Refusal Rate Research Articles

Determinants of COVID-19 vaccine acceptance amongst doctors practising in Cross River State, Nigeria

Background: COVID-19 vaccine is one of the most effective public health intervention approaches for prevention of COVID-19. Despite its well-known efficacy and safety, significant proportion of frontline COVID-19 healthcare workers remain hesitant about accepting the vaccine for whatever reasons. This study aimed to determine acceptance rate and determinants of vaccine refusal among doctors in Cross River State, Nigeria.
 Methodology: This was a cross-sectional survey of doctors using structured online questionnaire administered via the WhatsApp platform of the medical doctors’ association, in order to assess their rate of acceptance of COVID-19 vaccines, and reasons for vaccine refusal. The predictors of vaccine acceptance were analysed by univariate and multivariate logistic regression analyses.
 Results: Of the 443 medical doctors targeted on the WhatsApp platform, 164 responded to the questionnaire survey, giving a response rate of 37.0% (164/443). The mean age of the respondents is 38 ±6.28 years, 91 (55.5%) are 38 years old and above, 97 (59.1%) are males and 67 (40.9%) are females, giving a male-to-female ratio of 1.4:1. The greater proportion of the respondents are physicians (70/148, 47.3%) and about three-quarter of the participants (127/164, 77.4%) had received COVID-19 vaccine. The proportion of physicians who had received COVID-19 vaccine (57/70, 81.4%) was more than the proportion of general practitioners (31/42, 73.8%) and surgeons (24/35, 68.6%). Low perceived benefit of vaccination was the main reason given for COVID-19 vaccine refusal (45.9%, 17/37). No significant association was found between vaccine refusal and suspected predictors (p>0.05).
 Conclusion: Our study revealed high rate of COVID-19 vaccine acceptance among medical doctors especially among the physicians, with the surgeons showing lowest acceptance rate. A significant proportion would not take vaccine because they perceived it lacks much benefits. To raise vaccine acceptance among doctors, more efforts on vaccine literacy that would target doctors from all sub-specialties especially surgeons and incorporate vaccine benefits should be made.

The role of well-child visits in detecting developmental delay in preschool children

BackgroundEarly detection of developmental delay (DD) in preschool children is crucial for counselling parents, initiating diagnostic work-up, and starting early intervention (EI).MethodsWe conducted a register study of all preschool children referred for EI in the Canton of Zurich, Switzerland, in 2017 (N = 1,785) and used an online survey among primary care physicians (PCPs, N = 271) to evaluate the care service of DD children.ResultsPCPs accounted for 79.5% of all referrals by physicians and had correctly referred over 90% of the children in need of EI at an average age of 39.3 months (SD 8.9). In the survey, which represents 59.2% of all pediatricians and 11.3% of all general practitioners in the Canton, PCPs reported performing a mean of 13.5 (range 0–50, SD 10.7) well-child visits per week to preschool children and estimated well-child visits to be the most frequent type of consultation (66.7%) for the identification of DD. Parents’ hesitancy in accepting further evaluation or support were reported by 88.7%.ConclusionsMost preschool children with DD are identified in well-child visits. These visits represent an ideal opportunity for early detection of developmental impairment and initiation of EI. Carefully addressing parents’ reservations could reduce the rate of refusal, thus improving early support for children with DD.

Effectiveness of Neuropsychoeducation, Intrinsic Motivation, and Metaphoric Content Integrated with Cognitive Behavioral Therapy in the Treatment of Obsessive-Compulsive Disorder: A Pilot Study.

