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      Why are Some People Reluctant to be Vaccinated for COVID-19? A Cross-Sectional Survey among U.S. Adults in May-June 2020

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          Abstract

          Understanding reasons for COVID-19 vaccine hesitancy is necessary to ensure maximum uptake, needed for herd immunity. We conducted a cross-sectional online survey between May 29-June 20, 2020 among a national sample of U.S. adults ages 18 years and over to assess cognitive, attitudinal and normative beliefs associated with not intending to get a COVID-19 vaccine. Of 1,219 respondents, 17.7% said that they would not get a vaccine and 24.2% were unsure. In multivariable analyses controlled for gender, age, income, education, religious affiliation, health insurance coverage, and political party affiliation, those who reported that they were unwilling be vaccinated (versus those who were willing) were less likely to agree that vaccines are safe/effective (Relative Risk Ratio (RRR): 0.45, 95% confidence interval (CI): 0.31, 0.66), that everyone has a responsibility to be vaccinated (RRR: 0.39, 95% CI: 0.30, 0.52), that public authorities should be able to mandate vaccination (RRR: 0.75, 95% CI: 0.58, 0.98), and that if everyone else were vaccinated they would not need a vaccine (RRR: 1.36, 95% CI: 1.04, 1.78). Our results suggest that health messages should emphasize the safety and efficacy of vaccines, as well as the fact that vaccinating oneself is important, even if the level of uptake in the community is high.

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          Most cited references31

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          An Ecological Perspective on Health Promotion Programs

          During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.
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            Determinants of COVID-19 vaccine acceptance in the US

            Background The COVID-19 pandemic continues to adversely affect the U.S., which leads globally in total cases and deaths. As COVID-19 vaccines are under development, public health officials and policymakers need to create strategic vaccine-acceptance messaging to effectively control the pandemic and prevent thousands of additional deaths. Methods Using an online platform, we surveyed the U.S. adult population in May 2020 to understand risk perceptions about the COVID-19 pandemic, acceptance of a COVID-19 vaccine, and trust in sources of information. These factors were compared across basic demographics. Findings Of the 672 participants surveyed, 450 (67%) said they would accept a COVID-19 vaccine if it is recommended for them. Males (72%) compared to females, older adults (≥55 years; 78%) compared to younger adults, Asians (81%) compared to other racial and ethnic groups, and college and/or graduate degree holders (75%) compared to people with less than a college degree were more likely to accept the vaccine. When comparing reported influenza vaccine uptake to reported acceptance of the COVID-19 vaccine: 1) participants who did not complete high school had a very low influenza vaccine uptake (10%), while 60% of the same group said they would accept the COVID-19 vaccine; 2) unemployed participants reported lower influenza uptake and lower COVID-19 vaccine acceptance when compared to those employed or retired; and, 3) Black Americans reported lower influenza vaccine uptake and lower COVID-19 vaccine acceptance than all other racial groups reported in our study. Lastly, we identified geographic differences with Department of Health and Human Services (DHHS) regions 2 (New York) and 5 (Chicago) reporting less than 50 percent COVID-19 vaccine acceptance. Interpretation Although our study found a 67% acceptance of a COVID-19 vaccine, there were noticeable demographic and geographical disparities in vaccine acceptance. Before a COVID-19 vaccine is introduced to the U.S., public health officials and policymakers must prioritize effective COVID-19 vaccine-acceptance messaging for all Americans, especially those who are most vulnerable.
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              Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults

              Once a vaccine for coronavirus disease 2019 becomes available, it will be important to maximize vaccine uptake and coverage. This national survey explores factors associated with vaccine hesitancy. The results suggest that multipronged efforts will be needed to increase acceptance of a coronavirus disease 2019 vaccine.
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                Author and article information

                Journal
                Prev Med Rep
                Prev Med Rep
                Preventive Medicine Reports
                Published by Elsevier Inc.
                2211-3355
                14 July 2021
                14 July 2021
                : 101494
                Affiliations
                [a ]Department of Community Health, Tufts University, 574 Boston Ave, Medford MA 02155, USA
                [b ]Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
                [c ]Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA
                [d ]Department of Occupational Therapy, Tufts University, 574 Boston Ave, Medford, MA 02155, USA
                [e ]Department of Community Health, Tufts University, 574 Boston Ave, Medford MA 02155, USA
                [f ]Department of Political Science, Tufts University, Packard Hall, Medford, MA 02155, USA
                [g ]Department of Clinical Science, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA
                [h ]Department of Community Health, Tufts University, 574 Boston Ave, Medford MA 02155, USA
                [i ]Tufts Clinical and Translational Science Institute, 35 Kneeland Street, Boston, MA 02111, USA
                Article
                S2211-3355(21)00184-4 101494
                10.1016/j.pmedr.2021.101494
                8277541
                34277329
                140348c0-b03d-41ca-b5aa-277f78f2c932
                © 2021 Published by Elsevier Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 28 June 2021
                : 6 July 2021
                : 10 July 2021
                Categories
                Article

                covid-19,coronavirus,vaccine,attitudes,health disparities,united states

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