Vaccine Decision-making in Racial and Ethnic Minority Communities in Los Angeles, California | Vaccination | JN Learning | AMA Ed Hub [Skip to Content]
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COVID-19 Vaccine Decision-making Factors in Racial and Ethnic Minority Communities in Los Angeles, California

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
JAMA Network Open
September 30, 2021
Original Investigation
Savanna L. Carson, PhD1;
Alejandra Casillas, MD, MSHS1;
Yelba Castellon-Lopez, MD, MS2;
Lisa N. Mansfield, PhD, MSN, RN1;
D’Ann Morris, MPA1;
Juan Barron, BA1;
Ejiro Ntekume, MPH1;
Raphael Landovitz, MD, MSc3;
Stefanie D. Vassar, MS1,4;
Keith C. Norris, MD, PhD1;
Steven M. Dubinett, MD5,6,7;
Nanibaa’ A. Garrison, PhD1,8,9;
Arleen F. Brown, MD, PhD1,4
Author Affiliations
  • 1Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
  • 2Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles
  • 3Division of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles
  • 4Olive View-UCLA Medical Center, Sylmar, California
  • 5Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
  • 6Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
  • 7Jonsson Comprehensive Cancer Center, University of California, Los Angeles
  • 8Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles
  • 9Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
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Key Points

Question  What factors do members of multiethnic communities at high risk for COVID-19 infection and morbidity in Los Angeles County, California, cite as influencing vaccine decision-making and acceptability?

Findings  In this qualitative study, 70 participants from racial and ethnic minority communities in Los Angeles County described a complex vaccination decision-making process influenced by misinformation and politicization, deep apprehension related to historical inequity and mistreatment, access barriers related to social disadvantage, and a need for community engagement and trusted messengers.

Meaning  This study suggests that COVID-19 vaccine equity will require multifaceted policies and programming that respect community concerns and the need for informed deliberation, invest in community-based engagement, improve accessibility and transparency of information, and reduce structural barriers in vaccination.

Abstract

Importance  The COVID-19 pandemic has had disproportionate effects on racial and ethnic minority communities, where preexisting clinical and social conditions amplify health and social disparities. Many of these communities report lower vaccine confidence and lower receipt of the COVID-19 vaccine. Understanding factors that influence the multifaceted decision-making process for vaccine uptake is critical for narrowing COVID-19–related disparities.

Objective  To examine factors that members of multiethnic communities at high risk for COVID-19 infection and morbidity report as contributing to vaccine decision-making.

Design, Setting, and Participants  This qualitative study used community-engaged methods to conduct virtual focus groups from November 16, 2020, to January 28, 2021, with Los Angeles County residents. Potential participants were recruited through email, video, and telephone outreach to community partner networks. Focus groups were stratified by self-identified race and ethnicity as well as age. Transcripts were analyzed using reflexive thematic analysis.

Main Outcomes and Measures  Themes were categorized by contextual, individual, and vaccine-specific influences using the World Health Organization’s Vaccine Hesitancy Matrix categories.

Results  A total of 13 focus groups were conducted with 70 participants (50 [71.4%] female) who self-identified as American Indian (n = 17 [24.3%]), Black/African American (n = 17 [24.3%]), Filipino/Filipina (n = 11 [15.7%]), Latino/Latina (n = 15 [21.4%]), or Pacific Islander (n = 10 [14.3%]). A total of 39 participants (55.7%) were residents from high-poverty zip codes, and 34 (48.6%) were essential workers. The resulting themes included policy implications for equitable vaccine distribution: contextual influences (unclear and unreliable information, concern for inequitable access or differential treatment, references to mistrust from unethical research studies, accessibility and accommodation barriers, eligibility uncertainty, and fears of politicization or pharmaceutical industry influence); social and group influences (inadequate exposure to trusted messengers or information, altruistic motivations, medical mistrust, and desire for autonomy); and vaccination-specific influences (need for vaccine evidence by subpopulation, misconceptions on vaccine development, allocation ambiguity, vaccination safety preferences, the importance of perceiving vaccine equity, burden of vaccine scheduling, cost uncertainty, and desire for practitioner recommendation).

