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A National Survey Assessing COVID-19 Vaccine Hesitancy Among Arab Americans
Abstract
Background:
Arab Americans' experiences during the COVID-19 pandemic have been largely undocumented. Disparities in vaccine hesitancy between non-Hispanic Whites and minoritized groups have been observed, warranting exploration into the prevalence of COVID-19 vaccine hesitancy among Arab Americans.
Methods:
Data from the Survey of Arab Health in America (SAHA) (n = 638), collected between May 2020 and September 2020, were analyzed to determine predictors for vaccine intention among Arab Americans. Chi-squared tests and logistic regression models were performed to determine the relationship between sociodemographic, immigration, acculturation, and COVID-19 risk variables and vaccine intention.
Results:
More than half (56.7%) of respondents reported an intention to be vaccinated with a COVID-19 vaccine, 35.7% reported uncertainty, and 7.5% reported being unlikely to receive a vaccine. Of those unlikely to receive the vaccine, 72.9% were women and 85.4% reported moderate to high religiosity (p < 0.01). Arab American women had higher odds of being uncertain of their vaccine intention (OR = 1.68; 95% CI: 1.10, 2.57) or being unlikely to receive the vaccine (OR = 5.00; 95% CI: 1.95, 12.83) than men in this sample.
Discussion:
Factors such as high religiosity and gender were positively associated with being unlikely to receive a COVID-19 vaccine. Future studies should qualitatively assess the beliefs that undergird vaccine intention among Arab Americans.
... The included studies addressed human papillomavirus (HPV) (n = 25), 21,[29][30][31]35,37,40,42,44,[46][47][48]50,53,55,57,60,61,[65][66][67][68]71,72,74 influenza (n = 14), 20,[24][25][26]28,36,41,46,47,52,58,59,63,64 hepatitis B (n = 11), 22,27,34,39,42,43,46,49,51,56,75 COVID-19 (n = 9), 18,19,23,32,38,45,54,69,73 pneumococcal (n = 6), 26,41,46,47,58,59 tetanus, diphtheria, pertussis/ tetanus diphtheria (Tdap/Td) (n = 6), 33,41,42,46,47,62 hepatitis A (n = 2), 42,46 measles, mumps and rubella (MMR) (n = 2), 42,62 and shingles (n = 1) 47 vaccines. Several of the included studies covered multiple vaccinations. ...
... 43,63 The majority of studies included both men and women (n = 43), while 12 focused on women, 28,40,44,48,58,51,61,[66][67][68]70,71 and 2 on men. 50,59 The study aims included description of vaccination rates (n = 33), [18][19][20]22,[24][25][26][27]29,30,[32][33][34]36,37,39,[41][42][43]46,47,49,51,[57][58][59][60][61][62]64,65,69,72 barriers to vaccination (n = 34), 18,19,[21][22][23]28,[30][31][32][33]35,[38][39][40][41]44,[50][51][52][53]55,60,61,[63][64][65][66][67][68][69][70]73,75 and interventions to improve vaccination (n = 6). 35,36,45,48,56,71 The majority of studies were designed as cross-sectional (n = 41), [18][19][20][21][22][23][24][25][26][27][28][29][30][31]33,34,[37][38][39][40][41]43,44,46,47,49,51,52,55,[57][58][59][60][61][64][65][66][67]69,72,75 followed by qualitative (n = 10), 32,35,50,53,63,68,70,71,73,76 cohort (n = 3), 32,42,62 program evaluation (n = 2), 36,45 and quasi-experimental (n = 1). ...
... 43,63 The majority of studies included both men and women (n = 43), while 12 focused on women, 28,40,44,48,58,51,61,[66][67][68]70,71 and 2 on men. 50,59 The study aims included description of vaccination rates (n = 33), [18][19][20]22,[24][25][26][27]29,30,[32][33][34]36,37,39,[41][42][43]46,47,49,51,[57][58][59][60][61][62]64,65,69,72 barriers to vaccination (n = 34), 18,19,[21][22][23]28,[30][31][32][33]35,[38][39][40][41]44,[50][51][52][53]55,60,61,[63][64][65][66][67][68][69][70]73,75 and interventions to improve vaccination (n = 6). 35,36,45,48,56,71 The majority of studies were designed as cross-sectional (n = 41), [18][19][20][21][22][23][24][25][26][27][28][29][30][31]33,34,[37][38][39][40][41]43,44,46,47,49,51,52,55,[57][58][59][60][61][64][65][66][67]69,72,75 followed by qualitative (n = 10), 32,35,50,53,63,68,70,71,73,76 cohort (n = 3), 32,42,62 program evaluation (n = 2), 36,45 and quasi-experimental (n = 1). ...
Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.
... COVID-19 is caused by the highly infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in almost 6 million deaths worldwide (WHO, February 2022). Nadia Abuelezam [15,18]. Sociodemographic and general health data collected included: gender, education, age, marital status, residency status, religion, annual income, health insurance status, smoking status, alcohol consumption status, overall health, and chronic disease comorbidities. ...
