Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated?

Investigating the tendency to use COVID-19 vaccine booster dose in Iran

INTRODUCTION

Vaccine hesitancy is recognized as a significant public health threats, characterized by delays, refusals, or reluctance to accept vaccinations despite their availability. This study, aimed to investigate the willingness of Iranians to receive booster shots, refusal rate, and their preferred type of COVID-19 vaccine.

MATERIALS AND METHODS

This cross-sectional study was conducted over a month from August 23 to September 22, 2022 using an online questionnaire distributed through WhatsApp and Telegram online communities. The questionnaire assessed participants' intent to accept COVID-19 booster vaccination and had no exclusion criteria. Data analysis involved using SPSS version 16.0, with t-tests and chi-square tests used to assess the bivariate association of continuous and categorical variables. A multivariate logistic regression model was built to examine the association between Health Belief Model (HBM) tenets and COVID-19 vaccination intent. The Hosmer Lemeshow Goodness of Fit statistic was used to assess the model's fit, with a p-value > 0.05 indicating a good fit.

RESULTS

The survey was disseminated to 1041 adults and the findings revealed that 82.5% of participants expressed a desire to receive the booster dose. Participants who intended to be vaccinated were generally older (46.4 ± 10.9), mostly female (53.3%), single (78.9%), had received a flu vaccine (45.8%). The findings indicated that the HBM items, including perception of COVID-19 disease, perceived benefits of COVID-19 vaccines, COVID-19 safety/cost concerns, preference of COVID-19 vaccine alternatives, and prosocial norms for COVID-19 vaccination, received higher scores among individuals intending to be vaccinated compared to vaccine-hesitant individuals, with statistical significance (p < 0.05). However, the "COVID-19 risk-reduction habits" item had a higher score but did not reach statistical significance (p = 0.167).

CONCLUSION

Factors such as lack of trust in the effectiveness of the vaccine, trust in specific vaccine manufacturers, and concerns about side effects of COVID-19 vaccine are among the most important factors. These findings have implications for national vaccination policies, emphasizing the need for policymakers in the health sector to address these factors as vital considerations to ensure the continuity of vaccination as one of the most important strategies for controlling the pandemic.

Associations of Mental Health and Experience of the COVID-19 Pandemic with United States Adults' Intentions to Be Vaccinated

COVID-19 vaccine uptake in the United States has proved challenging. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. This study examined associations between US adults' vaccination intentions and mental health history, experience of the COVID-19 pandemic, and mental health outcomes. An online population-based cross-sectional survey was administered nationwide during January 4-7, 2021. Participants were questioned about past and current mental health, and completed the Patient Health Questionnaire 8 (PHQ-8), Generalized Anxiety Disorder 7-item (GAD-7), and Posttraumatic Diagnostic Scale (PDS)-5 (to capture symptoms of depression, anxiety, and traumatic stress, respectively). Experience of the pandemic included cumulative county-level COVID case and death rates, self-reported COVID-19 testing/exposure/diagnosis, and self-reported impact on routines, resources, and relationships. Of 936 respondents, 66% intended to be vaccinated, 14.7% responded "maybe," and 19.6% "no." Past diagnosis of obsessive compulsive disorder, less impact on routines or social supports, not having been screened or tested for COVID-19, not knowing someone who tested positive, and not self-isolating were associated with less intention to vaccinate. After controlling for demographic and pandemic experience factors, symptoms of traumatic stress, but not other mental health outcomes, were associated with less intention to vaccinate. The apparent contradiction between less negative impact of the pandemic and symptoms of traumatic stress being associated with less intention to be vaccinated indicates the complex nature of barriers to vaccine uptake. Results from this study contribute to the evidence base needed to improve ongoing and future communications about, and strategies to increase uptake of, vaccination.

Childhood Vaccination Practices and Parental Hesitancy Barriers in Rural and Urban Primary Care Settings

The purpose of our study was to identify primary care providers' (PCPs') practices in promoting childhood vaccination and their perceptions regarding barriers to vaccination in a primarily rural state. In January-May 2022, we conducted a mail and online survey of PCPs across Montana (n = 829). The survey included modules on routine immunizations in children 0-2 years old and COVID-19 vaccination in children 5-17 years old. The survey response rate was 36% (298/829). We categorized PCPs as working in rural (n = 218) or urban areas (n = 80), based on Rural-Urban Commuting Area codes. We then compared responses between rural and urban PCPs using chi-square tests. Urban PCPs (90-94%, depending on vaccine) stocked routinely recommended vaccines more frequently than rural PCPs (71-84%), but stocked the COVID-19 vaccine less often than rural PCPs (44% vs. 71%, respectively, p < 0.001). A higher percentage of rural providers reported parental beliefs that vaccine-preventable diseases are not severe enough to warrant vaccination (48% vs. 31%, p = 0.01) and concerns that vaccination will weaken their child's immune system (29% vs. 6%, p < 0.001). More rural (74%) compared to urban (59%) PCPs identified a social media campaign from local health departments promoting early childhood vaccinations as an effective strategy to increase childhood vaccination rates (p = 0.01). We identified key differences in some childhood vaccination practices and barriers between rural and urban PCPs. Interventions to increase rural vaccination rates could include increasing the number of providers stocking all recommended vaccines, identifying strategies to address parents' concerns regarding vaccine necessity, and collaborations with public health departments.

Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South

OBJECTIVE

The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South.

METHODS

Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews.

RESULTS

Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions.

CONCLUSIONS

In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician.

PRACTICE IMPLICATIONS

The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.

Willingness to be vaccinated against COVID-19: the role of risk perception, trust in institutions, and affects

Introduction

Vaccination is one of the most effective ways to stop the COVID-19 pandemic and prevent severe disease. This study aims to ascertain the determinants of COVID-19 vaccination acceptance in the French population before the vaccine was introduced (France's second lockdown) and during the roll-out of the vaccination campaign (France's third lockdown). We focus on the following as determinants of willingness to be vaccinated: risk perception, affects related to the risk, and trust in political and health institutions.

Method

The study was conducted among two convenient samples including 591 and 474 participants. The results show that the timing of the crisis was important. While the intention to be vaccinated was relatively low before the vaccines were introduced, it became significantly higher when the vaccination campaign was deployed.

Results

The results show that risk perception and trust in health institutions are the most relevant predictors of intention to be vaccinated.

Discussion

Results are discussed in terms of the effectiveness of communication campaigns.

Event Study Design for Modeling Early Relaxation in Turkish Public with COVID-19 Vaccine

OBJECTIVE

Vaccination is crucial to fighting the coronavirus disease (COVID-19) pandemic. A large body of literature investigates the effect of the initiation of the COVID-19 vaccination in case numbers in Turkey, including the resistance and willingness to taking the vaccine. The effect of early relaxation in the Turkish public with the initiation of vaccination on new daily cases is unknown.

METHODS

This study performs an event study analysis to explore the pre-relaxation effect of vaccination on the Turkish public by using daily data of new cases, stringency index, and residential mobility. Two events are comparatively defined as the vaccination of the health personnel (Event 1) and the citizens age 65 and over (Event 2). The initial dates of these events are January 13 and February 12, 2021, respectively. The length of the estimation window is determined as 14 days for the 2 events. To represent only the early stages of the vaccination, the study period ends on April 12, 2021. Thus, whereas the event window of Event 1 includes 90 observations, Event 2 covers 60 observations.

RESULTS

While average values of residential mobility, stringency index, and daily numbers of cases are 15.36, 71.03, and 11 978.93 in the estimation window for Event 1, these averages are 8.89, 70.88, and 17 303.20 in the event window. For Event 2, the same average values are 9.14, 69.38, and 7 664.93 in the estimation window and 8.25, 71.12, and 22 319.10 in the event window. When 14-day abnormal growth rates of the daily number of cases for Event 1 and Event 2 are compared, it is observed that Event 1 has negative growth rates initially and reaches a 7.59% growth at most. On the other hand, Event 2 starts with a 1.11% growth rate, and having a steady increase, it reaches a 23.70% growth in the last 14 days of the study period.

CONCLUSION

The preliminary result shows that, despite taking more strict governmental measures, while residential mobility decreases, the daily number of COVID-19 cases increases in the early stages of vaccination compared to short pre-periods of it. This indicates that the initiation of vaccination leads to early behavioral relaxation in public. Moreover, the effect of Event 2 on the case numbers is more significant and immediate, compared to that of Event 1, which may be linked to the characteristic of the Turkish culture being more sensitive to the older adult population.

Primary care physicians' strategies for addressing COVID-19 vaccine hesitancy

OBJECTIVE

To explore the strategies that primary care physicians use to address patient COVID-19 vaccine hesitancy.

METHOD

We administered an online survey to 625 primary care physicians from May 14 to May 25, 2021, to assess the messages that primary care physicians use to encourage hesitant patients to get vaccinated against COVID-19.589 physicians from the total pool of 625 provided open-ended responses. We conducted thematic content analysis on the responses based on previous research and themes identified within the data.

