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Introduction: Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence. Methods: We analyzed data using the CDC's Research and Development Survey (RANDS), a nationally representative survey of U.S. adults ≥18years, collected from 17 May 2021-30 June 2021 (n=5,458) and 3 November 2022-12 December 2022 (n=6,821). We assessed changes in vaccine hesitancy, changes in vaccine attitudes and attitudes, and factors associated with hesitancy toward both vaccines in general and COVID-19 vaccines among a nationally representative sample of U.S. adults. Results: Although COVID-19 vaccination (≥1 dose) increased from 67.2% (2021) to 74.7% (2022), COVID-19 vaccine hesitancy increased from 40.7% to 44.6% during the same period. During the same period, hesitancy toward both COVID-19 vaccines and vaccines in general increased among those who were aged ≥65 years and who were non-Hispanic White. However, COVID-19 vaccine hesitancy decreased among non-Hispanic Black adults. Current or former smokers were more hesitant toward vaccines in general (aPR = 1.13, 95%CI: 1.03-1.24) and toward COVID-19 vaccines (aPR = 1.08, 95%CI: 1.01-1.16) compared to never smokers. Among adults who did not receive any COVID-19 vaccines, COVID-19 vaccine hesitancy increased from 86.6% in 2021 to 92.4% in 2022. Furthermore, belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%. Conclusion: This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination. [ABSTRACT FROM AUTHOR]

Background: The United States (U.S.) has a growing population of Brazilian immigrant women. However, limited research has explored Pap tests and human papillomavirus (HPV) vaccination among this population. Methods: Participants completed an online survey between July—August 2020. Bivariate analyses examined associations between healthcare-related variables (e.g., insurance, having a primary care provider) and demographics (e.g., age, education, income, marital status, years living in the U.S., primary language spoken at home) with 1) Pap test recency (within the past 3 years) and 2) HPV vaccination (0 doses vs. 1 + doses). Variables significant at p < 0.10 in bivariate analyses were included in multivariable logistic regression models examining Pap test recency and HPV vaccination. Results: The study found that 83.7% of the sample had a Pap test in the past three years. Women who did not know their household income were less likely to be than women who reported a household income of < $25,000 (adjusted OR [aOR] = 0.34, 95% CI: 0.12, 0.95). Women who had seen a healthcare provider in the past year were more likely to have had a Pap test within the last three years than those who had not seen a provider in the past year ([aOR] = 2.43, 95% CI: 1.32, 4.47). Regarding HPV vaccination, 30.3% of respondents reported receiving one or more doses of the HPV vaccine. The multivariable logic regression models determined that women aged 27 -45 (aOR = 0.35, 95% CI: 0.18, 0.67) were less likely than women aged 18–26 to have been vaccinated against HPV). and that women with a PCP were more likely to be vaccinated than those without a PCP (aOR = 2.47. 95% CI:1.30, 4.59). Conclusion: This study found that Brazilian immigrant women in the youngest age groups (21 – 29) for Pap test, 18- 26 for HPV vaccination) had somewhat better rates of Pap screening and HPV vaccination than the general U.S. population. This study adds new information about cervical cancer prevention and control behaviors among Brazilian immigrant women. [ABSTRACT FROM AUTHOR]

Understanding how attitudes and beliefs about COVID-19 vaccination have changed over time is essential for identifying areas where targeted messaging and interventions can improve vaccination confidence and uptake. Using data from multiple waves of the nationally representative U.S. Census Bureau's Household Pulse Survey collected from January 2021 to May 2023, we assessed reasons for the non-vaccination of adults, adolescents, and children using the Health Belief Model as the framework for understanding behavior. Among unvaccinated adults, perceived vulnerability increased from 11.9% to 44.1%, attitudinal factors/mistrust increased from 28.6% to 53.4%, and lack of cue to action increased from 7.5% to 9.7% from January 2021 to May 2022. On the other hand, safety/efficacy concerns decreased from 74.0% to 60.9%, and logistical barriers to vaccination decreased from 9.1% to 3.4% during the same time period. Regarding reasons for non-vaccination of youth, perceived vulnerability increased from 32.8% to 40.0%, safety/efficacy concerns decreased from 73.9% to 60.4%, and lack of cue to action increased from 10.4% to 13.4% between September 2021 and May 2023. While safety/efficacy concerns and logistic barriers have decreased, increases in perceived vulnerability to COVID-19, mistrust, and lack of cues to action suggest that more efforts are needed to address these barriers to vaccination. [ABSTRACT FROM AUTHOR]

Men aged 27 to 45 are eligible for human papillomavirus (HPV) vaccination as of 2019, yet relatively little is known about whether they have received or intend to receive it. We conducted a cross-sectional, online survey among fathers aged 27 to 45 between March and April 2022, to assess associations between HPV vaccination awareness, behaviors, intentions, and psychosocial constructs from the Health Belief Model. We examined the characteristics of those who had (a) heard of the HPV vaccine, (b) already received ≥ 1 dose, and (c) intentions for future vaccination among those who had never been vaccinated. Among 400 men who completed the survey, 32% were not aware of the HPV vaccine. Among those who were aware, 41% had received ≥ 1 dose. Sixty-three percent of unvaccinated men reported that they intended to get vaccinated in the future. Multivariable logistic regression analyses revealed that age and race/ethnicity were associated with having been vaccinated previously. Among the unvaccinated, multivariable logistic regression analyses revealed that those with a higher perceived risk of HPV-associated cancer had 3.73 greater odds of reporting they would seek vaccination compared to those with lower perceived risk (95% confidence interval [CI] = [1.28, 12.3]). We did not find perceived benefits, barriers, or decision self-efficacy to be related to future vaccine intentions. Since recommendations for this group include shared clinical decision-making, public health efforts should focus on raising awareness of vaccine eligibility, emphasizing risk factors for HPV-associated cancers so that individuals have an accurate perception of risk, and encouraging conversation between men and their providers. [ABSTRACT FROM AUTHOR]

