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Sarbakhsh P, Jafari N, Salemi S, Akbarnejad R. Predictors of Pediatric COVID-19 vaccination: a case-control study in Tabriz, Iran. BMC Pediatr 2023; 23:379. [PMID: 37525177 PMCID: PMC10388523 DOI: 10.1186/s12887-023-04202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION COVID-19 vaccination of children can help reduce the severity of the infection and the death rate caused by it and also helps achieve herd immunity. The level of acceptance and high vaccination coverage is the main elements in the success of immunization programs. Children's vaccination is dependent on their parent's decision. This study aims to identify predictors of the children's COVID-19 vaccination accomplishment by their parents. METHOD In this case-control study, 577 vaccinated children as cases and 366 un-vaccinated children as controls were randomly selected from the general population of Tabriz, Iran 2022, and their data were collected by telephone calls and interviews with the children's parents. Cases and controls were compared in terms of clinical and demographic factors of the child as well as the socioeconomic status (SES) of their parents by using a multivariable mixed-effect logistic regression model. RESULTS According to the results of the multivariable logistic regression, the age of the child (OR = 1.26 95% CI (1.14, 1.40), p-value < 0.001), previous COVID-19 infection of the child (OR = 1.92, 95% CI (1.21, 3.04), p-value < 0.001), having no underlying disease in the child (OR = 1.76, 95% CI (1.02, 3.02), p-value = 0.04), the dwelling place of the household (the high-level dwelling in compared to a low level (OR = 3.34, 95% CI (1.6, 6.64), p-value = 0.001), the middle level of dwelling compared with low level (OR = 4.87, 95% CI (2.46, 9.51), p-value < 0.001)), and Father's job (Employee and technician Fathers compared to worker fathers (OR = 2.99, 95% CI (1.55, 5.77), p-value = 0.001)) were significant independent predictors of children COVID-19 vaccination. CONCLUSION Several demographic and socioeconomic factors were associated with children's vaccination. Older children, children without any underlying disease, children with a history of COVID-19 infection, and children of parents with higher levels of SES were more likely to receive the COVID-19 vaccine. This finding can be considered in children's vaccination policymaking.
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Affiliation(s)
- Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Nasrin Jafari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saman Salemi
- Department of Medicine, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
| | - Reza Akbarnejad
- Department of Knowledge and Information Science, Education and Psychology Faculty, Azarbaijan Shahid Madani University, Tabriz, Iran
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Fu LT, Qu ZL, Zeng X, Li LZ, Lan R, Zhou Y. Spatiotemporal dynamics of confirmed case distribution during the COVID-19 pandemic in China: data comparison between 2020/04-2020/08 and 2021/04-2021/08. Sci Rep 2023; 13:11896. [PMID: 37482580 PMCID: PMC10363524 DOI: 10.1038/s41598-023-39139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/20/2023] [Indexed: 07/25/2023] Open
Abstract
The COVID-19 pandemic across Chinese mainland was gradually stabilized at a low level with sporadic outbreaks, before the emergence of Omicron variant. Apart from non-pharmacological interventions (NPIs), COVID-19 vaccine has also been implemented to prevent and control the pandemic since early 2021. Although many aspects have been focused, the change of the spatiotemporal distribution of COVID-19 epidemic across Chinese mainland responding to the change of prevention and control measures were less concerned. Here, we collected the confirmed case data (including domestic cases and overseas imported cases) across Chinese mainland during both 2020/04-2020/08 and 2021/04-2021/08, and then conducted a preliminary data comparison on the spatiotemporal distribution of confirmed cases during the identical period between the two years. Distribution patterns were evaluated both qualitatively by classification method and quantitatively through employing coefficient of variation. Results revealed significant differences in the homogeneity of spatiotemporal distributions of imported or domestic cases between the two years, indicating that the important effect of the adjustment of prevention and control measures on the epidemic evolution. The findings here enriched our practical experience of COVID-19 prevention and control. And, the collected data here might be helpful for improving or verifying spatiotemporally dynamic models of infectious diseases.
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Affiliation(s)
- Lin-Tao Fu
- School of Architecture and Civil Engineering, Chengdu University, Chengdu, 610106, China.
| | - Zhong-Ling Qu
- School of Architecture and Civil Engineering, Chengdu University, Chengdu, 610106, China
| | - Xin Zeng
- School of Architecture and Civil Engineering, Chengdu University, Chengdu, 610106, China
| | - Liang-Zhi Li
- School of Architecture and Civil Engineering, Chengdu University, Chengdu, 610106, China
| | - Run Lan
- School of Architecture and Civil Engineering, Chengdu University, Chengdu, 610106, China
| | - Yu Zhou
- School of Architecture and Civil Engineering, Chengdu University, Chengdu, 610106, China
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3
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Akintunde TY, Chen JK, Ibrahim E, Isangha SO, Sayibu M, Musa TH. Factors associated with COVID-19 vaccine uptake among foreign migrants in China. Heliyon 2023; 9:e17567. [PMID: 37533745 PMCID: PMC10292914 DOI: 10.1016/j.heliyon.2023.e17567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
Background/Purpose The COVID-19 outbreak created unique policy challenges for vaccinating special groups like migrants. As part of sustainable development goals, the equitable distribution of the COVID-19 vaccine can contribute to ensuring health for all. This study examined COVID-19 vaccine uptake among foreign migrants in China based on sociodemographics, cultural beliefs, past vaccine behaviors, and psychosocial factors. Design An online cross-sectional survey was conducted among foreign migrants in mainland China via social media platforms from 21 November through 20 December 2021. Bivariate (unadjusted odd-ratio) and multivariate logistic regression analyses were performed to establish the correlates of COVID-19 vaccine uptake. Result Surveyed foreign migrants that are culture neutral (AOR: 2.5, CI: 95%, 1.02-5.90, p = 0.044), willing to pay for vaccination (AOR: 2.27, CI: 95%, 1.18-3.98, p = 0.012), believe in vaccine efficacy (AOR: 3.00, CI: 95%, 1.75-5.16, p < 0.000), have poor psychological health (AOR: 1.96, CI: 95%, 1.14-3.38, p = 0 0.014), and have higher perceived seriousness of COVID-19 (AOR: 2.12, CI: 95%, 1.26-3.57, p = 0.005) are more likely to receive COVID-19 vaccine. Those migrants with a history of declining vaccination (AOR: 0.34, CI: 95%, 0.18-0.65, p = 0.000) and middle-income earners $1701-3500 (AOR: 0.43, CI: 95%, 0.23-0.82, p = 0.010) are less likely to receive the COVID-19 vaccine. Conclusion This study brings a unique perspective to understanding vaccine behavior among international migrants in China. There is an urgent call from the World Health Organization and countries for complete vaccination and efforts to improve vaccine coverage. However, fewer studies have been conducted globally on the vaccination of migrant populations. The current study provides empirical information to increase the knowledge of the correlates of vaccine behavior among immigrants in countries around the globe. Future studies should conduct cross-country comparisons to understand the factors associated with increasing vaccination rates among immigrant populations to formulate a strong policy to increase vaccine coverage among immigrant populations across countries.
