The Use of Qualitative Methods to Guide the Development of the Border Resilience Scale in a Participatory Research Study.

U.S.-Mexico border residents experience pervasive social and ecological stressors that contribute to a high burden of chronic disease. However, the border region is primarily composed of high-density Mexican-origin neighborhoods, a characteristic that is most commonly health-promoting. Understanding factors that contribute to border stress and resilience is essential to informing the effective design of community-level health promotion strategies. La Vida en La Frontera is a mixed-methods, participatory study designed to understand factors that may contribute to border resilience in San Luis, Arizona. The study's initial qualitative phase included interviews with 30 Mexican-origin adults exploring community perceptions of the border environment, cross-border ties, and health-related concepts. Border residents described the border as a Mexican enclave characterized by individuals with a common language and shared cultural values and perspectives. Positive characteristics related to living in proximity to Mexico included close extended family relationships, access to Mexican food and products, and access to more affordable health care and other services. Based on these findings, we co-designed the 9-item Border Resilience Scale that measures agreement with the psychosocial benefits of these border attributes. Pilot data with 60 residents suggest there are positive sociocultural attributes associated with living in border communities. Further research should test if they mitigate environmental stressors and contribute to a health-promoting environment for residents.

Age-based spatial disparities of COVID-19 incidence rates in the United States counties.

COVID-19 incidence disparities have been documented in the literature, but the different driving factors among age groups have yet to be explicitly explained. This study proposes a community-based COVID-19 spatial disparity model, considering different levels of geographic units (individual and community), various contextual variables, multiple COVID-19 outcomes, and different geographic contextual elements. The model assumes the existence of age nonstationarity effects on health determinants, suggesting that health effects of contextual variables vary among place and age groups. Based on this conceptual model and theory, the study selected 62 county-level variables for 1,748 U.S. counties during the pandemic, and created an Adjustable COVID-19 Potential Exposure Index (ACOVIDPEI) using principal component analysis (PCA). The validation was done with 71,521,009 COVID-19 patients in the U.S. from January 2020 through June 2022, with high incidence rates shifting from the Midwest, South Carolina, North Carolina, Arizona, and Tennessee to the West and East coasts. This study corroborates the age nonstationarity effect of health determinants on COVID-19 exposures. These results empirically identify the geographic disparities of COVID-19 incidence rates among age groups and provide the evidentiary guide for targeting pandemic recovery, mitigation, and preparedness in communities.

Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S.

This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.

Qualitative assessment of COVID-19 vaccination acceptance among healthcare workers in Pima County.

In the Spring of 2021, the COVID-19 vaccination was authorized for emergency use by the Food and Drug Administration. Healthcare workers (HCWs) are one of the most trusted sources of information for vaccination choices. However, HCWs at this time appeared to continue to have lower rates of COVID-19 vaccination uptake than expected in Arizona. The objective of this study was to examine factors that play a role in the vaccination decision-making process among Arizona HCWs. Between January and April 2021, 18 semi-structured interviews were conducted among physicians, emergency medical technicians and long-term care nurses in Pima County. The informed consent process was completed for each participant. The interview guide was informed by the Increasing Vaccination model to collect information on vaccination decision-making. A codebook was developed using an inductive approach. Coding and analysis was conducted using the software MAXQDA. Participants were primarily male (11/18, 61%) and white (11/18, 61%). Three participants identified as Hispanic. Initial themes that emerged included: mixed opinions concerning the innovations in COVID-19 vaccine development, access-related barriers, issues related to distribution inequities, concerns about misinformation and conspiracy theories, and dialogue concerning the benefits of requiring mandatory vaccination. The results gathered from this study indicate that there continues to be hesitancy among some healthcare professionals in Pima County. These results will be used to help Arizonan Health Departments promote rollout of novel vaccines more effectively through targeting relevant vaccination decision-making factors among HCWs.

The effects of the 4/20 cannabis holiday and adult-use cannabis legalization on medical cannabis sales and medical cannabis patient registration in Arizona.

