Engaging staff to improve COVID-19 vaccination response at long-term care facilities (ENSPIRE): A cluster randomized trial of co-designed, tailored vaccine promotion materials.

BACKGROUND: COVID-19 vaccination rates among long-term care center (LTCC) workers are among the lowest of all frontline health care workers. Current efforts to increase COVID-19 vaccine uptake generally focus on strategies that have proven effective for increasing influenza vaccine uptake among health care workers including educational and communication strategies. Experimental evidence is lacking on the comparative advantage of educational strategies to improve vaccine acceptance and uptake, especially in the context of COVID-19. Despite the lack of evidence, education and communication strategies are recommended to improve COVID-19 vaccination rates and decrease vaccine hesitancy (VH), especially strategies using tailored messaging for disproportionately affected populations. METHODS: We describe a cluster-randomized comparative effectiveness trial with 40 LTCCs and approximately 4000 LTCC workers in 2 geographically, culturally, and ethnically distinct states. We compare the effectiveness of two strategies for increasing COVID-19 booster vaccination rates and willingness to promote COVID-19 booster vaccination: co-design processes for tailoring educational messages vs. an enhanced usual care comparator. Our study focuses on the language and/or cultural groups that are most disproportionately affected by VH and low COVID-19 vaccine uptake in these LTCCs. CONCLUSION: Finding effective methods to increase COVID-19 vaccine uptake and decrease VH among LTCC staff is critical. Beyond COVID-19, better approaches are needed to improve vaccine uptake and decrease VH for a variety of existing vaccines as well as vaccines created to address novel viruses as they emerge.

And It'll Come Back Real Baby Fine: Black Women's Experiences With Hair Loss and Regrowth After Chemotherapy for Breast Cancer Treatment.

In this study, I use a modified grounded theory, intersectional approach to understand the wellness-illness experience for black women experiencing breast cancer. I use interviews from 38 breast cancer survivors from Nashville, Durham-Chapel Hill, and Atlanta conducted between 2014 and 2015 to explore variations in perceptions of hair loss and regrowth. Universally, hair loss from chemotherapy treatments is a stressful experience, which cause women to question their health and femininity. Hair loss is a crisis in which women feel less beautiful and more sick. Interesting patterns steeped in race and beauty emerged from women's narratives as they experienced hair regrowth. Black women's stories of hair loss associated with chemotherapy are influenced by values associated racialized ideologies about beauty. Good, baby fine, soft and thick, loosely curled, straight, wavy, and beautiful are just some of the words many women chose to describe their chemically altered hair. The dialogue around hair regrowth and texture is problematic given Eurocentric standards of feminine beauty, notions that coincide the long ties between chemicals and hair straightening in the black community.

Dollar for Dollar: Racial and ethnic inequalities in health and health-related outcomes among persons with very high income.

Racial and ethnic disparities in health have been well-documented, and low SES is widely considered to be a driver of this relationship. However, the race-social class-health interrelationship is complex, as several studies have found race disparities between racial/ethnic minorities and whites at middle- income levels. Research on higher income persons is complicated by the lack of data for persons with incomes about $75,000. Most national datasets collect income data in categories with the highest income category being $75,000 and above. In our study, we examined racial/ethnic disparities in health status and behaviors among persons of very high income, reported income of $175,000 or above per year. Data are from the Medical Expenditure Panel Surveys (MEPS). Our findings revealed health disparities in 10 of the 16 health-related outcomes selected. African Americans were most dissimilar to whites at this income and with disadvantages on 6 health outcomes relative to whites. While results also showed some disparities for Asian Americans and Hispanic Americans relative to whites, these groups were advantaged, relative to whites on several health outcomes. Our findings indicate that income does not fully explain racial/ethnic disparities in health. Most public interventions are targeted to low income persons. However, public health interventions should target minority individuals of very high income as well, especially African Americans.