Predictors of Vaccine Hesitancy: Implications for COVID-19 Public Health Messaging

The impact of risk perception and institutional trust on COVID-19 vaccine hesitancy in China

Vaccination has become the primary means for citizens to prevent severe morbidity and mortality during the pandemic. However, vaccine hesitancy poses a major threat to global public health security. Based on the data from Chinese General Social Survey in 2021, this study aims to explore the socio-political aspects of COVID-19 vaccine hesitancy, focusing on the relationship between COVID-19 risk perceptions, institutional trust and vaccine hesitancy. Among the samples, 39.8% of the respondents exhibited COVID-19 vaccine hesitancy, 48.9% had a high awareness of the risk of COVID-19, and 74.6% presented a high level of trust in institutions. The results showed that higher risk perception and institutional trust are negatively correlated with vaccine hesitancy (p < .001). Institutional trust had no statistically significant moderating effect on the association between risk perception and vaccine hesitancy, but the role of institutional trust in influencing vaccine hesitancy is more significant at a lower level of perceptions of COVID-19 risk. Furthermore, regional variations in the factors contributing to vaccine hesitancy were demonstrated in China. These findings have important implications for developing strategies to address vaccine hesitancy.

Predicting COVID-19 Vaccination Intentions to Inform Evidence-Based Messaging for Building Vaccine Confidence Among Rural Americans

PURPOSE

Examine possible message topics to promote rural vaccination using psychosocial antecedents of vaccination.

DESIGN

Cross-sectional survey administered by Research America, Inc.

SETTING

West Virginia (WV).

SAMPLE

756 WV adults via convenience sample (n = 370; ∼2% response rate from online panel of ∼20 000 WV residents), and random digit dial of landlines (n = 174; ∼1% response rate from 18 432 numbers) and cellphones (n = 212; ∼1% response rate from 20 486 numbers).

MEASURES

Outcome measures included self-reported vaccination intention and behavior. Predictor measures, rooted in theories of social and behavioral science that have been found to be predictive of vaccination outcomes (i.e., Reasoned Action Approach, Extended Parallel Process Model), included perceived severity and susceptibility, negative affect, instrumental and affective attitudes, social norms, self-efficacy, response efficacy, and perceived control.

ANALYSIS

Multivariate linear regression for intention and logistic regression for behavior.

RESULTS

Intention was positively predicted by affective attitude, β = .30, P < .05, instrumental attitude, β = .19, P < .05, response efficacy, β = .19, P < .05, negative affect, β = .16, P < .05, self-efficacy, β = .13, P < .05, and subjective norm, β = .13, P < .05, F(10, 267) = 30.12, Adj. R2 = .53. Vaccination status was predicted by instrumental attitude, exp(B) = 2.09, and subjective norm, exp(B) = 2.00, Pseudo R2 = .29, log likelihood = 125.11, χ2(10) = 38.34, P < .05. Promising message targets were instrumental attitude, M = 3.21, SD = 1.46, and subjective norms, M = 3.76, SD = 1.71.

CONCLUSION

COVID-19 vaccine confidence messages should address (1) positive feelings and safety perceptions, (2) vaccination's effectiveness in preventing serious COVID-19, and (3) subjective vaccination norms.

Partisan Media, Trust, and Media Literacy: Regression Analysis of Predictors of COVID-19 Knowledge

BACKGROUND

The COVID-19 pandemic was a devastating public health event that spurred an influx of misinformation. The increase in questionable health content was aided by the speed and scale of digital and social media and certain news agencies' and politicians' active dissemination of misinformation about the virus. The popularity of certain COVID-19 myths created confusion about effective health protocols and impacted trust in the health care and government sectors deployed to manage the pandemic.

OBJECTIVE

This study explored how people's information habits, their level of institutional trust, the news media outlets they consume and the technologies in which they access it, and their media literacy skills influenced their COVID-19 knowledge.

METHODS

We administered a web-based survey using Amazon Mechanical Turk (MTurk) to assess US adults' (n=1498) COVID-19 knowledge, media and news habits, media literacy skills, and trust in government and health-related institutions. The data were analyzed using a hierarchical linear regression to examine the association between trust, media literacy, news use, and COVID-19 knowledge.

RESULTS

The regression model of demographic variables, political affiliation, trust in institutions, media literacy, and the preference for watching Fox or CNN was statistically significant (R2=0.464; F24,1434=51.653; P<.001; adjusted R2=0.455) in predicting COVID-19 knowledge scores. People who identified as politically conservative, watched Fox News, and reported lower levels of institutional trust and media literacy, scored lower on COVID-19 knowledge questions than those who identified as politically liberal, did not watch Fox News and reported higher levels of institutional trust and media literacy.

CONCLUSIONS

This study suggests that the media outlets people turn to, their trust in institutions, and their perceived degree of agency to discern credible information can impact people's knowledge of COVID-19, which has potential implications for managing communication in other public health events.

Associations between COVID-19 therapies and outcomes in rural and urban America: A multisite, temporal analysis from the Alpha to Omicron SARS-CoV-2 variants

PURPOSE

To investigate the enduring disparities in adverse COVID-19 events between urban and rural communities in the United States, focusing on the effects of SARS-CoV-2 vaccination and therapeutic advances on patient outcomes.

METHODS

Using National COVID Cohort Collaborative (N3C) data from 2021 to 2023, this retrospective cohort study examined COVID-19 hospitalization, inpatient death, and other adverse events. Populations were categorized into urban, urban-adjacent rural (UAR), and nonurban-adjacent rural (NAR). Adjustments included demographics, variant-dominant waves, comorbidities, region, and SARS-CoV-2 treatment and vaccination. Statistical methods included Kaplan-Meier survival estimates, multivariable logistic, and Cox regression.

FINDINGS

The study included 3,018,646 patients, with rural residents constituting 506,204. These rural dwellers were older, had more comorbidities, and were less vaccinated than their urban counterparts. Adjusted analyses revealed higher hospitalization odds in UAR and NAR (aOR 1.07 [1.05-1.08] and 1.06 [1.03-1.08]), greater inpatient death hazard (aHR 1.30 [1.26-1.35] UAR and 1.37 [1.30-1.45] NAR), and greater risk of other adverse events compared to urban dwellers. Delta increased, while Omicron decreased, inpatient adverse events relative to pre-Delta, with rural disparities persisting throughout. Treatment effectiveness and vaccination were similarly protective across all cohorts, but dexamethasone post-ventilation was effective only in urban areas. Nirmatrelvir/ritonavir and molnupiravir better protected rural residents against hospitalization.

CONCLUSIONS

Despite advancements in treatment and vaccinations, disparities in adverse COVID-19 outcomes persist between urban and rural communities. The effectiveness of some therapeutic agents appears to vary based on rurality, suggesting a nuanced relationship between treatment and geographic location while highlighting the need for targeted rural health care strategies.

Differential Mortality Among Heart Failure Patients Across Different COVID-19 Surges in New York City

ABSTRACT

Learning from the healthcare system's response to the COVID-19 pandemic is essential to better prepare for potential future crises. We sought to assess mortality rates for patients admitted for acute decompensated heart failure (HF) and to analyze which factors demonstrated a statistically significant correlation with this primary endpoint. We performed a retrospective analysis of patients hospitalized with a primary diagnosis of acute decompensated HF within the New York City Health and Hospitals 11-hospital system across the different COVID surge periods. Mortality information was collected in 4,405 participants (mean [SD] age 70.54 [14.44] years, 1885 [42.87%] female).The highest mortality existed in the first surge (9.02%), then improved to near prepandemic levels (3.65%) in the second (3.91%) and third surges (5.94%, p < 0.0001). In-hospital mortality inversely correlated with receipt of a COVID-19 vaccination, but had no correlation with left ventricular ejection fraction or the number of vaccination doses. Mortality for acute decompensated HF patients improved after the first surge, suggesting that hospitals adequately adapted to provide quality care. As future infectious outbreaks may occur, emergency preparedness must ensure that adequate focus and resources remain for other clinical entities, such as HF, to ensure optimal care is delivered across all areas of illness.

Investigating the trajectory of post-COVID impairments: a longitudinal study in Sweden

Introduction

Individuals recovering from COVID-19 often experience a range of post-recovery symptoms. However, the literature on post-COVID-19 symptoms reveals conflicting results, necessitating a heightened focus on longitudinal studies to comprehend the trajectory of impairments over time. Our study aimed to investigate changes in long-term impairments among individuals infected with COVID-19 and explore potential predictors influencing these changes.

Methods

We conducted a web-survey targeting individuals that had been infected with COVID-19 at four time-points: T0 (baseline), T1 (three months), T2 (six months), and T3 (twelve months). The survey included contextual factors, factors related to body functions and structures, and post-COVID impairments. The longitudinal sample included 213 individuals (with a mean age of 48.92 years). Linear mixed models were employed to analyze changes in post-COVID impairments over time and identify impacting factors.

