•COVID-19-related anxiety was positively associated with vaccine acceptance.•Health-related fears correlated positively with vaccine acceptance.•Social and economic fears were negatively associated ...with vaccine acceptance.•Distinguishing between different types of fears and anxiety seems to be important.•Acceptance differed between users/non-users of social and official media formats.
Vaccination is crucial to limit the pandemic spread of SARS-CoV-2/COVID-19. Therefore, besides the development and supply of vaccines, it is essential that sufficient individuals are willing to get vaccinated, but concerning proportions of populations worldwide show vaccine hesitancy. This makes it important to determine factors that are associated with vaccine acceptance.
1779 adults of a non-probability convenience sample in Germany were assessed with an online survey in a cross-sectional survey period from 1st to 11th January 2021 (a few days after the beginning of vaccinations in Germany).
64.5% of the sample stated that they absolutely would accept the vaccination, 13.8% would rather accept it, 10.4% were undecided, and 5.2% would rather not and 6.0% absolutely not get vaccinated. COVID-19-related anxiety, and fears of infection and health-related consequences correlated significantly positively with vaccine acceptance (all p < .001). In contrast, social (p = .006) and economic fears (p < .001) showed significant negative associations with vaccination willingness. The broader constructs of unspecific anxiety and depressive symptoms were not significantly associated with vaccine acceptance. Vaccine acceptance differed between users/non-users of social media and official websites to gain information about the pandemic (p < .001).
COVID-19-related anxiety and health-related fears were associated with higher vaccine acceptance, whereas the fear of social and economic consequences showed the contrary direction. These findings highlight the need to differentiate between several types of fears and anxiety to predict their influence on vaccine acceptance, and provide important information and an essential base for future studies and interventions.
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In October and November 2020, we conducted a survey of 2,678 healthcare workers (HCWs) involved in general population immunisation in France, French-speaking Belgium and Quebec, Canada to assess ...acceptance of future COVID-19 vaccines (i.e. willingness to receive or recommend these) and its determinants. Of the HCWs, 48.6% (n = 1,302) showed high acceptance, 23.0% (n = 616) moderate acceptance and 28.4% (n = 760) hesitancy/reluctance. Hesitancy was mostly driven by vaccine safety concerns. These must be addressed before/during upcoming vaccination campaigns.
•People who inject drugs frequently experience stigma in healthcare settings.•People who inject drugs internalize, reject, and react to external stigma.•When accessing care, people who inject drugs ...modify their behavior to avoid stigma.•Community based organizations are preferred over large healthcare settings.•Increased training and integrating healthcare into community settings is needed.
People who inject drugs (PWID) have limited engagement in healthcare services and report frequent experiences of stigma and mistreatment when accessing services. This paper explores the impact of stigma against injection drug use on healthcare utilization among PWID in the U.S. Northeast.
We recruited PWID through community-based organizations (CBOs; e.g., syringe service programs). Participants completed brief surveys and semi-structured interviews lasting approximately 45 min exploring HIV risk behaviors and prevention needs. Thematic analysis examined the emergent topic of stigma experiences in relation to healthcare utilization.
Among 33 PWID (55% male; age range 24–62 years; 67% White; 24% Latino), most used heroin (94%) and injected at least daily (60%). Experiences of dehumanization in healthcare settings were common, with many participants perceiving that they had been treated unfairly or discriminated against due to their injection drug use. As participants anticipated this type of stigma from healthcare providers, they developed strategies to avoid it, including delaying presenting for healthcare, not disclosing drug use, downplaying pain, and seeking care elsewhere. In contrast to large institutional healthcare settings, participants described non-stigmatizing environments within CBOs, where they experienced greater acceptance, mutual respect, and stronger connections with staff.
Stigma against injection drug use carries important implications for PWID health. Increased provider training on addiction as a medical disorder could improve PWID healthcare experiences, and integrating health services into organizations frequented by PWID could increase utilization of health services by this population.
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Developing a COVID-19 vaccine is a critical strategy for combatting the pandemic. However, for vaccination efforts to succeed, there must be widespread willingness to vaccinate. Prior research has ...found that Black Americans, who are disproportionately impacted by COVID-19, report lower intentions to get a vaccine than do other populations. We investigate two potential contributors to this disparity: COVID-19 vaccine-related behavioral beliefs and trust in four COVID-19 information sources (mainstream media, social media, President Trump, and public health officials and agencies). Using a nationally-representative survey (n= 889), we demonstrate that differences in vaccination beliefs explain the lower vaccination intentions reported by Black participants, compared to non-Black participants. However, while trust in information sources is associated with vaccination beliefs, differences in trust do not account for the observed differences in vaccination beliefs by race. Furthermore, we find that race moderates the relationships between trust in two sources (Trump and public health officials and agencies) and vaccination beliefs. The effects of trusting these sources on COVID-19 vaccine-related beliefs are smaller among Black participants; thus trust in these sources is less consequential to their pro-vaccination beliefs. Our results suggest that trust in information sources alone does not explain the observed relationship between race and vaccination beliefs.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
Focusing on subpopulations that express the intention to receive a COVID-19 vaccination but are unvaccinated may improve the yield of COVID-19 vaccination efforts.