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Affiliation(s)
- Tosin Yinka Akintunde
- Department of Sociology, School of Public Administration, Hohai University, China
- Department of Social Work, Chinese University of Hong Kong, Hong Kong
| | - Ji-Kang Chen
- Department of Social Work, Chinese University of Hong Kong, Hong Kong
| | - Elhakim Ibrahim
- Department of Demography, College for Health, Community and Policy, The University of Texas, San Antonio, TX, United States
| | - Stanley Oloji Isangha
- Department of Social and Behavioral Sciences, College of Liberal Art and Social Sciences, City University of Hong Kong, Hong Kong
| | - Muhideen Sayibu
- Department of Sci-Tech Communication and Policy, University of Science and Technology of China, Anhui, Hefei, China
| | - Taha Hussein Musa
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
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Tang S, Liu X, Jia Y, Chen H, Zheng P, Fu H, Xiao Q. Education level modifies parental hesitancy about COVID-19 vaccinations for their children. Vaccine 2023; 41:496-503. [PMID: 36494253 PMCID: PMC9705202 DOI: 10.1016/j.vaccine.2022.11.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
It is important to encourage parental acceptance of children's vaccination against COVID-19 to ensure population immunity and mitigate morbidity and mortality. This study drew upon protection motivation theory (PMT) to explore the factors of parental hesitancy about vaccinating their children. A national online survey was performed in China. A total of 2054 Chinese parents of children aged 6-12 years were included in this study. They reported on measures that assessed hesitancy about children's vaccination against COVID-19, PMT constructs (susceptibility, severity, response efficacy, self-efficacy, and response costs) and sociodemographic characteristics. Chinese parents reported a hesitancy rate of 29.4% for children's vaccination. Parents with higher level education were more likely to hesitate to vaccinate their children against COVID-19. After controlling for parents' and children's demographic variables, logistic regression showed that parents' hesitancy about their children's vaccination increased if parents had lower levels of susceptibility, response efficacy or self-efficacy, as well as higher levels of response costs. In addition, a high educational level can significantly increase the promotive effect of response cost and the protective effect of response efficacy on vaccine hesitancy. In conclusion, our findings suggested that PMT can explain parents' vaccine hesitancy and that education level can modify the effect of copying appraisal, but not threat appraisal, on parental hesitancy. This study will help public health officials send targeted messages to parents to improve the rate of COVID-19 vaccination in children aged 6-12 years and thus reach a higher level of immunity in the population.
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Affiliation(s)
- Shuning Tang
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, China
| | - Xin Liu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, China
| | - Yingnan Jia
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, China,School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Hao Chen
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, China
| | - Pinpin Zheng
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, China,School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Hua Fu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, China,School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Qianyi Xiao
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, China; School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China.
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Prosser LA, Wagner AL, Wittenberg E, Zikmund-Fisher BJ, Rose AM, Pike J. A Discrete Choice Analysis Comparing COVID-19 Vaccination Decisions for Children and Adults. JAMA Netw Open 2023; 6:e2253582. [PMID: 36716030 PMCID: PMC9887501 DOI: 10.1001/jamanetworkopen.2022.53582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
IMPORTANCE COVID-19 vaccination rates in the US remain below optimal levels. Patient preferences for different attributes of vaccine products and the vaccination experience can be important in determining vaccine uptake decisions. OBJECTIVE To assess preferences for attributes of adult and pediatric COVID-19 vaccination among US adults. DESIGN, SETTING, AND PARTICIPANTS An online survey of a national panel of 1040 US adults was conducted in May and June 2021. A discrete choice analysis was used to measure the relative value of each attribute in the decision to choose a COVID-19 vaccination option for adults or children. Six attributes were used to described hypothetical vaccination options: vaccine effectiveness, mild side effects, rare adverse events, number of doses, time required for vaccination, and regulatory approval. Respondents chose between hypothetical vaccination profiles or no vaccination. Additional survey questions asked about vaccination beliefs, COVID-19 illness experience, COVID-19 risk factors, vaccination status, and opinions about the risk of COVID-19. EXPOSURES Respondents chose which vaccine profile they would prefer to receive for themselves (or no vaccination). Respondents then considered an identical set of profiles for a hypothetical child aged 0 to 17 years. MAIN OUTCOMES AND MEASURES Relative value of vaccination-related attributes were estimated using Bayesian logit regression. Preference profiles for subgroups were estimated using latent class analyses. RESULTS A total of 1040 adults (610 [59%] female; 379 participants [36%] with an age of 55 years and older years) responded to the survey. When asked about vaccination choices for themselves, participants indicated that vaccine effectiveness (95% vs 60%) was a significant attribute (β, 9.59 [95% CrI, 9.20-10.00] vs β, 0.41 [95% CrI, 0-0.80]). Respondents also preferred fewer rare adverse events (β, 6.35 [95% CrI, 5.74-6.86), fewer mild side effects (β, 5.49; 95% CrI, 5.12-5.87), 1 dose (β, 5.41; 95% CrI, 5.04-5.78), FDA approval (β, 6.01; 95% CrI, 5.64-6.41), and shorter waiting times (β, 5.67; 95% CrI, 4.87-6.48). Results were very similar when framing the question as adult or child vaccination, with slightly stronger preference for fewer rare adverse events for children. Latent class analysis revealed 4 groups of respondents: (1) individuals sensitive to safety and regulatory status, (2) individuals sensitive to convenience, (3) individuals who carefully considered all attributes in making their choices, and (4) individuals who rejected the vaccine. CONCLUSIONS AND RELEVANCE In this survey study of US adults, the identification of 4 distinct preference groups provides new information to guide communications to support vaccine decision making. In particular, the group that prioritize convenience (less time required for vaccination and fewer doses) may present an opportunity to create actionable strategies to increase vaccination uptake for both adult and pediatric populations.
