COVID-19 Vaccination Intention and Factors Associated with Hesitance and Resistance in the Deep South: Montgomery, Alabama.

Using COVID-19-related survey data collected from residents in the city of Montgomery, Alabama, this study assessed the prevalence of COVID-19 vaccine acceptance, hesitance, and resistance, and identified factors associated with COVID-19 vaccine hesitance and resistance. To analyze the survey data (n = 1000), a consolidation approach (machine learning modeling and multinomial logistic regression modeling) was used to identify predictors of COVID-19 vaccine hesitancy and resistance. The prevalence of vaccine acceptance, hesitancy, and resistance was 62%, 23%, and 15%, respectively. Female gender and a higher level of trust that friends and family will provide accurate information about the COVID-19 vaccine were positively associated with vaccine hesitancy. Female gender and higher trust that social media will provide accurate information about COVID-19 were positively associated with vaccine resistance. Factors positively associated with COVID-19 vaccine hesitance and resistance in the study's geographical area are worrisome, especially given the high burden of chronic diseases and health disparities that exist in both Montgomery and the Deep South. More research is needed to elucidate COVID-19 vaccination attitudes and reasons for non-acceptance of the COVID-19 vaccine. Efforts to improve acceptance should remain a priority in this respective geographical area and across the general population.

Associations between Public Fear of COVID-19 and Number of COVID-19 Vaccinations: A County-Level Longitudinal Analysis.

BACKGROUND AND PURPOSE: A large number of COVID-19 infections and deaths and the ensuing socioeconomic problems created widespread public fear around COVID-19. Fear around COVID-19 greatly influences people's attitudes towards receiving the COVID-19 vaccines. The purpose of this study is examining (a) the impact of the public fear of COVID-19 (PFC) on the number of COVID-19 vaccinations at the county level; (b) the interaction effect between the PFC and per capita income, unemployment rates, and COVID-19 vaccines incentive policies, on the number of COVID-19 vaccinations at the county level. METHOD: This is a longitudinal analysis across states in the U.S. by using county-level data of 2856 counties from 1 February to 1 July. Random-effects models were adopted to analyze the associations between the PFC and the number of COVID-19 vaccinations. RESULT: the PFC was positively associated with the number of COVID-19 vaccinations at county-level, as PFC increases from 0 to 300, the predicted vaccination number increases from 10,000 to 230,000. However, the associations were divergent when the PFC interacts with county-level per capita income, unemployment rates, and incentive policies. CONCLUSION: public fear is an important indicator for the county-level vaccination numbers of COVID-19. However, it is critical to consider public fear and socioeconomic factors when making policies that aim to increase COVID-19 vaccination rates.

Associations between Bonus and Lottery COVID-19 Vaccine Incentive Policies and Increases in COVID-19 Vaccination Rates: A Social Epidemiologic Analysis.

The objectives of this longitudinal study were to analyze the impact of COVID-19 vaccine incentive policies (e.g., bonuses and lottery entries) on county-level COVID-19 vaccination rates, and to examine the interactive effects between COVID-19 vaccine incentive policies and socioeconomic factors on COVID-19 vaccination rates. Using publicly available data, county-level COVID-19 vaccination rates and socioeconomic data between January 2021 and July 2021 were extracted and analyzed across counties in the United States (US)-an analysis of 19,992 observations over time. Pooled ordinary least squares (OLS) analysis was employed to longitudinally examine associations with COVID-19 vaccination rates, and four random-effects models were developed to analyze interaction effects. Bonus incentive policies were effective in counties with a high per capita income, high levels of education, and a high percentage of racial minorities, but not in counties with high unemployment. Lottery incentive policies were effective in counties with a high percentage of racial minorities, but not in counties with high per capita income, high levels of education, and high unemployment. County-level socioeconomic factors should be considered ahead of implementing incentive policies, versus a blanket approach, to avoid the unintentional misuse of economic resources for futile COVID-19 vaccination outcomes.

An Epidemiologic Analysis of Associations between County-Level Per Capita Income, Unemployment Rate, and COVID-19 Vaccination Rates in the United States.

