Pediatric HPV vaccination: Provider recommendations matter among hesitant parents.

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. HPV-associated diseases are preventable with vaccination, but HPV vaccine coverage remains below other vaccines recommended during childhood and adolescence. We examined correlates of pediatric HPV vaccination among parents who have reported hesitancy toward the HPV vaccine. In addition to sociodemographic correlates, we investigated the relationships between the social process of healthcare provider recommendations and pediatric HPV vaccination. METHODS: We utilized phone survey data (N = 2201) collected in October 2022 via random digit dialing of Arkansan adults-Black and Hispanic respondents were oversampled for adequate representation. The survey was provided in English and Spanish. The analysis focused on a subsample of parents of children ages 9 to 17 years who reported HPV vaccine hesitancy (n = 201). Analyses include descriptive statistics, bivariate logistic regression, and multivariate logistic regression with Full Information Maximum Likelihood estimation. RESULTS: A third (32.96%) of vaccine-hesitant parents reported their child(ren) had received at least one dose of the HPV vaccine. Only half (50.93%) of vaccine-hesitant parents received a healthcare provider recommendation to vaccinate their child(ren) between the ages of 9 and 17 against HPV. Adjusted odds of pediatric HPV vaccination were four times greater when vaccine-hesitant parents received a healthcare provider's recommendation (OR = 4.67; 95% CI[1.89, 11.55]) compared to when they had not. Pediatric HPV vaccination for parents whose provider did not recommend the HPV vaccine was not significantly different from those with no provider. CONCLUSION: Healthcare provider recommendations are important for promoting HPV vaccination even among parents who are vaccine hesitant. Additional research is needed to understand why pediatric HPV vaccine recommendations are not made more often or consistently, particularly among vaccine-hesitant populations. This study demonstrates support for the growing body of research on hesitant adopters.

Hesitant but vaccinated: Lessons learned from hesitant adopters.

INTRODUCTION: The WHO SAGE vaccine hesitancy working group defined vaccine hesitancy as the delay or refusal of vaccination. Questions about individuals who become vaccinated while hesitant, or remain unvaccinated even though they are not hesitant, are unimaginable when starting from this behaviorally related definition of vaccine hesitancy. More critically, behaviorally related definitions limit the possibilities for vaccine hesitancy research to be translatable into clinical and public health practices that can increase vaccination. LESSONS LEARNED: Emerging research on hesitant adopters provides several lessons for the conceptualization of vaccine hesitancy and how practitioners might increase vaccination. Conceptualizations of vaccine hesitancy must account for some of the big lessons we have learned from hesitant adopters: (1) vaccine hesitancy and vaccination co-occur for many; (2) vaccine hesitancy may not always be characterized by a punctuated point-in-time or moment; and (3) following from the second lesson, vaccine hesitancy may not be temporally bound to the moments preceding a vaccination decision. CONCLUSIONS: We recommend conceptualizing vaccine-hesitant attitudes as distinctive from behaviors, and not temporally bound to moments preceding vaccination decisions. Sharpening the use of vaccine hesitancy and its temporal characteristics could benefit from engagement with the Life Course Paradigm. We recommend healthcare professionals provide a recommendation even when individuals express hesitancy. Finally, we recommend public health officials consider ways to improve the frequency and consistency of provider recommendations even among patients who are hesitant.

Influences on COVID-19 booster uptake among adults intending to receive a booster: a qualitative study.

Bivalent COVID-19 vaccine boosters have been recommended for all Americans 12 years of age and older. However, uptake remains suboptimal with only 17% of the United States (US) population boosted as of May 2023. This is a critical public health challenge for mitigating the ongoing effects of COVID-19 infection. COVID-19 booster uptake is not currently well understood, and few studies in the US have explored the vaccination process for booster uptake in a 'post-pandemic' context. This study fills gaps in the literature through qualitative analysis of interviews with a racially/ethnically diverse sample of Arkansans who received the COVID-19 vaccine main series and expressed intent to receive a booster (n = 14), but had not yet received the COVID-19 booster at the time we recruited them. All but one did not receive the booster by the time of the interview. Participants described influences on their vaccination behavior and uptake of boosters including reduced feelings of urgency; continued concerns about the side effects; social contagion as a driver of urgency; increasing practical barriers to access and missing provider recommendations. Our findings highlight the importance of considering vaccination as an ongoing, dynamic process drawing on past/current attitudes, prior experience, perceptions of risk and urgency and practical barriers. Based on these findings, healthcare providers should continue to provide strong, consistent recommendations for COVID-19 boosters to patients, even among those with histories of vaccine uptake.