Objective: To quantify the association between attributional ambiguity–the uncertainty of whether an experience is discrimination–and mental health. Methods: Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status. Results: Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms. Conclusion: Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations. [ABSTRACT FROM AUTHOR]

Long COVID and its symptoms have not been examined in different subpopulations of U.S. adults. Using the 2022 BRFSS (n = 445,132), we assessed long COVID and each symptom by sociodemographic characteristics and health-related variables. Multivariable logistic regression was conducted to examine factors associated with long COVID and the individual symptoms. Prevalence differences were conducted to examine differences in long COVID by vaccination status. Overall, more than one in five adults who ever had COVID-19 reported symptoms consistent with long COVID (21.8%). The most common symptom was tiredness or fatigue (26.2%), followed by difficulty breathing or shortness of breath (18.9%), and loss of taste or smell (17.0%). Long COVID was more common among adults under 65 years, women, American Indian or Alaska Native or other/multi race group, smokers, and people with a disability, depression, overweight or obesity compared to their respective counterparts. The prevalence of long COVID was higher among unvaccinated adults (25.6%) than vaccinated adults (21.6%) overall, and for 20 of 32 subgroups assessed. These findings underscore the benefits of vaccination, the importance of early treatment, and the need to better inform health care resource allocation and support services for those experiencing long COVID. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the effectiveness of a pilot mindfulness program for student athletes by assessing mental health, mindfulness ability, and perceived stress before and after the intervention. The mindfulness program was adapted from a program developed at the University of Southern California. The four-session intervention taught the basics of mindfulness, self-care skills, and guided meditations. Participants completed surveys before and after the intervention. Mindfulness ability was assessed with the Cognitive and Affective Mindfulness Scale, mental health was assessed with a modified Short Form Health Survey, and stress was assessed with the Perceived Stress Scale. After the intervention, participants reported improvement in mindfulness ability, t(28) = −2.61, p =.014, mental health, t(28) = −2.87, p =.008, and a trending improvement in perceived stress, t(28) = 1.86, p =.073. A short mindfulness program may be effective for improving mental health and mindfulness ability in collegiate student athletes. [ABSTRACT FROM AUTHOR]

Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents' intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions. Method: We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children (

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64–0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37–13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination. [ABSTRACT FROM AUTHOR]

There was a five-fold increase in COVID-19 hospitalization case counts among children and adolescents between June and October 2021. However, polls suggest that adolescent COVID-19 vaccination coverage has plateaued in the United States. Using the Census Bureau's Household Pulse Survey, we assessed trends in COVID-19 vaccination among adolescents ages 12–17 years, parents' intention to vaccinate their adolescent children, and their reasons for not intending to vaccinate their children from July to October 2021 using a large, nationally representative survey of U.S. households (n = 59,424). Trends in COVID-19 adolescent vaccination coverage, nationally and by sociodemographic characteristics, factors associated with adolescent vaccination status and parental intent to vaccinate their adolescent children, as well as changes in reasons for non-vaccination were examined using regression models. Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12–17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. However, there were no significant changes in parental intention to vaccinate their adolescent children during the same time period. Approximately one-quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Among those who had not vaccinated their children, lack of trust in the government and vaccines, and the belief that the COVID-19 vaccine is not needed or effective, was higher in October compared to July. Parental intention to vaccinate their children has remained relatively stable throughout the late summer and early fall of 2021. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines are important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents. Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12–17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. Approximately one quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines is important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has disproportionately impacted low-income immigrant communities. There is concern that the current uptake of COVID-19 vaccines is suboptimal and that this may be contributing to COVID-19 inequities. However, little is known about the acceptability of COVID-19 vaccines among immigrants in the U.S. Our goal was to gauge COVID-19 vaccine intentions among Brazilian immigrant women living in the U.S. Methods: We conducted an online survey between July and August 2020 offered in Portuguese and English languages among a convenience sample of Brazilian immigrant women ages 18 years and older. Women were recruited through online advertisements by community-based organizations and social media groups to complete a survey that assessed intention to get a COVID-19 vaccine, attitudes toward vaccines, and perceptions about the pandemic. Results: Of the total sample (N = 353), most (70.8%) indicated they intended to get a COVID-19 vaccine. In bivariate analyses, vaccine intentions were significantly associated with perceptions about the severity of the pandemic, trusted sources of health information, and the number of years lived in the U.S. Multinomial logistic regression models revealed that those who did not intend to be vaccinated had lived a longer time in the U.S. (OR: -0.12 95% CI: -0.19, -0.05), perceived the pandemic to be a minor issue (OR: 1.52, 95% CI: 0.62, 2.42), and trusted information from social networks (OR: -1.94, 95% CI: -3.25, -0.63) or private news sources (OR: -1.71, 95% CI: -2.78, -0.63). Conclusions: While most women reported they would get a COVID-19 vaccine, efforts to reach those who may be hesitant should target those who have lived in the U.S. for longer periods of time and do not perceive the pandemic to be a major crisis. Healthcare providers may be particularly suited to deliver this information given high levels of trust. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease 2019 (COVID-19) pandemic could disproportionately affect individuals who have a substance use disorder (SUD). However, little information exists on COVID-19-related experiences among individuals with a SUD. We examined whether individuals with a SUD differ from other individuals with regard to COVID-19 testing, susceptibility, and employment-related vulnerability. Methods: We used data from a U.S. nationally representative survey (n = 1,208). Using logistic regressions, we examined whether individuals with SUDs differ from other individuals regarding underlying health conditions, COVID-19 testing, access to paid sick leave, and loss of employment. Data were collected in late May-early June, 2020. Results: Four percent of participants reported that a healthcare professional had told them they had a SUD. We found that, compared to those without SUDs, respondents with SUDs had higher odds of having lost their job due to the pandemic (adjusted odds ratio [AOR]:5.17, 95% confidence interval [CI]:2.28–11.74). Among individuals who were employed prior to the pandemic, people with SUDs had lower odds of having paid sick leave (AOR:0.26, 95% CI:0.09–0.74). Conclusion: Our study indicates that individuals with SUDs could be disproportionately affected by COVID-19 economically, which might worsen SUD and racial/ethnic health disparities. [ABSTRACT FROM AUTHOR]

