Factors associated with COVID-19 vaccination or intent to be vaccinated across three U.S. states

Objectives: Vaccine hesitancy represents an important challenge to the effective control of the COVID-19 pandemic. In prior research on seasonal influenza, childhood vaccination, and emergency vaccination programs, hesitancy has been associated with a wide range of demographic, psychological, and compliance factors.

Methods: In January 2021, an online survey was distributed using the Qualtrics (Provo, UT) platform to a proportional quota sample of individuals in three states: Louisiana, New York, and Washington. Crude and adjusted risk differences and 95 % confidence intervals were calculated to describe the relationship between vaccination or intent to be vaccinated and demographic, psychological, compliance, and pandemic impact variables.

Results: Of 812 respondents, 696 indicated their vaccination status or intent to be vaccinated. Sixty-six percent indicated they were vaccinated or intended to be when available (n = 457) and 34 % were not vaccinated and did not intend to be vaccinated (n = 239). In bivariate analysis, respondents who were older, male, married, white, and reported higher household incomes were more likely to be vaccinated or intend to be. Those who complied with mask wearing, social distancing, and avoided gatherings with people outside their household were also more likely to report vaccination or intention. In the multivariable model, backward elimination resulted in a model that retained sex, race, household income, and avoiding large gatherings.

Conclusion: There are important demographic, behavioral, and other factors that influence vaccine acceptance. Identifying those factors is vital for targeted and effective messaging, education, and engagement to reach those most hesitant, increase vaccination coverage, and effectively address the COVID-19 pandemic.