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OBJECTIVES: To examine parental beliefs and logistical challenges to early childhood vaccination completion as well as opportunities to support improved vaccine uptake among families experiencing homelessness. STUDY DESIGN: A cross-sectional survey was conducted between February 2018 and October 2019 with parents of children ages 19-35 months old experiencing homelessness. Participants were recruited from 10 locations that serve families experiencing homelessness in Washington, DC and by referral from other participants. Vaccination records were obtained from health care providers to determine the child's up-to-date (UTD) status with a combined 7-vaccine series. RESULTS: Of 135 children of participants, only 69 (51.1%) were UTD. Most participants had at least 1 concern about childhood vaccines and at least 1 logistical barrier to completing vaccination (57% and 85.9%, respectively). The most frequent barriers were getting a convenient appointment time (46.3%), remembering appointments (44.8%), and commuting to appointments (44.4%). Although only 53.3% of the participants' children attended a licensed daycare center and only 43.7% received benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), use of either of these programs that routinely assess vaccination status was associated with over 3 times higher adjusted odds of being UTD (aOR 3.4, 95% CI 1.6-7.3, and aOR 3.1, 95% CI 1.4-6.5, respectively). CONCLUSIONS: Logistical barriers to accessing primary care services are common among children experiencing homelessness, underscoring the importance of health care providers offering vaccines at every opportunity. Government-regulated programs are useful for promoting vaccination, and enrollment should be encouraged because many children experiencing homelessness may not access them.
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Pessoas Mal Alojadas , Esquemas de Imunização , Pais , Vacinação/estatística & dados numéricos , Adulto , Pré-Escolar , Estudos Transversais , District of Columbia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To describe the structure of networks in a cohort of mothers and to analyze associations of social network characteristics and norms with infant sleep practices. STUDY DESIGN: We recruited a prospective cohort of mothers with infants <6 months of age from January 2015 to December 2016. Mothers completed a survey about their personal social networks and infant care practices. Latent class analysis identified unobserved network types. Binary statistics and path analysis were performed. RESULTS: Overall, 402 mothers were surveyed. Latent class analysis identified 2 a priori unknown social network types: "exclusive" (restricted) and "expansive." Mothers who were black, younger, unmarried, less educated, and of lower socioeconomic status were more likely to have exclusive networks than expansive networks. Mothers with exclusive networks were more likely to be exposed to the norm of soft bedding (P = .002). Exposure to norms of non-supine infant placement, bedsharing, and soft bedding use within one's network was associated with engaging in these practices (P < .0001 for each). First-time mothers were more likely to pay attention to a non-supine norm and place infants in a non-supine position. Black mothers and first-time mothers were more likely to pay attention to the norm and use soft bedding. CONCLUSIONS: Both the type of networks mothers have and the norms regarding infant sleep practices that circulate within these networks differed by race. Network norms were strongly associated with infant sleep practices and may partially explain the racial disparity therein.
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Cuidado do Lactente , Comportamento Materno , Mães , Assunção de Riscos , Sono , Rede Social , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Estudos ProspectivosAssuntos
Asma , Estudantes , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia , Criança , HumanosRESUMO
OBJECTIVE: To examine missed opportunities to administer an eligible vaccination (MOs) and their contribution to underimmunization in contemporary pediatric practices. STUDY DESIGN: This study was a retrospective analysis from 42 diverse pediatric practices located throughout the US. Medical records of 50 randomly selected children 3-18 months of age per practice were reviewed in Spring 2013. Immunization status for age and MOs were assessed as of each encounter and as of March 1, 2013. RESULTS: Of 2076 eligible patients, 72.7% (95% CI 67.6-77.9) were up-to-date with receipt of standard vaccines. Most children (82.4%; 95% CI 78.3-85.9) had at least 1 MO, and 37.8% (95% CI 30.0-46.2) had at least one MO to administer an overdue vaccination. After adjustment, risk of underimmunization was 3.5 times greater for patients who had ever experienced an MO for an overdue vaccination compared with those who had not (adjusted relative risk = 3.5; 95% CI 2.8-4.3). If all age-appropriate vaccinations had been administered at the last recorded encounter, 45.5% (95% CI 36.8-54.5) of the underimmunized patients would have been up to date at the time of assessment. CONCLUSION: MOs were common and contributed substantially to underimmunization in this contemporary sample of diverse primary care practice settings.