Results

Findings revealed a general decline in post-COVID impairments over time, with each symptom exhibiting a dynamic pattern of fluctuations. Factors such as initial infection severity, education level, and work status were significantly associated with the levels of impairments.

Discussion

The study emphasizes that post-COVID impairments are not static but exhibit variations over time. Personalized care, especially for vulnerable populations, is crucial. The results underscore the need for long-term monitoring and multidisciplinary treatment approaches. Targeted support and interventions are highlighted for individuals with severe initial infections and those in socioeconomically disadvantaged groups.

Examining the role of knowledge and trust on vaccine confidence in North Dakota among university students, faculty, and staff

BACKGROUND

Vaccination is one of the greatest tools for individuals to stay healthy. Individuals are, however, often exposed to misinformation via digital and social media, and thus, may miss the opportunity to develop scientific knowledge about vaccines and trust in relevant stakeholders. This has a damaging impact on vaccine confidence. Understanding vaccine confidence is particularly important in North Dakota, where vaccination rates are lower than national averages.

OBJECTIVES

The objectives of this research are to examine the association between vaccine confidence and three potential sources of it, namely, trust, vaccine knowledge, and vaccine information sources and to investigate the relative strength of three vaccine confidence sources, while accounting for covariates.

METHODS

Students (n = 517, 56.6%) and staff and faculty (n = 397, 43.4%) at the University of North Dakota (n = 914) completed an online survey. Logistic regressions estimated odds ratios (OR) and 95% confidence intervals (CI) for associations among trust in doctors, family/friends, government health agencies, charitable organizations, and religious organizations, vaccine knowledge, vaccine information sources as well as vaccine confidence, accounting for gender, race, marital status, age, religion, political ideology, education, and health status.

RESULTS

The mean age of participants was 29.43 years (SD = 13.48). Most were females (71.6%) and white (91.5%). Great trust in doctors (OR = 3.29, p < 0.001, 95%CI 1.89, 5.73) government health agencies (OR = 2.95, p < 0.001, 95%CI 2.13, 4.08) and vaccine knowledge (OR = 1.28, p < 0.001, 95%CI 1.18, 1.38) had higher odds of vaccine confidence. Using Internet Government source as the primary source of vaccine information (OR = 1.73, p < 0.05, 95%CI 1.22, 2.44) showed higher odds of vaccine confidence before all independent variables were introduced, but it became non-significant after they were introduced. Trust in government health agencies showed strongest associations with vaccine confidence.

CONCLUSION

Multiple stakeholders are necessary to ensure verified, accessible, and accurate information in order to advance vaccine confidence in rural, conservative areas.

Behavioral and social drivers of COVID-19 vaccination initiation in the US: a longitudinal study March─ October 2021

Many studies have examined behavioral and social drivers of COVID-19 vaccination initiation, but few have examined these drivers longitudinally. We sought to identify the drivers of COVID-19 vaccination initiation using the Behavioral and Social Drivers of Vaccination (BeSD) Framework. Participants were a nationally-representative sample of 1,563 US adults who had not received a COVID-19 vaccine by baseline. Participants took surveys online at baseline (spring 2021) and follow-up (fall 2021). The surveys assessed variables from BeSD Framework domains (i.e., thinking and feeling, social processes, and practical issues), COVID-19 vaccination initiation, and demographics at baseline and follow-up. Between baseline and follow-up, 65% of respondents reported initiating COVID-19 vaccination. Vaccination intent increased from baseline to follow-up (p < .01). Higher vaccine confidence, more positive social norms towards vaccination, and receiving vaccine recommendations at baseline predicted subsequent COVID-19 vaccine initiation (all p < .01). Among factors assessed at follow-up, social responsibility and vaccine requirements had the greatest associations with vaccine initiation (all p < .01). Baseline vaccine confidence, social norms, and vaccination recommendations were associated with subsequent vaccine initiation, all of which could be useful targets for behavioral interventions. Furthermore, interventions that highlight social responsibility to vaccinate or promote vaccination requirements could also be beneficial.

Trust in primary health care and COVID-19 vaccine uptake among Iranian pediatric: a web-based cross-sectional survey

BACKGROUND

Children are the most vulnerable group to diseases. Thus, it's critical to evaluate parents' or guardians' willingness to vaccinate their children. This study aims to investigate the prevalence and predictors of pediatric COVID-19 vaccination in Iran and its relationship with trust in the Primary Health Care (PHC) system.

METHOD

A cross-sectional online survey of 549 Iranian parents was conducted between January and March 2023. This study collected data from all provinces of Iran using a questionnaire shared on Google Forms and various social media platforms. After considering various background factors, we used a multivariable logistic regression model. This model explored how trust in the PHC system and parent-related and child-related factors were related to parents' vaccine uptake for their children.

RESULTS

Of 549 parents aged between 19 and 67 years (median = 38 years), 65.2% (358) were female. The prevalence of vaccine uptake among parents was 46.8%. After adjusting for background features, child's age (adjusted odds ratio [AOR] 0.81, 95% CI 0.71-0.91), vaccine doses (1-dose: AOR 14.72, 95% CI 6.44-33.65, 2-dose: AOR 32.54, 95% CI 15.22-69.57), child's disease (AOR 5.31, 95% CI 2.19-12.85), and trust in PHC (AOR 1.01, 95% CI 1.00-1.02) were associated with parental uptake of the COVID-19 vaccine.

CONCLUSIONS

The findings of this study suggest that the child's age, vaccine doses received, diseases, and trust in PHC are significant predictors of parental uptake of the COVID-19 vaccine for children in Iran. The results can be used in service planning regarding children's COVID-19 vaccination.

COVID-19 vaccine hesitancy among adults in India: A primary study based on health behavior theories and 5C psychological antecedents model

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy.

Health Literacy and Health Care System Confidence as Determinants of Attitudes to Vaccines in France: Representative Cross-Sectional Study

BACKGROUND

Health literacy involves individuals' knowledge, personal skills, and confidence to take action to evaluate and appraise health-related information and improve their health or that of their community.

OBJECTIVE

This study aimed to analyze the association between health literacy and attitude toward vaccines, adjusted with other factors.

METHODS

We used the SLAVACO Wave 3, a survey conducted in December 2021 among a sample of 2022 individuals, representative of the French adult population. We investigated factors associated with the attitude toward vaccines using respondents' different sociodemographic data, health literacy levels, and the health care system confidence levels using a multinomial logistic regression analysis.

RESULTS

Among the participants, 440.4 (21.8%) were classified as "distrustful of vaccines in general," 729.2 (36.1%) were "selectively hesitant," and 852.4 (42.2%) were "nonhesitant." In our model, the level of health literacy was not statistically different between the "distrustful of vaccines in general" and the "selectively hesitant" (P=.48), but it was associated with being a "nonhesitant" (adjusted odds ratio [aOR] 1.86, 95% CI 1.25-2.76). The confidence in the health care system was a strong predictor for a "nonhesitant" attitude toward vaccines (aOR 12.4, 95% CI 7.97-19.2). We found a positive correlation of 0.34 (P<.001) between health literacy and confidence in the health care system, but the interaction term between health literacy and health care system confidence was not significant in our model.

CONCLUSIONS

Health literacy was associated with a "nonhesitant" attitude toward vaccines. The findings demonstrated that health literacy and confidence in the health care system are modestly correlated. Therefore, to tackle the subject of vaccine hesitancy, the main focus should be on increasing the population's confidence and on increasing their health literacy levels or providing vaccine information addressing the needs of less literate citizens.

Partisan divide and Racial/Ethnic disparities in COVID-19 vaccine hesitancy among Parents/Guardians and vaccine uptake among children in the U.S

OBJECTIVES

We undertook an observational study to assess the impact of state-level partisanship and parents'/guardians' race/ethnicity on their degree of COVID-19 vaccine hesitancy.

MATERIAL AND METHODS

We observed a pooled cross-section of 59,280 U.S. adults residing with children in the same household between June 29 and November 14, 2022. Using household-weighted logistic regression models, we evaluated the association between partisanship, race/ethnicity, and vaccine hesitancy, while controlling for other social determinants of COVID-19 vaccine hesitancy.

RESULTS AND CONCLUSIONS

We found that children were less likely to receive a COVID-19 vaccine if they resided in Republican as compared to Democratic states, with the difference in probability greatest among those households where parents/guardians identified as White. We also found that children were less likely to receive a COVID-19 vaccine if their parents/guardians identified as White as compared to any other race/ethnicity, with the differences in probability greatest among households in Republican states.

