A COVID-19 Vaccination Program to Promote Uptake and Equity for People Experiencing Homelessness in Los Angeles County.

People experiencing homelessness (PEH) have been disproportionately affected by COVID-19, yet their vaccination coverage is lower than is that of the general population. We implemented a COVID-19 vaccination program that used evidence-based and culturally tailored approaches to promote vaccine uptake and equity for PEH in Los Angeles County, California. From February 2021 through February 2022, 33 977 doses of vaccine were administered at 2658 clinics, and 9275 PEH were fully vaccinated. This program may serve as a model for future service delivery in vulnerable populations. (Am J Public Health. 2023;113(2):170-174. https://doi.org/10.2105/AJPH.2022.307147).

Financial Incentives for COVID-19 Vaccines Among People Experiencing Homelessness.

INTRODUCTION: Novel strategies are needed to address barriers to COVID-19 vaccination among people experiencing homelessness (PEH), a population that faces increased COVID-19 risk. Although growing evidence suggests that financial incentives for vaccination are acceptable to PEH, their impact on uptake is unknown. This study aimed to assess whether offering $50 gift cards was associated with the uptake of the first doses of COVID-19 vaccine among PEH in Los Angeles County. METHODS: Vaccination clinics began on March 15, 2021; the financial incentive program was implemented from September 26, 2021 to April 30, 2022. Interrupted time-series analysis with quasi-Poisson regression was used to evaluate the level and slope change in the number of weekly first doses administered. Time-varying confounders included the weekly number of clinics and the weekly number of new cases. Demographic characteristics were compared for PEH vaccinated before and after the implementation of the incentive program using chi-square tests. RESULTS: Offering financial incentives was associated with the administration of 2.5 times (95% CI=1.8, 3.1) more first doses than would have been expected without the program. Level (-0.184, 95% CI= -1.166, -0.467) and slope change (0.042, 95% CI=0.031, 0.053) were observed. Individuals who were unsheltered, aged <55 years, and identified as Black or African American accounted for a higher percentage of those vaccinated during the post-intervention period than during the pre-intervention period. CONCLUSIONS: Financial incentives may be an effective tool for increasing vaccine uptake among PEH, but important ethical considerations must be made to avoid coercion of vulnerable populations.

Transgender Identity and Cardiovascular Disease.

Objectives: As of 2016, 1.4 million people in the United States were identified as transgender. Transgender people face health disparities and may be at high risk for cardiovascular disease (CVD). The objective of this study was to examine the odds of CVD for those who report a transgender identity compared with cisgender. Methods: We used logistic regression to examine whether transgender identity was associated with CVD after accounting for factors commonly associated with CVD. Data were obtained from the Behavioral Risk Factor Surveillance Survey for the years 2015 through 2019. Results: Of the participants, 93.1% reported no CVD and 6.9% reported CVD. For participants with female sex recorded at birth, those identifying as transgender had 2.66 times higher odds of CVD (95% confidence interval [CI]: 1.60-4.41) than those identifying as cisgender. For participants with male sex recorded at birth, the odds of CVD were not statistically significantly different for transgender identity compared with cisgender identity; however, those who were gender nonconforming had 2.21 times higher odds of CVD (95% CI: 1.04-4.70) compared with those with cisgender identity. Additional significant predictors of CVD were age, race, body mass index, alcohol consumption, exercise, and smoking status. Conclusion: Participants who were female sex recorded at birth had statistically significant increased odds of CVD for those reporting transgender identity compared with cisgender identity. However, transgender identity did not change the odds of CVD compared with cisgender identity for participants who were male sex recorded at birth.