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Atenção Primária à Saúde , Vacinação/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosAssuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Educação em Saúde , Programas de Imunização/organização & administração , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/prevenção & controle , Vacinas Virais , COVID-19 , Vacinas contra COVID-19 , Comunicação em Saúde/métodos , Humanos , Segurança do Paciente , SARS-CoV-2 , Confiança , Estados Unidos , Recusa de Vacinação , Vacinas Virais/efeitos adversosRESUMO
OBJECTIVE: To increase administration of influenza (flu), human papillomavirus (HPV) and meningococcal serogroup B (MenB) vaccinations to students at college student health centers (SHCs). PARTICIPANTS: Improvement teams from 45 US-based SHCs. METHODS: Teams participated in a 7-month virtual learning collaborative to implement immunization delivery best practices at their SHCs. A pre-post-intervention design was used to compare vaccination coverage in May 2017 to May 2018 among students who were unvaccinated at the start of the academic year. RESULTS: Data were compared from 29 SHCs and 152,648 students (2017) and from 18 SHCs and 122,315 students (2018). Percent of newly vaccinated students increased for ≥1 dose of flu vaccine by 14.3 percentage points to 32.3% (p < .01), ≥1 dose of HPV vaccine by 3.9 points to 7.8% (p < .05) and ≥3 doses of HPV vaccine by 0.7 points to 1.5% (p < .05). CONCLUSIONS: Participating in a learning collaborative may help SHCs improve vaccination delivery.
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Vacinas contra Influenza , Vacinas Meningocócicas , Vacinas contra Papillomavirus , Humanos , Melhoria de Qualidade , Universidades , Estudantes , Vacinação , Imunização , Vacinas contra Papillomavirus/uso terapêuticoRESUMO
OBJECTIVES: Addressing parental/caregivers' coronavirus disease 2019 (COVID-19) vaccine hesitancy is critical to improving vaccine uptake in children. Common concerns have been previously reported through online surveys, but qualitative data from KII and focus groups may add much-needed context. Our objective was to examine factors impacting pediatric COVID-19 vaccine decision-making in Black, Spanish-speaking, and rural white parents/caregivers to inform the content design of a mobile application to improve pediatric COVID-19 vaccine uptake. METHODS: Parents/caregivers of children aged 2 to 17 years from groups disproportionately affected by COVID-19-related vaccine hesitancy (rural-dwelling persons of any race/ethnicity, urban Black persons, and Spanish-speaking persons) were included on the basis of their self-reported vaccine hesitancy and stratified by race/ethnicity. Those expressing vaccine acceptance or refusal participated in KII, and those expressing hesitancy in focus groups. Deidentified transcripts underwent discourse analysis and thematic analysis, both individually and as a collection. Themes were revised until coders reached consensus. RESULTS: Overall, 36 participants completed the study: 4 vaccine acceptors and 4 refusers via KIIs, and the remaining 28 participated in focus groups. Participants from all focus groups expressed that they would listen to their doctor for information about COVID-19 vaccines. Infertility was a common concern, along with general concerns about vaccines. Vaccine decision-making was informed by the amount of information available to parents/caregivers, including scientific research; possible positive and negative long-term effects; and potential impacts of vaccination on preexisting medical conditions. CONCLUSIONS: Parents/caregivers report numerous addressable vaccine concerns. Our results will inform specific, targeted interventions for improving COVID-19 vaccine confidence.