The role of vaccine status homophily in the COVID-19 pandemic: a cross-sectional survey with modelling

BACKGROUND

Vaccine homophily describes non-heterogeneous vaccine uptake within contact networks. This study was performed to determine observable patterns of vaccine homophily, as well as the impact of vaccine homophily on disease transmission within and between vaccination groups under conditions of high and low vaccine efficacy.

METHODS

Residents of British Columbia, Canada, aged ≥ 16 years, were recruited via online advertisements between February and March 2022, and provided information about vaccination status, perceived vaccination status of household and non-household contacts, compliance with COVID-19 prevention guidelines, and history of COVID-19. A deterministic mathematical model was used to assess transmission dynamics between vaccine status groups under conditions of high and low vaccine efficacy.

RESULTS

Vaccine homophily was observed among those with 0, 2, or 3 doses of the vaccine. Greater homophily was observed among those who had more doses of the vaccine (p < 0.0001). Those with fewer vaccine doses had larger contact networks (p < 0.0001), were more likely to report prior COVID-19 (p < 0.0001), and reported lower compliance with COVID-19 prevention guidelines (p < 0.0001). Mathematical modelling showed that vaccine homophily plays a considerable role in epidemic growth under conditions of high and low vaccine efficacy. Furthermore, vaccine homophily contributes to a high force of infection among unvaccinated individuals under conditions of high vaccine efficacy, as well as to an elevated force of infection from unvaccinated to suboptimally vaccinated individuals under conditions of low vaccine efficacy.

INTERPRETATION

The uneven uptake of COVID-19 vaccines and the nature of the contact network in the population play important roles in shaping COVID-19 transmission dynamics.

Community Level Correlates of COVID-19 Booster Vaccine Hesitancy in the United States: A Cross-Sectional Analysis

Introduction: Evidence exists that individual-level sociodemographic factors contribute to vaccine hesitancy, but it is unknown how community-level factors affect COVID-19 booster dose hesitancy. The current study aims to fill this knowledge gap by comparing data from a nationwide survey on COVID-19 vaccine hesitancy with a community-level indicator, i.e., the Distressed Communities Index (DCI). Methods: Attitudes toward vaccinations, vaccine literacy, COVID-19 vaccine confidence index, and trust were measured using a 48-item, psychometrically valid and reliable survey tool. In this study, 2138 survey participants residing in the United States were divided into quintiles of varying community distress levels based on their zip codes using the DCI. Data were analyzed through Chi-square, one-way ANOVA, and post hoc analysis with Tukey's test. Results: A significantly higher proportion of participants from the distressed communities had lower trust than their prosperous counterparts (26.6% vs. 37.6%, p < 0.001). On the contrary, participants from the prosperous communities had significantly higher vaccine confidence index scores than those in distressed communities (2.22 ± 1.13 vs. 1.70 ± 1.01, p < 0.001). Conclusions: These findings affirm the importance of developing community-level interventions to promote trust in COVID-19 vaccinations and increase booster dose uptake. From these results, future studies can examine the efficacy of various community-level interventions.

Factors associated with COVID-19 vaccine uptake and hesitancy among healthcare workers in the Democratic Republic of the Congo

Vaccination is a critical intervention to reduce morbidity and mortality and limit strain on health systems caused by COVID-19. The slow pace of COVID-19 vaccination uptake observed in some settings raises concerns about COVID-19 vaccine hesitancy. The Democratic Republic of the Congo experienced logistical challenges and low uptake at the start of vaccine distribution, leading to one of the lowest overall COVID-19 vaccine coverage rates in the world in 2021. This study assessed the magnitude and associated factors of COVID-19 vaccine uptake among healthcare workers (HCWs) in seven provinces in DRC. We implemented a cross-sectional Knowledge, Attitudes, and Practices (KAP) questionnaire targeting HCWs, administered by trained data collectors in Haut-Katanga, Kasaï Orientale, Kinshasa, Kongo Centrale, Lualaba, North Kivu, and South Kivu provinces. Data were summarized and statistical tests were performed to assess factors associated with vaccine uptake. HCWs across the seven provinces completed the questionnaire (N = 5,102), of whom 46.3% had received at least one dose of COVID-19 vaccine. Older age, being married, being a medical doctor, being a rural resident, and having access to or having previously worked in a COVID-19 vaccination site were all strongly associated with vaccination uptake. Vaccinated individuals most frequently cited protection of themselves, their families, and their communities as motivations for being vaccinated, whereas unvaccinated individuals were most concerned about safety, effectiveness, and risk of severe side effects. The findings suggest an opinion divide between vaccine-willing and vaccine-hesitant HCWs. A multidimensional approach may be needed to increase the acceptability of the COVID-19 vaccine for HCWs. Future vaccine campaign messaging could center around the positive impact of vaccination on protecting friends, family, and the community, and also emphasize the safety and very low risk of adverse effects. These types of messages may further be useful when planning future immunization campaigns with new vaccines.

Examining vaccine hesitancy among a diverse sample of Canadian adults

The aim of this study was to explore the sociodemographic and individual-level factors associated with vaccine hesitancy in general, including political affiliation and beliefs in vaccine conspiracy theories, in a diverse group of Canadian adults within the context of the COVID-19 pandemic. 641 responses were included in the analysis, with those self-identifying as Indigenous, Black Canadian, and low-income (household income <$40,000) being sampled to yield data from historically marginalized populations. Demographic variables and responses to questions on vaccine hesitancy, and beliefs in vaccine conspiracy theories were used to explore explanatory variables of vaccine hesitancy. General linear regression models were fit using the method of least squares via PROC GLM and used to examine sociodemographic and individual explanatory variables of vaccine hesitancy. Age, ethnicity, political affiliation, and beliefs in vaccine conspiracies were associated with vaccine hesitancy. Findings are discussed in relation to the critical role of distrust and misinformation in hesitancy. Our data provide insight into how Canadian provincial governments may promote uptake of vaccines in ways that target diverse groups that may differ from those developed in a pre-pandemic context.

Seatbelts and raincoats, or banks and castles: Investigating the impact of vaccine metaphors

While metaphors are frequently used to address misconceptions and hesitancy about vaccines, it is unclear how effective they are in health messaging. Using a between-subject, pretest/posttest design, we investigated the impact of explanatory metaphors on people's attitudes toward vaccines. We recruited participants online in the US (N = 301) and asked them to provide feedback on a (fictional) health messaging campaign, which we organized around responses to five common questions about vaccines. All participants completed a 24-item measure of their attitudes towards vaccines before and after evaluating the responses to the five questions. We created three possible response passages for each vaccine question: two included extended explanatory metaphors, and one contained a literal response (i.e., no explanatory metaphors). Participants were randomly assigned to receive either all metaphors or all 'literal' responses. They rated each response on several dimensions and then described how they would answer the target question about vaccines if it were posed by a friend. Results showed participants in both conditions rated most messages as being similarly understandable, informative, and persuasive, with a few notable exceptions. Participants in both conditions also exhibited a similar small-but significant-increase in favorable attitudes towards vaccines from pre- to posttest. Notably, participants in the metaphor condition provided longer free-response answers to the question posed by a hypothetical friend, with different metaphors being reused to different extents and in different ways in their responses. Taken together, our findings suggest that: (a) Brief health messaging passages may have the potential to improve attitudes towards vaccines, (b) Metaphors neither enhance nor reduce this attitude effect, (c) Metaphors may be more helpful than literal language in facilitating further social communication about vaccines.

Quantitatively Identifying Messaging Topics to Encourage West Virginia nurses' COVID-19 Vaccination

Nurses are particularly influential to others as it relates to COVID-19 vaccination decision-making and are at higher risk of COVID-19 themselves. Yet, nurses' COVID-19 vaccination remains suboptimal. This study combines communication science frameworks with a novel conceptualize of identity-identity fusion-to explore why nurses may not vaccinate and what strategies might encourage them to protect themselves from COVID-19. Practicing nurses recruited from the West Virginia Nurses Association (N = 328) were asked about their nursing identity, COVID-19 threat perceptions, vaccination efficacy perceptions, vaccination social norms, and both vaccination and information seeking plans. Findings show that social norms may have particular influence over nurses' vaccination intentions, though this is unique to nurses who do not view themselves as completely "fused" with the nursing identity. "Fully fused" nurses, on the other hand, may respond well to information conveying their particular risk for COVID-19. Data suggest information on one's self-efficacy or ability to get vaccinated should be avoided, as it might discourage some nurses'vaccination. Findings are discussed in terms of how identity may influence vaccination.

A Psychosocial Model of COVID-19 Vaccination: Antecedent and Concurrent Effects of Demographics, Traits, Political Beliefs, Vaccine Intention, Information Sources, Mandates, and Flu Vaccine History

BACKGROUND

To date, research investigating psychosocial correlates of COVID-19 vaccination has been cross-sectional, parochial, and/or reliant upon non-stratified international samples, resulting in difficulty in clarifying the contributions of various vaccination-related influences.

