Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial
Abstract BackgroundNegative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health int...
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JMIR Publications
2025-04-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2025/1/e67370 |
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| author | Noah Mancuso Jenna Michaels Erica N Browne Allysha C Maragh-Bass Jacob B Stocks Zachary R Soberano C Lily Bond Ibrahim Yigit Maria Leonora G Comello Margo Adams Larsen Kathryn E Muessig Audrey Pettifor Lisa B Hightow-Weidman Henna Budhwani Marie C D Stoner |
| author_facet | Noah Mancuso Jenna Michaels Erica N Browne Allysha C Maragh-Bass Jacob B Stocks Zachary R Soberano C Lily Bond Ibrahim Yigit Maria Leonora G Comello Margo Adams Larsen Kathryn E Muessig Audrey Pettifor Lisa B Hightow-Weidman Henna Budhwani Marie C D Stoner |
| author_sort | Noah Mancuso |
| collection | DOAJ |
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Abstract
BackgroundNegative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines.
ObjectiveOur objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful.
MethodsBlack young adults aged 18‐29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI’s effects was assessed by latent profiles.
ResultsThree latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (PPPP<
ConclusionsOur findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the greatest improvements in vaccine outcomes. |
| format | Article |
| id | doaj-art-cb85ca9fe9f54c32a865d21ee1bc63ac |
| institution | OA Journals |
| issn | 2369-2960 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | JMIR Publications |
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| series | JMIR Public Health and Surveillance |
| spelling | doaj-art-cb85ca9fe9f54c32a865d21ee1bc63ac2025-08-20T02:24:46ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602025-04-0111e67370e6737010.2196/67370Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control TrialNoah Mancusohttp://orcid.org/0000-0002-4442-9293Jenna Michaelshttp://orcid.org/0000-0001-9479-2237Erica N Brownehttp://orcid.org/0000-0003-2069-6589Allysha C Maragh-Basshttp://orcid.org/0000-0002-7447-3498Jacob B Stockshttp://orcid.org/0000-0003-3067-4324Zachary R Soberanohttp://orcid.org/0000-0002-4320-1027C Lily Bondhttp://orcid.org/0000-0003-4382-4045Ibrahim Yigithttp://orcid.org/0000-0003-0556-9960Maria Leonora G Comellohttp://orcid.org/0000-0001-7430-6668Margo Adams Larsenhttp://orcid.org/0000-0002-6373-9692Kathryn E Muessighttp://orcid.org/0000-0002-8522-3240Audrey Pettiforhttp://orcid.org/0000-0002-3387-0817Lisa B Hightow-Weidmanhttp://orcid.org/0000-0002-2421-923XHenna Budhwanihttp://orcid.org/0000-0002-6716-9754Marie C D Stonerhttp://orcid.org/0000-0002-7189-8669 Abstract BackgroundNegative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines. ObjectiveOur objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful. MethodsBlack young adults aged 18‐29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI’s effects was assessed by latent profiles. ResultsThree latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (PPPP< ConclusionsOur findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the greatest improvements in vaccine outcomes.https://publichealth.jmir.org/2025/1/e67370 |
| spellingShingle | Noah Mancuso Jenna Michaels Erica N Browne Allysha C Maragh-Bass Jacob B Stocks Zachary R Soberano C Lily Bond Ibrahim Yigit Maria Leonora G Comello Margo Adams Larsen Kathryn E Muessig Audrey Pettifor Lisa B Hightow-Weidman Henna Budhwani Marie C D Stoner Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial JMIR Public Health and Surveillance |
| title | Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial |
| title_full | Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial |
| title_fullStr | Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial |
| title_full_unstemmed | Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial |
| title_short | Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial |
| title_sort | greater improvements in vaccination outcomes among black young adults with vaccine resistant attitudes in the united states south following a digital health intervention latent profile analysis of a randomized control trial |
| url | https://publichealth.jmir.org/2025/1/e67370 |
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