Correlates of Coronavirus Disease 2019 (COVID-19) Vaccine Hesitancy Among People Who Inject Drugs in the San Diego-Tijuana Border Region
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Abstract
Background
People who inject drugs (PWID) are vulnerable to acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We examined correlates of coronavirus disease 2019 (COVID-19) vaccine hesitancy among PWID in the US-Mexico border region, of whom only 7.6% had received ≥ 1 COVID-19 vaccine dose by September 2021.
Methods
Between October 2020 and September 2021, participants aged ≥ 18 years from San Diego, California, USA, and Tijuana, Baja California, Mexico, who injected drugs within the last month completed surveys and SARS-CoV-2, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) serologic testing. Logistic regressions with robust standard error estimation via generalized estimating equations identified factors associated with being unsure or unwilling to receive COVID-19 vaccines.
Results
Of 393 participants, 266 (67.7%) were willing to receive COVID-19 vaccines and 127 (32.3%) were hesitant (23.4% unwilling and 8.9% unsure). Older participants, those with greater food insecurity, and those with greater concern about acquiring SARS-CoV-2 were more willing to be vaccinated. Higher numbers of chronic health conditions, having access to a smart phone or computer, and citing social media as one’s most important source of COVID-19 information were independently associated with vaccine hesitancy. COVID-19-related disinformation was independently associated with vaccine hesitancy (adjusted odds ratio: 1.51 per additional conspiracy theory endorsed; 95% confidence interval: 1.31–1.74).
Conclusions
Nearly one third of people injecting drugs in the US-Mexico border region were COVID-19 vaccine hesitant, which was significantly associated with exposure to social media, disinformation and co-morbidities and inversely associated with food security and high perceived threat of COVID-19. Interventions that improve accurate knowledge of and trust in COVID-19 vaccines are needed in this vulnerable population.
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SciScore for 10.1101/2021.10.29.21265669: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Antibodies Sentences Resources SARS-CoV-2 Antibody Detection: Serology was conducted by Genalyte® (San Diego, CA), using their Maverick™ Multi-Antigen Serology Panel [15] that detects IgG and IgM antibodies to five SARS-CoV-2 antigens (Nucleocapsid, Spike S1-S2, Spike S1, Spike S1-RBD, Spike S2) within a multiplex format based on photonic ring resonance. IgMsuggested: Noneantigens (Nucleocapsid, Spike S1-S2suggested: NoneA machine learning algorithm was used to call results using the Random Forest Ensemble method with 3000 decision trees.[16] HIV and HCV Serology: Rapid HIV and HCV tests were conducted using the Miriad® HIV/HCV … SciScore for 10.1101/2021.10.29.21265669: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Antibodies Sentences Resources SARS-CoV-2 Antibody Detection: Serology was conducted by Genalyte® (San Diego, CA), using their Maverick™ Multi-Antigen Serology Panel [15] that detects IgG and IgM antibodies to five SARS-CoV-2 antigens (Nucleocapsid, Spike S1-S2, Spike S1, Spike S1-RBD, Spike S2) within a multiplex format based on photonic ring resonance. IgMsuggested: Noneantigens (Nucleocapsid, Spike S1-S2suggested: NoneA machine learning algorithm was used to call results using the Random Forest Ensemble method with 3000 decision trees.[16] HIV and HCV Serology: Rapid HIV and HCV tests were conducted using the Miriad® HIV/HCV Antibody InTec Rapid Anti-HCV Test (Avantor, Radnor, PA). Anti-HCVsuggested: NoneSoftware and Algorithms Sentences Resources All statistical analyses were conducted using SAS, version 9.4. SASsuggested: (SASqPCR, RRID:SCR_003056)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations of this study include the cross-sectional nature of the analysis, which precludes our ability to determine causal associations. Although this was a binational study, sampling was non-random and results may not generalize to other samples of PWID. We also relied on self-report and recall for many behaviors, which may have been subject to socially desirable responding. Although the COVID-19 disinformation scale we utilized had good internal consistency, other COVID-19 related knowledge measures have only been recently developed and, to our knowledge, have not been validated in this or other populations impacted by substance use. Our analysis excluded participants who were recruited before survey items on COVID-19 knowledge and vaccine hesitancy were developed. Since attitudes to COVID-19 vaccines may have changed over time, we controlled for time in our analysis. Future longitudinal, qualitative, and intervention-development studies are needed to better understand contextual factors influencing vaccine hesitancy in this population to identify strategies to best address these intervention targets. In conclusion, we identified a concerning level of COVID-19 vaccine hesitancy among community-recruited PWID in the San Diego-Tijuana border region, which was associated with COVID-19 related disinformation, reliance on social media as a source health information, younger age and co-morbidities. Interventions that increase accurate COVID-19 vaccine knowledge, trust and moti...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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