Universal Predictors of Dental Students' Attitudes towards COVID-19 Vaccination: Machine Learning-Based Approach

COVID-19 Vaccine Acceptance among Ajman Undergraduate Dental Students: A Cross-Sectional Study

Background

Achieving widespread coronavirus disease 2019 (COVID-19) vaccination is crucial in controlling the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This cross-sectional study aimed to identify factors associated with the willingness of dental medicine students to receive the COVID-19 vaccine.

Objectives

The study sought to assess the knowledge, attitudes, and behaviors of undergraduate dental students toward COVID-19 vaccines and to identify determinants, motivators, and barriers to vaccine uptake and booster receipt.

Methods

A web-based survey was distributed to all 882 undergraduate dental surgery students in January 2022, and 70.7% of the students responded. The survey used χ² tests and logistic regression analysis to examine the association among the variables. The significance level was set at α = 0.05.

Results

Most participants (72.4%) reported having adequate knowledge of COVID-19. The vaccine acceptance rate was higher among male and older trainees, with no significant difference compared to women and younger trainees with no significant difference (p = 0.849). Acceptance of the vaccine varied according to study level (5-year program), ranging from 44.8% to 73.0%, in the following order 4th > 1st > 3rd > 5th > 2nd year. Social media (76.8%), government websites (66.5%), and family and friends (57.2%) were the main sources of COVID-19-related information. Among hesitant and unwilling participants, the main concerns were side effects (34.0%) and lack of understanding about the vaccine's mechanism (67.3%).

Conclusions

Ajman dental students had moderate knowledge of COVID-19 and obtained information mainly from social media, government websites, and family and friends. Age, sex, and study year influenced vaccine acceptance. The main reasons for refusal were lack of knowledge, fear of side effects, and complications. Education campaigns are needed to increase vaccine acceptance among dental students.

Nuclear Anxiety Amid the Russian-Ukrainian War 2022 (RUW-22): Descriptive Cross-Sectional Study

Nuclear anxiety, which refers to the fear of nuclear war and its consequences, is expected to increase amid the Russian-Ukrainian War of 2022 (RUW-22). This study aimed to evaluate the prevalence of nuclear anxiety and its associated variables among university students in the Czech Republic during the first weeks of RUW-22. A cross-sectional survey-based study was carried out from March-April 2022, utilizing a digital self-administered questionnaire (SAQ) to collect data from the target population. The SAQ consisted of multiple-choice items inquiring about demographic characteristics; generalized anxiety symptoms using generalized anxiety disorder-7 (GAD-7); depressive symptoms using patient health questionnaire-9 (PHQ-9); and attitudes towards civilian uses of nuclear power, and nuclear war-related anxiety. Of the 591 participating students, 67.7% were females, 68.2% were Czech nationals, and 61.8% followed the RUW-22 news at least once daily. The mean GAD-7 score of our participants was 7.86 ± 5.32 (0-21); and their mean PHQ-9 score was 8.66 ± 6.29 (0-27). Regarding the civilian uses of nuclear power, most participants agreed that nuclear power was safe (64.5%), denied being afraid that civilian use of nuclear power might deteriorate their health (79.7%), and thought that public acceptance was important for building new nuclear power plants (56.9%). About 42.1% and 45.5% of the participants reported feeling depressed at the possibility of nuclear war and agreed that the chances that there would be a nuclear war in their lifetime were very high, respectively. When asked about their preparedness measures during the previous four weeks, less than one quarter (23.9%) reported looking for recommendations for protection against nuclear accidents, and less than one-fifth (19.3%) were looking for the nearest bomb shelter. The depression about nuclear war possibility was positively and relatively strongly correlated with the level of "feeling concerned about the RUW-22" (rs = 0.401), and it was moderately correlated with GAD-7 (rs = 0.377) and PHQ-9 (rs = 0.274) scores and weakly correlated with RUW-2-related news-following frequency (rs = 0.196). Within the limitations of the present study, nuclear anxiety was common among Czech university students. Its associated factors may include but are not limited to the female gender; common psychological disorders such as generalized anxiety and depression; RUW-22-related news following-frequency; and the level of "feeling concerned".

Can targeted messages reduce COVID-19 vaccination hesitancy? A randomized trial

Background

Widespread vaccination is certainly a critical element in successfully fighting the COVID-19 pandemic. We apply theories of social identity to design targeted messaging to reduce vaccine hesitancy among groups with low vaccine uptake, such as African Americans and political conservatives.

Methods

Participants. We conducted an online experiment from April 7 to 27, 2021, that oversampled Black, Latinx, conservative, and religious U.S. residents. We first solicited the vaccination status of over 10,000 individuals. Of the 4,609 individuals who reported being unvaccinated, 4,190 enrolled in our covariate-adaptive randomized trial.Interventions. We provided participants messages that presented the health risks of COVID-19 to oneself and others; they also received messages about the benefits of a COVID-19 vaccine and an endorsement by a celebrity. Messages were randomly tailored to each participant's identities-Black, Latinx, conservative, religious, or being a parent.Outcomes. Respondents reported their intent to obtain the vaccine for oneself and, if a parent, for one's child.

Results

We report results for the 2,621 unvaccinated respondents who passed an incentivized manipulation check. We find no support for the hypothesis that customized messages or endorsers reduce vaccine hesitancy among our segments. A post hoc analysis finds evidence that a vaccine endorsement from Dr. Fauci reduces stated intent to vaccinate among conservatives.

Conclusions

We find no evidence that tailoring public-health communication regarding COVID-19 vaccination for broad demographic groups would increase its effectiveness. We recommend further research on communicators and endorsers, as well as incentives.

