Patterns and mediators of racial and ethnic disparities in COVID-19 vaccine hesitancy among young adults

https://doi.org/10.1016/j.ypmed.2022.107077Get rights and content

Highlights

  • There are substantial racial disparities in young adults COVID-19 vaccine hesitancy.

  • Black young adults had four times greater odds of vaccine hesitancy than Whites.

  • Positive or negative beliefs mediated racial disparities in vaccine hesitancy.

  • Targeted messages are needed to promote equitable utilization of the effective vaccine.

Abstract

COVID-19 vaccines have been available for over a year, yet 26% of U.S. young adults remain unvaccinated. This study examines racial and ethnic disparities in young adult vaccine hesitancy and attitudes/beliefs that mediate disparities in vaccine hesitancy. Young adults (n = 2041;Mean[SD]:21.3[0.7] years-old) from a Los Angeles, CA, USA cohort were surveyed online in January–May 2021 and classified as vaccine hesitant (those who reported “Not at all likely”/“Not very likely” /“Slightly likely” to get vaccinated) versus non-hesitant (those who reported “Moderately likely”/”Very likely”/”Definitely likely” to get vaccinated or already vaccinated). Multivariable logistic regression was performed to examine racial/ethnic disparities in vaccine hesitancy. Factor analysis was conducted to create three subscales toward vaccination: positive, negative, and lack-of-access beliefs. Mediation analyses were performed to assess pathways from attitude/belief subscales to racial disparities in vaccine hesitancy. Overall 33.0% of respondents reported vaccine hesitancy. Black vs. White young adults had a higher prevalence of vaccine hesitancy (AOR[95%CI] = 4.3[2.4–7.8]), and Asians vs. Whites had a lower prevalence (AOR[95%CI] = 0.5[0.3–0.8]). Mediators explained 90% of the Black (vs. White) disparity in vaccine hesitancy, including significant indirect effects through positive belief–reducing (β = 0.23,p < .001) and negative belief–enhancing (β = 0.02,p = .04) effects. About 81% of the Asian (vs. White) disparity in vaccine hesitancy was explained by the three combined subscales, including significant positive belief–reducing (β = −0.18,p < .001) indirect effect. Substantial racial and ethnic disparities in young adult COVID-19 vaccine hesitancy were found, which were mediated by differences in attitudes and beliefs toward vaccination. Targeted education campaigns and messages are needed to promote equitable utilization of the effective vaccine.

Keywords

COVID-19
Vaccine hesitancy
Race/ethnicity
Attitude and belief
Young adults

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