• Krissy Moehling Geffel, Harika P Dyer, Andrea D Casas, Stephanie N Christian-Afflu, Dara D Méndez, and Tiffany L Gary-Webb.
• Department of Family Medicine, School of Medicine, University of Pittsburgh, 4420 Bayard St. Ste. 520, Pittsburgh, PA, USA 15260. Electronic address: kkm17@pitt.edu.
• J Natl Med Assoc. 2024 Aug 20.

BackgroundThere are demonstrated racial inequities in coronavirus 2019 (COVID-19) disease burden, and the initial vaccine rollout did not equitably address these disparities.MethodsWe conducted analyses of a national Facebook survey restricted to Black adult residents of Allegheny County, Pennsylvania for the period of May 2021 to January 2022. We assessed the associations between demographics, health status, social normative context, perceived racial discrimination, and beliefs about COVID-19 mitigation strategies on vaccine uptake and intention and compared reasons reported for vaccine hesitancy, and vaccine non-intention among the unvaccinated. Multivariable logistic regression was conducted on a subset of unvaccinated respondents to explore variables associated with vaccine intent.ResultsOver 85 % of 1,552 respondents were vaccinated against COVID-19 at the time of the survey. Compared to the unvaccinated, vaccinated respondents were older and more highly educated (P < 0.001), more likely to have at least one chronic health condition (P = 0.03) and had a stronger social normative context in support of vaccination (P < 0.001). Vaccinated respondents also reported greater personal adherence to wearing face masks when out in public and were more likely to report positive perceptions of the effectiveness of mitigation strategies (e.g., face masks) towards preventing COVID-19 transmission (P < 0.001). Unvaccinated respondents were more likely to report intention to be vaccinated if they felt that face masks were very effective in the prevention of COVID-19 compared to those who felt this mitigation strategy was only moderately/slightly/not at all effective (OR: 4.52; 95 % CI: 1.23-16.59; P = 0.02) and if they did not report mistrust in the government or COVID-19 vaccines compared to those reporting mistrust (OR: 7.72; 95 % CI: 1.34-44.64; P = 0.02).ConclusionCOVID-19 vaccination levels were high among Black adult residents of Allegheny County who responded to the survey. Future efforts should continue to strive towards addressing reasons for mistrust with focused attention from healthcare institutions and the government on increasing their trustworthiness, alongside employment of evidence-based strategies to increase vaccination rates. Additionally, efforts should continue to engage unvaccinated and vaccine hesitant persons' perspectives to inform ongoing health equity interventions.Copyright © 2024 National Medical Association. Published by Elsevier Inc. All rights reserved.

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