Predictors of COVID-19 Vaccination Intention and Behavior Among Young People in a European Union Country With Low COVID-19 Vaccination Rates: Cross-Sectional Study.

Vaccination against COVID-19 is a critical measure for managing the pandemic and achieving herd immunity. In 2021, Slovenia had a significantly lower COVID-19 vaccination rate compared to the average rate in the European Union, with individuals aged younger than 37 years showing the highest hesitancy. Previous studies primarily explored vaccination willingness before vaccines were available to young people, leaving a gap in understanding the factors influencing vaccination behavior and differences within the population of young people. This study aimed to investigate a wide set of predictors influencing COVID-19 vaccination intention and behavior among young people in Slovenia. Specifically, we aimed to compare vaccinated and unvaccinated young people, further categorizing the unvaccinated group into those who were hesitant, those who intended to vaccinate in the near future, and those who refused vaccination. An integrated model, based on the health belief model and theory of planned behavior, was developed, and it included additional contextual factors (such as trust in science, trust in vaccines, conspiracy theory tendencies, etc) and health-related and sociodemographic characteristics. Data were collected in August 2021 via the online access survey panel JazVem (Valicon), targeting individuals aged 15-30 years in Slovenia. Quotas ensured that the sample (n=507) was quasi-representative according to age, gender, education, and region. Bivariate analyses and multinomial logistic regression were performed to explore the determinants of vaccination intention and behavior. Among respondents, 45.8% (232/507) were vaccinated, 30.0% (152/507) refused vaccination, 12.4% (63/507) were hesitant, and 11.8% (60/507) intended to undergo vaccination in the near future. Vaccinated individuals were predominantly aged 23-26 years, had higher education, and reported above-average material status. Refusers were more common among the youngest (15-18 years) and oldest (27-30 years) groups, had lower education, and showed higher conspiracy theory tendencies. Multinomial regression analysis revealed that unvaccinated respondents who perceived greater COVID-19-related health consequences were more likely to delay vaccination (adjusted odds ratio [aOR] 2.0, 95% CI 1.2-3.3) or exhibit hesitancy (aOR 1.9, 95% CI 1.1-3.2) compared with vaccinated respondents. Subjective norms were less influential among hesitant individuals (aOR 0.4, 95% CI 0.2-0.7) and refusers (aOR 0.3, 95% CI 0.2-0.7) than among vaccinated individuals. Self-efficacy in managing health problems was less evident among those who delayed vaccination to the near future (aOR 0.5, 95% CI 0.3-0.9) than among vaccinated individuals. This study underscores the complexity of vaccination intentions and behaviors among young people, emphasizing the necessity for public health strategies promoting vaccination to be tailored to the specific reasons for nonvaccination within different subgroups. Interventions aimed at addressing vaccine hesitancy and delays should particularly focus on individuals with lower education and material disadvantages. By fostering trust and enhancing self-efficacy, these interventions could more effectively promote vaccine uptake.

Atanasova S ，Kamin T ，Perger N 《JMIR Public Health and Surveillance》

Can we convince the unvaccinated to vaccinate: lessons from COVID-19 vaccination.

Vaccine hesitancy affects vaccine uptake. Despite initial reluctance to receive the COVID-19 vaccine in 2020, by 2021, many individuals chose to get vaccinated once vaccines became available, while others who had previously been willing to vaccinate changed their minds. In this study, we focused on people who did not follow-up on their intentions to (or not to) vaccinate and why. This longitudinal study draws on data from a two-wave nationally representative survey of Americans from July 2020 (T1) and July/August 2021 (T2) to examine the factors that contribute to the COVID-19 vaccination-related intention-behavior gap, using multivariable logistic regression. By T2, 52% of previously COVID-19 vaccine-hesitant individuals were vaccinated and 14% of previously pro-vaccine individuals remained unvaccinated. Among the vaccine-hesitant individuals, factors associated with vaccination included higher risk perception, general vaccine acceptance, being informed about the vaccines, endorsing less COVID-19 misinformation, confidence in scientists, and having health insurance. Among the pro-vaccine individuals, factors associated with being unvaccinated included lower risk perception, lower general vaccine acceptance, being less informed about the vaccines, partisan identification, lower confidence in scientists and not having health insurance. The study highlights the factors that explain intention-behavior gap in vaccination. We identified what explains individuals' intentions to vaccinate and their actual vaccination behavior one year later, as well as the potential to influence vaccine-hesitant individuals to vaccinate and pro-vaccine individuals from actualizing their vaccination intentions. Understanding these factors is essential in developing evidence-based strategic communications, which can help convince individuals to vaccinate and increase the uptake of COVID-19 as well as other adult vaccines.