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Vacinas contra COVID-19 , COVID-19 , Humanos , Criança , COVID-19/prevenção & controle , Pesquisa Qualitativa , Grupos Focais , Pais , VacinaçãoRESUMO
Based on strong research evidence, the most common causes of apparent life-threatening events (ALTEs) are gastroesophageal reflux, lower respiratory tract infection, and seizure. ⢠The minimum initial diagnostic panel for ALTE should include complete blood cell (CBC) count with differential; blood levels of C-reactive protein,glucose, sodium, potassium, urea, calcium,magnesium, ammonia, lactate, and pyruvate; arterial blood gas determination, urinalysis, and toxicology screen; electrocardiography; and assessments for Bordetella pertussis and respiratory syncytial virus in season. ⢠Other testing should be done based on the infant's clinical presentation and clinician's degree of suspicion.⢠Most infants should be hospitalized for cardiorespiratory monitoring for 23 hours after an ALTE. ⢠There is strong evidence that newborns are at higher risk of ALTE and sudden infant death syndrome (SIDS)within the first 24 hours after birth and therefore should be frequently monitored as much as possible while room sharing with their mothers. ⢠Evidence suggests that maternal smoking may place an infant for higher risk of SIDS after an ALTE.
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Evento Inexplicável Breve Resolvido , Evento Inexplicável Breve Resolvido/diagnóstico , Evento Inexplicável Breve Resolvido/etiologia , Evento Inexplicável Breve Resolvido/terapia , Diagnóstico Diferencial , Hospitalização , Humanos , Lactente , Recém-Nascido , Fatores de Risco , Morte Súbita do Lactente/diagnóstico , Morte Súbita do Lactente/etiologiaRESUMO
OBJECTIVE: The interventions colleges use to help students be compliant with vaccinations is unknown. This study describes colleges' use of practices consistent with Centers for Disease Control and Prevention (CDC) recommendations to encourage student body vaccination. PARTICIPANTS: Participants were a convenience sample of 136 student health center (SHC) administrators from colleges across the U.S. METHODS: An online survey assessed SHCs' use of various practices, policies and services to improve student body vaccination coverage. RESULTS: There was wide variability in use of evidence-based interventions overall and with respect to specific vaccinations. While most SHCs (92.7%) coordinated vaccination outreach events on campus, only half (50%) accessed an immunization registry to verify vaccination histories. While 88.6% requested student vaccination histories for MMR, only 39.7% requested it for human papillomavirus (HPV). CONCLUSIONS: The discrepancies in SHC implementation of interventions to increase coverage of the recommended vaccinations for students suggest that helping colleges expand their capacity to intervene may decrease coverage rate disparities.
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Vacinas contra Papillomavirus , Cobertura Vacinal , Humanos , Vacinas contra Papillomavirus/uso terapêutico , Estudantes , Inquéritos e Questionários , Universidades , VacinaçãoRESUMO
Background: In the name of extensive vaccine uptake, understanding the public's attitude, perception, and intent toward COVID-19 vaccination is a significant challenge for public health officials. Methods: A cross-sectional survey via an online questionnaire rooted in the Health Belief Model and Integrated Behavioral Model was conducted to evaluate COVID-19 vaccination intent and its associated factors. Factor analysis and multivariate logistic regression were operated to be satisfactory. Results: Among the 4,933 respondents, 24.7% were health care workers, and 64.2% intended to accept COVID-19 vaccination. The adjusted odds (aOR) of COVID-19 vaccination intent was higher for individuals with greater exposure to social norms supportive of COVID-19 vaccination (aOR = 3.07, 95% Confidence Interval (CI) = 2.71, 3.47) and higher perceived benefits of COVID-19 vaccination (aOR = 2.9, 95% CI = 2.49, 3.38). The adjusted odds of vaccination intent were lower for individuals with greater COVID-19 vaccine safety concerns (aOR = 0.28, 95%CI = 0.25, 0.31). Lower vaccination intent was also associated with increasing age ((aOR = 0.99, 95% CI = 0.98, 0.999), female sex (aOR = 0.76, 95% CI = 0.65, 0.88), and working in the health care field (aOR = 0.75, 95% CI = 0.63, 0.9). Conclusions: The odds of COVID-19 vaccination intent were higher three or more times among those with a greater belief in vaccine effectiveness, lower concerns about vaccine safety, and greater exposure to cues to vaccinate, including from doctors. This last finding is concerning as vaccine acceptance was surprisingly lower among health care workers compared to others. The remarkable results of factor analysis and reliability of the questionnaire may encourage local health authorities to apply it to their regional population.
