programs that increase participation in EOL for non-white Hispanics may not work appropriately for Hispanic/Latinx patients and lead to overall lower satisfaction and enrollment in EOL care. This review will provide the practicing oncologist with the tools to address EOL in the Hispanic/Latinx population. Some promising strategies to address the EOL care disparities in Latinx/Hispanic patients have been culturally tailored patient navigation programs, geriatric assessment-guided multidisciplinary interventions, counseling sessions, and educational interventions. Through these strategies, we encourage oncologists to take advantage of every clinical setting to discuss EOL care. Treating physicians can engage family members in caring for their loved ones while practicing cultural humility and respecting cultural preferences, incorporating policies to foster treatment for the underserved migrant population, and providing patients with validated Spanish language tools.

Poverty and Suicidal Ideation Among Hispanic Mental Health Care Patients Leading up to the COVID-19 Pandemic.

Introduction: Suicide rates have risen in Hispanic communities since 2015, and poverty rates among Hispanics often exceed the national average. Suicidality is a complex phenomenon. Mental illness may not alone explain whether suicidal thoughts or behaviors will occur; it remains uncertain how poverty affects suicidality among Hispanic persons with known mental health conditions. Our objective was to examine whether poverty was associated with suicidal ideation among Hispanic mental healthcare patients from 2016 to 2019. Methods: We used de-identified electronic health record (EHR) data from Holmusk, captured using the MindLinc EHR system. Our analytic sample included 4,718 Hispanic patient-year observations from 13 states. Holmusk uses deep-learning natural language processing (NLP) algorithms to quantify free-text patient assessment data and poverty for mental health patients. We conducted a pooled cross-sectional analysis and estimated logistic regression models. Results: Hispanic mental health patients who experienced poverty had 1.55 greater odds of having suicidal thoughts in a given year than patients who did not experience poverty. Conclusion: Poverty may put Hispanic patients at greater risk for suicidal thoughts even when they are already receiving treatment for psychiatric conditions. NLP appears to be a promising approach for categorizing free-text information on social circumstances affecting suicidality in clinical settings.

COVID-19 Vaccine Uptake and Attitudes Within Two Cohorts of Younger Adult Cannabis Users

It is crucial to understand COVID-19 vaccine uptake and attitudes among young adult cannabis users given the lowest vaccination rates among young adults and negative association between cannabis use and willingness to get vaccinated. 18–21-year-old and 26–33-year-old cohorts of cannabis users, recruited in California, were surveyed about the COVID-19 vaccine uptake/attitudes between March-August 2021. Cannabis use/demographic differences were investigated by vaccination status. Vaccine attitudes data were categorized and presented descriptively. 44.4% of the older and 71.8% of the younger cohorts were vaccinated. Non-Hispanic Black/African American race/ethnicity, lack of health insurance, and medicinal orientation towards cannabis use were negatively associated with vaccine receipt within the older cohort. For both cohorts, top reasons for vaccine hesitancy and rejection were concerns about speed of development, potential side effects, natural immunity, and lack of trust of vaccines. Our results highlight greater vaccine hesitance/rejection and need for targeted interventions among mid-20's-early-30's cannabis users.

Racism in pediatric health

SPECIAL REPORT Since the inception of the United States, social, economic, political, and scientific institutions have been built on a foundation emphasizing the inferiority of individuals related to phenotypic differences.1 This hierarchy ensconced white individuals as superior to all other groups with Native Americans and Blacks on the bottom. Some fifty years after the discovery of the genetic code, at a White House ceremony in 2000 to announce the discovery, Craig Venter, a pioneer of DNA sequencing, observed, "The concept of race has no genetic or scientific basis. With structural or institutional racism, there is decreased access to health care and resources for education, leading to lower health literacy and fewer health care providers of color.12'13 Over time, this has led to a distrust of the health care system as a whole by POC due to widely publicized historical events such as the Tuskegee Syphilis Study and the Marion tuberculosis outbreak. [...]non-Hispanic Blacks have a higher prevalence of recurrent asthma exacerbations and hospitalizations than Whites after adjusting for demographic and socioeconomic factors.16 One study revealed that with non-Black children, poor children were 45% more likely than children who were not poor to have asthma.

The Impact of the COVID-19 Pandemic on Older Latino Immigrants

This article examines the impact of the COVID-19 pandemic on Latino immigrants age sixty and older from Cuba, Dominican Republic, El Salvador, Mexico, Puerto Rico, and Venezuela. Based on 178 interviews with immigrants in Florida and Massachusetts, this study identifies the financial and health hardships they endured, the kinds of government and nonprofit aid they accessed, the factors keeping many from accessing aid, and the coping strategies they adopted. Respondents faced unemployment, hunger, and loss of income. Unauthorized immigrants and people in mixed-status families were deliberately excluded from federal aid. Many other immigrants who qualified were reluctant or refused it. Immigrants without legal status and those who had more recently arrived were the most severely affected. Individuals and families responded to these challenges by doubling up, going without food and medicine, and working while sick. Greater outreach and more humane public policies could have prevented much of this suffering.

