HPV vaccine behaviors and intentions among a diverse sample of women aged 27-45 years: implications for shared clinical decision-making.

BACKGROUND: The Advisory Committee on Immunization Practices issued a shared clinical decision-making (SCDM) recommendation for HPV vaccination in persons aged 27-45. Since expanded eligibility for the vaccine was issued, little information has been available about HPV vaccine behaviors and intentions among women in this age group. METHODS: We conducted a cross-sectional online survey among women aged 27-45 years recruited through a Qualtrics™ respondent panel (N = 324) to answer the following questions (1) What is the prevalence of HPV vaccination among a diverse sample of adult women aged 27-45 years? (2) What are the characteristics of those who have or have not previously been vaccinated? and (3) What factors are associated with the intention to obtain the HPV vaccine among those who had never been vaccinated? Multivariable logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs). RESULTS: Only 31.1% had at least one dose of the HPV vaccine. In multivariable analyses, those more likely to have been vaccinated were younger and were more likely to believe that the vaccine was effective. Of those unvaccinated or unsure, 54.8% indicated they were likely to get vaccinated in the future. Factors associated with future vaccine intention (compared to those not intending) included beliefs about vaccine testing, perceived likelihood of HPV infection, greater comfort in asking one's provider for vaccination, and prior negative healthcare experiences. CONCLUSIONS: Our findings suggest that many women in this age group are interested in HPV vaccination. While the recommendation is for SCDM rather than routine vaccination for all women in this age group, efforts to promote informed decision-making among mid-adult women may include educating women about the rigorous vaccine testing and approval process, their risk factors for HPV infection, and encouraging them to engage in SCDM with their medical providers. Targeted efforts to reach women who have had negative experiences with healthcare may also be needed.

Pap test recency and HPV vaccination among Brazilian immigrant women in the United States: a cross-sectional study.

BACKGROUND: The United States (U.S.) has a growing population of Brazilian immigrant women. However, limited research has explored Pap tests and human papillomavirus (HPV) vaccination among this population. METHODS: Participants completed an online survey between July-August 2020. Bivariate analyses examined associations between healthcare-related variables (e.g., insurance, having a primary care provider) and demographics (e.g., age, education, income, marital status, years living in the U.S., primary language spoken at home) with 1) Pap test recency (within the past 3 years) and 2) HPV vaccination (0 doses vs. 1 + doses). Variables significant at p < 0.10 in bivariate analyses were included in multivariable logistic regression models examining Pap test recency and HPV vaccination. RESULTS: The study found that 83.7% of the sample had a Pap test in the past three years. Women who did not know their household income were less likely to be than women who reported a household income of < $25,000 (adjusted OR [aOR] = 0.34, 95% CI: 0.12, 0.95). Women who had seen a healthcare provider in the past year were more likely to have had a Pap test within the last three years than those who had not seen a provider in the past year ([aOR] = 2.43, 95% CI: 1.32, 4.47). Regarding HPV vaccination, 30.3% of respondents reported receiving one or more doses of the HPV vaccine. The multivariable logic regression models determined that women aged 27 -45 (aOR = 0.35, 95% CI: 0.18, 0.67) were less likely than women aged 18-26 to have been vaccinated against HPV). and that women with a PCP were more likely to be vaccinated than those without a PCP (aOR = 2.47. 95% CI:1.30, 4.59). CONCLUSION: This study found that Brazilian immigrant women in the youngest age groups (21 - 29) for Pap test, 18- 26 for HPV vaccination) had somewhat better rates of Pap screening and HPV vaccination than the general U.S. POPULATION: This study adds new information about cervical cancer prevention and control behaviors among Brazilian immigrant women.

HPV Vaccine Awareness, Past Behaviors, and Future Intentions Among a Diverse Sample of Fathers Aged 27 to 45 Years: A National Survey.