Conclusions and Relevance  In this qualitative study, participants reported a number of factors that affected their vaccine decision-making, including concern for inequitable vaccine access. Participants endorsed policy recommendations and strategies to promote vaccine confidence. These results suggest that support of informed deliberation and attainment of vaccine equity will require multifaceted, multilevel policy approaches that improve COVID-19 vaccine knowledge, enhance trust, and address the complex interplay of sociocultural and structural barriers to vaccination.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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Vaccination Public Health Coronavirus (COVID-19) Health Inequities Diversity, Equity, and Inclusion
Article Information

Accepted for Publication: July 23, 2021.

Published: September 30, 2021. doi:10.1001/jamanetworkopen.2021.27582

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Carson SL et al. JAMA Network Open.

Corresponding Author: Savanna L. Carson, PhD, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon, Ste 1820, Los Angeles, CA 90095 (scarson@mednet.ucla.edu).

Author Contributions: Dr Carson had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Carson, Casillas, Castellon-Lopez, Morris, Barron, Ntekume, Vassar, Norris, Dubinett, Garrison, Brown.

Acquisition, analysis, or interpretation of data: Carson, Casillas, Castellon-Lopez, Mansfield, Barron, Ntekume, Landovitz, Vassar, Garrison, Brown.

Drafting of the manuscript: Carson, Casillas, Castellon-Lopez, Mansfield, Morris, Ntekume, Vassar, Garrison, Brown.

Critical revision of the manuscript for important intellectual content: Carson, Casillas, Castellon-Lopez, Mansfield, Barron, Ntekume, Landovitz, Vassar, Norris, Dubinett, Garrison.

Statistical analysis: Carson, Mansfield.

Obtained funding: Carson, Vassar, Norris, Dubinett, Brown.

Administrative, technical, or material support: Carson, Casillas, Castellon-Lopez, Mansfield, Morris, Barron, Ntekume, Vassar, Garrison, Brown.

Supervision: Carson, Casillas, Landovitz, Vassar, Norris, Brown.

Conflict of Interest Disclosures: Drs Carson, Brown, Morris, Castellon, Casillas, and Garrison and Ms Vassar reported receiving grants from the National Heart, Lung, and Blood Institute, the National Center for Advancing Translational Science, and the UCLA Oversight COVID-19 Research Committee during the conduct of the study. Dr Ntekume reported receiving grants from the National Heart, Lung, and Blood Institute, the National Center for Advancing Translational Science, and the UCLA Oversight COVID-19 Research Committee during the conduct of the study. Dr Landovitz reported receiving grants from the National Institutes of Health during the conduct of the study and personal fees from Gilead Sciences, Merck Inc, Roche, and Janssen outside the submitted work. Dr Norris reported receiving grants from the National Heart, Lung, and Blood Institute during the conduct of the study and grants from National Center for Advancing Translational Science, National Institute on Aging, National Institute of Diabetes and Digestive and Kidney Diseases National Institute of General Medical Sciences, and National Institute on Minority Health and Health Disparities outside the submitted work. No other disclosures were reported.

Funding/Support: This research is supported by grant 21-312-0217571-66106L from CEAL/STOP COVID-19 CA, grant UL1TR001881 from the National Center for Advancing Translational Science, and grant OCRC 20-51 from UCLA.

Role of the Funder/Sponsor: The supporters of this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The study participants, our Community Advisory Board, the UCLA Community Consultants Panel, and our community partners supported recruitment or provided feedback on preliminary results. We thank the diverse communities we come from and are embedded within that shape, influence, and guide our research approach in culturally congruent ways.