BACKGROUND: This study examined whether the 4/20 cannabis holiday was associated with increases in medical cannabis sales from licensed dispensaries in Arizona from 2018-2021, and whether adult-use cannabis legalization (the vote in November 2020 and retail sales in January 2021) was associated with declines in medical cannabis sales and in the number of registered medical patients. METHODS: Data came from the Arizona Medical Marijuana Program monthly reports from January 2018-December 2021. The reports show daily sales from licensed medical cannabis dispensaries (i.e., the number of medical cannabis dispensary transactions and the amount of cannabis sold in pounds), which we averaged by week, and show the number of registered medical cannabis patients each month. Autoregressive integrated moving average models were used to test changes in these outcomes associated with the 4/20 cannabis holiday and with legalization of adult-use cannabis. RESULTS: During the week of the 4/20 cannabis holiday, medical cannabis dispensary transactions abruptly increased by an average of 2,319.4 transactions each day (95% CI: 1636.1, 3002.7), and the amount of medical cannabis sold increased by an average of 120.3 pounds each day (95% CI: 99.3-141.3). During the first week of adult-use cannabis sales in late January 2021, medical cannabis dispensary transactions abruptly decreased by an average of 5,073 transactions each day (95% CI: -5,929.5, -4216.7), and the amount of medical cannabis sold decreased by an average of 119.1 pounds each day (95% CI: -144.2, -94.0). Moreover, medical cannabis sales continued to gradually decline each week after the start of adult-use retail sales, with declines in sales preceding declines in registered patients. By December 2021, slightly over a year after the vote to legalize adult-use cannabis, the actual number of registered medical cannabis patients fell short of the forecasted number, had adult-use not been legalized, by 36.5%. Moreover, the number of medical dispensary transactions and the amount of medical cannabis sold fell short of expectations, had adult-use cannabis not been legalized, by 58% and 53%, respectively. CONCLUSIONS: Findings document the blurred boundary between medical and non-medical cannabis use and are consistent with the possibility that medical cannabis legalization contributes to increases in adult cannabis use and dependence.

Community Engagement Alliance (CEAL) Against COVID-19 Disparities: Academic-community partnership to support workforce capacity building among Arizona community health workers.

The COVID-19 pandemic has both highlighted and worsened existing health inequities among communities of color and structurally vulnerable populations. Community Health Workers, inclusive of Community Health Representatives (CHW/Rs) have entered the spotlight as essential to COVID-19 prevention and control. To learn about community experiences and perspectives related to COVID-19 and inform CHW/R workforce capacity building efforts, a series of focus groups were conducted with CHW/Rs throughout Arizona at two time points in 2021. Throughout the data collection and analysis process, researchers and community partners engaged in ongoing and open dialogue about what CHW/Rs on the ground were reporting as priority community concerns, needs, and challenges. Thus, CHW/Rs informed the development of culturally and linguistically relevant health education messages, materials, and training for CHW/Rs. In this community case study, we detail the efforts of partnership between a statewide CHW professional association and an academic research team that facilitated rapid decision-making and knowledge sharing to create community-grounded tools and resources supportive of CHW/R workforce capacity building in the context of the COVID-19 pandemic.

Unique Genomic Epidemiology of COVID-19 in the White Mountain Apache Tribe, April to August 2020, Arizona.

The first case of coronavirus disease 2019 (COVID-19) within the White Mountain Apache Tribe (WMAT) in Arizona was diagnosed almost 1 month after community transmission was recognized in the state. Aggressive contact tracing allowed for robust genomic epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and subsequent phylogenetic analyses implicated only two virus introductions, which resulted in the spread of two unique viral lineages on the reservation. The phylogenies of these lineages reflect the nature of the introductions, the remoteness of the community, and the extraordinarily high attack rates. The timing and space-limited nature of the outbreaks validate the public health tracing efforts involved, which were illustrated by multiple short transmission chains over a period of several weeks, eventually resulting in extinction of the lineages. Comprehensive sampling and successful infection control efforts are illustrated in both the effective population size analyses and the limited mortality outcomes. The rapid spread and high attack rates of the two lineages may be due to a combination of sociological determinants of the WMAT and a seemingly enhanced transmissibility. The SARS-CoV-2 genomic epidemiology of the WMAT demonstrates a unique local history of the pandemic and highlights the extraordinary and successful efforts of their public health response. IMPORTANCE This article discusses the introduction and spread of two unique viral lineages of SARS-CoV-2 within the White Mountain Apache Tribe in Arizona. Both genomic sequencing and traditional epidemiological strategies (e.g., contract tracing) were used to understand the nature of the spread of both lineages. Beyond providing a robust genomic analysis of the epidemiology of the outbreaks, this work also highlights the successful efforts of the local public health response.