PURPOSE

The present study tested a novel integration of prospective and concurrent associations of demographic and dispositional tendencies, intervening illness and preventive beliefs, vaccine intention, illness experiences, and concurrent contextual vaccine-related influences with subsequent COVID-19 vaccination.

METHODS

The preregistered study used a stratified online U.S. sample (N = 500), with assessments aligned to (a) "15 days to slow the spread" in March 2020, (b) vaccine authorization and major case/mortality surge during December 2020 and January 2021, and (c) the period following full vaccine approval in August 2021 during the third major/case mortality surge during September and October 2021.

RESULTS

Path modeling showed the absence of children in the household and greater education were prospective predictors of vaccination. Trait openness and less conservative political beliefs showed indirect prospective associations with vaccination via stronger intermediating vaccine intention. Contextual vaccine-related influences of vaccine-related information sources, employer mandates, and flu vaccine history also showed direct associations with vaccination. In contrast to expectations, lower conscientiousness showed a direct prospective association with vaccination.

CONCLUSIONS

Controlling for interrelations among study variables, the results of the integrative psychosocial model clarified the unique contributions and pathways from antecedent characteristics to vaccination while accounting for vaccine-related contextual influences, providing further direction for refining the timing and content of public health messaging for vaccination.

COVID-19 Vaccine Hesitancy Among US Adults: Safety and Effectiveness Perceptions and Messaging to Increase Vaccine Confidence and Intent to Vaccinate

OBJECTIVE

Public health agencies have a critical role in providing effective messaging about mitigation strategies during a public health emergency. The objectives of this study were (1) to understand perceptions of COVID-19 vaccines, including concerns about side effects, safety, and effectiveness and how these perceptions influence vaccine decision-making among US adults and (2) to learn what messages might motivate vaccine uptake.

METHODS

In April and May 2021, we conducted 14 online focus groups with non-Hispanic English-speaking and English- and Spanish-speaking Hispanic adults (N = 99) not vaccinated against COVID-19. We oversampled adults aged 18-39 years and rural residents and systematically assessed 10 test messages. Researchers used a standardized guide and an a priori codebook for focus group discussions, coding transcripts, and thematic analysis.

RESULTS

Vaccine hesitancy factors included fear of the unknown; long-term side effects, including infertility; and beliefs that the vaccines were developed too quickly and were not sufficiently effective. Motivating factors for receiving vaccination included the ability to safely socialize and travel. Health care providers were considered important trusted messengers. Participants were critical of most messages tested. Messages that came across as "honest" about what is not yet known about COVID-19 vaccines were perceived more positively than other messages tested. Messages were seen as ineffective if perceived as vague or lacking in data and specificity.

CONCLUSIONS

Messages that were simple and transparent about what is unknown about vaccines relative to emerging science were viewed most favorably. Health care providers, friends, and family were considered influential in vaccination decision-making. Findings underscore the benefits of research-informed strategies for developing and disseminating effective messages addressing critical issues in a public health emergency.

COVID-19 vaccine literacy: A scoping review

To address vaccine hesitancy, specific self-rated tools have been developed to assess vaccine literacy (VL) related to COVID-19, including additional variables, such as beliefs, behavior, and willingness to be vaccinated. To explore the recent literature a search was performed selecting articles published between January 2020 and October 2022: 26 papers were identified using these tools in the context of COVID-19. Descriptive analysis showed that the levels of VL observed in the studies were generally in agreement, with functional VL score often lower than the interactive-critical dimension, as if the latter was stimulated by the COVID-19-related infodemic. Factors associated with VL included vaccination status, age, educational level, and, possibly, gender. Effective communication based on VL when promoting vaccination is critical to sustaining immunization against COVID-19 and other communicable diseases. The VL scales developed to date have shown good consistency. However, further research is needed to improve these tools and develop new ones.

COVID-19 vaccination up-take in three districts of Nepal

Vaccine hesitancy during the COVID-19 pandemic continues to be an issue in terms of global efforts to decrease transmission rates. Despite high demand for the vaccines in Nepal, the country still contends with challenges related to vaccine accessibility, equitable vaccine distribution, and vaccine hesitancy. Study objectives were to identify: 1) up-take and intention for use of COVID-19 vaccines, 2) factors associated with vaccine up-take, and 3) trusted communication strategies about COVID-19 and the vaccines. A quantitative survey was implemented in August and September 2021 through an initiative at the Nepali Ministry of Health and Population Department of Health Services, Family Welfare Division. Data were collected from 865 respondents in three provinces (Bagmati, Lumbini, and Province 1). Ordinal multivariate logistic regression was utilized to determine relationships between vaccination status and associated factors. Overall, 62% (537) respondents were fully vaccinated and 18% (159) were partially vaccinated. Those respondents with higher education (p < .001) and higher household income (p < .001) were more likely vaccinated. There were also significant differences in vaccine up-take across the three provinces (p < .001). Respondents who were vaccinated were significantly more likely to perceive vaccines as efficacious in terms of preventing COVID-19 (p = .004) and preventing serious outcomes (p = .010). Among both vaccinated and unvaccinated individuals, there was a high level of trust in information about COVID-19 vaccines provided through local health-care workers [e.g. nurses and physicians]. These results are consistent with other findings within the South Asia region. Targeted advocacy and outreach efforts are needed to support ongoing COVID-19 vaccination campaigns throughout Nepal.

Public Attitudes Towards Vaccine Passports in Alberta During the "Pandemic of the Unvaccinated": A Qualitative Analysis of Reddit Posts

Objective: The goal of this study is to understand the attitudes and beliefs towards mandatory vaccination policies in Alberta, Canada in September 2021, during the fourth wave of COVID-19. Methods: 9400 posts between 1st September and 30th September 2021 were collected from the subreddit r/Alberta with Pushshift.io. Posts and comments were manually screened to determine their relevance to research objectives, and then coded using inductive coding and iterative qualitative analysis methods. Results: Inductive coding methods yielded five key themes: 1) opinions related to autonomy and consent, 2) concerns about COVID-19 vaccine passport enforcement, 3) concerns about government, 4) concerns about the logistics of passports, and 5) opinions relating to the necessity of passports to prevent lockdowns. Conclusion: Overall, the data presented favorable opinions towards an Albertan vaccine passport within r/Alberta. Anti-vaccine and anti-mandate opinions were often less extreme than those present in the literature, although this may be due to r/Alberta subreddit moderators removing those more extreme comments. Most reservations were due to issues of bodily autonomy, though concerns about the government and logistics also played a meaningful role.

Potential determinants of parental hesitancy to vaccinate their children against COVID-19 infection: a cross-sectional investigation

Coronavirus disease 2019 (COVID-19) vaccination hesitancy has emerged as a substantial concern among the adult population globally. However, limited evidence is available about parental hesitancy to vaccinate their children against COVID-19 within the Pakistani context. Thus, the present investigation aimed to assess parental attitudes, perceptions, and willingness regarding vaccination hesitancy and associated predictors of getting their children vaccinated against COVID-19. We conducted a cross-sectional population-based, self-administered online questionnaire in Punjab, Pakistan, on randomly selected parents between October 2022 and February 2023. The data were collected based on socio-demographics, attitudes, perceptions, and willingness of parents regarding COVID-19 vaccine hesitancy for their children. Adjusted odds ratios with 95% confidence intervals were estimated to identify the predictors of vaccine hesitancy. The findings demonstrated that among 1,478 participants, a total of 40% believed that the COVID-19 vaccine may pose a greater risk to children than adults, while 38% exhibited no concerns. Around 13% of children were not vaccinated in our study sample. More than half expressed hesitancy toward vaccination, and only 35.25% were inclined to get their children vaccinated in our study sample. In addition, only 16% of the parents believed that the COVID-19 vaccination may cause an alteration in their children's DNA. A similar proportion of parents were aware of the significance of getting their children vaccinated and expressed their willingness to vaccinate their children to prevent the COVID-19 infection. However, a higher odds ratio was observed in females with a higher educational background and those in the healthcare profession. In conclusion, healthcare awareness-supporting programs for educating parents should be designed and implemented. These insights might aid in the development of strategies to eradicate barriers in existing coronavirus vaccination programs and may vaccinate a larger child population to reduce the adverse consequences of the pandemic.

COVID-19 vaccination in urban American Indian and Alaska Native children: Parental characteristics, beliefs and attitudes associated with vaccine acceptance

Background

Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people.

Purpose

Our goal was to describe urban AI/AN parental attributes associated with COVID-19 vaccination of their children.