A nationally representative sample ...of 789,658 U.S. adults aged ≥18 years participated in the National Immunization Survey Adult COVID Module from May 2021 to April 2022. The survey assessed respondents’ COVID-19 vaccination status and intent by demographic characteristics (age, urbanicity, educational attainment, region, insurance, income, and race/ethnicity). This study compared composition and within-group estimates of those who responded that they definitely or probably will get vaccinated or are unsure (moveable middle) from the first and last month of data collection.
Because vaccination uptake increased over the study period, the moveable middle declined among persons aged ≥18 years. Adults aged 18–39 years and suburban residents comprised most of the moveable middle in April 2022. Groups with the largest moveable middles in April 2022 included persons with no insurance (10%), those aged 18–29 years (8%), and those with incomes below poverty (8%), followed by non-Hispanic Native Hawaiian or other Pacific Islander (7%), non-Hispanic multiple or other race (6%), non-Hispanic American Indian or Alaska Native persons (6%), non-Hispanic Black or African American persons (6%), those with below high school education (6%), those with high school education (5%), and those aged 30–39 years (5%).
A sizable percentage of adults open to receiving COVID-19 vaccination remain in several demographic groups. Emphasizing engagement of persons who are unvaccinated in some racial/ethnic groups, aged 18–39 years, without health insurance, or with lower income may reach more persons open to vaccination.
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This study explores willingness to use PrEP among Black individuals in the US. From February to April 2016, an online survey was administered to a nationally representative sample of Black ...individuals. 855 individuals who were HIV negative by self-report participated mean age: 33.6 (SD 9.2); 45.5% male. Among all respondents, 14.5% were aware of, and 26.0% would be willing to use PrEP. Among high-risk individuals (N = 327), 19.8% knew about and 35.1% would be willing to use PrEP. The most common reason for lack of willingness among high-risk individuals was low self-perceived risk (65.1%). In multivariate analysis, individuals reporting single marital status OR 1.8 (1.2, 2.5), p = 0.002, depressive symptoms OR 1.6 (1.2, 2.2), p = 0.0054, arrest history OR 1.7(1.2, 2.4), p = 0.0003, PrEP knowledge OR 1.5 (1.0, 2.3), p = 0.0247 and belief in HIV conspiracies OR 1.3 (1.1, 1.5), p = 0.0075 were more willing to use PrEP. Participants who saw a health care provider less frequently were less willing to use PrEP OR 0.5 (0.4, 0.8), p = 0.0044. Among a nationally representative sample of Black individuals, few high risk individuals were willing to use PrEP. Interventions to increase risk awareness, PrEP knowledge and access to care are necessary to improve PrEP uptake.
Hong Kong has been embroiled in increasingly violent social unrest since June, 2019. We examined the associated population mental health burden, risk factors, and health-care needs.
In a ...population-based prospective cohort, adult participants aged 18 years or older were assessed at nine timepoints from 2009. Probable depression was measured using the Patient Health Questionnaire-9 (score ≥10) and suspected post-traumatic stress disorder (PTSD) by the PTSD Checklist—Civilian Version (score ≥14), plus direct exposure to traumatic events related to the ongoing social unrest. We used multivariable logistic regression to identify factors associated with both outcomes, adjusting for doctor-diagnosed depression or anxiety disorders before the unrest. On the basis of routine service statistics and respondents' intention to seek professional care, we projected the number of additional ambulatory specialist psychiatric visits required.
After the two baseline surveys, we followed up random subsets of 1213–1736 adults at each timepoint. Probable depression was reported by 11·2% (95% CI 9·8–12·7) of participants in 2019, compared with 1·9% (1·6–2·1) during 2009–14 and 6·5% (5·3–7·6) in 2017 after the Occupy Central Movement and before the current unrest. Prevalence of suspected PTSD in 2019 was estimated to be 12·8% (11·2–14·4). Age, sex, educational attainment, or household income were not associated with either outcome, whereas heavy social media use (≥2 h per day) was associated with both. Political attitude or protest participation was not associated with probable depression, but neutrality towards the extradition bill approximately halved the risk of suspected PTSD. Family support mitigated against probable depression. We estimated that the mental health burden identified would translate into roughly an excess 12% service requirement to the public sector queue or equivalent.
We have identified a major mental health burden during the social unrest in Hong Kong, which will require substantial increases in service surge capacity. Health-care and social care professionals should be vigilant in recognising possible mental health sequelae. In a world of increasing unrest, our findings might have implications for service planning to better protect population mental health globally.
