The role of place-based consciousness in COVID-19 vaccine hesitancy: A survey analysis across rural and urban subgroups in the U.S.

BACKGROUND

Nuanced understandings of the origins of vaccine hesitancy are imperative to increasing vaccine uptake in hesitant populations. This paper examines the viability of the framework of place-based consciousness and its components (out-group resentment and in-group identity) to predict vaccine hesitancy across rural and urban subgroups.

METHODS

We conducted a national survey of 300 U.S. adults (150 urban, 150 rural) from February 12 to March 5, 2024. We used bivariate correlation tests to assess differences in urban and rural place-based consciousness and regression models to assess the relationship between place-based consciousness and influenza and COVID-19 vaccine hesitancy, controlling for measured personal characteristics.

RESULTS

The relationship between place-based consciousness and vaccine hesitancy was significantly modified by rurality for COVID-19 but not influenza vaccine hesitancy. Rural, but not urban, place-based consciousness was a significant predictor of greater odds of COVID-19 vaccine hesitancy. Out-group resentment among rural participants (anti-urban resentment) significantly predicted greater COVID-19 vaccine hesitancy while strength of rural in-group identity was a significant predictor of decreased COVID-19 vaccine hesitancy, both controlling for measured personal characteristics including political leaning, race, and education level.

CONCLUSIONS

Our finding that rural resentment, but not identity, predicted greater odds of COVID-19 vaccine hesitancy suggests a rural ethos which encourages rural community members to protect their community health via vaccination while rural resentment toward urban-appearing vaccines and their dissemination may be an important facet of rural vaccine hesitancy. Further exploration into these relationships should adopt ethnographic methods of deep inquiry to render visible the mechanisms through which they may operate.