Obsessive-compulsive disorder (OCD) is considered frequent, unnecessary thoughts that lead to repetitive actions to lessen the apprehension provoked by thoughts; this repetitive sequence may further influence trouble in one's daily activities. The remedial procedure for OCD includes medication (such as SSRIs, anxiolytics, and antidepressants) with psychotherapy [such as cognitive behavioral therapy (CBT) and exposure response prevention (ERP)]. Previous investigations indicated that regardless of the trend of adopting CBT and ERP to treat OCD, only around half of the patients experienced a full reduction in symptoms. The ERP component in CBT has been termed as a challenging treatment as it contains threatening anxiety-provoking indications, and it has been reflected that between 25-30% of OCD patients reject the ERP treatment, and the refusal and dropout rates for ERP in OCD are higher than other interventions. Thus, in the present investigation, researchers developed a proposed therapy that includes neuropsychoeducation, intrinsic motivation, and metaphoric content integrated with CBT in addition to regular pharmacological management to treat OCD patients and validated the efficacy of the proposed therapy through psychometric ratings (Y-BOCS). In this pilot study, 10 cases of OCD received a 12-week proposed therapy program. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), which was assessed at baseline and post-treatment. The present study's results revealed a significant decrease in scores on the obsessions and compulsions domains and overall total scores on Y-BOCS among OCD patients. The findings show that this proposed therapy, which includes neuropsychoeducation, intrinsic motivation, and metaphors contents integrated with CBT in combination with pharmacological management, is effective in the treatment of OCD. Therefore, the proposed therapy may be beneficial in the treatment of OCD. It has far-reaching implications in the areas of clinical, psychiatry, and mental health.

Управление объёмами медицинской помощи и процессом госпитализации в профильном федеральном центре с применением цифровых технологий

Introduction Scheduling and distribution of medical care capacities approved by a healthcare organization, management of the key processes of patient selection and hospitalization with the use of digital technology are the most important organizational tools for successful implementation of state assignments. Purpose To develop an organizational model of medical care capacities, management of the processes of patient selection and hospitalization at a specialized federal center with the use of digital technology. Materials and methods Analysis of the plans of rendering specialized medical care in 72,547 cases, including high-tech medical care, for 10-year period (years 2013-2022) in the fields of “traumatology and orthopedics” and “neurosurgery” by means of healthcare information system and digital patients’ registries was conducted by the continuous method. Results Rates and types of patients’ nonappearance for hospitalization were identified: the rate of informed nonappearance was 37.9 ± 0.4 (per 100 planned patients), the rate of uninformed nonappearance was 18.4 ± 0.4 (per 100 patients who referred to admission), the rate of repeated nonappearance was 1.6 ± 0.1, and the rate of patients’ unplanned referral (arrival) was 6.0 ± 0.1. The rate of hospitalization rejection for a 10-year period (2013-2022) was 6.4 ± 0.1 (per 100 patients who sought medical care). For a 3-year period (2020-2022), the rate of non-confirmed surgical indications was 6.9 ± 0.1 (per 100 patients). Comparative analysis of 5-year periods (2013-2017 and 2018-2022) identified a 1.4-fold increase in an average 5-year rate of hospitalization refusal (t = 13.6, P < 0.0001). For a 5-year period (2018-2022), the rate of hospitalization of patients aged 75 and older was 5.3 ± 0.1, of patients with co-morbidity (diabetes mellitus) 11.8 ± 0.2 per 100 treated patients. Multi-purpose calculation method for prediction of patients’ hospitalization was offered. Discussion Based on the specified rate of patients’ nonappearance for hospitalization it would be advisable to provide a number of patients that would be over the plan in order to achieve necessary hospitalization numbers. An operating reserve in the digital patients’ registry would solve an issue of hospitalization plan execution and to substitute the patients who were not able to appear. Conclusion Our study has identified regularities of implementation of planned hospitalization of patients to traumatology/orthopedics and neurosurgery units in the conditions of a federal center.

