The impact of COVID-19 on income and employment and willingness to become vaccinated among African Americans enrolled in a smoking cessation randomized trial

Abstract

Given vulnerability to COVID-19 among smokers and vaccine hesitancy among populations disproportionately burdened with COVID-19, it’s important to understand concerns about vaccines and the impact of COVID-19 on these subgroups. Among our all African American (AA) sample of smokers (N = 172) enrolled in a larger smoking cessation clinical trial, results demonstrated an intensive burden from COVID-19; 42 (24.4%) lost employment, 56 (32.6%) lost household income, and 66 (38.4%) reported inability to pay bills and buy food due to COVID. Most, 103 (64.4%), were willing to get vaccinated. Among the vaccine-hesitant, 57 (35.6%), concerns about COVID-19 vaccine development and mistrust in vaccines were primary reasons for unwillingness to get vaccinated. Few identified doctor’s advice as most valued in deciding if the vaccine was the best option. Findings highlight high openness to the vaccine among smokers impacted by COVID but reiterate the need for community-engaged versus health system-driven approaches to improve vaccine hesitancy among racial/ethnic minorities.

Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review

“…With higher rates of individuals indicating that they are either unsure or unwilling to get vaccinated, there is concern that “vaccine hesitancy” (VH) may further perpetuate the health disparities already experienced within Black communities [ 91 , 103 ]. In addition, these concerns were further heightened during flu season, when suboptimal flu vaccine uptake could exacerbate the adverse health outcomes similar to the effects of COVID-19 [ 101 ].…”

“…Those who were less willing to get vaccinated had low levels of vaccine necessity [ 61 ], had fewer general concerns about COVID-19 [ 75 ] and believed that other means of protection [ 92 ], such as wearing a mask, taking supplements, and staying home were more effective than the COVID-19 vaccine [ 58 ]. Whereas others did not take vaccines in general [ 91 ], were confident due to their current level of health [ 93 ], or felt that vaccinations were the wrong approach and that efforts should be focused on improving baseline health [ 62 ].…”

“…There is a variance in the likelihood of getting vaccinated for COVID-19 in the Black population [ 82 ]. Main reasons for participants not being VH is if they already received the vaccine, to protect themselves and others [ 93 ], such as family and small children [ 62 ], if it was mandatory for school or work [ 62 , 93 ], and for protection to feel safe and not worry of getting sick or dying from infection [ 91 ]. Willingness was also increased when there was the perception that other Black people were getting vaccinated and that it had social approval [ 67 ].…”

“…The main reason for VH was uncertainty due to the COVID-19 vaccine’s quick development [ 62 , 91 , 93 , 102 ], the newness of the vaccine itself [ 61 ], and that more time [ 58 , 59 , 94 ] was needed for vaccine side effects and its efficacy [ 59 ] as well as to observe vaccine rollout [ 58 ].…”

“…VH is associated with skepticism of the government and the healthcare system [ 56 ]; therefore, concerted efforts must be made by public health and the medical system to gain the trust of the ACB communities, which carry a higher burden of COVID-19 [ 91 ]. In addition, providers’ lack of cultural sensitivity, responsiveness, and competency in practice are also reasons for mistrust in providers and the health systems [ 59 ].…”