G Model
ARTICLE IN PRESS
JVAC 16250 1–10
Vaccine xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Review
1
Socioeconomic status and HIV vaccine preparedness studies in North America
2
3
4
Q1
5
Shayesta Dhalla ∗ , Gary Poole School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
6
7 20
a r t i c l e
i n f o
a b s t r a c t
8 9 10 11 12 13
Article history: Received 17 September 2014 Received in revised form 21 February 2015 Accepted 11 March 2015 Available online xxx
14
19
Keywords: HIV vaccine Socioeconomic status Willingness to participate Retention
21
1. Introduction
15 16 17 18
Educational level, employment, and income are key components of socioeconomic status (SES). This article is a systematic review of SES variables in North American countries, and their relationship to willingness to participate (WTP) and retention in a hypothetical preventive phase 3 HIV vaccine trial and in actual HIV vaccine trials. Men who have sex with men (MSM) tended to have higher educational levels, be more employed, and had higher income levels than injection drug users (IDU) and women at heterosexual risk (WAHR). In large part, there was no relationship between educational level and WTP, as well as between educational level and retention. Similarly, there was no relationship between employment and WTP. In WAHR who were African-American, those employed were less likely than others to complete the study at 18 months. The exact occupations of participants analyzed have not been specified, and specification of these occupations may help determine whether enhanced retention (ER) strategies are required. © 2015 Elsevier Ltd. All rights reserved.
A number of studies and reviews have examined factors that predict willingness to participate (WTP) in HIV vaccine prepared23 24Q3 ness studies (VPS) [1,2]. However, the research on socioeconomic status (SES) has yet to be reviewed systematically, though SES 25 may affect WTP in HIV vaccine trials. At the individual level, most 26 27 research on the effects of social stratification has used educa28 tional attainment, personal or household income including poverty, 29 and/or occupation and employment as indicators of SES. Each of 30 these attributes measures a different aspect of SES [3]. To further 31 complicate matters, SES interacts with race and ethnicity, as eth32 nic or racial groups are disproportionately represented in each SES 33 stratum. In one study in men who have sex with men (MSM) in San 34 Francisco in 2008, White MSM were more likely to have a college 35 education or greater, have higher incomes, and have health insur36 ance [4]. White MSM had the highest SES scores, while Black MSM 37 and transfemales had similar, lower levels of SES. 38 Educational level, income inequality, and income and job 39 security are prominent social determinants of health, and these 40 can contribute to health disparities [5]. For example, the better 22Q2
∗ Corresponding author at: Apartment 214, 5550 Cambie Street, Vancouver, BC, Canada. Tel.: +1 604 321 4116. E-mail address: [email protected] (S. Dhalla).
educated are less likely to smoke, drink, or to be obese [5,6]. Low SES has also been shown to increase the risk for HIV infection in the US [7]. Those people with higher educational levels may demonstrate better literacy and increased knowledge levels of HIV/AIDS, as well as knowledge and awareness regarding HIV vaccines and HIV vaccine trials. In addition, the race/ethnicity of individuals in the US is associated with educational level disparities [8]. Potential sources of income can include government sources such as social assistance, selling items, money from others including sex work, and irregular jobs [9]. Income has a strong correlation with health, but is only moderately correlated with educational level [3]. A higher income may allow the person to purchase health insurance and can ensure access to healthcare.
1.1. Barriers to participation HIV vaccine research in the US has examined barriers to participation in HIV vaccine trials among those with low SES, including racial/ethnic minorities. One study using focus groups in Los Angeles showed that mistrust is prevalent among low SES AfricanAmericans and Latinos [10]. Lack of information and knowledge about HIV vaccines and their development were also evidenced across communities at elevated risk of HIV [10]. The objective of this systematic review is, therefore, to assess and compare hypothetical and actual WTP and retention rates with
http://dx.doi.org/10.1016/j.vaccine.2015.03.022 0264-410X/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Dhalla S, Poole G. Socioeconomic status and HIV vaccine preparedness studies in North America. Vaccine (2015), http://dx.doi.org/10.1016/j.vaccine.2015.03.022
41 42 43 44 45 46 47 48 49 50 51 52 53 54
55
56 57 58 59 60 61 62 63 64
G Model
ARTICLE IN PRESS
JVAC 16250 1–10
S. Dhalla, G. Poole / Vaccine xxx (2015) xxx–xxx
2
67
respect to SES indicators such as educational level, income (personal and household), and employment in preventive phase 3 HIV vaccine trials in North America.
including their relationship to WTP and retention. In the cited studies, the types of questionnaires were either intervieweradministered or self-administered (Tables 1–6).
