RESUMEN
OBJECTIVES: The COVID-19 pandemic demonstrated how vaccination decisions are influenced by misinformation, disinformation, and social pressures, leading to varied and inequitable uptake rates. In this study, we examined how COVID-19 vaccine messages received via social networks were associated with vaccine uptake in rural Alabama. METHODS: From November 2021 through March 2022, we collected 700 responses to a telephone survey administered in 4 rural Alabama counties. We asked respondents to indicate whether certain social relationships (eg, family, businesses) tried to influence them to (1) obtain or (2) avoid a COVID-19 vaccine. We used χ2 tests, Kruskal-Wallis tests, Mantel-Haenszel χ2 tests, and Fisher exact tests to examine the associations between vaccination status and survey responses. RESULTS: Respondents in majority-African American counties were significantly more likely than those in majority-White counties to have received ≥1 dose of COVID-19 vaccine (89.8% vs 72.3%; P < .001). Respondents who received ≥1 dose had a significantly higher mean age than those who had not (58.0 vs 39.0 years; P < .001). Respondents who were encouraged to get vaccinated by religious leaders were more likely to have received ≥1 dose (P = .001), and those who were encouraged to avoid vaccination by family (P = .007), friends (P = .02), coworkers (P = .003), and health care providers (P < .001) were less likely to have received ≥1 dose. Respondents with more interpersonal relationships that encouraged them to avoid vaccination were more likely to be unvaccinated (P < .001). CONCLUSIONS: Interpersonal relationships and demographic characteristics appeared to be important in COVID-19 vaccine decision-making in rural Alabama. Further research needs to identify how to facilitate vaccine-positive interpersonal relationships, such as peer mentoring and trusted messenger interventions.
RESUMEN
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.
RESUMEN
The objectives of this study were to estimate the prevalence of co-occurring hypertension and depression among community-dwelling older adults and to examine predictors of co-occurring hypertension among community-dwelling older adults. A secondary analysis was conducted from a statewide survey of community-dwelling older adults in the state of Alabama. Binomial logistic regression was used to examine predictors of co-occurring hypertension and depression. The prevalence of co-occurring hypertension and depression among community-dwelling older adults was 35%. In the multivariate analysis, non-Hispanic African American ethnicity (OR = 1.690, CI 1.221-2.341) and diabetes (OR = 1.668, CI 1.173-2.372) were positively associated with co-occurring hypertension and depression. Income ≥ $20,000 (OR = 0.544, CI 0.400-0.739), ≥ 3 meals on average per day (OR = 0.576, CI 0.429-0.774), and higher self-ratings of general health (OR = 0.728, CI 0.628-0.843) and physical activity (OR = 0.827, CI 0.694-0.986) were negatively associated with co-occurring hypertension and depression. Public health professionals and clinicians who provide care to older adults in public health, community health, and primary care settings are in ideal positions to develop intervention strategies to curb the prevalence and incidence of co-occurring hypertension and depression in this population. If intervention strategies are not implemented in these respective settings, unfortunately community-dwelling older adults of non-Hispanic African American ethnicity, with diabetes, or with low self-ratings of general health and physical activity will likely suffer from cardiovascular disease at much higher rates than their counterparts.