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Affiliation(s)
| | | | - Eve Wittenberg
- Harvard Chan School of Public Health, Boston, Massachusetts
| | | | | | - Jamison Pike
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Parents' perception of COVID-19 risk of infection and intention to vaccinate their children. VACUNAS 2023; 24:37-44. [PMID: 36062027 PMCID: PMC9424507 DOI: 10.1016/j.vacun.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023]
Abstract
Background Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs. Objective Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children. Method Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire. Results Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766). Conclusion Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.
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Sharif Nia H, Allen KA, Arslan G, Kaur H, She L, Khoshnavay Fomani F, Gorgulu O, Sivarajan Froelicher E. The predictive role of parental attitudes toward COVID-19 vaccines and child vulnerability: A multi-country study on the relationship between parental vaccine hesitancy and financial well-being. Front Public Health 2023; 11:1085197. [PMID: 36875362 PMCID: PMC9980903 DOI: 10.3389/fpubh.2023.1085197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023] Open
Abstract
Background and purpose Recent new mutations and increases in transmission of COVID-19 among adolescents and children highlight the importance of identifying which factors influence parental decisions regarding vaccinating their children. The current study aims to explore whether child vulnerability and parents' attitudes toward vaccines mediate the association between perceived financial well-being and vaccine hesitancy among parents. Method A predictive, cross-sectional, multi-country online questionnaire was administered with a convenience sample of 6,073 parents (Australia, 2,734; Iran, 2,447; China, 523; Turkey, 369). Participants completed the Parent Attitude About Child Vaccines (PACV), the Child Vulnerability Scale (CVS), a Financial Well-being (FWB) measure, and Parental Vaccine Hesitancy (PVH) questionnaire. Results The current study revealed that perceived financial well-being had significant and negative associations with parents' attitudes toward COVID-19 vaccines and child vulnerability among the Australian sample. Contrary to the Australian findings, results from Chinese participants indicated that financial well-being had significant and positive predictive effects on parent attitudes toward vaccines, child vulnerability, and parental vaccine hesitancy. The results of the Iranian sample revealed that parents' attitudes toward vaccines and child vulnerability significantly and negatively predicted parental vaccine hesitancy. Conclusion The current study revealed that a parents' perceived financial well-being had a significant and negative relationship with parental attitudes about vaccines and child vulnerability; however, it did not significantly predict parental vaccine hesitancy among Turkish parents as it did for parents in Australia, Iran, and China. Findings of the study have policy implications for how certain countries may tailor their vaccine-related health messages to parents with low financial wellbeing and parents with vulnerable children.
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Affiliation(s)
- Hamid Sharif Nia
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kelly-Ann Allen
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Gökmen Arslan
- Department of Psychological Counselling and Guidance, Mehmet Akif Ersoy University, Burdur, Türkiye.,Centre for Wellbeing Science, University of Melbourne, Melbourne, VIC, Australia
| | - Harpaljit Kaur
- School of Management and Marketing, Faculty of Business and Law, Taylor's University, Subang Jaya, Malaysia
| | - Long She
- Faculty of Business, Design and Arts, Swinburne University of Technology, Kuching, Sarawak, Malaysia
| | | | - Ozkan Gorgulu
- Department of Biostatistics and Medical Informatics, Kirşehir Ahi Evran University Faculty of Medicine, Kırşehir, Türkiye
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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8
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Parents' perception of COVID-19 risk of infection and intention to vaccinate their children. VACUNAS (ENGLISH EDITION) 2023; 24. [PMCID: PMC9969534 DOI: 10.1016/j.vacune.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Background Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs. Objective Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children. Method Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire. Results Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766). Conclusion Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.
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9
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Wang J, Wagner AL, Chen Y, Jaime E, Hu X, Wu S, Lu Y, Ruan Y, Pan SW. Would COVID-19 vaccination willingness increase if mobile technologies prohibit unvaccinated individuals from public spaces? A nationwide discrete choice experiment from China. Vaccine 2022; 40:7466-7475. [PMID: 34742594 PMCID: PMC8531240 DOI: 10.1016/j.vaccine.2021.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/06/2021] [Accepted: 10/01/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Achieving COVID-19 community protection (aka, herd immunity) in China may be challenging because many individuals remain unsure or are unwilling to be vaccinated. One potential means to increase COVID-19 vaccine uptake is to essentially mandate vaccination by using existing mobile technologies that can prohibit unvaccinated individuals from certain public spaces. The "Health Code" is a ubiquitous mobile phone app in China that regulates freedom of travel based on individuals' predicted risk of exposure to SARS-CoV-2. Green-colored codes indicate ability to travel unrestricted in low-risk regions; yellow-colored codes indicate prohibition from major public spaces and modes of public transportation. We examined the effects of a "Health Code"-based vaccine mandate on willingness to vaccinate for COVID-19 in China. METHODS In August 2020, an online discrete choice experiment (DCE) was conducted among adults living in China. Participants completed up to six DCE choice sets, each containing two hypothetical COVID-19 vaccination scenario choices and a "do not vaccinate" choice. Half of the choice sets had a "Health Code" attribute that associated the "do not vaccinate" choice with a yellow Health Code implying restricted travel. Weighted, mixed effects multinomial logit regression was used to estimate preference utilities and predicted choice probabilities. RESULTS Overall, 873 participants completed 4317 choice sets. Most participants attained at least college-level education (90.9%). 29.8% of participants were identified as vaccine hesitators (defined as being unsure or unwilling to receive a COVID-19 vaccination). With and without the "Health Code"-based vaccine mandate, there was an 8.6% (85% CI: 6.4% - 10.92%) and 17.3% (85% CI:13.1% - 21.6%) respective predicted probability that vaccine hesitators would choose "do not vaccinate" over a common vaccination scenario currently in China (i.e., free, domestic vaccine, 80% effectiveness, 10% probability of fever side-effects, administered in a large hospital, two doses). Corresponding predicted probabilities for people who did not express vaccine hesitancy was 0.3% (93% CI: 0.0% - 14.3%) and 3.5% (93% CI:2.3% - 4.8%). The "Health Code"-based mandate significantly increased willingness to vaccinate when vaccine efficacy was greater than 60%. CONCLUSION Among vaccine hesitators with higher educational attainment, willingness to vaccinate for COVID-19 appears to increase if mobile technology-based vaccine mandates prohibit unvaccinated individuals from public spaces and public transportation. However, such mandates may not increase willingness if perceived vaccine efficacy is low.
