By Deborah E. Linares, Ph.D., M.A. and Vanessa Marshall, Ph.D.
National Institute on Minority Health and Health Disparities (NIMHD)
Posted March 7, 2024

Moving from willingness (to take a vaccine) to vaccination uptake remains a public health challenge, because there are multiple factors driving vaccine hesitancy. Vaccine hesitancy occurs when there is a reluctance to receive a vaccine despite its availability. Developing strategies to build trust with people from racial and ethnic minority communities and the medical community are essential to effectively promoting health.

NIMHD supports research in this area to eliminate health disparities and incorporate strategies to address:

• Social determinants of health that create barriers to accessing vaccines.
• Sustainable collaborations in communities disproportionately affected by illnesses.

NIMHD continues to invest in community-engaged research among populations experiencing health disparities to promote wellness and protect health through vaccines. We held an NIH extramurally funded grantee meeting on COVID-19 vaccine uptake in 2022 where several insights were shared. In this blog post, we share these insights and a brief overview of how applying knowledge, steadfastness, and collaboration can help promote vaccine uptake. While we know some people are reluctant and may be unsure about being vaccinated, hopefully this blog will help to inform them.

What are the benefits of vaccines?

Vaccines provide multiple benefits for the prevention or reduction of disease, serious illness, or death while also protecting against disease transmission. The Centers for Disease Control and Prevention (CDC) recommends vaccinations across the lifespan for protection against many diseases.

For example, influenza or the flu is an infection of the respiratory system that can cause serious complications for children ages 2 or younger, pregnant people, adults over age 65, and people with chronic health conditions. The flu causes more than 400,000 hospital stays and 50,000 deaths each year in the United States, with the highest rates among Black and African American and American Indian and Alaska Native (AI/AN) populations. Yet less than 43% of Latino and Hispanic, AI/AN, and Black and African American adults and less than 54% of Latino and Hispanic and Black and African American children receive the flu vaccine.

U.S. Food and Drug Administration-approved vaccines are critical for reducing infection rates and slowing the spread of infectious diseases. Despite the CDC’s recommendations and the overwhelming benefits of vaccination, disparities exist in the acceptance and uptake of vaccines (e.g., COVID-19, flu, pneumococcal, hepatitis B, pertussis, measles, and human papilloma virus) among populations experiencing health disparities. These disparities also occur for many routine immunizations for all ages.

What drives vaccine hesitancy?

The COVID-19 pandemic showed us that vaccine hesitancy is complex; context specific; and changes across time, place, and type of vaccine, as well as in the timely completion of a vaccine series (i.e., receiving all vaccines within a series). It can also be influenced by factors such as complacency, convenience, and confidence.

Pathways of vaccine hesitancy vary and are subject to change over time. For instance, parental vaccine hesitancy for childhood vaccines is growing within the United States for diseases such as measles, despite measles being declared eliminated in the United States in 2000 due to a prior robust vaccination program.

Racial and ethnic minority populations may be more likely to experience skepticism about the trustworthiness of the source(s) of vaccination recommendations due to prior experiences of marginalization and mistreatment within the medical community. Cultural and religious factors may also influence vaccine uptake and low risk perceptions of disease.

Other factors such as limited knowledge, limited information on vaccines, concerns about perceived safety, parental perceptions of vaccine safety, public uncertainty, low health literacy, considering immunization a low priority, and exposure to misinformation or disinformation via social media channels play a role in vaccine uptake.

Getting protected: What you need to know

Winter months are critical times for vaccines, especially COVID-19, flu, and respiratory syncytial virus (RSV). People may also be behind on other vaccines due to health care closures and accessibility issues during COVID-19. So how can we encourage the people around us to get vaccinated? Community-based organizations and health care providers can do the following:

• Engage others in meaningful, authentic communication when you discuss vaccines.
• Identify and address the needs, preferences, and concerns of a group in discussions about vaccines.
• Provide targeted messaging that meets people where they are, in terms of their decision to vaccinate and the places where they receive care.
• Give understandable communication that comes from a trusted source (e.g., health care provider or community leader).
• Provide different modalities for messaging about vaccines (e.g., text message, face-to-face interactions, social media, videos).

These strategies can be helpful to increase vaccine uptake within your community. In addition to getting vaccinated, please continue to use evidence-based mitigation strategies to reduce the risk of spreading infectious diseases, such as mask wearing and frequent hand washing. Persistence to these strategies and drawing on community-based collaborations can help promote health among populations experiencing health disparities.

On-going NIMHD vaccine related funding opportunities and initiatives:

• NOT-MD-23-008: Notice of Special Interest: Research to Address Vaccine Uptake and Implementation Among Populations Experiencing Health Disparities
• Approved Funding Concept: Multilevel Pathways and Interventions to Promote Vaccine Uptake Among Populations Experiencing Health Disparities

Want to know more about how NIH is addressing vaccine hesitancy, uptake, and implementation among populations experiencing health disparities in the United States and its territories?

• NIH Community Engagement Alliance (CEAL): CEAL Against COVID-19 Disparities works closely with the communities hit hardest by COVID-19.
• RADx® Underserved Populations (RADx-UP) was created by NIH to ensure that all Americans have access to COVID-19 testing, with a focus on communities most affected by the pandemic.

