Population Attributable Fraction of Nonvaccination of COVID-19 Due to Vaccine Hesitancy, United States, 2021.

Understanding the extent of coronavirus disease 2019 (COVID-19) nonvaccination attributable to vaccine hesitancy versus other barriers can help prioritize approaches for increasing vaccination uptake. Using data from the Centers for Disease Control and Prevention's Research and Development Survey, a nationally representative survey fielded from May 1 to June 30, 2021 (n = 5,458), we examined the adjusted population attribution fraction (PAF) of COVID-19 vaccine hesitancy attributed to nonvaccination according to sociodemographic characteristics and health-related variables. Overall, the adjusted PAF of nonvaccination attributed to vaccine hesitancy was 76.1%. The PAF was highest among adults who were ≥50 years of age (87.9%), were non-Hispanic White (83.7%), had a bachelor's degree or higher (82.7%), had an annual household income of at least $75,000 (85.5%), were insured (82.4%), and had a usual place for health care (80.7%). The PAF was lower for those who were current smokers (65.3%) compared with never smokers (77.9%), those who had anxiety or depression (65.2%) compared with those who did not (80.1%), and those who had a disability (64.5%) compared with those who did not (79.2%). Disparities in PAF suggest areas for prioritization of efforts for intervention and development of messaging campaigns that address all barriers to uptake, including hesitancy and access, to advance health equity and protect individuals from COVID-19.

Promising Practices Observed in High-Throughput COVID-19 Vaccination Sites in the United States, February-May 2021.

Objectives. To identify promising practices for implementing COVID-19 vaccination sites. Methods. The Centers for Disease Control and Prevention (CDC) and Federal Emergency Management Agency (FEMA) assessed high-throughput COVID-19 vaccination sites across the United States, including Puerto Rico, after COVID-19 vaccinations began. Site assessors conducted site observations and interviews with site staff. Qualitative data were compiled and thematically analyzed. Results. CDC and FEMA conducted 134 assessments of high-throughput vaccination sites in 25 states and Puerto Rico from February 12 to May 28, 2021. Promising practices were identified across facility, clinical, and cross-cutting operational areas and related to 6 main themes: addressing health equity, leveraging partnerships, optimizing site design and flow, communicating through visual cues, using quick response codes, and prioritizing risk management and quality control. Conclusions. These practices might help planning and implementation of future vaccination operations for COVID-19, influenza, and other vaccine-preventable diseases. Public Health Implications. These practices can be considered by vaccination planners and providers to strengthen their vaccination site plans and implementation of future high-throughput vaccination sites. (Am J Public Health. 2023;113(8):909-918. https://doi.org/10.2105/AJPH.2023.307331).

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.

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.

Population Attributable Fraction of Nonvaccination of Child and Adolescent Vaccines Attributed to Parental Vaccine Hesitancy, 2018-2019.

Understanding the role of vaccine hesitancy in undervaccination or nonvaccination of childhood vaccines is important for increasing vaccine confidence and uptake. We used data from April to June interviews in the 2018 and 2019 National Immunization Survey-Flu (n = 78,725, United States), a nationally representative cross-sectional household cellular telephone survey. We determined the adjusted population attributable fraction (PAF) for each recommended childhood vaccine to assess the contribution of vaccine hesitancy to the observed nonvaccination level. Hesitancy is defined as being somewhat or very hesitant toward childhood vaccines. Furthermore, we assessed the PAF of nonvaccination for influenza according to sociodemographic characteristics, Department of Health and Human Services region, and state. The proportion of nonvaccination attributed to parental vaccine hesitancy was lowest for hepatitis B birth dose vaccine (6.5%) and highest for ≥3-dose diphtheria and tetanus toxoids and acellular pertussis vaccine (31.3%). The PAF of influenza nonvaccination was highest for non-Hispanic Black populations (15.4%), households with high educational (17.7%) and income (16.5%) levels, and urban areas (16.1%). Among states, PAF ranged from 25.4% (New Hampshire) to 7.5% (Louisiana). Implementing strategies to increase vaccination confidence and uptake are important, particularly during the coronavirus disease 2019 pandemic.

