The Association Between Chronic Disease and Serious COVID-19 Outcomes and Its Influence on Risk Perception: Survey Study and Database Analysis

BackgroundCOVID-19, a viral respiratory disease first reported in December 2019, quickly became a threat to global public health. Further understanding of the epidemiology of the SARS-CoV-2 virus and the risk perception of the community may better inform targeted interventions to reduce the impact and spread of COVID-19.ObjectiveIn this study, we aimed to examine the association between chronic diseases and serious outcomes following COVID-19 infection, and to explore its influence on people’s self-perception of risk for worse COVID-19 outcomes.MethodsThis study draws data from two databases: (1) the nationwide database of all confirmed COVID-19 cases in Portugal, extracted on April 28, 2020 (n=20,293); and (2) the community-based COVID-19 Barometer survey, which contains data on health status, perceptions, and behaviors during the first wave of COVID-19 (n=171,087). We assessed the association between relevant chronic diseases (ie, respiratory, cardiovascular, and renal diseases; diabetes; and cancer) and death and intensive care unit (ICU) admission following COVID-19 infection. We identified determinants of self-perception of risk for severe COVID-19 outcomes using logistic regression models.ResultsRespiratory, cardiovascular, and renal diseases were associated with mortality and ICU admission among patients hospitalized due to COVID-19 infection (odds ratio [OR] 1.48, 95% CI 1.11-1.98; OR 3.39, 95% CI 1.80-6.40; and OR 2.25, 95% CI 1.66-3.06, respectively). Diabetes and cancer were associated with serious outcomes only when considering the full sample of COVID-19–infected cases in the country (OR 1.30, 95% CI 1.03-1.64; and OR 1.40, 95% CI 1.03-1.89, respectively). Older age and male sex were both associated with mortality and ICU admission. The perception of risk for severe COVID-19 disease in the study population was 23.9% (n=40,890). This was markedly higher for older adults (n=5235, 46.4%), those with at least one chronic disease (n=17,647, 51.6%), or those in both of these categories (n=3212, 67.7%). All included diseases were associated with self-perceptions of high risk in this population.ConclusionsOur results demonstrate the association between some prevalent chronic diseases and increased risk of worse COVID-19 outcomes. It also brings forth a greater understanding of the community’s risk perceptions of serious COVID-19 disease. Hence, this study may aid health authorities to better adapt measures to the real needs of the population and to identify vulnerable individuals requiring further education and awareness of preventive measures.     

Changes in Smoking Behavior Since the Declaration of the COVID-19 State of Emergency in Japan: A Cross-sectional Study From the Osaka Health App

BackgroundIn April 2020, the Japanese government declared a state of emergency due to the COVID-19 pandemic, and infection control measures, including requests to work from home and stay-at-home restrictions, were introduced. This study examined changes in smoking behavior during the COVID-19 state of emergency.MethodsAn online cross-sectional survey was conducted in Osaka, Japan. To assess differences in smoking behavior among 5,120 current smokers before and after the declaration of a state of emergency, prevalence ratios (PRs) for two outcomes, increased smoking and quitting smoking, were calculated using multivariable Poisson regression, adjusting for potential covariates.ResultsWe found 32.1% increased the number of cigarettes smoked and 11.9% quit smoking. After adjustment for all variables, we found risk factors for COVID-19 (men and older age group) had both significantly higher PR for quitting smoking (men: PR 1.38; 95% confidence interval [CI], 1.17–1.62) and participants aged ≥65 years: PR 2.45; 95% CI, 1.92–3.12) and significantly lower PR of increased smoking (men: PR 0.85; 95% CI, 0.78–0.93 and participants ≥65 years: PR 0.38; 95% CI, 0.29–0.49). Additionally, respondents working from home or living alone had significantly higher PR for increased smoking (working from home: PR 1.29; 95% CI, 1.17–1.41 and living alone: PR 1.23; 95% CI, 1.10–1.38) and respondents who changed from cigarettes to heated tobacco products (HTPs) had significantly lower PR for quitting smoking (PR 0.150; 95% CI, 0.039–0.582).ConclusionsWe suggest people who have high-risk factors for COVID-19 might change their smoking behavior for the better, while people who work from home or live alone might change their smoking behavior for the worse, during the COVID-19 state of emergency. Additionally, changing from smoking cigarettes to using HTPs makes smokers less likely to quit.Key words: tobacco, cigarette, COVID-19, declaring the state of emergency     