68
2. Methods
3.2. Educational levels in HIV vaccine preparedness studies (VPS) Twelve studies were retrieved that examined the relationship between educational level and WTP. In MSM, those with a HS educational level [17]. In IDU including methadone maintenance patients, those with a Baccaleurate degree 34.0% Older men ≤HS 10.1% ≤Baccalaureate degree 56.6% >Baccaleurate degree 33.3%
ARTICLE IN PRESS
JVAC 16250 1–10
Vaccine xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Review
1
Socioeconomic status and HIV vaccine preparedness studies in North America
2
3
4
Q1
5
Shayesta Dhalla ∗ , Gary Poole School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
6
7 20
a r t i c l e
i n f o
a b s t r a c t
8 9 10 11 12 13
Article history: Received 17 September 2014 Received in revised form 21 February 2015 Accepted 11 March 2015 Available online xxx
14
19
Keywords: HIV vaccine Socioeconomic status Willingness to participate Retention
21
1. Introduction
15 16 17 18
Educational level, employment, and income are key components of socioeconomic status (SES). This article is a systematic review of SES variables in North American countries, and their relationship to willingness to participate (WTP) and retention in a hypothetical preventive phase 3 HIV vaccine trial and in actual HIV vaccine trials. Men who have sex with men (MSM) tended to have higher educational levels, be more employed, and had higher income levels than injection drug users (IDU) and women at heterosexual risk (WAHR). In large part, there was no relationship between educational level and WTP, as well as between educational level and retention. Similarly, there was no relationship between employment and WTP. In WAHR who were African-American, those employed were less likely than others to complete the study at 18 months. The exact occupations of participants analyzed have not been specified, and specification of these occupations may help determine whether enhanced retention (ER) strategies are required. © 2015 Elsevier Ltd. All rights reserved.
A number of studies and reviews have examined factors that predict willingness to participate (WTP) in HIV vaccine prepared23 24Q3 ness studies (VPS) [1,2]. However, the research on socioeconomic status (SES) has yet to be reviewed systematically, though SES 25 may affect WTP in HIV vaccine trials. At the individual level, most 26 27 research on the effects of social stratification has used educa28 tional attainment, personal or household income including poverty, 29 and/or occupation and employment as indicators of SES. Each of 30 these attributes measures a different aspect of SES [3]. To further 31 complicate matters, SES interacts with race and ethnicity, as eth32 nic or racial groups are disproportionately represented in each SES 33 stratum. In one study in men who have sex with men (MSM) in San 34 Francisco in 2008, White MSM were more likely to have a college 35 education or greater, have higher incomes, and have health insur36 ance [4]. White MSM had the highest SES scores, while Black MSM 37 and transfemales had similar, lower levels of SES. 38 Educational level, income inequality, and income and job 39 security are prominent social determinants of health, and these 40 can contribute to health disparities [5]. For example, the better 22Q2
∗ Corresponding author at: Apartment 214, 5550 Cambie Street, Vancouver, BC, Canada. Tel.: +1 604 321 4116. E-mail address: [email protected] (S. Dhalla).
educated are less likely to smoke, drink, or to be obese [5,6]. Low SES has also been shown to increase the risk for HIV infection in the US [7]. Those people with higher educational levels may demonstrate better literacy and increased knowledge levels of HIV/AIDS, as well as knowledge and awareness regarding HIV vaccines and HIV vaccine trials. In addition, the race/ethnicity of individuals in the US is associated with educational level disparities [8]. Potential sources of income can include government sources such as social assistance, selling items, money from others including sex work, and irregular jobs [9]. Income has a strong correlation with health, but is only moderately correlated with educational level [3]. A higher income may allow the person to purchase health insurance and can ensure access to healthcare.
1.1. Barriers to participation HIV vaccine research in the US has examined barriers to participation in HIV vaccine trials among those with low SES, including racial/ethnic minorities. One study using focus groups in Los Angeles showed that mistrust is prevalent among low SES AfricanAmericans and Latinos [10]. Lack of information and knowledge about HIV vaccines and their development were also evidenced across communities at elevated risk of HIV [10]. The objective of this systematic review is, therefore, to assess and compare hypothetical and actual WTP and retention rates with
http://dx.doi.org/10.1016/j.vaccine.2015.03.022 0264-410X/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Dhalla S, Poole G. Socioeconomic status and HIV vaccine preparedness studies in North America. Vaccine (2015), http://dx.doi.org/10.1016/j.vaccine.2015.03.022
41 42 43 44 45 46 47 48 49 50 51 52 53 54
55
56 57 58 59 60 61 62 63 64
G Model
ARTICLE IN PRESS
JVAC 16250 1–10
S. Dhalla, G. Poole / Vaccine xxx (2015) xxx–xxx
2
67
respect to SES indicators such as educational level, income (personal and household), and employment in preventive phase 3 HIV vaccine trials in North America.
including their relationship to WTP and retention. In the cited studies, the types of questionnaires were either intervieweradministered or self-administered (Tables 1–6).
68
2. Methods
3.2. Educational levels in HIV vaccine preparedness studies (VPS) Twelve studies were retrieved that examined the relationship between educational level and WTP. In MSM, those with a HS educational level [17]. In IDU including methadone maintenance patients, those with a Baccaleurate degree 34.0% Older men ≤HS 10.1% ≤Baccalaureate degree 56.6% >Baccaleurate degree 33.3%
