Vaccine hesitancy and reasons for refusing the COVID-19 vaccination among the U.S. public: A cross-sectional survey

AbstractImportanceAlthough widespread vaccination will be the most important cornerstone of the public health response to the COVID-19 pandemic, a critical question remains as to how much of the United States population will accept it.ObjectiveDetermine: 1) rate of COVID-19 vaccine hesitancy in the United States public, 2) patient characteristics associated with hesitancy, 3) reasons for hesitancy, 4) healthcare sites where vaccine acceptors would prefer to be vaccinated.Design43-question cross-sectional survey conducted November 17-18, 2020, distributed on Amazon Mechanical Turk, an online labor marketplace where individuals receive a nominal fee (here, $1.80) for anonymously completing tasks.Eligible ParticipantsUnited States residents 18-88 years of age, excluding healthcare workers. A total 1,756 volunteer respondents completed the survey (median age 38 years, 53% female).Main Outcome MeasureMultivariable logistic regression modeled the primary outcome of COVID-19 vaccine hesitancy (defined as non-acceptance or being unsure about acceptance of the COVID-19 vaccine) with respondent characteristics.ResultsA total 663 respondents (37.8%) were COVID-19 vaccine hesitant (374 [21.3%] non-acceptors and 289 [16.5%] unsure about accepting). Vaccine hesitancy was associated with not receiving influenza vaccination in the past 5 years (odds ratio [OR] 4.07, 95% confidence interval [CI] 3.26-5.07, p<0.01), female gender (OR 2.12, 95%CI 1.70-2.65, p<0.01), Black race (OR 1.54, 95%CI 1.05-2.26, p=0.03), having a high school education or less (OR 1.46, 95%CI 1.03-2.07, p=0.03), and Republican party affiliation (OR 2.41, 95%CI 1.88-3.10, p<0.01). Primary reasons for hesitancy were concerns about side effects, need for more information, and doubts about vaccine efficacy. Preferred sites for vaccination for acceptors were primary doctors’ offices/clinics, pharmacies, and dedicated vaccination locations.ConclusionsIn this recent national survey, over one-third of respondents were COVID-19 vaccine hesitant. To increase vaccine acceptance, public health interventions should target vaccine hesitant populations with messaging that addresses their concerns about safety and efficacy.

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SARS-CoV-2 Vaccine Hesitancy in a Sample of US Adults: Role of Perceived Satisfaction With Health, Access to Healthcare, and Attention to COVID-19 News

Frontiers in Public Health ◽

10.3389/fpubh.2021.665724 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sarah Bauerle Bass ◽

Maureen Wilson-Genderson ◽

Dina T. Garcia ◽

Aderonke A. Akinkugbe ◽

Maghboeba Mosavel

Keyword(s):

Public Health ◽

New York ◽

San Francisco ◽

Healthcare Access ◽

The United States ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccination Rates

Understanding which communities are most likely to be vaccine hesitant is necessary to increase vaccination rates to control the spread of SARS-CoV-2. This cross-sectional survey of adults (n = 501) from three cities in the United States (Miami, FL, New York City, NY, San Francisco, CA) assessed the role of satisfaction with health and healthcare access and consumption of COVID-19 news, previously un-studied variables related to vaccine hesitancy. Multilevel logistic regression tested the relationship between vaccine hesitancy and study variables. Thirteen percent indicated they would not get vaccinated. Black race (OR 2.6; 95% CI: 1.38–5.3), income (OR = 0.64; 95% CI: 0.50–0.83), inattention to COVID-19 news (OR = 1.6; 95% CI: 1.1–2.5), satisfaction with health (OR 0.72; 95% CI: 0.52–0.99), and healthcare access (OR = 1.7; 95% CI: 1.2–2.7) were associated with vaccine hesitancy. Public health officials should consider these variables when designing public health communication about the vaccine to ensure better uptake.