Factors influencing acceptance of the COVID-19 vaccine in Malaysia: a web-based survey

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has set a precedent for the fastest-produced vaccine as a result of global collaboration and outreach. This study explored Malaysians’ acceptance of the COVID-19 vaccine and its associated factors.Methods A cross-sectional anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years old via social media platforms between July 10, 2020 and August 31, 2020.Results In the analysis of 4,164 complete responses, 93.2% of participants indicated that they would accept the COVID-19 vaccine if it was offered for free by the Malaysian government. The median out-of-pocket cost that participants were willing to pay for a COVID-19 vaccine was Malaysian ringgit (MYR) 100 (interquartile range [IQR], 100) if it was readily available and MYR 150 (IQR, 200) if the supply was limited. Respondents with a low likelihood of vaccine hesitancy had 13 times higher odds of accepting the COVID-19 vaccine (95% confidence interval [CI], 8.69 to 19.13). High perceived risk and severity were also associated with willingness to be vaccinated, with adjusted odds ratios of 2.22 (95% CI, 1.44 to 3.41) and 2.76 (95% CI, 1.87 to 4.09), respectively. Age and ethnicity were the only independent demographic characteristics that predicted vaccine uptake.Conclusion Public health strategies targeting perceived risk, perceived susceptibility and vaccine hesitancy could be effective in enhancing vaccine uptake.     

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.     

The Impact of Relationship Stressors on Trust and Prorelationship Behavior Within Adolescent Romantic Relationships: A Systems Approach

PurposeTrust is an essential component of romantic relationships. It is not understood how youth respond to a relationship stressor, which may impact trust, such as perceiving to be at risk for a sexually transmitted infection or their partner has other sex partners. We used a system science approach to examine feedback between trust and prorelationship behaviors within adolescent relationships.MethodsA prospective cohort of clinic-recruited young women (N = 122), aged 16–19 years, completed daily questionnaires on partner-specific feelings and risk perceptions for 18 months. Relationship stressor defined as either perceiving the risk of sexually transmitted infection from a partner or partner had other sex partners. Prorelationship behaviors were more time spent with partner, sex with partner, and/or gift from partner. Time-lagged generalized estimating equation models were used to examine whether a relationship stressor is associated with a decrease in trust and whether prorelationship behaviors changed following the stressor.ResultsExperiencing a stressor was associated with threefold increased odds of having a decrease in trust in the same week (odds ratio [OR] = 3.30, 95% confidence interval [CI]: 2.30–4.72). Trust increased significantly the week following the stressor (OR = 2.09, 95% CI: 1.54–2.85). An increase in trust relative to the week of the stressor was associated with a 65% increase in prorelationship behavior in the week following the stressor (OR = 1.65, 95% CI: 1.20–2.26).ConclusionsData uniquely show that trust is impacted following a relationship stressor and that youth increase prorelationship behaviors following a drop in trust. The findings suggest that adolescents prioritize maintaining trust, which may impact engagement in protective health behaviors.     