Mental health symptoms and association with COVID-19 vaccination receipt and intention to vaccinate among adults, United States.

Early studies suggest that adults with mental health conditions are at greater risk for COVID-19 infection, severe complications, and higher mortality, yet face barriers in accessing timely health services. Data from the Census Bureau's Household Pulse Survey, a large, nationally representative survey fielded from March 17-29, 2021 (n = 77,104) were analyzed to examine COVID-19 vaccination and intention among adults with mental health symptoms. Separate multivariable regression models were conducted to examine associations between symptoms of anxiety, depression, and anxiety or depression on vaccine receipt (≥ 1 dose) and intention to be vaccinated. Reasons for not being vaccinated were also assessed. Approximately 35% of adults had symptoms of anxiety or depression. This population was less likely to receive COVID-19 vaccination (adjusted prevalence ratio (aPR) = 0.94, 95%CI: 0.91-0.98) but more likely to intend to get a vaccine (aPR = 1.13, 95%CI: 1.08-1.19) than those without these conditions. Females with mental health symptoms were less likely to receive a COVID-19 vaccination but more likely to intend to get vaccinated, while there were fewer significant associations between mental health symptoms and vaccination coverage and intentions to vaccinate among males. Reasons for not getting vaccinated, including concerns about possible vaccine side effects, efficacy, cost, dislike of vaccines, as well as lack of trust in the government and vaccines, were all greater among those with any symptoms of anxiety or depressive disorders than those without symptoms. Efforts are needed to increase vaccination uptake and confidence among this vulnerable population by increasing vaccine confidence and addressing concerns about the vaccine.

COVID-19 Vaccination Coverage, Intent, Knowledge, Attitudes, and Beliefs among Essential Workers, United States.

We assessed coronavirus disease vaccination and intent and knowledge, attitudes, and beliefs among essential workers during March-June 2021. Coverage was 67%; 18% reported no intent to get vaccinated. Primary concerns were potential side effects, safety, and lack of trust in vaccines, highlighting the importance of increasing vaccine confidence in this population.

COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination - United States, September and December 2020.

As of February 8, 2021, 59.3 million doses of vaccines to prevent coronavirus disease 2019 (COVID-19) had been distributed in the United States, and 31.6 million persons had received at least 1 dose of the COVID-19 vaccine (1). However, national polls conducted before vaccine distribution began suggested that many persons were hesitant to receive COVID-19 vaccination (2). To examine perceptions toward COVID-19 vaccine and intentions to be vaccinated, in September and December 2020, CDC conducted household panel surveys among a representative sample of U.S. adults. From September to December, vaccination intent (defined as being absolutely certain or very likely to be vaccinated) increased overall (from 39.4% to 49.1%); the largest increase occurred among adults aged ≥65 years. If defined as being absolutely certain, very likely, or somewhat likely to be vaccinated, vaccination intent increased overall from September (61.9%) to December (68.0%). Vaccination nonintent (defined as not intending to receive a COVID-19 vaccination) decreased among all adults (from 38.1% to 32.1%) and among most sociodemographic groups. Younger adults, women, non-Hispanic Black (Black) persons, adults living in nonmetropolitan areas, and adults with lower educational attainment, with lower income, and without health insurance were most likely to report lack of intent to receive COVID-19 vaccine. Intent to receive COVID-19 vaccine increased among adults aged ≥65 years by 17.1 percentage points (from 49.1% to 66.2%), among essential workers by 8.8 points (from 37.1% to 45.9%), and among adults aged 18-64 years with underlying medical conditions by 5.3 points (from 36.5% to 41.8%). Although confidence in COVID-19 vaccines increased during September-December 2020 in the United States, additional efforts to tailor messages and implement strategies to further increase the public's confidence, overall and within specific subpopulations, are needed. Ensuring high and equitable vaccination coverage across all populations is important to prevent the spread of COVID-19 and mitigate the impact of the pandemic.