Methods

Survey participants (n = 572) were ≥18 years of age, had children ≥5 years of age, AI/AN, and seen at one of six urban health organizations serving primarily AI/AN people within the prior year. They were asked about gender, age, education, marital status, perceived stress, trauma history, whether they had received the COVID-19 vaccine, tested positive for COVID-19 in the past, and if their child was vaccinated. They were also asked about 16 vaccine hesitancy reasons.

Results

Parental vaccination rate was 82%, with 59% of their children vaccinated. Parents who vaccinated their children were older, had higher education, lower stress and trauma, and were more likely to be vaccinated compared to parents who did not vaccinate their children. Forty-two percent of parents indicated they would likely vaccinate their unvaccinated child in the future. Sixteen vaccine hesitancy reasons revealed four factors: distrust, inconvenience, lack of concern about the pandemic, and AI/AN concerns. Parents who had no plans to vaccinate their children had the highest vaccine distrust and lack of concern about the pandemic. Parents with greater vaccine distrust and AI/AN specific concern reported significantly greater trauma history and higher levels of education.

Conclusion

Even though vaccination rates for AI/AN parents and children are high, the consequences of COVID-19 for AI/AN people are more severe than for other US populations. Providers should use trauma-informed, trust-building and culturally competent communication when discussing choices about vaccination with AI/AN parents.

Impact of household decision makers' hesitancy to vaccinate children against COVID-19 on other household members: A family-based study in Taizhou, China

Background

Vaccination is the most effective means of preventing outbreaks of infectious diseases, and family ;decision makers play an important role in decision-making regarding family matters and may influence other family members to take an active role in vaccinating children against COVID-19.

Purpose

This study examined the influence of family decision makers on the hesitation of other family members to vaccinate their children against COVID-19.

Methods

A population-based, self-administered online questionnaire was administered in Taizhou, China, from September 1, 2021, to September 15, 2021. The questionnaire included demographic information, knowledge, attitudes, and perceptions about the COVID-19 vaccine as well as hesitation regarding the use of the COVID-19 vaccination in children. In total, 490 respondents were included in this study. Logistic regression was used to assess the factors associated with vaccine hesitancy.

Results

In total, 490 respondents from 190 households were interviewed. Of the 190 family decision makers, 43.7% (83/190) were hesitant to vaccinate their children against COVID-19. When family decision makers were hesitant to vaccinate children against COVID-19, 65.1% (82/126) of the other family members expressed similar hesitancy regarding vaccination. When family decision makers were not hesitant to vaccinate children, only 21.3% (37/174) of other family members were hesitant to do so. In the regression analysis, family decision makers' hesitation to vaccinate their children was associated with other family members' hesitation (OR=6.264, 95% CI:3.132-12.526). In addition, decision makers' perceptions of the safety of the vaccine (OR=0.422, 95% CI:0.215-0.826) and hesitation to vaccinate themselves (OR=8.967, 95% CI:4.745-16.948) influenced their hesitation to vaccinate their children.

Conclusion

The present study found that family decision makers' hesitation to vaccinate children against COVID-19 influenced other family members' hesitation to vaccinate children. In addition, family decision makers' perceptions of the safety of the vaccine and their hesitation to vaccinate themselves influenced other family members' hesitation to vaccinate their children.

Administration of an excessive dosage of covid-19 pfizer vaccine in an infant: Case report of clinical and immune responses

Introduction/Case report

We describe the case of a 6-month-old female infant who received the equivalent of 6 adult doses of the COVID-19 Pfizer vaccine due to an immunization error. The patient underwent clinical and laboratory evaluations from the time of vaccination error (January 2022) until November 2022. In the first three days after immunization, she presented with low-grade fever (38 °C) and mild pain and induration at the injection site. She showed no other symptoms afterwards. Laboratory tests were within normal limits for age, except for an elevated D-dimer (3.71 ug/mL; normal: up to 0.5 ug/mL) and as the echocardiogram and electrocardiogram were within normal limits as well, no interventions were instituted at that moment. On the tenth day, immune response evaluation showed a strong expression of cytokines related to the Th2 profile and a well-controlled inflammatory state. Forty-three days after the vaccine administration inflammation status remained, with a predominance of cellular immune response, IFN-γ expression increased compared to the previous evaluation, and a robust antiviral state was in place. After 90 days, immune response evaluation showed a significant reduction in the inflammatory state, still with a predominance of the cellular immune response. Clinically, the patient remained well, with no other noteworthy intercurrences, until the last appointment in November 2022. This child has had no evidence of a severe adverse effect associated to the vaccine overdose.

Conclusion

The close follow-up of this case of vaccination error demonstrated that the COVID-19 Pfizer was safe and immunogenic in this individual, noting careful monitoring and followup of these vaccine administration errors is crucial.

Identifying Mental Health Literacy as a Key Predictor of COVID-19 Vaccination Acceptance among American Indian/Alaska Native/Native American People

BACKGROUND

This study examines how health literacy and mental health literacy associate with the willingness to receive a COVID-19 vaccination among American Indian/Alaska Native/Native American (AI/AN) people.

METHODS

The data were collected with an online Qualtrics survey in February 2021 (n = 563). A purposive snowball sampling strategy was used by sending recruitment flyers to colleagues and organizations who work with AI/AN communities to share with appropriate potential respondents. We performed linear regression analyses examining the relationships between the willingness to receive a COVID-19 vaccination and socio-demographic characteristics such as age, gender, education, health literacy, mental health literacy, self-rated physical and mental health status, worry about getting COVID-19, perceived COVID-19 susceptibility, and perceived COVID-19 severity.

RESULTS

Mental health literacy and health literacy predicted 30.90% and 4.65% of the variance (R2adjusted) in the willingness to receive a COVID-19 vaccine, respectively. After holding the self-rated physical/mental health status, worry about getting COVID-19, perceived susceptibility, perceived severity, health literacy, and socio-demographics constant, mental health literacy was still a strong predictor (b = 0.03, p < 0.001) for the willingness to receive a COVID-19 vaccine (model R2adjusted = 40.14%).

CONCLUSIONS

We identified mental health literacy as a substantial factor associated with the willingness to receive a COVID-19 vaccination among AI/AN respondents.

Promoting data harmonization to evaluate vaccine hesitancy in LMICs: approach and applications

BACKGROUND

Factors influencing the health of populations are subjects of interdisciplinary study. However, datasets relevant to public health often lack interdisciplinary breath. It is difficult to combine data on health outcomes with datasets on potentially important contextual factors, like political violence or development, due to incompatible levels of geographic support; differing data formats and structures; differences in sampling procedures and wording; and the stability of temporal trends. We present a computational package to combine spatially misaligned datasets, and provide an illustrative analysis of multi-dimensional factors in health outcomes.

METHODS

We rely on a new software toolkit, Sub-National Geospatial Data Archive (SUNGEO), to combine data across disciplinary domains and demonstrate a use case on vaccine hesitancy in Low and Middle-Income Countries (LMICs). We use data from the World Bank's High Frequency Phone Surveys (HFPS) from Kenya, Indonesia, and Malawi. We curate and combine these surveys with data on political violence, elections, economic development, and other contextual factors, using SUNGEO. We then develop a stochastic model to analyze the integrated data and evaluate 1) the stability of vaccination preferences in all three countries over time, and 2) the association between local contextual factors and vaccination preferences.

RESULTS

In all three countries, vaccine-acceptance is more persistent than vaccine-hesitancy from round to round: the long-run probability of staying vaccine-acceptant (hesitant) was 0.96 (0.65) in Indonesia, 0.89 (0.21) in Kenya, and 0.76 (0.40) in Malawi. However, vaccine acceptance was significantly less durable in areas exposed to political violence, with percentage point differences (ppd) in vaccine acceptance of -10 (Indonesia), -5 (Kenya), and -64 (Malawi). In Indonesia and Kenya, although not Malawi, vaccine acceptance was also significantly less durable in locations without competitive elections (-19 and -6 ppd, respectively) and in locations with more limited transportation infrastructure (-11 and -8 ppd).

CONCLUSION

With SUNGEO, researchers can combine spatially misaligned and incompatible datasets. As an illustrative example, we find that vaccination hesitancy is correlated with political violence, electoral uncompetitiveness and limited access to public goods, consistent with past results that vaccination hesitancy is associated with government distrust.