The purpose of this longitudinal study was to examine associations between per capita income, unemployment rates, and COVID-19 vaccination rates at the county-level across the United States (U.S.), as well as to identify the interaction effects between county-level per capita income, unemployment rates, and racial/ethnic composition on COVID-19 vaccination rates. All counties in the U.S. that reported COVID-19 vaccination rates from January 2021 to July 2021 were included in this longitudinal study (n = 2857). Pooled ordinary least squares (OLS) with fixed-effects were employed to longitudinally examine economic impacts on racial/ethnic disparities on county-level COVID-19 vaccination rates. County-level per capita income and county-level unemployment rates were both positively associated with county-level COVID-19 vaccination rates across the U.S. However, the associations were divergent in the context of race/ethnicity. Public health efforts to bolster COVID-19 vaccination rates are encouraged to consider economic factors that are associated with decreases in COVID-19 vaccination rates.

A Longitudinal Analysis of Patient-Level Factors Associated with Pap Test Uptake Among Chinese American Women.

The purpose of this study was to longitudinally examine patient-level factors associated with Pap test uptake among middle-aged Chinese American women. The study analyzed data from 498 Chinese American women (1326 person-time-waves) who participated in the Study of Women's Health Across the Nation (SWAN) Series. Generalized estimating equation (GEE) was used to longitudinally examine patient-level factors associated with Pap test uptake over the 7-year period. Of the 1326 person-time-waves, 61% had a Pap test and 39% did not. Higher amounts of time spent by female healthcare providers for female health needs (eb = 3.35, p < 0.01), having a female healthcare provider for female health needs (eb = 3.36, p < 0.01),, and a history of cancer (eb = 6.05, p < 0.01) or fibroids (eb = 1.66, p < 0.01) were positively associated with Pap test uptake among Chinese American women, whereas not having a primary care provider (eb = 0.27, p < 0.05) and not having time to go to the doctor (eb = 0.31, p < 0.05) were negatively associated with Pap test uptake. Health education and health promotion messaging that accentuates the benefits of access to primary care providers and allocation of time to attend to health needs may bolster Chinese American women's acceptability and uptake of routine Pap testing for cervical cancer prevention. If health education and health promotion efforts are not developed, suboptimal rates of Pap testing will widen the disparity gap and contribute to Chinese American women's increased risk of cervical cancer morbidity and mortality in the coming years.

Adult Immigrants' Utilization of Physician Visits, Dentist Visits, and Prescription Medication.

This study sought factors in immigrants' utilization of services of physicians and dentists, as well as their use of prescription medication. The study used data from 1452 adult immigrants collected for the National Health and Nutrition Examination Survey 2011-2012. Logistic regression results showed that age, US citizenship, and health insurance status were associated with the use of physician, dentist, and medication services. For this sample, physician visits were associated negatively with Hispanic ethnicity, poverty-level family income, and English-language proficiency. Also, dentist visits were associated positively with female gender, good health, and more education; and negatively with Black ethnicity, family income at 101-200% of poverty level, and English-language proficiency. Medication use was associated positively with poor health and female gender, and negatively with Hispanic ethnicity. Implications for policy and intervention development/implementation are discussed.

A comparison of urban and non-urban African American older adults on health-related characteristics.

Although residential geographic health disparities have been noted in the previous literature, studies are specifically lacking on intra-group health comparisons of African American older adults by residential geography. The purpose of this study was to determine if health-related characteristics of African American older adults varied by residential geography. Socioeconomic demographics, medical conditions, primary care use, and self-ratings of general health, social activity, and physical activity were compared in a community-dwelling sample of 327 urban and non-urban African American older adults. Urban and non-urban African American older adults were compared on health-related factors. Compared to urban African American older adults, those in non-urban areas had lower incomes, lower self-ratings of general health, social activity, and physical activity, and a higher frequency of arthritis and gastroenterological and urological conditions. Despite poorer general health and medical conditions, non-urban African American older adults were less likely to visit the doctor when needed. Study findings suggest residential geography may be an underappreciated underlying contributing factor to inter-group health disparities between African American and white older adults and not race alone. Therefore, social workers in public health, health care, and clinical settings should be aware of the interaction between race and residential geography.

Short article: Alcohol and substance use, race, and insurance status predict nontreatment for hepatitis C virus in the era of direct acting antivirals: a retrospective study in a large urban tertiary center.