... Participants were asked to score each item on a four-point Likert scale ranging from 0 to 3. Each item's computed score was summed by adding each item to obtain a participant's total score. The total scores range from 0 to 27 scale and are divided into five categories: minimal (1)(2)(3)(4), mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe depression (20)(21)(22)(23)(24)(25)(26)(27) [21]. The GAD-7 scale is a seven-item self-reported anxiety questionnaire used in primary care and general populations. ...
... Participants were asked to score each item on a four-point Likert scale ranging from 0 to 3. Each item's computed score was summed to obtain a participant's total score. The total scores range from 0 to 21 scale and are divided into four categories: minimal (0-4), mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), and severe anxiety (15)(16)(17)(18)(19)(20)(21) [22]. ...
The COVID-19 pandemic has contributed to anxiety and depression in many communities across the United States. Here, we have focused on a sample of Houston-based Middle Eastern and North African (MENA) residents and assessed the prevalence of anxiety and depression in this community. The 7-item Generalized Anxiety Disorder and the 9-item Patient Health Questionnaires were used to identify the prevalence and severity of anxiety and depression, respectively. A sociodemographic, general health, and COVID-19 survey was used for a multivariable logistic regression model to determine predictors of anxiety and depression. The outcome of interest was “minimal/mild” versus “moderate/severe” anxiety and depression. A total of 368 participants completed the survey, with 24.73% reporting “moderate/severe” anxiety and 31.79% reporting “moderate/severe” depression. Male participants were less likely (OR = 0.29, 95% CI = 0.12, 0.75) to have “moderate/severe” anxiety compared to females. Respondents with self-reported depression were more likely (OR = 3.41, 95% CI = 1.33, 8.83) to have “moderate/severe” depression. Participants who reported having “Excellent/Good knowledge” about the prevention of COVID-19 spread were less likely (OR = 0.37, 95% CI = 0.15, 0.93) to have “moderate/severe” depression, and less likely (OR = 0.22, 95% CI = 0.07, 0.64) to have “moderate/severe” anxiety, compared to those who had “average/poor/terrible” knowledge. Identified predictors may be critical for designing culturally sensitive interventions to improve the healthcare of MENA Americans.
... Univariate and multivariate logistic regression analyses were performed to identify associations between vaccine hesitancy and respondents' characteristics and their beliefs about vaccines and vaccination. We selected covariates for multivariable analysis a priori, based on potential confounders identified in similar research [7,14]. All 14 variables in Table 1 were included for both univariate and multivariate analyses, except for three variables: "I would encourage my family or friends to get COVID-19 vaccine," "When available, I plan to have my kid(s) receive the COVID-19 vaccine," and "Have you received at least one dose of a COVID-19 vaccine?" ...
... Hesitancy was lower among older individuals, those born outside of the US, and among those that believe overall that vaccines are safe, including the COVID-19 vaccine. These findings can be compared to prior studies before the COVID-19 vaccine was widely available to the general public [12,14,16,17]. ...
... A previous survey on COVID-19 vaccine hesitancy among AAs was conducted between May and September of 2020 by Abouhala et al. [14]. It is important to note that at the time, vaccines were still not available, and respondents were reporting their future intentions on vaccination. ...
(1) Background: Coronavirus disease-2019 (COVID-19) vaccines have a significant impact on reducing morbidity and mortality from infection. However, vaccine hesitancy remains an obstacle in combating the pandemic. The Arab American (AA) population is understudied; thus, we aimed to explore COVID-19 attitudes within this community. (2) Methods: This was a cross-sectional study. An anonymous online survey was distributed to members of different AA associations and to the community through the snowball method. (3) Results: A total of 1746 participants completed the survey. A total of 92% of respondents reported having received at least one dose of a COVID-19 vaccine. A total of 73% reported willingness to receive a booster, and 72% plan to give their children the vaccine. On multivariate analysis, respondents were more likely to be vaccine-hesitant if they were hesitant about receiving any vaccine in general. They were less likely to be vaccine-hesitant if they were immigrants, over the age of 40, up to date on their general vaccination and if they believed that COVID-19 vaccines are safe and effective in preventing an infection. The belief that all vaccines are effective at preventing diseases was also associated with lower hesitancy. (4) Conclusions: This sample of AAs have higher vaccination rates and are more willing to vaccinate their children against COVID-19 when compared to the rest of the population. However, a reemergence of hesitancy might be arising towards the boosters.
... The survey comprised of previously validated questions that were originally written in English [19] then translated into Arabic by a bilingual Arabic translator [20]. The quantitative survey questions consisted of sociodemographic, general health, and COVID-19 specific questions. ...
... Research on health behaviors especially vaccination trends among MENA population in the US lags as compared to other immigrant and minority groups [21][22][23]. Only a few studies have examined COVID-19 vaccine hesitancy among Arab Americans [20,24,25,26], with the focus areas primarily being Michigan, Minnesota, California, New York and Virginia as the most frequent research sites for examining MENA health trends [27]. This cross-sectional study aimed at understanding the predictors of COVID-19 vaccination among MENA individuals focused on Harris County and Fort Bend MENA residents. ...
