Knowledge, attitudes, and intentions regarding COVID-19 vaccination in the general population and the effect of different framing messages for a brief video on intentions to get vaccinated among unvaccinated individuals in the United States during July 2021.

OBJECTIVE: To identify knowledge, attitudes, and beliefs (KABs) associated with COVID-19 vaccination intentions and assess the impact of vaccine-promoting messages on vaccination intentions. METHODS: Our nationally representative survey measured KABs of COVID-19 vaccination and incorporated a randomized experiment to assess the impact of different framing messages for a video encouraging vaccination intentions among unvaccinated adults in the US. Multivariable multinomial logistic regression models were fitted to investigate the relationships of KABs, trust in public health authorities (PHAs), and vaccine confidence with vaccination intentions. Difference-in-difference estimation was conducted to assess the impact of framing messages for a video on unvaccinated individuals' vaccination intentions. RESULTS: We observed that people with increasingly favorable vaccine KABs, trust in PHAs, and vaccine confidence were more likely to be vaccinated or intend to get vaccinated against COVID-19. Difference-in-difference estimates indicated a positive impact of exposure to the video on vaccination intentions while framing messages in some cases appeared to lower vaccination intentions. Associations between the video and vaccination intentions were more pronounced among Black/African American and Hispanic/Latinx populations and Democrats; however, associations did not vary by trust in PHAs or vaccine confidence. CONCLUSION: Videos that encourage people to get vaccinated may provide an efficient approach to nudge vaccine-hesitant individuals towards getting vaccinated. However, framing messages may negatively impact vaccination intentions and need to be developed carefully. PRACTICE IMPLICATIONS: This study provides solid experimental evidence for the importance of tailoring message framing to the characteristics and experience of the audience, while cautioning potential negative impacts of framing that does not match its intended audience. Our findings are applicable to health communication strategies on the population level, such as mass media campaigns, and the use of framing for messages to encourage vaccination but may also be informative for healthcare professionals consulting hesitant individuals about COVID-19 vaccinations.

Changes in vaccine attitudes and recommendations among US Healthcare Personnel during the COVID-19 pandemic.

A recommendation from healthcare personnel (HCP) is a strong predictor of vaccination. This study aimed to measure how HCP vaccine attitudes and recommendations changed during the COVID-19 pandemic. HCP were surveyed in January 2023 using a double opt-in network panel. Survey responses were summarized and stratified by HCP type and COVID-19 booster status. Multivariable logistic regression models were fitted. Comparisons were made to a September 2021 survey, with differences tested for significance (p < 0.05) using Pearson's χ2 Test. Nearly 82% of the 1207 HCP surveyed had received a COVID-19 booster, most commonly pediatricians (94%), followed by family medicine doctors (87%), pharmacists (74%), and nurses (73%) (p < 0.01). HCP with high trust in the Centers for Disease Control and Prevention (CDC) had nearly 6 times the odds (OR: 5.5; 95%CI: 3.9-7.7) of being boosted compared to HCP with low trust. From September 2021 to January 2023, the proportion of HCP recommending vaccines (COVID-19 and routine) to their patients decreased substantially for nearly all vaccines and patient populations specified. Trust in CDC also decreased (from 79 to 73%, p < 0.01), as did support for HCP COVID-19 vaccine mandates (from 65 to 46%, p < 0.01). HCP interest in additional online resources to improve their vaccine discussions with patients increased from 46 to 66% (p < 0.01). Additional regularly updated online resources from trusted medical sources that clarify progressing science and address dynamic public concerns are needed to improve vaccine confidence among HCP and help them support their patients' decision-making.

Routine Vaccination Coverage in an Adolescent Transgender Population in a Large Tertiary Care Center in the United States.

INTRODUCTION: To address healthcare disparities among transgender and gender diverse (TGD) adolescents, we examined vaccination coverage in those receiving gender-affirming care. METHOD: Our study analyzed de-identified data (2013-2022) from a tertiary care clinic. Comparing vaccination rates of 203 TGD adolescent patients to age-matched peers in New York State using CDC National Immunization Survey-Teen data. RESULTS: We found TGD patients had similar vaccination coverage to the general adolescent population. Notably, TGD patients had significantly higher up-to-date human papillomavirus vaccination coverage (76.4%, CI=69.9, 82.0) than the NYS adolescent population (60.5%, CI=53.0, 67.5). DISCUSSION: This suggests TGD adolescents at gender-affirming clinics maintain or exceed vaccination rates of their cisgender counterparts. Future research should explore vaccination rates for TGD individuals without access to gender-affirming care.