OBJECTIVE: Direct acting antivirals (DAAs) have overcome many long-standing medical barriers to hepatitis C virus (HCV) treatment (i.e. host characteristics and medical contraindications) and treatment outcome disparities that were associated with interferon regimens. The public health and clinical benefit of current and forthcoming DAA discoveries will be limited if efforts are not made to examine racial, psychological, and socioeconomic factors associated with being treated with DAAs. This study examined racial, psychological, and socioeconomic factors that facilitate and inhibit patients receiving DAAs for HCV. PATIENTS AND METHODS: This was a single-center retrospective cohort study at a large urban tertiary center of patients (n=747) who were referred for evaluation and treatment of HCV. RESULTS: Sixty-eight percent of patients were non-Hispanic White, 31% were African American, and 1% were of other ethnicities. The majority of patients received treatment, but 29% (218/747) did not. Patients who were older [odds ratio (OR)=1.02, 95% confidence interval (CI): 1.01-1.04] and insured (OR=2.73, 95% CI: 1.12-6.97) were more likely to receive HCV treatment. Patients who were African American (OR=0.46, 95% CI: 0.46-1.06), used drugs (OR=0.09, 95% CI: 0.04-0.17), smoked (OR=0.55, 95% CI: 0.37-0.81), and used alcohol (OR=0.11, 95% CI: 0.06-0.20) were less likely to receive HCV treatment. CONCLUSION: Though DAAs have eliminated many historically, long-standing medical barriers to HCV treatment, several racial, psychological and socioeconomic barriers, and disparities remain. Consequently, patients who are African American, uninsured, and actively use drugs and alcohol will suffer from increased HCV-related morbidity and mortality in the coming years if deliberate public health and clinical efforts are not made to facilitate access to DAAs.

Assessment of recent HIV testing among older adults in the United States.

Older adults are the fastest growing segment of people living with HIV, and unfortunately many are unaware of their HIV status. Many providers are reluctant to ask older adults about their sexual histories, evaluate their risk factors, and test for HIV, and older adults have low perception of HIV risk. Using data from the 2013 to 2014 National Health and Nutrition Examination Survey, this study assessed the prevalence of recent HIV testing among older adults in the United States (n = 1,056) and identified predictors and barriers to recent HIV testing. The prevalence of recent HIV testing was 28%. Recent HIV testing was associated positively with male gender, education level, having public insurance, having same sex sexual behavior, African, and Hispanic ethnicity, whereas age, income-to-poverty ratio, and Asian ethnicity were associated negatively with recent HIV testing. Public health social workers are advised that targeted HIV testing for Asian, economically disadvantaged, female older adults is needed to increase HIV awareness and detection and to decrease late diagnosis of HIV. Provided public insurance was identified as a predictor of recent HIV testing, facilitating economically disadvantaged older adults' eligibility for public insurance that will likely improve access to HIV testing services and increase HIV testing rates.

Analysis of the Molecular Evolution of the Mycobacterium Tuberculosis Drug-Resistant Gene rpoB in Asia Using a Bayesian Evolutionary Method.

BACKGROUND: Tuberculosis (TB) is a serious communicable disease throughout the world. Re-emergence of the TB epidemic is aggravated by the circulation of multidrug-resistant Mycobacterium tuberculosis strains, and more than half of new cases have occurred in Asia. Therefore, it is important to understand the gene mutations underlying the development of rifampicin resistance in Asia. METHODS: In this study, we classified the rifampicin-resistant Mycobacterium tuberculosis (MTB) rpoB data downloaded from Genbank, based on 12 mutation points. The relationship between the mutation sites and regional information was analyzed, after which the mutation dates and mutation trends of the rpoB gene were predicted by the Markov Chain Monte Carlo (MCMC) method. RESULTS: We discovered that the mutation sites of the rpoB gene were disparate in different regions of Asia. The results of this study clearly showed that drug-resistant gene mutations in Asia started to increase in 2000 and peaked in 2006, indicating the relationship between drug resistance and outbreak trends of TB. CONCLUSIONS: From our analysis, it was not difficult to see the relationship between the mutation rates of the rpoB gene and the outbreak of TB. Hence, to some degree, outbreak trends of TB can be predicted through genotyping based on the rpoB gene.