COVID-19 Vaccination Coverage and Intent Among Adults Aged 18-39 Years - United States, March-May 2021.

Since April 19, 2021, all persons aged ≥16 years in the United States have been eligible to receive a COVID-19 vaccine. As of May 30, 2021, approximately one half of U.S. adults were fully vaccinated, with the lowest coverage and lowest reported intent to get vaccinated among young adults aged 18-39 years (1-4). To examine attitudes toward COVID-19 vaccination and vaccination intent among adults in this age group, CDC conducted nationally representative household panel surveys during March-May 2021. Among respondents aged 18-39 years, 34.0% reported having received a COVID-19 vaccine. A total of 51.8% were already vaccinated or definitely planned to get vaccinated, 23.2% reported that they probably were going to get vaccinated or were unsure about getting vaccinated, and 24.9% reported that they probably or definitely would not get vaccinated. Adults aged 18-24 years were least likely to report having received a COVID-19 vaccine and were most likely to report being unsure about getting vaccinated or that they were probably going to get vaccinated. Adults aged 18-39 years with lower incomes, with lower educational attainment, without health insurance, who were non-Hispanic Black, and who lived outside of metropolitan areas had the lowest reported vaccination coverage and intent to get vaccinated. Concerns about vaccine safety and effectiveness were the primary reported reasons for not getting vaccinated. Vaccination intent and acceptance among adults aged 18-39 years might be increased by improving confidence in vaccine safety and efficacy while emphasizing that vaccines are critical to prevent the spread of COVID-19 to friends and family and for resuming social activities (5).

Report of Health Care Provider Recommendation for COVID-19 Vaccination Among Adults, by Recipient COVID-19 Vaccination Status and Attitudes - United States, April-September 2021.

Vaccination is critical to controlling the COVID-19 pandemic, and health care providers play an important role in achieving high vaccination coverage (1). To examine the prevalence of report of a provider recommendation for COVID-19 vaccination and its association with COVID-19 vaccination coverage and attitudes, CDC analyzed data among adults aged ≥18 years from the National Immunization Survey-Adult COVID Module (NIS-ACM), a nationally representative cellular telephone survey. Prevalence of report of a provider recommendation for COVID-19 vaccination among adults increased from 34.6%, during April 22-May 29, to 40.5%, during August 29-September 25, 2021. Adults who reported a provider recommendation for COVID-19 vaccination were more likely to have received ≥1 dose of a COVID-19 vaccine (77.6%) than were those who did not receive a recommendation (61.9%) (adjusted prevalence ratio [aPR] = 1.12). Report of a provider recommendation was associated with concern about COVID-19 (aPR = 1.31), belief that COVID-19 vaccines are important to protect oneself (aPR = 1.15), belief that COVID-19 vaccination was very or completely safe (aPR = 1.17), and perception that many or all of their family and friends had received COVID-19 vaccination (aPR = 1.19). Empowering health care providers to recommend vaccination to their patients could help reinforce confidence in, and increase coverage with, COVID-19 vaccines, particularly among groups known to have lower COVID-19 vaccination coverage, including younger adults, racial/ethnic minorities, and rural residents.

Prior COVID-19 Infection, Mental Health, Food and Financial Insecurity, and Association With COVID-19 Vaccination Coverage and Intent Among College-Aged Young Adults, US, 2021.