Attitudes toward COVID-19 and Other Vaccines: Comparing Parents to Other Adults, September 2022.

Few analyses of COVID-19 vaccine attitudes also cover routine vaccines or focus on parents. In this cross-sectional study, we surveyed US adults in September 2022, immediately following the authorization of updated bivalent COVID-19 boosters for adults but before their authorization for children. The vaccine attitudes of parents were compared to other adults. Fewer parents were up-to-date on COVID-19 vaccines than other adults (54% vs. 67%), even after adjusting for age, education, and race/ethnicity (Adjusted Odds Ratio: 0.58; 95% Confidence Interval: 0.45-0.76). More parents had concerns about COVID-19 vaccines' safety in children (67% vs. 58%; aOR: 1.59; 95%CI: 1.23-2.06) and vaccine ingredients (52% vs. 45%; aOR: 1.41; 95%CI: 1.09-1.81), and more parents perceived COVID-19 in children to be no worse than a cold or the flu (51% vs. 38%; aOR: 1.56; 95%CI: 1.22-2.01). Fewer parents supported COVID-19 vaccine school requirements (52% vs. 57%; aOR: 0.75; 95%CI: 0.58-0.97) and perceived high vaccine coverage among their friends (51% vs. 61%; aOR: 0.60; 95%CI: 0.46-0.78). However, three-quarters of parents intended their child to receive all routinely recommended vaccines, whereas only half of adults intended to receive all routinely recommended vaccines themselves. To improve parental informed vaccine decision-making, public health must ensure pediatric providers have updated resources to support their discussions of vaccine risks and benefits with their patients' parents.

Corrigendum: LetsTalkShots: personalized vaccine risk communication.

[This corrects the article DOI: 10.3389/fpubh.2023.1195751.].

Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences.

Background: Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases. Methods: We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video. Results: Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns. Conclusion: Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.

Attitudes towards HPV Vaccination Policy Strategies to Improve Adolescent Vaccination Coverage among Pediatric Providers in New York State.

Pediatric providers' stances on HPV vaccination-related policies are largely unknown. To gain insight into pediatric providers' perspectives and potential recommendations for directed policy, we conducted a cross-sectional survey of the American Academy of Pediatrics members in New York. Almost all providers expressed confidence in discussing the HPV vaccine with patients (98.6%, n = 72). Among common barriers to vaccination, providers listed parental safety concerns (n = 60, 82.2%), vaccination not being required for school entry (n = 59, 80.8%), and moral opposition to vaccination (n = 48, 65.8%). Among all respondents, 29 (39.7%), 13 (17.8%), and 2 (2.7%) agreed the vaccine should be required for middle, high, and tertiary school entry, respectively. Support for pharmacist-provision of the vaccine varied, with 31 (42.5%) providers expressing support. Most providers supported adolescent self-consent to vaccination, (n = 67, 91.8%). Providers continued to encounter barriers to HPV vaccination and indicated support of HPV vaccination mandates for school entry, pharmacist provision of the vaccine, and adolescent self-consent to vaccination.

Religious Exemptions, Public Health, and School Vaccination Requirements.

This Viewpoint examines 2 recent cases that encapsulate the debate on religious exemptions to school vaccination requirements and further argues against these exemptions for schoolchildren.

LetsTalkShots: personalized vaccine risk communication.

Introduction: Vaccine hesitancy is a global health threat undermining control of many vaccine-preventable diseases. Patient-level education has largely been ineffective in reducing vaccine concerns and increasing vaccine uptake. We built and evaluated a personalized vaccine risk communication website called LetsTalkShots in English, Spanish and French (Canadian) for vaccines across the lifespan. LetsTalkShots tailors lived experiences, credible sources and informational animations to disseminate the right message from the right messenger to the right person, applying a broad range of behavioral theories. Methods: We used mixed-methods research to test our animation and some aspects of credible sources and personal narratives. We conducted 67 discussion groups (n = 325 persons), stratified by race/ethnicity (African American, Hispanic, and White people) and population (e.g., parents, pregnant women, adolescents, younger adults, and older adults). Using a large Ipsos survey among English-speaking respondents (n = 2,272), we tested animations aligned with vaccine concerns and specific to population (e.g., parents of children, parents of adolescents, younger adults, older adults). Results: Discussion groups provided robust feedback specific to each animation as well as areas for improvements across animations. Most respondents indicated that the information presented was interesting (85.5%), clear (96.0%), helpful (87.0%), and trustworthy (82.2%). Discussion: Tailored vaccine risk communication can assist decision makers as they consider vaccination for themselves, their families, and their communities. LetsTalkShots presents a model for personalized communication in other areas of medicine and public health.