References
1.
Corbie-Smith  G.   Vaccine hesitancy is a scapegoat for structural racism.   JAMA Health Forum. 2021;2(3):e210434-e210434. doi:10.1001/jamahealthforum.2021.0434 Google ScholarCrossref
2.
Malik  AA , McFadden  SM , Elharake  J , Omer  SB .  Determinants of COVID-19 vaccine acceptance in the US.   EClinicalMedicine. 2020;26:100495. doi:10.1016/j.eclinm.2020.100495 PubMedGoogle Scholar
3.
Szilagyi  PG , Thomas  K , Shah  MD ,  et al.  National trends in the US public’s likelihood of getting a COVID-19 vaccine—April 1 to December 8, 2020.   JAMA. 2020;325(4):396-398. doi:10.1001/jama.2020.26419 PubMedGoogle ScholarCrossref
4.
Khubchandani  J , Sharma  S , Price  JH , Wiblishauser  MJ , Sharma  M , Webb  FJ .  COVID-19 vaccination hesitancy in the united states: a rapid national assessment.   J Community Health. 2021;46(2):270-277. doi:10.1007/s10900-020-00958-x PubMedGoogle ScholarCrossref
5.
Shekhar  R , Sheikh  AB , Upadhyay  S ,  et al.  COVID-19 vaccine acceptance among health care workers in the United States.   Vaccines (Basel). 2021;9(2):119. doi:10.3390/vaccines9020119 PubMedGoogle ScholarCrossref
6.
Bogart  LM , Ojikutu  BO , Tyagi  K ,  et al. COVID-19 related medical mistrust, health impacts, and potential vaccine hesitancy among Black Americans living with HIV. J Acquir Immune Defic Synd. 2021;86(2):200-2007. doi:10.1097/QAI.0000000000002570
7.
Savoia  E , Piltch-Loeb  R , Goldberg  B ,  et al.  Predictors of COVID-19 vaccine hesitancy: socio-demographics, co-morbidity and past experience of racial discrimination.  medRxiv. Preprint posted online January 13, 2021. 2021.
8.
Quinn  S , Jamison  A , Musa  D , Hilyard  K , Freimuth  V .  Exploring the continuum of vaccine hesitancy between African American and white adults: results of a qualitative study.   PLoS Curr. 2016;8:8. doi:10.1371/currents.outbreaks.3e4a5ea39d8620494e2a2c874a3c4201 PubMedGoogle Scholar
9.
Chen  JY , Fox  SA , Cantrell  CH , Stockdale  SE , Kagawa-Singer  M .  Health disparities and prevention: racial/ethnic barriers to flu vaccinations.   J Community Health. 2007;32(1):5-20. doi:10.1007/s10900-006-9031-7 PubMedGoogle ScholarCrossref
10.
Bajaj  SS , Stanford  FC .  Beyond Tuskegee—vaccine distrust and everyday racism.   N Engl J Med. 2021;384(5):e12. doi:10.1056/NEJMpv2035827 PubMedGoogle Scholar
11.
Cervantes  L , Martin  M , Frank  MG ,  et al.  Experiences of Latinx individuals hospitalized for COVID-19: a qualitative study.   JAMA Netw Open. 2021;4(3):e210684. doi:10.1001/jamanetworkopen.2021.0684 PubMedGoogle Scholar
12.
Caserotti  M , Girardi  P , Rubaltelli  E , Tasso  A , Lotto  L , Gavaruzzi  T . Associations of COVID-19 risk perception with vaccine hesitancy over time for Italian residents. Soc Sci Med. 2021;272:113688. doi:10.1016/j.socscimed.2021.113688
13.
MacDonald  NE ; SAGE Working Group on Vaccine Hesitancy.  Vaccine hesitancy: definition, scope and determinants.   Vaccine. 2015;33(34):4161-4164. doi:10.1016/j.vaccine.2015.04.036 PubMedGoogle ScholarCrossref
14.
Salmon  D , Opel  DJ , Dudley  MZ , Brewer  J , Breiman  R . Reflections On governance, communication, and equity: challenges and opportunities in COVID-19 vaccination. Health Aff (Millwood). 2021;40(3):419-425. doi:10.1377/hlthaff.2020.02254
15.
Su  Z , Wen  J , Abbas  J ,  et al.  A race for a better understanding of COVID-19 vaccine non-adopters.   Brain Behav Immun Health. 2020;9:100159. doi:10.1016/j.bbih.2020.100159 PubMedGoogle Scholar
16.
Burgess  RA , Osborne  RH , Yongabi  KA ,  et al.  The COVID-19 vaccines rush: participatory community engagement matters more than ever.   Lancet. 2021;397(10268):8-10. doi:10.1016/S0140-6736(20)32642-8 PubMedGoogle ScholarCrossref
17.
Vergara  RJD , Sarmiento  PJD , Lagman  JDN .  Building public trust: a response to COVID-19 vaccine hesitancy predicament.   J Public Health (Oxf). 2021;43(2):e291-e292. doi:10.1093/pubmed/fdaa282 PubMedGoogle ScholarCrossref
