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

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

10.1101/2021.02.28.21252610 ◽

2021 ◽

Cited By ~ 1

Author(s):

Ali S. Raja ◽

Joshua D. Niforatos ◽

Nancy Anaya ◽

Joseph Graterol ◽

Robert M. Rodriguez

Keyword(s):

Public Health ◽

United States ◽

The United States ◽

Amazon Mechanical Turk ◽

Vaccine Hesitancy ◽

Party Affiliation ◽

Critical Question ◽

Cross Sectional Survey ◽

Public Health Response ◽

Cross Sectional

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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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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Exploring the Role of Media Sources on COVID-19–Related Discrimination Experiences and Concerns Among Asian People in the United States: Cross-Sectional Survey Study (Preprint)

10.2196/preprints.21684 ◽

2020 ◽

Author(s):

Nan Yu ◽

Shuya Pan ◽

Chia-chen Yang ◽

Jiun-Yi Tsai

Keyword(s):

Public Health ◽

United States ◽

Social Media ◽

Asian Americans ◽

Asian American ◽

The United States ◽

Cross Sectional ◽

Racial Biases ◽

Asian People

BACKGROUND Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic. OBJECTIVE This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that were associated with everyday discrimination experience and concerns about future discrimination that the Asian community may face. METHODS A cross-sectional online survey was conducted. A total of 235 people who identified themselves as Asian or Asian American and resided in the United States completed the questionnaire. RESULTS Our study suggested that up to a third of Asians surveyed had experienced some type of discrimination. Pooling the responses “very often,” “often,” and “sometimes,” the percentages for each experienced discrimination type ranged between 14%-34%. In total, 49%-58% of respondents expressed concerns about discrimination in the future. The most frequently experienced discrimination types, as indicated by responses “very often” and “often,” were “people act as if they think you are dangerous” (25/235, 11%) and “being treated with less courtesy or respect” (24/235, 10%). About 14% (32/235) of individuals reported very often, often, or sometimes being threatened or harassed. In addition, social media use was significantly associated with a higher likelihood of experiencing discrimination (β=.18, P=.01) and having concerns about future episodes of discrimination the community may face (β=.20, P=.005). Use of print media was also positively associated with experiencing discrimination (β=.31, P<.001). CONCLUSIONS Our study provided important empirical evidence regarding the various types of discrimination Asians residing in the United States experienced or worried about during the COVID-19 pandemic. The relationship between media sources and the perception of racial biases in this group was also identified. We noted the role of social media in reinforcing the perception of discrimination experience and concerns about future discrimination among Asians during this outbreak. Our results indicate several practical implications for public health agencies. To reduce discrimination against Asians during the pandemic, official sources and public health professionals should be cognizant of the possible impacts of stigmatizing cues in media reports on activating racial biases. Furthermore, Asians or Asian Americans could also be informed that using social media to obtain COVID-19 information is associated with an increase in concerns about future discrimination, and thus they may consider approaching this media source with caution.

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The role of alternative and complementary medical practices in vaccine hesitancy among nurses: A cross-sectional survey in Brittany

Médecine et Maladies Infectieuses ◽

10.1016/j.medmal.2020.09.021 ◽

2020 ◽

Author(s):

A. Thomire ◽

J. Raude

Keyword(s):

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Medical Practices

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Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey

Journal of Medical Internet Research ◽

10.2196/23488 ◽

2021 ◽

Vol 23 (4) ◽

pp. e23488

Author(s):

Ken Resnicow ◽

Elizabeth Bacon ◽

Penny Yang ◽

Sarah Hawley ◽

M Lee Van Horn ◽

...