MP12-19 DISPARITIES IN REFUSAL OF SYSTEMATIC THERAPY IN METASTATIC PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP12-19 DISPARITIES IN REFUSAL OF SYSTEMATIC THERAPY IN METASTATIC PROSTATE CANCER Catherine Gu, Muhieddine Labban, Kevin R Melnick, Nicola Frego, Mara Koelker, Edoardo Beatrici, Dejan K. Filipas, Benjamin V. Stone, Alexander P. Cole, and Quoc-Dien Trinh Catherine GuCatherine Gu More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Kevin R MelnickKevin R Melnick More articles by this author , Nicola FregoNicola Frego More articles by this author , Mara KoelkerMara Koelker More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Benjamin V. StoneBenjamin V. Stone More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is evidence of racial disparities in the refusal of guideline-concordant treatment for localized prostate cancer. However, little is known about racial disparities in treatment refusal among men with metastatic prostate cancer. Therefore, we sought to examine whether Black-White disparities exist in patient refusal of various systematic therapies for metastatic prostate cancer. METHODS: We retrospectively queried the National Cancer Database for men with a clinical diagnosis of metastatic prostate cancer between 2004 – 2020 who were offered first-line systemic therapy using at least one of the following: hormone therapy, chemotherapy, or immunotherapy. Refusal of first-line therapy was recorded if systemic treatment was refused by the patient, the patient’s family member, or their guardian. We compared baseline sociodemographic, and clinical data, and rates of refusal of systemic therapies between Black and White men. Then, for each systemic therapy type, we fitted a multivariable logistic regression to evaluate whether there are Black-White disparities in treatment refusal adjusting for age, insurance coverage, Charlson comorbidity index, census tract median income quartiles, the burden of metastasis at diagnosis, facility type and location where care was sought, and the year of diagnosis. RESULTS: The cohort included 102,411 men with metastatic prostate cancer of which 21,444 (20.9%) men were Black. Black men were more likely to have a lower income, be uninsured, and have a higher burden of metastasis at diagnosis (p<0.001). After adjusting for covariates, NHB were more likely to refuse chemotherapy (aOR 2.18; 95%CI 1.54-3.09; p<0.001) compared to NHW. However, there were no racial disparities in the refusal of hormone therapy (aOR 1.16; 95%CI 0.94-1.43; p=0.16) or immunotherapy (aOR 1.10; 95%CI 0.59-2.07; p=0.76) as a first-line treatment for metastatic prostate cancer. CONCLUSIONS: Among men with metastatic prostate cancer, there are racial disparities in refusal of chemotherapy, but not for hormone therapy or immunotherapy. Cultural differences and economic disparities may play a role in accepting chemotherapy treatment. Further research is needed to elucidate the factors that may be driving this difference and how to address them. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e141 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Gu More articles by this author Muhieddine Labban More articles by this author Kevin R Melnick More articles by this author Nicola Frego More articles by this author Mara Koelker More articles by this author Edoardo Beatrici More articles by this author Dejan K. Filipas More articles by this author Benjamin V. Stone More articles by this author Alexander P. Cole More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

The first steps in facing your fears: The acceptability of virtual reality and in vivo exposure treatment for specific fears.

Phobic individuals are often reluctant to engage in exposure in vivo (IVE). We examined whether providing exposure in virtual reality (VRE) can increase the acceptability. In Study 1, we provided 186 fearful participants with (hypothetical) VRE and IVE treatment offers and examined their willingness to engage in treatment, estimated success, negative beliefs, acceptance/refusal and their preference. Almost 70 % preferred VRE over IVE and acceptance rates were higher for the VRE offer (58 %) than for IVE (35 %). Although participants held fewer negative beliefs about VRE, they did rate IVE as slightly more successful. In Study 2, we examined whether VRE can serve as a stepping stone to IVE in a sample of 102 spider fearful individuals. Willingness to engage, estimated success and negative beliefs about IVE were assessed before and after VRE. After VRE, participants rated IVE as more successful, but were not more willing to engage in IVE, nor were they more inclined to accept an IVE offer. No decreases in negative beliefs were observed. In conclusion, VRE is deemed more acceptable than IVE and could lower refusal rates, hereby resulting in more phobic individuals receiving treatment. Future research should shed light on underlying motivations and associations.