18.
Carson  SL , Gonzalez  C , Lopez  S ,  et al.  Reflections on the importance of community-partnered research strategies for health equity in the era of COVID-19.   J Health Care Poor Underserved. 2020;31(4):1515-1519. doi:10.1353/hpu.2020.0112 PubMedGoogle ScholarCrossref
19.
Los Angeles County Department of Public Health. Los Angeles County Daily COVID-19 Data: Age Adjusted Death Rates due to COVID-19 per 100K (March 14, 2021). 2021. Accessed March 16, 2021. http://publichealth.lacounty.gov/media/Coronavirus/data/index.htm
20.
O’Brien  BC , Harris  IB , Beckman  TJ , Reed  DA , Cook  DA .  Standards for reporting qualitative research: a synthesis of recommendations.   Acad Med. 2014;89(9):1245-1251. doi:10.1097/ACM.0000000000000388 PubMedGoogle ScholarCrossref
21.
King  O .  Two sets of qualitative research reporting guidelines: an analysis of the shortfalls.   Res Nurs Health. 2021;44(4):715-723. doi:10.1002/nur.22157 PubMedGoogle ScholarCrossref
22.
Grant  BM , Giddings  LS .  Making sense of methodologies: a paradigm framework for the novice researcher.   Contemp Nurse. 2002;13(1):10-28. doi:10.5172/conu.13.1.10 PubMedGoogle ScholarCrossref
23.
Archibald  MM , Ambagtsheer  RC , Casey  MG , Lawless  M .  Using Zoom videoconferencing for qualitative data collection: perceptions and experiences of researchers and participants.   Int J Qual Methods. 2019;18:1609406919874596. doi:10.1177/1609406919874596 Google Scholar
24.
Wong  T. Little noticed, Filipino Americans are dying of COVID-19 at an alarming rate. The Los Angeles Times. July 21, 2020. https://www.latimes.com/california/story/2020-07-21/filipino-americans-dying-covid
25.
Hayes-Bautista  DE , Hsu  P . For Whom the Bell Tolls: COVID-19 Death Patterns in California. UCLA Health, Center for the Study of Latino Health and Culture. July 8, 2020. Accessed March 16, 2021. https://www.uclahealth.org/ceslac/workfiles/Research/COVID19/For-Whom-the-Bell-Tolls-COVID-19-Death-Patterns-in-California.pdf
26.
Rudy  ET , Newman  PA , Duan  N , Kelly  EM , Roberts  KJ , Seiden  DS .  HIV vaccine acceptability among women at risk: perceived barriers and facilitators to future HIV vaccine uptake.   AIDS Educ Prev. 2005;17(3):253-267. doi:10.1521/aeap.17.4.253.66529 PubMedGoogle ScholarCrossref
27.
Mehta  P , Sharma  M , Lee  RC .  Using the health belief model in qualitative focus groups to identify HPV vaccine acceptability in college men.   Int Q Community Health Educ. 2012-2013;33(2):175-187. doi:10.2190/IQ.33.2.f PubMedGoogle ScholarCrossref
28.
Newman  PA , Logie  C , James  L ,  et al.  “Speaking the dialect”: understanding public discourse in the aftermath of an HIV vaccine trial shutdown.   Am J Public Health. 2011;101(9):1749-1758. doi:10.2105/AJPH.2011.300208 PubMedGoogle ScholarCrossref
29.
Kobetz  E , Menard  J , Hazan  G ,  et al.  Perceptions of HPV and cervical cancer among Haitian immigrant women: implications for vaccine acceptability.   Educ Health (Abingdon). 2011;24(3):479.PubMedGoogle Scholar
30.
Fletcher  AJ .  Applying critical realism in qualitative research: methodology meets method.   Int J Soc Res Methodol. 2017;20(2):181-194. doi:10.1080/13645579.2016.1144401 Google ScholarCrossref
31.
Braun  V , Clarke  V .  Using thematic analysis in psychology.   Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa Google ScholarCrossref
32.
Braun  V , Clarke  V , Hayfield  N , Terry  G.  Thematic analysis. In: Liamputtong  P , ed.  Handbook of Research Methods in Health Social Sciences. Springer Singapore; 2019:843-860. doi:10.1007/978-981-10-5251-4_103
33.
Schuster  M , Eskola  J , Duclos  P ; SAGE Working Group on Vaccine Hesitancy.  Review of vaccine hesitancy: Rationale, remit and methods.   Vaccine. 2015;33(34):4157-4160. doi:10.1016/j.vaccine.2015.04.035 PubMedGoogle ScholarCrossref
34.