Keyword(s):

Public Health ◽

Health Communication ◽

Online Survey ◽

Lessons Learned ◽

Vaccine Hesitancy ◽

Central Component ◽

Protective Behaviors ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Conspiracy Beliefs

Background A central component of the public health strategy to control the COVID-19 pandemic involves encouraging mask wearing and social distancing to protect individuals from acquiring and transmitting the virus. Objective This study aims to understand the psychological factors that drive adoption or rejection of these protective behaviors, which can inform public health interventions to control the pandemic. Methods We conducted an online survey of a representative sample of 1074 US adults and assessed three novel potential predictors of COVID-19 behaviors: trait reactance, COVID-19 conspiracy beliefs, and COVID-19 apocalypse beliefs. Key outcomes (dependent variables) included an index of COVID-19 protective behaviors, the number of trips taken from the home, and COVID-19 knowledge. Results In bivariate analyses, all three predictors were significantly correlated in the hypothesized direction with the three COVID-19 outcomes. Specifically, each predictor was negatively (P<.01) correlated with the COVID-19 protective behaviors index and COVID-19 knowledge score, and positively correlated with trips taken from home per week (more of which was considered higher risk). COVID-19 protective behaviors and COVID-19 knowledge were significantly lower in the top median compared to the bottom median for all three predictors. In general, these findings remained significant after adjusting for all novel predictors plus age, gender, income, education, race, political party, and religiosity. Self-identified Republicans (vs other political affiliations) reported the highest values for each of the novel predictors. Conclusions This study can inform the development of health communication interventions to encourage the adoption of COVID-19 protective behaviors. Interestingly, we found that higher scores of all three novel predictors were associated with lower COVID-19 knowledge, suggesting that lack of an accurate understanding of the virus may be driving some of these attitudes; although, it is also possible that these attributes may interfere with one’s willingness or ability to seek and absorb accurate health information. These individuals may be particularly immune to accepting new information and yielding their beliefs. Health communication professionals may apply lessons learned from countering similar beliefs around climate change and vaccine hesitancy. Messages designed for individuals prone to reactance may be more effective if they minimize controlling language and emphasize the individual’s independence in adopting these behavioral recommendations. Messaging for those who possess conspiracy beliefs should similarly not assume that providing evidence contrary to these beliefs will alone alter behavior. Other communication techniques such as rolling with resistance, a strategy used in motivational interviewing, may be helpful. Messaging for those with apocalyptic beliefs may require using religious leaders as the message source and using scripture that would support the adoption of COVID-19 protection behaviors.

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COVID-19 Vaccine Hesitancy in Underserved Communities of North Carolina

10.1101/2021.02.21.21252163 ◽

2021 ◽

Author(s):

Irene A. Doherty ◽

William Pilkington ◽

Laurin Brown ◽

Victoria Billings ◽

Undi Hoffler ◽

...

Keyword(s):

North Carolina ◽

Health Care Providers ◽

The United States ◽

Vaccine Hesitancy ◽

List Type ◽

Care Providers ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Underserved Communities ◽

Safety Concerns

AbstractBackgroundIn the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19, and widespread vaccination is critical for curbing this pandemic. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among racial minority and marginalized populations across 9 counties in North Carolina.MethodsWe conducted a cross-sectional survey with a self-administered questionnaire 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.ResultsThe sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. Thirty-two percent 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 the smallest decline was among Black respondents (12.0). 51.2% of the respondents reported vaccine safety concerns, 23.7% wanted others to get of the respondents reported they would trust health care providers with information 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 [1.106 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]).ConclusionsThis study reached underserved minority populations in a number of different locations to investigate COVID-19 vaccine hesitancy. We built on existing relationships and further engaged the community, stake holders and health department to provide free COVID-19 testing. This direct approach permitted assessment of vaccine hesitancy (which was much higher than national estimates), distrust, and safety concerns.HighlightsThis study surveyed 948 adults at COVID-19 testing sites in 9 counties of North Carolina between August 27 and December 15, 2020 where vaccine hesitancy was widespread including 74% in Blacks, 62.7% in Whites and 59.5% in Latinx.Vaccine hesitancy declined over time but remained high for Blacks.On-site surveys conducted in underserved areas that were paper-based and self-administered permitted reaching adults with no internet (17%), no cell phone (20%), no computer (40%) and yearly incomes less than 20K (31%).Widespread vaccine hesitancy in predominately minority communities of NC must be addressed to successfully implement mass COVID-19 vaccination programs.

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Physicians’ Experience with COVID-19 Vaccination: A Survey Study

Healthcare ◽

10.3390/healthcare9121746 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1746

Author(s):

Alina Dima ◽

Ciprian Jurcut ◽

Daniel Vasile Balaban ◽

Valeriu Gheorghita ◽

Ruxandra Jurcut ◽

...