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Affiliation(s)
- Jing Wang
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Ying Chen
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Etienne Jaime
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Xinwen Hu
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Shiqiang Wu
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Yihan Lu
- Ministry of Education Key Laboratory of Public Health Safety, Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Stephen W Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China.
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Bussink-Voorend D, Hautvast JLA, Vandeberg L, Visser O, Hulscher MEJL. A systematic literature review to clarify the concept of vaccine hesitancy. Nat Hum Behav 2022; 6:1634-1648. [PMID: 35995837 DOI: 10.1038/s41562-022-01431-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.
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Affiliation(s)
- Daphne Bussink-Voorend
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Lisa Vandeberg
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Olga Visser
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Khan YH, Rasheed M, Mallhi TH, Salman M, Alzarea AI, Alanazi AS, Alotaibi NH, Khan SUD, Alatawi AD, Butt MH, Alzarea SI, Alharbi KS, Alharthi SS, Algarni MA, Alahmari AK, Almalki ZS, Iqbal MS. Barriers and facilitators of childhood COVID-19 vaccination among parents: A systematic review. Front Pediatr 2022; 10:950406. [PMID: 36507133 PMCID: PMC9731120 DOI: 10.3389/fped.2022.950406] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background The acceptance of vaccination against COVID-19 among parents of young children plays a significant role in controlling the current pandemic. A wide range of factors that influence vaccine hesitancy in adults has been reported worldwide, but less attention has been given to COVID-19 vaccination among children. Vaccine hesitancy is considered a major challenge in achieving herd immunity, and it is more challenging among parents as they remain deeply concerned about their child's health. In this context, a systematic review of the current literature is inevitable to assess vaccine hesitancy among parents of young children to ensure a successful ongoing vaccination program. Method A systematic search of peer-reviewed English literature indexed in Google Scholar, PubMed, Embase, and Web of science was performed using developed keywords between 1 January 2020 and August 2022. This systematic review included only those studies that focused on parental concerns about COVID-19 vaccines in children up to 12 years without a diagnosis of COVID-19. Following PRISMA guidelines, a total of 108 studies were included. The quality appraisal of the study was performed by Newcastle-Ottawa Scale (NOS). Results The results of 108 studies depict that vaccine hesitancy rates differed globally with a considerably large number of factors associated with it. The highest vaccine hesitancy rates among parents were reported in a study from the USA (86.1%) and two studies from Saudi Arabia (>85%) and Turkey (89.6%). Conversely, the lowest vaccine hesitancy rates ranging from 0.69 and 2% were found in two studies from South Africa and Switzerland, respectively. The largest study (n = 227,740) was conducted in Switzerland while the smallest sample size (n = 12) was represented by a study conducted in the USA. The most commonly reported barriers to childhood vaccination were mothers' lower education level (N = 46/108, 43%), followed by financial instability (N = 19/108, 18%), low confidence in new vaccines (N = 13/108, 12%), and unmonitored social media platforms (N = 5/108, 4.6%). These factors were significantly associated with vaccine refusal among parents. However, the potential facilitators for vaccine uptake among respondents who intended to have their children vaccinated include higher education level (N = 12/108, 11%), followed by information obtained through healthcare professionals (N = 9/108, 8.3%) and strong confidence in preventive measures taken by the government (N = 5/81, 4.6%). Conclusion This review underscores that parents around the globe are hesitant to vaccinate their kids against COVID-19. The spectrum of factors associated with vaccine hesitancy and uptake varies across the globe. There is a dire need to address vaccine hesitancy concerns regarding the efficacy and safety of approved vaccines. Local context is inevitable to take into account while developing programs to reduce vaccine hesitancy. There is a dire need to devise strategies to address vaccine hesitancy among parents through the identification of attributing factors.
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Affiliation(s)
- Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Maria Rasheed
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Abdulaziz Ibrahim Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Abdullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Salah-Ud-Din Khan
- Department of Biochemistry, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ahmed D. Alatawi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Muhammad Hammad Butt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Sami I. Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Khalid Saad Alharbi
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | | | - Majed Ahmed Algarni
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Abdullah K. Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ziyad Saeed Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Yang Z, Luo X, Jia H, Xie Y, Zhang R. Personal Narrative under Nationalism: Chinese COVID-19 Vaccination Expressions on Douyin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12553. [PMID: 36231849 PMCID: PMC9566288 DOI: 10.3390/ijerph191912553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Scholars are divided over whether narrative/storytelling occupies a central position in health-related behaviour or in the health-related issues discussed on social media platforms. This study explored Chinese COVID-19 vaccination expressions on Douyin, China's biggest short-video sharing social media platform, and found that narration is still the most important tool employed by Chinese users when talking about COVID-19 vaccinations on Douyin, emphasizing nationalism and widespread optimism. Most of the narratives employed by Chinese users come from a first-person perspective. Nationalism, as manifested in the support expressed for national policies, rather than the external platform characteristics of memetics, makes the Chinese users' expressions about COVID-19 vaccinations similar on Douyin. Douyin seems to have become a 'pilgrimage platform' for the Chinese public to express their patriotic sentiment and their trust in the country and the government.
