Partners’ Consensus About Joint Effort and COVID-19 Prevention Among Sexual Minority Men

The current study examined the relevance of relationship functioning to partners’ agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with better relationship functioning tend to be more successful at negotiating joint (shared) goals and subsequently accomplishing them. The study recruited 134 cis-male, SARS-CoV-2 negative adults in relationships with cis-male partners from phone-based social networking applications. Participants completed an online survey assessing relationship functioning (Perceived Relationship Components Questionnaire), COVID-19 prevention behaviors, and risk perceptions. Partners’ consensus around joint COVID-19 prevention effort was assessed using an adapted version of the Preferences for Sexual Health Outcomes scale. Path analyses indicated that consensus for joint prevention effort predicted social distancing (B?=?0.23; p?=?.001) and the number of other COVID-19 prevention behaviors engaged in (B?=?0.17; p?=?.003) above and beyond perceived risk and relationship functioning. Relationship satisfaction predicted higher levels of consensus for joint COVID-19 prevention effort (B?=?0.40; p?=?.029). Findings suggest that the theoretical foundations of successful HIV prevention interventions that utilize joint goal formation may generalize to the prediction of COVID-19 prevention behavior and may be leveraged to mitigate the risk of SARS-CoV-2 infection among SMM in relationships. Interventions that overlook the potential for dyadic regulation of health behavior may miss opportunities to capitalize on shared coping resources and fail to address relational barriers to prevention.

     

How Can I Get COVID?: Understanding Differences in American Heterosexual and Sexual Minority Men’s Risk Perception

Men are more vulnerable to COVID-19 infections compared to women, but their risk perceptions around COVID-19 are persistently lower. Further, men often engage in less health promotion behavior because self-care in this capacity is seen as weak or less masculine. This combination has consequences for mortality; thus, a better understanding of men’s COVID-19 cognitions and individual difference factors is critical. In a web-based survey conducted during the beginning stages of the pandemic in the U.S., we collected risk perceptions of various sexual and non-sexual behaviors from heterosexual (n?=?137) and gay/bisexual men (n?=?108). There were no significant sexual orientation differences for perceptions of COVID-19 risk from routine activities or in overall risk estimates. However, gay/bisexual men did report engaging in more precautionary behavior while socializing (i.e., masking, social distancing) and reported higher risk perceptions than did heterosexual men for nearly all intimate and sexual activities. A more nuanced understanding of cognitions around COVID-19 is needed to better understand motivation for—and especially motivation against—pursuing vaccinations and continuing precautionary behavior.

     

Dynamic Public Perceptions of the Coronavirus Disease Crisis,the Netherlands, 2020

A key component of outbreak control is monitoring public perceptions and public response. To determine public perceptions and public responses during the first 3 months of the coronavirus disease (COVID-19) outbreak in the Netherlands, we conducted 6 repeated surveys of ≈3,000 persons. Generalized estimating equations analyses revealed changes over time as well as differences between groups at low and high risk. Overall, respondents perceived the risks associated with COVID-19 to be considerable, were positive about the mitigation measures, trusted the information and the measures from authorities, and adopted protective measures. Substantial increases were observed in risk perceptions and self-reported protective behavior in the first weeks of the outbreak. Individual differences were based mainly on participants’ age and health condition. We recommend that authorities constantly adjust their COVID-19 communication and mitigation strategies to fit public perceptions and public responses and that they tailor the information for different groups.     

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization’s conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.     

Do the vaccinated perform less distancing,mask wearing and hand hygiene? A test of the risk compensation hypothesis in a representative sample during the COVID-19 pandemic

The “risk compensation hypothesis” holds that vaccinated individuals may be less motivated to protect themselves using other COVID-19 mitigation behaviors—e.g., masking, distancing and hand hygiene—given that they may perceive their infection risk to be lower. The current investigation provides an empirical test of the risk compensation hypothesis in the COVID-19 context using prospective data from the Canadian COVID-19 Experiences Survey (CCES). The survey comprised 1,958 unvaccinated and fully vaccinated individuals drawn from a representative sample, using quota sampling to ensure substantial representation of unvaccinated individuals. Two waves of data were collected 6 months apart. Findings revealed that vaccinated individuals performed COVID-19 mitigation behaviors significantly more frequently than their unvaccinated counterparts, and they also showed lower rates of attenuation as the pandemic continued. In summary, our findings do not support the risk compensation hypothesis; instead they support the notion that people adopt vaccination and other protective behaviors in parallel.     