COVID-19 vaccine uptake among people with HIV: identifying characteristics associated with vaccine hesitancy

People with HIV (PWH) are at increased risk of COVID-19 infection. Both Canadian (NACI) and US (CDC) guidelines recommend that all PWH receive at least 2 doses of COVID-19 vaccine, and a booster. We examined vaccination uptake among PWH in Southern Alberta, Canada. Among adult PWH, we evaluated COVID-19 vaccination uptake between December 2020 and August 2022. Poisson regression models with robust variance (approximating log binomial models) estimated crude and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for receiving (1) any vs. no vaccine, and (2) primary series with booster (≥ 3 vaccines) versus primary series without booster. Among 1885 PWH, 10% received no COVID-19 vaccinations, 37% < 3 vaccines and 54% received ≥ 3 vaccines. Females (vs. males) were less likely to receive a vaccine booster. Receiving no COVID-19 vaccines was associated with White ethnicity, unsuppressed HIV viral load (> 200 copies/mL), and using illegal substances. Factors associated with decreased booster uptake included being younger, Black (vs. White) ethnicity, substance use, lower educational attainment, and having an unsuppressed HIV viral load. COVID-19 booster uptake among PWH does not meet vaccine guidelines, and receipt of vaccines is unevenly distributed. Booster uptake is lowest among young females and marginalized individuals. Focused outreach is necessary to close this gap.

Willingness to Pay for COVID-19 Vaccines in Japan

More than 80% of the Japanese population had received the coronavirus disease 2019 (COVID-19) vaccination by the end of April 2023; however, this vaccination rate continues to decline along with the need for booster shots. Further, the vaccines may not permanently be available free of charge. This study conducted a survey to determine the public's willingness to pay for the COVID-19 vaccine in Japan. Using an internet research panel, the questionnaire collected data on various sociodemographic variables and the respondents' willingness to pay for COVID-19 vaccines. Descriptive statistics and logistic regression analysis were used to evaluate the respondents' answers. The results showed that of 1100 respondents, 55.2% would not want to receive the vaccine if it was paid for. A total of 44.8% respondents expressed willingness to pay, with most (170 respondents) willing to pay for 1000-1999 JPY (7.1-14.2 USD). Logistic regression analysis revealed that age, educational status, history of contracting COVID-19, and COVID-19 vaccination frequency were significantly associated with those who were willing to receive the COVID-19 vaccine if it was free (p < 0.05). These findings provide valuable insights for the Japanese government in determining appropriate pricing strategies to promote COVID-19 vaccination effectively.

Impact of Coronavirus Disease 2019 and Vaccination Attitudes on Alpha-1 Antitrypsin Deficiency

Background

Individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) may be at increased risk of coronavirus disease 2019 (COVID-19) pneumonia since COPD is associated with an increased risk of severe COVID-19 infection.

Research Question

We hypothesized that the AlphaNet disease management program would lower COVID-19 burdens. We evaluated the prevalence of COVID-19 infection, severe COVID-19, interruptions in augmentation therapy, and intention to vaccinate.

Study Design and Methods

Data regarding COVID-19 were collected monthly from March 2020 through February 2022. Responses from 8019 individuals were analyzed to evaluate the prevalence and severity of COVID-19 infections, interruptions in AATD care, and the likelihood of vaccination.

Results

By the end of 2020, 4% of patients reported a positive COVID-19 test. Of those, 35.3% were hospitalized, with 8.6% admitted to the intensive care unit (ICU). By February 2022, the prevalence of COVID-19 infections had increased to 18.6%, with hospitalization rates of 22.1% and ICU admissions at 4.7%. Attitudes about COVID-19 vaccination assessed in December 2020 before the vaccine was widely available suggested 10.3% of patients would definitely not get the vaccine. Notably, 38.2% of those subsequently self-reported receipt of a COVID-19 vaccine.

Interpretation

The prevalence of COVID-19 infections in patients with AATD was lower than the prevalence in the general U.S. population during 2020, although with a higher hospitalization rate. This health-managed population has a high vaccination intent. Those with an initially low vaccination intent changed their minds over time. We interpret these results as showing that most AlphaNet individuals with AATD had success at navigating the COVID-19 pandemic with lower case rates than the general U.S. population.

Overcoming vaccine hesitancy by multiplex social network targeting: an analysis of targeting algorithms and implications

Incorporating social factors into disease prevention and control efforts is an important undertaking of behavioral epidemiology. The interplay between disease transmission and human health behaviors, such as vaccine uptake, results in complex dynamics of biological and social contagions. Maximizing intervention adoptions via network-based targeting algorithms by harnessing the power of social contagion for behavior and attitude changes largely remains a challenge. Here we address this issue by considering a multiplex network setting. Individuals are situated on two layers of networks: the disease transmission network layer and the peer influence network layer. The disease spreads through direct close contacts while vaccine views and uptake behaviors spread interpersonally within a potentially virtual network. The results of our comprehensive simulations show that network-based targeting with pro-vaccine supporters as initial seeds significantly influences vaccine adoption rates and reduces the extent of an epidemic outbreak. Network targeting interventions are much more effective by selecting individuals with a central position in the opinion network as compared to those grouped in a community or connected professionally. Our findings provide insight into network-based interventions to increase vaccine confidence and demand during an ongoing epidemic.

Exploring COVID-19 vaccine hesitancy and uptake in Nairobi's urban informal settlements: an unsupervised machine learning analysis of a longitudinal prospective cohort study from 2021 to 2022

OBJECTIVES

To illustrate the utility of unsupervised machine learning compared with traditional methods of analysis by identifying archetypes within the population that may be more or less likely to get the COVID-19 vaccine.

DESIGN

A longitudinal prospective cohort study (n=2009 households) with recurring phone surveys from 2020 to 2022 to assess COVID-19 knowledge, attitudes and practices. Vaccine questions were added in 2021 (n=1117) and 2022 (n=1121) rounds.

SETTING

Five informal settlements in Nairobi, Kenya.

PARTICIPANTS

Individuals from 2009 households included.

OUTCOME MEASURES AND ANALYSIS

Respondents were asked about COVID-19 vaccine acceptance (February 2021) and vaccine uptake (March 2022). Three distinct clusters were estimated using K-Means clustering and analysed against vaccine acceptance and vaccine uptake outcomes using regression forest analysis.

RESULTS

Despite higher educational attainment and fewer concerns regarding the pandemic, young adults (cluster 3) were less likely to intend to get the vaccine compared with cluster 1 (41.5% vs 55.3%, respectively; p<0.01). Despite believing certain COVID-19 myths, older adults with larger households and more fears regarding economic impacts of the pandemic (cluster 1) were more likely to ultimately to get vaccinated than cluster 3 (78% vs 66.4%; p<0.01), potentially due to employment requirements. Middle-aged women who are married or divorced and reported higher risk of gender-based violence in the home (cluster 2) were more likely than young adults (cluster 3) to report wanting to get the vaccine (50.5% vs 41.5%; p=0.014) but not more likely to have gotten it (69.3% vs 66.4%; p=0.41), indicating potential gaps in access and broader need for social support for this group.

CONCLUSIONS

Findings suggest this methodology can be a useful tool to characterise populations, with utility for improving targeted policy, programmes and behavioural messaging to promote uptake of healthy behaviours and ensure equitable distribution of prevention measures.

Vaccine hesitancy for COVID19: what is the role of statistical literacy?

Introduction

Vaccination is an important measure used to control the spread of COVID19. The estimation of risk versus benefit of vaccination is based on the understanding of information about the vaccine. Statistics are frequently part of communications about COVID19. Individuals that do not have an adequate foundation of statistical knowledge may not be able to properly assess associated risks and benefits. This study aims to assess the association between statistical literacy and hesitation to receive the COVID19 vaccine.

Methods

A nationally representative sample of 2,138 adults, recruited through CINT United States, Inc., (Lawrenceville, NJ; http://www.cint.com), completed an internet survey in the summer of 2021. This survey collected demographic measures and information about COVID19 vaccination status. The competency of respondents on various basic statistical concepts was assessed along with the corresponding confidence of respondents in their answers. A multivariable logistic regression model was constructed to assess the relationship between vaccine hesitancy and statistical literacy while controlling for covariates of interest.

Results

Statistical literacy was found to have a negligible association with COVID19 vaccine hesitancy (OR 1.01; 95% CI 1.00-1.02). In addition, differences in the proportion receiving the COVID19 vaccine between political affiliations, income levels, race groups, and ethnicities were observed.

Discussion

The statistical knowledge of the general American public is not commensurate with the need to be literate in basic statistical concepts in the data-driven world in which we live. An effective way to stem vaccine hesitancy may rely on increased statistical knowledge to not be biased by preconceived beliefs shaped by misinformation.

What Causes the Discrepancy in SARS-CoV-2 Vaccine Between Parental Hesitancy for Themselves and for Their Children During Lockdown Period?

BACKGROUND

Parents are usually the decision-makers for vaccinations of children. Therefore, it is important to understand parental beliefs and attitudes toward severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine for themselves and their children when it was approved for children age 3-17.

