Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overview
ContextAmerican Indians and Alaska Natives (AIANs) are historically disadvantaged, losing 20 million (95%) of their population largely through epidemics since 1,520 and continuing lower overall vaccination coverage than other races. Determinants of this lower coverage are underexamined.MethodsAmong...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-02-01
|
| Series: | Frontiers in Public Health |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1490286/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850066856994406400 |
|---|---|
| author | Junying Zhao Rashmi Jaggad Ying Zhang Janis E. Campbell Pallab K. Ghosh James R. Kennedye Tauqeer Ali |
| author_facet | Junying Zhao Rashmi Jaggad Ying Zhang Janis E. Campbell Pallab K. Ghosh James R. Kennedye Tauqeer Ali |
| author_sort | Junying Zhao |
| collection | DOAJ |
| description | ContextAmerican Indians and Alaska Natives (AIANs) are historically disadvantaged, losing 20 million (95%) of their population largely through epidemics since 1,520 and continuing lower overall vaccination coverage than other races. Determinants of this lower coverage are underexamined.MethodsAmong peer-reviewed relevant articles since 1968, 39 studied AIANs solely; 47 drew general population samples, including AIANs. We employed rigorous economic definitions and framework of Individual Decision-Making Under Uncertainty. The Social-Ecological model identified determinants and mechanisms at five levels.FindingsIndividual-level determinants include: (1) vaccine-preventable disease (VPD) and vaccine knowledge; (2) vaccine safety, efficacy, moral hazard beliefs; (3) preferences; (4) income and post-subsidy costs. Interpersonal-level determinants include others’ knowledge and preferences. Organizational-level characteristics of Indian Health Service, Tribal, Urban Indian (IHS/T/U) facilities include: (1) supply of vaccine products, providers, services; (2) provider cultural competency, vaccine recommendations, standing orders; (3) patient reminder/recall. Community-level characteristics include: (1) socioeconomics and geographics; (2) information infrastructure; (3) cultural values, practices, languages; (4) historical epidemic knowledge; (5) historical harms thus distrust in government, health system, science. Societal-level determinants include: (1) federal recognition and entitlements; (2) tribal self-determination; (3) state Medicaid enrollment; (4) structural racism.Policy recommendationsTribal interventions may (1) increase AIANs’ knowledge about VPDs, vaccines, Medicaid enrollment; (2) design risk/cost–benefit calculations using scientific objective probabilities of vaccine safety and efficacy; (3) tailor messages to epidemic histories, narratives, values; (4) outreach by trusted messengers. I/T/U organizational interventions may reduce transportation costs while increasing provider supplies, cultural competency, and vaccine standing orders. Federal policies may increase IHS funding, tribal infrastructure, and AIAN data representativeness while eliminating structural racism and generational trauma.ConclusionThis article contributes to literature and practice. It is the first multidisciplinary, comprehensive overview of multi-level determinants and mechanisms of AIAN vaccination. Its findings highlight the gaps and limitations of laws and policies impacting AIAN vaccination. It recommends future research, culturally-appropriate interventions, and policies to close the gap to enhance AIAN vaccination and healing. |
| format | Article |
| id | doaj-art-c59f3ee1908b48d9a23c8cdf95ef3af5 |
| institution | DOAJ |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj-art-c59f3ee1908b48d9a23c8cdf95ef3af52025-08-20T02:48:37ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-02-011310.3389/fpubh.2025.14902861490286Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overviewJunying Zhao0Rashmi Jaggad1Ying Zhang2Janis E. Campbell3Pallab K. Ghosh4James R. Kennedye5Tauqeer Ali6Department of Health Administration and Policy, University of Oklahoma Health Sciences, Oklahoma, OK, United StatesDepartment of Biostatistics and Epidemiology, University of Oklahoma Health Sciences, Oklahoma, OK, United StatesStrong Heart Study/Center for American Indian Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences, Oklahoma, OK, United StatesDepartment of Biostatistics and Epidemiology, University of Oklahoma Health Sciences, Oklahoma, OK, United StatesDepartment of Economics, University of Oklahoma, Norman, OK, United StatesChickasaw Nation Medical Center, Muscogee Creek Nation Medical Center, Department of Emergency Medicine, Kiowa Tribe of Oklahoma, Ada, OK, United StatesStrong Heart Study/Center for American Indian Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences, Oklahoma, OK, United