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30th September 2021
According to the Centers for Disease Control and Prevention in the US, the risk of infection, hospitalisation and death from COVID-19 among US citizens is higher among ethnic minorities compared their White counterparts. The introduction of COVID-19 vaccines has resulted in a significant reduction in the risk of severe illness, hospitalisation and death. However, not everyone has embraced the need for COVID-19 vaccination with one study finding that among those of Black ethnicity, vaccine hesitancy levels were 5-times higher than their white counterparts. Moreover, vaccine hesitancy is also a recognised problem among parents, with a 2019 study showing that a quarter of parents reported hesitancy over childhood influenza vaccination. With US data indicating that 22% of the population is under the age of 18, there is an urgent need to ensure that children receive a COVID-19 vaccine and therefore increase the levels of community protection against the virus.
But given the existence of vaccine hesitancy, a team from the Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital, Chicago, US, sought to understand, through an online, cross-sectional survey, not only the levels of vaccine hesitancy but how this was influenced by ethnicity and sociodemographic factors. The survey was conducted with parents who had children under 18 years of age and captured information on demographics, race, family income and the type of child insurance (e.g., public or private) as well as sources of information on COVID-19 using a defined list such as friends/word of mouth, internet, social media etc. COVID-19 vaccine hesitancy was measured from the question, “if a new vaccine against COVID-19 became available, how likely would you be to get your child vaccinated?” Responses were dichotomised as vaccine amenable or vaccine hesitancy for those responding “not likely” or “not sure” and this served as the outcome of interest. In their regression analysis, the authors examined the association between hesitancy and ethnicity, adjusting for parental race, household income, child insurance type and sources of information in which parents reported confidence.
A total of 1425 usable responses were obtained with 40% self-reporting as non-Hispanic White, 24% non-Hispanic Black and 27% as Hispanic (any race). Overall, 33% of parents reported COVID-19 vaccine hesitancy for their child. This was highest among non-Hispanic Blacks (48%) and lowest among non-Hispanic Whites (26%). The most common source of information on COVID-19 was the internet (67%). The authors calculated that non-Hispanic Black respondents had a significantly higher odds of COVID-19 vaccine hesitancy for their children compared to non-Hispanic White parents (adjusted odds ratio, aOR = 1.75, 95% CI 1.28 – 2.39, p < 0.001). In addition, parents on the lowest income also had a higher odds of hesitancy (aOR = 2.86) as did those having public insurance for their child (aOR = 1.33).
In discussing their findings, the authors commented on how non-Hispanic Black parents, with lower incomes and public health insurance had the highest levels of vaccine hesitancy. They concluded that given how this demographic had been most adversely affected by the pandemic, efforts to improve the dissemination of information about the COVID-19 vaccine should be culturally tailored to reduce disease burden in theis patient group.
Alfieri NL et al. Parental COVID-19 vaccine hesitancy for children: vulnerability in an urban hotspot. BMC Public Health 2021
9th September 2021
It is well established that physical activity is associated with health benefits such as a lower risk of coronary heart disease, stroke and type 2 diabetes. One widely accepted means of quantifying physical activity is the number of steps/day although this metric is not generally included in national physical activity guidelines. However, while a 2019 review noted an inverse relationship between daily steps and positive health outcomes such as all-cause mortality and cardiovascular events, it concluded that more independent studies are required before these observations can be translated into public health guidelines. This is despite a 2020 review concluding that walking an additional 1000 steps/day can help lower the risk of all-cause mortality and cardiovascular disease morbidity. In addition, while there is some evidence that an increased intensity of physical activity is associated with greater health benefits, it is unclear whether the number of steps/day and step intensity positively impact on mortality.
In trying to establish whether both the number of steps/day and intensity affected mortality, a team from the Institute for Applied Life Sciences, University of Massachusetts, US, conducted a prospective study in middle-aged Black and White adults. Participants were recruited from the Coronary Artery Risk Development in Young Adults (CARDIA) study which included a balanced sample by race (e.g., Black and White), sex, age and education levels from four different locations across the US. Participants were asked to wear an ActiGraph 72164, which measures the number of free-living steps/days, for 7 consecutive days during waking hours. Based on the number of recorded steps, participants were then grouped as low (<7000 steps/day), moderate (7000–10,000) and high (>10,000). They quantified step intensity as daily minutes at 100 steps/min or more, which indicates moderate intensity. The primary outcome was all-cause mortality and the results were adjusted for several covariates including smoking status, race, body mass index, alcohol intake and a measure of diet, the healthy eating index.
There were 2110 participants recruited with a mean age of 45.2 years (57.1% female), of whom 42.1% were of Black ethnicity. Individuals were followed-up for a period of 20 years. Compared with those in the low step group, there was a significantly lower mortality in those in the moderate group (adjusted hazard ratio, aHR = 0.28, 95% CI 0.15 – 0.54). Interestingly, among those taking a higher number of steps/day, the reduction in risk was less (aHR = 0.45, 95% CI 0.25 – 0.81), indicating no potential mortality benefit from taking more than 10,000 steps/day.
Subgroup analysis revealed no difference in risk reductions among Black (aHR = 0.30) or White participants (aHR = 0.37), for those in the moderate step groups or between the sexes, aHR = 0.28 (women) and aHR = 0.42 (men). Furthermore, the step intensity did not affect mortality estimates.
The authors concluded that taking at least 7,000 steps/day during middle-age was associated with a lower mortality risk but that step intensity had no impact.
Paluch AE et al. Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study. JAMA Netw Open 2021