METHOD

A cross-sectional survey based on an anonymous online questionnaire for parents was conducted in seven provinces of China, and demographic information, vaccination history, parental decision motives, and health belief model toward themselves and their children were collected, respectively.

RESULTS

The overall parental hesitancy rate toward themselves was 20.30%, and that toward their children was 7.80%. More parental concerns on disease severity (odd ratio [OR] = 1.11, 95% confidence interval [CI]: 1.01-1.61) and susceptibility (OR = 1.29, 95% CI: 1.01-1.63) of children could be the causes of discrepancy in hesitancy for themselves and for their children. Parents who hesitated to vaccinate themselves might also be hesitated to vaccinate their children (β = 0.077, P < 0.001).

CONCLUSION

Threat perception may lead to inconsistencies in parental vaccination decisions toward themselves and toward their children. Correcting misinformation and strengthening education about COVID-19 are of great significance in addressing vaccine hesitancy among parents and children.

Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences

Background

Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases.

Methods

We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video.

Results

Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns.

Conclusion

Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.

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 impact of health literacy on COVID-19 immunization

The COVID-19 pandemic can be controlled by vaccination in addition to public health measures. This study investigate the impact of Health Literacy (HL) on vaccination and COVID-19. 334 patients and patient's relatives aged 18 to 65 years who were followed up at the Infectious Diseases Clinic between March and July 2022 for reasons other than COVID-19 disease were included in the study. The COVID-19 vaccination status of each participant was queried and the preferred vaccination was recorded on the case form. The mean age was 40.9 years, and 52.4% (n:175) of participants were women. It was found that 82.3% (n:275) of participants had received at least one dose of the vaccine COVID-19. It was found that 17.6% of participants had not been COVID-19 vaccinated. It was found that 60.7% (n:203) of participants received ≥ 2 doses of the mRNA-based viral vaccine. Vaccination rates were found to be significantly lower in patients with 'inadequate' HL (p = .047). In addition, the vaccination rate was lower in people aged 39 years and younger and in the presence of one or more chronic diseases. When chronic diseases are present, COVID-19 becomes more severe. On the other hand, the disease shows a moderate clinical picture and plays a significant role in transmission to risk groups in the young population, where vaccination rates are low. This situation in the context of COVID-19 demonstrates once again the importance of informing at-risk groups and the healthy young population about vaccine-preventable diseases.

Vaccination intention and uptake within the Black community in Appalachia

OBJECTIVE

Black communities have disproportionately experienced adverse health effects from the COVID-19 pandemic while simultaneously having less vaccination access and decreased vaccine utilization. As such, predictors of vaccination uptake within Black communities are a public health imperative. Black Americans from socio-geographic regions associated with health inequities (e.g., Appalachia), including vaccination disparities, represent an intersection of racial, economic, and ethnic social identities. To better understand the preventive health needs of Black communities in Appalachia and elsewhere, this study examined psychosocial predictors of vaccination intention or behavior.

METHOD

Adults (n = 336) identifying as Black or African American from West Virginia indicated demographics, reported COVID-19 vaccination intention, flu vaccination uptake, and human papillomavirus (HPV) vaccination uptake, and completed assessments of vaccine hesitancy, medical mistrust, and racial discrimination. Hierarchical logistic regression modeling examined potential associations between psychosocial predictors and each vaccine type.

RESULTS

Results showed variation in significant predictors across the vaccines of focus. Racial discrimination (OR = 0.64) and medical mistrust (OR = 0.93) were negatively associated with COVID-19 vaccination intention. Vaccine confidence was positively associated with COVID-19 vaccination intention (OR = 2.17) and HPV vaccination uptake (OR = 1.77). Total household income was the only predictor associated with flu vaccination uptake (OR = 1.12).

CONCLUSIONS

These findings suggest that social interventions targeting racial discrimination in healthcare may significantly help address vaccination disparities in rural Black communities. Moreover, results emphasize unique aspects of vaccination behavior in the Black community within Appalachia that may generalize to other Black communities living in rural regions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The influence of sociodemographic factors on COVID-19 vaccine certificate acceptance: A cross-sectional study

Vaccine certificates have been implemented worldwide, aiming to promote vaccination rates and to reduce the spread of COVID-19. However, their use during the COVID-19 pandemic was controversial and has been criticized for infringing upon medical autonomy and individual rights. We administered a national online survey exploring social and demographic factors predicting the degree of public approval of vaccine certificates in Canada. We conducted a multivariate linear regression which revealed which factors were predictive of vaccine certificate acceptance in Canada. Self-reported minority status (p < .001), rurality (p < .001), political ideology (p < .001), age (p < .001), having children under 18 in the household (p < .001), education (p = .014), and income status (p = .034) were significant predictors of attitudes toward COVID-19 vaccine certificates. We observed the lowest vaccine-certificate approval among participants who: self-identify as a visible minority; live in rural areas; are politically conservative; are 18-34 years of age; have children under age 18 living in the household; have completed an apprenticeship or trades education; and those with an annual income between $100,000-$159,999. The present findings are valuable for their ability to inform the implementation of vaccine certificates during future pandemic scenarios which may require targeted communication between public health agencies and under-vaccinated populations.

Psychosocial Determinants of COVID-19 Vaccine Hesitancy and the Mediating Role of Various Attitudes towards Science

This study examined the way attitudes towards science in the U.S. mediate the relationship between COVID-19 vaccine hesitancy and psychosocial predictors, such as political ideology, religiosity, reactance proneness, dogmatism, perceived communal ostracism, education, and socioeconomic status. We analyzed the structure of people's attitudes towards science, revealing four distinct factors: epistemic confidence, belief that science and technology are beneficial, trust in science in general, and trust in medical science. With all four factors included as mediators in a saturated path analysis, low levels of trust in medical science and low epistemic confidence fully mediated the relationships between nearly all of the psychosocial predictors and COVID-19 vaccine hesitancy. Political conservativism's negative association with vaccine hesitancy was partially mediated by the same two facets of people's attitudes towards science. Adding nuance to existing research, we found that trust in science in general was not a significant mediator once all four facets were included in the model. These findings are discussed with a focus on their implications for understanding attitudes towards science and their substantial and complex role in COVID-19 vaccine hesitancy.

Political network composition predicts vaccination attitudes

Political polarization is growing rapidly in the United States and has been linked to politicized public health issues including vaccination. Political homogeneity among one's interpersonal relationships may predict polarization levels and partisan bias. In this study, we analyzed if political network structure predicted partisan beliefs about the COVID-19 vaccine, beliefs about vaccines in general, and COVID-19 vaccine uptake. Personal networks were measured by whom the respondent discussed "important matters" with to obtain a list of individuals who are close to the respondent. The number of associates listed who share the political identity or vaccine status with the respondent was calculated as a measure of homogeneity. We find that having more Republicans and unvaccinated individuals in one's network predicted lower vaccine confidence whereas having more Democrats and vaccinated individuals in one's network predicted higher vaccine confidence. Exploratory network analyses revealed that non-kin others are especially impactful on vaccine attitudes when those network connections are also Republican and unvaccinated.

Measuring the importance of influencing factor for COVID-19 vaccination intention in China

Background

Vaccination is considered an effective approach to deter the spread of coronavirus disease (COVID-19). However, vaccine hesitancy is a common issue that makes immunization programs more challenging. To promote vaccination in a targeted and efficient way, this study aims to develop and validate a measurement tool for evaluating the importance of influencing factors related to COVID-19 vaccination intention in China, and to examine the demographic differences.

Methods

In study 1, we developed a Factor Importance Evaluation Questionnaire (FIEQ) based on semi-structured interview results and used exploratory factor analysis (EFA) to explore its factor structure. In study 2, we verified the four-factor structure of FIEQ by confirmatory factor analysis (CFA). We then administered FIEQ to Chinese participants and conducted a student t-test and analysis of variance to examine the differences in the importance evaluation of factors based on gender and educational level.

Results

In study 1, we developed a four-factor construct and retained 20 items after EFA (N = 577), with acceptable reliability (alpha = 0.87) and validity. In study 2, we found that the model fit was good (χ2 = 748.03 (162), p < 0.001, GFI = 0.949, RMSEA = 0.049, SRMR = 0.048, AGFI = 0.934), and reliability was acceptable (alpha = 0.730) (N = 1,496). No gender difference was found in factor importance. However, individuals with different educational levels reported significantly different importance evaluations of three factors, including perceived benefits and social norms (F = 3.786, p = 0.005), perceived influences from reference groups (F = 17.449, p < 0.001), and perceived risks (F = 2.508, p = 0.04).

Conclusion

This study developed and validated FIEQ for measuring the importance of influencing factors related to the COVID-19 vaccination intention in Chinese participants. Moreover, our findings suggest that the educational level may play a role in how individuals evaluate the importance of factors. This study provides insights into the concerns that individuals have regarding vaccination and offers potentially effective and targeted strategies for promoting COVID-19 vaccination.

