Abstract COVID-19 has created a "state of emergency" for African Americans in the US. Africans Americans with pre- existing conditions and greater economic difficulties are especially vulnerable in the current pandemic. As of 3/1/2021, three vaccines have received emergency use authorization that protect against severe illness related to COVID-19. However, recent findings indicate 31% of adults self-reported “wait and see”, of which 16% were African American. It is a national priority to identify strategies to address vaccine hesitancy and tailoring communication strategies is a top recommendation. Our preliminary studies suggest that a social marketing campaign disseminating tailored messages informed by using community-engaged approaches may effectively increase confidence in COVID-19 vaccines, and ultimately, uptake among African Americans. This project seeks to test the feasibility and impact of a multi-layered, culturally-appropriate social marketing intervention targeting COVID-19 vaccine hesitant (VH) African Americans to increase vaccine confidence, uptake, and completion of multi-dose vaccine series in Nashville/Davidson County, Tennessee. To achieve this goal, we propose the following specific aims: Aim 1: Engage with key stakeholders to develop a multi-layered, culturally-appropriate social marketing intervention (CoVax Facts) targeting African Americans who are COVID-19 VH. Aim 2a: Conduct a pilot study of the intervention and study protocol to demonstrate feasibility and assess impact on COVID-19 vaccine rates. Aim 2b. To retrospectively explore knowledge, attitudes, intentions, and implementation outcomes post intervention. This study’s novelty lies in being the first to assess the feasibility and preliminary efficacy of a multi-layered, theory-based social marketing intervention, which is deemed culturally-appropriate using tailoring strategies. A multi-disciplinary group of investigators on this project have expertise in biological concepts (e.g., viruses and vaccines), epidemiology (e.g., COVID-19 surveillance/disparities), vaccine hesitancy, community engagement, health communication, and intervention development and implementation science. Our team is led by Jennifer C. Erves, PhD, MPH, MAED, MS, CHES (Meharry Medical College [MMC]), Co-Is Jamaine Davis, PhD (MMC) and Heather Brandt, PhD (St. Jude), and mentor Maureen Sanderson, PhD (MMC). The research team will leverage their community partnerships and resources of the Research Centers in Minority Institutions Program in Health Disparities Research at MMC, Vanderbilt Qualitative Research Core, and St. Jude HPV Cancer Prevention Program to conduct this research. IMPACT: The knowledge, experience, and data provided by this award will: 1) further inform research on social-marketing interventions using tailored health communication to reduce COVID-19 health-related disparities, and 2) prepare our team to secure future R01 funding to assess a larger, well- powered RCT to assess efficacy. This application supports the NIMHD’s mission by seeking to improve minority health and reduce disparities using community engagement.

Public Health Relevance/Project Narrative Improving COVID-19 vaccine rates among African Americans who are vaccine hesitant is necessary to improve the disparities in incidence, mortality, and hospitalization rates in this high-risk group. This proposed research is innovative because a multi-disciplinary team has been assembled to apply community-engaged research principles to develop a social marketing intervention disseminating tailored educational messages.