Exploring Hesitancy, Motivations, and Practical Issues for COVID-19 Vaccination Among Vaccine-Hesitant Adopter Parents Using the Increasing Vaccination Model.

INTRODUCTION: COVID-19 vaccination coverage among children remains low, and many parents report being hesitant to get their children vaccinated. This study explores factors influencing hesitancy and the facilitators that helped hesitant adopter parents choose to vaccinate their children against COVID-19 despite their hesitancy. METHOD: We use a qualitative descriptive design with individual interviews (n = 20) to explore COVID-19 vaccine hesitancy and facilitators of vaccination among hesitant adopter parents. The Increasing Vaccination Model domains (thoughts and feelings, social processes, and practical issues) provided the framework for initial coding, and the research team identified nine emergent themes. RESULTS: Findings document the factors influencing hesitancy and the facilitators motivating COVID-19 vaccination among hesitant adopter parents. DISCUSSION: Findings fill the gap in the literature by providing hesitant adopters' lived experience, perspectives on vaccine hesitancy, and the influential factors that helped participants overcome their hesitancy and choose to vaccinate their children against COVID-19.

"Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine.

COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.

Social Processes and COVID-19 Vaccination of Children of Hesitant Mothers.

OBJECTIVE: Investigate relationships between pediatric COVID-19 vaccination and social processes of healthcare provider recommendations and school encouragement to provide insights into social processes that may support pediatric COVID-19 vaccination among hesitant mothers. METHODS: We analyzed survey data from a subsample (n = 509) of vaccine-hesitant mothers to child patients (ages 2 to 17) in regional clinics across Arkansas. Data were collected between September 16th and December 6th, 2022. Full information maximum likelihood multivariable logistic regression was conducted to evaluate associations with pediatric COVID-19 vaccination. RESULTS: Adjusted odds of pediatric COVID-19 vaccination were more than three times greater when a child's healthcare provider recommended vaccination compared to when they did not (aOR = 3.52; 95% CI[2.06, 6.01]). Adjusted odds of pediatric COVID-19 vaccination were 85% greater when a child's school encouraged parents to vaccinate compared to when the school did not (aOR = 1.85; 95% CI[1.13, 3.03]). CONCLUSIONS: For pediatric COVID-19 vaccination, having a personal healthcare provider is not significantly different from having no personal healthcare provider if they do not recommend the child be vaccinated. PRACTICE IMPLICATIONS: Clinical and public health interventions should consider social processes of healthcare provider recommendations and school encouragement.

Experiences of Discrimination Among Native Hawaiians and Pacific Islanders Living in the USA.

Experiences of racism and discrimination are stressors that adversely affect the well-being of marginalized populations, including Native Hawaiians and Pacific Islanders (NHPI). However, commonly used data aggregation methods obscure information on NHPI communities and their lived experiences. The aim of our study is to understand the types and frequency of discrimination experienced by NHPI adults in the USA. The study utilized online survey data collected from 252 NHPI adults living in the USA between September and October 2021. Younger NHPI adults, those who report constantly thinking about their race/ethnicity, and those who are socially assigned a race/ethnicity that does not match their own report experiencing more types of discrimination. NHPI who constantly think about their race/ethnicity and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. Findings indicate the need to understand the experiences of discrimination in this population.

Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA.

BACKGROUND: Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA). METHODS: Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health. RESULTS: Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results. CONCLUSIONS: Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.

Factors Associated with Online Patient Portal Utilization Experience in an Arkansas Phone Survey.