A national survey of COVID-19 vaccine acceptance in Nigeria

IntroductionThe COVID-19 vaccine is essential to reduce the global impact of the pandemic. Understanding its acceptance is key to Nigeria’s national COVID-19 control strategies.MethodsBetween the 6th and 22nd of January 2021, we conducted a non-probability convenience sampling of 3076 respondents using online and in-person interviews to assess the prevalence and predictors of the COVID-19 vaccine acceptance in Nigeria.FindingsOf the 3076 recruited participants, 74.7% (n = 2300/3076) had tertiary education. The median age group was 30–39 years (35.1%, n = 1097/3076) whereas 31% (n = 952/3076) of all respondents had a monthly income<30,000 Naira (65 USD). The survey results indicated that a wide range of the respondents were in government employment (34.1%, n = 1050/3076). The majority of our study participants (92.2%, n = 2835/3076) believe that COVID-19 is real and not a hoax. Only 27.9% (n = 858/3076) of the study participants have been tested for COVID-19 and 17.8 % (n = 152/858) of the tested respondents were COVID-19 positive by PCR. Half (50.7%; n = 1560/3076) of the study participants were willing to take the vaccine once available. The majority of the respondents (81.1%, n = 2496/3076) were not willing to pay for the vaccine. Only 15.9% (n = 483/3076) of the respondents rated the government’s handling of the pandemic above average. The potential acceptance of the COVID-19 vaccine was significantly affected by the age and the monthly income of the respondents. Respondents older than 60 years old (OR: 3.02, 95% CI: 1.69,5.41; p < 0.001) and those that earn between 250,000–500,000 Naira monthly (OR: 1.38; 95% CI: 1.11,1.70; p < 0.001) were more likely to accept the COVID-19 vaccine respectively. In addition, the respondents’ perception of the existence of the disease (OR: 1.45; 95% CI: 0.99,2.18; p > 0.05), the need for a COVID-19 vaccine (OR: 16; 95% CI: 11.63,22.10; p < 0.001), the willingness to pay (OR: 1.68; 95% CI: 1.39,2.01; p < 0.001) and the rating of the government handling of the pandemic (OR: 2.25; 95% CI: 1.57,3.23; p < 0.001) were critical to the acceptance of the COVID-19 vaccine.InterpretationWith 50.7% vaccine acceptance, Nigeria’s public health policymakers must prioritize and develop strategies that will effectively increase COVID-19 vaccine acceptance across the country with emphasis on trust, transparency and strong leadership.     

Risk of COVID-19 and major adverse clinical outcomes among people with disabilities in South Korea

BackgroundEvidence regarding the risk of coronavirus disease (COVID-19) and the major adverse clinical outcomes of COVID-19 among people with disabilities (PwDs) is scarce.ObjectiveThis study investigated the association of disability status with the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity and the risk of major adverse clinical outcomes among participants who tested positive for SARS-CoV-2.MethodsThis study included all patients (n = 8070) who tested positive for SARS-CoV-2 and individuals without COVID-19 (n = 121,050) in South Korea from January 1 to May 30, 2020. The study variables included officially registered disability status from the government, SARS-CoV-2 test positivity, and major adverse clinical outcomes of COVID-19 (admission to the intensive care unit, invasive ventilation, or death).ResultsThe study participants included 129,120 individuals (including 7261 PwDs), of whom 8070 (6.3%) tested positive for SARS-CoV-2. After adjusting for potential confounding factors, PwDs had an increased risk of SARS-CoV-2 test positivity compared with people without disabilities (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.24–1.48). Among participants who tested positive for SARS-CoV-2, PwDs were associated with an increased risk of major adverse clinical outcomes from COVID-19 compared to those without disabilities (OR: 1.43, 95% CI: 1.11–1.86).ConclusionsPwDs had an increased risk of COVID-19 and major adverse clinical outcomes of COVID-19 compared with people without disabilities. Given the higher vulnerability of PwDs to COVID-19, tailored policy and management to protect against the risk of COVID-19 are required.     

Associations Between General Perceptions of COVID-19 and Posttraumatic Stress Disorder in Korean Hospital Workers: Effect Modification by Previous Middle East Respiratory Syndrome Coronavirus Experience and Occupational Type

