Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Prev Med. 2023 Jan;166:107341. doi: 10.1016/j.ypmed.2022.107341. Epub 2022 Nov 11.
COVID-19 vaccine coverage in the US has marked demographic and geographical disparities, but few explanations exist for them. Our paper aimed to identify behavioral and social drivers that explain these vaccination disparities. Participants were a national probability sample of 3562 American adults, recruited from the Ipsos KnowledgePanel. Participants completed an online survey in spring 2021, when COVD-19 vaccination was available for higher-risk groups but not yet available to all US adults. The survey assessed COVID-19 vaccination stage (intentions and vaccine uptake), constructs from the Increasing Vaccination Model (IVM) domains (thinking and feeling, social processes, and direct behavior change), self-reported exposure to COVID-19 vaccine information, and demographic characteristics. Analyses used multiple imputation to address item nonresponse and linear regressions to conduct mediation analyses. Higher COVID-19 vaccination stage was strongly associated with older age, liberal political ideology, and higher income in adjusted analyses (all p < .001). Vaccination stage was more modestly associated with urbanicity, white race, and Hispanic ethnicity (all p < .05). Some key mediators that explained more than one-third of demographic differences in vaccination stage were perceived vaccine effectiveness, social norms, and recommendations from family and friends across most demographic characteristics (all p < .05). Other mediators included safety concerns, trust, altruism, provider recommendation, and information seeking. Access to vaccination, barriers to vaccination, and self-efficacy explained few demographic differences. One of the most reliable explanations for demographic differences in COVID-19 vaccination stage is social processes, including social norms, recommendations, and altruism. Interventions to promote COVID-19 vaccination should address social processes and other domains in the IVM.
美国的 COVID-19 疫苗接种覆盖率存在人口统计学和地理差异，但对这些差异的解释很少。我们的论文旨在确定解释这些疫苗接种差异的行为和社会驱动因素。参与者是从 Ipsos KnowledgePanel 招募的 3562 名美国成年人的全国概率样本。参与者在 2021 年春季完成了一项在线调查，当时 COVID-19 疫苗可用于高风险人群，但尚未向所有美国成年人提供。该调查评估了 COVID-19 疫苗接种阶段（意向和疫苗接种率）、递增疫苗接种模型（IVM）领域的构建（思考和感觉、社会过程和直接行为改变）、自我报告的 COVID-19 疫苗信息暴露情况以及人口统计学特征。分析采用多重插补法解决项目无反应问题，采用线性回归法进行中介分析。在调整后的分析中，更高的 COVID-19 疫苗接种阶段与年龄较大、自由政治意识形态和较高收入呈强烈相关（均 p < 0.001）。疫苗接种阶段与城市人口、白人和西班牙裔种族也呈适度相关（均 p < 0.05）。在大多数人口统计学特征中，解释疫苗接种阶段在人口统计学差异中超过三分之一的一些关键中介因素包括疫苗有效性的感知、社会规范以及来自家人和朋友的建议（均 p < 0.05）。其他中介因素包括安全性问题、信任、利他主义、提供者建议和信息搜索。疫苗接种机会、疫苗接种障碍和自我效能感解释了很少的人口统计学差异。解释 COVID-19 疫苗接种阶段人口统计学差异的最可靠因素之一是社会过程，包括社会规范、建议和利他主义。促进 COVID-19 疫苗接种的干预措施应解决 IVM 中的社会过程和其他领域。