INTRODUCTION: More than 700,000 COVID-19 cases have been linked to American colleges and universities since the beginning of the pandemic. However, studies are limited on the effects of the pandemic on college-aged young adults and its association with their COVID-19 vaccination status and intent. METHODS: Using the Census Bureau's Household Pulse Survey (HPS), a large, nationally representative survey fielded from April 14 through May 24, 2021, we assessed the effects of the pandemic (COVID-19 infection, mental health, food and financial security) on COVID-19 vaccination coverage (≥1 dose) and intentions toward vaccination among college-aged young adults in the United States (N = 6,758). We examined factors associated with vaccination coverage and intent, and reasons for not getting vaccinated. RESULTS: Approximately one-fifth (19.6%) of college-aged young adults had a previous diagnosis of COVID-19, 43.5% and 39.1% reported having anxiety or depression, respectively, 10.9% reported that they sometimes or often did not have enough food to eat, and 22.6% and 12.3% found it somewhat or very difficult, respectively, to pay for household expenses. Of college-aged young adults, 63.1% had received at least 1 dose of the COVID-19 vaccine, 15.4% probably would be vaccinated or were unsure about getting the vaccine, and 14.0% probably will not or definitely will not get vaccinated. Adults who were non-Hispanic Black (vs non-Hispanic White) or had food or financial insecurities (vs did not) were less likely to be vaccinated or intend to be vaccinated. Among adults who probably will not or definitely will not be vaccinated, more than one-third said that they did not believe a vaccine was needed. CONCLUSION: Ensuring high and equitable vaccination coverage among college-aged young adults is critical for safely reopening in-person learning and resuming prepandemic activities.

Sampling design and methodology of the Violence Against Children and Youth Surveys.

INTRODUCTION: Globally 1 billion children are exposed to violence every year. The Violence Against Children Surveys (VACS) are nationally representative surveys of males and females ages 13-24 that are intended to measure the burden of sexual, physical and emotional violence experienced in childhood, adolescence and young adulthood. It is important to document the methodological approach and design of the VACS to better understand the national estimates that are produced in each country, which are used to drive violence prevention efforts. METHODS: This study describes the surveys' target population, sampling design, statistical considerations, data collection process, priority violence indicators and data dissemination. RESULTS: Twenty-four national household surveys have been completed or are being planned in countries across Africa, Asia, the Caribbean, Central and South America, and Eastern Europe. The sample sizes range from 891 to 7912 among females (72%-98% response rate) and 803-2717 among males (66%-98% response rate). Two face-to-face interviews are conducted: a Household and an Individual Questionnaire. A standard set of core priority indicators are generated for each country that range from prevalence of different types of violence, contexts, risk and protective factors, and health consequences. Results are disseminated through various platforms to expand the reach and impact of the survey results. CONCLUSION: Data obtained through VACS can inform development and implementation of effective prevention strategies and improve health service provision for all who experience violence. VACS serves as a standardised tool to inform and drive prevention through high-quality, comprehensive data.

Effects of Poly-Victimization Before Age 18 on Health Outcomes in Young Kenyan Adults: Violence Against Children Survey.

Children's exposure to poly-victimization, which is the experience of multiple types of victimization, has been found to be associated with negative health outcomes and risk behaviors. We examined the collective effects of childhood sexual, physical, and emotional violence on selected self-reported health outcomes among young Kenyan females and males using the Violence Against Children Survey (VACS). Overall, 76.2% of females and 79.8% of males were victims of sexual, physical, or emotional violence prior to age 18, and one-third (32.9% and 34.5%, respectively) experienced two or more types of violence. Poly-victimization was significantly associated with current feelings of anxiety, depression, and suicidal thoughts in females and males, as well as self-reported fair or poor health in males (p < .05) as compared to those who experienced no violence. The study data demonstrate an urgent need to reduce all types of violence against children, as well develop appropriate strategies for its prevention.

Perceptions of Harm to Children Exposed to Secondhand Aerosol From Electronic Vapor Products, Styles Survey, 2015.