Keyword(s):

Side Effects ◽

Safety Profile ◽

Vaccine Dose ◽

Vaccine Safety ◽

Survey Study ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccination Rates ◽

Additional Information

Background: COVID-19 vaccine hesitancy remains high in the general population and is the main determinant of low vaccination rates and of the fourth pandemic wave severity in Romania. Additional information is needed to raise awareness over vaccine efficiency and the safety profile. Objective: To assess self-reported experience related to COVID-19 vaccination in Romanian physicians. Design, Setting, and Participants: A cross-sectional, self-administered questionnaire-based survey, distributed online in the period 24 March to 24 May 2021. The survey included 30 cascade questions with skip logic filters. All physicians included filled in the questionnaire voluntarily and anonymously. Not all respondents filled in all questions. Main outcome and measure: Primary outcomes addressed were related to the COVID-19 vaccine safety profile. Results: 407/467 (87.15%) of the respondents’ physicians were fully vaccinated, mostly with the Pfizer—BioNTech (Comirnaty)—BNT162b2 vaccine, with the peak of immunization in January 2021, with almost four-fifths of the study participants. Regarding COVID-19, almost 20% physicians had the infection and one declared COVID-19 re-infection. A number of 48/420 (11.42%) and 47/419 (11.22%) of the vaccinated physicians did not report any side effects after the first or second vaccine dose. However, most of the side effects reported were minor. Only 50/360 (13.88%) physicians reported the vaccine side effects on the dedicated online national platform. Approximately 40% respondents checked the anti-spike SARS-CoV2 antibodies’ titer after complete vaccination, of which two cases reported indeterminate levels. Lower anti-spike SARS-CoV2 antibodies’ titer of 100–1000 times the laboratory limit was more frequent in naive physicians (36.95% versus 14.28%, p = 0.012), moderate titers were similar, while very high levels, more than 10,000 times laboratory limit, were more frequent in physicians with previous COVID-19 infection (2.17% versus 42.85%, p < 0.001). Conclusions and relevance: In this cross-sectional survey study on the COVID-19 vaccination among Romanian physicians, we describe a safety vaccination profile among Romanian physicians.

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Understanding Beliefs, Intention, and Behavior on Daily PrEP Uptake Among MSM in California and New York

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.2.129 ◽

2021 ◽

Vol 33 (2) ◽

pp. 129-142

Author(s):

Minhao Dai ◽

Nancy Grant Harrington

Keyword(s):

New York ◽

Hiv Infections ◽

The United States ◽

Integrative Model ◽

Path Modeling ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Sex With Men ◽

Exposure Prophylaxis ◽

And Behavior

Pre-exposure prophylaxis (PrEP) is an effective daily prevention medicine to reduce the risks of HIV infections. Even though the number of PrEP users has been rapidly growing in the United States since 2012, only approximately 5% of the men who have sex with men (MSM) population is currently taking PrEP. This study examined PrEP uptake among MSM using the integrative model of behavioral prediction (IMBP) as the theoretical framework. The authors conducted formative elicitation interviews and a cross-sectional survey with MSM. Among the survey respondents, half of them were PrEP takers and half were not. The path modeling results showed that attitudes and norms predicted behavioral intention, and intention predicted PrEP uptake among MSM. The results also identified the strongest attitudinal predictors and normative referents of PrEP uptake. The study offers practical implications in helping professionals and scholars to understand PrEP uptake among MSM in a theoretically grounded way.

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Exploring the Role of Media Sources on COVID-19–Related Discrimination Experiences and Concerns Among Asian People in the United States: Cross-Sectional Survey Study

Journal of Medical Internet Research ◽

10.2196/21684 ◽

2020 ◽

Vol 22 (11) ◽

pp. e21684

Author(s):

Nan Yu ◽

Shuya Pan ◽

Chia-chen Yang ◽

Jiun-Yi Tsai

Keyword(s):