Objective: As COVID-19 vaccines become more accessible to all people in the United States, more employees are returning to the workforce or switching to in-person work. However, limited information is available on vaccination coverage and intent among the US workforce. Methods: We used data from the US Census Bureau's Household Pulse Survey, fielded during April 14–May 24, 2021 (N = 218 787), to examine the prevalence of previous COVID-19 infection, vaccination receipt, and intent to vaccinate by essential worker status and employment type. In addition, we analyzed factors associated with vaccination receipt and reasons for not getting vaccinated. Results: More than 15% of the US workforce had a previous diagnosis of COVID-19, and 73.6% received ≥1 dose of COVID-19 vaccine; however, 12.4% reported that they probably will not or definitely will not get vaccinated. Vaccination coverage (range, 63.8%-78.3%) was lowest and non-intent to get vaccinated (12.9%-21.7%) was highest among self-employed adults across all essential and nonessential worker groups. Factors associated with receipt of vaccination were age, race, Hispanic ethnicity, educational attainment, annual household income, health insurance status, and previous COVID-19 diagnosis. The main reasons for not getting vaccinated were concerns about possible side effects and waiting and seeing if the vaccine is safe. Conclusion: Identifying and addressing disparities in COVID-19 vaccination coverage in the US workforce can protect groups with low vaccine coverage and increase understanding of reasons for vaccine hesitancy. Educating employees about the vaccine and its potential side effects, promoting a culture of health and safety in the workplace, and building social norms around vaccination can help create a safe work environment for all employees and their families. [ABSTRACT FROM AUTHOR]

To determine the extent of gaps in coronavirus disease (COVID-19) vaccine coverage among those in the United States with and without previous COVID-19 diagnoses, we used data from a large, nationally representative survey conducted during July 21-August 2, 2021. We analyzed vaccine receipt (≥1 dose and full vaccination) and intention to be vaccinated for 63,266 persons. Vaccination receipt was lower among those who had a prior diagnosis of COVID-19 compared to those without: >1 dose: 73% and 85%, respectively, p<0.001; full vaccination: 69% and 82%, respectively, p<0.001). Reluctance to be vaccinated was higher among those with a previous COVID-19 diagnosis (14%) than among those without (9%). These findings suggest the need to focus educational and confidence-building interventions on adults who receive a COVID-19 diagnosis during clinic visits, or at the time of discharge if hospitalized, and to better educate the public about the value of being vaccinated, regardless of previous COVID-19 infection. [ABSTRACT FROM AUTHOR]

Background: We investigate the relationships among political preferences, risk for COVID-19 complications, and complying with preventative behaviors, such as social distancing, quarantine, and vaccination, as they remain incompletely understood. Since those with underlying health conditions have the highest mortality risk, prevention strategies targeting them and their caretakers effectively can save lives. Understanding caretakers' adherence is also crucial as their behavior affects the probability of transmission and quality of care, but is understudied. Examining the degree to which adherence to prevention measures within these populations is affected by their health status vs. voting preference, a key predictor of preventative behavior in the U. S, is imperative to improve targeted public health messaging. Knowledge of these associations could inform targeted COVID-19 campaigns to improve adherence for those at risk for severe consequences.Methods: We conducted a nationally-representative online survey of U.S. adults between May-June 2020 assessing: 1) attempts to socially-distance; 2) willingness/ability to self-quarantine; and 3) intention of COVID-19 vaccination. We estimated the relationships between 1) political preferences 2) underlying health status, and 3) being a caretaker to someone with high-risk conditions and each dependent variable. Sensitivity analyses examined the associations between political preference and dependent variables among participants with high-risk conditions and/or obesity.Results: Among 908 participants, 75.2% engaged in social-distancing, 94.4% were willing/able to self-quarantine, and 60.1% intended to get vaccinated. Compared to participants intending to vote for Biden, participants who intended to vote for Trump were significantly less likely to have tried to socially-distance, self-quarantine, or intend to be vaccinated. We observed the same trends in analyses restricted to participants with underlying health conditions and their caretakers Underlying health status was independently associated with social distancing among individuals with obesity and another high-risk condition, but not other outcomes.Conclusion: Engagement in preventative behavior is associated with political voting preference and not individual risk of severe COVID-19 or being a caretaker of a high-risk individual. Community based strategies and public health messaging should be tailored to individuals based on political preferences especially for those with obesity and other high-risk conditions. Efforts must be accompanied by broader public policy. [ABSTRACT FROM AUTHOR]