Research Grants Council, University Grants Committee of Hong Kong, Hong Kong Jockey Club Charities Trust.
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In December 2020, the first COVID-19 vaccines were approved. Despite more than 85 million reported cases and 1.8 million known deaths, millions worldwide say they may not accept it. This study ...assesses the associations of age, gender, and level of education with vaccine acceptance, from a random sample of 13,426 participants selected from 19 high-COVID-19 burden countries in June 2020. Based on univariable and multivariable logistic regression, several noteworthy trends emerged: women in France, Germany, Russia, and Sweden were significantly more likely to accept a vaccine than men in these countries. Older (≥50) people in Canada, Poland, France, Germany, Sweden, and the UK were significantly more favorably disposed to vaccination than younger respondents, but the reverse trend held in China. Highly educated individuals in Ecuador, France, Germany, India, and the US reported that they will accept a vaccine, but higher education levels were associated with lower vaccination acceptance in Canada, Spain, and the UK. Heterogeneity by demographic factors in the respondents' willingness to accept a vaccine if recommended by employers were substantial when comparing responses from Brazil, Ecuador, France, India, Italy, Mexico, Poland, Russia, South Africa, South Korea, Sweden, and the US. This information should help public health authorities target vaccine promotion messages more effectively.
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Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing ...patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.
Although vaccines are considered the most effective and fundamental therapeutic tools for consistently preventing the COVID-19 disease, worldwide vaccine hesitancy has become a widespread public ...health issue for successful immunization. The aim of this review was to identify an up-to-date and concise assessment of potential factors influencing COVID-19 vaccine acceptance and refusal intention, and to outline the key message in order to organize these factors according to country count.
A systematic search of the peer-reviewed literature articles indexed in reputable databases, mainly Pub Med (MEDLINE), Elsevier, Science Direct, and Scopus, was performed between21stJune 2021 and10th July 2021. After obtaining the results via careful screening using a PRISMA flow diagram, 47 peer-reviewed articles met the inclusion criteria and formed the basic structure of the review.
In total, 11 potential factors were identified, of which the greatest number of articles (n = 28) reported "safety" (34.46%; 95% CI 25.05─43.87) as the overarching consideration, while "side effects" (38.73%; 95% CI 28.14─49.32) was reported by 22 articles, which was the next common factor. Other potential factors such as "effectiveness" were identified in 19 articles (29.98%; 95% CI 17.09─41.67), followed by "trust" (n = 15 studies; 27.91%; 95% CI 17.1─38.73),"information sufficiency"(n = 12; 34.46%; 95% CI 35.87─63.07),"efficacy"(n = 8; 28.73%; 95% CI 9.72─47.74), "conspiracy beliefs" (n = 8; 14.30%; 95% CI 7.97─20.63),"social influence" (n = 6; 42.11%; 95% CI 14.01─70.21), "political roles" (n = 4; 16.75%; 95% CI 5.34─28.16), "vaccine mandated" (n = 4; 51.20%; 95% CI 20.25─82.15), and "fear and anxiety" (n = 3; 8.73%; 95% CI 0.59─18.05). The findings for country-specific influential vaccination factors revealed that, "safety" was recognized mostly (n = 14) in Asian continents (32.45%; 95% CI 19.60─45.31), followed by the United States (n = 6; 33.33%; 95% CI12.68─53.98). "Side effects" was identified from studies in Asia and Europe (n = 6; 35.78%; 95% CI 16.79─54.77 and 16.93%; 95% CI 4.70─28.08, respectively), followed by Africa (n = 4; 74.60%, 95% CI 58.08─91.11); however, public response to "effectiveness" was found in the greatest (n = 7) number of studies in Asian countries (44.84%; 95% CI 25─64.68), followed by the United States (n = 6; 16.68%, 95% CI 8.47─24.89). In Europe, "trust" (n = 5) appeared as a critical predictor (24.94%; 95% CI 2.32─47.56). "Information sufficiency" was identified mostly (n = 4) in articles from the United States (51.53%; 95% CI = 14.12─88.74), followed by Asia (n = 3; 40%; 95% CI 27.01─52.99). More concerns was observed relating to "efficacy" and "conspiracy beliefs" in Asian countries (n = 3; 27.03%; 95% CI 10.35─43.71 and 18.55%; 95% CI 8.67─28.43, respectively). The impact of "social influence" on making a rapid vaccination decision was high in Europe (n = 3; 23.85%, 95% CI -18.48─66.18), followed by the United States (n = 2; 74.85%). Finally, "political roles" and "vaccine-mandated" were important concerns in the United States.
The prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy varied globally; however, the global COVID-19 vaccine acceptance relies on several common factors related to psychological and, societal aspect, and the vaccine itself. People would connect with informative and effective messaging that clarifies the safety, side effects, and effectiveness of prospective COVID-19 vaccines, which would foster vaccine confidence and encourage people to be vaccinated willingly.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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