Men aged 27 to 45 are eligible for human papillomavirus (HPV) vaccination as of 2019, yet relatively little is known about whether they have received or intend to receive it. We conducted a cross-sectional, online survey among fathers aged 27 to 45 between March and April 2022, to assess associations between HPV vaccination awareness, behaviors, intentions, and psychosocial constructs from the Health Belief Model. We examined the characteristics of those who had (a) heard of the HPV vaccine, (b) already received ≥ 1 dose, and (c) intentions for future vaccination among those who had never been vaccinated. Among 400 men who completed the survey, 32% were not aware of the HPV vaccine. Among those who were aware, 41% had received ≥ 1 dose. Sixty-three percent of unvaccinated men reported that they intended to get vaccinated in the future. Multivariable logistic regression analyses revealed that age and race/ethnicity were associated with having been vaccinated previously. Among the unvaccinated, multivariable logistic regression analyses revealed that those with a higher perceived risk of HPV-associated cancer had 3.73 greater odds of reporting they would seek vaccination compared to those with lower perceived risk (95% confidence interval [CI] = [1.28, 12.3]). We did not find perceived benefits, barriers, or decision self-efficacy to be related to future vaccine intentions. Since recommendations for this group include shared clinical decision-making, public health efforts should focus on raising awareness of vaccine eligibility, emphasizing risk factors for HPV-associated cancers so that individuals have an accurate perception of risk, and encouraging conversation between men and their providers.

Reasons for COVID-19 Non-Vaccination from 2021 to 2023 for Adults, Adolescents, and Children.

Understanding how attitudes and beliefs about COVID-19 vaccination have changed over time is essential for identifying areas where targeted messaging and interventions can improve vaccination confidence and uptake. Using data from multiple waves of the nationally representative U.S. Census Bureau's Household Pulse Survey collected from January 2021 to May 2023, we assessed reasons for the non-vaccination of adults, adolescents, and children using the Health Belief Model as the framework for understanding behavior. Among unvaccinated adults, perceived vulnerability increased from 11.9% to 44.1%, attitudinal factors/mistrust increased from 28.6% to 53.4%, and lack of cue to action increased from 7.5% to 9.7% from January 2021 to May 2022. On the other hand, safety/efficacy concerns decreased from 74.0% to 60.9%, and logistical barriers to vaccination decreased from 9.1% to 3.4% during the same time period. Regarding reasons for non-vaccination of youth, perceived vulnerability increased from 32.8% to 40.0%, safety/efficacy concerns decreased from 73.9% to 60.4%, and lack of cue to action increased from 10.4% to 13.4% between September 2021 and May 2023. While safety/efficacy concerns and logistic barriers have decreased, increases in perceived vulnerability to COVID-19, mistrust, and lack of cues to action suggest that more efforts are needed to address these barriers to vaccination.

Changes in general and COVID-19 vaccine hesitancy among U.S. adults from 2021 to 2022.

INTRODUCTION: Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence. METHODS: We analyzed data using the CDC's Research and Development Survey (RANDS), a nationally representative survey of U.S. adults ≥18 years, collected from 17 May 2021-30 June 2021 (n = 5,458) and 3 November 2022-12 December 2022 (n = 6,821). We assessed changes in vaccine hesitancy, changes in vaccine attitudes and attitudes, and factors associated with hesitancy toward both vaccines in general and COVID-19 vaccines among a nationally representative sample of U.S. adults. RESULTS: Although COVID-19 vaccination (≥1 dose) increased from 67.2% (2021) to 74.7% (2022), COVID-19 vaccine hesitancy increased from 40.7% to 44.6% during the same period. During the same period, hesitancy toward both COVID-19 vaccines and vaccines in general increased among those who were aged ≥65 years and who were non-Hispanic White. However, COVID-19 vaccine hesitancy decreased among non-Hispanic Black adults. Current or former smokers were more hesitant toward vaccines in general (aPR = 1.13, 95%CI: 1.03-1.24) and toward COVID-19 vaccines (aPR = 1.08, 95%CI: 1.01-1.16) compared to never smokers. Among adults who did not receive any COVID-19 vaccines, COVID-19 vaccine hesitancy increased from 86.6% in 2021 to 92.4% in 2022. Furthermore, belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%. CONCLUSION: This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination.