INTRODUCTION: The US Surgeon General has concluded that e-cigarette aerosol is not harmless and can contain harmful and potentially harmful chemicals, including nicotine. We assessed factors associated with adults' perceptions of harm related to children's exposure to secondhand aerosol from electronic vapor products (EVPs). METHODS: Data came from the 2015 Styles, an Internet panel survey of US adults aged 18 years or older (n = 4,127). Respondents were asked whether they believe aerosol from other people's EVPs causes children harm. Harm perceptions were assessed overall and by cigarette smoking, EVP use, and sociodemographic characteristics. Multinomial logistic regression was used to assess odds of perceived harm. RESULTS: Overall, 5.3% of adults responded that secondhand EVP exposure caused "no harm" to children, 39.9% responded "little harm" or "some harm," 21.5% responded "a lot of harm," and 33.3% responded "don't know." Odds of "no harm" response were greater among men than among women, current and former cigarette smokers than among never smokers, and current and former EVP users than among never users; odds were lower among non-Hispanic blacks, Hispanics, and non-Hispanic other races than among non-Hispanic whites. Odds of responding "don't know" were greater among men, current cigarette smokers, and current and former EVP users; odds were lower among those aged 45 to 64 years than those aged 18 to 24 years and lower among non-Hispanic other races and Hispanics than non-Hispanic whites. CONCLUSION: Two-fifths of US adults believe that children's exposure to secondhand EVP aerosol causes some or little harm, while one-third do not know whether it causes harm. Efforts are warranted to educate the public about the health risks of secondhand EVP aerosol, particularly for children.

State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults - United States, 2014.

Tobacco use is the leading cause of preventable disease and death in the United States, resulting in approximately 480,000 premature deaths and more than $300 billion in direct health care expenditures and productivity losses each year (1). In recent years, cigarette smoking prevalence has declined in many states; however, there has been relatively little change in the prevalence of current smokeless tobacco use or concurrent use of cigarettes and smokeless tobacco in most states, and in some states prevalence has increased (2). CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) to assess state-specific prevalence estimates of current use of cigarettes, smokeless tobacco, and cigarette and/or smokeless tobacco (any cigarette/smokeless tobacco use) among U.S. adults. Current cigarette smoking ranged from 9.7% (Utah) to 26.7% (West Virginia); current smokeless tobacco use ranged from 1.4% (Hawaii) to 8.8% (Wyoming); current use of any cigarette and/or smokeless tobacco product ranged from 11.3% (Utah) to 32.2% (West Virginia). Disparities in tobacco use by sex and race/ethnicity were observed; any cigarette and/or smokeless tobacco use was higher among males than females in all 50 states. By race/ethnicity, non-Hispanic whites had the highest prevalence of any cigarette and/or smokeless tobacco use in eight states, followed by non-Hispanic other races in six states, non-Hispanic blacks in five states, and Hispanics in two states (p<0.05); the remaining states did not differ significantly by race/ethnicity. Evidence-based interventions, such as increasing tobacco prices, implementing comprehensive smoke-free policies, conducting mass media anti-tobacco use campaigns, and promoting accessible smoking cessation assistance, are important to reduce tobacco use and tobacco-related disease and death among U.S. adults, particularly among subpopulations with the highest use prevalence (3).

US Adults' Perceptions of the Harmful Effects During Pregnancy of Using Electronic Vapor Products Versus Smoking Cigarettes, Styles Survey, 2015.

INTRODUCTION: Research suggests aerosol from electronic vapor products (EVPs) has fewer harmful constituents than conventional cigarette smoke. Even so, EVPs and other nicotine-containing products are not safe to use during pregnancy. We examined perceptions among US adults regarding harm in using EVPs rather than smoking cigarettes during pregnancy. METHODS: Data came from the 2015 Styles Survey, an Internet panel survey of a sample of US adults aged 18 years or older (N = 4,127). Perceived harm was assessed by asking respondents whether using EVPs was less, equally, or more harmful for pregnant women than smoking cigarettes. Descriptive statistics were used to estimate perceived harm overall and by sociodemographic characteristics and tobacco-use status. Perceived harm was assessed among all adults, women of reproductive age (18-44 years, n = 820), and women of nonreproductive age (≥45 years, n = 1,398). RESULTS: Among all adults, 11.1% believed using EVPs during pregnancy was less harmful than smoking conventional cigarettes, 51.0% believed it was equally harmful, 11.6% believed it was more harmful, and 26.2% did not know. Prevalence of perception of less harm, by demographic category, was greatest among adults aged 18 to 24 years, men, non-Hispanic whites, adults with less than a high school diploma, current EVP users, and current cigarette smokers (P < .05). Prevalence of perception of less harm was greater among women of reproductive age (9.6%) than among those of nonreproductive age (7.9%) (P < .05). CONCLUSION: US adults have varying levels of perceptions about the harms of EVP use versus cigarette smoking during pregnancy. Efforts are warranted to prevent nicotine exposure during pregnancy and to educate adults on the dangers of using any form of tobacco during pregnancy, including EVPs.