Vaccination Refusal in Children under 2 Years of Age in Malaysia 2016-2019

Aims: This study will explore the incidence rate of childhood vaccination refusal in Malaysia as well as the reasons for this refusal over a four-year period (2016–2019). Given the complexities and dynamic nature of vaccine refusal, this research is essential for defining the target group, identifying the vaccine types they commonly refuse, and comprehending their vaccination concerns.&#x0D; Study Design: This is a retrospective review study.&#x0D; Methodology: This study used a nationally representative secondary data set from the Malaysian Ministry of Health's Family Health Division for the years 2016 to 2019. We included vaccination refusals involving children younger than 24 months of age. Data was extracted from the mothers’ immunization refusal form includes information of the ethnicity, citizenship, religion, occupation, the type of vaccine they refused, and the reason for their refusal. The annual incidence rates of childhood vaccination refusal, the types of vaccines and the refusal reason were summarized by percentage, with 95% confidence intervals.&#x0D; Results: There was a decline in incidence rates of vaccination refusal from 3.2 in 2016 to 2.3 in 2019 (P&lt;0.001). The refusal rate is highest in the states of Terengganu (15.9%), Kedah (14.1%), and Perak (12.2%). Of the 4052 mothers who refused to vaccinate their children, the majority were Muslims (99.0%) who had secondary education (53.7%) and were housewives (65.3%). Furthermore, most mothers refused to vaccinate their children due to religious beliefs (37.5–39.0%), safety concerns (26.3–34.0%), or belief in complementary and alternative medicine (11.4–15.8%). The reasons of refusal are associated with the mothers’ religion, socioeconomic class, and education level (P&lt;0.001). Muslims have refused vaccinations due to religious beliefs, as they were concerned about the vaccine's halal status. Meanwhile, mothers from a higher socioeconomic class and with a higher educational level were apprehensive about the vaccine's safety.&#x0D; Conclusion: Consolidated strategies are required to increase vaccination uptake, combined with a concerted effort to comprehend, analyse, and overcome vaccine refusal.

Factors Associated with the Decision to Decline Chemotherapy in Metastatic Non-Small Cell Lung Cancer

(1) Background: Disparities in cancer treatment and outcomes have long been well-documented in the medical literature. With the eruption of advances in new treatment modalities, the long-existing disparities are now being further uncovered and brought to the attention of the medical community. While social health determinants have previously been linked to treatment disparities in lung cancer, we analyzed data from the National Cancer Database to explore sociodemographic and geographic factors related to accepting or declining physician-recommended chemotherapy. Patients diagnosed with metastatic lung cancer between 2004 and 2016 who declined chemotherapy recommended by their physicians were included in this study. Multivariate logistic regression analysis was performed. Cox Regression and Kaplan-Meier analyses were performed to look for survival characteristics. (2) Results: 316,826 patients with Stage IV lung cancer were identified. Factors related to a higher rate of refusal by patients included older age > 70, female sex, low income, lack of insurance coverage, residency in the New England region, and higher comorbidity. Patients living in areas with lower education were less likely to decline chemotherapy. (3) Conclusion: Further understanding of the factors impacting treatment decisions would be essential to improve the efficacy of care delivery in patients with cancer and reduce reversible causes of disparity.

Strategies and costs of building and maintaining a longitudinal disaster cohort

Long-term individual recovery from a catastrophic event involves the restoration of critical lifelines such as housing and employment as well as social and emotional well-being, particularly for displaced and highly traumatized populations. One strategy for measuring recovery over time involves a longitudinal observational cohort. This analysis examines the cost and effort involved in developing and maintaining a longitudinal cohort. The Gulf Coast Child and Family Health Study recruited 1,079 randomly sampled individuals in Louisiana and Mississippi within months after Hurricane Katrina and followed them for 13 years. Participants in the study were interviewed in person five times over the study period. Despite the challenges involved in maintaining a transient and economically vulnerable study cohort, 80.4 percent of all eligible participants were surveyed at the fifth time point, over a decade after the event. At each round of data collection, the refusal rate ranged from less than 1 percent to 3.3 percent. Reasons for non-participation included institutional inaccessibility for those who were incarcerated, in treatment programs, or in nursing homes. Physical and mental health issues which precluded participation included cognitive decline and significant loss of function. Other participants were lost to follow-up or death. At the final round of face-to-face interviewing in 2018, the average field cost per survey was $353.27, not including a respondent incentive of $50, and required an average of 15.74 hours per case to complete. This report describes the strategies employed to maintain such a long-term disaster cohort.