Attitudes and Values of US Adults Not Yet Up-to-Date on COVID-19 Vaccines in September 2022.

(1) Background: Periodic resurgences in COVID-19 due to more contagious variants highlight the need to increase coverage of booster doses. (2) Methods: Our September 2022 nationally representative survey of US adults measured COVID-19 vaccination status, intentions, attitudes, values, and confidence in information sources. (3) Findings: Although 85% of the weighted sample reported receiving at least one dose of a COVID-19 vaccine, only 63% reported being up-to-date on COVID-19 vaccines (e.g., received a booster dose). Only 12% of those not yet up-to-date indicated they were likely to get up-to-date as soon as possible, whereas 42% were unlikely to ever get up-to-date, and 46% were still uncertain. Most of those not up-to-date on their COVID-19 vaccines were under 45 years of age (58%), without a bachelor's degree (76%), making under $75,000 annually (53%), and Republican or Independent (82%). Prevalent concerns about COVID-19 vaccines among those uncertain about getting up-to-date included: potential side effects that have not been figured out yet (88%), speed of development (77%), newness (75%), ingredients (69%), drug companies making money (67%), allergic reactions (65%), and experimenting on people (63%). (4) Conclusions: Nearly half of adults not yet up-to-date on COVID-19 vaccines were uncertain about doing so, indicating an opportunity to support their decision-making.

When Adolescents Disagree with Their Vaccine-Hesitant Parents about COVID-19 Vaccination.

AbstractAs we journey into the fourth year of the COVID-19 pandemic, a majority of Americans express relief at a "return to normal," experience pandemic fatigue, or embrace the idea of living with COVID-19 in much the same way we live with the seasonal flu. But transition to a new phase of life with SARS-CoV-2 does not diminish the importance of vaccination. The US Centers for Disease Control and the Food and Drug Administration recently recommended another round of booster dose for persons age 5 and up, or an initial series for those not previously vaccinated, with an updated bivalent formula that protects against both the original virus strain and Omicron subvariants that are now the dominant source of infection. By most accounts most of the population has been or will become infected with SARS-CoV-2. Suboptimal uptake of the COVID-19 vaccines among the approximately 25 million adolescents in the United States is a significant obstacle to population coverage, public health, and the health and well-being of adolescents. A major cause of low adolescent uptake is parental vaccine hesitancy. This article discusses parental vaccine hesitancy and argues that permitting independent adolescent consent to COVID-19 vaccination should be an ethical and policy priority as we continue to confront the threat of Omicron and other variants of the coronavirus. We discuss the central role of the pediatric healthcare team in caring for adolescent patients who disagree with their parents about vaccination.

Sources of coronavirus disease 2019 (COVID-19) exposure among healthcare personnel (HCP) in a large tertiary-care medical center.

Objectives: To describe the burden and sources of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel (HCP), such as occupational role, work setting, vaccination status, and patient contact between March 2020 through May 2022. Design: Active prospective surveillance. Setting: Large tertiary-care teaching institution with inpatient and ambulatory care services. Results: We identified 4,430 cases among HCPs between March 1, 2020, through May 31, 2022. The median age of this cohort was 37 years (range, 18-89); 2,840 (64.1%) were female; and 2,907 (65.6%) were white. Most of the infected HCP were in the general medicine department, followed by ancillary departments and support staff. Less than 10% of HCP SARS-CoV-2-positive cases worked on a COVID-19 unit. Of the reported SARS-CoV-2 exposures, 2,571 (58.0%) were from an unknown source, 1,185 (26.8%) were from a household source, 458 (10.3%) were from a community source, and 211 (4.8%) were healthcare exposures. A higher proportion of cases with reported healthcare exposures was vaccinated with only 1 or 2 doses, whereas a higher proportion of cases with reported household exposure was vaccinated and boosted, and a higher proportion of community cases with reported and unknown exposures were unvaccinated (P < .0001). HCP exposure to SARS-CoV-2 correlated with community-level transmission regardless of type of reported exposure. Conclusions: The healthcare setting was not an important source of perceived COVID-19 exposure among our HCPs. Most HCPs were not able to definitively identify the source of their COVID-19, followed by suspected household and community exposures. HCP with community or unknown exposure were more likely to be unvaccinated.

