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Abstract

Vaccine hesitancy is important to examine to understand disparities in vaccine uptake and improve public health in the United States. Despite accessible vaccines for COVID-19, Black adults in the U.S. have some of the lowest vaccination rates compared to their White counterparts, and medical mistrust may be a critical factor that drives this hesitancy within the Black population. The purpose of this study was to investigate the association between medical mistrust and hesitancy in receiving the COVID-19 vaccine, as well as examine whether identifying with the Black/African American culture correlated with medical mistrust and vaccine hesitancy. A survey was developed to understand factors associated with vaccine hesitancy within the Black community. The investigator-initiated 38-item survey assessed beliefs and behaviors regarding COVID-19, the COVID-19 vaccine, and attitudes toward the medical system; the survey also included the Interracial Attitudes subscale of the African American Acculturation Scale to assess identification with traditional African American culture. Adults (aged 18+) who self-identified as Black/African American (N=53) were recruited from the community (local health fair, college campus, etc.) in two major U.S. cities and completed the survey on paper. The majority of participants (54.9% U.S. born, 45.1% immigrants) reported receiving the vaccine (86.8%), yet half (50%) endorsed hesitancy to receiving it. Additionally, 26.4% reported that they did not trust the medical system to keep them healthy, and 39.5% expressed a general mistrust towards the government. Compared to those who were not vaccine hesitant, respondents who were vaccine hesitant reported lower rates of trust in the medical care system (M = 2.77 , SD = 1.18; t=4.15, p <0.001). We also found that respondents who were vaccine hesitant reported higher rates of distrust in their healthcare providers (M = 2.42, SD = 1.02; t= -3.11, p <0.05). There was no significant difference between those with hesitancy versus COVID-19 Hesitancy and Medical Mistrust 4 without in identification with traditional African American culture nor was identification with African American culture correlated with medical mistrust in this sample. In this sample, many Black adults received the vaccine; however, about half reported hesitation to do so, and distrust in the healthcare system was associated with this hesitancy. Future research with larger samples should explore mistrust towards the U.S. government to better understand hesitancy in the Black community.

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