COVID-19 vaccine hesitancy increased from 40.7% in 2021 to 44.6% in 2022.During the same period, hesitancy regarding both the COVID-19 vaccine and vaccines in general increased among those who were ≥65 years and non-Hispanic White while hesitancy toward COVID-19 vaccines decreased among non-Hispanic Black adults.Belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%, sug­gesting need to frame messaging on benefits such as protection from severe disease outcomes.

The cost of doubt: assessing the association between attributional ambiguity and mental health.

OBJECTIVE: To quantify the association between attributional ambiguity-the uncertainty of whether an experience is discrimination-and mental health. METHODS: Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status. RESULTS: Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms. CONCLUSION: Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations.

Prevalence and Factors Associated with Long COVID Symptoms among U.S. Adults, 2022.

Long COVID and its symptoms have not been examined in different subpopulations of U.S. adults. Using the 2022 BRFSS (n = 445,132), we assessed long COVID and each symptom by sociodemographic characteristics and health-related variables. Multivariable logistic regression was conducted to examine factors associated with long COVID and the individual symptoms. Prevalence differences were conducted to examine differences in long COVID by vaccination status. Overall, more than one in five adults who ever had COVID-19 reported symptoms consistent with long COVID (21.8%). The most common symptom was tiredness or fatigue (26.2%), followed by difficulty breathing or shortness of breath (18.9%), and loss of taste or smell (17.0%). Long COVID was more common among adults under 65 years, women, American Indian or Alaska Native or other/multi race group, smokers, and people with a disability, depression, overweight or obesity compared to their respective counterparts. The prevalence of long COVID was higher among unvaccinated adults (25.6%) than vaccinated adults (21.6%) overall, and for 20 of 32 subgroups assessed. These findings underscore the benefits of vaccination, the importance of early treatment, and the need to better inform health care resource allocation and support services for those experiencing long COVID.

The Influence of Contested Racial Identity and Perceived Everyday Discrimination Exposure on Body Mass Index in US Adults.

Contested racial identity-the discrepancy between one's self-identified race and socially assigned race-is a social determinant of health and may contribute to overweight and obesity. Obesity is associated with a host of short- and long-term health conditions, including cardiovascular disease, a leading cause of death. Individuals racialized as Black, Hispanic, and Latino are at the greatest risk of obesity. Previous research indicates that experiencing interpersonal discrimination is associated with higher body mass index (BMI) in adults, and individuals with a contested racial identity are disproportionately exposed to interpersonal discrimination. However, the association between BMI and contested racial identity is unknown. This cross-sectional study measured the relationship between contested racial identity and perceived everyday discrimination on BMI in a nationally representative sample of US adults. Contested racial identity was measured with a binary variable indicating agreement between participants' self-identified race and socially assigned race. Weighted unadjusted and adjusted multiple linear regression models quantified the associations between BMI and contested racial identity with and without the mean discrimination score. Covariates included nativity status, income, education, racial identity salience, gender, and age. Among 1689 participants, 18.3% had a contested racial identity. Contested identity was associated with significantly higher BMI (ß = 1.01, 95% CI = 0.06, 1.92), but the relationship was attenuated when adjusting for interpersonal discrimination, suggesting that individuals with contested identity may face a greater risk of obesity due to their disproportionately high exposure to interpersonal racial discrimination. Further research is needed to elucidate the impact of racism on BMI and obesity risk.

Preferred Location for Human Papillomavirus Self-Sampling for Cervical Cancer Screening.