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Changes in social behavior over time in the COVID-19 pandemic

10.1101/2020.08.27.20183376 ◽

2020 ◽

Cited By ~ 1

Author(s):

Megan M Sheehan ◽

Elizabeth R. Pfoh ◽

Sidra Speaker ◽

Michael B. Rothberg

Keyword(s):

Public Health ◽

United States ◽

Social Behavior ◽

The United States ◽

Survey Study ◽

Age Group ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Group A ◽

Over Time

Public health recommendations aimed at limiting spread of SARS-CoV-2 have encouraged social distancing and masks as economies across the United States re-open. Understanding adherence to these guidelines will inform further efforts to reduce transmission. In this repeated cross-sectional survey study, we describe changes in social behavior in Ohio during periods of declining and rising cases. While essential activities remained consistent over time, more individuals attended gatherings of 10 or more people as cases rose, particularly in the 18-29 age group. A majority of individuals wore masks. It appears necessary to continue limiting gatherings and encourage mask-wearing, particularly among younger groups.

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COVID-19 Vaccine Hesitancy and Uptake among Nursing Staff during an Active Vaccine Rollout

Vaccines ◽

10.3390/vaccines9080858 ◽

2021 ◽

Vol 9 (8) ◽

pp. 858

Author(s):

Lynn M. Baniak ◽

Faith S. Luyster ◽

Claire A. Raible ◽

Ellesha E. McCray ◽

Patrick J. Strollo

Keyword(s):

United States ◽

Nursing Staff ◽

Work Experience ◽

Medical Center ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

To Receive

Even with the availability of COVID-19 vaccines, factors associated with vaccine hesitancy and uptake among nurses are unknown. This study evaluated COVID-19 vaccine hesitancy and uptake of nursing staff during one of the first COVID-19 vaccine rollouts in the United States. A cross-sectional survey was conducted during February 2021 among nursing staff working in a large medical center in central United States. There were 276 respondents; 81.9% of participants were willing to receive the vaccine during the initial rollout, 11.2% were hesitant, and only 5.1% were unwilling. The hesitant group was likely to report having inadequate information to make an informed decision about whether to receive the vaccine (45.2%) and about vaccine expectations (32.3%). The majority (83.3%) received at least one dose of the vaccine. Having greater than 10 years’ work experience (OR 3.0, 95% CI 1.16–7.9) and confidence in vaccine safety (OR 7.78, 95% CI 4.49–13.5) were significantly associated with vaccine uptake. While our study indicates higher vaccine uptake among nursing staff during an active vaccine rollout, there remains sustained hesitancy and unwillingness to uptake. For those hesitant to receive the COVID-19 vaccine, public health efforts to provide more data on side effects and efficacy may help increase vaccine uptake.

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Public Health Workforce Burnout in the COVID-19 Response in the U.S.

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084369 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4369

Author(s):

Kahler W. Stone ◽

Kristina W. Kintziger ◽

Meredith A. Jagger ◽

Jennifer A. Horney

Keyword(s):

Public Health ◽

Health Workforce ◽

Work Experience ◽

Large Scale ◽

Health Workers ◽

Public Health Workforce ◽

Cross Sectional Survey ◽

Public Health Response ◽

Cross Sectional ◽

The U.S

While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1–4 vs. <1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08−3.36; 5–9 vs. <1 years: PR = 1.89, CI = 1.07−3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08–1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce’s future when many challenges related to the ongoing COVID-19 response remain unaddressed.

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Pre-Exposure Prophylaxis Training among Medical Schools in the United States

Journal of Primary Care & Community Health ◽

10.1177/21501327211028713 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110287

Author(s):

Robert L. Cooper ◽

Mohammad Tabatabai ◽

Paul D. Juarez ◽

Aramandla Ramesh ◽

Matthew C. Morris ◽

...

Keyword(s):

United States ◽

Hiv Prevention ◽

Injection Drug Users ◽

Drug Users ◽

Healthcare Providers ◽

Medical Schools ◽

The United States ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Exposure Prophylaxis

Pre-Exposure Prophylaxis (PrEP) has been shown to be an effective method of HIV prevention for men who have sex with-men (MSM) and -transgender women (MSTGWs), serodiscordant couples, and injection drug users; however fewer than 50 000 individuals currently take this regimen. Knowledge of PrEP is low among healthcare providers and much of this lack of knowledge stems from the lack or exposure to PrEP in medical school. We conducted a cross sectional survey of medical schools in the United States to assess the degree to which PrEP for HIV prevention is taught. The survey consisted Likert scale questions assessing how well the students were prepared to perform each skill associated with PrEP delivery, as well as how PrEP education was delivered to students. We contacted 141 medical schools and 71 responded to the survey (50.4%). PrEP education was only reported to be offered at 38% of schools, and only 15.4% reported specific training for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. The most common delivery methods of PrEP content were didactic sessions with 11 schools reporting this method followed by problem-based learning, direct patient contact, workshops, and small group discussions. Students were more prepared to provide PrEP to MSM compared to other high-risk patients. Few medical schools are preparing their students to prescribe PrEP upon graduation. Further, there is a need to increase the number of direct patient contacts or simulations for students to be better prepared.

