Background Recent epidemiological data indicate that minority groups, especially Hispanic communities, experience higher rates of infection, hospitalization, and death due to COVID-19. It is important to understand the nature of this health disparity and the socioeconomic or behavioral factors that are placing Hispanic communities and other minority populations at higher risk for morbidity and mortality. Objective The purpose of this project is to assess current COVID-19–related knowledge, attitudes, and practices (KAP) among a predominantly Hispanic population from Orange County, California, and identify risk factors that may contribute to increased susceptibility and vulnerability to contracting SARS-CoV-2. Methods Our Orange County–wide community survey consists of quantitative survey questions in four domains: demographic information, COVID-19 knowledge questions, COVID-19 attitude questions, and COVID-19 practices questions. The survey questions are adapted from recent global KAP studies. Participants are being recruited from Amistad Medical Clinic, a private primary health clinic group in Orange County that treats a predominantly Hispanic population. Patients recruited during telehealth visits are surveyed remotely by telephone, and those recruited during in-person clinic visits are surveyed in person. Surveys are conducted by trained members of the study team who are native to the community setting. Results As of October 12, 2020, we had recruited and enrolled 327 participants. Data collection occurred June 26th to October 30th. Data analysis is ongoing. Conclusions Very few current COVID-19 studies focus on the perspective and experience of minority populations. Because Hispanic communities are disproportionately affected by COVID-19, it is important to understand the factors the contribute to this disparity and the next steps that should be taken to reduce the COVID-19 burden in this population. We believe that our study model of partnering with a local clinic system that serves our study population can be expanded to other settings to compare COVID-19 KAP and associated factors within different minority communities. International Registered Report Identifier (IRRID) DERR1-10.2196/25265

Background The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available.  Methods Participants aged ≥18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1% (n=191) were female, 77% (n=204) had at most a high school degree, 34.7% (n=92) had an annual income <US $25,000, and 11.7% (n=31) had previously tested positive for COVID-19. We found high knowledge regarding transmission and spread; moderate knowledge regarding symptoms awareness; overall negative attitudes, which included high pessimism in government public health efforts and high amounts of fear, anxiety, and frustration due to COVID-19 pandemic; and moderate participation in preventive practices. A college education was positively associated with a higher knowledge score than those without a college education (β=0.14, 95% CI 0.01-1.60; P=.04) when adjusted for covariates. Male gender had a positive association with COVID-19 attitude scores compared to female gender (β=1.61, 95% CI 0.50-2.72; P=.05), and male gender was negatively associated with the COVID-19 practices score compared to female gender (β=–0.16, 95% CI –0.56 to –0.06; P=.03), when both were adjusted for covariates. Among a subset of 203 patients, 26.6% (n=54) indicated that if the vaccine was available, they would not take a COVID-19 vaccine, and 18.7% (n=38) were unsure. Conclusions Good knowledge and preventative practices in the population may have reflected effective public health messaging and the implementation of public health laws during the first wave of the pandemic; however, the overall fear and anxiety may have reflected the negative impact that the pandemic had on vulnerable populations such as the Latinx community. Although our data are a reflection of a previous time in the pandemic, we believe it captures a critical time that can be used to provide unique insights regarding potential avenues to better protect the Latinx communities against future vaccine-resistant COVID-19 strains. International Registered Report Identifier (IRRID) RR2-10.2196/25265

BACKGROUND Background: The Latinx population in the United States have experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices in specifically Latinx communities in the United States. OBJECTIVE We conducted a study to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages COVID-19 pandemic, from July 2020 to October 2020 at a unique time when a vaccine was not available. METHODS Participants 18 years and older were recruited in a primary-care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes towards the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fit to test associations between sociodemographic characteristics and KAP scores. For our current analysis, we only included patients who self-identified as Latinx. RESULTS Our final data set included 256 participants. Participants had a mean age of 49 years (IQR 38.5-59), 72% of which were female, 77% had at most a high school degree, 35% had an annual income < $25,000, and 12% had previously tested positive for COVID-19. We found high knowledge regarding transmission and spread, moderate knowledge regarding symptoms awareness, overall negative attitudes which included high pessimism in government public health efforts and high amounts fear, anxiety, and frustration due to COVID-19 pandemic, and moderate participation in preventive practices. A college education was positively associated with a higher knowledge score compared to those without a college education (β = 0.14, 95% CI =0.01-1.60, p<0.01) when adjusted for covariates. Male gender had a positive association with COVID-19 attitude scores compared to female gender (β = 1.61, 95% CI = 0.50, 2.72, p<0.01) and male gender was negatively associated with the COVID-19 practices score compared to female gender (β = -0.16, 95% CI = -0.56- -0.06, p<0.01), when both adjusted for covariates. Among a subset of 203 patients, 19% indicated that if the vaccine were available, they would not take a COVID-19 vaccine and 27% were unsure. CONCLUSIONS Good knowledge and preventative practices in the population may have been a reflection of effective public health messaging and implementation of public health laws during the first wave of the pandemic; however, the overall fear and anxiety and may have been a reflection of the negative impact that the pandemic had on vulnerable populations such as Latinx community. Although our data is reflection of a previous time in the pandemic, we believe it captures a critical time in that can be used to provide unique insights regarding potential avenues for better protecting Latinx communities in future vaccine-resistant COVID-19 strains. INTERNATIONAL REGISTERED REPORT RR2-10.2196/25265

BACKGROUND Recent epidemiological data indicates that minority groups, especially Hispanic communities, experience a higher rate of infection, hospitalization, and death due to COVID-19. It is important to understand the nature of this health disparity and what socioeconomic or behavioral factors are putting Hispanic communities and other minority populations at higher risk for morbidity and mortality. OBJECTIVE The purpose of this project is to assess current COVID-19-related knowledge, attitudes, and practices (KAP) among a predominantly Hispanic population from the Orange County, California community and identify risk factors that may contribute to increased susceptibility and vulnerability to contracting SARS-CoV-2. METHODS Our community Orange County-wide survey consists of quantitative survey questions in four domains: demographic information, COVID-19 knowledge questions, COVID-19 attitude questions, and COVID-19 practices questions. Survey questions are adapted from recent global KAP studies. Participants are being recruited from Amistad Medical Clinic, a private, primary health clinic group in Orange County that treats a predominantly Hispanic population. Patients recruited during telehealth visits are surveyed remotely by phone and those recruited during in-person clinic visits are surveyed in-person. Surveys are conducted by trained members of the study team who are native to the community setting. RESULTS The first study patient was enrolled on 26 June 2020, and recruitment and enrollment will proceed until 30 October 2020. As of 12 October 2020, we have recruited and enrolled 327 participants, and we project to recruit and enroll 400 participants by the end of the recruitment period. We will conduct data analysis after the recruitment period on 30 October 2020. The study was approved exempt from review by the University of California, San Diego Institutional Review Board on 22 June 2020. CONCLUSIONS Very few current COVID-19 studies focus on the perspective and experience of minority populations. Since Hispanic communities are disproportionately affected by COVID-19, it is important to understand what factors contribute to this disparity and what next steps should be taken to reduce the COVID-19 burden in this population. We believe that our study model of partnering with a local clinic system that serves our study population can be expanded to other settings to compare COVID-19 KAP and associated factors within different minority communities.