The Dynamic Relationship between the Intention and Final Decision for the COVID-19 Booster: A Study among Students and Staff at the University of Liège, Belgium

While many studies have documented the intentions for the COVID-19 vaccine booster, few have explored the change from intention to final decision. This study explores the COVID-19 booster intentions and the change from intention to decision in a primo-vaccinated university population, with a distinction between staff members and students. It looks at the sociodemographic and medical characteristics, health literacy, personal COVID-19 infection and vaccination history, and attitudes/intentions regarding the booster, among the 1030 participants (64.4% staff members, 61.3% female, median age 36.0 years). Of the 8.7% who were initially hesitant, 72.7% ultimately got a booster and 27.3% did not. Another 84.2% intended to get a booster and 7.1% did not. Among the latter two groups, 88.9% maintained their intention and 11.1% changed their minds. The determinants associated with the intentions were health literacy and previous intentions regarding the COVID-19 primo-vaccination. The determinants associated with the change to non-vaccination were a previous COVID-19 infection, a past COVID-19 primo-vaccination intention, and a neutralizing antibody level. The results point to an opening for the support in decision-making, with a significant percentage of the study population potentially changing their mind between intention and final decision; this process should start early and be tailored to the individual's COVID-19 history. A personalized approach seems necessary in order to ensure that individuals make an informed choice.

COVID-19 vaccine booster hesitancy (VBH) of healthcare professionals and students in Poland: Cross-sectional survey-based study

Since healthcare professionals (HCPs) play a critical role in shaping their local communities' attitudes toward vaccines, HCPs' beliefs and attitudes toward vaccination are of vital importance for primary prevention strategies. The present study was designed as a cross-sectional survey-based study utilizing a self-administered questionnaire to collect data about COVID-19 vaccine booster hesitancy (VBH) among Polish HCPs and students of medical universities (MUSs). Out of the 443 included participants, 76.3% were females, 52.6% were HCPs, 31.8% were previously infected by SARS-CoV-2, and 69.3% had already received COVID-19 vaccine booster doses (VBD). Overall, 74.5% of the participants were willing to receive COVID-19 VBD, while 7.9 and 17.6% exhibited their hesitance and rejection, respectively. The most commonly found promoter for acceptance was protection of one's health (95.2%), followed by protection of family's health (81.8%) and protection of community's health (63.3%). Inferential statistics did not show a significant association between COVID-19 VBH and demographic variables, e.g., age and gender; however, the participants who had been previously infected by SARS-CoV-2 were significantly more inclined to reject the VBD. Protection from severe infection, community transmission, good safety profile, and favorable risk-benefit ratio were the significant determinants of the COVID-19 VBD acceptance and uptake. Fear of post-vaccination side effects was one of the key barriers for accepting COVID-19 VBD, which is consistent with the pre-existing literature. Public health campaigns need to highlight the postulated benefits of vaccines and the expected harms of skipping VBD.

The level and determinants of COVID-19 vaccine acceptance in Ghana

Objective

As part of the efforts to curb the COVID-19 pandemic, the government of Ghana has received several shipments of approved vaccines, and administration has begun in the country. Studies examining the determinants of COVID-19 vaccine acceptance in Ghana were mostly conducted before the vaccination exercise. Vaccine acceptance decisions however vary with time and hence, peoples’ decisions may have changed once vaccines became accessible. This study examines the level and determinants of COVID-19 vaccine acceptance among adult Ghanaians during the vaccination exercise.

Methods

The study was a cross-sectional online survey involving Ghanaian adults (18 years and above) eligible to take the COVID-19 vaccine. The study was conducted from 18th May 2021 to 14th July 2021 and the questionnaire was answered by 362 respondents. Snowball sampling technique was utilized to obtain the respondents. Probit regression analysis was used to identify factors influencing COVID-19 vaccine acceptance.

Key findings

Only 62.7% of the respondents indicated that they will accept the COVID-19 vaccine if provided. The regression results revealed that the decision to accept the COVID-19 vaccine was influenced by occupation, perceived susceptibility, perceived benefits and attitudes towards the vaccines.

Conclusion

The findings suggest that government must implement strategies to enhance positive attitudes toward vaccines, increase the risk perception of contracting the virus and also educate the populace about the benefits of the vaccine.

Determining the Prevalence and Correlates of COVID-19 Booster Vaccine Hesitancy in the Singapore Population Following the Completion of the Primary Vaccination Series

In response to declining vaccine-induced immunity and the emergence of new COVID-19 variants, COVID-19 booster vaccination programmes have been widely launched in several high-income countries. However, public response has been slow, and scepticism about these programmes is rising in these settings. This study sought to identify the sociodemographic, emotional, and psychological factors associated with COVID-19 booster vaccine hesitancy in Singapore. Derived from a community cohort, 1005 fully vaccinated adults (62.1% female, mean age = 42.6 years) that had not received their COVID-19 booster shots completed an online survey between October and November 2021 on vaccination beliefs, intentions, and behaviours. Results indicated that despite completing the primary COVID-19 vaccination, 30.5% of those surveyed were hesitant about receiving the booster shot (25.9% unsure; 4.7% refused the booster), and 39.2% perceived more vaccine risks than benefits. Multivariable models indicated that a tertiary education, lower COVID-19 threat perception, lower perceived benefits, higher perceived concerns, a decreased need for booster vaccination, and a lower benefit/concerns differential score were associated with higher odds of booster vaccine hesitancy. Success in the primary vaccination series may not warrant widespread public acceptance for recurrent COVID-19 vaccination doses. In addressing booster vaccine hesitancy as restrictive measures and mandates are lifted, health perceptions relevant or unique to booster vaccine uptake should be considered.

COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis

INTRODUCTION

As for other vaccines, vaccination hesitancy may be a determining factor in the success (or otherwise) of the COVID-19 immunization campaign in healthcare workers (HCWs).

AREAS COVERED

To estimate the proportion of HCWs in Italy who expressed COVID-19 vaccine hesitancy, we conducted a systematic review of the relevant literature and a meta-analysis. Determinants of vaccine compliance and options suggested by these studies to address vaccine hesitancy among HCWs were also analyzed. Seventeen studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases between January 1, 2020 and January 25, 2022. The vaccine hesitancy rate among HCWs was 13.1% (95%CI: 6.9-20.9%). The vaccine hesitancy rate among HCWs investigated before and during the vaccination campaign was 18.2% (95%CI=12.8-24.2%) and 8.9% (95%CI=3.4-16.6%), respectively. That main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Despite strategies to achieve a greater willingness to immunize in this category, mandatory vaccination appears to be one of the most important measures that can guarantee the protection of HCWs and the patients they care for.

Willingness to accept COVID-19 vaccination among people living with HIV in a high HIV prevalence community

BACKGROUND

People living with HIV (PLWH) may have a poorer prognosis with COVID-19 infection and are an important population for COVID-19 vaccination. We assessed the willingness and reasons for COVID-19 vaccine acceptance or hesitancy among PLWH in South Africa.

METHODS

We conducted a cross-sectional study consisting of telephone interviews with a randomly selected subset of participants enrolled in a prospective observational cohort study evaluating a decentralized antiretroviral therapy (ART) delivery program in South Africa. Questions assessed willingness to accept a future COVID-19 vaccine, concerns regarding COVID-19 vaccination, and overall vaccine confidence. Interviews were conducted between September 2020 and January 2021. We evaluated participant demographics, sources of COVID-19 information, stigma and medical mistrust, uptake of non-pharmaceutical interventions, and socioeconomic impacts of the COVID-19 pandemic as potential covariates of willingness to accept vaccination.

RESULTS

We completed interviews with 213 participants; 153 (72%) were female, median age 35y, and 100 (47%) had completed secondary school. Among the participants, 121 (57%) were willing to accept future vaccination, 46 (22%) were unsure, and 45 (21%) stated they did not intend to be vaccinated. Fear of side effects, reported by 42 (20%), was the most common concern about COVID-19 vaccination. Older age was associated with willingness to accept vaccination (aOR 1.75 for every 10-year increase in age, 95% CI 1.10-2.78, p = 0.02), while higher medical mistrust related to COVID-19 (aOR 0.21, 95% CI 0.093-0.45, p < 0.001) and use of social media for COVID-19 information (aOR 0.30, 95% CI 0.11-0.84, p = 0.02) were associated with lower willingness to accept vaccination.

CONCLUSIONS

In this cohort of PLWH in South Africa, over half were willing to accept COVID-19 vaccination, although a substantial proportion remained unsure or were not willing to be vaccinated. Public health messaging should emphasize the safety and efficacy of COVID-19 vaccination and address misinformation and medical mistrust among PLWH. Ongoing efforts to ensure access to COVID-19 vaccines for vulnerable populations are crucial.

Side Effects of COVID-19 Inactivated Virus vs. Adenoviral Vector Vaccines: Experience of Algerian Healthcare Workers

Healthcare workers were prioritized in vaccination campaigns globally because they are exposed to the highest risk of contamination by SARS-CoV-2. This study evaluated the self-reported post-vaccination side effects of inactivated (BBIBP-CorV and CoronaVac) and adenoviral vector-based (AZD1222, Gam-COVID-Vac and Ad26.COV2.S) vaccines among Algerian healthcare workers using a validated questionnaire. The final analysis included 721 healthcare workers, with a predominance of females (59.1%) and younger individuals 20–30 years old (39.4%). Less than half (49.1%) of the respondents reported at least one local side effect, while 53.8% reported at least one systemic side effect. These side effects were more prevalent among viral vector vaccinees than inactivated virus vaccinees. The most common local side effects were injection site pain (39%) and arm pain (25.4%), while fatigue (34.4%), fever (28.4%), headache (24.8%) and myalgia (22.7%) were the most prevalent systemic side effects. The side effects appeared earlier among inactivated virus vaccines recipients and generally lasted for 2 to 3 days for the two vaccinated groups. The risk factors associated with a higher prevalence of side effects included female gender, allergic individuals, individuals with regular medication, those who contracted the COVID-19 disease and those who received two doses for both inactivated and viral-based vaccines groups. Despite the higher prevalence of post-vaccination side effects among adenoviral vector vaccines recipients, both vaccines groups were equally effective in preventing symptomatic infections, and no life-threatening side effects were reported in either vaccine group.

Do Attitudes, Mental Health Status, and Interpersonal Factors Predict COVID-19 Vaccine Hesitancy at the Early Phase of the Pandemic? A Longitudinal Study in Chinese College Students

Purpose

The present study examined whether and how attitudes toward the COVID-19 vaccine (i.e., safety, efficacy, and price), mental health statuses (i.e., perceived stress and depression), and interpersonal factors (i.e., online social support, perceived social support) would predict COVID-19 vaccine hesitancy.

Patients and methods

The two-wave longitudinal surveys were conducted in December 2019 and 2020 in Chinese medical college students (N = 194). Well- validated measures were used, including the Perceived Stress Scale, the Center for Epidemiologic Studies Depression Scale, the Online Social Support Questionnaire, and the Perceived Social Support Scale. Perceived safety, efficacy, price of COVID-19 vaccine, vaccine hesitancy, and actual intake were also measured.