SETTING

The survey was administered online using the survey research firm Dynata.

RESULTS

Eleven primary themes emerged from our analysis, which included, physicians addressing specific concerns about vaccine safety (including costs versus benefits), physicians helping patients understand what it means to remain unvaccinated, or whether physicians try to connect emotionally through the use of guilt, or personal experience, whether physicians use derisive language to communicate with unvaccinated patients. In addition, a small number of physicians indicated they would not attempt to persuade someone who is vaccine hesitant.

CONCLUSIONS

Our study shows that while some of the physicians used different strategies to address vaccine hesitancy, some of the physicians used harsh language or did not make any effort to reduce COVID-19 related vaccine hesitancy among their patients. Focused advocacy and training are needed to increase physician engagement in vaccine-related dialogues with their patients. Such efforts will ensure that critical opportunities for patient education and awareness-building are not missed and ensure high levels of vaccination uptake.

Factors associated with COVID-19 vaccination hesitancy in South Korea: A cross-sectional study

Vaccination against COVID-19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID-19 vaccines, the factors that affect COVID-19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID-19 vaccination hesitancy among Korean adults, focusing on COVID-19 knowledge and attitudes toward vaccination. This was a cross-sectional study conducted with 2286 Korean adults aged 20-64 years. Demographic characteristics, knowledge regarding COVID-19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID-19 vaccination hesitancy. Approximately 67% of the COVID-19 knowledge-related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID-19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID-19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID-19 vaccines should be implemented.

Assessing the acceptability of technological health innovations in sub-Saharan Africa: a scoping review and a best fit framework synthesis

Acceptability is a key concept used to analyze the introduction of a health innovation in a specific setting. However, there seems to be a lack of clarity in this notion, both conceptually and practically. In low and middle-income countries, programs to support the diffusion of new technological tools are multiplying. They face challenges and difficulties that need to be understood with an in-depth analysis of the acceptability of these innovations. We performed a scoping review to explore the theories, methods and conceptual frameworks that have been used to measure and understand the acceptability of technological health innovations in sub-Saharan Africa. The review confirmed the lack of common definitions, conceptualizations and practical tools addressing the acceptability of health innovations. To synthesize and combine evidence, both theoretically and empirically, we then used the "best fit framework synthesis" method. Based on five conceptual and theoretical frameworks from scientific literature and evidence from 33 empirical studies, we built a conceptual framework in order to understand the acceptability of technological health innovations. This framework comprises 6 determinants (compatibility, social influence, personal emotions, perceived disadvantages, perceived advantages and perceived complexity) and two moderating factors (intervention and context). This knowledge synthesis work has also enabled us to propose a chronology of the different stages of acceptability.

The role and influence of perceived experts in an anti-vaccine misinformation community

The role of perceived experts (i.e., medical professionals and biomedical scientists) as potential anti-vaccine influencers has not been characterized systematically. We describe the prevalence and importance of anti-vaccine perceived experts by constructing a coengagement network based on a Twitter data set containing over 4.2 million posts from April 2021. The coengagement network primarily broke into two large communities that differed in their stance toward COVID-19 vaccines, and misinformation was predominantly shared by the anti-vaccine community. Perceived experts had a sizable presence within the anti-vaccine community and shared academic sources at higher rates compared to others in that community. Perceived experts occupied important network positions as central anti-vaccine nodes and bridges between the anti- and pro-vaccine communities. Perceived experts received significantly more engagements than other individuals within the anti- and pro-vaccine communities and there was no significant difference in the influence boost for perceived experts between the two communities. Interventions designed to reduce the impact of perceived experts who spread anti-vaccine misinformation may be warranted.

Unveiling Vaccine Hesitancy on Twitter: Analyzing Trends and Reasons during the Emergence of COVID-19 Delta and Omicron Variants

Given the high amount of information available on social media, the paper explores the degree of vaccine hesitancy expressed in English tweets posted worldwide during two different one-month periods of time following the announcement regarding the discovery of new and highly contagious variants of COVID-19-Delta and Omicron. A total of 5,305,802 COVID-19 vaccine-related tweets have been extracted and analyzed using a transformer-based language model in order to detect tweets expressing vaccine hesitancy. The reasons behind vaccine hesitancy have been analyzed using a Latent Dirichlet Allocation approach. A comparison in terms of number of tweets and discussion topics is provided between the considered periods with the purpose of observing the differences both in quantity of tweets and the discussed discussion topics. Based on the extracted data, an increase in the proportion of hesitant tweets has been observed, from 4.31% during the period in which the Delta variant occurred to 11.22% in the Omicron case, accompanied by a diminishing in the number of reasons for not taking the vaccine, which calls into question the efficiency of the vaccination information campaigns. Considering the proposed approach, proper real-time monitoring can be conducted to better observe the evolution of the hesitant tweets and the COVID-19 vaccine hesitation reasons, allowing the decision-makers to conduct more appropriate information campaigns that better address the COVID-19 vaccine hesitancy.

Let's talk about COVID-19 vaccination: Relevance of conversations about COVID-19 vaccination and information sources on vaccination intention in Switzerland

BACKGROUND

COVID-19 vaccine hesitancy is known to be more pronounced among young people. However, there are a lack of studies examining determinants of COVID-19 vaccination intention in the general population in this young age-group in Switzerland, and in particular, studies investigating the influence of information sources and social networks on vaccination intention are missing.

METHODS

The cross-sectional study "COVIDisc - Discussion with young people about the corona pandemic" provided the opportunity to investigate COVID-19 vaccination intention in 893 individuals aged 15-34 years from the cantons of Zurich, Thurgau, and Ticino in Switzerland. An online survey was administered between 10 November 2020 and 5 January 2021. Associations of public information sources and conversations about COVID-19 with COVID-19 vaccination intention were analyzed with multivariable logistic regression and mediation analysis using generalized structural equation modeling.

RESULTS

51.5% of the participants intended or probably intended to get vaccinated once the vaccine would be available. Using print or online news (AOR 1.50, 95% CI 1.09-2.07) as an information source and having conversations about the COVID-19 vaccine (AOR 2.09, 95% CI 1.52-2.87) increased participants' COVID-19 vaccination intention. The effects of female gender (b = -0.267, p = 0.039) and risk perception (b = 0.163, p = 0.028) were partially mediated by having conversations about the COVID-19 vaccine. The effects of age (b = -0.036, p = 0.016), secondary educational level (b = 0.541, p = 0.010) and tertiary educational level (b = 0.726, p = 0.006) were fully mediated via having conversations about the COVID-19 vaccine.

CONCLUSIONS

Conversations and campaigns should start even before vaccines become available. Our data support interventions for young women and less educated people using social norms and supporting information seeking with news. Trust and risk perceptions are essential foundations for vaccine intentions.

Public Opinions About Palliative and End-of-Life Care During the COVID-19 Pandemic: Twitter-Based Content Analysis

BACKGROUND

Palliative and end-of-life care (PEoLC) played a critical role in relieving distress and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinions concerning PEoLC during the pandemic. Given that social media have the potential to collect real-time public opinions, an analysis of this evidence is vital to guide future policy-making.

OBJECTIVE

This study aimed to use social media data to investigate real-time public opinions regarding PEoLC during the COVID-19 crisis and explore the impact of vaccination programs on public opinions about PEoLC.

METHODS

This Twitter-based study explored tweets across 3 English-speaking countries: the United States, the United Kingdom, and Canada. From October 2020 to March 2021, a total of 7951 PEoLC-related tweets with geographic tags were retrieved and identified from a large-scale COVID-19 Twitter data set through the Twitter application programming interface. Topic modeling realized through a pointwise mutual information-based co-occurrence network and Louvain modularity was used to examine latent topics across the 3 countries and across 2 time periods (pre- and postvaccination program periods).

RESULTS

Commonalities and regional differences among PEoLC topics in the United States, the United Kingdom, and Canada were identified specifically: cancer care and care facilities were of common interest to the public across the 3 countries during the pandemic; the public expressed positive attitudes toward the COVID-19 vaccine and highlighted the protection it affords to PEoLC professionals; and although Twitter users shared their personal experiences about PEoLC in the web-based community during the pandemic, this was more prominent in the United States and Canada. The implementation of the vaccination programs raised the profile of the vaccine discussion; however, this did not influence public opinions about PEoLC.

CONCLUSIONS

Public opinions on Twitter reflected a need for enhanced PEoLC services during the COVID-19 pandemic. The insignificant impact of the vaccination program on public discussion on social media indicated that public concerns regarding PEoLC continued to persist even after the vaccination efforts. Insights gleaned from public opinions regarding PEoLC could provide some clues for policy makers on how to ensure high-quality PEoLC during public health emergencies. In this post-COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from web-based public discussion how to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media's potential in acting as an effective tool to reflect public opinions in the context of PEoLC.

