January 31, 2023

Classmates often stop Alma Gallegos as she makes her way down the bustling hallways of Theodore Roosevelt High School in southeast Fresno, California. The 17-year-old senior is frequently asked by fellow students about covid-19 testing, vaccine safety, and the value of booster shots.

Alma earned her reputation as a trusted source of information through her internship as a junior community health worker. She was among 35 Fresno County students recently trained to discuss how covid vaccines help prevent serious illness, hospitalization, and death, and to encourage relatives, peers, and community members to stay up to date on their shots, including boosters.

When Alma’s internship drew to a close in October, she and seven teammates assessed their work in a capstone project. The students took pride in being able to share facts about covid vaccines. Separately, Alma persuaded her family to get vaccinated. She said her relatives, who primarily had received covid information from Spanish-language news, didn’t believe the risks until a close family friend died.

“It makes you want to learn more about it,” Alma said. “My family is all vaccinated now, but we learned the hard way.”

Community health groups in California and across the country are training teens, many of them Hispanic or Latino, and deputizing them to serve as health educators at school, on social media, and in communities where covid vaccine fears persist. According to a 2021 survey commissioned by Voto Latino and conducted by Change Research, 51% of unvaccinated Latinos said they didn’t trust the safety of the vaccines. The number jumped to 67% for those whose primary language at home is Spanish. The most common reasons for declining the shot included not trusting that the vaccine will be effective and not trusting the vaccine manufacturers.

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And vaccine hesitancy is not prevalent only among the unvaccinated. Although nearly 88% of Hispanics and Latinos have received at least one dose of a covid vaccine, few report staying up to date on their shots, according to the Centers for Disease Control and Prevention. The CDC estimated fewer than 13% of Hispanics and Latinos have received a bivalent booster, an updated shot that public health officials recommend to protect against newer variants of the virus.

Health providers and advocates believe that young people like Alma are well positioned to help get those vaccination numbers up, particularly when they help navigate the health system for their Spanish-speaking relatives.

“It makes sense we should look to our youth as covid educators for their peers and families,” said Dr. Tomás Magaña, an assistant clinical professor in the pediatrics department at the University of California-San Francisco. “And when we’re talking about the Latino community, we have to think deeply and creatively about how to reach them.”

Melissa Lopez (left) and Alma Gallegos get ready to distribute covid tests to a taco shop in Fresno, California. Both are seniors at Theodore Roosevelt High School participating in the Promotoritos program, an internship organized by the nonprofit Fresno Building Healthy Communities.(Heidi de Marco / KHN)

Some training programs use peer-to-peer models on campuses, while others teach teens to fan out into their communities. FACES for the Future Coalition, a public youth corps based in Oakland, is leveraging programs in California, New Mexico, Colorado, and Michigan to turn students into covid vaccine educators. And the Health Information Project in Florida, which trains high school juniors and seniors to teach freshmen about physical and emotional health, integrates covid vaccine safety into its curriculum.

In Fresno, the junior community health worker program, called Promotoritos, adopted the promotora model. Promotoras are non-licensed health workers in Latino communities tasked with guiding people to medical resources and promoting better lifestyle choices. Studies show that promotoras are trusted members of the community, making them uniquely positioned to provide vaccine education and outreach.

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“Teenagers communicate differently, and they get a great response,” said Sandra Celedon, CEO of Fresno Building Healthy Communities, one of the organizations that helped design the internship program for students 16 and older. “During outreach events, people naturally want to talk to the young person.”

The teens participating in Promotoritos are mainly Latino, immigrants without legal status, refugee students, or children of immigrants. They undergo 20 hours of training, including social media campaign strategies. For that, they earn school credit and were paid $15 an hour last year.

“Nobody ever thinks about these kids as interns,” said Celedon. “So we wanted to create an opportunity for them because we know these are the students who stand to benefit the most from a paid internship.”

Last fall, Alma, who is Latina, and three other junior community health workers distributed covid testing kits to local businesses in their neighborhood. Their first stop was Tiger Bite Bowls, an Asian fusion restaurant. The teens huddled around the restaurant’s owner, Chris Vang, and asked him if he had any questions about covid. Toward the end of their conversation, they handed him a handful of covid test kits.

Teens deliver covid tests and information flyers to Chris Vang, a restaurant owner. Vang is seated at a table inside the restaurant while the teens stand around him.
Teens deliver covid tests and information flyers to Chris Vang, owner of Tiger Bite Bowls, an Asian fusion restaurant in Fresno, California. The teens have been trained as health educators to promote covid vaccinations. (Heidi de Marco / KHN)

“I think it’s good that they’re aware and not afraid to share their knowledge about covid,” Vang said. “I’m going to give these tests to whoever needs them — customers and employees.”

There’s another benefit of the program: exposure to careers in health care.

California faces a widespread labor shortage in the health care industry, and health professionals don’t always reflect the increasing diversity of the state’s population. Hispanics and Latinos represent 39% of California’s population, but only 6% of the state’s physician population and 8% of the state’s medical school graduates, according to a California Health Care Foundation report.

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Alma said she joined the program in June after she saw a flyer at the school counselor’s office. She said it was her way to help prevent other families from losing a loved one.

Now, she is interested in becoming a radiologist.

“At my age,” Alma said, “this is easily the perfect way to get involved.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.