Background
COVID-19 vaccination has averted a significant number of deaths in the United States, but vaccination hesitancy continues to be a problem. Therefore, examining vaccination acceptance and/or hesitancy in local communities is critical.
Methods
A quantitative survey and a multivariable logistic regression model was utilized to determine predictors of COVID-19 vaccination in Middle Eastern and North African (MENA) origin Houston residents. The outcome of interest was COVID-19 vaccination status (vaccinated versus not vaccinated). Covariates included: demographics, health, and COVID-19 factors. Statistical analyses included SAS version 9.4 at a priori significance level of 0.05.
Results
The overall vaccine acceptance rate was significantly high in this population subset (N = 366), with 77.60% vaccinated, and 22.40% not vaccinated. MENA individuals with some college degrees were less likely to report vaccination than those with a graduate degree [Odds Ratio (OR): 0.18; 95% Confidence Interval (CI): 0.04, 0.77]. Homeowners were more likely to get vaccinated than renters (OR: 2.58; 95%CI: 1.17, 5.68). Individuals practicing Islamic faith were more likely to get vaccinated than other religious affiliations (OR: 3.26; 95%CI: 1.15, 9.19). Individuals with hypertension were less likely to get vaccinated than those without it (OR: 0.34; 95%CI: 0.13, 0.92), and those with anxiety were more likely to get vaccinated than those without anxiety (OR: 4.23; 95%CI: 1.68, 10.64).
Conclusions
Health status, education level, financial stability, and religious affiliation are some of the determining factors that potentially influence vaccination acceptance/hesitancy among the MENA community.
... Consequently, health behavior research data of the MENA group is mixed with Caucasian data, thus masking MENA-specific public health behaviors. Only a handful of studies have examined MENA health behaviors [9][10][11][12], emphasizing the need to conduct more systematic studies in this important group. The estimated number of MENA individuals in the US is more than 3.5 million [13], and Texas has the fourth largest MENA population in the country, with over 281,000 MENA Texas residents [14,15]. ...
... Survey: The survey was created by Dr. Nadia Abuelezam [11,20], William F. Connell School of Nursing, Boston College, MA. The survey comprised of previously validated questions that were originally written in English and translated into Arabic by a bilingual Arabic translator. ...
(1) Background: Knowledge of COVID-19 prevention among communities is the first step towards protective behaviors. The objective of this study was to assess COVID-19 prevention knowledge among a Middle Eastern and North African community in Houston, Texas. (2) Methods: A cross-sectional study was conducted using a validated quantitative survey; survey questions consisted of three parts: COVID-19 specific questions, general health questions, and sociodemographic questions. A multivariable logistic regression model was used to determine predictors of perception of knowledge on preventing COVID-19 spread. The outcome of interest comprised of “good/excellent” versus “average and below” knowledge. (3) Results: A total of 366 participants (66.39% males) completed the survey. A univariate analysis demonstrated significant differences in self-reported COVID-19 prevention knowledge among those with and without health insurance, different ages, level of knowledge, and perceived severity of COVID-19 infection. In the multivariate logistic regression, two predictors were identified: those in the 18–25-year-old group were more likely to have “excellent/good” knowledge on COVID-19 spread compared to the ≥40-year-old group (OR: 6.36; 95% CI: 1.38, 29.34). Those who somewhat agree with knowing how to protect themselves from COVID-19 were more likely to have “excellent/good” knowledge of preventing COVID-19 spread compared to those that neither agree nor disagree or disagree (OR: 7.74; 95% CI: 2.58, 23.26). (4) Conclusions: Younger adults reported higher knowledge of COVID-19 prevention.
... Regarding COVID-19 vaccination campaigns, a national survey covering 638 Arab Americans-more than half foreign-born-between May 2020 and September 2020 highlighted that only 56.7% of respondents reported an intention to be vaccinated and that 7.5% stated being frankly unlikely to receive a vaccine. Of those, 85.4% self-reported a moderate to high religiosity and women were five times more unlikely to receive the vaccine than men, suggesting that relying on religion as a coping mechanism in facing the COVID-19 pandemic, coupled with possible misinformation about COVID-19 vaccines, informally spread throughout religious communities and posed additional barriers in vaccine literacy among Arab American women [41]. In the US, the "Religion and the Vaccine Survey", conducted in March 2021 underlined that Protestants (Black, Hispanic, White evangelical and "other Protestant of color") and Mormons were the least vaccine-receptive religious groups (share of accepters equal/less than 50%). ...
Culture, religion and health are closely intertwined, profoundly affecting people’s attitudes and behaviors as well as their conception and experience of illness and disease. In order to analyze the impact of religion in the current COVID-19 pandemic, we performed a literature review investigating both the scientific and grey literature on the topic. COVID-19 outbreaks reported in pilgrimages and religious ceremonies around the world—especially in the first wave of the pandemic wave—and the role played by religion in conveying culturally sensitive information about COVID-19 are some of the evidence we reviewed. Our research highlights how religions have represented, on the one hand, a risk for the spread of the virus and, on the other, a precious opportunity to engage people, and in particular minorities, in fighting the pandemic. To overcome this pandemic and to be prepared for similar ones in the future, scientists, politicians and health professionals should acknowledge the role that culture and religion play in people’s lives and how it can assist in tackling complex health challenges.
