Exploring the Relationship between Social Determinants of Health and COVID-19 Behaviors Among Latinx Adults across the United States

Background: Sixty million Latinxs (18% of the population) make up 26.4% of all COVID-19 cases in the United States. In this time of unparalleled challenge and political polarization, knowledge of COVID-19 in Latinxs is lacking across the literature. More specifically, it is uncertain if knowledge and utilization of immunizations among Latinxs is influenced by social determinants of health. The purpose of this study was to examine how social determinants of health predict COVID-19 behaviors and perceptions toward COVID-19 behaviors and immunization uptake among a Latinx-only sample.

Methods: This quantitative study utilized a cross-sectional survey. The National Association of Hispanic Nurses, an organization of Latinx nurses, was used to recruit Latinxs over the age of 18 in 11 chapters across the United States. Each chapter was asked to complete at least 20 surveys. The CDC National 2009 H1N1 Flu Survey was adapted for COVID-19 and used to measure knowledge and beliefs about immunizations of COVID-19. The Health Access Survey was used to measure social determinants of health. Instruments were available in both Spanish and English.

Results: Across the United States, 228 surveys were completed from participants in approximately 30 states. A three-step analysis was used to explore the data. First, an Exploratory Factor Analysis (EFA) was conducted to determine domains of social determinants of health in the Latinx communities surveyed. Second, the factorial structure of the data was assessed using a Confirmatory Factor Analytic (CFA) approach. Finally, a structural equation model (SEM) was used to examine associations between COVID-19 behaviors and social determinants of health. When controlling for several demographic characteristics, Latinxs reported higher COVID-19 protective factors (p < .05) and more worry about taking a COVID-19 vaccine (p < .05). Those who reported higher education (p < .05) and having health insurance (p < .05) tended to have less worry about taking a COVID-19 vaccine. There was a positive association between access to resources and COVID-19 Protective Factors (p < .05). A negative association between alternative medicine and COVID-19 Protective Factors was present (p < .05). Exposure to drugs and violence was associated with a decrease in likelihood to pursue a vaccine (p < .05).

Conclusion: Results suggest that community outreach efforts should be made to increase knowledge and awareness of COVID-19, especially among less educated individuals who are exposed to drugs and violence and have limited access to social resources. From a methodological standpoint, results highlight the importance of careful measurement when assessing social determinants of health among Latinx-only samples. More research is needed to identify attitudes and beliefs about immunizations and strategies to improve assessment of social determinants of health and uptake of immunizations in Latinxs. Community based intervention research could be a feasible avenue for further assessing the impact of immunizations in Latinx communities. In order to decrease the mortality rate of COVID-19 in Latinxs, researchers and practitioners must provide health literacy in a culturally congruent setting targeted toward improving specific health outcomes.