key: cord-0971094-5z8ygsp9
authors: Budhwani, Henna; Maycock, Tiffani; Murrell, Wilnadia; Simpson, Tina
title: COVID-19 Vaccine Sentiments among African American or Black Adolescents in Rural Alabama
date: 2021-09-25
journal: J Adolesc Health
DOI: 10.1016/j.jadohealth.2021.09.010
sha: 2c43e78c1c189d9e92cd5737dbf7182c033e15ac
doc_id: 971094
cord_uid: 5z8ygsp9

Considering the urgent need to increase vaccine uptake in Alabama, a rural state with the lowest levels of COVID-19 vaccination in the country, we conducted an exploratory study to elucidate sentiments toward vaccination among African American or Black adolescents. We conducted in-depth interviews with 15-17 year olds in rural Alabama (N=28). About 54% of our sample were female. Nearly a third lived with an older family member; 18% knew someone who contracted COVID-19. Using Rapid Qualitative Analysis, three COVID-19 vaccine-related themes emerged: influence of community leaders and older family members, fear of side effects and mis-information, and institutional distrust. To address COVID-19 vaccine hesitancy among rural African American or Black adolescents, we suggest adopting a socioecological approach to public health messaging that addressed mis-information and government distrust, and is delivered by local influencers with the social capital necessary to promote behavior change, namely older family members and Church officials.

On May 10 th , 2021, the Pfizer-BioNTech COVID-19 vaccine emergency use authorization was expanded to include younger adolescents. 1 While studies with adults suggest reasons for vaccine hesitancy, 2,3 few studies highlight adolescents' views toward COVID-19 vaccination, and to our knowledge, no such studies exist with AAB adolescents in rural settings. Considering the importance of promoting COVID-19 vaccine uptake in rural America 4 and among AAB communities, 5 we conducted this qualitative study in Alabama to ascertain sentiments toward COVID-19 vaccination among rural AAB adolescents. Alabama is currently a COVID-19 hotspot with the lowest rate of COVID-19 vaccination in the nation. 6

Participants were recruited through a Selma (population ~17,000) high school in May 2021. All adolescents agreed to participate (N=28). Written informed consent was obtained. We conducted face-to-face, qualitative in-depth interviews, using a standardized guide. This interview guide included four domains assessing knowledge and sentiments related to: vaccines in general, HPV J o u r n a l P r e -p r o o f vaccination, COVID-19 vaccination, and local contexts or culture. Intent to accept COVID-19 vaccination and reasons for acceptance or declination were assessed. Recruitment and interviews continued until we achieved data saturation. Upon completion of interviews, participants were provided a $35 incentive card. Audio-recorded files were professionally transcribed. Rapid Qualitative Analysis 7 was conducted to identify themes related to COVID-19 vaccination. The

University of Alabama at Birmingham reviewed protocols and provided ethical approval (IRB-300006490).

Participants were 15-17 years old and were currently attending high school; 54% were female, 46% were male. About 71% had health insurance. Over 30% lived with an older family member;

18% knew someone who contracted COVID-19. Half (50%) had accepted a flu shot in the prior year. Three COVID-19 vaccine-related themes emerged: influence of community leaders and older family members; fear of side effects and misinformation, and institutional distrust.

Participants noted that their older family members' and community members' vaccine-related behaviors and sentiments influenced their own likelihood of accepting the COVID-19 vaccine. 

Among participants, mis-information, obtained from peers and the Internet, and personal fear of side effects were intertwined. 

Participants expressed skepticism toward the government and healthcare systems.

Yeah. I think the system or the government admits they're sneaky. They don't really care for the people for real. They just care about money and power…. AAB families are more likely to live in intergenerational households, and older family members are more likely to play a key role in the day-to-day of AAB adolescents. [8] [9] [10] Prior studies have highlighted the influence of the Church on providing social support and promoting positive health behaviors within AAB communities. [11] [12] [13] We also found evidence to suggest that institutional distrust, as well as mis-information related to side effects, may affect vaccine confidence (in addition to the fear of needles, a common fear among adolescents). 14 Considering the importance of the Church in AAB communities 11 and that nearly a third of our sample lived with an older family member, a socioecological approach 15 that delivers vaccine promoting messaging at multiple levels may be warranted. If public health professionals and clinical providers are committed to promoting vaccine equity within adolescent health, then not only should scholarly communities listen to what rural AAB adolescents say about their lived experiences, but then our systems must respond by leveraging pathways and tailoring messages that are acceptable to rural AAB adolescents. While this study provides a foundation for potential next steps, including targets for tailored messaging and identification of conduits to deliver messages, additional exploration is warranted to better understand what influences vaccine-related decision-making among rural AAB adolescents.

COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19

Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic

Fear of Adverse Effects and COVID-19 Vaccine Hesitancy: Recommendations of the Treatment Expectation Expert Group

Trends in Health Care Worker Intentions to Receive a COVID-19 Vaccine and Reasons for Hesitancy

Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties -United States

The Impact of COVID-19 on African American Communities in the United States

Alabama Department of Public Health (ADPH). Vaccine Distribution

Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration

Instrumental Social Support Exchanges in African American Extended Families

Family Social Support Networks of African American and Black Caribbean Adolescents

The Family Safety Net of Black and White Multigenerational Families

We've Come This Far by Faith: The Role of the Black Church in Public Health

Church Support among African American and Black Caribbean Adolescents

HPV Vaccine Promotion: The church as an agent of change

Survey of the prevalence of immunization noncompliance due to needle fears in children and adults

Trust in a COVID-19 vaccine in the U.S.: A social-ecological perspective

Research reported in this publication was supported by Merck Sharp and Dohme, Corp. as part of an investigator initiated study, MISP #60590 (NCT04604743). We thank our adolescent participants, and we acknowledge the contributions of our research team, including our staff, recruiters, and community partners. Special thank you to Ms. Jerria Martin with Drug Free Communities of Dallas County for her work aimed at improving health outcomes among adolescents in rural Alabama and Ms. Barge for her years of teaching and service in Selma.