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Affiliation(s)
- Zheng Yang
- Center for Chinese Urbanization Studies, School of Communication, Soochow University, Suzhou 215123, China
- School of Communication, Soochow University, Suzhou 215123, China
| | - Xi Luo
- School of Communication, Soochow University, Suzhou 215123, China
| | - Hepeng Jia
- School of Communication, Soochow University, Suzhou 215123, China
| | - Yu Xie
- School of Communication, Soochow University, Suzhou 215123, China
| | - Ruifen Zhang
- School of Communication, Soochow University, Suzhou 215123, China
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13
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Nour R, Powell L, Alnakhi WK, Mamdouh H, Zidoun Y, Hussain HY, Al Suwaidi H, Zary N. Adult Vaccine Hesitancy Scale in Arabic and French: Protocol for the translation and validation in the WHO EMRO region. JMIR Res Protoc 2022; 11:e36928. [PMID: 35247043 PMCID: PMC9007230 DOI: 10.2196/36928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/05/2022] [Indexed: 01/22/2023] Open
Abstract
Background The world as we know it changed during the COVID-19 pandemic. Hope has emerged with the development of new vaccines against the disease. However, many factors hinder vaccine uptake and lead to vaccine hesitancy. Understanding the factors affecting vaccine hesitancy and how to assess its prevalence have become imperative amid the COVID-19 pandemic. The vaccine hesitancy scale (VHS), developed by the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization, has been modified to the adult VHS (aVHS) and validated in English and Chinese. To our knowledge, no available aVHS has been designed or validated in Arabic or French. Objective The aim of this research is to translate the aVHS from its original English language to Arabic and French and validate the translations in the WHO Eastern Mediterranean region. Methods The study will follow a cross-sectional design divided into 5 phases. In phase 1, the original aVHS will be forward-translated to Arabic and French, followed by backward translation to English. An expert committee will review and rate all versions of the translations. Expert agreement will then be measured using the Cohen kappa coefficient (k). In phase 2, the translated aVHS will be pilot-tested with 2 samples of participants (n=100): a group that speaks both Arabic and English and another that speaks French and English. Participants’ responses to the English version will also be collected. In phase 3, responses will then be compared. Descriptive statistics and paired t tests or one-way analyses of variance (ANOVA) and Pearson correlation coefficient will be used in the preliminary validation. In phase 4, prefinal versions (Arabic and French) will be tested with larger sample sizes of Arabic speakers (n=1000) and French speakers (n=1000). Sociodemographic information and vaccination status will be collected and used for further analysis. In phase 5, the scale's statistical reliability and internal consistency will be measured using Cronbach alpha. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to examine the model fit resulting from the EFA. ANOVA and regression models will be constructed to control for confounders. All data will be electronically collected. Results As of January 2022, the scale had been translated to Arabic and French and was undergoing the process of back translation. All data collection tools have been prepared (ie, sociodemographics, vaccination status, and open-ended questions) and are ready to go into their electronic formats. We expect to reach the desired sample size in this phase by June 2022. Conclusions This study will provide researchers with a validated tool to assess adult vaccine hesitancy within populations that speak Arabic and/or French and provide a road map to scale translation and ensure cross-cultural adaptation. International Registered Report Identifier (IRRID) PRR1-10.2196/36928
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Affiliation(s)
- Radwa Nour
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, AE
| | - Leigh Powell
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, AE
| | - Wafa K Alnakhi
- Department of Data Analysis, Research and Studies, Dubai Health Authority, Dubai, AE
| | - Heba Mamdouh
- Department of Data Analysis, Research and Studies, Dubai Health Authority, Dubai, AE
| | - Youness Zidoun
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, AE
| | - Hamid Y Hussain
- Department of Data Analysis, Research and Studies, Dubai Health Authority, Dubai, AE
| | - Hanan Al Suwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, AE
| | - Nabil Zary
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare CityP.O Box 505055, Dubai, AE
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14
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Bianco A, Della Polla G, Angelillo S, Pelullo CP, Licata F, Angelillo IF. Parental COVID-19 vaccine hesitancy: a cross-sectional survey in Italy. Expert Rev Vaccines 2022; 21:541-547. [PMID: 34949136 DOI: 10.1080/14760584.2022.2023013] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Understanding parents' hesitancy against COVID-19 vaccination for their children is useful. METHODS A self-administered online survey was conducted among 394 parents with at least one child aged 12-18 years in Italy. RESULTS The mean perceived risk that their child can be infected by the SARS-CoV-2, measured on a 10-point Likert-type scale, was 7.7 and it was higher if at least one parent/partner cohabitant have had COVID-19, in those who believed that COVID-19 is a serious illness, and in those who had not vaccinated their child. 82.1% respondents were willing to vaccinate their child and this was more likely among those who believed that this vaccine is useful and who did not need additional information. 12.4% were, according to the 5-item Parent Attitudes About Childhood Vaccines Survey (PACV-5) score, high-hesitant toward anti-COVID-19 vaccination. Respondents not graduated, those who did not believe that this vaccination was useful, those who did not get this vaccine, those who did not obtain information from physicians, and those who needed additional information were more likely to be high-hesitant. CONCLUSIONS Communication and public health interventions must be intensified to enhance the attitude and to help parents in deciding on COVID-19 vaccination of their children.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Giorgia Della Polla
- Health Direction, Teaching Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvia Angelillo
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Concetta P Pelullo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Licata
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Italo F Angelillo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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15
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Ma Y, Ren J, Zheng Y, Cai D, Li S, Li Y. Chinese parents' willingness to vaccinate their children against COVID-19: A systematic review and meta-analysis. Front Public Health 2022; 10:1087295. [PMID: 36590001 PMCID: PMC9798204 DOI: 10.3389/fpubh.2022.1087295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction To evaluate Chinese parents' willingness to vaccinate their children against COVID-19, identify its predictors, and provide a reference for raising the COVID-19 vaccination rate for children. Method PubMed, Cochrane Library, Embase, and the databases in Chinese, including CNKI, WanFang, VIP, CBM, were searched from December 2019 to June 2022, and citation tracking was used to identify relevant studies. To calculate the rate with 95% confidence intervals (CI), a random-effects model was used. To explore sources of heterogeneity, sensitivity analysis and subgroup analysis were conducted. This analysis was registered on PROSPERO (CRD42022346866) and reported in compliance with the PRISMA guidelines. Result Overall, 80 studies were screened, and 13 studies with 47994 parents were included after removing duplicates and excluding 19 studies that did not meet the selection criteria by title, abstract and full-text screening. The pooled willingness rate of Chinese parents to vaccinate their children against COVID-19 was 70.0% (95% CI: 62.0~78.0%). Level of education, perceived susceptibility of children infected with COVID-19, and parental attitudes toward vaccination (such as perceived efficacy and safety of the COVID-19 vaccines, parental willingness to vaccinate themselves, parental vaccination hesitancy, and the history of children's vaccination against influenza) were the main predictors of parents' intention to vaccinate their children. Discussion Chinese parents' willingness to vaccinate their children against COVID-19 is moderate, and factors including parental education level, perceived susceptibility of children infected with COVID-19, and parental attitudes toward vaccination affect this decision. Fully identifying these factors and their mechanism will be essential to further raise the willingness rate. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022346866.