World Health Organization.  Report of the SAGE Working Group on Vaccine Hesitancy. World Health Organization; 2014.
35.
World Health Organization. Appendices to the Report of the SAGE Working Group on Vaccine Hesitancy. World Health Organization Strategic Advisory Group of Experts on Immunization Working Group; October 1, 2014.
36.
Thomson  A , Robinson  K , Vallée-Tourangeau  G .  The 5As: a practical taxonomy for the determinants of vaccine uptake.   Vaccine. 2016;34(8):1018-1024. doi:10.1016/j.vaccine.2015.11.065 PubMedGoogle ScholarCrossref
37.
World Health Organization. Meeting Report: Measuring Behavioural and Social Drivers (BeSD) of Vaccination Working Group. 2019. Accessed July 9, 2021. https://www.who.int/immunization/programmes_systems/Meeting_report_May2019.pdf?ua=1
38.
World Health Organization. Data for action: achieving high uptake of COVID-19 vaccines: gathering and using data on the behavioural and social drivers of vaccination: a guidebook for immunization programmes and implementing partners: interim guidance, 1 April 2021. World Health Organization; 2021. Accessed July 9, 2021. https://apps.who.int/iris/handle/10665/339452
39.
Shapiro  GK , Kaufman  J , Brewer  NT , Wiley  K , Menning  L , Leask  J ; BeSD Working Group.  A critical review of measures of childhood vaccine confidence.   Curr Opin Immunol. 2021;71:34-45. doi:10.1016/j.coi.2021.04.002 PubMedGoogle ScholarCrossref
40.
Bedford  H , Attwell  K , Danchin  M , Marshall  H , Corben  P , Leask  J .  Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology.   Vaccine. 2018;36(44):6556-6558. doi:10.1016/j.vaccine.2017.08.004 PubMedGoogle ScholarCrossref
41.
Lee  BY , Mueller  LE , Tilchin  CG .  A systems approach to vaccine decision making.   Vaccine. 2017;35(suppl 1):A36-A42. doi:10.1016/j.vaccine.2016.11.033 PubMedGoogle ScholarCrossref
42.
Latkin  CA , Dayton  L , Yi  G , Konstantopoulos  A , Boodram  B .  Trust in a COVID-19 vaccine in the U.S.: A social-ecological perspective.   Soc Sci Med. 2021;270:113684. doi:10.1016/j.socscimed.2021.113684 PubMedGoogle Scholar
43.
Callaghan  T , Moghtaderi  A , Lueck  JA ,  et al.  Correlates and disparities of intention to vaccinate against COVID-19.   Soc Sci Med. 2021;272:113638. doi:10.1016/j.socscimed.2020.113638PubMedGoogle Scholar
44.
HelpAge USA. Early Insights on Research Among Older Black and Hispanic Adults [press release]. February 19, 2021. Accessed July 9, 2021. https://helpageusa.org/resources/news-headlines-test/early-insights-on-helpage-usas-covid19-vaccine-communications-research
45.
Bogart  LM , Dong  L , Gandhi  P ,  et al. What Contributes to COVID-19 Vaccine Hesitancy in Black Communities, and How Can It Be Addressed? RAND Corporation; 2021. Accessed July 9, 2021. https://www.rand.org/pubs/research_reports/RRA1110-1.html
46.
Galbraith  KV , Lechuga  J , Jenerette  CM , Moore  LA , Palmer  MH , Hamilton  JB .  Parental acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United States: A literature review.   Soc Sci Med. 2016;159:116-126. doi:10.1016/j.socscimed.2016.04.028 PubMedGoogle ScholarCrossref
47.
Jeudin  P , Liveright  E , Del Carmen  MG , Perkins  RB .  Race, ethnicity, and income factors impacting human papillomavirus vaccination rates.   Clin Ther. 2014;36(1):24-37. doi:10.1016/j.clinthera.2013.11.001 PubMedGoogle ScholarCrossref
48.
Center  KE , Da Silva  J , Hernandez  AL ,  et al.  Multidisciplinary community-based investigation of a COVID-19 outbreak among Marshallese and Hispanic/Latino communities—Benton and Washington Counties, Arkansas, March-June 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(48):1807-1811. doi:10.15585/mmwr.mm6948a2 PubMedGoogle ScholarCrossref
49.
Karlsson  LC , Soveri  A , Lewandowsky  S ,  et al.  Fearing the disease or the vaccine: the case of COVID-19.   Pers Individ Dif. 2021;172:110590. doi:10.1016/j.paid.2020.110590 PubMedGoogle Scholar
50.