Background: The principle of equity is fundamental to many current debates about social issues and plays an important role in community and individual health. Traditional research has focused on singular dimensions of equity (e.g., wealth), and often lacks a comprehensive perspective. The goal of this study was to assess relationships among three domains of equity, health, wealth, and civic engagement, in a nationally representative sample of U.S. residents. Methods: We developed a conceptual framework to guide our inquiry of equity across health, wealth, and civic engagement constructs to generate a broad but nuanced understanding of equity. Through Ipsos' KnowledgePanel service, we conducted a cross-sectional, online survey between May 29–June 20, 2020 designed to be representative of the adult U.S. population. Based on our conceptual framework, we assessed the population-weighted prevalence of health outcomes and behaviors, as well as measures of wealth and civic engagement. We linked individual-level data with population-level environmental and social context variables. Using structural equation modeling, we developed latent constructs for wealth and civic engagement, to assess associations with a measured health variable. Results: We found that the distribution of sociodemographic, health, and wealth measures in our sample (n = 1267) were comparable to those from other national surveys. Our quantitative illustration of the relationships among the domains of health, wealth, and civic engagement provided support for the interrelationships of constructs within our conceptual model. Latent constructs for wealth and civic engagement were significantly correlated (p = 0.013), and both constructs were used to predict self-reported health. Beta coefficients for all indicators of health, wealth, and civic engagement had the expected direction (positive or negative associations). Conclusion: Through development and assessment of our comprehensive equity framework, we found significant associations among key equity domains. Our conceptual framework and results can serve as a guide for future equity research, encouraging a more thorough assessment of equity. [ABSTRACT FROM AUTHOR]

Previous studies suggested that almost one-third of U.S. adults did not plan to get a COVID-19 vaccine once it is available to them. The purpose of this study was to examine changes in vaccine intentions and attitudes by sociodemographic characteristics and geographic areas, factors associated with vaccination intent, and reasons for non-vaccination among a nationally representative sample of U.S. adults. Data from six waves of the Household Pulse Survey (6 January – 29 March 2021) were analyzed. Differences between January and March were assessed using t-tests. Factors associated with vaccination intent were examined in multivariable logistic regression models. From early January to late March, vaccination receipt of ≥1 dose of the COVID-19 vaccine or intention to definitely get vaccinated increased from 54.7 to 72.3%; however, disparities in vaccination intent continued to exist by age group, race/ethnic groups, and socioeconomic characteristics. Vaccine receipt and the intent were the lowest for region 4 (southeastern U.S.) throughout this period. Adults who had a previous COVID-19 diagnosis or were unsure if they have had COVID-19 were less likely to intend to get vaccinated [prevalence ratio = 0.92 (95%CI: 0.90–0.93) and 0.80 (95%CI: 0.74–0.85), respectively]. The belief that a vaccine is not needed increased by more than five percentage points from early January to late March. Intent to definitely get a COVID-19 vaccine increased by almost 18 percentage points from early January to late March; however, younger adults, adults who are non-Hispanic Black or other races, adults of lower socioeconomic status, and adults living in the southeastern U.S. region (Region 4) continue to have higher coverage gaps and levels of vaccine hesitancy. Emphasizing the importance of vaccination among all populations, and removing barriers to vaccines, may lead to a reduction of COVID-19 incidence and bring an end to the pandemic. Receipt of ≥1 dose of the COVID-19 vaccine and intent to probably or definitely get vaccinated increased from early January to late March; however, disparities in vaccine intent continued to exist by age group, race/ethnic groups, and socioeconomic characteristics. Vaccine receipt and the intent were the lowest for region 4 (southeastern U.S.) compared to other regions during this period. Adults who had a previous COVID-19 diagnosis or were unsure if they have had COVID-19 were less likely to intend to get vaccinated; overall, the belief that a vaccine is not needed to be increased by more than 5% points from early January to late March. [ABSTRACT FROM AUTHOR]