... As far as is known, few studies have been conducted to assess the association between acculturation and vaccination and of these, most have examined the association between acculturation and human papillomavirus vaccine (HPV). In the latter studies, acculturation was measured by the parameters of being native borne, years of living in the host country, or ability to speak in the native host language rather than acculturation style (15,54). a study from USA found that students with Asian orientation (affinity to separation style) were less likely to have the HPV vaccine and less likely to consult with health professionals regarding the HPV vaccine compared to students with Western orientation (affinity to assimilation style) (55). ...
Background:
Since the mass vaccination against SARS-CoV-2 was launched in Israel, the Arab ethnicity minority had lower vaccine uptake. The syndemics theory suggests a closely interrelated complex of health and social crises among vulnerable societies results in an increased disease burden or in more adverse health conditions. Syndemics may explain the health disparities between different people or communities. Likewise, acculturation was found to be associated with different health outcomes among minority populations. The purpose of the study is to explore the association between syndemic construct, acculturation style, and adherence to recommended COVID-19 vaccination among the Arab ethnicity in Israel.
Methods:
A cross-sectional study among 305 participants who completed a self-report questionnaire. Syndemic construct (syndemics score and syndemics severity) was calculated from the participants' health behavior index, self-rated health status, and adherence to flu vaccination. Four acculturation strategies were defined according to Barry's acculturation model: assimilation, integration, separation, and marginalization style. Linear regression (stepwise method) was conducted to determine the explanatory factors for COVID-19 vaccine adherence.
Results:
Assimilation and separation acculturation styles and syndemics severity were significantly associated with higher adherence to the recommended COVID-19 vaccination (B = 1.12, 95%CI = 0.34-1.98; B = 0.45, 95%CI = 0.10-0.80; B = 0.18, 95%CI = 0.09-0.28; respectively). The explained variance of the model (R 2) was 19.9%.
Conclusion:
Syndemics severity, assimilation and separation acculturation styles were associated with higher adherence to recommended COVID-19 vaccination in the Israeli Arab minority population. Syndemics score was not associated with recommended COVID-19 vaccination. To encourage COVID-19 vaccination among minority communities, campaigns should be tailored to the social determinants in a sensitive and individualized manner.
... Our finding of the importance of religiosity being associated with higher vaccination uncertainty and unwillingness is in agreement with previous studies in the US and other countries [8,[24][25][26][27]. A review of COVID-19 vaccine hesitancy revealed that religiosity was one of the factors influencing vaccine refusal [28]. ...
Religiosity may influence COVID-19 vaccination. However, it remains unclear how religiosity is associated with beliefs toward COVID-19 and vaccination against it, particularly amongst ethnic minorities. This study examined the association between religiosity, vaccination intent, beliefs, and attitudes related to COVID-19 and vaccination among adults in Puerto Rico. Data from an online survey conducted between December 2020-February 2021 among adults (≥18 yr; n = 1895) residing in Puerto Rico were used. Rating of the importance of religiosity was used to capture the level of religiosity ('less important', 'somewhat important', 'important', and 'very important'). The health belief model (HBM) assessed beliefs and attitudes toward COVID-19 and vaccination against it. Adjusted Poisson models with robust error variance estimated prevalence ratios (PR) and 95% confidence intervals for vaccination intent and individual COVID-19 HBM constructs. Compared to individuals rating religiosity as 'less important' to them, those rating it as 'very important' were more likely to be unwilling or uncertain to get the COVID-19 vaccine (PR = 1.51, 95% CI = 1.10-2.05). Higher ratings of importance of religiosity, compared to the lowest level, were associated with significantly lower perceived COVID-19 susceptibility, more vaccine barriers, and lower vaccine benefits (all p < 0.05). Individuals who reported religiosity being very important to them were more likely to report that they will get the COVID-19 vaccine only if given adequate information about it (PR = 1.14, 95% CI = 1.02-1.27) and more likely to get the vaccine if more people decide to receive it (all p < 0.05). In conclusion, our results suggest an association between religiosity and COVID-19 vaccination intent and beliefs and attitudes toward vaccination. The study highlights important guidelines for public health campaigns to increase vaccine uptake among religious communities in Puerto Rico.
... There is little evidence on vaccine uptake in general in the Arab American population. A California study found that Arab Americans are significantly less likely than non-Hispanic Whites to receive influenza vaccinations, and there is evidence of Arab American COVID-19 vaccine hesitancy [9,10]. A systematic review found no articles on Arab American HPVV attitudes and behaviors [11]. ...