Quinn  SC , Jamison  A , Freimuth  VS , An  J , Hancock  GR , Musa  D .  Exploring racial influences on flu vaccine attitudes and behavior: results of a national survey of White and African American adults.   Vaccine. 2017;35(8):1167-1174. doi:10.1016/j.vaccine.2016.12.046 PubMedGoogle ScholarCrossref
51.
Jamison  AM , Quinn  SC , Freimuth  VS .  “You don’t trust a government vaccine”: narratives of institutional trust and influenza vaccination among African American and white adults.   Soc Sci Med. 2019;221:87-94. doi:10.1016/j.socscimed.2018.12.020 PubMedGoogle ScholarCrossref
52.
Warren  RC , Forrow  L , Hodge  DA  Sr , Truog  RD .  Trustworthiness before trust—Covid-19 vaccine trials and the Black community.   N Engl J Med. 2020;383(22):e121. doi:10.1056/NEJMp2030033 PubMedGoogle Scholar
53.
Leitch  S , Corbin  JH , Boston-Fisher  N ,  et al.  Black Lives Matter in health promotion: moving from unspoken to outspoken.   Health Promot Int. 2020;daaa121. doi:10.1093/heapro/daaa121 PubMedGoogle Scholar
54.
Bor  J , Venkataramani  AS , Williams  DR , Tsai  AC .  Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study.   Lancet. 2018;392(10144):302-310. doi:10.1016/S0140-6736(18)31130-9 PubMedGoogle ScholarCrossref
55.
Momplaisir  F , Haynes  N , Nkwihoreze  H , Nelson  M , Werner  RM , Jemmott  J .  Understanding drivers of COVID-19 vaccine hesitancy among Blacks.   Clin Infect Dis. 2021;ciab102. doi:10.1093/cid/ciab102 PubMedGoogle Scholar
56.
Page  KR , Venkataramani  M , Beyrer  C , Polk  S .  Undocumented U.S. immigrants and Covid-19.   N Engl J Med. 2020;382(21):e62. doi:10.1056/NEJMp2005953 PubMedGoogle Scholar
57.
Gover  AR , Harper  SB , Langton  L .  Anti-Asian hate crime during the COVID-19 pandemic: exploring the reproduction of inequality.   Am J Crim Justice. 2020;45(4):1-21. doi:10.1007/s12103-020-09545-1 PubMedGoogle ScholarCrossref
58.
Oluyomi  AO , Gunter  SM , Leining  LM , Murray  KO , Amos  C .  COVID-19 community incidence and associated neighborhood-level characteristics in Houston, Texas, USA.   Int J Environ Res Public Health. 2021;18(4):1495. doi:10.3390/ijerph18041495 PubMedGoogle ScholarCrossref
59.
Paremoer  L , Nandi  S , Serag  H , Baum  F .  Covid-19 pandemic and the social determinants of health.   BMJ. 2021;372(n129):n129. doi:10.1136/bmj.n129 PubMedGoogle Scholar
60.
Kaiser Family Foundation. Data as of February 1 on State Vaccinations by Race/Ethnicity. Kaiser Family Foundation. Newsroom website. Published 2021. Accessed February 16, 2021. https://www.kff.org/coronavirus-covid-19/press-release/data-as-of-february-1-on-state-vaccinations-by-race-ethnicity/
61.
National Institutes of Health. Rapid Acceleration of Diagnostics (RADx) Programs. National Institutes of Health. Published 2021. Accessed March 26, 2021. https://www.nih.gov/research-training/medical-research-initiatives/radx
62.
National Institutes of Health. NIH Community Engagement Alliance (CEAL). National Institutes of Health. Published 2021. Accessed March 26, 2021. https://covid19community.nih.gov
63.
Los Angeles County Large-Scale Vaccination Sites Open; Vaccine Eligibility Opens to County Residents Aged 65 Years and Older [press release]. Los Angeles: Los Angeles County Department of Public Health, January 19, 2021. Accessed February 15, 2021. http://publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=2923
64.
Griffith  DM , Bergner  EM , Fair  AS , Wilkins  CH .  Using mistrust, distrust, and low trust precisely in medical care and medical research advances health equity.   Am J Prev Med. 2021;60(3):442-445. doi:10.1016/j.amepre.2020.08.019 PubMedGoogle ScholarCrossref
65.
Larson  HJ , Clarke  RM , Jarrett  C ,  et al.  Measuring trust in vaccination: a systematic review.   Hum Vaccin Immunother. 2018;14(7):1599-1609. doi:10.1080/21645515.2018.1459252 PubMedGoogle ScholarCrossref
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