Results

Only 2.1% of participants had been vaccinated against COVID-19 in the early stages of the pandemic; 13.4% intended to get vaccinated in the next 3 months, and 66% intended to have it in the next 12 months upon follow-up. Multiple regression analyses revealed that perceived stress (βm = -0.15, p < 0.05) and depression (βm = -0.15, p < 0.05) were risk factors for positive attitudes toward the COVID-19 vaccine; online social support (ORm = 1.41, p < 0.01) and positive attitudes toward the COVID-19 vaccine (ORm = 1.83, p < 0.01) were protective factors of intention to get vaccinated in future.

Conclusion

Findings suggest that intervention efforts should be made to reduce negative attitudes toward the COVID-19 vaccine among people with poor mental health and enhance online social support to promote COVID-19 vaccination.

COVID-19 Vaccine Hesitancy Among Older Adolescents and Young Adults: A National Cross-Sectional Study in China

Background

With promotion of COVID-19 vaccinations, there has been a corresponding vaccine hesitancy, of which older adolescents and young adults represent groups of particular concern. In this report, we investigated the prevalence and reasons for vaccine hesitancy, as well as potential risk factors, within older adolescents and young adults in China.

Methods

To assess these issues, an online survey was administered over the period from March 14 to April 15, 2021. Older adolescents (16–17 years old) and young adults (18–21 years old) were recruited nationwide from Wechat groups and results from a total of 2,414 respondents were analyzed. Socio-demographic variables, vaccine hesitancy, psychological distress, abnormal illness behavior, global well-being and social support were analyzed in this report.

Results

Compared to young adults (n = 1,405), older adolescents (n = 1,009) showed higher prevalence rates of COVID-19 vaccine hesitancy (16.5 vs. 7.9%, p < 0.001). History of physical diseases (p = 0.007) and abnormal illness behavior (p = 0.001) were risk factors for vaccine hesitancy among older adolescents, while only a good self-reported health status (p = 0.048) was a risk factor for young adults. Concerns over COVID-19 vaccine side effects (67.1%) and beliefs of invulnerability regarding infection risk (41.9%) were the most prevalent reasons for vaccine hesitancy. Providing evidence on the vaccine reduction of COVID-19 infection risk (67.5%), ensuring vaccine safety (56.7%) and the low risk of side effects (52.7%) were the most effective persuasions for promoting vaccinations.

Conclusion

In China, older adolescents showed a higher prevalence for vaccine hesitancy than that of young adults. Abnormal illness behavior and history of physical diseases were risk factors for vaccine hesitancy among these older adolescents, while social support represents an important factor which could help to alleviate this hesitancy.

Willingness to accept COVID-19 vaccination among people living with HIV in a high HIV prevalence community

Background People living with HIV (PLWH) may have a poorer prognosis with COVID-19 infection and are an important population for COVID-19 vaccination. We assessed the willingness and reasons for COVID-19 vaccine acceptance or hesitancy among PLWH in South Africa. Methods We conducted a cross-sectional study consisting of telephone interviews with a randomly selected subset of participants enrolled in a prospective observational cohort study evaluating a decentralized antiretroviral therapy (ART) delivery program in South Africa. Questions assessed willingness to accept a future COVID-19 vaccine, concerns regarding COVID-19 vaccination, and overall vaccine confidence. Interviews were conducted between September 2020 and January 2021. We evaluated participant demographics, sources of COVID-19 information, stigma and medical mistrust, uptake of non-pharmaceutical interventions, and socioeconomic impacts of the COVID-19 pandemic as potential covariates of willingness to accept vaccination. Results We completed interviews with 213 participants; 153 (72%) were female, median age 35y, and 100 (47%) had completed secondary school. Among the participants, 121 (57%) were willing to accept future vaccination, 46 (22%) were unsure, and 45 (21%) stated they did not intend to be vaccinated. Fear of side effects, reported by 42 (20%), was the most common concern about COVID-19 vaccination. Older age was associated with willingness to accept vaccination (aOR 1.75 for every 10-year increase in age, 95% CI 1.10-2.78, p=0.02), while higher medical mistrust related to COVID-19 (aOR 0.21, 95% CI 0.093-0.45, p<0.001) and use of social media for COVID-19 information (aOR 0.30, 95% CI 0.11-0.84, p=0.02) were associated with lower willingness to accept vaccination. Conclusions In this cohort of PLWH in South Africa, over half were willing to accept COVID-19 vaccination, although a substantial proportion remained unsure or were not willing to be vaccinated. Public health messaging should emphasize the safety and efficacy of COVID-19 vaccination and address misinformation and medical mistrust among PLWH. Ongoing efforts to ensure access to COVID-19 vaccines for vulnerable populations are crucial.

Prevalence and Drivers of COVID-19 Vaccine Booster Hesitancy Among German University Students and Employees