Applying the Hornik & Woolf Approach to Identify Messaging Themes and Improve COVID-19 Vaccine Confidence Among Federally Qualified Health Centers' Workforce in Wisconsin

The Federally Qualified Health Centers (FQHCs) in Wisconsin serve the most under-resourced communities in the state and are trusted sources in local communities. Although healthcare workers can be leveraged to champion COVID-19 vaccines, existing vaccine hesitancy among the FQHC workforce itself calls for research to identify promising messaging themes that can boost their vaccine confidence. In spring 2021, through a partnership with the Wisconsin Primary Health Association, we took a community-engaged approach to develop and field a survey including 46 beliefs (Ms = 1.36-4.25, SDs = 0.81-1.46, all on 5-point Likert scales) among employees of 10 out of the 17 FQHCs in Wisconsin. In total, 347 clinical team members and 349 non-clinical staff members (a) indicated their levels of (dis)agreement with all 46 belief items and (b) reported vaccine acceptance (dichotomized, acceptance = 77.6%) as well as recommendation intentions (dichotomized, yes = 73.9%). We carried out the Hornik & Woolf analyses in a multilevel logistic regression framework with bootstrapping to rank order all beliefs, segmented by subgroup and behavioral outcome. Our results suggest that communication-based interventions should promote beliefs such as those related to perceived safety and efficacy, rather than normative pressure from peers, while aiming to reduce doubts about information withholding and manipulation, the safety of the mRNA technology, the approval process, and "unnatural" ingredients in the vaccines. Subgroup-specific belief rankings are also provided. This study demonstrates the usefulness of incorporating the H&W approach into community-engaged research with local healthcare systems to improve health messaging for vaccine promotion.

The community acceptance of COVID-19 vaccines in Rakhine State: A cross-sectional study in Myanmar

The global pandemic situation of SARS-CoV-2 (COVID-19) has been ongoing for more than 2 years with the emergence of different variants. With the rapid development of vaccines, countries including Myanmar rolled out vaccination programs to reduce the morbidity and mortality due to COVID-19 with the ultimate goal to end the pandemic. This study seeks to explore the acceptance of the general adult population towards the COVID-19 vaccines administered by the Ministry of Health, and barriers to vaccine acceptance. A quantitative cross-sectional study was conducted by adopting valid and reliable questionnaires from similar studies around the world. Simple random sampling was used to select 288 participants from 12 townships of Rakhine State, Myanmar. The interview was performed using standardized paper-based documents. While the data entry and manipulation were performed using Microsoft Excel, the data analysis process was performed using the Statistical Package for Social Science (SPSS) software. As descriptive statistics, the level of vaccine acceptance, and barriers to vaccine acceptance were calculated. Chi-square analysis and bivariate logistics regression was performed to explore the associated socio-demographic characteristics, COVID-19 and vaccine-related experience, and perceptions of participants on the health belief model (HBM) domains related to vaccine acceptance. A total of 276 participants entered the study and revealed an overall vaccine acceptance level of 91.3%. Higher level of education, working in skilled manual and sales services, monthly income of more than 200,000 MMK (111 USD), history of previous vaccination, not experiencing side effects of vaccine after previous immunization, and elements of the health belief model (HBM) were associated with higher vaccine acceptance. The barriers to vaccine acceptance were mistrust of the efficacy of vaccines and potential major adverse events of COVID-19 vaccines. The high level of vaccine acceptance among the general population in Rakhine state provides an opportunity for health authorities to achieve high vaccination coverage within the community. Nevertheless, the vaccine-related education campaigns should be targeted and conveyed frequently to the sub-groups of the population with vaccine hesitancy to obtain the highest achievable level of vaccine coverage within the community for the ultimate goal to end the pandemic.

Determinants for COVID-19 vaccination intention in Mexico

This investigation aims to determine the predictors that have the most significant influence over COVID-19 vaccination intention for the population of 18 years or above in Mexico. This will be done through a comprehensive theoretical model comprising: the theory of planned behaviour, the health belief model, and the model of goal-directed behaviour. An exploratory, cross-sectional study with a quantitative approach was carried out. The structured questionnaire was applied to 1085 adults in the first trimester of 2021 through Google Forms in social media groups. The data analysis was carried out through partial least square structural equation modelling. Positive anticipated emotions, desire, subjective norms, attitude, and perceived behavioural control were the most significant predictors of intention. The model that combines the theoretical perspectives explains mostly the vaccination intention. The study can be a valuable theoretical perspective for understanding similar behavioural intentions related to health risks. The results are also valuable for public health decision-makers to design strategies that promote vaccination.

Disparities in COVID-19 vaccine hesitancy among a diverse community-based sample in Connecticut, United States

Though vaccination is among our strongest tools to prevent COVID-19 infections, its delivery has proven challenging. At a time when COVID-19 cases were rapidly increasing in the Northeast, we examined the role of sociodemographic factors, social determinants of health (SDOH), and health-related beliefs, including conspiracy theories, in influencing COVID-19 vaccine hesitancy among a diverse sample of Connecticut (United States) residents. Between August and December 2020, utilizing community partners and advertisements via social media, we surveyed communities known to be most impacted by COVID-19. We used descriptive analysis and multivariable logistic regression to examine vaccine hesitancy. Among 252 participants, most were female (69.8%) and under the age of 55 (62.7%). Approximately one-third reported household incomes less than $30,000 per year and 23.5% were non-Hispanic Black and 17.5% were Hispanic/Latinx. While 38.9% of participants were vaccine hesitant, non-Hispanic Black and Hispanic/Latinx participants were more vaccine hesitant (adjusted odds ratio [AOR] = 3.62; 95% CI 1.77, 7.40) compared to non-Hispanic Whites/Others. Additional factors associated with vaccine hesitancy after adjustment for socioeconomic status and barriers related to SDOH included low perceived risk of COVID-19 and not receiving COVID-19 information from medical institutions and community health workers (p < 0.05). Race/ethnicity, perceived risk, sources of health information, and conspiracy beliefs played a significant role in vaccine hesitancy among this diverse sample. Interventions to promote vaccination should include trusted messengers and sources of information, while long term efforts should focus on addressing the social conditions that deter confidence in scientific data, vaccine efficacy, and the healthcare system.

College students' knowledge and attitudes toward clinical trials and their relationship with willingness to participate in COVID-19 trials or vaccines

OBJECTIVE

We examined clinical trial knowledge and attitudes, and their relationship with willingness to participate in COVID-19 vaccine trials, and willingness to accept a COVID-19 vaccine among college students.

PARTICIPANTS

331 undergraduates: mean age 25; 72% women; and 78% white.

METHODS

We administered an online, anonymous survey to undergraduate students in July, 2020, during the COVID-19 pandemic.

RESULTS

The mean clinical trial knowledge score was 65% (SD = 16) correct. The mean attitudes toward clinical trials score (1 most negative: 5 most positive) was 3.3 (SD = 0.5). Attitudes toward clinical trials were associated with likelihood of COVID-19 trial participation (positive 76% vs. negative 35%, p = 0.001) and a trend toward likelihood of accepting a COVID-19 vaccine if available (positive 89% vs. negative 67%, p = 0.066).

CONCLUSIONS

General clinical trial knowledge and attitudes appear to be important targets for educational interventions. Furthermore, fostering positive attitudes may lead to improved COVID-19 trial participation and vaccine uptake.

Parents' intention to vaccinate their preschool children against COVID-19: Combining the health belief model and the theory of planned behavior

The vaccination rate of COVID-19 in preschool children is low, and parents' intention to vaccinate their children is also low due to multiple factors. This study aimed to establish an integrated model based on the Health Belief Model (HBM)and Theory of Planned Behavior (TPB), to explore the factors influencing parents' intention to vaccinate their preschool children with the first and second doses of COVID-19 vaccines. A total of 1264 parents of preschool children from 10 kindergartens participated in this study. Hierarchical multiple logistic regression was used to analyze the intention separately. For the integrated model with the first dose of vaccine of COVID-19, introducing the HBM variable in model 1 explained 33.98% of the variance (F = 398.71, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 41.93% (F = 491.94, p < .001) and parents' intention were associated with their perceived barriers, cues to action, and subjective norms. For the integrated model with the second dose of vaccine of COVID-19, introducing the HBM variable in Model 1 explained 23.76% of the variance (F = 68.82, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 26.67% (F = 77.24, p < .001), and parents' intention was associated with cues to action and subjective norms. The combination of the two theories improves the explanatory power of parents' intention to vaccinate their preschool children against COVID-19, and provides a basis for the development of effective interventions for vaccination of COVID-19 for preschool children.

Attitudes toward annual COVID-19 boosters are highly structured by partisan self-identification and trust in government: Evidence from a longitudinal survey

Objectives

On January 26, 2023, an advisory panel of the United States Food and Drug Administration (FDA) approved a plan for annual vaccination for COVID-19. Given slowing booster uptake in the US, full participation of the public is in doubt. Using data from a longitudinal survey, we investigated the predictors of attitudes toward receiving a COVID-19 booster dose annually.

Study design

In February 2023, we completed a panel study of 243 adults from South Dakota who indicated being at least fully vaccinated in a survey conducted in May 2022.