Widespread uptake of the COVID-19 vaccine is critical to halt the pandemic. At present, little is known about factors that will affect vaccine uptake, especially among diverse racial/ethnic communities that have experienced the highest burden of COVID. We administered an online survey to a Qualtrics respondent panel of women ages 27–45 years (N = 396) to assess vaccine intentions and attitudes, and trusted vaccine information sources. 56.8% intended to be vaccinated and 25.5% were unsure. In bivariate analyses, a greater percentage of non-Latina White (NLW) and Chinese women reported that they would be vaccinated, compared with Latina and non-Latina Black (NLB) women (p < 0.001). Those who were uninsured, unemployed and those with lower incomes were less likely to say that they would be vaccinated. In analyses stratified by race/ethnicity, NLB women remained significantly less likely to report that they would be vaccinated compared with NLW women (adjusted odds ratio: 0.47; 95% confidence interval: 0.23, 0.94), controlling for age, marital status, income, education, employment, and insurance status. When analyses were additionally controlled for beliefs in vaccine safety and efficacy, racial/ethnic differences were no longer significant (adjusted odds ratio: 0.64; 95% confidence interval: 0.31, 1.34). Given that NLB women were less likely to report the intention to be vaccinated, targeted efforts will be needed to promote vaccine uptake. It will be critical to emphasize that the vaccine is safe and effective; this message may be best delivered by trusted community members. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies suggested that almost one-third of U.S. adults did not plan to get a COVID-19 vaccine once it is available to them. The purpose of this study was to examine changes in vaccine intentions and attitudes by sociodemographic characteristics and geographic areas, factors associated with vaccination intent, and reasons for non-vaccination among a nationally representative sample of U.S. adults. Methods: Data from six waves of the Household Pulse Survey (6 January - 29 March 2021) were analyzed. Differences between January and March were assessed using t-tests. Factors associated with vaccination intent were examined in multivariable logistic regression models. Results: From early January to late March, vaccination receipt of ≥1 dose of the COVID-19 vaccine or intention to definitely get vaccinated increased from 54.7 to 72.3%; however, disparities in vaccination intent continued to exist by age group, race/ethnic groups, and socioeconomic characteristics. Vaccine receipt and the intent were the lowest for region 4 (southeastern U.S.) throughout this period. Adults who had a previous COVID-19 diagnosis or were unsure if they have had COVID-19 were less likely to intend to get vaccinated [prevalence ratio = 0.92 (95%CI: 0.90-0.93) and 0.80 (95%CI: 0.74-0.85), respectively]. The belief that a vaccine is not needed increased by more than five percentage points from early January to late March. Conclusion: Intent to definitely get a COVID-19 vaccine increased by almost 18 percentage points from early January to late March; however, younger adults, adults who are non-Hispanic Black or other races, adults of lower socioeconomic status, and adults living in the southeastern U.S. region (Region 4) continue to have higher coverage gaps and levels of vaccine hesitancy. Emphasizing the importance of vaccination among all populations, and removing barriers to vaccines, may lead to a reduction of COVID-19 incidence and bring an end to the pandemic. [ABSTRACT FROM AUTHOR]

Background: Uptake and completion of the HPV vaccine is suboptimal. This study assessed the feasibility of implementing a one-month Twitter campaign to promote knowledge about the human papillomavirus (HPV) vaccine among low-income women living in public housing.Methods: We recruited a convenience sample (n = 35) of women ages 18-26 years residing in low-come, public housing in Massachusetts. We assessed the feasibility and acceptability of a communication campaign that consisted of daily Twitter messages. Online surveys assessed changes in HPV knowledge, attitudes, and vaccine intentions before and after the campaign.Results: Most believed that Twitter was an acceptable educational strategy and remained engaged with the campaign throughout the intervention. We observed no changes in HPV knowledge, perceived benefits of or barriers to vaccination, decision self-efficacy, or vaccine intentions after the campaign, although perceived risk for cervical cancer decreased.Conclusions: Twitter may be a feasible and acceptable method for promoting knowledge about the HPV vaccine, but more research is needed to understand how best to reach low-income women with low levels of vaccine uptake.Trial Registration: Clinicaltrials.gov 1,603,045, retrospectively registered 0610/19. [ABSTRACT FROM AUTHOR]

In general, it has been found that cancer fatalism is negatively associated with important cancer prevention and control behaviors, whereas religiosity is positively associated with these behaviors. Yet, the notion that religiosity gives rise to fatalistic beliefs that may discourage health behaviors is deeply ingrained in the public health literature. In addition, racial/ethnic group membership is associated with higher reports of cancer fatalism, though this association may be confounded by socioeconomic status (SES). A better understanding of the relationships between racial/ethnic group membership, SES, and religiosity may contribute to the development of effective interventions to address cancer fatalism and improve health behaviors. In this study, we examined associations between racial/ethnic group membership, SES, and cancer fatalism as the outcome. In addition, we tested whether religiosity (as measured by religious service attendance) moderated these relationships. [ABSTRACT FROM AUTHOR]

Routine prostate cancer screening is not recommended but African American men who are at higher risk for the disease should be offered the opportunity for shared decision-making with their health-care providers. This qualitative study sought to better understand the potential role of women in educating their male spouses/partners about prostate cancer screening. Nine focus groups were conducted (n = 52). Women were recruited from a variety of community venues. Those eligible were African American and married to or in a partnership with an African American male age ≥ 45. Women provide numerous types of support to their male partners in an effort to facilitate participation in preventive health care. While women agreed that they would like to educate their partners about prostate cancer screening, they had little information about screening guidelines or the potential harms and limitations. The current findings suggest that women are eager information-seekers and can disseminate information to men and facilitate their efforts to make more informed decisions about prostate cancer screening. Women should be included in educational interventions for to promote informed decision-making for prostate cancer screening. [ABSTRACT FROM AUTHOR]