COVID-19 booster hesitancy (VBH) is a serious public health challenge which acts simultaneously with the waning vaccine-elicited immunity and the emerging viral variants to prolong the pandemic interval. Therefore, this study aimed to evaluate the prevalence of COVID-19 VBH among a highly educated subset of the German population and to explore the potential demographic, anamnestic, and psychosocial determinants of this problem. A cross-sectional survey-based study was conducted in December 2021 among German university students and employees to evaluate their attitudes toward COVID-19 vaccine booster (VB) doses. The study used a self-administered questionnaire that was developed and disseminated digitally, and the questionnaire inquired about participants' demographic characteristics, COVID-19-related anamnesis, COVID-19 vaccine-related anamnesis, and psychosocial predictors of COVID-19 VBH. A total of 930 participants were recruited, of which 608 (65.4%) were students, 682 (73.3%) were females, and their mean age was 29.08 ± 10.93 years. Fifty-five participants (5.9%) had been previously infected by COVID-19 and the vast majority of infections happened before the first vaccine dose. Over 95% of the participants had received at least one vaccine dose, and the most commonly administered vaccine was BNT162b2. The overall COVID-19 VB acceptance was satisfactory (87.8%) and induced by various altruistic promoters, e.g., family health protection, community health protection, and patients' health protection. The students (86.3%), the previously infected participants (76.4%), the participants who did not receive primer doses of COVID-19 vaccines (2.5 %), and those who were hospitalized (40%) and sought medical care/treatment after receiving primer doses (86.8%) were less likely to accept COVID-19 VB compared to the employees (90.7%), the participants who were not previously infected (88.6%) and those who received primer dose (91.7%), and the participants who were not hospitalized (92%) nor sought medical care/treatment after primer doses (92.9%), respectively. The perceived effectiveness of COVID-19 VB against severe illness (adjusted odds ratio "AOR": 47.65-95% confidence interval "CI": 23.65-96.49), symptomatic infection (AOR: 9.87-95% CI: 5.20-18.71), community transmission (AOR: 5.34-95% CI: 3.00-9.49) and emerging variants (AOR: 19.12-95% CI: 10.57-34.55) were key predictors for COVID-19 VB acceptance; therefore, it needs to be highlighted in vaccine messaging. In addition, the perceived safety of COVID-19 VB and ethical dilemmas of vaccine justice need to be addressed publicly.

Factors associated with COVID-19 vaccine intent among Latino SNAP participants in Southern California

Background

COVID-19 is significantly impacting the health and well-being of the country, particularly for ethnic minority populations and low-income groups. Our goal was to determine COVID-19 vaccination intent in a low-income, Latino population receiving aid from the Supplemental Nutrition Assistance Program (SNAP) in Southern California, and identify contributing factors and concerns.

Methods

A cross-sectional, mixed-methods survey was conducted among participants in the Southern California Nutrition Incentives Program (¡Más Fresco! More Fresh). Only Latino respondents were included in this analysis. Primary outcome was vaccine intent trichotomized into: “definitely/likely yes”, “not sure/don’t know”, and “definitely/likely not.”

Results

The majority of participants (n = 486) were female (93%), Spanish speaking (74%), with a median age of 40 years (IQR = 13). Approximately half (48%) reported they would get a COVID-19 vaccine, 39% were unsure, and 13% reported “definitely/likely not”. In the multivariable multinomial logistic regression model, participants with a household member with a COVID-19 health risk factor were more likely to be unsure about getting the vaccine. Participants who were primarily English speaking, did not receive the influenza vaccine last season, and reported not reading or talking about COVID-19 were more likely to report not intending to receive the vaccine. Many respondents were concerned about “side effects and ingredients”, and did not trust the vaccine development process, particularly with how fast it happened.

Conclusion

Low-income Latinos in Southern California were generally hesitant to get a COVID-19 vaccine. Culturally sensitive vaccine promotion campaigns need to address the concerns of minority populations who experience increased morbidity and mortality from COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13027-w.

Human Consciousness and Behavior towards Infectious Diseases and Vaccines 2.0: A Commentary from Special Issue Editors

The WHO has identified vaccine hesitancy as one of the 10 threats to global health [...]

Oral Health Knowledge, Attitudes, and Behaviors (KAB) of German Dental Students: Descriptive Cross-Sectional Study

Germany's 2030-oral health agenda incorporates behavioral targets such as twice-daily toothbrushing and routine dental check-ups. Given the professional and social roles of dentists in oral health promotion, the oral health-related knowledge, attitudes, and behaviors (KAB) of dentists and dental students became worth investigation. The present study was designed as a descriptive cross-sectional study that aimed to evaluate oral health KAB of German dental students using the Hiroshima University - Dental Behavioral Inventory (HU-DBI). A total of 508 dental students filled in the questionnaire, out of which 74.2% were females, 38.8% were clinical students, 11.4% reported tobacco smoking at least once week, 26.6% reported drinking alcohol at least once a week, and 82.9% reported suffering from problematic internet use. The overall HU-DBI score was high (7.67 ± 1.32), and it was slightly higher among females (7.70 ± 1.33) than males (7.59 ± 1.29), and gender-diverse students (7.33 ± 1.37). Clinical students (7.88 ± 1.26) had a significantly higher HU-DBI score, especially in the domain of oral health behaviors, compared with preclinical students (7.53 ± 1.34). A significant improvement in oral health behaviors and HU-DBI score was found between the third- vs. the fourth year, which corresponds to the period when prophylaxis, hygiene, and periodontology courses are delivered. Tobacco smoking was significantly associated with poor oral health knowledge, behaviors, and overall HU-DBI score. Problematic internet use and alcohol drinking had slightly lower HU-DBI scores. The findings of the present study call for early implementation of preventive dentistry elements in German curricula and addressing oral health needs of gender minorities in Germany by future epidemiologic studies.

