Study Sheds Light on Vaccine Acceptance Among Sexual and Gender Minorities

Equitable implementation of COVID‐19 vaccine delivery is a national and global priority, with a strong focus on reducing existing disparities and not creating new disparities. But while a framework has been recognized for equitable allocation of COVID‐19 vaccine that acknowledges the rights and interests of sexual and gender minorities (SGM), it fails to identify strategies or data to achieve that goal.

A new study with support from researchers at the University of Pennsylvania School of Nursing (Penn Nursing) examined the prevalence of COVID testing and diagnosis and assessed COVID‐19 vaccine acceptance among a large national sample of SGM. It showed that medical mistrust, social concern, and race were significantly associated with decreased COVID‐19 vaccine acceptance by SGM participants. Results have been published in the article “COVID‐19 Vaccine Acceptance Among an Online Sample of Sexual and Gender Minority Men and Transgender Women” in the journal Vaccines.

“Given that stigma and discrimination drive health inequities among SGM, which may result in increased risk of severe COVID‐19 disease and influence COVID‐19 vaccine acceptance, research examining COVID‐19 vaccine acceptance among SGM is needed,” says Daniel Teixeira da Silva, MD, National Clinician Scholar and Postdoctoral Fellow at the Penn Program for Sexuality, Technology and Action Research and the lead investigator of the study.

The psychosocial and economic impact of the COVID‐19 pandemic disproportionately affects SGM compared to cisgender heterosexual populations. Studies show that since the beginning of the COVID‐19 pandemic, SGM have been more likely to experience job loss, income reduction, and decreased access to gender-affirming resources. While SGM populations are disproportionately vulnerable to poor COVID‐19 outcomes, little has been known about COVID‐19 vaccine acceptance among this group until this study.

The study showed that SGM who experienced medical mistrust were less likely to accept a COVID‐19 vaccine. In addition, SGM participants in the study who identified as Black reported decreased COVID‐19 vaccine acceptance. COVID‐19 vaccine acceptance was greater among study participants who endorsed altruistic attitudes and were less concerned about COVID‐19 social concerns.

“The confluence of disproportionate psychosocial and economic burdens with increased vulnerability to minority stressors among SGM may decrease COVID‐19 vaccine uptake and further deepen health inequities,” says José A. Bauermeister, PhD, MPH, chair of the department of family and community health at Penn Nursing, one of the coinvestigators of the study.

Health care provider recommendations have been found to be associated with increased COVID‐19 acceptance. These results suggest that providers and public health efforts that approach medical mistrust with empathy and validation—and which also address concerns about discrimination and support altruistic intentions—may be more successful engaging SGM in COVID‐19 vaccine uptake.

“As the planning of COVID‐19 vaccine rollout efforts is conceptualized and designed, these data may inform equitable implementation strategies and prevent worsening health inequities among SGM populations,” Bauermeister says.

Other coauthors of the study include Willey Y. Lin of Penn Nursing; Katie Biello and Pablo K. Valente of Brown University; Kenneth H. Mayer of Fenway Health; and Lisa Hightow‐Weidman of the University of North Carolina- Chapel Hill.

— Source: University of Pennsylvania School of Nursing

Medical School Curriculum Takes Aim at Social Determinants of Health

There is a growing recognition in health care that social factors such as racial bias, access to care and housing, and food insecurity have a significant impact on people’s health. Compounding and amplifying those underlying inequalities are the ongoing disruptions related to the COVID-19 pandemic and social unrest in our country.

Although many health care organizations (e.g., the National Academy of Medicine, American College of Physicians, and the American Academy of Pediatrics) currently recommend that screening for social determinants of health (SDOH) be included in clinical care, medical education has lagged behind in teaching students how to recognize and address these disparities with patients.

However, in a study published in the Journal of the American Medical Association Network Open, doctors at Wake Forest School of Medicine found that incorporating a health equity curriculum was associated with a significant improvement in students’ knowledge and understanding of SDOH and their confidence in working with underserved populations.

“Our goal was to better prepare our future doctors to recognize the social and economic factors that affect health and to think about new ways to help their future patients with these issues,” says the study’s corresponding author, Deepak Palakshappa, MD, an assistant professor of internal medicine and pediatrics at Wake Forest School of Medicine, part of Wake Forest Baptist Health.

“We wanted to offer it as part of our third-year training when medical students start seeing patients, rather than in the first- or second-year classroom setting like other medical schools that offer social equity curriculums.”

The Wake Forest School of Medicine team, led by Nancy Denizard-Thompson, MD, an associate professor of internal medicine, developed and implemented the longitudinal health equity curriculum for third-year medical students at the school in 2018. Simultaneously, they began a study to evaluate the effectiveness of the curriculum on students’ self-reported knowledge of SDOH and their confidence in working with underserved populations.

The curriculum consisted of health equity simulations, a series of online modules presenting available scientific data on the issues, and experiential learning through partnerships with community-based organizations in the city. For example, medical students would spend a day going out to help deliver food with Help Our People Eat, or HOPE, a group focused on access to food in low-income neighborhoods, Palakshappa says.

To evaluate the effectiveness of the new curriculum, the 314 third-year medical students in the classes of 2019 and 2020 were surveyed at baseline, at the end of third year, and at graduation. The class of 2018, which did not participate in the curriculum, served as the control group.

Total self-reported knowledge and confidence scores increased between baseline and end of the third year of medical school by eight points based on a standard measuring method. Total scores at graduation remained higher by eight points for those who participated in the new program vs the control group.

“Ideally this experience will stay with students through residency and beyond, and hopefully they will begin incorporating screening for social determinants when they begin their practices,” Palakshappa says.

Based on this research, the curriculum is now mandatory for all third-year medical students at Wake Forest School of Medicine.

— Source: Wake Forest Baptist Health

Hope Means Nevada Partners With Children’s Advocacy Alliance

Hope Means Nevada (HMN), the community-based nonprofit focused on eliminating youth suicide in the state, announces its partnership with the Children’s Advocacy Alliance (CAA). This partnership will enable HMN to access and monitor data CAA collects in its annual Children’s Report Card, which provides insights into factors impacting youth mental health.

Since 2000, CAA’s Children’s Report Card gathers and analyzes data to better understand how the state is taking care of children. Currently, Nevada fails to make the grade when it comes to the safety, education, health, and economic well-being of children. Nevada’s current grade in Safety, which covers child maltreatment, youth homelessness, juvenile violence, child deaths and injuries, and substance abuse, currently ranks as a C+. Meanwhile Nevada’s grade in School Readiness is an F, in Children’s Health is a D, and in Economic Well-Being is a D+.

“In addition to continuing to chart health, safety, economic and education data, the Children’s Advocacy Alliance plans to begin collecting data on the mental health of Nevada’s youth,” says Tara C. Raines, PhD, NCSP, director of Kids Count Initiative at CAA. “Ultimately, we would like to create a resource guide for each county, and we are currently seeking additional funding to support these efforts.”

Julie Murray, cochair of HMN, adds: "The Children’s Advocacy Alliance’s work provides tremendous value to our state in terms of building consensus around priorities related to improving our children’s lives. As we seek to identify and eradicate factors adversely affecting youth mental wellness, their Children’s Report Card data will provide an important resource.”

— Source: Hope Means Nevada