The Impact of COVID-19 Vaccination on Inflammatory Skin Disorders and Other Cutaneous Diseases: A Review of the Published Literature

Background: Four vaccines have been authorized by the European Medicines Agency (EMA): viral vector-based vaccines (AstraZeneca; AZD1222 and Johnson & Johnson; Ad26.COV2. and 2 mRNA-based vaccines (Pfizer/BioNTech; BNT162b2 and Moderna; mRNA-1273). Adverse events (AEs) related to vaccination have been described in the literature. The main aim of the dermatological practice was to avoid the diffusion of COVID-19, allowing the continuity of care for patients. Objective: The aim of this review article is to investigate current literature regarding cutaneous reactions following COVID-19 vaccination, mainly inflammatory dermatological diseases. Materials and methods: Investigated manuscripts included metanalyses, reviews, letters to the editor, real-life studies, case series, and reports. Results: We selected a total of 234 articles involving more than 550 patients. We have divided the results section into various sub-sections to ensure greater understanding for readers. Conclusions: Clinicians should keep in mind the possibility of new onsets or the worsening of several dermatoses following vaccination in order to promptly recognize and treat these AEs. Certainly, vaccination should not be discouraged.

Parents' Intentions, Concerns and Information Needs about COVID-19 Vaccination in New Jersey: A Qualitative Analysis

BACKGROUND

In 2019, the World Health Organization identified vaccine hesitancy as a top ten global health threat, which has been exacerbated by the COVID-19 pandemic. Despite local and nationwide public health efforts, adolescent COVID-19 vaccination uptake in the US remains low. This study explored parents' perceptions of the COVID-19 vaccine and factors influencing hesitancy to inform future outreach and education campaigns.

METHODS

We conducted two rounds of individual interviews via Zoom in May-September 2021 and January-February 2022, with parents of adolescents from the Greater Newark Area of New Jersey, a densely populated area with historically marginalized groups that had low COVID-19 vaccination uptake. Data collection and analysis was guided by the Increasing Vaccination Model and WHO Vaccine Hesitancy Matrix. Interview transcripts were double-coded and thematically analyzed in NVivo.

RESULTS

We interviewed 22 parents (17 in English, 5 in Spanish). Nearly half (45%) were Black and 41% were Hispanic. Over half (54%) were born outside of the US. Most of the parents described that their adolescents had received at least one dose of a COVID-19 vaccine. All but one parent had received the COVID-19 vaccine. Despite strong vaccination acceptance for themselves, parents remained hesitant about vaccinating their adolescents. They were mostly concerned about the safety and potential side effects due to the novelty of the vaccine. Parents sought information about the vaccines online, through healthcare providers and authorities, and at community spaces. Interpersonal communication exposed parents to misinformation, though some personal connections to severe COVID-19 illness motivated vaccination. Historical mistreatment by the healthcare system and politicization of the vaccine contributed to parents' mixed feelings about the trustworthiness of those involved with developing, promoting, and distributing COVID-19 vaccines.

CONCLUSIONS

We identified multilevel influences on COVID-19 vaccine-specific hesitancy among a racially/ethnically diverse sample of parents with adolescents that can inform future vaccination interventions. To increase vaccine confidence, future COVID booster campaigns and other vaccination efforts should disseminate information through trusted healthcare providers in clinical and also utilize community settings by addressing specific safety concerns and promoting vaccine effectiveness.

Is knowledge about COVID-19 associated with willingness to receive vaccine, vaccine uptake, and vaccine booster uptake in rural Malang, Indonesia?

Background

Lack of knowledge regarding the coronavirus disease (COVID-19) and COVID-19 vaccines is a key barrier to COVID-19 vaccine uptake in low- and middle-income countries (LMICs).

Aims

To examine factors associated with knowledge about COVID-19 and the association between knowledge of COVID-19, willingness to receive a COVID-19 vaccine, and vaccine uptake in Malang, East Java, Indonesia.

Method

A cross-sectional study among individuals aged 15-99 years was conducted in Malang, Java Timur, Indonesia between November 2022 and January 2023. Of 10,050 potential respondents, 10,007 were able to complete the survey. The main independent variable was knowledge about COVID-19, which was assessed using a six-item questionnaire. The dependent variables were COVID-19 vaccine uptake and COVID-19 booster vaccine uptake. The mediating variable was respondent's willingness to receive a COVID-19 vaccine. Linear regression was used to examine factors associated with knowledge about COVID-19. Logistic regression was employed to examine the association of knowledge about COVID-19 with vaccine uptake. Generalized structural equation modeling (GSEM) was performed to examine whether willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccination uptake.

Findings

The percentage of respondents who reported having received at least one dose of a COVID-19 vaccine was 94.8%, while the percentage of those who reported having received at least three doses was 88.5%. These numbers are higher than the national average for COVID-19 vaccine and booster vaccine uptake. Most respondents answered about four of six knowledge items correctly (M = 4.60, SD = 1.1). Among respondents who had not received a vaccine, 83.1% expressed willingness to receive a vaccine when it became available to them. Older, more educated, employed respondents, and those with higher economic status, demonstrated more accurate knowledge about COVID-19 than younger, less educated, unemployed respondents and those with lower economic status. Respondents who demonstrated more accurate knowledge about COVID-19 were more likely to have received a vaccine (OR = 1.528, 95% CI = 1.428-1.634) and a booster vaccine (OR = 1.260, 95% CI = 1.196-1.328). Willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccine uptake (coef. = 0.426, 95% CI = 0.379-0.473).

Implications

Interventions and public health programs aiming to improve knowledge about COVID-19 can be implemented to improve individual willingness to receive COVID-19 vaccination and to improve COVID-19 vaccine uptake among the general population.

COVID-19 and Kidney Disease (KD): A Retrospective Investigation in a Rural Southwestern Missouri Region Patient Population

BACKGROUND

Studies have linked pre-existing kidney disease (KD) to higher rates of mortality due to coronavirus disease 2019 (COVID-19) infection. In the rural Midwest, where KD is prevalent, the impact of COVID-19 has been significant in a population that includes many patients on Medicare or Medicaid.

METHODS

A retrospective cohort study was performed assessing patients with acute kidney injury (AKI), chronic kidney disease (CKD) and end stage renal disease (ESRD), with and without COVID-19. International Classification of Diseases 10^th Revision codes were submitted by physicians into Freeman Health System's Electronic Medical Records and gathered from April 2020 to January 2021. The data were analyzed and compared to determine whether the mortality rate in patients with varying stages of KD and COVID-19 was higher than the mortality rate in patients with KD alone, excluding variables such as sex and age.

RESULTS

The 95% confidence interval (CI) of the mortality rate of patients with COVID-19 and any degree of KD, encompassing both AKI and CKD, was between 30.21% and 37.63%. This metric was significantly higher than the 95% CI of COVID-19 infection (6.70%-9.96%, p<0.0001) or KD alone (10.89%-13.01%, p<0.0001). Within those with COVID-19 and KD, the highest rate of mortality was in patients with AKI (38.13% and 49.02%). There was not sufficient statistical support in our sample to assert that COVID-19 increased mortality in ESRD patients.

CONCLUSIONS

Based on our results, patients with KD and COVID-19 are at higher risk for mortality when compared to patients with KD alone. Further studies are warranted into individual comorbidities affecting KD patient outcomes with COVID-19.

Is parental propensity to risk associated with their child's medically-attended injuries? A cross-sectional study

BACKGROUND

Societal expectations about safety influence parents' risk perceptions and children's risky play opportunities. This study examined parents' propensity to take risks themselves and their propensity to accept risks for their child, sex-related differences in parents' propensity to accept risks for their child, and the association between parents' propensity to accept risks for their child and that child's medically-attended injury history.

METHODS

A total of 467 parents attending a pediatric hospital with their 6-12-year-old child completed a questionnaire about their risk propensity for themselves and for their child and reported their child's injury history.

RESULTS

Parents' risk propensity for themselves was significantly higher than for their child, and fathers' risk propensity for themselves was higher than mothers'. Linear regressions showed that fathers reported significantly more propensity to accept risks for their child than mothers, but parents did not differentiate between their sons and daughters. A binary logistic regression showed that parents' propensity to accept risks for their child was a significant predictor of pediatric medically-attended injury.

CONCLUSIONS

Parents were more comfortable in taking risks for themselves than for their child. While fathers were more comfortable with their children engaging in risks than mothers, child's sex was not related to parents' propensity to accept risks for their child. Pediatric injury was predicted by parents' propensity to accept risks for their child. Further research investigating injury type and severity related parent risk propensity is needed to determine how parents' attitudes toward risk might relate to severe injury.