Public Health ◽

United States ◽

Social Media ◽

Asian Americans ◽

Asian American ◽

The United States ◽

Cross Sectional ◽

Racial Biases ◽

Asian People

Background Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic. Objective This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that were associated with everyday discrimination experience and concerns about future discrimination that the Asian community may face. Methods A cross-sectional online survey was conducted. A total of 235 people who identified themselves as Asian or Asian American and resided in the United States completed the questionnaire. Results Our study suggested that up to a third of Asians surveyed had experienced some type of discrimination. Pooling the responses “very often,” “often,” and “sometimes,” the percentages for each experienced discrimination type ranged between 14%-34%. In total, 49%-58% of respondents expressed concerns about discrimination in the future. The most frequently experienced discrimination types, as indicated by responses “very often” and “often,” were “people act as if they think you are dangerous” (25/235, 11%) and “being treated with less courtesy or respect” (24/235, 10%). About 14% (32/235) of individuals reported very often, often, or sometimes being threatened or harassed. In addition, social media use was significantly associated with a higher likelihood of experiencing discrimination (β=.18, P=.01) and having concerns about future episodes of discrimination the community may face (β=.20, P=.005). Use of print media was also positively associated with experiencing discrimination (β=.31, P<.001). Conclusions Our study provided important empirical evidence regarding the various types of discrimination Asians residing in the United States experienced or worried about during the COVID-19 pandemic. The relationship between media sources and the perception of racial biases in this group was also identified. We noted the role of social media in reinforcing the perception of discrimination experience and concerns about future discrimination among Asians during this outbreak. Our results indicate several practical implications for public health agencies. To reduce discrimination against Asians during the pandemic, official sources and public health professionals should be cognizant of the possible impacts of stigmatizing cues in media reports on activating racial biases. Furthermore, Asians or Asian Americans could also be informed that using social media to obtain COVID-19 information is associated with an increase in concerns about future discrimination, and thus they may consider approaching this media source with caution.

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Attitudes towards the COVID-19 Vaccine and Willingness to Get Vaccinated among Healthcare Workers in French Guiana: The Influence of Geographical Origin

Vaccines ◽

10.3390/vaccines9060682 ◽

2021 ◽

Vol 9 (6) ◽

pp. 682

Author(s):

Nicolas Vignier ◽

Kepha Brureau ◽

Sybille Granier ◽

Jacques Breton ◽

Céline Michaud ◽

...

Keyword(s):

Public Health ◽

French Guiana ◽

Medical Profession ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Health Concern ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Negative Attitudes

Background: In the context of the global COVID-19 pandemic and the expansion of the more transmissible 20J/501Y.V3 (Gamma) variant of concern (VOC), mRNA vaccines have been made available in French Guiana, an overseas French territory in South America, from mid-January 2021. This study aimed to estimate the willingness to be vaccinated and the socio-demographic and motivational correlates among Health Care Workers (HCWs) in French Guiana. Methods: A cross-sectional survey was conducted from January 22 to March 26, 2021 among a sample of HCWs in French Guiana. They were asked about their willingness to get vaccinated against COVID-19 and vaccine hesitancy, vaccine uptake and vaccines attitudes. Factors associated with willingness to get vaccinated have been analyzed with ordinal logistic regression, using Stata software. Results: A total of 579 HCWs were interviewed, including 220 physicians and 200 nurses most often working in hospital (54%) or in the liberal sector (22%). Overall, 65.6% of respondents reported that they were willing or had already been vaccinated against COVID-19, while 24.3% of respondents reported that they did not want to get vaccinated against COVID-19 and 11.2% were unsure. HCWs were more willing to get vaccine if they were older, were worried about COVID-19 and were confident in the management of epidemic. Conversely, participants were less likely to have been vaccinated or willing to if they were nurses or of another non-medical profession, born in French Guiana, feared adverse effects, or if they did not trust pharmaceutical companies and management of the epidemic by authorities. Conclusion: Negative attitudes towards vaccines are a major public health concern among HCWs in French Guiana when considering the current active epidemic with Gamma VOC. General vaccine hesitancy and concerns about future side effects in particular represent important barriers. Low confidence in government and science are significant in COVID-19 vaccine refusal among non-medical staffs. Public health messaging with information on vaccine safety should be tailored to address these concerns. The specific challenges of HCWs from French Guiana must be taken into account.

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