Arizona Surge Line: An emergent statewide COVID-19 transfer service with equity as an outcome.

Introduction: The Arizona Surge Line was an emergent initiative during the COVID-19 pandemic to facilitate COVID-19 patient transfers and load-level hospitals on a statewide level. It was designed and implemented by the Arizona Department of Health Services in preparation for the first hospital surge due to COVID-19, recognizing the disproportionate impact that hospital surge would have on rural and tribal populations. Methods: We analyzed the Arizona Surge Line transfer data for the state's first two COVID-19 surges (4/16/2020-3/6/2021). Transfer data included transfer request characteristics, patient demographics and participating hospital characteristics. When applicable, we compared this data with Arizona census data, COVID-19 case data, and the CDC/ATSDR Social Vulnerability Index. The primary outcomes studied were the proportion of COVID-19 patient requests being successfully transferred, the median transfer time, and the proportion of vulnerable populations impacted. Results: During the period of study, 160 hospitals in Arizona made 6,732 requests for transfer of COVID-19 patients. The majority of these patients (84%, 95% CI: 83-85%) were placed successfully with a median transfer time of 59 min (inter-quartile range 33-116). Of all transfer requests, 58% originated from rural hospitals, 53% were for patients of American Indian/Alaska Native ethnicity, and 73% of patients originated from highly vulnerable areas. The majority (98%) of receiving facilities were in urban areas. The Arizona Surge Line matched the number of transfers with licensed market shares during the period of study. Conclusions: The Arizona Surge Line is an equity-enhancing initiative that disproportionately benefited vulnerable populations. This statewide transfer infrastructure could become a standard public health mechanism to manage hospital surges and enhance access to care during a health emergency.

Evolution of COVID-19 Health Disparities in Arizona.

COVID-19 burdens are disproportionally high in underserved and vulnerable communities in Arizona. As the pandemic progressed, it is unclear if the initial associated health disparities have changed. This study aims to elicit the dynamic landscape of COVID-19 disparities at the community level and identify newly emerging vulnerable subpopulations. Findings from this study can inform interventions to increase health equity among minoritized communities in the Southwest, other regions of the US, and globally. We compiled biweekly COVID-19 case counts of 274 zip code tabulation areas (ZCTAs) in Arizona from October 21, 2020, to November 25, 2021, a time spanning multiple waves of COVID-19 case growth. Within each biweekly period, we tested the associations between the growth rate of COVID-19 cases and the population composition in a ZCTA including race/ethnicity, income, employment, and age using multiple regression analysis. We then compared the associations across time periods to discover temporal patterns of health disparities. The association between the percentage of Latinx population and the COVID-19 growth rate was positive before April 2021 but gradually converted to negative afterwards. The percentage of Black population was not associated with the COVID-19 growth rate at the beginning of the study but became positive after January 2021 which persisted till the end of the study period. Young median age and high unemployment rate emerged as new risk factors around mid-August 2021. Based on these findings, we identified 37 ZCTAs that were highly vulnerable to future fast escalation of COVID-19 cases. As the pandemic progresses, vulnerabilities associated with Latinx ethnicity improved gradually, possibly bolstered by culturally responsive programs in Arizona to support Latinx. Still communities with disadvantaged social determinants of health continued to struggle. Our findings inform the need to adjust current resource allocations to support the design and implementation of new interventions addressing the emerging vulnerabilities at the community level.

Baseline Sequencing Surveillance of Public Clinical Testing, Hospitals, and Community Wastewater Reveals Rapid Emergence of SARS-CoV-2 Omicron Variant of Concern in Arizona, USA.