OBJECTIVE: To examine associations among women's preferred locations for human papillomavirus (HPV) self-sampling in relation to their demographic, social, and health characteristics and their perceived benefits and concerns regarding this procedure. DESIGN: Cross-sectional, descriptive survey. SETTING: Online distribution between March 2022 and April 2022. PARTICIPANTS: People who were assigned female sex at birth and were eligible for cervical cancer screening (N = 367: cis-gender women, n = 364; another gender identity, n = 3). METHODS: We used quota sampling to obtain a racially and ethnically diverse sample. We conducted bivariate analyses to examine differences in participants' preferred locations for HPV self-sampling by sociodemographic and health characteristics. We used a multinomial logistic regression model to examine the associations between preferred HPV self-sampling location, characteristics of participants, and perceived benefits and concerns regarding this procedure. RESULTS: In our sample, 43% (n = 158) of participants preferred HPV self-sampling at the office of a health care provider, 50% (n = 182) preferred HPV self-sampling anywhere (office or home), and 7% (n = 27) did not feel comfortable with HPV self-sampling anywhere. Participants 39 to 45 years of age were more likely to prefer HPV self-sampling anywhere (office or home) than participants 27 to 32 years of age, OR = 2.47, 95% confidence interval (CI) [1.21, 5.06]. Participants who preferred HPV self-sampling anywhere perceived greater benefit related to limited geographic access to a clinic compared to those who preferred office only, OR = 1.82, 95% CI [1.08, 3.07]. Participants who preferred HPV self-sampling anywhere had less concern related to performing the procedure accurately than those who preferred office only, OR = 0.44, 95% CI [0.31, 0.62]. CONCLUSION: HPV self-sampling is an alternative strategy to increase cervical cancer screening. As providers consider implementation of HPV self-sampling, our findings suggest that office and home-based collection strategies should be considered to increase access to cervical cancer screening.

Mental Health of Brazilian Immigrant Women: The Role of Discrimination, Social Support, and Community Strengths.

Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (ß = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (ß = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility.

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

Parental Decision Making Regarding COVID-19 Vaccines for Children under Age 5: Does Decision Self-Efficacy Play a Role?

BACKGROUND: COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents' intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions. METHOD: We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children (

Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults.

Background: COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together. Method: We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale. Results: 1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were 'very' or 'somewhat' likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses. Conclusions: Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the 'trustworthiness' of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust.

Intention to obtain a COVID-19 vaccine among Brazilian immigrant women in the U.S.

BACKGROUND: COVID-19 has disproportionately impacted low-income immigrant communities. There is concern that the current uptake of COVID-19 vaccines is suboptimal and that this may be contributing to COVID-19 inequities. However, little is known about the acceptability of COVID-19 vaccines among immigrants in the U.S. Our goal was to gauge COVID-19 vaccine intentions among Brazilian immigrant women living in the U.S. METHODS: We conducted an online survey between July and August 2020 offered in Portuguese and English languages among a convenience sample of Brazilian immigrant women ages 18 years and older. Women were recruited through online advertisements by community-based organizations and social media groups to complete a survey that assessed intention to get a COVID-19 vaccine, attitudes toward vaccines, and perceptions about the pandemic. RESULTS: Of the total sample (N = 353), most (70.8%) indicated they intended to get a COVID-19 vaccine. In bivariate analyses, vaccine intentions were significantly associated with perceptions about the severity of the pandemic, trusted sources of health information, and the number of years lived in the U.S. Multinomial logistic regression models revealed that those who did not intend to be vaccinated had lived a longer time in the U.S. (OR: -0.12 95% CI: -0.19, -0.05), perceived the pandemic to be a minor issue (OR: 1.52, 95% CI: 0.62, 2.42), and trusted information from social networks (OR: -1.94, 95% CI: -3.25, -0.63) or private news sources (OR: -1.71, 95% CI: -2.78, -0.63). CONCLUSIONS: While most women reported they would get a COVID-19 vaccine, efforts to reach those who may be hesitant should target those who have lived in the U.S. for longer periods of time and do not perceive the pandemic to be a major crisis. Healthcare providers may be particularly suited to deliver this information given high levels of trust.