Strategies that Promote Equity in COVID-19 Vaccine Uptake for Undocumented Immigrants: A Review

There has been a dearth of reports that examine the effect of immigration status on COVID-19 vaccine hesitancy. While intention to be vaccinated has been higher among adults in immigrant families than non-immigrant adults, uptake of the vaccine has been lower among immigrants and especially those who are undocumented. Concerns raised by immigrants usually centered on the lack of access to information, language barriers, conflicts between work and clinic hours, and fears over their precarious status in the U.S. To perform a rapid review, our time frame was December 2020 through August 2021. Our search strategy used the PUBMED and Google search engines with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during the early period of roll-out and real-time perspectives were crucially needed. Strategies used to promote equity include the use of trusted leaders as well as direct communication styles. Other strategies centered informational messaging from government agencies and the medical community, with a strong emphasis on coalescing broad engagement of the community and being responsive to language and cultural needs. In addition to communication and messaging to educate about COVID-19 vaccines, another important aspect of COVID-19 vaccine uptake was overcoming multiple obstacles that affect ease of access. This report suggests that vaccine uptake, and more generally pandemic response, in vulnerable communities may be better able to launch when they build on existing, trusted, culturally intelligent community-based organizations and local sociocultural processes. These organizations need continued support to contribute to population health equity in emerging health crises.

     

Views on COVID-19 and Use of Face Coverings Among U.S. Youth

PurposeLittle is known about the views of U.S. youth on COVID-19 or their use of face coverings. Closing this gap could facilitate messaging to promote COVID-19 risk mitigation behaviors.MethodsIn July 2020, a five-question text message survey was sent to 1,087 youth aged 14–24 years. Questions assessed youths' perceptions regarding the likelihood of contracting COVID-19, the potential impact of contracting COVID-19 on their lives, the possibility of spreading COVID-19 to others, and their use of face coverings around others with whom they do not live. Coding was conducted to assign responses to discrete categories and to identify common themes.ResultsOf 1,087 eligible participants, 797 (73.3%) were included in analyses. Of these participants, 27.3% believed they would likely contract COVID-19 in the next few months, 90.3% believed contracting COVID-19 would have a moderate or significant impact on their lives, 86.0% were moderately or very concerned about spreading COVID-19, and 89.2% reported wearing face coverings all or most of the time. Factors affecting face covering use included the desire to avoid contracting and spreading COVID-19, peer influence, and policy mandates.ConclusionsYouths' perceptions regarding the risk of contracting COVID-19 varied, but most believed their lives would be adversely impacted if this occurred. Most youth were concerned about spreading COVID-19 and wore face coverings, but many made exceptions to face covering use when around close contacts. Public health campaigns may be most effective if they leverage positive peer influence and appeal to youths' desire not to spread COVID-19 to others.     

The Effect of Health Beliefs,Media Perceptions,and Communicative Behaviors on Health Behavioral Intention: An Integrated Health Campaign Model on Social Media

ABSTRACT

Social media have recently gained attention as a potential health campaign tool. This study examines this line of expectation concerning the role social media may play in health campaigns by testing an integrated health campaign model that combines insights from research on social media-specific perceptions and communicative behaviors in order to predict health behaviors. Specifically, this study aims to (a) develop a more holistic social media campaign model for predicting health behaviors in the social media context, (b) investigate how social media channel-related perceptions affect preventive health behaviors, and (c) investigate how communicative behaviors mediate perceptions and behavioral intention. The study conducted an online survey of 498 females who followed the Purple Ribbon Twitter campaign (@pprb), a cervical cancer prevention campaign. The results indicated that information acquisition mediated perceived risk’s effect on intention. Information acquisition also mediated the relationships between intention and information selection and information transmission. On the other hand, social media-related perceptions indirectly impacted behavioral intention through communicative behaviors. The findings’ theoretical and practical implications are discussed.     