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Neisseria meningitidis is a bacterial pathogen capable of causing rapidly progressing illness from nonspecific symptoms to end-organ failure or death in a matter of hours to days. Despite the availability of meningococcal vaccines, there remains a notable disease incidence peak among individuals aged 18-19 years, with college students at increased risk for disease relative to non-college students. Between 2007 and 2017, as many as one in five colleges in the United States experienced an outbreak of meningococcal disease at their own or a nearby institution. Evidence-based strategies to promote meningococcal vaccination among students can be adapted for the college setting, but barriers exist that limit widespread implementation of these strategies by colleges. In this article, we review meningococcal disease characteristics and epidemiology among US college students, vaccination indications and coverage levels among US college students, as well as college vaccination policies and practices that can impact students' vaccine uptake.
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Infecções Meningocócicas , Vacinas Meningocócicas , Neisseria meningitidis , Humanos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Estudantes , Estados Unidos/epidemiologia , VacinaçãoRESUMO
PURPOSE: Young adults are at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and transmission due to their social behaviors. The purpose of this study was to determine their attitudes toward coronavirus disease 2019 (COVID-19) testing, an important approach for minimizing infection and transmission. METHODS: One hundred seventy eight US individuals aged 19-25 years completed an online survey measuring COVID-19 health beliefs and testing intentions. Multivariable logistic regression evaluated the association of heath belief measures (perceived COVID-19 susceptibility, COVID-19 severity, barriers and benefits to testing, and social concerns) with testing intentions. RESULTS: Most respondents (86.0%) intended to accept a COVID-19 test if recommended by a health professional. High social concern and low perceived obstacles were associated with intent to get tested. CONCLUSIONS: In this sample, most young adults intended to accept COVID-19 testing. Health beliefs predicted testing intention and point to possible intervention approaches to increase willingness to accept COVID-19 testing.
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Teste para COVID-19/estatística & dados numéricos , COVID-19/diagnóstico , Emoções , Conhecimentos, Atitudes e Prática em Saúde , Intenção , Adulto , Feminino , Humanos , Masculino , SARS-CoV-2 , Inquéritos e Questionários , Adulto JovemRESUMO
Purpose: Black Americans are disproportionately affected by coronavirus disease 2019 (COVID-19) hospitalizations and deaths. Decreasing health disparities requires widespread uptake of COVID-19 testing, but attitudes about COVID-19 testing among Black Americans have not been studied. We aimed to characterize knowledge, attitudes, and beliefs about COVID-19 testing among Black parents. Methods: Semi-structured interviews were conducted and analyzed using a phenomenology approach with 26 self-identified Black parents after telemedicine visits with a children's health center. Interviews were recorded and transcribed; 65% were double coded with a resultant free-marginal interrater kappa score of 86.8%. Results: Most participants were women, spent time inside the homes of friends or family members, and almost half knew someone diagnosed with COVID-19. Three central themes emerged regarding COVID-19 testing decision making, including: 1) perceived COVID-19 disease susceptibility; 2) barriers to testing, with subthemes including trust in test accuracy and safety, perceived stigma of a positive test result, and impact of racism on self-efficacy; and 3) cues to action. Conclusions: When considering these themes as constructs of the Health Belief Model, we are better able to understand Black Americans' views of COVID-19 testing and motivations for accessing testing. Culturally responsive educational campaigns delivered by trusted community members should aim to improve understanding about disease transmission and types of tests available. Importantly, framing testing as a means to ensure safety may improve self-efficacy to obtain testing. Lastly, the health community should learn from these conversations with Black Americans so that disease prevention and mitigation strategies prioritize health equity.