StatesContextAmerican Indians and Alaska Natives (AIANs) are historically disadvantaged, losing 20 million (95%) of their population largely through epidemics since 1,520 and continuing lower overall vaccination coverage than other races. Determinants of this lower coverage are underexamined.MethodsAmong peer-reviewed relevant articles since 1968, 39 studied AIANs solely; 47 drew general population samples, including AIANs. We employed rigorous economic definitions and framework of Individual Decision-Making Under Uncertainty. The Social-Ecological model identified determinants and mechanisms at five levels.FindingsIndividual-level determinants include: (1) vaccine-preventable disease (VPD) and vaccine knowledge; (2) vaccine safety, efficacy, moral hazard beliefs; (3) preferences; (4) income and post-subsidy costs. Interpersonal-level determinants include others’ knowledge and preferences. Organizational-level characteristics of Indian Health Service, Tribal, Urban Indian (IHS/T/U) facilities include: (1) supply of vaccine products, providers, services; (2) provider cultural competency, vaccine recommendations, standing orders; (3) patient reminder/recall. Community-level characteristics include: (1) socioeconomics and geographics; (2) information infrastructure; (3) cultural values, practices, languages; (4) historical epidemic knowledge; (5) historical harms thus distrust in government, health system, science. Societal-level determinants include: (1) federal recognition and entitlements; (2) tribal self-determination; (3) state Medicaid enrollment; (4) structural racism.Policy recommendationsTribal interventions may (1) increase AIANs’ knowledge about VPDs, vaccines, Medicaid enrollment; (2) design risk/cost–benefit calculations using scientific objective probabilities of vaccine safety and efficacy; (3) tailor messages to epidemic histories, narratives, values; (4) outreach by trusted messengers. I/T/U organizational interventions may reduce transportation costs while increasing provider supplies, cultural competency, and vaccine standing orders. Federal policies may increase IHS funding, tribal infrastructure, and AIAN data representativeness while eliminating structural racism and generational trauma.ConclusionThis article contributes to literature and practice. It is the first multidisciplinary, comprehensive overview of multi-level determinants and mechanisms of AIAN vaccination. Its findings highlight the gaps and limitations of laws and policies impacting AIAN vaccination. It recommends future research, culturally-appropriate interventions, and policies to close the gap to enhance AIAN vaccination and healing.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1490286/fullAmerican Indian and Alaska nativesafetyvaccination behaviorvaccination coveragevaccination decision-making processvaccine hesitancy |
| spellingShingle | Junying Zhao Rashmi Jaggad Ying Zhang Janis E. Campbell Pallab K. Ghosh James R. Kennedye Tauqeer Ali Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overview Frontiers in Public Health American Indian and Alaska native safety vaccination behavior vaccination coverage vaccination decision-making process vaccine hesitancy |
| title | Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overview |
| title_full | Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overview |
| title_fullStr | Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overview |
| title_full_unstemmed | Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overview |
| title_short | Multi-level determinants of vaccination of the American Indian and Alaska Native population: a comprehensive overview |
| title_sort | multi level determinants of vaccination of the american indian and alaska native population a comprehensive overview |
| topic | American Indian and Alaska native safety vaccination behavior vaccination coverage vaccination decision-making process vaccine hesitancy |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1490286/full |
| work_keys_str_mv | AT junyingzhao multileveldeterminantsofvaccinationoftheamericanindianandalaskanativepopulationacomprehensiveoverview AT rashmijaggad multileveldeterminantsofvaccinationoftheamericanindianandalaskanativepopulationacomprehensiveoverview AT yingzhang multileveldeterminantsofvaccinationoftheamericanindianandalaskanativepopulationacomprehensiveoverview AT janisecampbell multileveldeterminantsofvaccinationoftheamericanindianandalaskanativepopulationacomprehensiveoverview AT pallabkghosh multileveldeterminantsofvaccinationoftheamericanindianandalaskanativepopulationacomprehensiveoverview AT jamesrkennedye multileveldeterminantsofvaccinationoftheamericanindianandalaskanativepopulationacomprehensiveoverview AT tauqeerali multileveldeterminantsofvaccinationoftheamericanindianandalaskanativepopulationacomprehensiveoverview |