COVID-19 vaccine perceptions in New York State's intellectual and developmental disabilities community

BackgroundPeople with intellectual and developmental disabilities (IDD) are at disproportionate risk for severe COVID-19 outcomes, particularly those living in congregate care settings. Yet, there is limited data on vaccine perceptions in the disability community.ObjectiveTo explore COVID-19 vaccine perceptions in individuals with IDD, their family members, and those who work with them, to inform a statewide vaccine information and messaging project.MethodsA national survey, adapted in five languages for the IDD community, was distributed to a convenience sample of IDD organizations throughout New York State. Constructs included vaccine intention, reasons for vaccine hesitancy, and trusted sources of vaccine information. Zip code data were used to map respondent location and vaccine preferences.ResultsOf n = 825 respondents, approximately 75% intended to or had received the vaccine across roles (i.e., people with developmental disabilities, family members, direct care workers) and racial/ethnic groups. Greater vaccine hesitancy was reported in younger individuals and those making decisions on behalf of a person with IDD. Concerns included side effects and the swiftness of vaccine development. Black and Hispanic participants had heightened concerns about being an “experiment” for the vaccine. Trusted sources of information included healthcare providers and family members. Respondents who intended to/received the vaccine were dispersed throughout the state.ConclusionsVaccine preferences in this New York State disability community sample align with national data. Identified concerns suggest the need for community education that addresses misperceptions. Age and race differences in perspectives highlight the need for tailored education, delivered by trusted messengers.     

A Qualitative Comparison of Susceptibility and Behavior in Recreational and Occupational Risk Environments: Implications for Promoting Health and Safety

Although internal factors that influence risk are frequently studied to understand human behavior, external factors, including social, cultural, and institutional factors, should be better utilized to inform ways to efficiently target, tailor, and promote safety messaging to at-risk populations. Semi-structured interviews obtained data from 37 motorcyclists and 18 mineworkers about their risk perceptions and behaviors within their respective dynamic environments. A comparative thematic analysis revealed information about external factors that influence risk perceptions and behaviors. Results support the importance of qualitative approaches for assessing and targeting individuals’ risk perceptions and behaviors. In addition, segmenting at-risk subgroups within target populations and tailoring messages for these at-risk groups is critical for safety behavior modification. Practitioners should utilize strategic, culture-centric risk communication that takes into account external factors when determining when, who, and what to communicate via health promotion activities to more accurately disseminate valid, empathetic, and engaging communication with a higher level of fidelity.     

Cross-Verification of COVID-19 Information Obtained From Unofficial Social Media Accounts and Associated Changes in Health Behaviors: Web-Based Questionnaire Study Among Chinese Netizens

BackgroundAs social media platforms have become significant sources of information during the pandemic, a significant volume of both factual and inaccurate information related to the prevention of COVID-19 has been disseminated through social media. Thus, disparities in COVID-19 information verification across populations have the potential to promote the dissemination of misinformation among clustered groups of people with similar characteristics.ObjectiveThis study aimed to identify the characteristics of social media users who obtained COVID-19 information through unofficial social media accounts and were (1) most likely to change their health behaviors according to web-based information and (2) least likely to actively verify the accuracy of COVID-19 information, as these individuals may be susceptible to inaccurate prevention measures and may exacerbate transmission.MethodsAn online questionnaire consisting of 17 questions was disseminated by West China Hospital via its official online platforms, between May 18, 2020, and May 31, 2020. The questionnaire collected the sociodemographic information of 14,509 adults, and included questions surveying Chinese netizens’ knowledge about COVID-19, personal social media use, health behavioral change tendencies, and cross-verification behaviors for web-based information during the pandemic. Multiple stepwise regression models were used to examine the relationships between social media use, behavior changes, and information cross-verification.ResultsRespondents who were most likely to change their health behaviors after obtaining web-based COVID-19 information from celebrity sources had the following characteristics: female sex (P=.004), age ≥50 years (P=.009), higher COVID-19 knowledge and health literacy (P=.045 and P=.03, respectively), non–health care professional (P=.02), higher frequency of searching on social media (P<.001), better health conditions (P<.001), and a trust rating score of more than 3 for information released by celebrities on social media (P=.005). Furthermore, among participants who were most likely to change their health behaviors according to social media information released by celebrities, female sex (P<.001), living in a rural residence rather than first-tier city (P<.001), self-reported medium health status and lower health care literacy (P=.007 and P<.001, respectively), less frequent search for COVID-19 information on social media (P<.001), and greater level of trust toward celebrities’ social media accounts with a trust rating score greater than 1 (P≤.04) were associated with a lack of cross-verification of information.ConclusionsThe findings suggest that governments, health care agencies, celebrities, and technicians should combine their efforts to decrease the risk in vulnerable groups that are inclined to change health behaviors according to web-based information but do not perform any fact-check verification of the accuracy of the unofficial information. Specifically, it is necessary to correct the false information related to COVID-19 on social media, appropriately apply celebrities’ star power, and increase Chinese netizens’ awareness of information cross-verification and eHealth literacy for evaluating the veracity of web-based information.     