Little is known of Arab Americans’ human papilloma virus vaccination (HPVV) behaviors. We explored associations between US Arab immigrant mothers’ beliefs regarding HPVV for their children with socioeconomic, medical, and religious/cultural factors. A cross-sectional survey was conducted in New York City (August 2019–April 2021) with 162 Arab American immigrant women who had at least one child aged 9 through 26 years. Among those reporting that their child/children had not received the HPVV (63.5%), reasons included not having heard of it (67.3%) and lack of provider recommendation (59.4%). HPVV awareness and uptake, respectively, were more likely among those with education ≥ 10 years (p < .001 and p < .001, respectively), with more years in the US (p < .001 and p < .001), and with higher household income (p < .001 and p = .002). Participants with limited English proficiency were less likely to have HPVV awareness and uptake (p < .001 and p < .001). Christian religious affiliation was positively associated with HPVV awareness and uptake (p = .014 and p = .048). A greater number of years in the US was significantly associated with willingness to vaccinate if recommended by the doctor (p = .031). In open-ended responses, mothers indicated that they did not receive strong provider HPVV recommendations, potentially because of their providers’ perceptions of their cultural backgrounds. Mothers indicated a desire for HPVV educational materials in Arabic to help them with decision making. Potential opportunities to augment HPVV uptake among Arab immigrants’ children include increasing population knowledge, increasing provider recommendation, and providing culturally/religiously responsive HPVV education in English and Arabic.
... Many Arab Americans have strong familial ties and live in multigenerational homes. For example, the average household size for Yemeni families is 4.3 compared to the national average of 2.6 [30,31]. These living situations could increase the transmission of the virus, especially if social distancing, masking, and hand sanitizing are not practiced. ...
Racial and ethnic disparities in COVID-19 cases are pervasive. Some minority, immigrant, and marginalized groups, such as Arab Americans, have been excluded from the research. This population confronts barriers to health care, discrimination, and other factors that may affect understanding, testing, and treatment as it relates to COVID-19. Arab Americans are unique compared to Hispanic, non-Hispanic black, and Asians because Arab Americans do not have a specific ethnic identifier and are classified as non-Hispanic white. Given these issues, this study will estimate COVID-19 cases and examine associations among Arab Americans compared to Hispanic, non-Hispanic black, non-Hispanic white, and Asian adults. Data from the Michigan Disease Surveillance System (March 2020-July 2021), the American Community Survey (2015-2019), and an Arab/Chaldean surname algorithm were used. Chi-square tests were used to determine statistically significant differences between groups. Logistic regression was used to estimate age-adjusted and sex-stratified proportions among Arab Americans compared to non-Hispanic whites before and after adjusting for age and sex. Approximately 17% of Arab Americans tested positive for COVID-19 compared to 11.32% of Hispanics, 9.80% of non-Hispanic blacks, 7.50% of non-Hispanic whites, and 4.24% of Asians. Arab Americans had 2.63 (95% CI: 2.59, 2.66) times greater odds of testing positive for COVID-19 compared to non-Hispanic whites. When Arab Americans were disaggregated from non-Hispanic whites, alarming patterns in COVID-19 cases were observed for Arab Americans. To accurately represent the burden of COVID-19 among Arab Americans, this population needs to have an ethnic identifier that informs appropriate health policy decisions and practice.
... On the other hand, a systematic literature review revealed that more recent (and therefore less acculturated) migrants tend to be undervaccinated (54). In the specific case of COVID-19 vaccination intention it was shown that acculturation was not a statistically significant predictor of vaccination intentions (55). ...
Objectives
The aim of the study is to investigate the relationship between migration background and COVID-19 vaccine intentions, exploring multiple mediation paths. We argue that the migrational and sociocultural background influences general attitudes toward health and political/public institutions. The effects of these general attitudes on vaccination intentions are mediated by fears of infection. Additionally, we analyze a migrant-only model including acculturation variables (years since migration, foreign and host country media consumption) and region of origin (European vs. Non-European). Design: The data (n = 1027) stem from an online access panel collected between March 15 and March 25, 2021. Quotas for gender and age were set according the online population of Germany. The use of an oversampling framework for first generation migrants resulted in a sample with 50% first generation migrants and 50% native Germans without migration background. Models were calculated using a Structural Equation Modeling approach.
Results
Migration background both increases and decreases antecedents of vaccination intentions. Being a migrant increases positive antecedents like religiosity, which in turn positively influence general attitudes and thus fears of infection and vaccination intentions. But being a migrant has also a significant direct negative association with vaccination intentions, implying missing mediators. Increasing years since migration increase host country (German) media consumption and decrease consumption of media from the country of origin. Both media variables are positively associated with political trust and health consciousness. Additionally, European compared to Non-European migrants have less political trust, fear of personal infection and lower vaccination intentions on the whole.
Conclusions
The study found that vaccination intentions can be understood by applying the proposed hypothetical structure. We found complex associations of the migration and sociocultural background and COVID-19 vaccination intentions, where antecedents of vaccination intentions are both increased and decreased by migration background and migration specific factors.
Background
At the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients.
Methods
Between April and November 2021, the Ethics and Oncology Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint (= quality of life/survival). We used a mainly qualitative methodological approach based on questionnaires and interviews.
Results
In April 2021, 29 cancer patients refused or were reluctant to be vaccinated (5.6%; 29/522). Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal (1.9%; 10/522). One of the main reasons for the decrease in refusals was probably the introduction of the “ pass sanitaire ” (health pass) in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients.