Oral Health Knowledge, Attitudes, and Behaviors (KAB) of German Dental Students: Descriptive Cross-Sectional Study

Germany's 2030–oral health agenda incorporates behavioral targets such as twice-daily toothbrushing and routine dental check-ups. Given the professional and social roles of dentists in oral health promotion, the oral health-related knowledge, attitudes, and behaviors (KAB) of dentists and dental students became worth investigation. The present study was designed as a descriptive cross-sectional study that aimed to evaluate oral health KAB of German dental students using the Hiroshima University – Dental Behavioral Inventory (HU-DBI). A total of 508 dental students filled in the questionnaire, out of which 74.2% were females, 38.8% were clinical students, 11.4% reported tobacco smoking at least once week, 26.6% reported drinking alcohol at least once a week, and 82.9% reported suffering from problematic internet use. The overall HU-DBI score was high (7.67 ± 1.32), and it was slightly higher among females (7.70 ± 1.33) than males (7.59 ± 1.29), and gender-diverse students (7.33 ± 1.37). Clinical students (7.88 ± 1.26) had a significantly higher HU-DBI score, especially in the domain of oral health behaviors, compared with preclinical students (7.53 ± 1.34). A significant improvement in oral health behaviors and HU-DBI score was found between the third- vs. the fourth year, which corresponds to the period when prophylaxis, hygiene, and periodontology courses are delivered. Tobacco smoking was significantly associated with poor oral health knowledge, behaviors, and overall HU-DBI score. Problematic internet use and alcohol drinking had slightly lower HU-DBI scores. The findings of the present study call for early implementation of preventive dentistry elements in German curricula and addressing oral health needs of gender minorities in Germany by future epidemiologic studies.

Reported Adverse Effects and Attitudes among Arab Populations Following COVID-19 Vaccination: A Large-Scale Multinational Study Implementing Machine Learning Tools in Predicting Post-Vaccination Adverse Effects Based on Predisposing Factors

Background: The unprecedented global spread of coronavirus disease 2019 (COVID-19) has imposed huge challenges on the healthcare facilities, and impacted every aspect of life. This has led to the development of several vaccines against COVID-19 within one year. This study aimed to assess the attitudes and the side effects among Arab communities after receiving a COVID-19 vaccine and use of machine learning (ML) tools to predict post-vaccination side effects based on predisposing factors. Methods: An online-based multinational survey was carried out via social media platforms from 14 June to 31 August 2021, targeting individuals who received at least one dose of a COVID-19 vaccine from 22 Arab countries. Descriptive statistics, correlation, and chi-square tests were used to analyze the data. Moreover, extensive ML tools were utilized to predict 30 post vaccination adverse effects and their severity based on 15 predisposing factors. The importance of distinct predisposing factors in predicting particular side effects was determined using global feature importance employing gradient boost as AutoML. Results: A total of 10,064 participants from 19 Arab countries were included in this study. Around 56% were female and 59% were aged from 20 to 39 years old. A high rate of vaccine hesitancy (51%) was reported among participants. Almost 88% of the participants were vaccinated with one of three COVID-19 vaccines, including Pfizer-BioNTech (52.8%), AstraZeneca (20.7%), and Sinopharm (14.2%). About 72% of participants experienced post-vaccination side effects. This study reports statistically significant associations (p < 0.01) between various predisposing factors and post-vaccinations side effects. In terms of predicting post-vaccination side effects, gradient boost, random forest, and XGBoost outperformed other ML methods. The most important predisposing factors for predicting certain side effects (i.e., tiredness, fever, headache, injection site pain and swelling, myalgia, and sleepiness and laziness) were revealed to be the number of doses, gender, type of vaccine, age, and hesitancy to receive a COVID-19 vaccine. Conclusions: The reported side effects following COVID-19 vaccination among Arab populations are usually non-life-threatening; flu-like symptoms and injection site pain. Certain predisposing factors have greater weight and importance as input data in predicting post-vaccination side effects. Based on the most significant input data, ML can also be used to predict these side effects; people with certain predicted side effects may require additional medical attention, or possibly hospitalization.

Czech and Slovak Dental Students' Oral Health-Related Knowledge, Attitudes, and Behaviours (KAB): Multi-Country Cross-Sectional Study

Dentists play a key role in the primary prevention of oral diseases and related systemic complications; therefore, their views on behavioural interventions need to be aligned with the current agendas for oral health. Likewise, dental students' oral health-related knowledge, attitudes, and behaviours (KAB) are of practical importance, as they are the future opinion leaders for oral health in their respective communities. A cross-sectional survey-based study was designed to evaluate the oral health KAB of dental students in both the Czech Republic and Slovakia. The study utilized translated versions of the Hiroshima University Dental Behavioural Inventory (HU-DBI), and it aimed to recruit students from all Czech and Slovak dental schools. A total of 487 students were included in this study, out of which 372 (76.4%) were females, 271 (55.6%) were enrolled in preclinical years, 68 (14%) reported smoking tobacco at least once a week, and 430 (88.3%) reported problematic internet use. The mean HU-DBI score of Czech and Slovak dental students (8.18 ± 1.80) was comparable with the previously reported scores of dental students in Nordic and Western European countries. Czech students (9.34 ± 1.29) had a significantly higher score than their Slovak counterparts (7.56 ± 1.73). In both countries, preclinical students (8.04 vs. 8.35), the students who reported tobacco smoking (7.63 vs. 8.27), and those who reported problematic internet use (8.11 vs. 8.70) had significantly lower HU-DBI scores than their counterparts, respectively. In the Czech Republic, the significant increases in HU-DBI scores occurred after the first academic year when the students received preventive dentistry courses; therefore, one can put forward that early implementation of preventive elements in undergraduate dental curricula may yield better and more sustainable oral health gains for the students. Future research on Czech and Slovak dental curricula need to re-evaluate the oral hygiene and anti-smoking components and their impact on students' views and attitudes.