Experiences with and impacts of the COVID-19 pandemic by substance use disorder in the early phase of pandemic in the United States: A cross-sectional survey, 2020.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic could disproportionately affect individuals who have a substance use disorder (SUD). However, little information exists on COVID-19-related experiences among individuals with a SUD. We examined whether individuals with a SUD differ from other individuals with regard to COVID-19 testing, susceptibility, and employment-related vulnerability. METHODS: We used data from a U.S. nationally representative survey (n = 1,208). Using logistic regressions, we examined whether individuals with SUDs differ from other individuals regarding underlying health conditions, COVID-19 testing, access to paid sick leave, and loss of employment. Data were collected in late May-early June, 2020. RESULTS: Four percent of participants reported that a healthcare professional had told them they had a SUD. We found that, compared to those without SUDs, respondents with SUDs had higher odds of having lost their job due to the pandemic (adjusted odds ratio [AOR]:5.17, 95% confidence interval [CI]:2.28-11.74). Among individuals who were employed prior to the pandemic, people with SUDs had lower odds of having paid sick leave (AOR:0.26, 95% CI:0.09-0.74). CONCLUSION: Our study indicates that individuals with SUDs could be disproportionately affected by COVID-19 economically, which might worsen SUD and racial/ethnic health disparities.

Who has not been vaccinated, fully vaccinated, or boosted for COVID-19?

We assessed COVID-19 vaccination coverage (≥1 dose, full vaccination, and booster vaccination) using a large, nationally representative survey of US households (December 29, 2021-January 10, 2022). Almost 1 in 6 adults have not been vaccinated or not been fully vaccinated, and almost one-half of fully vaccinated adults have not received a booster vaccine. All eligible individuals should receive the recommended number of vaccines to prevent further transmission of COVID-19.

Prevalence of Previous COVID-19 Infection, COVID-19 Vaccination Receipt, and Intent to Vaccinate Among the US Workforce.

OBJECTIVE: As COVID-19 vaccines become more accessible to all people in the United States, more employees are returning to the workforce or switching to in-person work. However, limited information is available on vaccination coverage and intent among the US workforce. METHODS: We used data from the US Census Bureau's Household Pulse Survey, fielded during April 14-May 24, 2021 (N = 218 787), to examine the prevalence of previous COVID-19 infection, vaccination receipt, and intent to vaccinate by essential worker status and employment type. In addition, we analyzed factors associated with vaccination receipt and reasons for not getting vaccinated. RESULTS: More than 15% of the US workforce had a previous diagnosis of COVID-19, and 73.6% received ≥1 dose of COVID-19 vaccine; however, 12.4% reported that they probably will not or definitely will not get vaccinated. Vaccination coverage (range, 63.8%-78.3%) was lowest and non-intent to get vaccinated (12.9%-21.7%) was highest among self-employed adults across all essential and nonessential worker groups. Factors associated with receipt of vaccination were age, race, Hispanic ethnicity, educational attainment, annual household income, health insurance status, and previous COVID-19 diagnosis. The main reasons for not getting vaccinated were concerns about possible side effects and waiting and seeing if the vaccine is safe. CONCLUSION: Identifying and addressing disparities in COVID-19 vaccination coverage in the US workforce can protect groups with low vaccine coverage and increase understanding of reasons for vaccine hesitancy. Educating employees about the vaccine and its potential side effects, promoting a culture of health and safety in the workplace, and building social norms around vaccination can help create a safe work environment for all employees and their families.

Trends in adolescent COVID-19 vaccination receipt and parental intent to vaccinate their adolescent children, United States, July to October, 2021.