COVID-19 vaccine intentions in the United States,a social-ecological framework

BackgroundCOVID-19 vaccine hesitancy is a major obstacle for pandemic mitigation. As vaccine hesitancy occurs along multiple dimensions, we used a social-ecological framework to guide the examination of COVID-19 vaccine intentions.MethodsUsing an online survey in the US conducted in July 2020, we examined intentions to obtain a COVID-19 vaccine, once available. 592 respondents provided data, including measures of demographics, vaccine history, social norms, perceived risk, and trust in sources of COVID-19 information. Bivariate and multivariate multinomial models were used to compare respondents who intended to be vaccinated against COVID-19 to respondents who did not intend or were ambivalent about COVID-19 vaccination.ResultsOnly 59.1% of the sample reported that they intended to obtain a COVID-19 vaccine. In the multivariate multinomial model, those respondents who did not intend to be vaccinated, as compared to those who did, had significantly lower levels of trust in the CDC as a source of COVID-19 information (aOR = 0.29, CI = 0.17–0.50), reported lower social norms of COVID-19 preventive behaviors (aOR = 0.67, CI 0.51–0.88), scored higher on COVID-19 Skepticism (aOR = 1.44, CI = 1.28–1.61), identified as more politically conservative (aOR = 1.23, CI = 1.05–1.45), were less likely to have obtained a flu vaccine in the prior year (aOR = 0.21, CI = 0.11–0.39), were less likely to be female (aOR = 0.51, CI = 0.29–0.87), and were much more likely to be Black compared to White (aOR = 10.70, CI = 4.09–28.1). A highly similar pattern was observed among those who were ambivalent about receiving a COVID-19 vaccine compared to those who intended to receive one.ConclusionThe results of this study suggest several avenues for COVID-19 vaccine promotion campaigns, including social network diffusion strategies and cross-partisan messaging, to promote vaccine trust. The racial and gender differences in vaccine intentions also suggest the need to tailor campaigns based on gender and race.     

“Any idea how fast ‘It’s just a mask!’ can turn into ‘It’s just a vaccine!’”: From mask mandates to vaccine mandates during the COVID-19 pandemic

Protests starting in the summer of 2020, notedly in the US and UK, have brought together two constituencies: pre-existing anti-vaccine groups and newly formed oppositional COVID-19 groups. The oppositional COVID-19 groups vary in composition and nature, but the central focus is a disagreement about the seriousness and threat of COVID-19 and with the public health measures to control COVID-19. What unites many disparate interests is an aversion to mandates. The compulsion to undertake particular public health activities such as mask-wearing and vaccination is a complex topic of public attitudes and beliefs alongside public health goals and messaging. We aim to analyse social media discussions about facemask wearing and the adoption of potential vaccines for COVID-19.Using media monitoring software Meltwater^TM, we analyse English-language tweets for one year from 1st June 2020 until 1st June 2021. We pay particular attention to connections in conversations between key topics of concern regarding masks and vaccines across social media networks. We track where ideas and activist behaviours towards both health interventions have originated, have similarities, and how they have changed over time.Our aim is to provide an overview of the key trends and themes of discussion concerning attitudes to and adoption of health measures in the control of COVID-19 and how publics react when confronted with mandatory policies. We draw on an already extensive literature about mandatory vaccination policies to inform our assessment, from psychology and behavioural science to ethics, political theory, sociology, and public policy.     

“I won’t be a guinea pig”: Rethinking public health communication and vaccine hesitancy in the context of COVID-19

At the beginning of 2021, when Canada started distribution of COVID-19 vaccines, the unprecedented scope and severity of the pandemic led to very high levels of public awareness and attention, with Canadians actively seeking information. We argue that while there was continuous public health communication about COVID-19 and the newly available vaccines, these messages did not address the specific anxieties elicited by the novel vaccines, even as vaccination guidelines changed. Instead, public health messages about COVID-19 vaccines resembled those aimed at reducing vaccine hesitancy for routine immunization and did not sufficiently address the constant changes to COVID-19 vaccine recommendations. In a context of heightened public concern and significant public attention, it is crucial for communicators to acknowledge that hesitancy is vaccine-specific, and that novel diseases and new vaccines produce specific concerns. Long-term strategies should address the novelty of the technology and of the risk, thoroughly explain the reasons for shifting vaccination guidelines, and leverage trusted sources, such as community leaders. Further, as COVID-19 vaccines become less effective against some of the more recent variants of the virus, vaccine messaging needs to be tailored to evolve with shifting realities to not lose productive gains in the COVID-19 vaccination campaign to date.     