Conclusion
We identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between “the recommendation of anti-COVID-19 vaccination” (a new clinical practice) and “free will” (a moral value), and the duty to “protect each other” (a moral standard). Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life (i.e. happiness), or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished.
Objetivo: estimar a prevalência e a chance de ser vacinado contra a influenza entre idosos
católicos brasileiros, segundo frequência religiosa. Metodologia: foram considerados os
indivíduos com 60 anos ou mais (n =2867) participantes do Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI-Brasil), realizado em 2015/2016. Fo-ram calculadas as prevalências da vacinação segundo frequência religiosa e os respectivos intervalos de confiança (IC95%). As associações foram medidas pelo teste X2 (Rao-Scott), considerando um nível de significância de 5%. A chance de os idosos católicos serem vacinados foi calculada a partir de um modelo de regressão logística binomial. Resultados: os resultados mostram que a prevalência e a chance de os idosos católicos serem vacinados aumenta quanto maior a religiosidade, que foi medida pela frequência religiosa aos cultos e missas. Conclusão: este estudo aponta para uma associação positiva entre a religiosidade e as maiores prevalência e chance de vacinar contra influenza na população idosa de católicos.
Arab Americans (ARAM) comprise approximately 3.7 million individuals in the United States (US). The Census Bureau classifies ARAM as white and does not acknowledge them as a minority group in the Middle East North African (MENA) category creating a challenge when assessing their health outcomes. Like other minority groups, ARAM have unique social behaviors and cultural attributes that directly affect their health outcomes. However, many health care professionals in the US are not well‐informed of their culture. Hence, it is important for clinical pharmacists to familiarize themselves with the Arab culture in order to engage the ARAM patient and provide culturally competent care. This article reviews ARAM demographics and some of their common health behaviors and associated outcomes. The authors also offer culturally sensitive recommendations addressing important areas of health care to mitigate health disparities for this growing patient population. This article is protected by copyright. All rights reserved.
Background
COVID-19 vaccine hesitancy is a major obstacle for pandemic mitigation. As vaccine hesitancy occurs along multiple dimensions, we used a social-ecological framework to guide the examination of COVID-19 vaccine intentions.
Methods
Using an online survey in the US conducted in July 2020, we examined intentions to obtain a COVID-19 vaccine, once available. 592 respondents provided data, including measures of demographics, vaccine history, social norms, perceived risk, and trust in sources of COVID-19 information. Bivariate and multivariate multinomial models were used to compare respondents who did not intend to get or were ambivalent about COVID-19 vaccination and to those who intended to be vaccinated against COVID-19.
Results
Only 59.1% of the sample reported that they intended to obtain a COVID-19 vaccine. In the multivariate multinomial model, those respondents who did not intend to be vaccinated, as compared to those who did, had significantly lower levels of trust in the CDC as a source of COVID-19 information (aOR= 0.29, CI=0.17-0.50), reported lower social norms of COVID-19 preventive behaviors (aOR=0.6, CI 0.51-0.88), scored higher on COVID-19 Skepticism (aOR=1.44, CI=1.28-1.61), identified as more politically conservative (aOR=1.23, CI=1.05-1.45), were less likely to have obtained a flu vaccine in the prior year (aOR=0.21, CI= 0.11-0.39), were less likely to be female (aOR=0.51, CI=0.29-0.87), and were much more likely to be Black compared to White (aOR=10.7, CI=4.09-28.1). A highly similar pattern was observed among those who were ambivalent about receiving a COVID-19 vaccine compared to those who intended to receive one.
Conclusion
The results of this study suggest several avenues for COVID-19 vaccine promotion campaigns, including social network diffusion strategies and cross-partisan messaging, to promote vaccine trust. The racial and gender differences in vaccine intentions also suggest the need to tailor campaigns based on gender and race.
Background
Influenza vaccination among minoritized groups remains below federal benchmarks in the United States (US). We used data from the 2004–2016 California Health Interview Surveys (CHIS) to characterize influenza vaccination patterns among Arab Americans in California.
Methods
Influenza vaccination was self-reported by Arab American adults (N = 1163) and non-Hispanic Whites (NHW, N = 166,955). Differences in influenza vaccination prevalence and odds were compared using chi-squared tests and survey-weighted logistic regression, respectively.
Results
Across all years, 30.3% of Arab Americans self-reported receiving an influenza vaccine (vs. 40.5% for NHW, p < 0.05). After sequential adjustment by sociodemographic, health behavior, and acculturation variables no differences in odds of self-reported influenza vaccination were observed between Arab Americans and NHW (odds ratio: 1.02, 95% confidence interval: 0.76–1.38). Male and unemployed Arab Americans had higher odds of reporting influenza vaccination than female and employed Arab Americans.
Conclusions
Future work should consider specific barriers to influenza vaccination in Arab American communities.
The urgency to develop a vaccine against the 2019 coronavirus (COVID-19) has waxed stronger in speed, scale, and scope. However, wisdom dictates that we take a vantage position and start to examine the demographic predictors of COVID-19 vaccine hesitancy. The objective of this study was to examine the role of health locus of control (HLOC) in the relationship between religiosity and COVID-19 vaccination intention. In a cross-sectional survey (N = 501), we found a significantly negative association between religiosity and COVID-19 vaccination intention. This relationship was partially mediated by external HLOC. Collaborative efforts with religious institutions may influence COVID-19 vaccine uptake.