COVID-19 vaccination among different types of US Healthcare Personnel.

BACKGROUND: Increasing vaccine coverage remains the best way to control the COVID-19 pandemic. Healthcare personnel (HCP) have long been the most credible and frequently used source of vaccine information for the public, and an HCP recommendation is a strong predictor of vaccination. METHODS: A survey of HCP was conducted in September 2021 via a double opt-in network panel. Responses to survey items were summarized and stratified by HCP type and adjusted logistic regression models were fitted. RESULTS: >94% of the 1074 HCP surveyed reported receiving at least one dose of COVID-19 vaccine or intending to soon, with vaccinating most common among pediatricians (98%), followed by family medicine doctors (96%), pharmacists (94%), and nurses/nurse practitioners/physician assistants (88%). HCP with high trust in the Centers for Disease Control and Prevention had 26 times the odds of vaccinating of HCP with low trust (95%CI: 9, 74). Nearly half of unvaccinated HCP (47%) were concerned about side effects, and one third of unvaccinated HCP (33%) were concerned the vaccine was developed too quickly. About three quarters of HCP reported strongly recommending the Pfizer-BioNTech (75%) and Moderna (70%) vaccines to their patients, compared to about one quarter (24%) strongly recommending Johnson & Johnson. CONCLUSIONS: Although most HCP are vaccinated against COVID-19 and strongly recommend vaccination to their patients, some harbor similar concerns to the public. Additional resources - regularly updated to explain the progressing scientific landscape and address ever evolving public concerns - are needed to further improve vaccine coverage among HCP and aid them in supporting the decision-making of their patients.

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis.

Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.

COVID-19 Vaccination Among Environmental Service Workers Using Agents of Change.

Introduction: Vaccine hesitancy remains a barrier to community immunity against SARS-CoV-2 infection. Health care workers are at risk both of infection and for nosocomial transmission, but have low rates of vaccine uptake due to hesitancy. This project sought to improve the SARS-CoV-2 vaccine uptake among environmental services (EVS) workers at a large academic regional medical center using a community-based participatory approach (CBPA). Methods: The CBPA engaged environmental service workers from January 2021 to March 2021. Public health experts and environmental services department leaders developed a 1-hour training for peer lay health educators (N=29), referred to as agents of change (AOC). AOC were trained on COVID-19 infection, benefits of SARS-CoV-2 vaccination, and techniques to address vaccine misinformation among their peers. Following the program, we conducted semistructured interviews with the AOC to document their experiences. Results: Analysis of the semistructured interviews shows that 89.6% of participants (N=26) felt the training was informative; 79.3% of participants (N=23) reported using personal testimony while engaging in discussions about vaccination with their peers, and the majority of participants (N=26, 89.6%) discussed vaccination outside of the workplace in other community settings. During the 2-month time span of the program, mRNA COVID-19 vaccination rates among the EVS staff increased by 21% (N=126 to N=189). Conclusion: Our CBPA program demonstrated an increase in mRNA COVID-19 vaccine uptake through using an AOC lay health educator model. As the need for COVID-19 vaccination continues, we must continue to investigate barriers and sources of hesitancy in order to address these through tailored interventions.

COVID-19 vaccination intention and behavior in a large, diverse, U.S. refugee population.