Suffering, the Safety Net, and Disparities During COVID-19

The economic and public health crisis caused by COVID-19 was devastating and disproportionately hurt Blacks and Hispanics and some other groups. Unemployment rates and other measures of material hardship were higher and increased more during the crisis among Blacks and Hispanics than among non-Hispanic Whites. Congress authorized a historic policy response, incorporating both targeted and universal supports, and expanding both the level and duration of benefits. This response yielded the remarkable result of an estimated decline in the Supplemental Poverty Measure between 2019 and 2020. We study administrative data to investigate the impact of the Supplemental Nutrition Assistance Program (SNAP) during the crisis. We find that participation in SNAP increased more in counties that experienced a larger employment shock. By contrast, the increase in total SNAP benefits was inversely related to the employment shock. The SNAP benefit increases were less generous to Black and Hispanic SNAP participants than to White.

Black and Latino Perspectives on COVID-19 Vaccines: A Mixed-methods Examination

OBJECTIVES/GOALS: COVID-19 vaccines were met with both public excitement and concern. Our goal was to understand individual's attitudes about COVID-19 vaccines within Black and Latino communities deeply impacted by COVID-19, in an effort to highlight their potential similarities and differences. METHODS/STUDY POPULATION: Using a community-based participatory approach, we partnered with 16 leaders from community-based organizations to conduct a mixed-methods study examining the perspectives of Black and Latino communities regarding their vaccine acceptance or hesitancy. We focused on Michigan counties highly impacted by COVID-19 infection and deaths. In 2021, we interviewed 24 Black and 16 Latino residents in English or Spanish. We combined this with survey data on vaccine attitudes and behavior from the Detroit Metro Area Communities Study (n=1,800). This research is part of the NIH Community Engagement Alliance Against COVID-19. RESULTS/ANTICIPATED RESULTS: Qualitative and quantitative analysis highlight that Black participants expressed greater mistrust and hesitance around vaccines and less willingness to get vaccinated, often citing historical mistreatment as a contributing factor. The desire to keep themselves, their families and community safe was cited as the most important factor shaping vaccine decisions among both groups. Trust in information and in science was rated as a stronger reason for vaccination among Latinx participants;however, they also appeared to highlight the issue of vaccine access more often than Black participants. Fear of side effects and risks were equally cited as factors that influenced their vaccine hesitancy. DISCUSSION/SIGNIFICANCE: Despite being labeled as minority communities, these two groups have important differences regarding their perspective of COVID-19 vaccines. Our results suggest that public health interventions must be tailored to address the concerns, differences in attitudes, and beliefs among Blacks and Latinos.

Contextualizing COVID-19 Consequences for Cancer Care

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly escalated to a pandemic with significant morbidity and mortality resulting from the associated coronavirus disease 2019 (COVID-19).1 Approximately one-third of patients developing COVID-19 experienced severe complications, including acute respiratory distress syndrome, acute renal failure, acute respiratory injury, septic shock, and severe pneumonia.2 Populations particularly vulnerable to COVID-19 include older adults and immunosuppressed patients. [...]when we looked at some of the early data about which patients are going to have increased mortality from COVID-19, it was those individuals who had cardiovascular disease or diabetes. [...]we have pulled together as an oncology community to determine the safety measures that we can put in place to ensure that someone who may potentially have a cancer diagnosis, or maybe they need a diagnostic image because they felt a lump in their breast or had symptoms related to colorectal cancer, we know cancer doesn't stop because of COVID-19. Regarding chemotherapies and those that reduce the immune system, people will say that any cancer treatment can impact the immune system, and they're right. When it comes to systemic therapies, in addition to those that actually reduce your blood counts and have impact on marrow or impact marrow suppression, there are also data to suggest that immune checkpoint inhibitors like the PD-L1 and the PD-1 Inhibitors may be associated with worse outcomes and may actually be associated with increased morbidity and mortality, although it's fascinating because there was another study seemed to contradict these results.9,10 But all the data that we have suggest that patients getting new checkpoint inhibitors as part of their care may be at increased risk.