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Use of diagnostic tests by dermatologists, podiatrists and family practitioners in the United States: pilot data from a cross-sectional survey

Mycoses ◽

10.1111/j.1439-0507.2007.01422.x ◽

2007 ◽

Vol 50 (6) ◽

pp. 463-469 ◽

Cited By ~ 14

Author(s):

Rebecca L. Koshnick ◽

Kia K. Lilly ◽

Katherine St Clair ◽

Mary T. Finnegan ◽

Erin M. Warshaw

Keyword(s):

United States ◽

Diagnostic Tests ◽

The United States ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Pilot Data ◽

Family Practitioners

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COVID-19 and the Risk for Increased Intimate Partner Violence Among Gay, Bisexual and Other Men Who Have Sex With Men in the United States

Journal of Interpersonal Violence ◽

10.1177/0886260521997454 ◽

2021 ◽

pp. 088626052199745

Author(s):

Rob Stephenson ◽

Tanaka M.D. Chavanduka ◽

Matthew T. Rosso ◽

Stephen P. Sullivan ◽

Renée A. Pitter ◽

...

Keyword(s):

United States ◽

Intimate Partner Violence ◽

Partner Violence ◽

Social Contact ◽

The United States ◽

Intimate Partner ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Sex With Men ◽

First Time

Stay at home orders–intended to reduce the spread of COVID-19 by limiting social contact–have forced people to remain in their homes. The additional stressors created by the need to stay home and socially isolate may act as triggers to intimate partner violence (IPV). In this article, we present data from a recent online cross-sectional survey with gay, bisexual and other men who have sex with men (GBMSM) in the United States to illustrate changes in IPV risks that have occurred during the U.S. COVID-19 epidemic. The Love and Sex in the Time of COVID-19 survey was conducted online from April to May 2020. GBMSM were recruited through paid banner advertisements featured on social networking platforms, recruiting a sample size of 696 GBMSM. Analysis considers changes in victimization and perpetration of IPV during the 3 months prior to the survey (March-May 2020) that represents the first 3 months of lockdown during the COVID-19 epidemic. During the period March-May 2020, 12.6% of participants reported experiencing any IPV with higher rates of emotional IPV (10.3%) than sexual (2.2%) or physical (1.8%) IPV. Of those who reported IPV victimization during lockdown, for almost half this was their first time experience: 5.3% reported the IPV they experienced happened for the first time during the past 3 months (0.8% physical, 2.13% sexual, and 3.3% emotional). Reporting of perpetration of IPV during lockdown was lower: only 6% reported perpetrating any IPV, with perpetration rates of 1.5% for physical, 0.5% for sexual, and 5.3% for emotional IPV. Of those who reported perpetration of IPV during lockdown, very small percentages reported that this was the first time they had perpetrated IPV: 0.9% for any IPV (0.2% physical, 0.2% sexual, and 0.6% emotional). The results illustrate an increased need for IPV resources for GBMSM during these times of increased stress and uncertainty, and the need to find models of resource and service delivery that can work inside of social distancing guidelines while protecting the confidentiality and safety of those who are experiencing IPV.

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Early introductions and community transmission of SARS-CoV-2 variant B.1.1.7 in the United States

10.1101/2021.02.10.21251540 ◽

2021 ◽

Author(s):

Tara Alpert ◽

Erica Lasek-Nesselquist ◽

Anderson F. Brito ◽

Andrew L. Valesano ◽

Jessica Rothman ◽

...