Introduction: Accessing electronic health record information through a patient portal is associated with numerous benefits to both health care providers and patients. However, patient portal utilization remains low. Little is known about the factors associated with patient portal utilization following the onset of the COVID-19 pandemic. Methods: In March 2022, we conducted a random digit dial phone survey of both cell phones and landlines of adults living in Arkansas that asked numerous demographic and health-related measures, including patient portal utilization in the past 12 months. A total of 2,201 adult Arkansans completed the survey between March 1 and March 28, 2022. Weighted estimates were generated using rank ratio estimation to approximate the 2019 American Community Survey 1-year Arkansas estimates for race/ethnicity (72% White, 15% Black/African American, 7.8% Hispanic, 4.9% other race/ethnicity), age (73% 18-39, 32% 40-59, and 31% 60+), and gender (49% male, 51% female). We fit the data to a logistic regression model. Results: We found that education, employment, prior telehealth experience, having a check-up in the past 2 years, and having a primary care provider were all positively associated with patient portal utilization. We also found that non-Hispanic Black/African-American respondents were less likely to access a patient portal relative to non-Hispanic White respondents. Discussion: Patient portal utilization is related to several demographic and health-related factors among an adult population in Arkansas. Given that the documented benefits of patient portal utilization are broad, under-utilization by groups that already experience relatively worse health outcomes could reproduce or even exacerbate existing health disparities. Additional research is needed to further investigate what barriers to patient portal utilization remain for these populations.

Understanding HPV Vaccine Hesitancy and What Helped Hesitant Adopter Parents Have Their Children Vaccinated Despite Their Hesitancy.

INTRODUCTION: One out of four parents reported HPV vaccine hesitancy; however, little is known about HPV vaccine-hesitant parents who vaccinate their children (e.g., hesitant adopters). METHOD: We use individual interviews (n = 8) to explore hesitancy and facilitators for overcoming hesitancy among hesitant adopter parents. We drew a priori codes from the Increasing Vaccination Model domains and identified seven emergent secondary themes. RESULTS: Understandable information about safety, side effects, and effectiveness could address HPV vaccine hesitancy. Health care professionals, family, friends, and coworkers were trusted vaccine and vaccination information sources. The study documents the lack of access to HPV vaccines with established health care providers as a barrier to vaccination. DISCUSSION: This is the first study of hesitant adopter parents that expands our understanding of factors driving HPV vaccination among them. Study insights can inform future efforts to increase HPV vaccine uptake among the hesitant.

Association of the COVID-19 Pandemic With Women, Infants, and Children (WIC) Receipt Among Pregnant Individuals: United States, 2016-2022.

Objectives. To evaluate the effect of COVID-19 on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receipt among pregnant individuals overall and by race/ethnicity. Methods. We measured changes in WIC receipt among Medicaid-covered births (n = 10 484 697) from the US National Center for Health Statistics Natality Files (2016-2022). Our interrupted time series logistic model included a continuous monthly variable, a binary post-COVID variable, and a continuous slope shift variable. We additionally fit separate models for each race/ethnicity relative to White individuals, using interaction terms between the time series variables and race/ethnicity. Results. We found decreases in WIC receipt (adjusted odds ratio [AOR] = 0.899; P < .001) from before COVID (66.6%) to after COVID (57.9%). There were larger post-COVID decreases for American Indian/Alaska Native (AOR = 0.850; P < .001), Native Hawaiian/Other Pacific Islander (AOR = 0.877; P = .003), Black (AOR = 0.974; P < .001), and Hispanic (AOR = 0.972, P < .001) individuals relative to White individuals. Conclusions. The greater reductions in WIC receipt among minoritized individuals highlights a pathway through which the pandemic may have widened gaps in already disparate maternal and infant health. Public Health Implications. Continued efforts to increase WIC utilization are needed overall and among minoritized populations. (Am J Public Health. 2023;113(S3):S240-S247. https://doi.org/10.2105/AJPH.2023.307525).

Hesitant adopters: COVID-19 vaccine hesitancy among diverse vaccinated adults in the United States.