Latino-Targeted Misinformation and the Power of Factual Corrections

Do individual, interpersonal, or institutional factors condition the effects of misinformation on beliefs? Can interventions such as fact checks stem the tide of the "infodemic” within marginalized communities? We explore the sudden flood of misinformation and disinformation targeting Latinos during the 2020 election and global COVID-19 pandemic to answer these questions. In a preregistered experiment, we find that exposure to misinformation can decrease factual accuracy, and neither trust in nor consumption of media, including ethnic media, serves as a buffer against these misinformation effects. However, fact checks eliminate the effects of misinformation on false beliefs without "backfiring” and reducing accuracy. Fact checks improve factual accuracy among subgroups varying in levels of political knowledge, trust, and acculturation. These findings provide crucial support for recent investments into fact checking by Latino-oriented media outlets and address gaps within the literature over whether such interventions are also effective within marginalized groups.

Colonias, Water, and Extractable Bodies: COVID19's impact on the Rio Grande Valley

This paper develops the concept of "extractible bodies" and extends it to apply to Latinxs' experience in the Rio Grande Valley (RGV) subject to structural problems and predatory market practices before and during the pandemic. The RGV has had more COVID cases than counties of equal population size. Through a mixed-methods approach, this paper describes, in detail, how racist state practices, structural inadequacies, poor administration, and predatory capitalism effectively explain why the RGV was the epicenter of COVID-19 in the State of Texas in 2020. We introduce a concept, extractable bodies, to show how Mexican Americans provide limitless opportunities for exploitation while, at the same time, lacking basic public services and shouldering the blame for such circumstances. We focus our analysis on Latinx "essential workers" in an area challenged by health issues, high obesity rates, inadequate infrastructure, the situation in las colonias, and how these factors contributed to the COVID crisis.

Civic Engagement and Latina Immigrant Mothers' Remote Learning Involvement During COVID‐19

Immigrant incorporation scholars have established that racialized immigrant parents encounter several barriers in their children's schooling: namely, language and cultural differences, discrimination, unfamiliarity with the U.S. schooling system, and unhelpful school agents. However, less is known about the mechanisms that lessen these challenges. Drawing on insights from immigrant incorporation and civic engagement literature, this study examines how advocacy organizations can mediate the barriers racialized immigrant parents face in their children's schooling. A case study of 20 Latina immigrant mothers is used to demonstrate how civically engaged parents drew on their participation with a local advocacy organization—Parent's Choice—to overcome the barriers that emerged during the transition to remote learning due to the coronavirus disease 2019 pandemic. Findings suggest that immigrant mothers leveraged their connection to Parent's Choice to learn how to use technology, get district‐related updates, secure devices necessary for at‐home learning, create complaints or demands for services at their children's school, fill out paperwork, and access community‐based referrals. Parent's Choice provided support and empowered Latina immigrant parents by minimizing the overwhelming barriers they faced during online learning. These findings complicate our understanding of immigrant civic engagement patterns and provide implications of how civic engagement can facilitate the incorporation of marginalized parents in educational institutions.

THE US‑MEXICAN BORDER AND CONTEMPORARY AMERICAN IMMIGRATION POLICY

There have been several periods in American history that are referred to as turbulent times. They were characterized by a wide range of changes that happened to respond to issues that brought anxiety, threat, discontent, or trouble. Donald Trump's presidency and the Covid-19 pandemic significantly influenced American immigration policy and the lives of immigrants. The present article pays special attention to the Mexican-American border. This area plays a crucial role in migration studies focusing on the Americas for at least two reasons: international relations between Mexico (and the Latin American region) and the United States, and homeland security issues related to irregular and regular migrant flows. This study aims to determine what changes have been implemented in border policy, investigate why they occurred, and finally, discuss their results. The article analyzes the most challenging issues characteristic of the situation of unaccompanied minor migrants, the concept of Trump's wall or the 'remain in Mexico' program. The US-Mexican border studies have played a crucial role in research dedicated to American immigration policy since its inception. Today, it is also an area of concern and special attention is paid to this region due to the dynamics of processes taking place at the border. The work presented here discusses and highlights the most turbulent issues that echoed not only in the United States but also worldwide.

Rural-Urban Differences in Workers' Access to Paid Sick Leave

Paid sick leave (PSL) is associated with health care access and health outcomes. The COVID-19 pandemic highlighted the importance of PSL as a public health strategy, yet PSL is not guaranteed in the United States. Rural workers may have more limited PSL, but research on rural PSL has been limited. We estimated unadjusted and adjusted PSL prevalence among rural versus urban workers and identified characteristics of rural workers with lower PSL access using the 2014–2017 Medical Expenditure Panel Survey. We found rural workers had lower access to PSL than urban workers, even after adjusting for worker and employment characteristics. Paid sick leave access was lowest among rural workers who were Hispanic, lacked employer-sponsored insurance, and reported poorer health status. Lower rural access to PSL poses a threat to the health and health care access of rural workers and has implications for the COVID-19 public health emergency and beyond.