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Teste para COVID-19 , COVID-19 , Adulto , Negro ou Afro-Americano , Atitude , Criança , Feminino , Humanos , SARS-CoV-2 , Estados UnidosRESUMO
Background: An individual's personal social network influences behavior; one is more likely to adopt behaviors consistent with norms within the network to avoid social stigma. Personal social network types, which are associated with individual behaviors, have been identified for new mothers: exclusive (kin centric) and expansive (not kin centric). Objective: To analyze the impact of personal social network type on breastfeeding practices in U.S.-born Black and White mothers. Methods: Mothers of infants <6 months old completed surveys about their personal social networks and feeding practices. Multinomial logit models examined how social network types moderated effects of sociodemographic factors on feeding practices. Results: Of 402 mothers, 67% self-identified as Black and 33% as White. Forty-six percent were exclusively breastfeeding; 26% were mixed breast and formula feeding. The likelihood of exclusively breastfeeding was positively associated with percentage of network members who had breastfed; this association was stronger for mothers with exclusive networks than those with expansive networks (ß = 2.74, p < 0.001 versus ß = 1.78, p = 0.03). Black race was positively correlated with exclusive breastfeeding or mixed feeding for mothers with exclusive networks (ß = 1.50, p = 0.046; ß = 1.86, p = 0.02, respectively). Lower educational level was negatively correlated with exclusive breastfeeding; this correlation was stronger for mothers with exclusive networks (ß = -1.91, p = 0.002 versus ß = -1.70, p = 0.04). Lower educational level was also negatively correlated with mixed feeding for mothers with exclusive networks (ß = -1.61, p = 0.02). Conclusions: Mothers' personal social network type likely moderates the relationship between sociodemographic variables and feeding practices. While the influence of having network members with breastfeeding experience is important, the magnitude of influence is stronger in exclusive networks.
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Aleitamento Materno , Fatores Sociodemográficos , População Negra , Feminino , Humanos , Lactente , Mães , Rede Social , Estados UnidosRESUMO
INTRODUCTION: Comprehensive vaccination coverage among homeless children in the United States (US) is largely unknown although a few studies suggest low coverage with single vaccinations. This study compared vaccination coverage with a combined 7-vaccines series among homeless children in the District of Columbia (DC) to coverage among other US children. MATERIALS AND METHODS: A cross-sectional survey of homeless children in DC was conducted from 2018 to 2019. Recruitment occurred at housing shelters, social services centers, and a diaper dispensary, and through limited chain referral. English-speaking parents of a child aged 19 to 35 months who spent the majority of the last 30 nights homeless were recruited. Participants consented for their child's healthcare providers to submit vaccination records. The vaccination coverage estimate of this sample was compared with estimates of three populations in the 2018 National Immunization Survey (NIS): children in DC (NIS DC), children in the US (NIS US), and children in the US below the federal poverty level (NIS poor). RESULTS: Most of the 135 children had experienced at least two lifetime episodes (63.7%) and 12 months (57%) of homelessness. The estimated percent up to date was 52.6% (95% CI: 43.8%, 61.3%). This estimate was 20.4 (95% CI: 11.9, 28.8, p < .0001), 20 (95% CI: 11.5, 28.4, p < .0001), and 11.5 (95% CI: 3.1, 20, p < .01) percentage points lower than estimates for the NIS DC, NIS US and NIS poor populations, respectively. After adjusting for child's age and race/ethnicity, vaccination coverage of the NIS DC sample was below that of NIS US (p < .01) and NIS poor samples (p < .05). CONCLUSION: Children experiencing homelessness may be at risk of under-vaccination, even when compared to a general population of children in poverty. Awareness of this heightened risk may allow for more precise targeting of vaccination delivery support specifically to children experiencing homelessness.