Methods

In addition to attitudes on an annual booster, we measured partisan self-identification, trust in government, interpersonal trust, COVID-19 vaccination status, age, gender, education, and income. We examined the effect of changes in COVID-19 vaccination status, and the two trust variables on the willingness to receive a COVID-19 booster dose annually.

Results

Logistic regression analysis results showed statistically significant relationships between partisan self-identification, changes in trust in government and COVID-19 vaccination status, age, and the willingness to receive a COVID-19 booster dose annually.

Conclusions

The findings underscore the continued relevance of partisan self-identification and trust in government on attitudes toward COVID-19 mitigation measures.

Application of Protection Motivation Theory to COVID-19 vaccination among a predominantly Hispanic sample of adolescents

Despite the efficacy and widespread availability of COVID-19 vaccines, vaccine uptake has been relatively low in U.S. Hispanic communities, especially among adolescents. This study examined vaccination status among 444 high school students in predominantly Hispanic neighborhoods of Los Angeles County, California in May-June 2022 (mean age = 15.74 years, 55% female, 93% Hispanic). Guided by Protection Motivation Theory, we hypothesized that the odds of being fully vaccinated (at least 2 vaccine doses) would be significantly associated with higher levels of perceived severity, perceived vulnerability, response efficacy, and self-efficacy. 79% of the respondents were fully vaccinated. Binary logistic regression analyses found that response efficacy (belief in the effectiveness of the COVID-19 vaccine) and self-efficacy to get vaccinated were significantly associated with the likelihood of being fully vaccinated. Perceived severity of COVID-19 and perceived vulnerability to COVID-19 were not associated with the likelihood of being fully vaccinated. Results indicate that health communications are needed to convince Hispanic adolescents and their parents that the COVID-19 vaccine is effective, and outreach efforts are needed to remove barriers to vaccination among this population.

Compliance, procrastination and refusal: American COVID-19 vaccination trust and value orientation

INTRODUCTION

COVID-19 vaccine hesitancy studies, most of which were completed prior to the release of the vaccine, speculated on factors that might influence inoculation intention when a vaccine was introduced. This paper examines actual vaccination decisions among US residents after COVID-19 vaccines were approved, with a focus on trust in vaccine effectiveness, increased trust in government pandemic response, and individual-versus-collective value orientation.

METHOD

The data set was from the Kaiser Family Foundation COVID-19 Vaccine Monitor, a nationally representative sample reflecting the opinions of 1519 American adults aged 18 and above. Data were collected in September 2021-approximately nine months after the first COVID-19 vaccines were approved for distribution. Indicators of trust in vaccine effectiveness included individual opinions regarding breakthrough infections and vaccine boosters. Increased trust in government indicated approval of official COVID-19 responses, and value orientation denoted respondent emphasis on personal choice versus protecting the health of others. We established three categories of a vaccine hesitancy dependent variable: none, some, and full rejection. A multinomial regression analysis was employed to compare vaccine hesitancy in three pairs of contrasting groups.

RESULTS

While we noted distinct patterns in decision-making factors for each of the contrasting pairs, we also observed strong effects for trust in vaccine effectiveness and value orientation on vaccine decisions across all three. Both effects were more substantial than those associated with three control variables-social-demographic characteristics, political party affiliation, and health risk.

CONCLUSION

Our findings suggest that in order to increase vaccination rates, policymakers and influencers should focus on reducing individual scepticism over breakthrough infections and vaccine boosters, and on influencing a value orientation shift from personal choice to social responsibility.

Psychological and Personality Characteristics Associated With COVID-19 Vaccination Behavior in Korean General Population

BACKGROUND

This study characterized coronavirus disease 2019 (COVID-19) vaccination behavior in the Korean general population using cluster analysis and explored related psychological factors.

METHODS

We categorized 1,500 individuals based on their attitudes toward COVID-19 vaccination using hierarchical clustering and identified their level of vaccine acceptance. We examined the associations between vaccine acceptance and behavioral and psychological characteristics.

RESULTS

Clustering revealed three groups according to vaccine acceptance: 'totally accepting' (n = 354, 23.6%), 'somewhat accepting' (n = 523, 34.9%), and 'reluctant' (n = 623, 41.5%). Approximately 60% of all participants who belonged to the 'totally accepting' and 'somewhat accepting' groups were willing to receive a COVID-19 vaccine despite concerns about its side effects. High vaccine acceptance was associated with older age, regular influenza vaccination, and trust in formal sources of information. Participants with high vaccine acceptance had higher levels of gratitude, extraversion, agreeableness, and conscientiousness, and lower levels of depression, anxiety, and neuroticism.

CONCLUSIONS

People weighed the benefits of COVID-19 vaccination against the risk of side effects when deciding to receive the COVID-19 vaccine. Our findings also indicate that this vaccination behavior may be affected by coping mechanisms and psychological factors.

Public perception of COVID-19 vaccines through analysis of Twitter content and users

BACKGROUND

With the global continuation of the COVID-19 pandemic, the large-scale administration of a SARS-CoV-2 vaccine is crucial to achieve herd immunity and curtail further spread of the virus, but success is contingent on public understanding and vaccine uptake. We aim to understand public perception about vaccines for COVID-19 through the wide-scale, organic discussion on Twitter.

METHODS

This cross-sectional observational study included Twitter posts matching the search criteria (('covid*' OR 'coronavirus') AND 'vaccine') posted during vaccine development from February 1st through December 11th, 2020. These COVID-19 vaccine related posts were analyzed with topic modeling, sentiment and emotion analysis, and demographic inference of users to provide insight into the evolution of public attitudes throughout the study period.

FINDINGS

We evaluated 2,287,344 English tweets from 948,666 user accounts. Individuals represented 87.9 % (n = 834,224) of user accounts. Of individuals, men (n = 560,824) outnumbered women (n = 273,400) by 2:1 and 39.5 % (n = 329,776) of individuals were ≥40 years old. Daily mean sentiment fluctuated congruent with news events, but overall trended positively. Trust, anticipation, and fear were the three most predominant emotions; while fear was the most predominant emotion early in the study period, trust outpaced fear from April 2020 onward. Fear was more prevalent in tweets by individuals (26.3 % vs. organizations 19.4 %; p < 0.001), specifically among women (28.4 % vs. males 25.4 %; p < 0.001). Multiple topics had a monthly trend towards more positive sentiment. Tweets comparing COVID-19 to the influenza vaccine had strongly negative early sentiment but improved over time.

INTERPRETATION

This study successfully explores sentiment, emotion, topics, and user demographics to elucidate important trends in public perception about COVID-19 vaccines. While public perception trended positively over the study period, some trends, especially within certain topic and demographic clusters, are concerning for COVID-19 vaccine hesitancy. These insights can provide targets for educational interventions and opportunity for continued real-time monitoring.

Determinant Factors of Voluntary or Mandatory Vaccination against COVID-19: A Survey Study among Students at Albanian University

INTRODUCTION

The world faced serious health and socioeconomic issues with the advent of COVID-19. Along with handwashing, social distancing, and the wearing of masks, vaccination was considered by medical authorities as a key way to curb the spread of the virus. One of the measures that have been proposed to increase vaccinations is the mandatory policy. The purpose of this study was to compare the determinants of voluntary and mandatory vaccination among students at Albanian University.

METHODOLOGY

This cross-sectional study, conducted by means of an online survey, was conducted among students enrolled at the private Albanian University, Tirana, Albania during the last week of the winter semester, 7-14 February 2022.

RESULTS

In sum, 878 students participated in this study, among whom 612 (69.7%) were females and 266 (30%) were males. Of the participants, 506 (57%) were enrolled in medical science (MS) and 372 (42.3%) were in the non-medical science (Non-MS) group. A total of 773 (88%) were vaccinated against COVID-19, and 105 (11.8%) were not vaccinated. A total of 466 (53%) reported voluntary vaccination, and 412 (46.9%) reported mandatory vaccination. Among the students who were vaccinated voluntarily, 266 (57%) were from the MS group and 200 (42.9%) were from the Non-MS group. A total of 237 (57.5%) of students in the mandatory vaccination group were from the MS group, and 175 (42.4%) were from the Non-MS group.

CONCLUSIONS

Vaccine safety and efficacy were hindering factors in vaccination. Additionally, based on the results of this study, the students felt encouraged by the academic staff to vaccinate. This clearly demonstrates that the staff does not lack the skills to enhance students' knowledge about the risk of infectious diseases and the importance of vaccination. Therefore, to influence students' attitudes as much as possible toward vaccination, comprehensive educational programs, including modifications of existing curricula, should be considered.