The adaptive evolution of SARS-CoV-2 variants is driven by selection for increased viral fitness in transmissibility and immune evasion. Understanding the dynamics of how an emergent variant sweeps across populations can better inform public health response preparedness for future variants. Here, we investigated the state-level genomic epidemiology of SARS-CoV-2 through baseline genomic sequencing surveillance of 27,071 public testing specimens and 1,125 hospital inpatient specimens diagnosed between November 1, 2021, and January 31, 2022, in Arizona. We found that the Omicron variant rapidly displaced Delta variant in December 2021, leading to an "Omicron surge" of COVID-19 cases in early 2022. Wastewater sequencing surveillance of 370 samples supported the synchronous sweep of Omicron in the community. Hospital inpatient COVID-19 cases of Omicron variant presented to three major hospitals 10.51 days after its detection from public clinical testing. Nonsynonymous mutations in nsp3, nsp12, and nsp13 genes were significantly associated with Omicron hospital cases compared to community cases. To model SARS-CoV-2 transmissions across the state population, we developed a scalable sequence network methodology and showed that the Omicron variant spread through intracounty and intercounty transmissions. Finally, we demonstrated that the temporal emergence of Omicron BA.1 to become the dominant variant (17.02 days) was 2.3 times faster than the prior Delta variant (40.70 days) or subsequent Omicron sublineages BA.2 (39.65 days) and BA.5 (35.38 days). Our results demonstrate the uniquely rapid sweep of Omicron BA.1. These findings highlight how integrated public health surveillance can be used to enhance preparedness and response to future variants. IMPORTANCE SARS-CoV-2 continues to evolve new variants throughout the pandemic. However, the temporal dynamics of how SARS-CoV-2 variants emerge to become the dominant circulating variant is not precisely known. Genomic sequencing surveillance offers unique insights into how SARS-CoV-2 spreads in communities and the lead-up to hospital cases during a surge. Specifically, baseline sequencing surveillance through random selection of positive diagnostic specimens provides a representative outlook of the virus lineages circulating in a geographic region. Here, we investigated the emergence of the Omicron variant of concern in Arizona by leveraging baseline genomic sequence surveillance of public clinical testing, hospitals, and community wastewater. We tracked the spread and evolution of the Omicron variant as it first emerged in the general public, and its rapid shift in hospital admissions in the state health system. This study demonstrates the timescale of public health preparedness needed to respond to an antigenic shift in SARS-CoV-2.

Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol.

Introduction: The long-term impact of COVID-19 is unknown. We developed a 5-year prospective cohort study designed to generate actionable community-informed research about the consequences of COVID-19 on adolescents ages 12-17 years in Arizona. Methods: The study has two primary outcomes: 1) acute and long-term outcomes of COVID-19 illness and 2) symptoms of depression and anxiety. Data is collected using an online survey with plans to integrate qualitative data collection methods. The survey is administered at baseline, 4, and 8 months in year one, and annually in years two through five. This study is informed by Intersectionality Theory, which considers the diverse identities adolescents have that are self and socially defined and the influence they have collectively and simultaneously. To this end, a sample of variables collected is race/ethnicity, language usage, generational status, co-occurring health conditions, and gender. Additional measures capture experiences in social contexts such as home (parent employment, food, and housing security), school (remote learning, type of school), and society (racism). Results: Findings are not presented because the manuscript is a protocol designed to describe the procedure instead of report results. Discussion: The unique contributions of the study is its focus on COVID-19 the illness and COVID-19 the socially experienced pandemic and the impact of both on adolescents.

Racial/ethnic disparities in influenza risk perception and vaccination intention among Pima County residents in Arizona.

While influenza cases in Arizona have nearly tripled since 2018, vaccination rates continue to lag. Statewide, Hispanics and African Americans had the lowest vaccination rates despite having higher influenza infection rates than Whites. Given Arizona's racial influenza vaccination disparity and the general increase in vaccination hesitancy due to COVID-19, the purpose of this study was to better understand the influences of seasonal influenza vaccination in Arizona during the COVID-19 pandemic using qualitative methods. Findings from this study revealed that many participants were motivated to get the influenza vaccine to protect their family and close friends. The heightened concern for COVID-19 prompted some Hispanic/Latino focus group discussion participants to consider getting vaccinated. However, many Hispanic/Latino participants also expressed that they stopped getting influenza vaccine due to negative vaccination experiences or concern about sickness following immunization. African American participants primarily discussed receiving the vaccine as part of their routine health visit. Compared to other races, more White participants believed that vaccination was unimportant because they were healthy, and the people they interacted with never got sick. Distinct factors influence risk perception and vaccination intention across different racial/ethnic groups. Effective interventions can account for these factors and be tailored to the target population to maximize vaccination uptake.