ObjectivesThis study investigated associations between perceptions of coronavirus disease 2019 (COVID-19) and the prevalence of posttraumatic stress disorder (PTSD) in workers at hospitals designated to treat COVID-19, as well as the difference in the magnitude of these associations by occupational type and previous Middle East respiratory syndrome coronavirus (MERS-CoV) experience.MethodsThe participants were workers at hospitals designated to treat COVID-19 who completed a questionnaire about their perceptions related to COVID-19, work experience during the previous MERS-CoV outbreak, and symptoms of PTSD ascertained by the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders. Participants’ characteristics were compared using the chi-square test. Multivariable logistic regression was performed to evaluate the associations between perceptions and the prevalence of PTSD, stratified by occupational type and previous MERS-CoV experience.ResultsNon-medical personnel showed stronger associations with PTSD than medical personnel according to general fear (odds ratio [OR], 6.67; 95% confidence interval [CI], 1.92 to 23.20), shortages of supplies (OR, 1.29; 95% CI, 1.07 to 1.56), and issue-specific fear (OR, 1.29; 95% CI, 1.05 to 1.59). Those with prior MERS-CoV quarantine experience were more prone to PTSD than those without such experience in terms of general fear (OR, 1.70; 95% CI, 1.22 to 2.37), shortages of supplies (OR, 1.24; 95% CI, 1.10 to 1.40), and issue-specific fear (OR, 1.21; 95% CI, 1.06 to 1.38). ConclusionsDuring the COVID-19 pandemic, non-medical personnel tended to have higher odds of being categorized as having PTSD. Workers with prior MERS-CoV experience were more susceptible than those without such experience. These findings suggest the need for timely interventions to manage human resources for a sustainable quarantine system.     

Association of Sources of COVID-19 Information with Vaccine Uptake,Preventive Behaviors,and Perceived Severity of COVID-19

ObjectiveTo investigate the association of using informal sources and reliance on multiple sources of information with actual COVID-19 vaccine uptake, the number of doses of vaccine received, COVID-19 testing, essential preventive measures, and perceived severity of COVID-19.DesignRetrospective cross-sectional study.Setting and ParticipantsOur study sample consisted of 9584 community-dwelling Medicare beneficiaries, representing a weighted 50,029,030 beneficiaries from the Winter 2021 Medicare Current Beneficiary Survey COVID-19 Supplement.MethodsTwo key independent variables were whether a respondent relied on a formal source (ie, traditional news, government guidance, or health care providers) or an informal source (ie, social media, Internet, or friends/family) the most for the COVID-19 information and the total number of information sources a respondent relied on.ResultsCompared with beneficiaries relying on formal sources of information, those relying on informal sources of information were less likely to receive COVID-19 vaccine (odds ratio [OR], 0.65; 95% CI, 0.56–0.75) and COVID-19 testing (OR, 0.85; 95% CI, 0.74–0.98), to engage in preventive behaviors (OR, 0.61; 95% CI, 0.50–0.74), to have high perception of COVID-19 severity, and were more likely to be unvaccinated vs 2 doses of vaccine (relative risk ratio [RRR], 1.64; 95% CI, 1.41–1.91). Relying on more information sources was significantly associated with higher odds of actual vaccine uptake (OR, 1.21; 95% CI, 1.17–1.26), COVID-19 testing (OR, 1.11; 95% CI, 1.07–1.15), engagement of essential preventive behaviors (OR, 1.33; 95% CI, 1.25–1.42), having high perception of COVID-19 severity, and with lower likelihood of being unvaccinated vs 2 doses of vaccine (RRR, 0.82; 0.79–0.85).Conclusions and ImplicationsThe COVID-19 pandemic has made communicating information about coronavirus more important than ever. Our findings suggest that information from formal sources with expertise and more balanced sources of information were key to effective communication to prevent from COVID-19 infection among older adults.     

Individual-level factors associated with COVID-19 vaccine acceptance among U.S. patients with cancer