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Affiliation(s)
- Yundi Ma
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingjing Ren
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- *Correspondence: Jingjing Ren
| | - Yang Zheng
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dongping Cai
- The Healthcare Center for Shishan Street Community of Suzhou New District, Suzhou, Jiangsu, China
| | - Shuai Li
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yangni Li
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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16
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Parents' Decisions to Vaccinate Children against COVID-19: A Scoping Review. Vaccines (Basel) 2021; 9:vaccines9121476. [PMID: 34960221 PMCID: PMC8705627 DOI: 10.3390/vaccines9121476] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/13/2022] Open
Abstract
Since 2019, the COVID-19 pandemic has resulted in sickness, hospitalizations, and deaths of the old and young and impacted global social and economy activities. Vaccination is one of the most important and efficient ways to protect against the COVID-19 virus. In a review of the literature on parents’ decisions to vaccinate their children, we found that widespread vaccination was hampered by vaccine hesitancy, especially for children who play an important role in the coronavirus transmission in both family and school. To analyze parent vaccination decision-making for children, our review of the literature on parent attitudes to vaccinating children, identified the objective and subjective influencing factors in their vaccination decision. We found that the median rate of parents vaccinating their children against COVID-19 was 59.3% (IQR 48.60~73.90%). The factors influencing parents’ attitudes towards child vaccination were heterogeneous, reflecting country-specific factors, but also displaying some similar trends across countries, such as the education level of parents. The leading reason in the child vaccination decision was to protect children, family and others; and the fear of side effects and safety was the most important reason in not vaccinating children. Our study informs government and health officials about appropriate vaccination policies and measures to improve the vaccination rate of children and makes specific recommendations on enhancing child vaccinate rates.
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17
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Zhang F, Shih SF, Harapan H, Rajamoorthy Y, Chang HY, Singh A, Lu Y, Wagner AL. Changes in COVID-19 risk perceptions: methods of an internet survey conducted in six countries. BMC Res Notes 2021; 14:428. [PMID: 34823587 PMCID: PMC8613724 DOI: 10.1186/s13104-021-05846-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives This study assessed changes in behaviors/attitudes related to the COVID-19. With the understanding that behaviors and vaccine decision-making could contribute to global spread of infectious diseases, this study collected several waves of internet-based surveys from individuals in the United States, mainland China, Taiwan, Malaysia, Indonesia, and India. The aims of this study were to (1) characterize the relationship between the epidemiology of disease and changes over time in risk perceptions, knowledge, and attitudes towards hygienic behaviors; (2) examine if risk perceptions affect acceptance of less-than-ideal vaccines; and (3) contrast adherence to public health recommendations across countries which have had different governmental responses to the outbreak. Data description We conducted cross-sectional online surveys in six countries from March 2020 to April 2021. By the end of June 2021, there will be six waves of surveys for the United States and China, and four waves for the rest of countries. There are common sets of questions for all countries, however, some questions were adapted to reflect local situations and some questions were designed intentionally for specific countries to capture different COVID-19 mitigation actions. Participants were asked about their adherence towards countermeasures, risk perceptions, and acceptance of a hypothetical vaccine for COVID-19.
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Affiliation(s)
- Felicia Zhang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia.,Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia.,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
| | - Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Sungai Long Campus, Jalan Sungai Long, Cheras, 43000, Kajang, Selangor, Malaysia
| | - Hao-Yuan Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, 10051, Taiwan
| | - Awnish Singh
- National Technical Advisory Group on Immunisation Secretariat, National Institute of Health and Family Welfare, New Delhi, 110067, India
| | - Yihan Lu
- Key Laboratory of Public Health Safety (Ministry of Education), Fudan University School of Public Health, Shanghai, 200032, China
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA.