Vaccine Equity: Lessons Learned Exploring Facilitators and Barriers to COVID-19 Vaccination in Urban Black Communities

COVID-19 vaccines were developed at unparalleled speed, but racial disparities persist in vaccine uptake. This is a cross-sectional survey that was conducted in mid-2021 in ambulatory clinics across Brooklyn, New York. The objectives of the study were to assess: knowledge of COVID-19, healthcare communication and access, attitudes including trust in the process of vaccine development and mistrust due to racial discrimination, and to determine the relationship of the above to vaccine receipt. 58 respondents self-identified as Black non-Hispanic and completed the survey: the majority were women (79%), <50 years old (65%), employed (66%), and had annual household income <$75,000 (59%). The majority reported having some health insurance (97%) and a regular place of healthcare (95%). 60% of respondents reported COVID-19 vaccination receipt. A significant percentage of the vaccinated group compared to the unvaccinated group scored higher on knowledge questions (91% vs. 65%; p = 0.018), felt it was important that others in the community get vaccinated (89% vs. 65%, p = 0.04), and trusted vaccine safety (86% vs. 35%; p < 0.0001) and effectiveness (88% vs. 48%; p < 0.001). The unvaccinated group reported a lower annual household income of <$75,000 (72% vs. 50%; p = 0.0002) and also differed by employment status (p = 0.04). Majority in both groups agreed that racial discrimination interferes with healthcare (78%). In summary, unvaccinated Black non-Hispanic respondents report significant concerns about vaccine safety and efficacy and have greater mistrust in the vaccine development process. The relationship between racial discrimination, mistrust, and vaccine hesitancy needs further study in order to improve vaccine uptake in this population.

Healthcare workers' (HCWs) attitudes and related factors towards COVID-19 vaccination: a rapid systematic review

Herd immunity through vaccination is a key measure to control COVID-19 pandemic. However, vaccine hesitancy remains a public health threat, which is still common among healthcare workers (HCWs). This systematic review aimed to synthesise evidence on HCWs' attitudes towards COVID-19 vaccination and analyse associated factors to provide information for vaccine policy development and practice. We searched PubMed, Embase, ScienceDirect, Web of Science and three Chinese databases for literature published on 12 February 2021. Two researchers screened the literature independently, and 13 studies were included in the systematic review. Vaccine acceptance varied widely and ranged from 27.7% to 77.3%. HCWs had positive attitudes towards future COVID-19 vaccines, while vaccine hesitancy was still common. Demographic variables such as men, older age and physicians were positive predictive factors. Women and nurses had more vaccine hesitancy. Previous influenza vaccination and self-perceived risk were facilitators. Concerns for safety, efficacy and effectiveness and distrust of the government were barriers. Influences of direct (COVID-19) patient care towards vaccination intention were less conclusive. Tailored communication strategies were needed to increase the uptake rate of COVID-19 vaccines among HCWs. More importantly, more data and information on the safety and efficacy of vaccines should be provided with transparency.

COVID-19 vaccination coverage and its cognitive determinants among older adults in Shanghai, China, during the COVID-19 epidemic

Objectives

This study aimed to examine the coverage of coronavirus disease 2019 (COVID-19) vaccination and its cognitive determinants among older adults.

Methods

A cross-sectional study was conducted using a questionnaire to conduct a survey among 725 Chinese older adults aged 60 years and above in June 2022, 2 months after the mass COVID-19 outbreak in Shanghai, China. The questionnaire covered demographic characteristics, COVID-19 vaccination status, internal risk perception, knowledge, and attitude toward the efficacy and safety of COVID-19 vaccines.

Results

The vaccination rate was 78.3% among the surveyed individuals. Self-reported reasons for unwillingness to get vaccinated (multiple selections) were "concerns about acute exacerbation of chronic diseases after vaccination (57.3%)" and "concerns regarding vaccine side effects (41.4%)." Compared to the unvaccinated group, the vaccinated group tended to have a higher score in internal risk perception (t = 2.64, P < 0.05), better knowledge of COVID-19 vaccines (t = 5.84, P < 0.05), and a more positive attitude toward the efficacy and safety of COVID-19 vaccines (t = 7.92, P < 0.05). The path analysis showed that the cognitive effect on vaccination behavior is relatively large, followed by the internal risk perception, and then the attitude toward COVID-19 vaccines. The more knowledgeable the participants were about COVID-19 vaccines, the more likely they were to receive the COVID-19 vaccines. In the multivariate logistic regression, the increased coverage of COVID-19 vaccination was associated with reduced age (OR = 0.53 95% CI 0.43-0.66, P < 0.001), being a resident in other places than Shanghai (OR = 0.40, 95% CI 0.17-0.92, P < 0.05), a shorter time of lockdown (OR = 0.33, 95% CI 0.13-0.83, P < 0.05), a history of other vaccines (OR = 2.58, 95% CI 1.45-4.60, P < 0.01), a fewer number of chronic diseases (OR = 0.49, 95% CI 0.38-0.62, P < 0.001), better knowledge about COVID-19 vaccines (OR = 1.60, 95% CI 1.17-2.19, P < 0.01), and a positive attitude toward COVID-19 vaccines (OR = 9.22, 95% CI 4.69-18.09, P < 0.001).

Conclusion

Acquiring accurate knowledge and developing a positive attitude toward COVID-19 vaccines are important factors associated with COVID-19 vaccination. Disseminating informed information on COVID-19 vaccines and ensuring efficacious communication regarding their efficacy and safety would enhance awareness about COVID-19 vaccination among older adults and consequently boost their vaccination coverage.

Coronavirus-Related Searches on the Internet Predict COVID-19 Vaccination Rates in the Real World: A Behavioral Immune System Perspective

According to the smoke detector and functional flexibility principles of human behavioral immune system (BIS), the exposure to COVID-19 cues could motivate vaccine uptake. Using the tool of Google Trends, we tested that coronavirus-related searches-which assessed natural exposure to COVID-19 cues-would positively predict actual vaccination rates. As expected, coronavirus-related searches positively and significantly predicted vaccination rates in the United States (Study 1a) and across the globe (Study 2a) after accounting for a range of covariates. The stationary time series analyses with covariates and autocorrelation structure of the dependent variable confirmed that more coronavirus-related searches compared with last week indicated increases in vaccination rates compared with last week in the United States (Study 1b) and across the globe (Study 2b). With real-time web search data, psychological scientists could test their research questions in real-life settings and at a large scale to expand the ecological validity and generalizability of the findings.

The Role of Political Belief in COVID-19 Vaccine Resistance, Virus Transmission, and Closure Policy Response

We employ unique panel data on the universe of COVID-19 vaccination and infection cases in Israel to examine the role of political belief in COVID-19 vaccine uptake, virus transmission, and closure policy response. The paper identifies political beliefs based on statistical area votes in national elections held in Israel on the eve of the COVID-19 outbreak in March 2020. Unlike the U.S. and elsewhere, pandemic policy intervention in Israel was broadly supported by politicians across the belief spectrum. As such, household response to virus risk was not biased by contemporaneous partisan disagreement and debate among political leaders. Findings show, all things equal, that in the wake of emergent and localized virus risk, voters in politically right-of-center and religious areas displayed substantially higher odds of both vaccine resistance and virus transmission as compared to their left-center counterparts. Moreover, political belief is highly salient to aggregate pandemic outcomes. Model simulation shows that had all areas responded to virus risk with the more risk-averse behaviors of left-of-center areas, the number of vaccinations nationwide would have increased by 15 percent. That same scenario results in a full 30 percent reduction in total infection cases. Results also show that coercive policy measures such as economic closure were more effective in reducing virus transmission among less risk-averse right-wing and religious areas. Findings provide new evidence of the role of political belief in household response to health risks. Results further underscore the importance of timely, targeted messaging and intervention among divergent political belief groups to reduce vaccine hesitancy and enhance disease control. Future studies should explore the external validity of findings, including the use of individual voter data, if available, to evaluate political belief effects.

COVID-19 vaccination in adults with inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) are not at increased risk of SARS-CoV-2 infection compared to the general population, and most are not at increased risk for severe disease. COVID-19 is nonetheless common, and vaccination is critical. Four safe and efficacious vaccines are now available for the prevention of COVID-19, with most data available for mRNA vaccines. Patients with IBD have a robust humoral response to vaccination with rates of seroconversion exceeding 95% following a two-dose mRNA vaccine series and 99% following a three-dose mRNA series, although those on certain therapies including anti-tumor necrosis factor α agents may have lower antibody concentrations and waning of antibodies over time. Additionally, rates of cell-mediated immune response, even in those patients with IBD who did not have evidence of humoral immunity, are high. Vaccines are safe and have not been associated with flares in disease activity. Gastroenterology providers should take an active role in ensuring patients with IBD are appropriately vaccinated against COVID-19.

A qualitative study on COVID-19 pandemic impacts on parental attitudes and intentions for routine adolescent vaccinations: The role of trust

INTRODUCTION

The COVID-19 pandemic has contributed to declines in routine childhood and adolescent vaccination coverage globally. While the declines in Australia have been less, they are a concern, given steady increases in coverage prior to the pandemic. Given limited evidence on how the experiences of parents during the pandemic affected their attitudes about and intentions towards adolescent vaccinations, with this study we aimed to explore these.

METHODS

This was a qualitative study. We invited parents of adolescents eligible for school-based vaccinations in 2021 from metropolitan, regional and rural areas of New South Wales and Victoria (the most affected States) and South Australia (less affected) to half hour-long online semi-structured interviews. We analysed data thematically and applied a conceptual model of trust in vaccination.