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Jovens em Situação de Rua , Cobertura Vacinal , Criança , Estudos Transversais , Humanos , Imunização , Lactente , Estados Unidos , VacinaçãoRESUMO
Introduction: Children exposed to adverse childhood experiences (ACEs) may access multiple systems of care to address medical and social complexities. Care coordination (CC) optimizes health outcomes for children with special health care needs who often use multiple systems of care. Little is known about whether ACEs are associated with need and unmet need for CC. Methods: Use of the 2016-2017 National Survey of Children's Health to identify children who saw ≥1 health care provider in the last 12 months. The study team used weighted logistic regression analyses to examine associations between 9 ACE types, ACE score and need and unmet need for CC. Results: In the sample (N=39,219, representing 38,316,004 US children), material hardship (aOR, 1.50; 95% CI, 1.29-1.75), parental mental illness (aOR, 1.31; 95% CI, 1.07-1.60), and neighborhood violence (aOR, 1.33; 95% CI, 1.01-1.74) were significantly associated with an increased need for CC. Material hardship was also associated with unmet need for CC (aOR, 2.37; 95% CI, 1.80 - 3.11). Children with ACE scores of 1, 2, 3, and ≥4 had higher odds of need and unmet need for CC than children with 0 ACEs. Discussion: Specific ACE types and higher ACE scores were associated with need and unmet need for CC. Evaluating the unique needs of children who endured ACEs should be considered in the design and implementation of CC processes in the pediatric healthcare system.
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BACKGROUND: Respondent driven sampling (RDS) is employed to recruit populations that are hard-to-reach, "hidden," or without a sampling frame. For new mothers (those with infants <6 months) in countries without national health care systems or registries, there is no sampling frame, and random samples may only be attained through costly strategies, e.g., random-dial calling. OBJECTIVE: To assess the feasibility of RDS to recruit new mothers. METHODS: In the initial study, we recruited 30 new mothers ("seeds") from a single birth hospital; each was given 3 referral coupons to give to other mothers ("referrals"). When our sample did not self-perpetuate with referrals, additional seeds were recruited. Demographics of seeds and referrals were compared. A subset of mothers participated in focus groups and were asked about their experience with RDS. We also conducted a second survey of new mothers to further assess feasibility of RDS in this population. RESULTS: Of the 402 mothers recruited in the initial study, 305 were seeds and only 97 were referrals. Referrals were more likely to be White, highly educated, older, and privately insured (all p≤0.001). Focus group participants indicated that the time required to meet other mothers was an important barrier. In the second survey we recruited 201 mothers; only 53.7% knew ≥1 mother whom they could invite to the study. CONCLUSIONS: New mothers are not easily recruited using RDS because they have a limited number of contacts who are also new mothers. Those recruited through RDS are more likely to be older, Caucasian and of high socioeconomic status, indicating it is not an effective way to recruit a representative sample of new mothers.
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Mães , Adulto , Atenção à Saúde , District of Columbia , Feminino , Grupos Focais , Hospitais , Humanos , Lactente , Recém-Nascido , Masculino , Estudos de Amostragem , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Most Neisseria meningitidis involved in invasive disease among American college students express serogroup B antigen. The Advisory Committee on Immunization Practices (ACIP) recommends healthcare providers (HCPs) share clinical decision making with patients to determine individual value of meningococcal serogroup B vaccination (MenB) rather than routinely recommend vaccination as with the meningococcal A,C,W,Y vaccine (MenACWY). This study examines the attitudes and practices of HCPs working in college student health centers (SHCs) regarding the recommendation and administration of MenB to students. METHODS: The study was conducted as an online and phone survey of SHC HCPs from a sample of colleges across the United States between May 2017 and July 2018. Items compared college SHC policies and practices for MenB to those for MenACWY. It also assessed perceived barriers to and facilitators of MenB delivery to students. RESULTS: Among the 147 respondents, almost 50% more reported their SHC stocked and administered MenACWY (54.1%) than MenB (37%) (p = .004). Almost five times as many colleges required their students receive MenACWY as MenB (53.5% vs. 10.5%, p < .001). A greater percentage requested students to submit records for MenACWY than MenB (77.3% vs. 46.9%, p < .001), and over three times as many tracked student-body coverage rates for MenACWY than MenB (55.6% vs. 15.8%, p < .001). Nearly three quarters of respondents estimated their college's student body MenB coverage rate to be ≤ 10% or were unable to provide any estimate. Factors perceived by over half of the participants as moderate to extreme barriers to administering MenB included high upfront costs for SHCs to purchase and stock MenB (68.7%), and high out-of-pocket costs for students to receive it (82.8%). CONCLUSIONS: A minority of college SHCs require, offer or track Men B vaccination on their campuses. Financial concerns are common barriers to SHCs' stocking and administering MenB to students.