Estonian Dental Students' Oral Health-Related Knowledge, Attitudes and Behaviours (KAB): National Survey-Based Study

The strategic plan for dentistry and oral health in Estonia of 2030 focuses on oral health promotion and disease prevention through undergraduate dental curricula and fostering public health-oriented research among students. The present study was designed as a descriptive cross-sectional study to evaluate oral health-related knowledge, attitudes, and behaviours (KAB) of dental students in Estonia. The study was carried out in the spring semester of 2020, and it used a modified version of the Hiroshima University Dental Behavioural Inventory (HU-DBI). A total of 129 students responded to the survey, constituting a response rate of 93.5% due to the total population sampling (census) technique used in this study and the small target population size. Out of the 124 students included in the final analysis, 79% were females, 62.1% were clinical students, 11.3% reported smoking tobacco at least once a week, and 86.3% reported problematic internet use. The present study found that mean HU-DBI score of Estonian dental students was 8.09 ± 1.22 which is so far the highest recorded HU-DBI score in Europe. There was no significant difference between female vs. male or preclinical vs. clinical students in terms of HU-DBI score. While clinical students reported less faulty oral hygiene practices, such as hard toothbrush use and aggressive toothbrushing, preclinical students reported a slightly higher mean HU-DBI score. Smoking behaviour was more common among male and clinical students, and it was also associated with alcohol drinking and worry about teeth colour and halitosis.

Oral Health-Related Knowledge, Attitudes and Behaviours of Arab Dental Students: Multi-National Cross-Sectional Study and Literature Analysis 2000-2020

Dental students are the future leaders of oral health in their respective communities; therefore, their oral health-related attitudes and behaviours are of practical value for primary disease prevention. The present study aimed to evaluate oral health-related knowledge, attitudes, and behaviours of dental students in Arab countries and explore the potential sociodemographic predictors of their oral health outcomes. A multi-centre, cross-sectional study was conducted during the academic year 2019/2020 in three Arab countries: Lebanon, Syria, and Tunisia. The study used a validated Arabic version of the Hiroshima University Dental Behavioural Inventory (HU-DBI) composed of original twenty items that assess the level of oral health-related knowledge, attitudes, and behaviours, and four additional dichotomous items related to tobacco smoking, alcohol drinking, problematic internet use, and regular dental check-up The HU-DBI score ranges between 0 and 12. A total of 1430 students took part in this study, out of which 60.8% were females, 57.8% were enrolled in clinical years, 24.5% were tobacco smokers, 7.2% were alcohol drinkers, and 87% reported internet addiction. The mean HU-DBI score was 6.31 ± 1.84, with Lebanon having the highest score (6.67 ± 1.83), followed by Syria (6.38 ± 1.83) and Tunisia (6.05 ± 1.83). Clinical students (6.78 ± 1.70) had higher HU-DBI scores than their preclinical peers (5.97 ± 1.86). The year-over-year analysis revealed that dental public health and preventive dentistry courses had significantly and positively impacted the undergraduate students’ knowledge, attitudes, and behaviours. The gender-based differences were not statistically significant, with a modest trend favouring males, especially oral health behaviours. Tobacco smoking, alcohol drinking, and problematic internet use were associated with lower HU-DBI scores. In the Arab world, the economic rank of the country where the dental students live/study was weakly correlated with the students’ mean HU-DBI score.

Relief After COVID-19 Vaccination: A Doubtful or Evident Outcome?

Background: Since development of the first COVID-19 vaccine, the landscape of public confidence in these vaccines is uncertain. Building confidence is crucial for better preparedness of future pandemics. Following the mandatory COVID-19 vaccination policy in the country, the aim of this study was to examine whether the Saudi public feels relieved post-vaccination and to identify the factors predicting such relief.

Methods: An online cross-sectional survey was conducted in July 2021 among COVID-19 vaccine recipients in Saudi Arabia. A multivariable logistic regression analysis was employed to examine and identify the variables associated with feeling relieved post-vaccination.

Results: Most of the respondents (66%) stated feeling more relieved post-vaccination. Male gender [adjusted odds ratio (AOR): 1.380; 95% confidence interval (CI): 0.981–1.943], being a student (AOR: 3.902; 95% CI: 1.674–9.096), and received two doses of the vaccine (AOR: 2.278; 95% CI: 1.630–3.182) were associated with feeling more relieved after getting vaccinated. Respondents who were anxious about the vaccine before receiving it (AOR: 0.220; 95% CI: 0.160–0.302), and experienced a severe reaction after vaccination (AOR: 0.288; 95% CI: 0.165–0.504) had lower odds of feeling relieved post-vaccination. Respondents who relied on social media as the main source of vaccine-related information and those having no information about the vaccine were also less likely to feel relieved post-vaccination.

Conclusions: Individuals' attitudes toward COVID-19 vaccines may not necessarily alter post-vaccination. Although mandatory vaccination policies can significantly contribute to achieving herd immunity, public confidence toward vaccines might be eroded, which could in turn impose significant challenges in future pandemics efforts.

COVID-19 Vaccine Acceptance of Pregnant and Lactating Women (PLW) in Czechia: An Analytical Cross-Sectional Study

