Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States

Abstract

In the United States, African Americans (AAs) have been disproportionately affected by COVID-19 mortality. However, AAs are more likely to be hesitant in receiving COVID-19 vaccinations when compared to non-Hispanic Whites. We examined factors associated with vaccine hesitancy among a predominant AA community sample. We performed a cross-sectional analysis on data collected from a convenience sample of 257 community-dwelling participants in the Central Savannah River Area from 5 December 2020, through 17 April 2021. Vaccine hesitancy was categorized as resistant, hesitant, and acceptant. We estimated relative odds of vaccine resistance and vaccine hesitancy using polytomous logistic regression models. Nearly one-third of the participants were either hesitant (n = 40, 15.6%) or resistant (n = 42, 16.3%) to receiving a COVID-19 vaccination. Vaccine-resistant participants were more likely to be younger and were more likely to have experienced housing insecurity due to COVID-19 when compared to both acceptant and hesitant participants, respectively. Age accounted for nearly 25% of the variation in vaccine resistance, with 21-fold increased odds (OR: 21.93, 95% CI: 8.97–5.26–91.43) of vaccine resistance in participants aged 18 to 29 compared to 50 and older adults. Housing insecurity accounted for 8% of the variation in vaccine resistance and was associated with 7-fold increased odds of vaccine resistance (AOR: 7.35, 95% CI: 1.99–27.10). In this sample, AAs under the age of 30 and those experiencing housing insecurity because of the COVID-19 pandemic were more likely to be resistant to receiving a free COVID-19 vaccination.

Positive Association between Individualism and Vaccination Resistance against COVID-19 Vaccination among Chinese Adults: Mediations via Perceived Personal and Societal Benefits

“…Our literature review found four studies conducted in the U.K., the U.S., Australia, and Japan, which investigated vaccination resistance (or refusal) in the general adult population [12,14,[18][19][20]. The prevalence only ranged from 5.5% to 16.3% and was much lower than that reported in the present study.…”

“…Most of the studies investigating inclination toward vaccination involved terms, such as 'acceptability' [12,13], 'willingness' [14,15], 'intention' [8,16], and 'hesitancy' [3,17]. Such concepts and related items used, however, overlapped with each other, and distinctions were blurred.…”

“…However, lack of hesitancy should not be confused with certainty. Some people will still accept vaccines even when they are uncertain or refuse vaccines when they are uncertain" [12]. Better conceptualization of inclination toward vaccination is warranted.…”

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

“…( Alang et al, 2020 ) Other reasons for COVID-19 vaccine hesitancy among Black population included perceived less likelihood of getting COVID-19, perceived potential harms or ineffectiveness of a COVID-19 vaccine and low socioeconomic status (e.g., lack of financial resources or housing insecurity). ( Latkin et al, 2021 , Callaghan et al, 2021 , Shaw et al, 2021 , Khubchandani et al, 2021 , Moore et al, 2021 ) Concerted efforts to address Blacks’ social determinants of health (e.g., early childhood education, community development and employment) and to build their trust in vaccine (e.g., strategic messaging from credible sources, collaboration between Black communities and healthcare system) are required to foster their COVID-19 vaccine acceptance. ( Thornton et al, 2016 )…”

The impact of COVID-19 on income and employment and willingness to become vaccinated among African Americans enrolled in a smoking cessation randomized trial

“… [10] Several studies have identified attitudes and beliefs associated with vaccine hesitancy among AAs but none have explored reasons for hesitancy among AA smokers or AAs engaged with medical community research, which may provide a different and more nuanced viewpoint than those from prior studies. [11] , [12] , [13] , [14] , [15] This study aims to better understand concerns about vaccines and the impact of the pandemic on income and employment among AA smoker participants of a randomized clinical trial (RCT). Further, the current sample is comprised solely of smokers who, given increased vulnerability to COVID, offer a unique perspective which could help clinicians and researchers better customize health communication strategies, increase vaccine uptake, and reduce adverse outcomes within this highly vulnerable population.…”