IntroductionVaccine hesitancy in the wake of the COVID-19 pandemic is a major public health concern in the US. Cancer patients are especially vulnerable to adverse COVID-19 outcomes and require targeted prevention efforts against COVID-19.MethodsWe used longitudinal survey data from patients seen at Moffitt Cancer Center to identify attitudes, beliefs, and sociodemographic factors associated with COVID-19 vaccination acceptance among cancer patients. Patients with confirmed invasive cancer diagnosis through Cancer Registry data were asked about vaccine acceptance through the question “Now that a COVID-19 vaccine is available, are you likely to get it?” and dichotomized into high accepters (already received it, would get it when available) and low accepters (waiting for a doctor to recommend it, waiting until more people received it, not likely to get it).ResultsMost patients (86.8% of 5,814) were high accepters of the COVID-19 vaccine. High accepters had more confidence in the effectiveness and safety of the vaccine than low accepters. Multivariable logistic regression showed older individuals (70–89 vs.18–49: OR:2.57, 95% CI:1.33–4.86), those with greater perceived severity of COVID-19 infection (very serious vs. not at all serious: OR:2.55, 95% CI:1.76–3.70), practicing more risk mitigation behaviors (per one standard deviation OR:1.75, 95% CI:1.57–1.95), and history of receiving the flu shot versus not (OR:6.56, 95% CI:5.25–8.20) had higher odds of vaccine acceptance. Individuals living with more than one other person (vs. alone: OR: 0.53, 95% CI: 0.35, 0.79) and those who were more socioeconomically disadvantaged (per 10 percentile points: OR: 0.89, 95 %CI: 0.85, 0.93) had lower odds of reporting vaccine acceptance.ConclusionMost patients with cancer have or would receive the COVID-19 vaccine. Those who are less likely to accept the vaccine have more concerns regarding effectiveness and side effects, are younger, more socioeconomically disadvantaged, and have lower perceptions of COVID-19 severity.     

Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey

BackgroundHIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA.ObjectiveThe aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China.MethodsThis cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis.ResultsOut of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions (β=.43, 95% CI .37-.51; P<.001).ConclusionsAs compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA’s perceptions and willingness to receive COVID-19 vaccination.     

Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria

ObjectivesThe study aimed to examine health workers’ perceptions of the coronavirus disease 2019 vaccine in Nigeria and their willingness to receive the vaccine when it becomes available.Methods This multi-center cross-sectional study used non-probability convenience sampling to enroll 1,470 hospital workers aged 18 and above from 4 specialized hospitals. A structured and validated self-administered questionnaire was used for data collection. Data entry and analysis were conducted using IBM SPSS ver. 22.0.Results The mean age of respondents was 40±6 years. Only 53.5% of the health workers had positive perceptions of the COVID-19 vaccine, and only slightly more than half (55.5%) were willing to receive vaccination. Predictors of willingness to receive the COVID-19 vaccine included having a positive perception of the vaccine (adjusted odds ratio [AOR], 4.55; 95% confidence interval [CI], 3.50−5.69), perceiving a risk of contracting COVID-19 (AOR, 1.50; 95% CI, 1.25–3.98), having received tertiary education (AOR, 3.50; 95% CI, 1.40−6.86), and being a clinical health worker (AOR, 1.25; 95% CI, 1.01−1.68).Conclusion Perceptions of the COVID-19 vaccine and willingness to receive the vaccine were sub-optimal among this group. Educational interventions to improve health workers'' perceptions and attitudes toward the COVID-19 vaccine are needed.     

A case-crossover study of the effect of vaccination on SARS-CoV-2 transmission relevant behaviours during a period of national lockdown in England and Wales