Background: Despite the United States (US) having an abundant supply of COVID-19 vaccines, vaccination rates lag behind other high-income countries, suggesting that vaccine hesitancy and attitudes play a greater role in public health measures than pure supply and access. With the acknowledgment that vaccination attitudes and status may or may not be correlated, this study examined COVID-19 vaccine hesitancy among vaccinated US adults by asking: 1) What is the prevalence of COVID-19 vaccine hesitancy among the vaccinated? 2) Does COVID-19 vaccine hesitancy vary across sociodemographic characteristics? 3) Does COVID-19 vaccine hesitancy vary by healthcare access and influenza vaccination over the past 5 years? Methods: Data were collected through an online survey of 2022 US adults with a final analytic sample of 1383 vaccinated respondents. Results: Overall, 48.8% of vaccinated adults reported some level of hesitancy, while a slight majority reported they were "not at all hesitant". Younger respondents, women, and Black and American Indian or Alaska Native participants had greater adjusted odds of being more hesitant towards receiving the COVID-19 vaccine. Respondents who had a primary care physician had greater adjusted odds than those who did not have a primary care physician of being more hesitant towards receiving the COVID-19 vaccine. Conclusions: This is the first population-based national sample study examining COVID-19 vaccine hesitancy among vaccinated individuals from subgroups of distinctive backgrounds in order to inform targeted strategies for reducing vaccine hesitancy. Findings can assist in efforts to increase vaccination rates and also decrease vaccine hesitancy at the national level.

Correlates of COVID-19 vaccine coverage in Arkansas: Results from a weighted random sample survey.

We assessed COVID-19 vaccination (≥1 dose) status as influenced by sociodemographic factors (i.e., age, gender, race/ethnicity, education, income, and parent or guardian status), healthcare provider recommendation, and personal vaccine hesitancy among Arkansas residents in October 2022. We asked: did the likelihood of vaccination differ across sociodemographic groups of Arkansas during this period of the pandemic? Is COVID-19 vaccination associated with recommendations from healthcare providers and/or COVID-19 vaccine hesitancy? We analyzed data from a random sample survey of adults in Arkansas (N = 2,201). Three in four adults self-reported vaccination against COVID-19 in October 2022. We found both positive and negative association between COVID-19 vaccination and age, gender, race/ethnicity, education, income, healthcare provider recommendation, and vaccine hesitancy. We highlight racial differences in COVID-19 coverage and the higher odds of COVID-19 vaccination among Black adults compared to White adults in particular, which has broad implications for the study of vaccine coverage and hesitancy. We also discuss implications of our findings regarding healthcare provider recommendations to be vaccinated against COVID-19.

COVID-19 Booster Uptake: Are Hesitant Adopters Less Likely to Get a Booster Shot Than Nonhesitant Adopters?

The main objective of this study was to assess whether hesitancy toward receiving the initial COVID-19 vaccine was associated with uptake of the COVID-19 booster several months after it became available to all US adults. We ask whether hesitancy toward the initial COVID-19 vaccine was significantly associated with lower odds of COVID-19 booster uptake among adults. We test this association within the context of the highly rural state of Arkansas. By January 2022, the US had set a global record of nearly 1 million daily cases. The purpose of this study was to advance our understanding of vaccine hesitancy among those who have already received a dose of the COVID-19 vaccine and how that hesitancy may shape COVID-19 booster uptake. We analyzed data from a random sample survey of Arkansan adults (N = 2,201) between March 1 and March 28, 2022 and constrained our analytical sample to those who had received a vaccine (N = 1,649). Nearly two-thirds of vaccinated Arkansas residents had received a COVID-19 booster. Hesitancy was common even among vaccinated individuals and was significantly associated with reduced odds of COVID-19 booster uptake, even after controlling for other factors. Findings provide further support for conceptualizing vaccine hesitancy as an attitude related to-but separate from-the behavior of vaccination, as opposed to conflating vaccination with being nonhesitant. Public health interventions aimed at increasing COVID-19 booster uptake should pay attention to vaccine hesitancy indicated at the initiation of the series and should not ignore the vaccinated as an important population to target for intervention.

Key Conversations and Trusted Information Among Hesitant Adopters of the COVID-19 Vaccine.