RESULTS

In July 2022 we interviewed 15 accepting, 4 hesitant and two parents who refused adolescent vaccinations. We identified three themes: 1. Pandemic impacting on professional and personal lives and routine immunisations; 2. Pandemic strengthening preexisting vaccine hesitancy, with perceived lack of clarity in governmental information about vaccination and stigma around non-vaccinating as contributing factors; 3. Pandemic raising awareness of the benefits of COVID-19 and routine vaccinations, with communication campaigns and one's trusted doctor's vaccination recommendations as contributing factors.

CONCLUSIONS

For some parents, experiences of poor system readiness and growing distrust towards health and vaccination systems strengthened their pre-existing vaccine hesitancy. We offer recommendations on how trust in the health system and immunisation can be optimised post-pandemic to increase uptake of routine vaccines. These include improving access to vaccination services and clear, timely information about vaccines; supporting immunisation providers in their immunisation consultations; working alongside communities, and building capacity of vaccine champions.

Discovery of interconnected causal drivers of COVID-19 vaccination intentions in the US using a causal Bayesian network

Holistic interventions to overcome COVID-19 vaccine hesitancy require a system-level understanding of the interconnected causes and mechanisms that give rise to it. However, conventional correlative analyses do not easily provide such nuanced insights. We used an unsupervised, hypothesis-free causal discovery algorithm to learn the interconnected causal pathways to vaccine intention as a causal Bayesian network (BN), using data from a COVID-19 vaccine hesitancy survey in the US in early 2021. We identified social responsibility, vaccine safety and anticipated regret as prime candidates for interventions and revealed a complex network of variables that mediate their influences. Social responsibility's causal effect greatly exceeded that of other variables. The BN revealed that the causal impact of political affiliations was weak compared with more direct causal factors. This approach provides clearer targets for intervention than regression, suggesting it can be an effective way to explore multiple causal pathways of complex behavioural problems to inform interventions.

Supporting US healthcare providers for successful vaccine communication

BACKGROUND

While many healthcare providers (HCPs) have navigated patients' vaccine concerns and questions prior to the rollout of the COVID-19 vaccines, sentiments surrounding the COVID-19 vaccines have presented new and distinct challenges.

OBJECTIVE

To understand the provider experience of counseling patients about COVID-19 vaccinations, aspects of the pandemic environment that impacted vaccine trust, and communication strategies providers found supportive of patient vaccine education.

METHODS

7 focus groups of healthcare providers were conducted and recorded during December 2021 and January 2022, at the height of the Omicron wave in the United States. Recordings were transcribed, and iterative coding and analysis was applied.

RESULTS

44 focus group participants representing 24 US states with the majority (80%) fully vaccinated at the time of data collection. Most participants were doctors (34%) or physician's assistants and nurse practitioners (34%). The negative impact of COVID-19 misinformation on patient-provider communication at both intrapersonal and interpersonal levels as well as barriers and facilitators to patient vaccine uptake are reported. People or sources that play a role in health communication ("messengers") and persuasive messages that impact behavior or attitudes towards vaccination ("messages") are described. Providers expressed frustration in the need to continuously address vaccine misinformation in clinical appointments among patients who remained unvaccinated. Many providers found value in resources that provided up-to-date and evidence-based information as COVID-19 guidelines continued to change. Additionally, providers indicated that patient-facing materials designed to support vaccination education were not frequently available, but they were the most valuable to providers in a changing information environment.

CONCLUSIONS

While vaccine decision-making is complex and hinges on diverse factors such as health care access (i.e., convenience, expense) and individual knowledge, providers can play a major role in navigating these factors with their patients. But to strengthen provider vaccine communication and promote vaccine uptake, a comprehensive communication infrastructure must be sustained to support the patient-provider dyad. The findings provide recommendations to maintain an environment that facilitates effective provider-patient communication at the community, organizational and policy levels. There is a need for a unified multisectoral response to reinforce the recommendations in patient settings.

Knowledge, attitudes, and behaviors with mask use and vaccines for COVID-19 prevention at 13 colleges and universities, April 2021

Objectives: To understand college and university student knowledge, attitudes, and behaviors (KAB) regarding COVID-19 prevention strategies. Methods: Thirteen colleges and universities volunteered to conduct an anonymous electronic survey in April 2021 to assess students' KAB about mask use and vaccination to prevent COVID-19. Results: Three-quarters of students indicated they "Always" wore a mask correctly when in public indoor places. Of those not yet vaccinated, 55% expressed concern about unknown side effects. Over half of students were unsure or believe they do not need to continue wearing masks after vaccination and older students more likely to be vaccinated. There was a significant inverse correlation between intention of getting vaccinated and intention to attend a large indoor party without a mask. Conclusions: Colleges and universities are important to community efforts to slow the COVID-19 pandemic. The KAB findings can inform approaches to increase overall mask use and vaccination uptake among young students.

Provider confidence in counseling preconception, pregnant, and postpartum patients regarding COVID-19 vaccination: A cross-sectional survey study

Background and Aims

Healthcare provider counseling surrounding COVID-19 vaccine in pregnancy and lactation is essential to vaccination uptake in this population; however, provider knowledge and confidence are not well characterized. We aimed to assess knowledge and confidence in COVID-19 vaccine counseling among practitioners who provide care to pregnant persons and to describe factors associated with confidence in counseling.

Methods

A web-based anonymous survey was distributed via email to a cross-sectional convenience sample of Obstetrics and Gynecology, Primary Care, and Internal Medicine faculty at three hospitals in a single healthcare network in Massachusetts, United States. Individual demographics and institution-specific variables were included in the survey along with questions assessing both attitudes toward COVID-19 illness and confidence in counseling regarding the use of the vaccine in pregnancy.

Results

Almost all providers (151, 98.1%) reported that they received a COVID-19 vaccine, and most (111, 72.1%) reported that they believe the benefits of the vaccine in pregnancy outweigh the risks. Forty-one (26.6%) reported feeling very confident in counseling patients who primarily speak English about the evidence for messenger ribonucleic acid vaccination in pregnancy, and 36 (23%) reported feeling very confident in counseling patients who are not primarily English-speaking. Forty-three providers (28.1%) expressed strong confidence in their comfort talking to individuals with vaccine hesitancy based on historic and continued racism and systemic injustices. The sources that survey respondents most used to find information regarding COVID-19 vaccination in pregnancy were the Centers for Disease Control (112, 74.2%), hospital-specific resources (94, 62.3%), and the American College of Obstetricians and Gynecologists (82, 54.3%).

Conclusion

Ensuring that providers feel comfortable bridging the gap between their belief that the vaccine is beneficial for pregnant patients and their comfort with holding conversations with patients regarding vaccination is paramount to ensure equitable access to vaccines for pregnant patients.

Reasons for not getting COVID-19 vaccine in Ardabil, a Northwestern province in Iran: Based on an ecological approach

BACKGROUND

Understanding the reasons for not getting the COVID-19 vaccine can help to increase acceptability and tackle vaccine hesitancy and consequently reach high coverage for this new vaccine. Using an ecological approach, the reasons for not getting the vaccine in the Iranian population was investigated.

METHODS AND MATERIAL

This study was conducted from October to December 2021 on 426 participants who had not received the COVID-19 vaccine. The following subsets of questions were included in the questionnaire: intrapersonal level factors, interpersonal level factors, group and organization, and society and policy-making. Multivariable logistic regression was used, and the odds ratio (OR) and 95% confidence intervals (CIs) were estimated for vaccine hesitancy (dependent variable) according to the reasons for not getting COVID vaccine scores (independent variable) using multivariable logistic regression in 3 different models, including Model 0: unadjusted, Model 1: adjusted for age, gender, and underlying disease, and Model 2: adjustment for age, gender, underlying disease, education, place of living, income, marital status, and employment.

RESULTS

A significant difference was found regarding gender between likely and not likely groups (P = 0.016). A significant association was observed between the vaccine hesitancy and interpersonal (unadjusted model: OR = 0.833 (CI: 0.738-0.942), P for trend = 0.003; model 1: OR = 0.820 (CI: 0.724-0.930), P for trend = 0.002; model 2: OR = 0.799 (CI: 0.703-0.909), P for trend = 0.001) and group and organization (unadjusted model: OR = 0.861 (CI: 0.783-0.948), P for trend = 0.002; model 1: OR = 0.864 (CI: 0.784-0.952, P for trend = 0.003; model 2:OR = 0.862 (CI: 0.781-0.951, P for trend = 0.003). There was no significant association between vaccine hesitancy and intrapersonal and society and policy-making (P > 0.05).

CONCLUSIONS

We found that a high score of "interpersonal" and "group and organization" factors were associated with lower intention to COVID vaccine. Moreover, women had higher vaccination intentions than men.