Keyword(s):

Public Health ◽

United States ◽

New York ◽

Diagnostic Testing ◽

The United States ◽

International Travel ◽

Health Concern ◽

Public Health Response ◽

Community Transmission ◽

The Uk

SummaryThe emergence and spread of SARS-CoV-2 lineage B.1.1.7, first detected in the United Kingdom, has become a national public health concern in the United States because of its increased transmissibility. Over 500 COVID-19 cases associated with this variant have been detected since December 2020, but its local establishment and pathways of spread are relatively unknown. Using travel, genomic, and diagnostic testing data, we highlight the primary ports of entry for B.1.1.7 in the US and locations of possible underreporting of B.1.1.7 cases. New York, which receives the most international travel from the UK, is likely one of the key hubs for introductions and domestic spread. Finally, we provide evidence for increased community transmission in several states. Thus, genomic surveillance for B.1.1.7 and other variants urgently needs to be enhanced to better inform the public health response.

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Similarities and Differences in COVID-19 Awareness, Concern, and Symptoms by Race and Ethnicity in the United States: Cross-Sectional Survey (Preprint)

10.2196/preprints.20001 ◽

2020 ◽

Author(s):

Jeb Jones ◽

Patrick S Sullivan ◽

Travis H Sanchez ◽

Jodie L Guest ◽

Eric W Hall ◽

...

Keyword(s):

United States ◽

Race And Ethnicity ◽

Online Survey ◽

Statistical Tests ◽

The United States ◽

Control Measures ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Similarities And Differences ◽

Hispanic White

BACKGROUND Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality during the coronavirus disease (COVID-19) pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. OBJECTIVE The aim of this study was to describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the United States. METHODS We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure web-based survey platform. We used chi-square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. RESULTS A total of 1435 participants completed the survey; 52 (3.6%) were Asian, 158 (11.0%) were non-Hispanic Black, 548 (38.2%) were Hispanic, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) identified as other or multiple races. Only one symptom (sore throat) was found to be different based on race and ethnicity (<i>P</i>=.003); this symptom was less frequently reported by Asian (3/52, 5.8%), non-Hispanic Black (9/158, 5.7%), and other/multiple race (8/90, 8.9%) participants compared to those who were Hispanic (99/548, 18.1%) or non-Hispanic White (95/587, 16.2%). Non-Hispanic White and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (<i>P</i>=.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian participants, 13/52, 25.0%; non-Hispanic White participants, 180/587, 30.7%) compared to Hispanic (108/548, 19.7%) and non-Hispanic Black (25/158, 15.8%) participants. CONCLUSIONS We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods may further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and create effective messaging to disseminate correct COVID-19 prevention and treatment information.

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COVID-19 vaccine hesitancy in underserved communities of North Carolina

PLoS ONE ◽

10.1371/journal.pone.0248542 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0248542

Author(s):

Irene A. Doherty ◽

William Pilkington ◽

Laurin Brown ◽

Victoria Billings ◽

Undi Hoffler ◽

...

Keyword(s):

North Carolina ◽

Health Care Providers ◽

Vaccine Safety ◽

The United States ◽

Vaccine Hesitancy ◽

Care Providers ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Underserved Communities ◽

Safety Concerns

Background In the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among historically marginalized populations across 9 counties in North Carolina. Methods We conducted a cross-sectional survey distributed at free COVID-19 testing events in underserved rural and urban communities from August 27 –December 15, 2020. Vaccine hesitancy was defined as the response of “no” or “don’t know/not sure” to whether the participant would get the COVID-19 vaccine as soon as it became available. Results The sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. 32% earned <$20K annually, 60% owned a computer and ~80% had internet access at home. The prevalence of vaccine hesitancy was 68.9% including 62.7%, 74%, and 59.5% among Whites, Blacks, and Latinx, respectively. Between September and December, the largest decline in vaccine hesitancy occurred among Whites (27.5 percentage points), followed by Latinx (17.6) and only 12.0 points among Blacks. 51.2% of respondents reported vaccine safety concerns, 23.7% wanted others to get vaccinated first, and 63.1% would trust health care providers about the COVID-19 vaccine. Factors associated with hesitancy in multivariable logistic regression included being female (OR = 1.90 95%CI [1.36, 2.64]), being Black (OR = 1.68 1.16, 2.45]), calendar month (OR = 0.76 [0.63, 0.92]), safety concerns (OR = 4.28 [3.06, 5.97]), and government distrust (OR = 3.57 [2.26, 5.63]). Conclusions This study engaged the community to directly reach underserved minority populations at highest risk of COVID-19 that permitted assessment of vaccine hesitancy (which was much higher than national estimates), driven in part by distrust, and safety concerns.

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