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18
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Xu Y, Xu D, Luo L, Ma F, Wang P, Li H, Li Q, Wei L, Diao J, Liu Y, Zhang W, Zheng X. A Cross-Sectional Survey on COVID-19 Vaccine Hesitancy Among Parents From Shandong vs. Zhejiang. Front Public Health 2021; 9:779720. [PMID: 34805084 PMCID: PMC8602062 DOI: 10.3389/fpubh.2021.779720] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction: With the approval of COVID-19 vaccinations for children and adolescents in China, parental vaccine hesitancy will emerge as a new challenge with regard to the administration of these vaccines. However, little is known regarding this hesitancy as well as regional differences that may exist between parents from Shandong vs. Zhejiang. Methods: To assess these issues, an online survey was conducted via a Wenjuanxing platform over the period from July 22 to August 14, 2021. Parents from Shandong and Zhejiang were recruited from Wechat groups and results from a total of 917 subjects were analyzed. Factors evaluated in this survey included socio-demographic variables, parental vaccine hesitancy, Parental Attitudes toward Childhood Vaccines (PACV) domains (behavior, safety and efficacy, general attitudes) and social support. Results: Compared with those from Shandong (N = 443), parents from Zhejiang (N = 474) showed significantly higher prevalence rates of COVID-19 vaccine hesitancy (19.4 vs. 11.7%, p = 0.001). Multivariate logistic regression showed that yearly household incomes of ≥120,000 RMB (p = 0.041), medical workers (p = 0.022) and general attitudes of PACV (p = 0.004) were risk factors for vaccine hesitancy among parents from Shandong, while behavior (p = 0.004), safety and efficacy (p < 0.001) and general attitudes of PACV (p = 0.002) were risk factors for parents from Zhejiang. Among parents with vaccine hesitancy (N = 144), concerns over side effects (91.0%) and unknown effects (84.0%) of the COVID-19 vaccine were the most prevalent reasons for hesitancy. Evidence providing proof of vaccine safety (67.4%) and assurance of a low risk of being infected by COVID-19 (60.4%) were the two most effective persuasive factors. Conclusion: Parents from Zhejiang showed a higher prevalence of COVID-19 vaccine hesitancy as compared with those from Shandong. Behavior, safety and efficacy, and general attitudes of PACV were the risk factors associated with this hesitancy in these parents from Zhejiang. Given the identification of the various reasons for parental vaccine hesitancy, different strategies as well as regional adjustments in these strategies will be required for an effective and convincing protocol for childhood vaccinations.
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Affiliation(s)
- Yunyun Xu
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Zhejiang, China
| | - Dongjuan Xu
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Zhejiang, China
| | - Liyan Luo
- Department of Epidemiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengqiao Ma
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Zhejiang, China
| | - Ping Wang
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongfei Li
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Zhejiang, China
| | - Qing Li
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lianyan Wei
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Zhejiang, China
| | - Jiuzhou Diao
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuanyuan Liu
- Department of Dermatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Weiqiang Zhang
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Zhejiang, China
| | - Xiaolei Zheng
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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19
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Knowledge about, attitude and acceptance towards, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China: A cross-sectional survey. JOURNAL OF INTEGRATIVE MEDICINE 2021; 20:34-44. [PMID: 34774463 PMCID: PMC8559872 DOI: 10.1016/j.joim.2021.10.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has had a serious impact on health all over the world. Cancer patient, whose immunity is often compromised, faces a huge challenge. Currently, some COVID-19 vaccines are being developed and applied on general population; however, whether cancer patients should take COVID-19 vaccine remains unknown. Our study aimed to explore the knowledge, attitude, acceptance, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China. METHODS A cross-sectional study was conducted in Eastern China from June 17th to September 3rd, 2021. Patients were selected using a convenience sampling method. A self-report questionnaire was developed to assess knowledge about the COVID-19 vaccine, attitude towards the vaccine and acceptance of the vaccine; following a review of similar studies previously published in the scientific literature, multivariate logistic regression analysis was used to determine the predictors associated with COVID-19 vaccine acceptance. RESULTS A total of 2158 cancer patients were enrolled in this study. The rate of vaccine hesitancy was 24.05% (519/2158); further, among the participants of vaccine acceptance, 767 had taken COVID-19 vaccine (35.54%), and 872 were willing to get vaccinated (40.01%). A total of 24 variables including demographic characteristics, clinical status of cancer, impact of COVID-19 pandemic on study participants, patients' knowledge about the COVID-19 vaccine, and attitude towards the vaccine, had significant differences between the "vaccine hesitancy" population and "vaccine acceptance" population. Multivariate logistic regression analysis indicated that parameters including alcohol consumption (odds ratio [OR] = 1.849; 95% confidence interval [CI]: 1.375-2.488; P-reference [P-Ref] < 0.001 vs non-drinkers), income impacted by COVID-19 pandemic (OR = 1.930, 2.037 and 2.688 for mild, moderate, and severe impact, respectively; all P-Ref < 0.01 vs no impact), knowledge of how the vaccine was developed (OR = 1.616; 95% CI: 1.126-2.318; P-Ref = 0.009 vs unknown), believing in the safety of the vaccine (OR = 1.502; 95% CI: 1.024-2.203; P-Ref = 0.038 vs denying the safety of vaccine), willingness to pay for the vaccine (OR = 3.042; 95% CI: 2.376-3.894; P-Ref < 0.001 vs unwilling), and willingness to recommend families and friends to get vaccinated (OR = 2.744; 95% CI: 1.759-4.280; P-Ref < 0.001 vs do not recommend) were contributors to vaccine acceptance. While such as being retired (OR = 0.586; 95% CI: 0.438-0.784; P-Ref < 0.001 vs unemployed), undergoing multiple therapies of cancer (OR = 0.408; 95% CI: 0.221-0.753; P-Ref = 0.004 vs no ongoing treatment), and worrying that the vaccine might deteriorate the prognosis of cancer (OR = 0.393; 95% CI: 0.307-0.504; P-Ref < 0.001 vs might not) were contributors to vaccine hesitancy. CONCLUSION This study provided preliminary estimates of the rates of vaccine acceptance and vaccine hesitancy among cancer patients in Eastern China. The intention to receive the COVID-19 vaccine was impacted by factors such as patient occupation, alcohol consumption, and some parts of knowledge about and attitude towards COVID-19 vaccine. It is recommended to develop individualized vaccination plans that meet the healthcare needs of cancer patients.