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Infecções Meningocócicas , Vacinas Meningocócicas , Neisseria meningitidis Sorogrupo B , Humanos , Masculino , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Sorogrupo , Estados Unidos , VacinaçãoRESUMO
Exposure to pro-vaccination messages from nonmedical peers and others perceived to share a similar value system for society (referred to as worldview outlook) improves vaccination attitudes. Nonetheless, a minority of African American parents have friends and family members who provide them with vaccine advice. The aims of the current study were to identify the presumed worldview outlook of eight types of community figures as perceived by African American parents, and determine parents' trust in these figures for vaccine advice, and whether trust varied according to the figures' racial concordance. A cross-sectional survey was administered to 110 African American parents in 2015. Parents perceived the community figures to represent a spectrum of worldview outlooks. Although levels of trust in the community figures differed overall (p < .001), it was high in the school nurse, pediatrician, mother, father, disease survivor, and vaccine scientist. All trusted figures except the father were perceived to hold a communitarian outlook. Parents shown race-concordant figures had higher levels of trust in them than those who were shown race-discordant equivalents (p < .01). These findings suggest that vaccination campaigns geared toward African American parents may be strengthened by including other nonmedical, African American spokespersons who convey their community contributions in messages.
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Negro ou Afro-Americano/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Confiança , Vacinação/psicologia , Adulto , Negro ou Afro-Americano/psicologia , Estudos Transversais , Feminino , Educação em Saúde , Humanos , Relações Interpessoais , Masculino , Valores Sociais/etnologia , Vacinação/estatística & dados numéricos , Adulto JovemRESUMO
PURPOSE: Despite that human papillomavirus (HPV) vaccination could prevent â¼90% of HPV-associated cancers, only 65.5% of American adolescents initiate vaccination. African Americans have the highest prevalence of morbidity and mortality from HPV-associated cancers. Mounting evidence suggests that advice from social contacts is associated with vaccine acceptance. The present study examines the associations of social processes with HPV vaccine refusal among African American parents. METHODS: A cross-sectional survey was conducted among African American parents of children aged 10-12 years before a health-care visit at which HPV vaccine was offered by the health-care provider. Data from the 353 parents who named at least one social contact who advised them about vaccines were included in these analyses. RESULTS: Only 54.4% of the participants consented to HPV vaccination for their children. On average, parents had 2 to 3 social contacts who provided vaccine advice. Vaccine advice networks were generally dense, family-centric, and homophilous. Slightly over 80% of all parents trusted family members and friends for vaccine advice "some" or "a lot." Controlling for sociodemographic characteristics and reason for the health-care visit, perceived high exposure to anti-HPV vaccine viewpoints and low exposure to pro-HPV vaccine viewpoints were both associated with HPV vaccine refusal (adjusted odds ratio = 1.5, 95% confidence interval = 1.01, 2.3, and adjusted odds ratio = 1.7, 95% confidence interval = 1.2, 2.6, respectively). CONCLUSIONS: Social processes may be associated with HPV vaccine refusal among African American parents. Interventions designed to educate African American parents about HPV vaccine to increase uptake should consider leveraging vaccine advice networks for greater impact.