A National Cancer Disparities Analysis of Predictors for Radiation Therapy Refusal by Race

Radiation therapy (RT) refusal by patients with cancer is infrequent but is significant because it portends poor outcomes. No prior study has evaluated all five federally defined racial categories with respects to RT refusal. Here we use a large nationally representative population with cancer to determine: 1) which race of patients refuse RT the most and 2) predictive factors for RT refusal by race. A retrospective study included patients ≥18 years old with diagnostically confirmed cancer between 2004-2017, using the National Cancer Database. All patients included were offered RT for first course treatment. Multivariable logistic regression assessed RT refusal (adjusted odds ratio [aOR]) with 95% confidence intervals (95%CI). Analyses were adjusted for patient factors (age, rurality, income, education, and comorbidities) and cancer characteristics (stage, cancer type, facility type, year of diagnosis, and region). Median overall survival was calculated using the Kaplan-Meier method. Of 11,609,044 patients, 2,759,753 patients were included and recommended for RT by the treating physician. Median follow-up was 50 months. RT was refused by 139,383 patients (5.0%), varying by race: 416 NHPI (7.2%), 489 AIAN (5.8%), 118,186 Non-Hispanic White (5.0%), 17,427 Black (4.8%), and 2,865 Asian (4.8%) patients. The rates of annual RT refusal were increasing, especially among NHPI patients. The populations with the highest likelihood of refusing RT were NHPI (aOR=1.53, 95%CI=1.36-1.71), AIAN (aOR=1.24, 95%CI=1.12-1.37), and Black (aOR=1.11, 95%CI=1.09-1.14) patients, compared to Non-Hispanic White patients. Older age and higher comorbidity burden predicted RT refusal across all races. Median overall survival was 81 months and 144 months for patients who refused RT and received RT, respectively. Indigenous and Black patients are more likely to refuse RT, which may contribute to inferior cancer outcomes. Understanding NHPI and AIAN patient perspectives and perceptions may elucidate interventions to mitigate these disparities.

Types and correlates of school absenteeism among students with intellectual disability.

It appears that students with intellectual disability (ID) are more frequently absent from school compared with students without ID. The objective of the current study was to estimate the frequency of absence among students with ID and the reasons for absence. Potential reasons included the attendance problems referred to as school refusal, where absence is related to emotional distress; truancy, where absence is concealed from parents; school exclusion, where absence is instigated by the school; and school withdrawal, where absence is initiated by parents. Study participants were 629 parents (84.6% mothers) of Australian school students (Mage =11.18years; 1.8% Aboriginal and/or Torres Strait Islander) with an ID. Participants completed a questionnaire battery that included the School Non-Attendance ChecKlist via which parents indicated the reason their child was absent for each day or half-day absence their child had over the past 20 school days. The absence data presented to parents had been retrieved from school records. Across all students, absence occurred on 7.9% of the past 20 school days. In terms of school attendance problems as defined in existing literature, school withdrawal accounted for 11.1% of absences and school refusal for 5.3% of absences. Students were also absent for other reasons, most commonly illness (32.0%) and appointments (24.2%). Of students with more than one absence (n=217; 34.5%), about half were absent for more than one reason. Students attending mainstream schools had lower attendance than those attending special schools. Students with ID were absent for a range of reasons and often for multiple reasons. There were elevated rates of school withdrawal and school refusal. Understanding the reasons for absenteeism can inform targeted prevention and intervention supports.

Local infectious disease experience influences vaccine refusal rates: a natural experiment.

Vaccination has been critical to the decline in infectious disease prevalence in recent centuries. Nonetheless, vaccine refusal has increased in recent years, with complacency associated with reductions in disease prevalence highlighted as an important contributor. We exploit a natural experiment in Glasgow at the beginning of the twentieth century to investigate whether prior local experience of an infectious disease matters for vaccination decisions. Our study is based on smallpox surveillance data and administrative records of parental refusal to vaccinate their infants. We analyse variation between administrative units of Glasgow in cases and deaths from smallpox during two epidemics over the period 1900-1904, and vaccine refusal following its legalization in Scotland in 1907 after a long period of compulsory vaccination. We find that lower local disease incidence and mortality during the epidemics were associated with higher rates of subsequent vaccine refusal. This finding indicates that complacency influenced vaccination decisions in periods of higher infectious disease risk, responding to local prior experience of the relevant disease, and has not emerged solely in the context of the generally low levels of infectious disease risk of recent decades. These results suggest that vaccine delivery strategies may benefit from information on local variation in incidence.