Vaccine Confidence and Uptake of the Omicron Bivalent Booster in Tennessee: Implications for Vulnerable Populations

The COVID-19 Omicron variant and its subvariants are now the dominant variants circulating in the US. Therefore, the original COVID-19 vaccine cannot offer full protection. Instead, vaccines that target the spike proteins of the Omicron variants are warranted. Hence, the FDA recommended the development of a bivalent booster. Unfortunately, despite the safety and immunogenicity of the Omicron bivalent boosters from Pfizer and Moderna, uptake in the US has been poor. At this time, only 15.8% of individuals in the US aged five and older have received the Omicron bivalent booster (OBB). The rate is 18% for those aged 18 and older. Poor vaccine confidence and booster uptake are often fueled by misinformation and vaccine fatigue. These result in more problems associated with vaccine hesitancy, which are particular prevalent in Southern states in the US. In Tennessee, the OBB vaccination rate for eligible recipients is only 5.88% at time of writing (16 February 2023). In this review, we discuss (1) the rationale for developing the OBBs; (2) the efficacy and safety of the bivalent boosters; (3) the adverse events associated with these boosters; (4) vaccine hesitancy associated with the OBBs uptake in Tennessee; (5) implications for vulnerable populations, disparities in uptake of OBBs in Tennessee, and strategies to improve vaccine confidence and OBB uptake. In support of public health, it is essential that we continue to provide education, awareness, and vaccine access to the vulnerable and medically underserved populations in Tennessee. Receiving the OBBs is the most effective method to date of protecting the public against severe COVID disease, hospitalization, and death.

A Qualitative Investigation on COVID-19 Vaccine Hesitancy in Neurodivergent Communities

Vaccine hesitancy is a major barrier to vaccination, hindering the success of vaccine efforts and thereby increasing public health risk to viral diseases, including COVID-19. Neurodivergent (ND) individuals, including individuals with an intellectual and/or developmental disability, have demonstrated a heightened risk of hospitalization and death due to COVID-19, highlighting the need for further research specifically on ND communities. We conducted a qualitative analysis using in-depth interviews with medical professionals, non-medical health professionals and communicators, and ND individuals or their caregivers. Using a thematic coding analysis methodology, trained coders identified major themes according to 24 distinct codes spanning across the categories of (1) barriers to vaccination; (2) facilitators to vaccination; and (3) suggestions for improving vaccine confidence. Qualitative findings identify misinformation, perception of vaccine risk, sensory sensitivities, and structural hardship as the most significant barriers to COVID-19 vaccination. We highlight the importance of accommodations to vaccination for the ND community alongside coordinated efforts by healthcare leaders to direct their communities to accurate sources of medical information. This work will inform the direction of future research on vaccine hesitancy, and the development of programs specific to the ND community's access to vaccines.

Analysis of Differences in User Groups and Post Sentiment of COVID-19 Vaccine Hesitators in Chinese Social-Media Platforms

(1) Background: The COVID-19 epidemic is still global and no specific drug has been developed for COVID-19. Vaccination can both prevent infection and limit the spread of the epidemic. Eliminating hesitation to the COVID-19 vaccine and achieving early herd immunity is a common goal for all countries. However, efforts in this area have not been significant and there is still a long way to go to eliminate vaccine hesitancy. (2) Objective: This study aimed to uncover differences in the characteristics and sentiments of COVID-19 vaccine hesitators on Chinese social-media platforms and to achieve a classification of vaccine-hesitant groups. (3) Methods: COVID-19-vaccine-hesitation posts and user characteristics were collected on the Sina Microblog platform for posting times spanning one year, and posts were identified for hesitation types. Logistic regression was used to conduct user-group analysis. The differences in user characteristics between the various types of COVID-19 vaccine posts were analysed according to four user characteristics: gender, address type, degree of personal-information disclosure, and whether they followed health topics. Sentiment analysis was conducted using sentiment analysis tools to calculate the sentiment scores and sentiment polarity of various COVID-19 vaccine posts, and the K-W test was used to uncover the sentiment differences between various types of COVID-19-vaccine-hesitation posts. (4) Results: There are differences in the types of COVID-19-vaccine-hesitation posts posted by users with different characteristics, and different types of COVID-19-vaccine-hesitation posts differ in terms of sentiment. Differences in user attributes and user behaviors are found across the different COVID-19-vaccine-hesitation types. Ultimately, two COVID-19-vaccine-hesitant user groups were identified: Body-related and Non-bodily-related. Users who posted body-related vaccine-hesitation posts are more often female, disclose more personal information and follow health topics on social-media platforms. Users who posted non-bodily-related posts are more often male, disclose less personal information, and do not follow health topics. The average sentiment score for all COVID-19-vaccine-hesitant-type posts is less than 0.45, with negative-sentiment posts outweighing positive- and neutral-sentiment posts in each type, among which the "Individual rights" type is the most negative. (5) Conclusions: This paper complements the application of user groups in the field of vaccine hesitation, and the results of the analysis of group characteristics and post sentiment can help to provide an in-depth and comprehensive analysis of the concerns and needs of COVID-19 vaccine hesitators. This will help public-health agencies to implement more targeted strategies to eliminate vaccine hesitancy and improve their work related to the COVID-19 vaccine, with far-reaching implications for COVID-19-vaccine promotion and vaccination.

Demographic and Psychosocial Correlates of COVID-19 Vaccination Status among a Statewide Sample in Texas

The COVID-19 pandemic has been a global public health concern since early 2020 and has required local and state-level responses in the United States. There were several Food and Drug Administration (FDA) approved vaccines available for the prevention of COVID-19 as of August 2022, yet not all states have achieved high vaccination coverage. Texas is a particularly unique state with a history of opposing vaccination mandates, as well as a large and ethnically/racially diverse population. This study explored the demographic and psychosocial correlates of COVID-19 vaccinations among a statewide sample in Texas. A quota sample of 1089 individuals was surveyed online from June-July 2022. The primary outcome in this study was COVID-19 vaccination status (fully vaccinated, partially vaccinated, or unvaccinated) and included independent variables related to demographics, COVID-19 infection/vaccine attitudes and beliefs, and challenges related to the COVID-19 pandemic. Hispanic/Latinx individuals were more likely than non-Hispanic White individuals to be partially vaccinated as opposed to unvaccinated. Higher education levels and confidence that the FDA would ensure a safe COVID-19 vaccine were strongly associated with a higher likelihood of being fully vaccinated. In addition, some challenges brought on by the pandemic and concerns about becoming infected or infecting others were associated with a higher likelihood of being partially or fully vaccinated. These findings emphasize the need to further investigate the interaction between individual and contextual factors in improving COVID-19 vaccination rates, especially among vulnerable and disadvantaged populations.

COVID-19 Vaccine Refusal and Delay among Adults in Italy: Evidence from the OBVIOUS Project, a National Survey in Italy

BACKGROUND

Vaccine hesitancy was defined by the World Health Organization (WHO) in 2019 as a major threat to global health. In Italy, reluctance to receive vaccines is a widespread phenomenon that was amplified during the COVID-19 pandemic by fear and mistrust in government. This study aims to depict different profiles and characteristics of people reluctant to vaccinate, focusing on the drivers of those who are in favor of and those who are opposed to receiving the COVID-19 vaccine.

METHODS

A sample of 10,000 Italian residents was collected. A survey on COVID-19 vaccination behavior and possible determinants of vaccine uptake, delay, and refusal was administered to participants through a computer-assisted web interviewing method.

RESULTS

In our sample, 83.2% stated that they were vaccinated as soon as possible ("vaccinators"), 8.0% delayed vaccination ("delayers"), and 6.7% refused to be vaccinated ("no-vaccinators"). In general, the results show that being female, aged between 25 and 64, with an education level less than a high school diploma or above a master's degree, and coming from a rural area were characteristics significantly associated with delaying or refusing COVID-19 vaccination. In addition, it was found that having minimal trust in science and/or government (i.e., 1 or 2 points on a scale from 1 to 10), using alternative medicine as the main source of treatment, and intention to vote for certain parties were characteristics associated with profiles of "delayers" or "no-vaccinators". Finally, the main reported motivation for delaying or not accepting vaccination was fear of vaccine side effects (55.0% among delayers, 55.6% among no-vaccinators).

CONCLUSION

In this study, three main profiles of those who chose to be vaccinated are described. Since those who are in favor of vaccines and those who are not usually cluster in similar sociodemographic categories, we argue that findings from this study might be useful to policy makers when shaping vaccine strategies and choosing policy instruments.

Understanding the barriers and facilitators of vaccine hesitancy towards the COVID-19 vaccine in healthcare workers and healthcare students worldwide: An Umbrella Review

BACKGROUND

Healthcare workers (HCWs) and healthcare students display high levels of vaccine hesitancy with impact on healthcare provision, patient safety, and health promotion. The factors related to vaccine hesitancy have been reported in several systematic reviews. However, this evidence needs to be synthesised, as interventions to reduce vaccination hesitancy in this population are needed.