To locate vaccines near you: www.vaccines.gov

Deborah Linares, Ph.D., M.A., is a Health Scientist Administrator (Program Official) at NIMHD. She focuses on promoting research to understand behavioral and interpersonal factors contributing to resilience and susceptibility to adverse health conditions among disadvantaged and underserved populations. She provides expertise in conducting minority health and health disparities research in the areas of behavioral health, women’s health, child development, healthy aging, eHealth, and cancer control.

Vanessa Marshall, Ph.D., is a Social Behavioral Scientist Administrator (Program Officer) in the Division of Community Health and Population Science at NIMHD. She manages and conducts research to advance public health prevention science. Her research focuses on improving health outcomes and promoting research to understand and address the multilevel determinants of factors that play a role in health disparities. She provides expertise in key research areas including minority health, health disparities, health services research, community engaged research, clinical trials, public health, quality improvement, implementation, dissemination and evaluation.

By Paul Cotton, Ph.D., RDN
National Institute on Minority Health and Health Disparities
Posted Feb. 27, 2024

Insights Into the 2023 NIH Data Management and Sharing Policy

In a significant development for the scientific community, the National Institutes of Health (NIH) unveiled its Data Management and Sharing (DMS) policy. The DMS policy represents a major step forward in promoting transparency, reproducibility, and collaboration within the realm of biomedical research. By emphasizing responsible and efficient sharing of research data, the NIH aims to maximize the impact of its investments and foster scientific discoveries that benefit society at large. This blog post explores the key elements and implications of the NIH's groundbreaking policy.

Enhancing Data Management Practices

The DMS policy places a strong emphasis on robust data management practices throughout the research lifecycle, requiring grant applicants to submit a detailed Data Management and Sharing Plan (DMSP). The DMSP should outline how prospective grantees will handle, store, and share research data generated throughout the duration of NIH-funded projects and beyond. This proactive approach ensures that data management is considered an integral part of the research process from the outset, thereby minimizing the risk of data loss or mismanagement.

Promoting Data Sharing and Accessibility

One of the primary objectives of the NIH's DMS policy is to enhance data sharing and accessibility. Under the new guidelines, researchers are expected to make their data widely available to the scientific community, enabling other researchers to validate findings, conduct secondary analyses, and generate new insights. By fostering a culture of data sharing, the NIH aims to accelerate scientific progress, encourage collaborations, and avoid unnecessary duplication of efforts.

The new policy facilitates data sharing by encouraging the use of data repositories that comply with FAIR (Findable, Accessible, Interoperable, and Reusable) principles. FAIR ensures that research data is easily discoverable, accessible to all interested parties, and effectively utilized across different platforms and disciplines. Moreover, the NIH requires that data be shared in a timely manner, allowing other researchers to benefit from and build upon existing knowledge.

Protecting Privacy and Confidentiality

While promoting data sharing, the NIH also recognizes the importance of protecting individual privacy and confidential information. The data management and sharing policy emphasizes the need for researchers to handle sensitive data responsibly and take appropriate measures to safeguard participant privacy. It encourages the use of de-identified data whenever possible, ensuring that personal information remains protected while still enabling valuable research insights.

Training and Compliance

Recognizing the need to support researchers in implementing the new policy, the NIH is committed to providing training, resources, and guidance on data management and sharing practices. Our commitment helps equip researchers with the necessary knowledge and skills to adhere to the policy requirements. Additionally, compliance with the new data management and sharing policy will be monitored as part of the NIH's existing grant oversight and evaluation processes.

Conclusion

The NIH's new Data Management and Sharing Policy marks a significant milestone in advancing scientific collaboration and transparency. By promoting responsible data management and sharing practices, the policy aims to accelerate scientific discoveries, maximize the impact of research investments, and ultimately improve human health. While fostering collaboration and accessibility, it also recognizes the importance of privacy protection and compliance with ethical guidelines.

The NIH's commitment to supporting researchers through training and resources underscores our dedication to facilitating the implementation of this progressive policy. Stay tuned for future posts, where we will explore specific Data Management and Sharing Policy updates, share success stories, and provide valuable insights to help you navigate the evolving landscape of grant funding. Together, let us embark on this journey of clarity and collaboration as we strive to make a lasting impact in the fields of health and research as the scientific community embraces this new era of data sharing, exciting opportunities for breakthroughs and collaborations lie ahead.

Paul Cotton, Ph.D., RDN, is the Director of NIMHD’s Office of Extramural Research Activities. He advises on and manages science policy and program activities related to extramural administrative management, scientific management, and scientific initiatives, and is responsible for the development and implementation of policies for managing research awards and overseeing research training policies, as well as supporting diversity, equity, and inclusion research initiatives.

By August "A.J." Jenkins, Ph.D.
University of Illinois at Urbana-Champaign
Posted Feb. 16, 2024

When I think about the resources that may be important to Black Americans' psychological health and their intimate relationships, I often think about my grandparents' neighborhood on the westside of Detroit (my hometown). Growing up, my sister and I regularly went to their house. I was fascinated by their community—because it was exactly that: a community. All the neighbors knew each other's families, looked out for each other, shared resources, and had get-togethers and barbeques.