Feasibility of a Remote-based Nutrition Education and Culinary Skills Program for Young Adults With Autism Spectrum Disorder

ObjectiveTo evaluate the feasibility of a remote-based nutrition education and culinary skills program for young adults with autism spectrum disorder (ASD). MethodsThirteen young adults with ASD (26.6 ± 4.4 years; 77% male) participated in a remote-based nutrition program twice a week over 12 weeks. Principles of Social Cognitive Theory were used to develop the curriculum, which focused on nutrition education and meal preparation. Feasibility was assessed through attendance records, retention rates, duration/frequency of participant engagement, session notes, and participant interviews. ResultsThe program had a 13% refusal rate and a 7% attrition rate. Participants had a session attendance rate of 83%. Session notes revealed that the remote format offered several methods of participant communication and captured evidence of family support. Interview themes included increased nutrition-related knowledge, self-efficacy, and behavioral capability. Conclusions and ImplicationsThe remote-based nutrition program met feasibility benchmarks for adherence and retention and was well-accepted by participants. A remote-based format for nutrition interventions can reach a wider range of young adults with ASD; however, input from the target population should be considered in the development of the program.

Knowledge of the Malaysian National Immunisation Programme and its associated factors among parents in Dungun, Terengganu: A cross-sectional study.

The number of unvaccinated children and the rate of vaccination refusal among parents have recently increased despite the robust vaccination programme in Malaysia. The purpose of this study was to determine the level of knowledge of the Malaysian National Immunisation Programme among Malaysian parents as well as the variables that contribute to poor knowledge. Methods: This study used systematic random sampling to recruit 375 parents from seven health clinics in the Dungun District of Malaysia. The participants were asked to complete a selfadministered validated questionnaire that included sociodemographic and knowledge questions. A multiple logistic regression analysis was applied to determine the associated factors of poor knowledge of immunisation. P-values of <0.05 were considered statistically significant. A total of 189 (50.4%) respondents had poor knowledge of immunisation. The multiple logistic regression analyses revealed that a low educational level (adjusted odds ratio (OR): 1.92; 95% CI 1.25-2.95) was associated with poor knowledge while the age-group of 30-40 years old (adjusted OR: 0.56; 95% CI 0.34-0.93) was protected against it as compared to the age-group of <30 years old. The prevalence of poor knowledge of immunisation among parents in Dungun, Terengganu, is relatively high. The focus of health promotion and education must be switched to increasing immunisation knowledge among the public, particularly among high-risk groups.

The refusal of COVID-19 vaccination and its associated factors: a systematic review

Background: To date, more than 10% of the global population is unvaccinated against the coronavirus disease 2019 (COVID-19), and the reasons why this population is not vaccinated are not well identified. Objectives: We investigated the prevalence of COVID-19 vaccine refusal and to assess the factors associated with COVID-19 vaccine refusal. Methods: A meta-analysis was conducted during August to November 2022 (PROSPERO: CRD42022384562). We searched articles investigating the refusal of COVID-19 vaccination and its potential associated factors in PubMed, Scopus, and the Web of Sciences. The quality of the articles was assessed using the Newcastle–Ottawa scale, and the data were collected using a pilot form. The cumulative prevalence of the refusal to vaccinate against COVID-19 was identified using a single-arm meta-analysis. The factors associated with COVID-19 vaccine refusals were determined using the Mantel-Haenszel method. Results: A total of 24 articles were included in the analysis. Our findings showed that the global prevalence of COVID-19 vaccine refusal was 12%, and the highest prevalence was in the general population, and the lowest prevalence was in the healthcare worker subgroup. Furthermore, individuals with a high socioeconomic status, history of previous vaccination, and medical background had a lower rate of COVID-19 vaccination refusal. Subsequently, the following factors were associated with an increased risk of COVID-19 vaccine refusal: being female, educational attainment lower than an undergraduate degree, and living in a rural area. Conclusion: Our study identified the prevalence of and factors associated with COVID-19 vaccine refusal. This study may serve as an initial reference to achieve global coverage of COVID-19 vaccination by influencing the population of COVID-19 vaccine refusal.