One health genomic surveillance and response to a university-based outbreak of the SARS-CoV-2 Delta AY.25 lineage, Arizona, 2021.

Genomic surveillance and wastewater tracking strategies were used to strengthen the public health response to an outbreak of the SARS-CoV-2 Delta AY.25 lineage associated with a university campus in Arizona. Epidemiologic and clinical data routinely gathered through contact tracing were matched to SARS-CoV-2 genomes belonging to an outbreak of AY.25 identified through ongoing phylogenomic analyses. Continued phylogenetic analyses were conducted to further describe the AY.25 outbreak. Wastewater collected twice weekly from sites across campus was tested for SARS-CoV-2 by RT-qPCR, and subsequently sequenced to identify variants. The AY.25 outbreak was defined by a single mutation (C18804T) and comprised 379 genomes from SARS-CoV-2 positive cases associated with the university and community. Several undergraduate student gatherings and congregate living settings on campus likely contributed to the rapid spread of COVID-19 across the university with secondary transmission into the community. The clade defining mutation was also found in wastewater samples collected from around student dormitories a week before the semester began, and 9 days before cases were identified. Genomic, epidemiologic, and wastewater surveillance provided evidence that an AY.25 clone was likely imported into the university setting just prior to the onset of the Fall 2021 semester, rapidly spread through a subset of the student population, and then subsequent spillover occurred in the surrounding community. The university and local public health department worked closely together to facilitate timely reporting of cases, identification of close contacts, and other necessary response and mitigation strategies. The emergence of new SARS-CoV-2 variants and potential threat of other infectious disease outbreaks on university campuses presents an opportunity for future comprehensive One Health genomic data driven, targeted interventions.

Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID.

OBJECTIVE: To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. METHODS: This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. RESULTS: Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. CONCLUSIONS: MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.

Making Vaccines Equitably Available to All Persons in Pima County, Arizona, 2020-2021.

We review the Pima County (Arizona) Health Department's efforts to achieve equitable COVID-19 vaccine distribution in a county with a social vulnerability index of 0.88. We expedited vaccine distribution, focusing on equitable distribution, implementing a multi-point of dispensing approach, and using a periurban and rural strategy. Pima County has one of the highest vaccine distribution percentages among the highest social vulnerability index quartiles and is more than 10 percentage points ahead of other large counties in Arizona in vaccine uptake. (Am J Public Health. 2022;112(11):1560-1563. https://doi.org/10.2105/AJPH.2022.307040).

Novel chaotic oppositional fruit fly optimization algorithm for feature selection applied on COVID 19 patients' health prediction.

The fast-growing quantity of information hinders the process of machine learning, making it computationally costly and with substandard results. Feature selection is a pre-processing method for obtaining the optimal subset of features in a data set. Optimization algorithms struggle to decrease the dimensionality while retaining accuracy in high-dimensional data set. This article proposes a novel chaotic opposition fruit fly optimization algorithm, an improved variation of the original fruit fly algorithm, advanced and adapted for binary optimization problems. The proposed algorithm is tested on ten unconstrained benchmark functions and evaluated on twenty-one standard datasets taken from the Univesity of California, Irvine repository and Arizona State University. Further, the presented algorithm is assessed on a coronavirus disease dataset, as well. The proposed method is then compared with several well-known feature selection algorithms on the same datasets. The results prove that the presented algorithm predominantly outperform other algorithms in selecting the most relevant features by decreasing the number of utilized features and improving classification accuracy.

The Arizona Prevention Research Center partnerships in Arizona to promote COVID-19 vaccine health equity.