BackgroundStudies of COVID-19 vaccine effectiveness show increases in COVID-19 cases within 14 days of a first dose, potentially reflecting post-vaccination behaviour changes associated with SARS-CoV-2 transmission before vaccine protection. However, direct evidence for a relationship between vaccination and behaviour is lacking. We aimed to examine the association between vaccination status and self-reported non-household contacts and non-essential activities during a national lockdown in England and Wales.MethodsParticipants (n = 1154) who had received the first dose of a COVID-19 vaccine reported non-household contacts and non-essential activities from February to March 2021 in monthly surveys during a national lockdown in England and Wales. We used a case-crossover study design and conditional logistic regression to examine the association between vaccination status (pre-vaccination vs 14 days post-vaccination) and self-reported contacts and activities within individuals. Stratified subgroup analyses examined potential effect heterogeneity by sociodemographic characteristics such as sex, household income or age group.Results457/1154 (39.60 %) participants reported non-household contacts post-vaccination compared with 371/1154 (32.15 %) participants pre-vaccination. 100/1154 (8.67 %) participants reported use of non-essential shops or services post-vaccination compared with 74/1154 (6.41 %) participants pre-vaccination. Post-vaccination status was associated with increased odds of reporting non-household contacts (OR 1.65, 95 % CI 1.31–2.06, p < 0.001) and use of non-essential shops or services (OR 1.50, 95 % CI 1.03–2.17, p = 0.032). This effect varied between men and women and different age groups.ConclusionParticipants had higher odds of reporting non-household contacts and use of non-essential shops or services within 14 days of their first COVID-19 vaccine compared to pre-vaccination. Public health emphasis on maintaining protective behaviours during this post-vaccination time period when individuals have yet to develop full protection from vaccination could reduce risk of SARS-CoV-2 infection.     

Changes in COVID-19 vaccine acceptance rate among recovered critically Ill patients: A 12-month follow-up study

IntroductionWe surveyed a cohort of patients who recovered from severe SARS-CoV-2 infection to determine the COVID-19 vaccination rate. We also compared the willingness to accept COVID-19 vaccine before and after its availability to assess changes in perception and attitude towards vaccination.Materials and MethodsRecovered patients with severe hypoxemic respiratory failure from SARS-CoV-2 infection treated in the ICU at Grady Memorial Hospital, Atlanta, Georgia between April 1, 2020, and June 30, 2020 were followed up over a 1-year period to assess vaccine acceptability and acceptance rates, and changes in perception towards COVID-19 vaccination before and after vaccine availability.ResultsA total of 98 and 93 patients completed the initial and follow up surveys respectively. During the initial survey, 41% of the patients intended to receive vaccination, 46% responded they would not accept a vaccine against COVID-19 even if it were proven to be ‘safe and effective ‘and 13% undecided. During the follow up survey, 44% of the study cohort had received at least one dose of a COVID-19 vaccine. Major reasons provided by respondents for not accepting COVID-19 vaccine were lack of trust in the effectiveness of the vaccine, pharmaceutical companies, government, vaccine technology, fear of side effects and perceived immunity against COVID-19. Respondents were more likely to be vaccinated if recommended by their physicians (OR 6.4, 95% CI 2.8–8.3), employers (OR 2.5, 95% CI 1.9–5.8), and family and friends (OR 1.6, 95% CI 1.1–4.5).ConclusionWe found a suboptimal COVID-19 vaccination rate in a cohort of patients who recovered from severe infection. COVID-19 vaccine information and recommendation by healthcare providers, employers, and family and friends may improve vaccination uptake.     

Trust and distrust in low-income Michigan residents during the early COVID-19 pandemic: A qualitative study

Background

Trust and distrust have shaped health behaviour during the COVID-19 pandemic. Since the start of the pandemic, misinformation and polarization eroded trust across the United States. In states like Michigan, pandemic restrictions led to significant unrest. Michiganders also faced disproportionate morbidity and mortality from COVID-19 during this period.

Objective

The objective of this qualitative study was to understand the individual experiences of trust in low-income Michiganders during the early COVID-19 pandemic.

Participants

Twenty-four participants at or below 200% of the federal poverty line who resided in Michigan were recruited for this study.

Approach

Interviews were conducted during the winter of 2020 using a formal interview guide that addressed sources of information, perceptions of risk and exposure, protective behaviours and impacts of the pandemic at home, work and in receiving healthcare.

Results

Thematic analysis showed that themes of trust and distrust emerged in multiple facets of our participants' experiences, including in the context of information sources, the behaviours of others, health, financial security, employment and overall safety. Trust and distrust in low-income communities often stemmed from significant financial and economic vulnerabilities and instability in access to healthcare that was exacerbated in the pandemic. Furthermore, participant trust was shaped by internal (e.g., relationships with others) and external (e.g., source of information, social inequity) factors that influenced their perceptions and experiences during the pandemic.