During the current COVID-19 pandemic, religious gatherings have become intense hot spots for the spread of the virus. In this research, we focus on the religiosity of communities to examine whether religiosity helps or hinders adherence to mitigation policies such as shelter-in-place directives. Prior research makes opposing predictions as to the influence of religiosity. One stream predicts greater adherence because of rule-abiding norms and altruistic tendencies while another predicts lower adherence as a reaction against the restriction of personal and religious freedom. We used shelter-in-place directives as an intervention in a quasi-experiment to examine adherence over 30 days as a function of religiosity in the most populous metropolitan areas in the United States. When a shelter-in-place directive had not been imposed, religiosity did not affect people’s movements. However, when the directive was imposed, higher religiosity resulted in less adherence to shelter-in-place directives.
The outbreak of a novel coronavirus, referred to as coronavirus disease-19 (COVID-19), with its sentinel case in Wuhan, China, in December 2019, has spread rapidly around the globe. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a worldwide pandemic, which led to most countries implementing social distancing protocols. Most non-essential medical practices have been halted to direct resources to the facilities caring for patients with COVID infection. The pediatric orthopaedic practice is in a unique position, with the treatment of many conditions being treated by pediatric orthopedists being non-emergent, but time-sensitive. We hereby review the current literature and guidelines surrounding the practice change around the world and give recommendations regarding the practice of pediatric orthopaedics during the COVID pandemic.
Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field.
Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly).
Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination.
Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.
Despite substantial attention paid to Arab-Americans (AAs) in the media and in public discourse, there is limited research about the health of AAs in the United States (US) in the public health literature. This review aims to synthesize the extant peer-reviewed literature concerned with the health of AAs living in the US.
We summarize existing research on the prevalence, relative burden compared to other ethnic and racial groups, and determinants of diseases within each morbidity cluster among AAs living in the US.
Available evidence suggests that the health of AAs may differ from that of other ethnic and racial groups in the US, and that exposures specific to this ethnic group, such as immigration, acculturation, and discrimination may be important in the etiology of several diseases among AAs.
Given the growth of this ethnic group and its marginalization in the current sociopolitical climate, more research about the health of AAs in the US seems warranted. We summarize relevant methodological concerns and suggest avenues for future research.
Persons who were perceived to be Arabs experienced a period of increased harassment, violence, and workplace discrimination in the United States in the weeks immediately following September 11, 2001. Drawing on prior studies that have hypothesized that experiences of discrimination increase the risk of preterm birth and low birth weight, this study explores whether there was an effect on birth outcomes for pregnant women of Arab descent. California birth certificate data are used to determine the relative risk of poor birth outcomes by race, ethnicity, and nativity for women who gave birth in the six months following September 2001, compared with the same six calendar months one year earlier. The relative risk of poor birth outcomes was significantly elevated for Arabic-named women and not for any of the other groups.
Background
Public polling indicates that vaccine uptake will be suboptimal when COVID-19 vaccines become available. Formative research seeking an understanding of weak vaccination intentions is urgently needed.
Methods
Nationwide online survey of 804 U.S. English-speaking adults. Compensated participants were recruited from the U.S. through an internet survey panel of 2.5 million residents developed by a commercial survey firm. Recruitment was based on quota sampling to produce a U.S. Census-matched sample representative of the nation with regard to region of residence, sex, and age.
Results
COVID-19 vaccination intentions were weak, with 14.8% of respondents being unlikely to get vaccinated and another 23.0% unsure. Intent to vaccinate was highest for men, older people, individuals who identified as white and non-Hispanic, the affluent and college-educated, Democrats, those who were married or partnered, people with pre-existing medical conditions, and those vaccinated against influenza during the 2019-2020 flu season.
In a multiple linear regression, significant predictors of vaccination intent were general vaccine knowledge (β = .311, p < .001), rejection of vaccine conspiracies (β = -.117, p = .003), perceived severity of COVID-19 (β = .273, p < .001), influenza vaccine uptake (β = .178, p < .001), having ≥ 5 pre-existing conditions (β = .098, p = .003), being male (β = .119, p < .001), household income of ≥ $120,000 (β = .110, p = .004), identifying as a Democrat (β = .075, p < .029), and not relying upon social media for virus information (β = -.090, p < 002). Intent to vaccinate was lower for Fox News (57.3%) than CNN/MSNBC viewers (76.4%) (χ2 (1) = 12.68, p < .001). Political party differences in threat appraisals and vaccine conspiracy beliefs are described.
Conclusions
Demographic characteristics, vaccine knowledge, perceived vulnerability to COVID-19, risk factors for COVID-19, and politics likely contribute to vaccination hesitancy.
In response to the Institute on Minority Health and Health Disparities’ (NIMHD) new health disparities research framework, we call on the National Institutes of Health (NIH) to acknowledge Arabs in the United States as a health disparity population. Arab classification as White leads to their cultural invisibility and perpetuates a cycle of undocumented health disparities.