Background: Vaccine hesitancy in the face of the COVID-19 pandemic is a complex issue that undermines our national ability to reduce the burden of the disease and control the pandemic. The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity and mortality among Arizona's Latinx rural, underserved, farmworker, disabled and elderly populations. In March 2021, ~8.1% of those vaccinated were Latinx, though Latinxs make up 32% of Arizona's population. The Arizona Vaccine Confidence Network (AzVCN) proposed to leverage the expertise of the Arizona Prevention Research Center (AzPRC) and the resources of the Mel and Enid Zuckerman College of Public Health (MEZCOPH) Mobile Health Unit (MHU) to identify, implement and evaluate a MHU intervention to increase uptake of COVID-19 vaccines. Methods: The AzVCN focused efforts on Latinx, rural, un/underinsured and farmworker communities in the four Arizona border counties that are at greater risk of COVID-19 morbidity and mortality and may have limited access to vaccination and other essential health services. The AzVCN used listening sessions to create a feedback loop with key stakeholders and critical health care workers to validate barriers/enablers and identify solutions to increase vaccination uptake emerging from the network. The AzVCN also implemented a community-based intervention using community health workers (CHWs) based in a MHU to increase knowledge of the COVID-19 vaccines, reduce vaccination hesitancy and increase vaccination uptake among Latinx rural, un/underinsured and farmworker populations in Southern Arizona. Results: AzVCN outcomes include: identification of enablers and barriers of COVID-19 vaccination in the priority populations; identification of strategies and solutions to address vaccine hesitancy and increase vaccine uptake among priority population; and evidence that the proposed solutions being tested through the AzVCN contribute to increased vaccine uptake among the priority populations. Conclusion: Through these efforts the AzPRC contributed to the CDC's Vaccinate with Confidence Strategy by collaborating with CHWs and other key stakeholders to engage directly with communities in identifying and addressing structural and misinformation barriers to vaccine uptake.

Community Conversations About COVID-19.

"Community Conversations About COVID-19" was a multi-group program designed to address the need for culturally sensitive health information about COVID-19 for Latinx and Native American communities. Three medical librarians worked closely with Latinx and/or Spanish-speaking promotores, also known as community health workers (CHWs), and native patient navigators (NPNs) from Native American communities in Tucson, Arizona. In addition, the librarians collaborated with second-year medical students from the University of Arizona College of Medicine - Phoenix. The focus was to train the CHWs, NPNs, and students on how to access health information resources from the National Library of Medicine, National Institutes of Health, Centers for Disease Control and Prevention, and other reliable agencies. The second segment of the program provided the opportunity for the groups to learn from each other's experiences working with health information through this pandemic, which is especially important given the fact the CHWs and NPNs live in, care for, and were brought up in these communities.

A Multiresource Event Model Developed to Increase Access to COVID-19 Vaccines in Pima County, Arizona, Summer 2021.

In summer 2021, the Pima County Health Department (PCHD) developed and implemented a multiresource event model for vaccine clinics to increase access to COVID-19 vaccines and other resources, such as food, rental assistance, and public health services, in Pima County, Arizona, communities. The PCHD aimed to improve vaccine access in areas with vaccination rates <40% by involving community partners to plan a multiresource event with resources (eg, food, connection to economic resources, information on childcare, and heat relief)and incentives specific to community needs that could drive attendance. Resources would be made available to community members regardless of whether they received a COVID-19 vaccine at the event. The PCHD selected census tract 41.15 as the pilot group to apply the multiresouce COVID-19 vaccine event model. Census tract 41.15 is a heat-stressed area of Pima County comprising mostly Latino people and people with lower incomes and is an area with low vaccination rates for COVID-19. The vaccination rate increased in census tract 41.15 by 12.8 percentage points (absolute increase), starting at 33.9% on June 1, 2021, and increasing to 46.7% as of September 1, 2021. In addition, attendance at the pilot event versus attendance at previous events that did not use this model increased by >100%. The multiresource COVID-19 vaccine event, when held within a hyperlocal area and when the needs of residents in the community are considered, can improve vaccine uptake. This model provides a roadmap for COVID-19 vaccine delivery in areas of low uptake.