Socio-demographic disparities in knowledge,practices, and ability to comply with COVID-19 public health measures in Canada

ObjectivesThe effectiveness of public health interventions for mitigation of the COVID-19 pandemic depends on individual attitudes, compliance, and the level of support available to allow for compliance with these measures. The aim of this study was to describe attitudes and behaviours towards the Canadian COVID-19 public health response, and identify risk-modifying behaviours based on socio-demographic characteristics.MethodsA cross-sectional online survey was administered in May 2020 to members of a paid panel representative of the Canadian population by age, gender, official language, and region of residence. A total of 4981 respondents provided responses for indicators of self-reported risk perceptions, attitudes, and behaviours towards COVID-19 public health measures.ResultsMore than 90% of respondents reported confidence in the ability to comply with a variety of public health measures. However, only 51% reported preparedness for illness in terms of expectation to work if sick or access to paid sick days. Risk perceptions, attitudes, and behaviours varied by demographic variables. Men, younger age groups, and those in the paid workforce were less likely to consider public health measures to be effective, and had less confidence in their ability to comply. Approximately 80% of respondents reported that parents provided childcare and 52% reported that parents in the workforce provided childcare while schools were closed.ConclusionPolicies to help address issues of public adherence include targeted messaging for men and younger age groups, social supports for those who need to self-isolate, changes in workplace policies to discourage presenteeism, and provincially co-ordinated masking and safe school policies.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00501-y.Keywords: COVID-19, Attitude, Behaviour, Risk perception, Survey     

江西省农村初中生健康素养对新冠肺炎疫情防护知信行的影响

  目的  了解江西省农村地区初中生健康素养对新冠肺炎疫情防护知信行的影响,为提升初中生应对突发公共卫生事件的能力提供参考。  方法  采用分层整群随机抽样法,对江西省农村地区的4 311名七至八年级学生健康素养及新冠肺炎疫情防护知识水平和行为进行调查;运用χ2检验和Logistic回归分析初中生健康素养与新冠肺炎疫情防护知信行之间的关联。  结果  农村地区初中生健康素养高水平比例为18.21%(785名),中水平为56.92%(2 454名),低水平为24.87%(1 072名)。农村地区初中生新冠肺炎疫情防护知识知晓率较低(63.49%),防护态度积极率为74.25%,良好防护行为具备率为85.36%。多因素Logistic回归分析显示,高水平健康素养者新冠肺炎疫情防护知识知晓率(OR=4.85,95%CI=3.80~6.18)、防护态度积极率(OR=44.07,95%CI=24.57~79.05)、防护行为具备率(OR=25.99,95%CI=19.67~34.35)均高于低水平健康素养者(P值均 < 0.01)。  结论  江西省农村地区初中生健康素养与新冠肺炎疫情防护知信行之间存在正向关联,为提升初中生应对突发公共卫生事件的能力提供了方向。     

新型冠状病毒肺炎相关急性呼吸道感染及就诊情况调查

目的了解我国新型冠状病毒肺炎(新冠肺炎)流行期间,人群急性呼吸道感染(ARI)的患病和就诊情况。方法根据截至2020年3月31日各省(市)新冠肺炎病例累计报告发病率,将各省(市)划分为高、中、低流行地区,采用分层两阶段整群随机抽样方法抽取社区人群进行面对面问卷调查。收集新冠肺炎流行期间社区人群新冠肺炎相关ARI的患病和就诊资料,计算新冠肺炎相关ARI罹患率和就诊比例,采用非条件logistic回归分析社区人群新冠肺炎相关ARI患病和就诊的影响因素。结果共调查34857名社区居民,647名(1.9%)调查对象自报在新冠肺炎流行期间出现过新冠肺炎相关ARI,其中241名(37.2%)患者曾前往医疗机构就诊。从新冠肺炎相关ARI患病情况来看,在高流行地区,罹患新冠肺炎相关ARI的风险是低流行地区的1.36倍(95%CI:1.12~1.65);在不同年龄组中,20~39岁、≥60岁组罹患新冠肺炎相关ARI的风险分别是1~9岁组的1.80倍(95%CI:1.29~2.59)、1.63倍(95%CI:1.14~2.40);有基础疾病史罹患新冠肺炎相关ARI的风险是无基础疾病史的1.53倍(95%CI:1.23~1.89);有新冠肺炎确诊病例、发热或呼吸道症状者接触史的人群罹患新冠肺炎相关ARI的风险分别是无接触史的1.53倍(95%CI:1.01~2.27)、6.60倍(95%CI:5.05~8.53)。有发热或呼吸道症状者接触史的新冠肺炎相关ARI患者就诊的比例是无接触史的1.68倍(95%CI:1.05~2.70)。结论新冠肺炎相关ARI的罹患率受该地区的新冠肺炎流行水平高低的影响,新冠肺炎高流行地区新冠肺炎相关ARI罹患率也高。然而我国新冠肺炎相关ARI患者发病后就诊的比例较低。因此,在新冠疫情流行期间,应加强卫生服务利用宣传,积极提高人群ARI等疾病的就诊意识。     