Background: This paper identifies and describes measures of constructs relevant to the adoption or implementation of innovations (i.e., new policies, programs or practices) at the organizational-level. This work is intended to advance the field of dissemination and implementation research by aiding scientists in the identification of existing measures and highlighting methodological issues that require additional attention.Methods: We searched for published studies (1973-2013) in 11 bibliographic databases for quantitative, empirical studies that presented outcome data related to adoption and/or implementation of an innovation. Included studies had to assess latent constructs related to the "inner setting" of the organization, as defined by the Consolidated Framework for Implementation Research.Results: Of the 76 studies included, most (86%) were cross sectional and nearly half (49%) were conducted in health care settings. Nearly half (46%) involved implementation of evidence-based or "best practice" strategies; roughly a quarter (26%) examined use of new technologies. Primary outcomes most often assessed were innovation implementation (57%) and adoption (34%); while 4% of included studies assessed both outcomes. There was wide variability in conceptual and operational definitions of organizational constructs. The two most frequently assessed constructs included "organizational climate" and "readiness for implementation." More than half (55%) of the studies did not articulate an organizational theory or conceptual framework guiding the inquiry; about a third (34%) referenced Diffusion of Innovations theory. Overall, only 46% of articles reported psychometric properties of measures assessing latent organizational characteristics. Of these, 94% (33/35) described reliability and 71% (25/35) reported on validity.Conclusions: The lack of clarity associated with construct definitions, inconsistent use of theory, absence of standardized reporting criteria for implementation research, and the fact that few measures have demonstrated reliability or validity were among the limitations highlighted in our review. Given these findings, we recommend that increased attention be devoted toward the development or refinement of measures using common psychometric standards. In addition, there is a need for measure development and testing across diverse settings, among diverse population samples, and for a variety of types of innovations. [ABSTRACT FROM AUTHOR]

Most professional organizations, including the American College of Physicians and U.S. Preventive Services Task Force, emphasize that screening for prostate cancer with the prostate-specific antigen (PSA) test should only occur after a detailed discussion between the health-care provider and patient about the known risks and potential benefits of the test. In fact, guidelines strongly advise health-care providers to involve patients, particularly those at elevated risk of prostate cancer, in a "shared decision making" (SDM) process about PSA testing. We analyzed data from the National Cancer Institute's Health Information National Trends Survey 2011-2012-a nationally representative, cross-sectional survey-to examine the extent to which health professionals provided men with information critical to SDM prior to PSA testing, including (1) that patients had a choice about whether or not to undergo PSA testing, (2) that not all doctors recommend PSA testing, and (3) that no one is sure if PSA testing saves lives. Over half (55 %) of men between the ages of 50 and 74 reported ever having had a PSA test. However, only 10 % of men, regardless of screening status, reported receiving all three pieces of information: 55 % reported being informed that they could choose whether or not to undergo testing, 22 % reported being informed that some doctors recommend PSA testing and others do not, and 14 % reported being informed that no one is sure if PSA testing actually saves lives. Black men and men with lower levels of education were less likely to be provided this information. There is a need to improve patient-provider communication about the uncertainties associated with the PSA test. Interventions directed at patients, providers, and practice settings should be considered. [ABSTRACT FROM AUTHOR]

In January 2010, a massive earthquake struck Haiti. The devastation not only affected those living in Haiti at the time but also those Haitians living in the United States (U.S.). Few studies have assessed the degree of impact of the earthquake in U.S. Haitian communities. The purpose of this study was to elicit information about health priorities, concerns and resources needed to improve the delivery of health and social care for Haitians in Boston, MA. We conducted six focus groups among 78 individuals in the spring of 2011. Participants were recruited through community organisations, including churches, Haitian social service centres, restaurants and by word of mouth. Analysis of qualitative data revealed an enormous psychological, emotional, financial and physical toll experienced by Boston-area Haitians following the earthquake. Participants described increased distress, depressive episodes, headaches and financial hardship. They also noted insufficient resources to meet the increased needs of those living in the U.S., and those who had immigrated after the earthquake. Most participants cited an increased need for mental health services, as well as assistance with finding employment, navigating the immigration system, and balancing the health and financial needs of families in the U.S. and in Haiti. Despite this, many reported that the tragedy created a sense of unity and solidarity within the Haitian community. These findings corroborate the need for culturally and linguistically appropriate mental health services, as well as for employment, immigration and healthcare navigation services. Participants suggested that interventions be offered through Haitian radio and television stations, as well as group events held in churches. Further research should assess the need for and barriers to utilisation of mental health services among the Haitian community. A multi-faceted approach that includes a variety of outreach strategies implemented through multiple channels may offer a means of improving awareness of and access to health and social services. [ABSTRACT FROM AUTHOR]

Background: The CRUZA randomized trial tested the efficacy of an organizational-level intervention to increase the capacity of Catholic faith-based organizations (FBOs) serving Latinos to implement evidence-based strategies (EBS) for cancer control.Methods: Thirty-one Catholic parishes were enrolled. Twenty were randomized to a "capacity enhancement" (CE) intervention and 11 to a "standard dissemination" (SD) condition. Each received a Program Implementation Manual and Toolkit of materials culturally adapted for FBOs with Latino audiences for five types of EBS recommended by the US Preventive Services Community Guide. CE parishes were offered a menu of capacity-building activities over a 3-month period, while SD parishes were provided a one-time consultation by an Intervention Specialist. Baseline and follow-up surveys compared the number and types of EBS offered.Results: At baseline, only one parish had offered any cancer-related program in the prior year, yet a third (36 %) had offered some other type of health program or service. At post-intervention follow-up, all parishes offered a greater number of EBS. The only statistically significant difference between CE and SD groups was the number of parishes offering small media interventions (90 % in CE, 64 % in SD; p < 0.05).Conclusions: All parishes increased the number of cancer control activities offered to their members. These findings suggest that Catholic parishes may already have capacity to implement EBS if they are appropriately adapted and packaged and may only require low levels of support to carry out programming. Further research is needed to examine the extent to which program offerings continued after the period of grant funding.Trial Registration: Clinicaltrials.gov NCT01740219 . [ABSTRACT FROM AUTHOR]