COVID-19 vaccines effectively protect against COVID-19-related hospitalization or death, and 67.1% of the US population is fully vaccinated. However, the disparity in COVID-19 vaccination persists among minority and rural populations who often report greater hesitancy about COVID-19 vaccines. This exploratory study aimed to understand and document trusted sources of information about the COVID-19 vaccine among a diverse sample of hesitant adopters with in-depth interviews. Participants (n = 21) described how information from trusted sources influenced their decision to get a COVID-19 vaccine despite being hesitant. Participants reported health care professionals, family members, friends, coworkers, community leaders, public health experts, government officials, and the mainstream media as trusted sources of information about the COVID-19 vaccines. Participants discussed obtaining trusted information from multiple modes, including direct conversations with trusted messengers and public health communications from public influencers who reinforced the information shared with trusted messengers. Notably, participants discussed having multiple conversations with trusted messengers during their decision-making process, and these trusted messengers often facilitated the participants' vaccination process. Study findings highlight the continued need for clear, understandable information about vaccine side effects, safety, and efficacy to address concerns that contribute to vaccine hesitancy.

Self-reported Racial Discrimination and Healthy Behaviors in Black Adults Residing in Rural Persistent Poverty Areas.

BACKGROUND: Racism is a social determinant of health inequities and associated with poorer health and health behaviors. As a domain of racism, self-reported racial discrimination affects health through unhealthy behaviors (e.g., smoking) but the understudied impact of self-reported racial discrimination's relationship with healthy behaviors (e.g., cancer screening) precludes a comprehensive understanding of racism's impact on health inequities. Understanding how self-reported racial discrimination impacts healthy behaviors is even more important for those living in rural persistent poverty areas (poverty rates of 20% or more of a population since 1980), who have a higher disease burden due to poverty's interaction with racism. The distinct sociocultural context of rural persistent poverty areas may result in differential responses to self-reported racial discrimination compared to those in non-persistent poverty areas. METHODS: A community-engaged process was used to administer a survey to a convenience sample of 251 Black adults residing in 11 rural persistent poverty counties in the state of Arkansas. Self-reported racial discrimination, fruit and vegetable intake, colorectal cancer screening, cervical cancer screening, and screening mammography were assessed. Stress and religion/spirituality were also assessed as potential mediators or moderators in the relationship between self-reported racial discrimination and healthy behaviors. RESULTS: In adjusted models, those reporting more self-reported racial discrimination had a higher probability of having had a test to check for cervical cancer (situation discrimination: OR = 1.23, 95% CI: 1.04-1.5; frequency discrimination: OR = 1.06, 95% CI: 1.02-1.12). Stress and religion/spirituality were not significant mediators/moderators. DISCUSSION: Greater self-reported racial discrimination was associated with a higher odds of cervical cancer screening. Black adults residing in rural persistent poverty areas may have greater self-reported racial discrimination-specific coping and racial identity attitudes.

Understanding Vaccination Among Hesitant Adopters of the COVID-19 Vaccine Using the Increasing Vaccination Model.

The coronavirus disease (COVID-19) was the third leading cause of death in 2021 in the United States and has led to historic declines in life expectancy for Americans. While vaccination is an effective mitigation strategy for COVID-19, vaccine hesitancy remains a major barrier to individual and population-level protection. An emerging literature on hesitant adopters of COVID-19 vaccines highlights co-occurrence of hesitancy and vaccine uptake as an understudied phenomenon, with the potential to provide insight into factors that lead hesitant individuals to become vaccinated despite their hesitancy. We use qualitative interviews among hesitant adopters in Arkansas to examine vaccine hesitancy among this understudied group. Drawing on the Increasing Vaccination Model, we find that the most frequently reported motivations of hesitant adopters were within the domain of social processes, pointing to a critical focal point for targeted health communications intervening in this domain (e.g. social norms, social networks, and altruistic behavior). We find that recommendations from health care workers (HCWs) other than physicians/providers may serve as an effective influence to vaccinate. We also demonstrate negative effects of low provider and HCW confidence and weak recommendations on motivations to vaccinate among individuals expressing vaccine hesitancy. Additionally, we find individual information-seeking behaviors among hesitant adopters bolstered confidence in the efficacy of the COVID-19 vaccine. Based on these findings, clear, accessible, and authoritative health communication has a role in combatting the COVID-19 misinformation/disinformation infodemic.