The History of Ethnic Minority Psychological Associations in the United States

The American Psychological Association (APA, 2021) issued an apology to people of color for their role in "promoting, perpetuating and failing to challenge racism, racial discrimination, and human hierarchy (p.1)." This may be related to the criticisms that American psychology is ahistorical, ignores social realities, (Crenshaw, 1995;Martin-Baro, 1996) and has a Eurocentric bias (Bhatia, 2020). This paper briefly describes historical examples of the oppression of Black, Indigenous and People of Color (BIPOC) in the United States in the health and social sciences fields. It details the context of the historical emergence of ethnic minority psychological associations led by the departure of Black psychologists from APA in the late 1960's. Several other BIPOC groups followed their lead. APA governance then met with the ethnic minority association leaders at the Dulles Conference in 1978. The recommendations of this conference took longer to achieve than what was originally expected yet these demonstrate the diversity, equity and inclusion efforts initiated by ethnic minority psychologists and later supported by funding agencies.

Long Covid IDs show racial skew

The article reports that Black and Hispanic individuals are likely to develop Long Covid than white individuals, and Black patients were up to twice as likely as white patients to develop Long Covid symptoms, and Long Covid patients diagnosed were white women living in areas with low poverty.

Documenting the advocacy experiences among eight Latina mothers of children with intellectual and developmental disabilities

Internationally, it has been recognized that parent involvement is an essential component of the special education process for children with intellectual and/or developmental disabilities (IDD). Parent involvement often includes parents advocating for their children. However, many parents face barriers when advocating to obtain appropriate special education services for their children with IDD. In the United States, Latinx families face greater systemic barriers (e.g., language and cultural differences) to access services for their own children with IDD. To this end, parents may turn to parent advocacy training programs to learn about special education and feel empowered to advocate for school services for their own children and other families of children with disabilities. Yet, it is unclear how Latinx families advocate for services for their own children and for other Latinx families of children with disabilities after attending an advocacy program. We designed a study to explore the advocacy experiences of eight Latinx families one year after attending an advocacy program. Participants reported that they used three advocacy strategies when advocating for their own children with disabilities: knowledge of special education law, non‐adversarial advocacy strategies, and requests for data. Notably, some participants reported not having an advocacy experience due to the COVID‐19 pandemic. Implications for research and practice are discussed.

Families' Job Characteristics and Economic Self-Sufficiency: Differences by Income, Race-Ethnicity, and Nativity

Policy debates about whether wages and benefits from work provide enough resources to achieve economic self-sufficiency rely on data for workers, not working families. Using data from the Current Population Survey, we find that almost two-thirds of families working full time earn enough to cover a basic family budget, but that less than a quarter of low-income families do. A typical low-income full-time working family with wages below a family budget would need to earn about $11.00 more per hour to cover expenses. This wage gap is larger for black, Hispanic, and immigrant families. Receipt of employer-provided benefits varies—health insurance is more prevalent than pension plans—and both are less available to low-income families, and black, Hispanic, and immigrant working families. Findings suggest that without policies to decrease wage inequality and increase parents' access to jobs with higher wages and benefits, child opportunity gaps by income, race-ethnicity, and nativity will likely persist.

COVID-19 survey among NYC non-Hispanic Black and Hispanic/Latino adults with diabetes.

OBJECTIVES: To better understand the knowledge, practice, importance, awareness, usefulness, and confidence of non-Hispanic Black and English- and Spanish-speaking Hispanic/Latino adults with diabetes. DESIGN: A descriptive cross-sectional survey study design was used and descriptive statistics was conducted. SAMPLE: Non-Hispanic Black and Hispanic/Latino adults with diabetes were recruited from three New York City public hospitals. MEASUREMENTS: A one-time survey was delivered via email, text message or over the phone. RESULTS: Of the 96 participants, 47.9% were Hispanic/Latino and 52.1% were non-Hispanic Black individuals; 43.8% of the surveys were completed in Spanish and 56.3% in English; 41.7% were female and 58.3% male; 77.1% preferred to complete the survey via the telephone, 14.6% through email, and 8.3% via text message. Chi-square findings showed, 90.6% knew mask wearing prevented COVID-19; 96.9% knew that covering the nose and mouth during mask wearing is needed, 93.8% wore a mask, and 92.8% felt it important or very important to wear a mask to prevent the spread of COVID-19. For social distancing, 88.5% knew it prevented the spread of COVID-19, 93.8% practiced it, and 95.8% felt it important or very important. CONCLUSION: In having a better understanding of the knowledge and practices of COVID-19 among non-Hispanic Black and Hispanic populations with diabetes, the development of culturally and linguistically tailored community-based mitigation strategies can be developed that are aimed at improving the preparedness of these groups for the next emerging infectious disease, such as COVID-19.