Conclusion

Trust has played an important role in many aspects of the experiences of low-income communities during the COVID-19 pandemic. This is important for clinicians to consider as COVID-19 becomes endemic, and trust continues to impact patients' approaches to vaccines, testing and treatment options.

Patient or Public Contribution

This study was designed and conducted with the assistance and input of the members of the DECIDERS Steering Committee, a diverse statewide network of community members in Michigan. The DECIDERS team allows community members to have a voice in the design and conduct of health research, and collaborates with researchers to improve health across the state of Michigan.     

Risk factors for cooking-related burn injuries in children,WHO Global Burn Registry

ObjectiveTo assess the characteristics of cooking-related burn injuries in children reported to the World Health Organization Global Burn Registry.MethodsOn 1 February 2021, we downloaded data from the Global Burn Registry on demographic and clinical characteristics of patients younger than 19 years. We performed multivariate regressions to identify risk factors predictive of mortality and total body surface area affected by burns.FindingsOf the 2957 paediatric patients with burn injuries, 974 involved cooking (32.9%). More burns occurred in boys (532 patients; 54.6%) than in girls, and in children 2 years and younger (489 patients; 50.2%). Accidental contact and liquefied petroleum caused most burn injuries (729 patients; 74.8% and 293 patients; 30.1%, respectively). Burn contact by explosions (odds ratio, OR: 2.8; 95% confidence interval, CI: 1.4–5.7) or fires in the cooking area (OR: 3.0; 95% CI: 1.3–6.8), as well as the cooking fuels wood (OR: 2.2; 95 CI%: 1.3–3.4), kerosene (OR: 1.9; 95% CI: 1.0–3.6) or natural gas (OR: 1.5; 95% CI: 1.0–2.2) were associated with larger body surface area affected. Mortality was associated with explosions (OR: 7.5; 95% CI: 2.2–25.9) and fires in the cooking area (OR: 6.9; 95% CI: 1.9–25.7), charcoal (OR: 4.6; 95% CI: 2.0–10.5), kerosene (OR: 3.9; 95% CI: 1.4–10.8), natural gas (OR: 3.0; 95% CI: 1.5–6.1) or wood (OR: 2.8; 95% CI: 1.1–7.1).ConclusionPreventive interventions directed against explosions, fires in cooking areas and hazardous cooking fuels should be implemented to reduce morbidity and mortality from cooking-related burn injuries.     

Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated?

BackgroundCoronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020. Several prophylactic vaccines against COVID-19 are currently in development, yet little is known about people’s acceptability of a COVID-19 vaccine.MethodsWe conducted an online survey of adults ages 18 and older in the United States (n = 2,006) in May 2020. Multivariable relative risk regression identified correlates of participants’ willingness to get a COVID-19 vaccine (i.e., vaccine acceptability).ResultsOverall, 69% of participants were willing to get a COVID-19 vaccine. Participants were more likely to be willing to get vaccinated if they thought their healthcare provider would recommend vaccination (RR = 1.73, 95% CI: 1.49–2.02) or if they were moderate (RR = 1.09, 95% CI: 1.02–1.16) or liberal (RR = 1.14, 95% CI: 1.07–1.22) in their political leaning. Participants were also more likely to be willing to get vaccinated if they reported higher levels of perceived likelihood getting a COVID-19 infection in the future (RR = 1.05, 95% CI: 1.01–1.09), perceived severity of COVID-19 infection (RR = 1.08, 95% CI: 1.04–1.11), or perceived effectiveness of a COVID-19 vaccine (RR = 1.46, 95% CI: 1.40–1.52). Participants were less likely to be willing to get vaccinated if they were non-Latinx black (RR = 0.81, 95% CI: 0.74–0.90) or reported a higher level of perceived potential vaccine harms (RR = 0.95, 95% CI: 0.92–0.98).ConclusionsMany adults are willing to get a COVID-19 vaccine, though acceptability should be monitored as vaccine development continues. Our findings can help guide future efforts to increase COVID-19 vaccine acceptability (and uptake if a vaccine becomes available).