We provide examples of how this contested identity reinforces challenges associated with identifying this population and contributes to enactments of structural violence and undocumented health disparities. Decades of research with Arabs in the United States provides consistent evidence that their health does not fit the health profile of White Americans and that Arabs do not benefit from Whiteness and White privilege associated with their White racial categorization. On the contrary, Arabs in the United States experience discrimination and health disparities that require urgent attention; this can be achieved only by identifying the population with a racial category other than White.
We conclude with recommendations to NIH and NIMHD to revise their definition of health disparity populations to include Arabs in the United States.
Americans of Middle Eastern and North African (MENA) descent in the United States have been historically understudied, in part due to limitations of racial classification systems that typically include MENA under the broad umbrella of White. As a result, enormous gaps in knowledge about health and mental health disparities exist, with broad public health significance. In particular, there is an urgent need to attend more specifically to MENA Americans’ experiences of cumulative racial–ethnic trauma, which occurs at every level of their social ecologies. This article offers a conceptual model of cumulative racial–ethnic trauma to represent the unique experiences of the MENA American population. Traumatic factors at the macrolevel include historical trauma, pervasive institutional discrimination, and a hostile national context. These factors interact with one another and further impact microlevel traumatic experiences related to interpersonal discrimination and microaggressions, as well as struggles with identity and recognition. The deleterious impacts of these experiences may include a ubiquitous sense of insecurity, hopelessness, and alienation among MENA American individuals, in addition to more specific mental health and physical health concerns. It also compromises the overall well-being of the MENA American population in terms of belonging versus alienation, freedom versus restriction, and opportunities versus disadvantage. We discuss how the model can help to create a foundation for future inquiry and contribute to intervention efforts to find effective ways to support resilience and thriving for the MENA American population. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Abstract
BACKGROUND:
Disparities in vaccinations and cancer screening exist when comparing foreign-born and U.S.-born women collectively and disaggregated by race and ethnicity. The purpose of this study was to estimate and compare the age-adjusted prevalence of not receiving a flu or pneumonia vaccine, clinical breast examination, mammogram or Pap smear among U.S.- and foreign-born White women by region of birth and examine associations while controlling for potential confounders.
METHODS:
We pooled 12 years of National Health Interview Survey data (n = 117,893). To approximate an "Arab-American" ethnicity, we identified 15 "Arab" countries from the Middle East region that comprise the Arab Nations. Data was requested from the National Center for Health Statistics Research Data Center. We used the χ2 statistic to compare descriptive statistics and odds ratios (ORs) with 95% CIs were used for inferential statistics.
FINDINGS:
Compared to U.S.-born, foreign-born Whites from the Arab Nations had higher estimates of not receiving recommended vaccinations and cancer screenings. In crude and adjusted analyses, foreign-born Arab-American women were less likely to report receiving a flu vaccine (OR, 0.34; 95% CI, 0.21-0.58), pneumonia vaccine (OR, 0.14; 95% CI, 0.06-0.32), Pap smear (OR, 0.13; 95% CI, 0.05-0.31), or clinical breast examination (OR, 0.16; 95% CI, 0.07-0.37) compared with U.S.-born White women. There were no differences for mammography.
CONCLUSIONS:
This national study examining uptake of flu and pneumonia vaccines and preventive cancer screenings suggests that estimates are lower for foreign-born Arab-American women compared with U.S.-born White women. Future studies should collect qualitative data that assess the cultural context surrounding prevention and screening behaviors among Arab-American women.
The events of September 11, 2001 reverberated through many Arab American communities across the country in ways that other Americans have not experienced. During the period directly following the attacks, people of Arab descent were harassed; churches and mosques were damaged, and in a few instances people were physically attacked, shot, or killed. In cities and towns with high concentrations of Arab Americans, public hostility and suspicion grew due to outside pressures. Utilizing interview data from a current national study of relations between Arab American communities and law enforcement, we explore issues of victimization, the perceived prevalence of hate and bias crimes among immigrants of Arab descent and law enforcement, and community-level feelings of vulnerability and fear in a post-September 11 environment. In addition, we examine the degree to which federal policies, media attention and law enforcement practices have led to a sense of community-wide victimization, which we label as a type of cultural trauma. Bearing the brunt of enforcement actions, Arab American communities are grappling with the insecurity and fear that has come from increased scrutiny in the name of security for others.
Two studies were conducted to provide reliability and validity support for a new anti-Arab prejudice scale. The scale was designed to fit to the European context and showed very satisfactory reliability. Moreover, both studies provided convergent validity support. Anti-Arab prejudice was correlated with authoritarianism, anti-Semitism, and conservatism. The correlation between the new scale and an adapted version of McConahay's (1986) Modern Racism scale was very strong. Furthermore, the second study provided predictive validity support. Scores in the new scale explained 20% of the variance in an ulterior actual behavior (to return a signed form supporting an association aimed to defend European values and culture against Islamization).
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Blacks in US less likely to trust medical scientists, get vaccinated amid COVID-19 risks
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