INTRODUCTION: Refugees often face increased risk of exposure to COVID-19 due to their disproportionate representation in the essential workforce and crowded household conditions. There is a paucity of data about risk factors for under-immunization for COVID-19 among refugees. METHODS: Refugees were surveyed in two phases that corresponded to before and after wide availability of COVID-19 vaccines. Participants were asked about their attitudes, and perceptions about COVID-19, previous acceptance of vaccines, sources utilized to obtain trusted health information, and intent to get vaccinated. The overall participant vulnerability was assessed using the social vulnerability index. In-depth semi-structured interviews were completed with key stakeholders through snowball sampling. RESULTS: Of 247 refugees, 244 agreed to participate in the initial survey. Among those, 140 (57.4%) intended to get vaccinated, 43 (17.6%) were unsure, and 61 (25%) did not intend to get vaccinated. In the follow up survey, all 215 who were reached, agreed to provide information about their vaccination status. Among those respondents, 141 (65.6%) were either vaccinated or expressed intent to do so, and 74 (34.4%) remained hesitant. We did not observe any significant correlation between socio-demographic variables, country of origin, and vaccination status/intent. Among those who initially intended to get vaccinated, nearly 1 in 5 changed their mind and decided to forego vaccination, and among those who initially did not plan getting vaccinated, 1 in 3 changed their mind and got vaccinated. Fears related to the vaccine, concerns that the vaccine is religiously prohibited, "wait and see" how others did with the vaccine, communication and transportation barriers were commonly cited as reason not to get vaccinated. CONCLUSIONS: Over a third of refugees in our study were hesitant to get vaccinated. Refugees desired additional education about the benefits and safety of vaccines along with easier access to vaccination clinics in their communities.

Public Education Interventions and Uptake of Human Papillomavirus Vaccine: A Systematic Review.

CONTEXT: Human papillomavirus (HPV) vaccine uptake remains suboptimal in the United States. Public education is considered an important aspect of increasing vaccination rates. OBJECTIVES: We systematically reviewed the literature on the impact of public education on HPV vaccine uptake. DESIGN: PubMed was searched to identify studies published between January 1, 2007, and April 30, 2018, meeting the following inclusion criteria: the study was conducted in the US, education was directed toward the public, and the research included HPV vaccine uptake and/or completion as outcomes. RESULTS: A total of 3764 studies were screened, and 30 published studies were included in the review. Among those, 13 focused on parent/guardian education, 8 on young adults, 6 on parent/daughter dyads, 1 focused only on adolescents, and 2 studies recruited a mixed-age population. Studies that included parents and young adults and were delivered by experts led to increased uptake of HPV vaccination (n = 14). A majority of the studies included female and Non-Hispanic White population (n = 20). Less than a third of studies included minority groups: Hispanic (n = 4), African American (n = 1), Cambodian American (n = 1), Indian American (n = 1), Korean American (n = 1), and combined Haitian and African American (n = 1) population. Minority group interventions that provided individually tailored messages, addressed misconceptions, removed barriers to vaccination, and engaged parents and community members improved HPV vaccine acceptance (n = 5). CONCLUSION: Interventions that delivered HPV-related education by authoritative sources and included parents improved HPV vaccination rates among adolescents and young adults. Community engagement played an important role in vaccine uptake among minority populations. Future studies should focus on male participants and minority populations to reduce disparities in HPV-related cancer incidence and HPV vaccine coverage.

Healthcare Personnel (HCP) Attitudes About Coronavirus Disease 2019 (COVID-19) Vaccination After Emergency Use Authorization.

BACKGROUND: We previously reported on coronavirus disease 2019 (COVID-19) vaccination intent among healthcare personnel (HCP) before emergency use authorization. We found widespread hesitancy and a substantial proportion of HCP did not intend to vaccinate. METHODS: We conducted a cross-sectional survey of HCP, including clinical and nonclinical staff, researchers, and trainees between 21 February and 19 March 2021. The survey evaluated vaccine attitudes, beliefs, intent, and acceptance. RESULTS: Overall, 3981 (87.7%) of respondents had already received a COVID-19 vaccine or planned to get vaccinated. There were significant differences in vaccine acceptance by gender, age, race, and hospital role. Males (93.7%) were more likely than females (89.8%) to report vaccine acceptance (P < .001). Mean age was higher among those reporting vaccine acceptance (P < .001). Physicians and scientists showed the highest acceptance rate (97.3%), whereas staff in ancillary services showed the lowest acceptance rate (79.9%). Unvaccinated respondents were more likely to be females, to have refused vaccines in the past due to reasons other than illness or allergy, to care for COVID-19 patients, or to rely on themselves when making vaccination decision. Vaccine acceptance was more than twice previous intent among Black respondents, an increase from 30.8% to 73.8%, and across all hospital roles with all > 80% vaccine acceptance. CONCLUSIONS: The majority of HCP were vaccinated, much higher than reporting intent before vaccine was available. However, many HCP-particularly ancillary services-are still hesitant. Feasible and effective interventions to address the hesitant, including individually-tailored education strategies are needed, or vaccine can be mandated.