To me, my grandparents' community defied the things people typically associated with living in the city. Detroit neighborhoods are often thought of as dangerous and disadvantaged, but for me, our neighborhoods can also provide a sense of belonging, safety, and protection.

I understand that neighborhoods are not only a context for living but also a resource for flourishing, and this has shaped my perspective and how I approach work. I investigate how racism impacts Black Americans' mental health and intimate relationships, along with how they are connected over time. Experiences have taught me that resilience can always be found in adverse circumstances, so I also study how Black Americans leverage available sociocultural and ecological capital and coping resources to maintain and enhance their well-being.

Racism impacts multiple levels (e.g., interpersonal, cultural levels), with scholars noting the incredibly devastating consequences of structural racism for Black Americans' health and health inequities. For Black Americans, the residential context is one of the most striking examples of structural racism. There is a long history and enduring practice of segregation; no other racial group has experienced the same degree of residential segregation as Black Americans.

Consequently, Black Americans are also more likely to live in disadvantaged environments and be exposed to community stressors like poverty, crime, physical, and/or social disrepair that are associated with poorer mental-emotional health outcomes for Black Americans. Nonetheless, neighborhoods can also provide residents a sense of community, cohesion, and safety and offer resources that benefit mental health.

Notably, neighborhood environments not only affect individual functioning but also intimate relationships. Research shows the significance of the neighborhood context for Black romantic relationships, as disadvantaged areas can influence relationship behaviors and quality. Black adults living in urban neighborhoods have discussed how neighborhood violence and distress can contribute to their reluctance to be emotionally vulnerable/available with romantic partners and reinforce feelings of worry and anxiety.

Still, positive neighborhood characteristics can benefit romantic relationship quality, providing couples with healthy relationship role models and providing opportunities for support (e.g., childcare support from neighbors) and access to helpful resources (e.g., community centers, religious organizations).

In a study funded by my NIMHD F31 fellowship, my colleagues and I investigated the ways that neighborhood quality and romantic relationship functioning combine to impact Black Americans' mental health over time. Utilizing an intersectional frame, we also looked at how these variables were related to mental health in unique ways for Black men and women.

Research highlights that Black men can be particularly sensitive to neighborhood factors—possibly because they contend with societal pressure to appear fearless and tough and counter stereotypes around criminality even when exposed to gangs, negative police interactions/profiling, and other racialized community stressors. Black men's perceptions of community strife have also been linked to hostile behaviors within their marriage, which are connected to poorer mental health for both men and their partners/wives.

A key takeaway from my F31 fellowship is that better neighborhood quality is related to better mental health for both men and women. Study participants living in higher-quality neighborhoods showed lower levels of negative mood and higher levels of positive mood 10 years later, even after accounting for their initial levels of emotional functioning and socioeconomic status.

Additionally, neighborhood quality and relationship functioning combined to uniquely affect Black men's (but not women's) psychological health. Men who reported better relationship functioning, but poorer neighborhood quality showed more emotional distress ten years later. Perhaps Black men in positive relationships want to provide the best for their partners, but ambient neighborhood stress is detracting, signaling that they are not living up to their desires to provide for and protect their family or interfering with their attempts to do so, resulting in more distress. However, men in better-quality neighborhoods might not experience this level of external stress, allowing them to capitalize on the positive effects of both their romantic relationships and neighborhoods, showing less emotional distress over time.

Together, these results underscore the powerful, long-lasting psychological effects of people's ideas about the support (or stress) that is present in their communities. Further, the results highlight the specific ways neighborhood context and romantic relationship functioning intersect to impact psychological health, suggesting that interventions at the neighborhood level could have valuable mental health impacts for Black Americans and their ability to take advantage of the positive psychological consequences of relationship functioning.

Ultimately, in my work, I aim to illuminate complex issues related to health, relationships, and social inequity for Black Americans and uncover opportunities to redress disparities in these areas. I intend to continue interrogating the connections between community contexts and other manifestations of racism to Black mental health and relationships by unpacking these links at multiple intersections (e.g., gender, social class) and examining their contribution to long-term psychological and relational health outcomes. This work helps highlight points for change/intervention in policy, clinical, and community realms. Through this work, I hope that eventually, we all can experience a sense of community just like my grandparents in their neighborhood.

Citations
Bryant, C. M., & Wickrama, K. A. S. (2005). Marital relationships of African Americans: A contextual approach. In V. McLoyd, N. Hill, & K. A. Dodge (Eds.), African American family life: Ecological and cultural diversity (pp. 111–134). Guilford Press.

August "A.J." Jenkins, Ph.D., is a 2023 - 2024 Vice Chancellor's Distinguished Postdoctoral Fellow and Visiting Scholar in the Department of Human Development and Family Studies at the University of Illinois at Urbana-Champaign. Dr. Jenkins investigates how racism impacts Black Americans' mental health and intimate relationships, along with how they are connected over time. She also studies how Black Americans leverage available sociocultural and ecological capital and coping resources to maintain and enhance their well-being.