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Du M, Tao L, Liu J. The Association Between Risk Perception and COVID-19 Vaccine Hesitancy for Children Among Reproductive Women in China: An Online Survey. Front Med (Lausanne) 2021; 8:741298. [PMID: 34568394 PMCID: PMC8455903 DOI: 10.3389/fmed.2021.741298] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 01/15/2023] Open
Abstract
Background: This study aimed to explore the association between risk perception and coronavirus disease 2019 (COVID-19) vaccine hesitancy among reproductive women in China to supplement limited studies in this area. Methods: From December 14, 2020, to January 31, 2021, an anonymous cross-sectional online survey was conducted on COVID-19 vaccine hesitancy for children among reproductive women in China. We assessed risk perception, including perceived susceptibility, severity, barriers, and benefits using the health belief model, and then classified each variable into three groups (low, moderate, and high) based on tertiles. Information on sociodemographic characteristics, health status, and knowledge of COVID-19 was also collected. The Pearson χ2-test was used to compare vaccine hesitancy among the above mentioned factors. Logistic regression models were used to calculate the adjusted odds ratio (aOR) of risk perception related to vaccine hesitancy after controlling for the above covariates. Results: Among 3,011 reproductive women, 8.44% (95%CI: 7.44. 9.43) had COVID-19 vaccine hesitancy. Vaccine hesitancy was observed more in women who lived in eastern China (11.63%), aged >45 years (12.00%), had a lower than high school education level (12.77%), and a low score on knowledge of COVID-19 (12.22%). Vaccine hesitancy was associated with lower perceived susceptibility (moderate: aOR = 1.72, 95%CI: 1.17-2.54, P = 0.0061; low: aOR = 2.44, 95%CI: 1.60-3.70, P < 0.0001), high perceived barriers (aOR = 2.86, 95%CI: 1.57-5.22, P < 0.0001), and lower perceived benefit (moderate: aOR = 3.29, 95%CI: 2.30-4.70, P < 0.0001; low: aOR = 4.59, 95%CI: 2.98-7.07, P < 0.0001), but not with perceived severity. Conclusions: Although the proportion of COVID-19 vaccine hesitancy for children among Chinese reproductive women was <1 out of 10, to improve COVID-19 vaccine hesitancy, our findings suggest that tailored public health measures are needed to increase perceived susceptibility and benefit, and decrease perceived barriers among reproductive women.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
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21
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A K, Lu X, Wang J, Hu L, Li B, Lu Y. Association between Adult Vaccine Hesitancy and Parental Acceptance of Childhood COVID-19 Vaccines: A Web-Based Survey in a Northwestern Region in China. Vaccines (Basel) 2021; 9:1088. [PMID: 34696196 PMCID: PMC8539638 DOI: 10.3390/vaccines9101088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
China has initiated the COVID-19 vaccination for children aged 15-17 years since late July 2020. This study aimed to determine the association between adult vaccine hesitancy and parental acceptance of childhood COVID-19 vaccines in a multi-ethnicity area of northwestern China. A web-based investigation was performed with a convenience sampling strategy to recruit the parents aged 20-49 years. In a total of 13,451 valid respondents, 66.1% had received the COVID-19 vaccination, 26.6% were intent to receive, while 7.3% were not intent, with an increasing vaccine hesitancy (p < 0.001). Moreover, vaccination uptake of four common vaccines in their children remained low (29.0% for influenza vaccine, 17.9% for pneumonia vaccine, 10.9% for rotavirus vaccine, 8.0% for Enterovirus-71 vaccine), while overall parental acceptance of childhood COVID-19 vaccines was 50.0% (32.7% for those aged 0-5, 46.6% for 6-10, 73.3% for 11-18; p < 0.001). Vaccination uptake of these four vaccines and parental acceptance of childhood COVID-19 vaccine were negatively associated with adult vaccine hesitancy. In addition, respondents mostly preferred childhood COVID-19 vaccines with weak mild common adverse events (β = 1.993) and no severe adverse events (β = 1.731), demonstrating a positive association with adult vaccine hesitancy. Thus, it warrants specific countermeasures to reduce adult vaccine hesitancy and improve strategies for childhood vaccination.
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Affiliation(s)
- Kezhong A
- Institute of Immunization, Qinghai Provincial Center for Disease Control and Prevention, Xining 810007, China;
| | - Xinyue Lu
- Department of Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (X.L.); (L.H.); (B.L.)
| | - Jing Wang
- Department of Health and Environmental Sciences, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China;
| | - Linjie Hu
- Department of Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (X.L.); (L.H.); (B.L.)
| | - Bingzhe Li
- Department of Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (X.L.); (L.H.); (B.L.)
| | - Yihan Lu
- Department of Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (X.L.); (L.H.); (B.L.)
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Zhang MX, Lin XQ, Chen Y, Tung TH, Zhu JS. Determinants of parental hesitancy to vaccinate their children against COVID-19 in China. Expert Rev Vaccines 2021; 20:1339-1349. [PMID: 34376095 DOI: 10.1080/14760584.2021.1967147] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vaccine hesitancy seriously hinders herd immunity. We explored the determinants of parental hesitancy to vaccinate children against Coronavirus Disease 2019 (COVID-19) in China.A population-based self-administered online questionnaire evaluating parental hesitancy in vaccinating their children against COVID-19 was conducted in Taizhou, China. Of the 2463 parents who received the invitation, 1788 (72.6%) responded to the survey.Of the repondents, 52.5% were hesitant. Mothers exhibited a greater proportion of vaccine hesitancy than fathers did (57.5% vs. 41.7%, P < 0.001). Multiple logistic regression analysis indicated that parents with children under 18 years of age (OR = 0.94, 95%CI: 0.90-0.99), lower knowledge scores about COVID-19 vaccination (Q1: OR = 1.92, 95%CI: 1.37-2.69; Q2: OR = 1.51, 95%CI: 1.10-2.08), lower awareness of the permission of vaccinating children (OR = 1.74, 95%CI: 1.36-2.23) and hesitancy to inoculate themselves (OR = 8.18, 95%CI: 6.48-10.33) were associated with parental hesitancy to inoculate their children. Results also revealed the disparity between fathers and mothers regarding associated factors.This study found that a substantial proportion of parents reported being hesitant to vaccinate children against COVID-19, implying the necessity of comprehensive assessment and health education programs for vaccination systems in China.
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Affiliation(s)
- Mei-Xian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.,Public Laboratory, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xiao-Qing Lin
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yan Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jian-Sheng Zhu
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
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