Trends in awareness and use of electronic cigarettes among US adults, 2010-2013.

INTRODUCTION: Electronic cigarette (e-cigarette) marketing has increased considerably since the product entered the US market in 2007, thereby warranting additional surveillance to monitor recent trends in population-level awareness and utilization. We assessed the prevalence, characteristics, and trends in e-cigarette awareness and use among nationally representative samples of US adults during 2010-2013. METHODS: Data came from the 2010-2013 HealthStyles survey, an annual consumer-based web survey of US adults aged ≥ 18 years. Sample sizes ranged from 2,505 (2010) to 4,170 (2012). Descriptive statistics were used to assess e-cigarette awareness, ever use, and current use (use within the past 30 days) overall and by sex, age, race/ethnicity, education, income, US region, and cigarette smoking status. Trends were assessed using logistic regression. RESULTS: During 2010-2013, increases (p < .05) were observed for e-cigarette awareness (40.9%-79.7%), ever use (3.3%-8.5%), and current use (1.0%-2.6%). Awareness increased among all socio demographic subpopulations during 2010-2013 (p < .05); an increase in ever use of e-cigarettes occurred among all sociodemographic groups except those aged 18-24 years, Hispanics, and those living in the Midwest (p < .05). During 2010-2013, ever use increased among current (9.8%-36.5%) and former (2.5%-9.6%) cigarette smokers (p < .05), but it remained unchanged among never smokers (1.3%-1.2%). CONCLUSIONS: Awareness and use of e-cigarettes increased considerably among US adults during 2010-2013. In 2013, more than one-third of current cigarette smokers reported having ever used e-cigarettes. Given the uncertain public health impact of e-cigarettes, continued surveillance of emerging use patterns is critical for public health planning.

Association between current asthma and secondhand smoke exposure in vehicles among adults living in four US states.

OBJECTIVE: Many states have implemented laws prohibiting tobacco smoking in indoor public places. However, private settings remain a major source of secondhand smoke (SHS) exposure for many people. We assessed the association between current asthma and SHS exposure in vehicles among adult never-smokers in Indiana, Kentucky, Louisiana and Mississippi. METHODS: Data came from the 2011 Behavioral Risk Factor Surveillance System, a state-based telephone survey of US adults aged ≥18 years. Analyses were restricted to states (n=4) that administered an optional SHS module. Prevalence of self-reported asthma and past 7-day SHS exposure in vehicles was calculated by demographics, voluntary smoke-free vehicle rules and SHS exposure in homes, public places and workplaces. Logistic regression was used to assess the adjusted association between asthma and SHS exposure in vehicles. RESULTS: Among 17 863 never-smoking adults, 7.4% reported having current asthma, whereas 12.3% reported past 7-day SHS exposure in vehicles. Among adults with asthma, SHS exposure in vehicles was lower among those with voluntary smoke-free rules compared with those without voluntary smoke-free rules (9.5% vs 56.7%, p<0.0001). Following adjustment, adults exposed to SHS in a vehicle had a higher odds of having current asthma compared with unexposed adults (OR=2.01, 95% CI 1.18 to 3.40). CONCLUSIONS: Never-smoking adults recently exposed to SHS in a vehicle had higher odds of having current asthma compared with unexposed adults. Efforts are warranted to warn about the dangers of SHS and to encourage voluntary smoke-free rules in vehicles, especially among adults with asthma.

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.