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Using the "3Cs" vaccine hesitancy framework which categorizes determinants of vaccine hesitancy across three dimensions-confidence, complacency, and convenience-we identify factors that shape COVID-19 vaccination intake and intention among Black and white residents in Southeast Michigan. We consider both historical discrimination in medicine and contemporary health and environmental crises (i.e., the Flint Water Crisis) as potential correlates. This study uses data from an online survey conducted between March-April 2021 in Flint and surrounding counties. we find that while historical mistreatment of Black people in healthcare and the Flint Water Crisis were of concern, those factors did not directly impact vaccination intention. Rather, concerns over safety, efficacy, and structural barriers related to access and occupation emerge as responsible for lower vaccination rates among Black residents. Effective vaccination programs require that public health authorities consider multiple factors, including the structural realities faced by racial ethnic minority groups which shape their vaccination decisions., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness., Competing Interests: The authors have declared that no competing interests exist.

Effective risk communication strategies are critical to reducing lead exposure in mining-impacted communities. Understanding the strength of the associations between perceived risk and individuals' behavioral intentions to protect their health is important for developing these strategies. We conducted a survey within three communities of northern Idaho, USA ( n = 306) in or near a Superfund Megasite with legacy mining contamination. Survey data were used to test a theoretical model based on the Health Belief Model. Respondents had higher intentions to practice health protective behaviors when they perceived the risk of lead contamination as severe and recognized the benefits of practicing health protective behaviors. Women reported higher behavioral intentions than men, but age and mining affiliation were not significantly associated with behavioral intentions. Although managing lead hazards in communities impacted by mining is challenging due to widely distributed contamination, effective health risk messages, paired with remediation, are powerful tools to protect the health and safety of residents.

Using interviews with residents of Idaho (a rural northwest US state) who identify as skeptical of climate change, we examine how skeptics rationalize their doubts about climate science. Skeptics tend to question the reality and human causes of climate change by (1) raising concerns about incentive structures in science that could bias climatology, (2) doubting the accuracy of data and models used by climate scientists, and (3) perceiving some practices of climate science and scientists as exclusionary. Despite these concerns, skeptics exhibit deference to scientific authority when using scientific assessments to make policy decisions, including environmental policy. Understanding skeptics' concerns about climate science and areas where they support science-based policy, will lead to better dialogue between scientists, interest groups, policy makers, and the skeptical public, potentially clarifying avenues to communicate climate information and enact climate policy.

Accurately measuring vaccine acceptance is important, especially under current conditions in which misinformation may increase public anxiety about vaccines and politicize vaccination policies. We integrated substantive knowledge, conceptualization and measurement expertise, and survey design principles to develop an instrument for measuring vaccine acceptance across the general public. Given this broad goal, we expect our novel instrument will complement, rather than replace, existing instruments designed specifically to measure parents' vaccine hesitancy. Our instrument measures five key facets of vaccine acceptance: (1) perceived safety of vaccines; (2) perceived effectiveness and necessity of vaccines; (3) acceptance of the selection and scheduling of vaccines; (4) positive values and affect toward vaccines; and (5) perceived legitimacy of authorities to require vaccinations. We report results of analyses demonstrating the reliability and validity of this instrument. High Cronbach's alpha values for five sub-scales and for the full scale indicate the instrument's reliability, and the consistent performance of expected predictors (i.e., trust in biologists, conspiratorial ideation, and political ideology) demonstrates the instrument's construct validity. Further, scientific reasoning increases vaccine acceptance among liberals but decreases vaccine acceptance among conservatives, which is consistent with motivated cognition. Also, trust in biologists has a stronger positive effect on vaccine acceptance among conservatives than among liberals, signaling a potentially promising means to reduce political polarization on vaccines and increase vaccine acceptance across the general public. We end by identifying key ways that public health researchers, science studies scholars, and health practitioners may employ the full (or short) version of our vaccine acceptance instrument., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In the past decade the U.S. public has expressed varying degrees of skepticism about certain factual claims, and of "expertise" more broadly. Ideological and partisan belief polarization seems to have elevated public anxiety about topics ranging from climate change and vaccines to immigration and healthcare policy. Furthermore, polarized narratives about scientific, medical, and political topics have encouraged "directionally motivated cognition", leading to a decline in institutional trust among some fractions of the U.S. political spectrum. Our case study of the Tea Party Patriots (TPP) (i.e. a political organization that promotes the Tea Party goals) uses data from 45 interviews, 80 hours of participant observation, and content analysis of movement literature, to examine the nature and nuance of health narratives employed by the Tea Party. Specifically, we explain a central narrative in TPP organizing that features "a villainous Left covertly seeking to harm U.S. citizens" as the root of three key TPP health care narratives: (1) Democratic health initiatives enslaving youth; (2) the political left profiting from covertly making Americans dependent on state's health care programs; and (3) the left clandestinely seeking to violate the constitution as represented by their efforts to "kill grandma". These narratives reflect the increased polarization of attitudes towards healthcare, as well as a broader distrust of the political left who, activists believe, are advancing a political agenda of social control. Ultimately, we argue that culturally driven healthcare narratives of the Tea Party have had a significant impact on right-wing public opinion and Republican politics regarding U.S. healthcare policy. Many Tea Party concerns are reflected in the Republican policy positions, including those related to the Affordable Care Act of 2010., Competing Interests: Conflicts of Interest: All authors declare no conflicts of interest in this paper.

Prior studies on population health have reported an "immigrant health advantage" in which immigrants tend to show better health outcomes compared to their native-born racial/ethnic counterparts. Migrant selectivity and cultural buffering have been proposed as explanations for this relative advantage, predominantly in studies that focus on Latino immigrants' health in the US. This study adds to the relatively scant literature on black immigrant health advantage by comparing the two hypotheses (migrant selectivity and cultural buffering) as related to black immigrant health. The effect of nativity on infant low birth weight is tested using data from the US Fragile Families and Child Wellbeing Study. Results indicate that immigrant black mothers do have relatively better health outcomes that may result from cultural buffering, which reduces their risky health behaviors.

Background: As an island and a former British colony, Sri Lanka is a case of special interest for the study of 1918-1919 influenza pandemic because of its potential for isolation from as well as integration into the world epidemiologic system., Objectives: To estimate population loss attributable to the influenza pandemic and weekly district-level excess mortality from the pandemic to analyze its spread across the island., Methods: To measure population loss, we estimated a population growth model using a panel of 100 district-level observations on population for five consecutive censuses from 1891 to 1931, allowing for a one-time drop in population in 1918-1919. To estimate weekly excess mortality from the pandemic, we estimated a seasonally adjusted weekly time series of district-specific mortality estimates from vital registration records, ranked them, and plotted the ranks on weekly maps to create a picture of the geographic pattern of propagation across Sri Lanka., Results: Total loss of population from the influenza pandemic was 307 000 or approximately 6·7% of the population. The pandemic peaked in two discrete (northern and southern) regions in early October of 1918 and in a third (central) region in early March 1919., Conclusions: The population loss estimate is significantly higher than earlier estimates of mortality from the pandemic in Sri Lanka, suggesting underreporting of influenza-attributable deaths and a role for influenza-related fertility declines. The spatial pattern of peak mortality indicates the presence of two distinct entry points and three distinct epidemiologic regions, defined by population density and ethnicity, in colonial Sri Lanka., (© 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)