Soil-transmitted helminth surveillance in Benin: A mixed-methods analysis of factors influencing non-participation in longitudinal surveillance activities.

Despite the significant success of deworming programs in reducing morbidity due to soil-transmitted helminth (STH) infections globally, efforts to achieve elimination of STH as a public health problem or to potentially interrupt transmission will require improving and intensifying surveillance. However, non-participation in surveillance threatens the ability of programs to adequately monitor program status and limited research has been conducted to investigate drivers of non-participation in stool-based surveillance. This mixed-methods exploratory sequential study took place in Comé, Benin in association with the DeWorm3 Project. Six focus group discussions were conducted with individuals invited to participate in annual DeWorm3 stool surveillance. Thematic analysis was used to identify facilitators and barriers to participation and inform the quantitative analysis. A mixed-effects logistic regression model was built using baseline DeWorm3 survey data to identify factors associated with non-participation. Qualitative and quantitative findings were merged for interpretation. Among the 7,039 individuals invited to participate in baseline stool surveillance, the refusal rate was 8.1%. Qualitative themes included: community members weighing community-level benefits against individual-level risks, circulating rumors about misuse of stool samples, interpersonal communication with field agents, and cultural norms around handling adult feces. The quantitative analysis demonstrated that adults were significantly less likely to provide a stool sample than school-aged children (OR:0.69, 95%CI: 0.55-0.88), a finding that converged with the qualitative results. Individuals from areas in the highest quartile of population density were more likely to refuse to participate (OR:1.71, 95%CI:1.16-2.52). Several variables linked to community-affinity aligned with qualitative results; residing mainly in the community (OR:0.36, 95%CI:0.20-0.66) and having lived in the community for more than 10 years (OR:0.82, 95%CI:0.54-1.25) decreased likelihood of refusal. Optimizing STH surveillance will require that programs reimagine STH surveillance activities to address community concerns and ensure that no subpopulations are inadvertently excluded from surveillance data.

Safety of Vaccination within First Year of Life-The Experience of One General Medicine Center.

Vaccines represent an important preventive strategy in paediatric populations, but the rate of vaccination has been constantly declining in the last decade. Concerns about vaccines' safety represent one of the main causes of vaccine hesitancy among parents. The aim of this study was the analysis of the immediate adverse reactions induced by vaccines included in the national program of immunization for the first year of life. Method: Eighty-one children born between 1st of January 2018 and 31st of March 2019 were included. The vaccination refusal rate, and incidence and severity of adverse effects induced by three mandatory vaccines (Hexavalent, Prevenar 13 and MMR) were analyzed. The level of parents' education and the sources of information that were consulted in order to understand the adverse effects were also analyzed. Results and conclusions: The rate of adverse events was lower than 30% of the total number of doses, and most of them were mild. The incidence and severity of vaccine-induced adverse effects were correlated with prematurity. The vaccine hesitancy rate was lower than the national one, possibly due to a high level of education and good information provided by doctors that might have led to parents' concerns regarding vaccination being answered.

Inter-ethnic differences in self-reported alcohol-related harm to children in Han vs. Yi ethnic minority households in Yunnan Province, China

China is a multi-ethnic country, but inter-ethnic disparities in alcohol-related harm to children have not been described. In this study, we assessed differences in prevalence of self-reported alcohol-related harm to children in Yi and Han households in Chuxiong Yi Prefecture, Yunnan Province, China. We conducted a cross-sectional study among caregivers in households with a child age less than 18 years using structured questionnaire interview. Participants included 241 Yi caregivers and 610 Han caregivers (overall refusal rate = 1.1%). Heavy drinking was more common in Yi households than Han households (41.9% vs. 30.8%, respectively), but there was no difference in alcohol-related harm to children (21.2% vs. 17.9%; Adjusted OR = 0.98; 95% CI = 0.65, 1.46). Caveats such as social desirability in reporting sensitive issues and the cross-sectional study design should be considered in the interpretation of the study findings.