INTRODUCTION: There was a five-fold increase in COVID-19 hospitalization case counts among children and adolescents between June and October 2021. However, polls suggest that adolescent COVID-19 vaccination coverage has plateaued in the United States. METHODS: Using the Census Bureau's Household Pulse Survey, we assessed trends in COVID-19 vaccination among adolescents ages 12-17 years, parents' intention to vaccinate their adolescent children, and their reasons for not intending to vaccinate their children from July to October 2021 using a large, nationally representative survey of U.S. households (n = 59,424). Trends in COVID-19 adolescent vaccination coverage, nationally and by sociodemographic characteristics, factors associated with adolescent vaccination status and parental intent to vaccinate their adolescent children, as well as changes in reasons for non-vaccination were examined using regression models. RESULTS: Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12-17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. However, there were no significant changes in parental intention to vaccinate their adolescent children during the same time period. Approximately one-quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Among those who had not vaccinated their children, lack of trust in the government and vaccines, and the belief that the COVID-19 vaccine is not needed or effective, was higher in October compared to July. CONCLUSIONS: Parental intention to vaccinate their children has remained relatively stable throughout the late summer and early fall of 2021. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines are important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.KEY MESSAGEReceipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12-17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables.Approximately one quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October.Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines is important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.

COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States.

To determine the extent of gaps in coronavirus disease (COVID-19) vaccine coverage among those in the United States with and without previous COVID-19 diagnoses, we used data from a large, nationally representative survey conducted during July 21-August 2, 2021. We analyzed vaccine receipt (≥1 dose and full vaccination) and intention to be vaccinated for 63,266 persons. Vaccination receipt was lower among those who had a prior diagnosis of COVID-19 compared to those without: >1 dose: 73% and 85%, respectively, p<0.001; full vaccination: 69% and 82%, respectively, p<0.001). Reluctance to be vaccinated was higher among those with a previous COVID-19 diagnosis (14%) than among those without (9%). These findings suggest the need to focus educational and confidence-building interventions on adults who receive a COVID-19 diagnosis during clinic visits, or at the time of discharge if hospitalized, and to better educate the public about the value of being vaccinated, regardless of previous COVID-19 infection.

Associations among political voting preference, high-risk health status, and preventative behaviors for COVID-19.

BACKGROUND: We investigate the relationships among political preferences, risk for COVID-19 complications, and complying with preventative behaviors, such as social distancing, quarantine, and vaccination, as they remain incompletely understood. Since those with underlying health conditions have the highest mortality risk, prevention strategies targeting them and their caretakers effectively can save lives. Understanding caretakers' adherence is also crucial as their behavior affects the probability of transmission and quality of care, but is understudied. Examining the degree to which adherence to prevention measures within these populations is affected by their health status vs. voting preference, a key predictor of preventative behavior in the U. S, is imperative to improve targeted public health messaging. Knowledge of these associations could inform targeted COVID-19 campaigns to improve adherence for those at risk for severe consequences. METHODS: We conducted a nationally-representative online survey of U.S. adults between May-June 2020 assessing: 1) attempts to socially-distance; 2) willingness/ability to self-quarantine; and 3) intention of COVID-19 vaccination. We estimated the relationships between 1) political preferences 2) underlying health status, and 3) being a caretaker to someone with high-risk conditions and each dependent variable. Sensitivity analyses examined the associations between political preference and dependent variables among participants with high-risk conditions and/or obesity. RESULTS: Among 908 participants, 75.2% engaged in social-distancing, 94.4% were willing/able to self-quarantine, and 60.1% intended to get vaccinated. Compared to participants intending to vote for Biden, participants who intended to vote for Trump were significantly less likely to have tried to socially-distance, self-quarantine, or intend to be vaccinated. We observed the same trends in analyses restricted to participants with underlying health conditions and their caretakers Underlying health status was independently associated with social distancing among individuals with obesity and another high-risk condition, but not other outcomes. CONCLUSION: Engagement in preventative behavior is associated with political voting preference and not individual risk of severe COVID-19 or being a caretaker of a high-risk individual. Community based strategies and public health messaging should be tailored to individuals based on political preferences especially for those with obesity and other high-risk conditions. Efforts must be accompanied by broader public policy.