Native Hawaiians and other Pacific Islanders (NHPIs) were disproportionately impacted by COVID-19 and remain significantly under-vaccinated against SARS-CoV-2. To understand vaccine hesitancy, we surveyed 1124 adults residing in a region with one of the lowest vaccination rates in Hawaii during our COVID-19 testing program. Probit regression analysis revealed that race/ethnicity was not directly associated with the probability of vaccine uptake. Instead, a higher degree of trust in official sources of COVID-19 information increased the probability of vaccination by 20.68%, whereas a higher trust in unofficial sources decreased the probability of vaccination by 12.49% per unit of trust. These results revealed a dual and opposing role of trust on vaccine uptake. Interestingly, NHPIs were the only racial/ethnic group to exhibit a significant positive association between trust in and consumption of unofficial sources of COVID-19 information, which explained the vaccine hesitancy observed in this indigenous population. These results offer novel insight relevant to COVID-19 mitigation efforts in minority populations.

Vaccine hesitancy remains a significant barrier to achieving herd immunity and preventing the further spread of COVID-19. Understanding contributors to vaccine hesitancy and how they change over time may improve COVID-19 mitigation strategies and public health policies. To date, no mechanism explains how trust in and consumption of different sources of information affect vaccine uptake. A total of 1594 adults enrolled in our COVID-19 testing program completed standardized surveys on demographics, vaccination status, use, reliance, and trust in sources of COVID-19 information, from September to October 2021, during the COVID-19 Delta wave. Of those, 802 individuals ($50.3$%) completed a follow-up survey, from January to February 2022, during the Omicron-wave. Regression analyses were performed to understand contributors to vaccine and booster uptake over time. Individuals vaccinated within two months of eligibility (early vaccinees) tended to have more years of schooling, with greater trust in and consumption of official sources of COVID-19 information, compared to those who waited 3–6 months (late vaccinees), or those who remained unvaccinated at 6 months post-eligibility (non-vaccinees). Most ($70.1$%) early vaccinees took the booster shot, compared to only $30.5$% of late vaccinees, with the latter group gaining trust and consumption of official information after four months. These data provide the foundation for a mechanism based on the level of trust in and consumption of official information sources, where those who increased their level of trust in and consumption of official information sources were more likely to receive a booster. This study shows that social factors, including education and individual-level degree of trust in (and consumption of) sources of COVID-19 information, interact and change over time to be associated with vaccine and booster uptakes. These results are critical for the development of effective public health policies and offer insights into hesitancy over the course of the COVID-19 vaccine and booster rollout.

Importance: Climate-driven wildfires are increasing in frequency and severity, but their association with midterm and long-term health trajectories during the course of recovery remain poorly characterized, particularly in underserved populations.Objective: To assess the midterm health outcomes of wildfire exposure, including respiratory and mental health, and evaluate the interaction of social support with these health burdens.Design, Setting, and Participants: The Maui Wildfire Exposure Study (MauiWES) is a community-based, cohort study that enrolled 1174 adults in 2024, 6 to 14 months after the 2023 Maui wildfires. Participants completed exposure assessments, spirometry, biomonitoring, and validated mental health evaluations. Data were accrued from January 26 to September 30, 2024.Exposure: Living or working in or near areas affected by the August 2023 Maui wildfires.Main Outcomes and Measures: Primary outcomes included lung function (forced expiratory volume in the first second of expiration [FEV₁] and forced vital capacity [FVC]), blood pressure, depressive symptoms (10-item Center for Epidemiologic Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder Scale), and days affected by health issues. Social support was assessed using the Multidimensional Scale of Perceived Social Support.Results: Among 1174 participants (median age, 47 [IQR, 36-59] years; 684 [59.1%] female; 108 [9.3%] Asian; 239 [20.5%] Filipino; 203 [17.4%] Hispanic or Latino; 238 [20.4%] Native Hawaiian or Other Pacific Islander; 343 [29.4%] White), 150 of 670 (22.4%) exhibited FEV₁ of less than 80% predicted, 725 of 1152 (62.9%) had high blood pressure (>130/80 mm Hg), and 554 of 1110 (49.9%) reported depressive symptoms. Participants residing within the fire perimeter had significantly lower lung function compared with those outside (FEV₁ β, −5.97 [95% CI, −10.81 to −1.14] percentage points predicted). Acute wildfire exposure was associated with an increase in days affected by health issues (β, 20.03 [95% CI, 8.87-31.18] days) and elevated depressive symptoms (β, 9.43 [95% CI, 0.61-18.25] points). Higher social support was associated with fewer days affected by health issues (β, −5.08 [95% CI, −8.50 to −1.65] days) but did not mitigate low lung function.Conclusions and Relevance: In this cohort study of adults affected by the Maui wildfires, substantial midterm cardiopulmonary and psychological health burdens were observed. Higher social support was associated with improved mental health outcomes but did not appear to buffer physiological outcomes such as reduced lung function. These findings highlight the need for disaster response models that integrate clinical surveillance, targeted mental health interventions, and culturally anchored community-based support. As climate-driven disasters intensify, proactive strategies to monitor and mitigate their long-term health effects will be essential to protect vulnerable populations and enhance resilience.