BACKGROUND: Accumulating evidence suggests that worksite interventions integrating worksite health promotion (WHP) and occupational safety and health (OSH) may be more efficacious and have higher participation rates than health promotion programs offered alone. However, dissemination of integrated programs is complicated by lack of tools for implementation -particularly for small and medium-sized businesses (SMBs). OBJECTIVE: The goal of this study is to describe perceptions of acceptability and feasibility of implementing an integrated approach to worker health that coordinates WHP and OSH in SMBs. METHODS: In September to November 2012, decision-makers for employee health programming within SMBs (< 750 employees) in greater Minneapolis were identified. Fourteen semi-structured interviews were conducted and analyzed to develop an understanding of perceived benefits and barriers, awareness, and capacity for implementing an integrated approach. RESULTS: Worker health was widely valued by participants. They reported strong management support for improving employee health and safety. Most participants indicated that their company was open to making changes in their approach to worker health; however, cost and staffing considerations were frequently perceived as barriers. CONCLUSIONS: There are opportunities for implementing integrated worksite health programs in SMBs with existing resources and values. However, challenges to implementation exist, as these worksites may lack the appropriate resources. [ABSTRACT FROM AUTHOR]

Background. We describe activities undertaken to conduct organizational surveys among faith-based organizations in Massachusetts as part of a larger study designed to promote parish-based cancer control programs for Latinos. Method. Catholic parishes located in Massachusetts that provided Spanish-language mass were eligible for study participation. Parishes were identified through diocesan records and online directories. Prior to parish recruitment, we implemented a variety of activities to gain support from Catholic leaders at the diocesan level. We then recruited individual parishes to complete a four-part organizational survey, which assessed (A) parish leadership, (B) financial resources, (C) involvement in Hispanic Ministry, and (D) health and social service offerings. Our goal was to administer each survey component to a parish representatives who could best provide an organizational perspective on the content of each component (e.g., A = pastors, B = business managers, C = Hispanic Ministry leaders, and D = parish nurse or health ministry leader). Here, we present descriptive statistics on recruitment and survey administration processes. Results. Seventy-five percent of eligible parishes responded to the survey and of these, 92% completed all four components. Completed four-part surveys required an average of 16.6 contact attempts. There were an average of 2.1 respondents per site. Pastoral staff were the most frequent respondents (79%), but they also required the most contact attempts (M = 9.3, range = 1-27). While most interviews were completed by phone (71%), one quarter were completed during in-person site visits. Conclusions. We achieved a high survey completion rate among organizational representatives. Our lessons learned may inform efforts to engage and survey faith-based organizations for public health efforts. [ABSTRACT FROM AUTHOR]

Background: Faith-based organizations (FBOs) have been successful in delivering health promotion programs for African Americans, though few studies have been conducted among Latinos. Even fewer have focused on organizational change, which is required to sustain community-based initiatives. We hypothesized that FBOs serving Latinos would be more likely to offer evidence-based strategies (EBS) for cancer control after receiving a capacity enhancement intervention to implement health programs, and designed the CRUZA trial to test this hypothesis. This paper describes the CRUZA design and baseline findings. Methods: We identified Catholic parishes in Massachusetts that provided Spanish-language mass (n = 65). A baseline survey assessed organizational characteristics relevant to adoption of health programs, including readiness for adoption, "fit" between innovation and organizational mission, implementation climate, and organizational culture. In the next study phase, parishes that completed the baseline assessment will be recruited to a randomized cluster trial, with the parish as the unit of analysis. Both groups will receive a Program Manual and Toolkit. Capacity Enhancement parishes will also be offered technical support, assistance forming health committees and building inter-institutional partnerships, and skills-based training. Results: Of the 49 parishes surveyed at baseline (75%), one-third (33%) reported having provided at least one health program in the prior year. However, only two program offerings were cancer-specific. Nearly one-fifth (18%) had an active health ministry. There was a high level of organizational readiness to adopt cancer control programs, high congruence between parish missions and CRUZA objectives, moderately conducive implementation climates, and organizational cultures supportive of CRUZA programming. Having an existing health ministry was significantly associated with having offered health programs within the past year. Relationships between health program offerings and other organizational characteristics were not statistically significant. Conclusions: Findings suggest that many parishes do not offer cancer control programs, yet many may be ready to do so. However, the perceptions about existing organizational practices and policies may not be conducive to program initiation. A capacity enhancement intervention may hold promise as a means of increasing health programming. The efficacy of such an intervention will be tested in phase two of this study. [ABSTRACT FROM AUTHOR]

Objectives: To assess cancer perceptions among churchgoers and to examine the potential influence of fatalism and religious beliefs on the use of cancer screening tests. Methods: Eight semi-structured focus groups were conducted among 67 Hispanic Catholics in Massachusetts. Results: In this sample, there were few references to fatalistic beliefs about cancer and nearly universal endorsement of the utility of cancer screening for cancer early detection. Most participants reported that their religious beliefs encouraged them to use health services, including cancerscreening tests. Although participants agreed that God plays an active role in health, they also affirmed the importance of self-agency in determining cancer outcomes. Conclusions: Our findings challenge the assumption that fatalism is an overriding perspective among Hispanics. Catholic religious beliefs may contribute to positive health attitudes and behaviors. [ABSTRACT FROM AUTHOR]

