Disparities in COVID-19 vaccine hesitancy among Los Angeles County adults after vaccine authorization.

An equitable COVID-19 vaccine rollout is a necessary piece of the public health strategy to end the current pandemic; however, vaccine hesitancy may present a major hurdle. This study examines racial/ethnic and income-based disparities in vaccine hesitancy in Los Angeles County, a recent epicenter of the pandemic in the US, immediately after the Food and Drug Administration issued its emergency use authorization of a COVID-19 vaccine. We conducted online, stratified cross-sectional surveys of 1,984 adults living in Los Angeles County between December 2020 and January 2021 to assess hesitancy towards getting a COVID-19 vaccine. We used multivariable logistic regression to predict vaccine hesitancy after adjusting for covariates and calculated weighted population level estimates of hesitancy and reasons for hesitancy. Blacks and Hispanics were significantly more likely to be hesitant than Whites (AOR = 3.3, P < 0.001; AOR = 2.1, P = 0.008) as were those in the lowest income group (annual income <$20,000 compared to >$100,000) (AOR = 1.8, P = 0.009). Additionally, those having no confidence in doing things online (AOR = 3.3, P < 0.001) were less likely to accept the vaccine than those who were confident. Compared to hesitant White respondents, Black respondents had higher mistrust of the government (36.1% vs 22.1%, P = 0.03) and Black and Hispanic respondents were more likely to want to wait to see how the vaccine works (41.2% and 42.0% vs 27.3%, P = 0.02 and P = 0.006). Our study suggests that culturally appropriate messaging that addresses concerns for lower income and racial/ethnic minority communities, as well as alternatives to online vaccine appointments, are necessary for improving vaccine rollout.

Real-Time Data Collection to Examine Relations Between Physical Activity and Affect in Adults With Mental Illness.

Adults with serious mental illness engage in limited physical activity, which contributes to significant health disparities. This study explored the use of both ecological momentary assessments (EMAs) and activity trackers in adults with serious mental illness to examine the bidirectional relationship between activity and affect with multilevel modeling. Affective states were assessed up to seven times per day using EMA across 4 days. The participants (n = 20) were equipped with a waist-worn accelerometer to measure moderate to vigorous physical activity. The participants had a mean EMA compliance rate of 88.3%, and over 90% of completed EMAs were matched with 30-min windows of accelerometer wear. The participants who reported more positive affect than others had a higher probability of engaging in moderate to vigorous physical activity. Engaging in more moderate to vigorous physical activity than one's usual was associated with more negative affect. This study begins to address the effect of momentary mood on physical activity in a population of adults that is typically difficult to reach.

Improving attendance at post-emergency department follow-up via automated text message appointment reminders: a randomized controlled trial.

OBJECTIVES: Patients discharged from the emergency department (ED) are often referred for primary care, specialty, or other disease-specific follow-up appointments. Attendance at these scheduled follow-up appointments has been found to improve patient outcomes, decrease ED bounce-backs, and reduce malpractice risk. Reasons for missing follow-up visits are complex, but the most commonly reason cited by patients is simply forgetting. In this study the authors evaluated the ability of an automated text message reminder system to increase attendance at post-ED discharge follow-up appointments in a predominantly Hispanic safety-net population. METHODS: This was a randomized controlled trial of ED patients with outpatient follow-up visits scheduled at the time of ED discharge. A total of 374 English- and Spanish-speaking patients with text-capable mobile phones were enrolled. Patients in the intervention arm received automated, personalized text message appointment reminders including date, time, and clinic location at 7, 3, and 1 day before scheduled visits. A t-test of proportions was used to compare outcomes between intervention and control groups. Both an intention-to-treat (ITT) and a per-protocol analysis of the data were performed. The ITT more accurately reflects real-world conditions where errors such as number entry errors are bound to occur. The per-protocol analysis adds value by isolating the effect of the intervention by comparing patients who actually received it compared with those who did not. RESULTS: In the per-protocol analysis of the primary outcome, the overall appointment adherence rate was 72.6% in the intervention group compared with 62.1% in the control group (difference between groups = 10.5%, 95% confidence interval [CI] = 0.3% to 20.8%; p = 0.045; number needed to treat = 9.5). In the ITT analysis, the overall appointment attendance rate 70.2% in the intervention group compared with 62.1% in the control group (difference between groups = 8.2%; 95% CI = -1.6% to 17.7%; p = 0.100). In a secondary largely exploratory analysis, the intervention was found to have the most benefit in patients with the lowest baseline follow-up rate (English speakers with specialty care appointments). CONCLUSIONS: Automated text message appointment reminders resulted in improvement in attendance at scheduled post-ED discharge outpatient follow-up visits and represent a low-cost and highly scalable solution to increase attendance at post-ED follow-up appointments, which should be further explored in larger sample sizes and diverse patient populations.