A comparison of 2020 health policy responses to the COVID-19 pandemic in Canada,Ireland, the United Kingdom and the United States of America

This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating cross-country learning. Evidence is taken from the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, which has documented country responses to COVID-19 using a structured template completed by country experts. We show all countries faced common challenges during the pandemic, including difficulties in scaling-up testing capacity, implementing timely and appropriate containment measures amid much uncertainty and overcoming shortages of health and social care workers, personal protective equipment and other medical technologies. Country responses to address these issues were similar in many ways, but dissimilar in others, reflecting differences in health system organization and financing, political leadership and governance structures. In the US, lack of universal health coverage have created barriers to accessing care, while political pushback against scientific leadership has likely undermined the crisis response. Our findings highlight the importance of consistent messaging and alignment between health experts and political leadership to increase the level of compliance with public health measures, alongside the need to invest in health infrastructure and training and retaining an adequate domestic health workforce. Building on innovations in care delivery seen during the pandemic, including increased use of digital technology, can also help inform development of more resilient health systems longer-term.     

COVID-19 vaccination intention and behavior in a large,diverse, U.S. refugee population

IntroductionRefugees often face increased risk of exposure to COVID-19 due to their disproportionate representation in the essential workforce and crowded household conditions. There is a paucity of data about risk factors for under-immunization for COVID-19 among refugees.MethodsRefugees were surveyed in two phases that corresponded to before and after wide availability of COVID-19 vaccines. Participants were asked about their attitudes, and perceptions about COVID-19, previous acceptance of vaccines, sources utilized to obtain trusted health information, and intent to get vaccinated. The overall participant vulnerability was assessed using the social vulnerability index. In-depth semi-structured interviews were completed with key stakeholders through snowball sampling.ResultsOf 247 refugees, 244 agreed to participate in the initial survey. Among those, 140 (57.4%) intended to get vaccinated, 43 (17.6%) were unsure, and 61 (25%) did not intend to get vaccinated. In the follow up survey, all 215 who were reached, agreed to provide information about their vaccination status. Among those respondents, 141 (65.6%) were either vaccinated or expressed intent to do so, and 74 (34.4%) remained hesitant. We did not observe any significant correlation between socio-demographic variables, country of origin, and vaccination status/intent. Among those who initially intended to get vaccinated, nearly 1 in 5 changed their mind and decided to forego vaccination, and among those who initially did not plan getting vaccinated, 1 in 3 changed their mind and got vaccinated. Fears related to the vaccine, concerns that the vaccine is religiously prohibited, “wait and see” how others did with the vaccine, communication and transportation barriers were commonly cited as reason not to get vaccinated.ConclusionsOver a third of refugees in our study were hesitant to get vaccinated. Refugees desired additional education about the benefits and safety of vaccines along with easier access to vaccination clinics in their communities.     

Young Adults' COVID-19 Testing Intentions: The Role of Health Beliefs and Anticipated Regret

PurposeYoung adults are at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and transmission due to their social behaviors. The purpose of this study was to determine their attitudes toward coronavirus disease 2019 (COVID-19) testing, an important approach for minimizing infection and transmission.MethodsOne hundred seventy eight US individuals aged 19–25 years completed an online survey measuring COVID-19 health beliefs and testing intentions. Multivariable logistic regression evaluated the association of heath belief measures (perceived COVID-19 susceptibility, COVID-19 severity, barriers and benefits to testing, and social concerns) with testing intentions.ResultsMost respondents (86.0%) intended to accept a COVID-19 test if recommended by a health professional. High social concern and low perceived obstacles were associated with intent to get tested.ConclusionsIn this sample, most young adults intended to accept COVID-19 testing. Health beliefs predicted testing intention and point to possible intervention approaches to increase willingness to accept COVID-19 testing.