Pregnant and lactating women (PLW) represent a particular population subset with increased susceptibility for COVID-19 morbidity and mortality, even though the evidence about the safety and efficacy of COVID-19 vaccines was delayed due to their initial exclusion from development trials. This unclear situation could have led to increased COVID-19 vaccine hesitancy levels among PLW; therefore, this study aimed to evaluate the attitudes of Czech PLW towards COVID-19 vaccines and the determinants of their attitudes. An analytical cross-sectional survey-based study was carried out in the University Hospital Brno (South Moravia, Czechia) between August and October 2021. The study utilised a self-administered questionnaire (SAQ) adapted from previous instruments used for the same purpose. The SAQ included closed-ended items covering demographic characteristics, clinical and obstetric characteristics, attitudes towards COVID-19 vaccination, and potential psychosocial predictors of vaccine acceptance. Out of the 362 included participants, 278 were pregnant (PW) and 84 were lactating women (LW). The overall COVID-19 vaccine acceptance (immediate and delayed) level was substantially high (70.2%), with a significant difference between PW (76.6%) and LW (48.8%). Out of the 70.2% who agreed to receive the vaccine, 3.6% indicated immediate acceptance, and 66.6% indicated delayed acceptance. Only 13.3% of the participants indicated their acceptance of their physician's vaccination recommendation during pregnancy or while lactating, and 62.2% were against it. Our results agreed with the recent studies that revealed that PW tended to have a high level of COVID-19 vaccine acceptance, and they were also inclined to resist professional recommendations because they predominantly preferred to delay their vaccination. The pregnancy trimester, education level, employment status, and previous live births were significant determinants for COVID-19 vaccine acceptance. The most commonly preferred vaccine type was mRNA-based vaccines, followed by viral vector-based and inactivated virus vaccines. The first top priority of PLW was vaccine safety for their children, followed by vaccine safety for the PLW and vaccine effectiveness. Regarding psychosocial predictors, media/social media, trust in the government, the pharmaceutical industry, and healthcare professionals, partners, and a positive risk-benefit ratio were significant promoters for COVID-19 vaccine acceptance. Findings from this study suggest that promotional interventions targeting PLW should use web platforms and focus on vaccine safety evidence, the expected benefits of vaccines and potential harms of the infection.

COVID-19 Vaccine Booster Hesitancy (VBH) of Healthcare Workers in Czechia: National Cross-Sectional Study

The emerging SARS-CoV-2 variants and waning vaccine-elicited immunity are two public health challenges that occurred simultaneously and synergistically during the summer of 2021 and led to a surging demand for COVID-19 vaccine booster dose (BD) rollout. This study aimed to evaluate the COVID-19 vaccine booster hesitancy (VBH) among Czech healthcare workers to explore the potential determinants of VBH. A national cross-sectional survey-based study was carried out between 3 and 11 November 2021, using an online self-administered questionnaire (SAQ) that explored the participants' demographic characteristics, COVID-19 infection and vaccine anamneses, willingness to receive COVID-19 vaccine BD, and the psychosocial drivers of VBH. A total of 3454 HCW properly responded to the online SAQ, of which 80.9% were females, 30.3% were medical professionals, and 50.5% were ≤47 years old. Most of the participants were already inoculated against SARS-CoV-2 (95.2%), and BTN162b2 was the most commonly administered vaccine (90.7%). As the study sample was planned to represent the target population, it revealed a high level of BD acceptance (71.3%) among Czech HCW, while 12.2% were still hesitant and 16.6% were against the currently available BD. These results are consistent with other recent results from central Europe. Medical professional, male, and older participants were more likely to accept BD rather than allied health professional, female, and younger participants. The BDs' perceived effectiveness against severe illness, symptomatic infection, and community transmission was a significant and strong predictor for BD acceptance, while the effectiveness against the circulating variants was not that important for our target population. The BDs' perceived safety and ethical dilemmas of vaccine justice should be addressed sufficiently while communicating with HCW and other population groups. The altruistic reasons for BD acceptance, i.e., family protection, patient protection, and community health protection, underpin the recommendation of postponing the COVID-19 vaccine mandating in favour of stressing these altruistic concerns amid public health messaging.

Self-Reported Adverse Events of COVID-19 Vaccines in Polish Healthcare Workers and Medical Students. Cross-Sectional Study and Pooled Analysis of CoVaST Project Results in Central Europe

BACKGROUND

Optimization of COVID-19 vaccination rate among healthcare personnel is of utmost priority to secure provision of uninterrupted care and to protect the most vulnerable patients. This study, as part of the global CoVaST project, aimed to assess the occurrence of short-term adverse events (SRAEs) of two most administered COVID-19 vaccines, mRNA-based (Pfizer-BioNTech and Moderna) and viral vector-based (AstraZeneca) in healthcare sector workers (HWs).

METHODS

A cross-sectional survey-based study was carried out for the first time among 317 Polish healthcare sector personnel and medical students using a validated and pre-tested questionnaire. The online questionnaire included 25 pre-tested, validated questions concerning demographic data, medical parameters, COVID-19-related anamneses, and local or systemic reactions (reactogenicity) associated with COVID-19 vaccination. Descriptive statistics, inferential tests and binary logistic regression were performed.

RESULTS

Out of the 247 participating HWs, 79.8% were females, and 77.5% received mRNA-based vaccines, while 24.5% received a viral vector-based vaccine. Cumulatively, 78.9% and 60.7% of the participants reported at least one local and one systemic SRAE respectively, following their COVID-19 first or second dose of vaccine. A wide array of SRAEs was observed, while pain at injection site (76.9%) was the most common local SRAE, and fatigue (46.2%), headache (37.7%), muscle pain (31.6%) were the most common systemic SRAEs. The vast proportion of local (35.2%) and systemic (44.8%) SRAEs subsided up to 1 day after inoculation with both types of vaccines. The mRNA-based vaccine versions seem to cause higher prevalence of local SRAEs, mainly pain within injection site (81.3% vs. 71.7%; p = 0.435), while the viral vector-based vaccine was linked with increased incidents of mild systemic side effects (76.7% vs. 55.3%; p = 0.004) after both doses. Pooled analysis revealed uniform results while comparing the prevalence of SRAEs in HWs as recipients in four central European countries (OR = 2.38; 95% CI = 2.03-2.79).

CONCLUSIONS

The study confirmed the safety of commonly administered vaccines against COVID-19, which were associated with mild, self-resolving adverse events. No major vaccine-related incidents were reported which would affect every day functioning, significantly. The younger age group (below 29 y.o.) were associated with an increased risk of adverse events generally. The results enhanced current data regarding COVID-19 vaccination active surveillance in selected occupational groups.