Although most U.S. Latinos identify as Catholic, few studies have focused on the influence of this religious tradition on health beliefs among this population. This study explores the role of Catholic religious teachings, practices, and ministry on cancer screening knowledge, attitudes, and behaviors among Latinos. Eight focus groups were conducted with 67 Catholic Latino parishioners in Massachusetts. Qualitative analysis provided evidence of strong reliance on faith, God, and parish leaders for health concerns. Parishes were described as vital sources of health and social support, playing a central role in the community's health. Participants emphasized that their religious beliefs promote positive health behaviors and health care utilization, including the use of cancer screening services. In addition, they expressed willingness to participate in cancer education programs located at their parishes and provided practical recommendations for implementing health programs in parishes. Implications for culturally appropriate health communication and faith-based interventions are discussed. [ABSTRACT FROM AUTHOR]

Background: Special events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening. Methods: Articles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers. Results: Of the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50–1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening. Conclusions: Special events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening. [ABSTRACT FROM AUTHOR]

Background The 2009 U.S. Preventive Services Task Force (USPSTF) changed mammography guidelines to recommend routine biennial screening starting at age 50. This study describes women's awareness of, attitudes toward, and intention to comply with these new guidelines. Methods Women ages 40-50 years old were recruited from the Boston area to participate in focus groups (k = 8; n = 77). Groups were segmented by race/ethnicity (Caucasian = 39%; African American = 35%; Latina = 26%), audio-taped, and transcribed. Thematic content analysis was used. Results Participants were largely unaware of the revised guidelines and suspicious that it was a cost-savings measure by insurers and/or providers. Most did not intend to comply with the change, viewing screening as obligatory. Few felt prepared to participate in shared decision-making or advocate for their preferences with respect to screening. Conclusions Communication about the rationale for mammography guideline changes has left many women unconvinced about potential disadvantages or limitations of screening. Since further guideline changes are likely to occur with advances in technology and science, it is important to help women become informed consumers of health information and active participants in shared decision-making with providers. Additional research is needed to determine the impact of the USPSTF change on women's screening behaviors and on breast cancer outcomes. [ABSTRACT FROM AUTHOR]

Objective: To describe parents' knowledge, attitudes, and decision-making with regard to obtaining the HPV vaccine for their daughters. Methods:White, Black, and Hispanic parents of daughters who were age eligible to receive the HPV vaccine (9-17 years) were recruited from community settings to participate in focus groups. Parents were asked about knowledge and awareness ofHPV, decision-making about HPV vaccine, as well as preferred and actual sources of HPV information. Results: Seven focus groups (n = 64 participants) were conducted. Groups were segmented by gender (women = 72%) and race/ethnicity (Black = 59%; White = 23%; Hispanic = 19%). Prevalent themes included: insufficient information to make informed decisions; varied preferences for involvement in decision-making; concerns about vaccine safety; mistrust of medical providers and pharmaceutical companies; and mismatch between actual and preferred sources of information. Discussion: Improving communication between providers and caregivers and helping parents to access information necessary for informed decision-making, while alleviating concerns about vaccine safety, may help to improve vaccine acceptance. [ABSTRACT FROM AUTHOR]

Breast cancer is a growing concern in low- and middle-income countries (LMCs). We explore community health worker (CHW) programs and describe their potential use in LMCs. We use South Africa as an example of how CHWs could improve access to breast health care because of its middle-income status, existing cancer centers, and history ofCHWprograms. CHWs could assume three main roles along the cancer control continuum: health education, screening, and patient navigation. By raising awareness about breast cancer through education, women are more likely to undergo screening. Manymore women can be screened resulting in earlier-stage disease if CHWs are trained to perform clinical breast exams. As patient navigators, CHWs can guide women through the screening and treatment process. It is suggested that these roles be combined within existing CHW programs to maximize resources and improve breast cancer outcomes in LMCs. [ABSTRACT FROM AUTHOR]

Background. The efficacy of prostate cancer (CaP) screening with the prostate-specific antigen (PSA) test is debated. Most medical organizations recommend that men make individual, informed decisions about whether to undergo screening. Informed decision making (IDM) requires adequate knowledge about CaP as well as the risks and benefits of screening; confidence in the ability to participate in decision making at a personally desired level (decision self-efficacy); and decision making that reflects one’s values and preferences (decisional consistency). Methods. Baseline data from a randomized trial in 12 worksites were analyzed. Men aged 45+ (n = 812) completed surveys documenting screening history, screening preferences and decisions, CaP knowledge, decision self-efficacy, and decisional consistency. Psychosocial and demographic correlates of IDM were also assessed. Results. Approximately half of the sample had a prior PSA test, although only 35% reported having made an explicit screening decision. Across the sample, CaP knowledge was low (mean = 56%), although decision self-efficacy was high (mean = 78%), and the majority of men (81%) made decisions consistent with their stated values. Compared with those who were undecided, men who made an explicit screening decision had significantly higher levels of knowledge, greater decisional self-efficacy, and were more consistent in terms of making a decision in alignment with their values. They tended to be white, have high levels of income and education, and had discussed screening with their health care provider. Conclusions. Many men undergo CaP screening without being fully informed about the decision. These findings support the need for interventions aimed at improving IDM about screening, particularly among men of color, those with lower levels of income and education, and those who have not discussed screening with their provider. [ABSTRACT FROM PUBLISHER]