METHODS

This Umbrella Review aimed to explore the barriers and facilitators of vaccine hesitancy toward the COVID-19 vaccine for HCWs and healthcare students. The review was performed and reported in accordance with Joanna Briggs Institutes guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A protocol was preregistered on PROSPERO (CRD42022327354). Eight databases were searched from November 2019 to 23rd May 2022 to identify any systematic reviews that explored factors associated with hesitancy towards the COVID-19 vaccine for HCWs or healthcare students.

RESULTS

A total of 31 studies were included in the review. The majority of studies (71%) were appraised as strong or moderate quality and there was a slight degree of overlap (<5%) of primary studies between the reviews. Vaccine hesitancy was more common among HCWs and healthcare students in specific occupational roles (e.g. nurses) than others (e.g. physicians). Frequent reasons for hesitancy were related to sociodemographic factors (gender, age, ethnicity), occupational factors (COVID-19 exposure, perceived risk, mandatory vaccination), health factors (vaccination history), vaccine-related factors (concerns about safety, efficacy, side-effects, rapid development, testing, approval and distribution of the vaccine), social factors (social pressure, altruism and collective responsibility), distrust factors (key social actors, pandemic management), information factors (inadequate information and sources, exposure to misinformation).

CONCLUSION

The results from this Umbrella Review have wide-reaching implications for the research area, healthcare systems and institutions and governments worldwide. Designing tailored strategies for specific occupational groups is pivotal to increasing vaccine uptake and securing a safe healthcare provision worldwide.

How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago

BACKGROUND

A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas.

METHODS

Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI).

RESULTS

Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree).

CONCLUSIONS

Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity.

CLINICAL TRIALS NUMBER

NCT03584490.

The impact of educational interventions on COVID-19 and vaccination attitudes among patients in Michigan: A prospective study

Background

Mass vaccination serves as an effective strategy to combat the COVID-19 pandemic. Vaccine hesitancy is a recognized impediment to achieving a vaccination rate necessary to protect communities. However, solutions and interventions to address this issue are limited by a lack of prior research.

Methods

Over 200 patients from 18 Michigan counties participated in this study. Each participant received an initial survey, including demographical questions and knowledge and opinion questions regarding COVID-19 and vaccines. Participants were randomly assigned an educational intervention in either video or infographic format. Patients received a post-survey to assess changes in knowledge and attitudes. Paired sample t-tests and ANOVA were used to measure the effectiveness of the educational interventions. Participants also elected to complete a 3-month follow-up survey.

Results

Patients showed increased knowledge after the educational intervention in six out of seven COVID-19 topics (p &lt; 0.005). There was increased vaccine acceptance after the intervention but no difference in the effectiveness between the two intervention modalities. Post-intervention, more patients believed in CDC recommendations (p = 0.005), trusted the vaccine (p = 0.001), believed the vaccines had adequate testing (p = 0.019), recognized prior mistreatment in the medical care system (p = 0.005), agreed that a source they trust told them to receive a vaccine (p = 0.015), and were worried about taking time off of work to get a vaccine (p = 0.023). Additionally, post-intervention, patients were less concerned about mild reactions of the virus (p = 0.005), the rapid development of the vaccines (p &lt; 0.001), and vaccine side effects (p = 0.031). Data demonstrated that attitude and knowledge improved when comparing pre-educational intervention to follow-up but decreased from post-intervention to follow-up.

Conclusion

The findings illustrate that educational interventions improved COVID-19 and vaccine knowledge among patients and that the knowledge was retained. Educational interventions serve as powerful tools to increase knowledge within communities and address negative views on vaccination. Interventions should be continually utilized to reinforce information within communities to improve vaccination rates.

Communication and Perspectives About COVID-19 and Vaccinations Among Native Americans

The COVID-19 pandemic disproportionately affected Native American people and communities across the United States. Despite unequal losses during the pandemic, Native Americans have high vaccination rates. We provide insight into perspectives of COVID-19 and vaccinations through in-depth interviews with Native Americans. Through this research, we provide a holistic view of how Native Americans perceive vaccines by pairing Indigenous perspectives of risk and the Health Belief Model. We discuss the importance of tribal sovereignty in developing health communication strategies, and the need for messaging that is trusted and culturally appropriate.

Provision of and trust in COVID-19 vaccines information: Perspectives of people who have had COVID-19

AIM

The aim of this study was to understand the provision and need, quality of and trust in COVID-19 vaccines information from the perspectives of people who have had COVID-19 infection.

METHOD

People who have had a COVID-19 infection were approached via their general practice and invited to participate in the Nivel Corona Cohort. They completed questionnaires at baseline (Q1), and at three months (Q2). Outcome measures were based on health information-seeking behaviour, as used in the Comprehensive Model of Information Seeking. Antecedents (i.e., gender, age, education level, health literacy) were used from Q1, and one's beliefs and experiences (i.e., trust in the information and healthcare system, how applicable the information is), information carrier factors (i.e., information quality perceptions and via which sources), health-information seeking actions (i.e., decision to vaccinate and information sufficiency) and vaccination status from Q2. Data were analysed using descriptive analyses, analysis of variance tests (F-tests) and χ² tests with the statistical software STATA.

RESULTS

Of the respondents (N = 314), 96% were vaccinated at least once, mostly after having had the virus. Most retrieved information about COVID-19 vaccines on the website of the National Institute for Public Health and the Environment (79%), broader via the internet (56%), or from family and friends (35%). Almost all had trust in the information (89%) and healthcare system (94%). Most found the information applicable to their situation (67%). Moreover, most perceived the information as correct (71%) and did not perceive the information to be misleading (85%), while fewer people found the information reliable (59%) and clear (58%). Overall, the majority indicated that the information met their expectations to make a well-informed decision to vaccinate (89%).

CONCLUSION

Different characteristics of people who had COVID-19 and sought information were identified, which is important to offer tailored information. People who had COVID-19 in this study, mainly middle-aged, vaccinated and highly educated, were generally positive about the vaccines information, but overall the reliability and clarity could be improved. This is important for a high vaccination uptake, booster programs and coming pandemics.

PATIENT OR PUBLIC CONTRIBUTION

The questionnaire was reviewed by patients who had COVID-19, one of whom is a health services researcher.

COVID-19 vaccine uptake and attitudes towards mandates in a nationally representative U.S. sample

Widespread uptake of COVID-19 vaccination is vital to curtailing the pandemic, yet rates remain suboptimal in the U.S. Vaccine mandates have previously been successful, but are controversial. An April 2021 survey of a nationally representative sample (N = 1208) examined vaccine uptake, attitudes, and sociodemographic characteristics. Sixty-seven percent were vaccine acceptors, 14% wait-and-see, and 19% non-acceptors. Compared to wait-and-see and non-acceptors, acceptors were more likely to have a household member over age 65, have received a flu shot, have positive COVID-19 vaccine attitudes, and view COVID-19 vaccination as beneficial. Mandate support was higher among respondents who were vaccine acceptors, had positive views about COVID-19 vaccines, believed in COVID-19 preventive strategies, perceived COVID-19 as severe, were liberal, resided in the Northeast, were non-White, and had incomes < $75,000. Public health campaigns should target attitudes that appear to drive hesitancy and prepare for varying mandate support based on demographics, COVID-19 vaccine attitudes, and the scope of the mandate.

Shifting Mobility Behaviors in Unprecedented Times: A Multigroup MIMIC Model Investigating Intentions to Use On-Demand Ride Services During the COVID-19 Pandemic

The spread of COVID-19 has been a major disruptive force in people's everyday lives and mobility behavior. The demand for on-demand ride services, such as taxis and ridehailing, has been specifically affected given both restrictions in service operations and users' concerns about virus transmission in shared vehicles. In the early months of the pandemic, demand for these modes decreased by as much as 80%. This study examines intentions to use on-demand ride services in the early lockdown stage of the pandemic in the United States, a period of unprecedented mobility reductions, changing household routines and transforming travel behaviors. Using data from a survey disseminated in June 2020 to 700 U.S. respondents, we use multigroup MIMIC (Multiple Indicator Multiple Cause) models to investigate the stated shift in intentions to use on-demand modes of travel. By using group-based segmentation we control for variation in ridership intentions according to personal, household, attitudinal factors, and pandemic experiences. The results point to a reduction across the board in the likelihood of using on-demand mobility associated with a significant COVID-19 effect. Beyond this general decrease, several groups are found to have more positive intentions, including younger adults, urban residents, graduate-degree holders, and people of Hispanic, Latino, Asian, and Pacific Islander ethnicities/races. The attitudinal effect of "tech-savviness" drives higher user intentions, revealing indirect effects of gender, education, and age. Multigroup analysis provides further evidence of potential COVID-triggered shifts in on-demand ridership intentions. The most significant drops in likelihood are observed for younger respondents (below 45), Black compared with all other racial/ethnic status, and for past users of on-demand mobility. This latter result is somewhat surprising, as riders who are younger and more experienced with on-demand travel are more likely to have been users in the past, but also more likely to reduce use during the pandemic. To conclude, we discuss the need to investigate pandemic experiences, risk attitudes, and circumstances to understand evolving mobility behavior and specific service model impacts.