Vaccine refusal risk factors among parents of children with autism spectrum disorders.

Vaccine refusal is a global trend and was announced as one of the top ten health threats in recent years. The rate of vaccine refusal (VR) among children with autism spectrum disorders (ASD) has also increased in parallel with the global trend but their vaccination behavior may differ from that of the normal population. This study aims to determine the VR rates among parents of children with ASD, to define the risk factors for developing VR, and to evaluate the parental concerns for childhood vaccinations in this susceptible population. We conducted a 4-part survey questionnaire among parents of children with ASD, evaluating the vaccination status for both the child with ASD and their younger sibling. The vaccination uptake of the first child was accepted as the `baseline` behavior, while the following sibling`s uptake was suggested as the `current` behavior. The risk factors of VR were determined with logistic regression analysis. The study group included 110 parents of children with ASD (M/F:76/34) and their younger siblings (M/F:57/53). The rate of `baseline VR` was 12.7 % whereas the `current VR` was 40% (p=0.001). High socioeconomic status (relative risk [RR]: 4.4; 95% confidence interval [CI]: 1.01-16.6; p=0.04), using social media as the main source of information (RR: 7; 95% CI: 1.5-32; p= 0.01) and lack of regular well-child visits of the sibling (RR: 25; 95% CI 4.1-166; p=0.001) were determined as risk factors for VR. The vaccination behavior of parents changed after having a child with ASD, and thus, the younger siblings may constitute a risk group for VR. In clinical practice, pediatricians should be aware of this risk and evaluate the vaccination uptake of the younger siblings of children with ASD more carefully. Regular well-child visits and improving media literacy may be the key points to prevent VR in this susceptible population.

Abstract B067: Trend and factors associated with mothers’ refusal of HBV birth dose to their infants, 2018-2020, Washington metropolitan areas

Abstract Background. Vertical transmission of HBV is the leading mode of acquisition of the infection worldwide. Prevention of vertical transmission is possible in the majority of cases through the correct administration of the birth dose of HBV vaccine to the neonate. The purpose of this study to examine the trend and factors associated with mothers’ refusal of HBV birth dose to their infants in 2018-2020 in the targeted region. Methods. We performed a retrospective analysis of electronic birth dose vaccination of newborns in the 2018-2020. Six birthing facilities and home delivery records sent the birth dose data to the DC Health Department, representing 40,269 newborns. This data from the DC health department has mother’s race and ethnicity, health insurance type, birthing facilities, and mother’s refusal to give her newborn birth dose. Descriptive analysis and multivariable logistic regression analysis were conducted. Results. A total of 34,509 (85.7%) received hepatitis B birth dose within 12 hours or discharge from the facility. Mother’s refusal rate to give her newborn has been significantly decreased from 2018 to 2020 (11.5% in 2018, 8.6% in 2019, and 4.2% in 2020, p&amp;lt;.001). There were racial/ethnic differences in the HepB birth dose rates: Asian newborns (90.4%) had the highest vaccination rate followed by Hispanics (88.7%), Whites (86.1%), and African Americans (84.4%). In multivariate logistic regression analysis, race, birthing facility, and health insurance were associated with mother’s refusal. African American mothers (aOR=1.26, 95% CI: 1.15-1.39) and those with home birth (aOR=4.12, 95% CI: 2.96-5.74) had high likelihood to refuse having birth dose. Those with Medicaid were less likely to refuse than those with private insurance (aOR=0.90; 95% CI: 0.82-0.99). Discussion. Our study indicated that the overall mother’s refusal to give HepB birth dose vaccination rate has decreased in the past 3 years. A policy for universal vaccination of all newborns (regardless of mother’s HBsAg status) should be implemented to prevent unrecognized perinatal transmission. Citation Format: Hee-Soon Juon, Donna Sheler, Jane Pan, Daisy Le, Tony Yang. Trend and factors associated with mothers’ refusal of HBV birth dose to their infants, 2018-2020, Washington metropolitan areas [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B067.