Longitudinal Pathways to Influenza Vaccination Vary With Socio-Structural Disadvantages.

BACKGROUND: Although influenza vaccination can prevent influenza-related deaths, uptake remains low, particularly in disadvantaged populations. PURPOSE: A theoretical model of psychological pathways to vaccination accounting for the direct and moderating role of socio-structural factors was tested. The study sought to understand the joint contributions of psychological (i.e., knowledge, attitudes, and intention) and socio-structural factors (i.e., income, education, and insurance) to influenza vaccination, prospectively. METHODS: A nationally representative empaneled sample of over 3,000 U.S. adults answered questions about vaccination knowledge, attitudes, and intentions, as well as actual vaccination across five timepoints from September 2018 to May 2019. Socio-structural factors were examined as moderators. RESULTS: Findings revealed strong positive associations between knowledge and attitudes, attitudes and intentions, as well as intentions and subsequent vaccination. Importantly, health insurance moderated the associations between attitudes and intentions and between intentions and vaccination, such that those without insurance had weaker associations between attitudes and intentions and between intentions and vaccination. In addition, education moderated the path from knowledge to attitude and from intentions to vaccination, such that people with lower educational attainment had weaker associations between knowledge and attitudes and between intentions and vaccination. CONCLUSIONS: Socio-structural factors act as barriers to the influence of knowledge on attitudes, attitudes on intentions, and intentions on behavior. Future research needs to be mindful of the specific paths disrupted by social disadvantages and examine ways to intervene to decrease those effects.

Testing a digitally distributed method to recruit a network of community organizations to fight the consequences of the drug epidemic: A study in 13 American states.

To mitigate the opioid epidemic, a concerted effort to educate, prevent, diagnose, treat, and engage residents is required. In this study, a digitally distributed method to form a large network of organizations was tested with 99 counties in regions with high vulnerability to hepatitis C virus (HCV). The method involved a cascade of contacts going from email to phone calls, to videoconferencing and measuring the number of contacts required, amount of time taken, and the proportion of success at recruiting at least one community organization per county. A recruitment period of 5 months and 2118 contact attempts led to the recruitment of organizations from 73 out of our 99 target counties. Organizations belonging to health departments required more attempts and time to recruit but ultimately enrolled at higher rates than did other organizations such as coalitions and agencies. Organizations from counties more (vs. less) vulnerable to HCV outbreaks required more attempts to recruit and, using multiple recruitment methods (e.g., emails, phone calls, and Zoom meetings), improved enrollment success. Overall, this method proved to be successful at remotely engaging a large-scale network of communities with different levels of risk within a large geographic region.

Do COVID-19 Vaccination Policies Backfire? The Effects of Mandates, Vaccination Passports, and Financial Incentives on COVID-19 Vaccination.

Faced with the challenges of motivating people to vaccinate, many countries have introduced policy-level interventions to encourage vaccination against COVID-19. For example, mandates were widely imposed requiring individuals to vaccinate to work and attend school, and vaccination passports required individuals to show proof of vaccination to travel and access public spaces and events. Furthermore, some countries also began offering financial incentives for getting vaccinated. One major criticism of these policies was the possibility that they would produce reactance and thus undermine voluntary vaccination. This article therefore reviews relevant empirical evidence to examine whether this is indeed the case. Specifically, we devote separate sections to reviewing and discussing the impacts of three major policies that were implemented during the COVID-19 pandemic: vaccination mandates, vaccination passports, and the provision of financial incentives. A careful analysis of the evidence provides little support that these policies backfire but instead can effectively promote vaccination at the population level. The policies are not without limitations, however, such as their inability to mobilize those that are strongly hesitant to vaccines. Finally, we discuss how policy-level interventions should be designed and implemented to address future epidemics and pandemics.

State policies increase vaccination by shaping social norms.

In a survey and four preregistered experiments, we examined if implementing a vaccine-promoting policy is likely to encourage vaccination by shaping the norms of a society. By combining state-level policy data with a longitudinal survey, we found that vaccine-supportive policies and laws are associated with more positive social norms. To establish a causal effect, we conducted four preregistered experiments to gauge the impact of policies, including the government recommendation for children to receive the COVID-19 vaccine and changes in funding for immunization programs. We find that vaccine-supportive policies strengthen the intention to receive an additional recommended COVID-19 booster shot and the intention to vaccinate children against COVID-19. We also find that these effects are mediated by the promotion of social norms supportive of vaccination. In this context, communicating about laws and policies in favor of vaccination may create a culture of vaccination and increase vaccination coverage.

Insights on the implications of COVID-19 mitigation measures for mental health.

Given the unprecedented level and duration of mitigation policies during the 2020 COVID-19 pandemic, it is not surprising that the public and the media have raised important questions about the potential for negative mental health consequences of the measures. To answer them, natural variability in policy implementation across US states and over time was analyzed to determine if mitigation policies correlated with Google searches for terms associated with symptoms of depression and anxiety. Findings indicated that restaurant/bar limits and stay-at-home orders correlated with immediate increases in searches for isolation and worry but the effects tapered off two to four weeks after their respective peaks. Moreover, the policies correlated with a reduction in searches for antidepressants and suicide, thus revealing no evidence of increases in severe symptomatology. The policy implications of these findings are discussed.

Effect of Medicaid Expansions on HIV Diagnoses and Pre-Exposure Prophylaxis Use.

INTRODUCTION: Increased insurance coverage and access to health care can increase identification of undiagnosed HIV infection and use of HIV prevention services such as pre-exposure prophylaxis. This study investigates whether the Medicaid expansions facilitated by the Affordable Care Act had these effects. METHODS: A difference-in-differences design was used to estimate the effects of the Medicaid expansions using data on HIV diagnoses per 100,000 population, awareness of HIV status, and pre-exposure prophylaxis use. The analyses involved first calculating differences in new diagnoses and pre-exposure prophylaxis use before and after the expansions and then comparing these differences between treatment counties (i.e., all counties in states that expanded Medicaid) and control counties (i.e., all counties in states that did not expand Medicaid). Further analyses to investigate mechanisms addressed associations with HIV incidence, rates of sexually transmitted infections, and substance use. Analyses were conducted between August 2019 and July 2020. RESULTS: Medicaid expansions were associated with an increase in HIV diagnoses of 0.508 per 100,000 population, or 13.9% (p=0.037), particularly for infections contracted via injection drug use and among low-income, rural counties with a high share of pre-Affordable Care Act uninsured rates that were most likely to be affected by the expansions. In addition, Medicaid expansions were associated with improvements in the knowledge of HIV status and pre-exposure prophylaxis use. There was no impact of the expansions on incident HIV, substance use, or sexually transmitted infection rates with the exception of gonorrhea, which decreased after the expansions. Altogether, these results suggest that the changes in new HIV diagnoses, awareness of HIV status, and pre-exposure prophylaxis were not simply because of a higher incidence or an increase in infection risk. CONCLUSIONS: Medicaid expansions were associated with increases in the percentage of people living with HIV who are aware of their status and pre-exposure prophylaxis use. Expanding public health insurance may be an avenue for curbing the HIV epidemic.