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. 2023 Jan:166:107341.
doi: 10.1016/j.ypmed.2022.107341. Epub 2022 Nov 11.

Explaining demographic differences in COVID-19 vaccination stage in the United States - April-May 2021

Qian Huang  1 , Neetu Abad  2 , Kimberly E Bonner  2 , Brittney Baack  2 , Robert Petrin  3 , Megan A Hendrich  3 , Zachary Lewis  3 , Noel T Brewer  4
Affiliations

Explaining demographic differences in COVID-19 vaccination stage in the United States - April-May 2021

Qian Huang et al. Prev Med. 2023 Jan.

Abstract

COVID-19 vaccine coverage in the US has marked demographic and geographical disparities, but few explanations exist for them. Our paper aimed to identify behavioral and social drivers that explain these vaccination disparities. Participants were a national probability sample of 3562 American adults, recruited from the Ipsos KnowledgePanel. Participants completed an online survey in spring 2021, when COVD-19 vaccination was available for higher-risk groups but not yet available to all US adults. The survey assessed COVID-19 vaccination stage (intentions and vaccine uptake), constructs from the Increasing Vaccination Model (IVM) domains (thinking and feeling, social processes, and direct behavior change), self-reported exposure to COVID-19 vaccine information, and demographic characteristics. Analyses used multiple imputation to address item nonresponse and linear regressions to conduct mediation analyses. Higher COVID-19 vaccination stage was strongly associated with older age, liberal political ideology, and higher income in adjusted analyses (all p < .001). Vaccination stage was more modestly associated with urbanicity, white race, and Hispanic ethnicity (all p < .05). Some key mediators that explained more than one-third of demographic differences in vaccination stage were perceived vaccine effectiveness, social norms, and recommendations from family and friends across most demographic characteristics (all p < .05). Other mediators included safety concerns, trust, altruism, provider recommendation, and information seeking. Access to vaccination, barriers to vaccination, and self-efficacy explained few demographic differences. One of the most reliable explanations for demographic differences in COVID-19 vaccination stage is social processes, including social norms, recommendations, and altruism. Interventions to promote COVID-19 vaccination should address social processes and other domains in the IVM.

Keywords: COVID-19 vaccination; Demographic differences; Mediation analysis; Recommendations; Social norms.

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Conflict of interest statement

Declaration of Competing Interest Noel Brewer has served as a paid advisor for Merck, Novartis, US Centers for Disease Control and Prevention, and the World Health Organization. The remaining authors declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Mediation approach. C′ pathway adjusts for the potential mediator.
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