This study investigated racial/ethnic differences in pregnant and postpartum women's intentions to receive the COVID-19 vaccination (maternal COVID-19 vaccination intent) and intentions to vaccinate their children against COVID-19 (child COVID-19 vaccination intent) during the early months of the COVID-19 pandemic (April-June 2020). This study also assessed Health Belief Model constructs to examine their influence on maternal and child COVID-19 vaccination intent by race/ethnicity. This study includes 489 US pregnant and postpartum women (18-49 years) recruited via Prolific Academic to complete a 55-item cross-sectional online survey. Crude and adjusted logistic regression analyses were conducted to determine the associations between race/ethnicity, maternal COVID-19 vaccination intent, and child COVID-19 vaccination intent. Among pregnant women, the odds of maternal COVID-19 vaccination intent (aOR = 2.20, 95% CI: .862, 5.61) and child COVID-19 vaccination intent (aOR = .194, 95% CI: .066, .565) among NH Black women were statistically significantly lower than that of NH White women after adjustment for demographic, health, and health belief model variables. Among postpartum women, although some racial differences in maternal or child COVID-19 vaccination intent were observed, these differences were not statistically significant in unadjusted and adjusted models. The findings have implications for future research and interventions which should adopt a racial health equity lens and identify strategies grounded in institutional trustworthiness and systems perspectives to address racial/ethnic disparities in COVID-19 vaccination intent among pregnant and postpartum women during novel pandemics.

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Focusing on non‐Hispanic Black women (NHBW) in North Texas, this study employed participatory system dynamics modeling to explore three hypotheses: (1) stakeholders will conceptualize structural racism is a pervasive macrostructural force that exerts downstream impacts to shape and perpetuate maternal health disparities among NHBW; (2) stakeholders will identify key causal forces and leverage points that exist across levels of influence; and (3) stakeholders will identify complex interactions, in the form of circular causality, that are present among the key causal forces and leverage points that shape NHBW maternal health disparities. Nine participants engaged in a virtual system dynamics group model‐building session that focused on eliciting key variables, behavior‐over‐time graphs (BOTGs), causal loop diagram (CLD), and targets for action. Participants identified 83 key variables. BOTGs included an average of 6.56 notations and time horizons that, on average, started in 1956. The CLD featured 11 reinforcing and seven balancing feedback loops. Eleven targets for action were identified. Structural racism was revealed as a pervasive macrostructural force that shaped maternal health outcomes among NHBW. Key causal forces and leverage points were identified across levels of influence. Finally, feedback loops within the CLD exhibited circular causality.

Objective: The aims of the study were to examine the association between social media sentiments surrounding COVID-19 vaccination and the effects on vaccination rates in the United States (US), as well as other contributing factors to the COVID-19 vaccine hesitancy. Method: The dataset used in this study consists of vaccine-related English tweets collected in real-time from January 4 - May 11, 2021, posted within the US, as well as health literacy (HL), social vulnerability index (SVI), and vaccination rates at the state level. Results: The findings presented in this study demonstrate a significant correlation between the sentiments of the tweets and the vaccination rate in the US. The results also suggest a significant negative association between HL and SVI and that the state demographics correlate with both HL and SVI. Discussion: Social media activity provides insights into public opinion about vaccinations and helps determine the required public health interventions to increase the vaccination rate in the US. Conclusion: Health literacy, social vulnerability index and monitoring of social media sentiments need to be considered in public health interventions as part of vaccination campaigns. Keywords: COVID–19, Health Literacy, COVID–19 Vaccine Hesitancy, Social Vulnerability Index, Social Media, Social Determinants of Health Abbreviations: Health Literacy (HL), Social Vulnerability Index (SVI), Social Determinants of Health (SDOH), United States (US) Correspondence: gabriela.wilson@uta.edu

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