Associations between COVID-19 Death Exposure and COVID-19 Vaccine Hesitancy and Vaccine Uptake.

OBJECTIVES: The aim of the study was to determine the relation between coronavirus disease 2019 (COVID-19) death exposure and COVID-19 vaccine hesitancy and vaccine uptake among Arkansans, controlling for sociodemographic factors. METHODS: Data were collected from a telephone survey administered in Arkansas between July 12 and July 30, 2021 (N = 1500) via random digit dialing of telephone landlines and cellular telephones. Weighted data were used to estimate regressions. RESULTS: Controlling for sociodemographic variables, COVID-19 death exposure was not a significant predictor of COVID-19 vaccine hesitancy (P = 0.423) or COVID-19 vaccine uptake (P = 0.318). Younger individuals, those with lower levels of education, and those who live in rural counties were more likely to be COVID-19 vaccine hesitant. Older individuals, Hispanic/Latinx individuals, those who reported higher levels of education, and those who reported living in urban counties were more likely to have reported receiving the COVID-19 vaccine. CONCLUSIONS: Many efforts to promote COVID-19 vaccines have focused on prosocial norms, including encouraging vaccination to protect the community from COVID-19 infection and death; however, COVID-19 death exposure was not related to COVID-19 vaccine hesitancy or uptake in the present study. Future research should examine whether prosocial messaging is effective in decreasing hesitancy or motivating some individuals to receive the vaccine among those who have been exposed to COVID-19 deaths.

Social processes, practical issues, and COVID-19 vaccination among hesitant adults.

INTRODUCTION: The purpose of this study is to examine relationships between COVID-19 vaccination, social processes, and the practical issues of healthcare coverage and workplace requirements. We examine these relationships among individuals who expressed some degree of hesitancy towards receiving the vaccine. Assessing relationships between COVID-19 vaccination, social processes, and practical issues among vaccine-hesitant individuals has implications for public health policy and intervention. METHODS: We analyzed weighted data from a random sample phone survey of Arkansas adults (N = 2,201) between March 1st and March 28th, 2022 and constrained our analytical sample to those who had reported some degree of vaccine hesitancy (N = 1,251). Statistical analyses included weighted and unweighted descriptive statistics, weighted bivariate logistic regressions, and a weighted multivariate logistic regression to obtain adjusted odds ratios for COVID-19 vaccination. RESULTS: More than two-thirds (62.5 %) of respondents were vaccinated, despite their hesitancy. Adjusted odds of COVID-19 vaccination were greater among Black (OR = 2.55; 95 % CI[1.63, 3.97]) and Hispanic respondents (OR = 2.46; 95 % CI[1.53, 3.95]), respondents whose healthcare provider recommended vaccination (OR = 2.50; 95 % CI[1.66, 3.77]), and as perceptions of vaccination coverage (OR = 2.04; 95 % CI[1.71, 2.43]) and subjective social status increased (OR = 1.10; 95 % CI[1.01, 1.19]). Adjusted odds of COVID-19 vaccination were greater among respondents with a workplace that recommended (OR = 1.96; 95 % CI[1.03, 3.72]) or required vaccination (OR = 12.62; 95 % CI[4.76, 33.45]) and among respondents who were not employed (OR = 1.82; 95 % CI[1.10, 3.01]) compared to those whose workplace did not recommend or require COVID-19 vaccination. CONCLUSIONS: Some hesitant individuals become vaccinated despite their hesitancy-a group we refer to as "hesitant adopters." Social processes and practical issues are important correlates of vaccination among those who are hesitant. Workplace requirements appear to be of particular importance for vaccination among hesitant individuals. Provider recommendations, norms, social status, and workplace policies may be effective points of intervention among those who express vaccine hesitancy.