Dhawan D ，Kikut-Stein A ，Pinnamaneni R ，McCloud R ，Viswanath K ... -  《-》

Knowledge, attitudes, and intentions regarding COVID-19 vaccination in the general population and the effect of different framing messages for a brief video on intentions to get vaccinated among unvaccinated individuals in the United States during July 20

To identify knowledge, attitudes, and beliefs (KABs) associated with COVID-19 vaccination intentions and assess the impact of vaccine-promoting messages on vaccination intentions. Our nationally representative survey measured KABs of COVID-19 vaccination and incorporated a randomized experiment to assess the impact of different framing messages for a video encouraging vaccination intentions among unvaccinated adults in the US. Multivariable multinomial logistic regression models were fitted to investigate the relationships of KABs, trust in public health authorities (PHAs), and vaccine confidence with vaccination intentions. Difference-in-difference estimation was conducted to assess the impact of framing messages for a video on unvaccinated individuals' vaccination intentions. We observed that people with increasingly favorable vaccine KABs, trust in PHAs, and vaccine confidence were more likely to be vaccinated or intend to get vaccinated against COVID-19. Difference-in-difference estimates indicated a positive impact of exposure to the video on vaccination intentions while framing messages in some cases appeared to lower vaccination intentions. Associations between the video and vaccination intentions were more pronounced among Black/African American and Hispanic/Latinx populations and Democrats; however, associations did not vary by trust in PHAs or vaccine confidence. Videos that encourage people to get vaccinated may provide an efficient approach to nudge vaccine-hesitant individuals towards getting vaccinated. However, framing messages may negatively impact vaccination intentions and need to be developed carefully. This study provides solid experimental evidence for the importance of tailoring message framing to the characteristics and experience of the audience, while cautioning potential negative impacts of framing that does not match its intended audience. Our findings are applicable to health communication strategies on the population level, such as mass media campaigns, and the use of framing for messages to encourage vaccination but may also be informative for healthcare professionals consulting hesitant individuals about COVID-19 vaccinations.

Zapf AJ ，Schuh HB ，Dudley MZ ，Rimal RN ，Harvey SA ，Shaw J ，Balgobin K ，Salmon DA ... -  《-》

Predictors of Change in Vaccination Decisions Among the Vaccine Hesitant: Examining the Roles of Age and Intolerance of Uncertainty.

Halilova JG ，Fynes-Clinton S ，Addis DR ，Rosenbaum RS ... -  《-》

Lessons learned from the COVID-19 pandemic: identifying hesitant groups and exploring reasons for vaccination hesitancy, from adolescence to late adulthood.

The COVID-19 (COronaVIrus Disease-2019) pandemic highlighted the importance of assessing the rationales behind vaccine hesitancy for the containment of pandemics. In this nationwide study, representative of the Luxembourgish population, we identified hesitant groups from adolescence to late adulthood and explored motivations both for and against vaccination. We combined data collected via online surveys for the CON-VINCE (COvid-19 National survey for assessing VIral spread by Non-affected CarriErs) study, 1865 respondents aged 18-84, and for the YAC (Young people And Covid-19) study, 3740 respondents aged 12-29. Data from both studies were harmonized and weighted to ensure a sample representative of Luxembourg's resident population. The surveys included information on demographic and socio-economic factors as well as vaccination hesitancy. At the time of the survey, 67.0% of respondents had been vaccinated against SARS-CoV-2 (Severe Acute Respiratory Syndrome COronaVirus-2), while 33.0% of the respondents had not yet been vaccinated. Of those not yet vaccinated, 41.8% of respondents were vaccine hesitant. The most important concerns against vaccination were that the vaccine had not been tested sufficiently (59.4%) and the fear of side effects (52.4%). The most frequent reasons for vaccination were to help society overcome the pandemic (74.8%), and to protect oneself from the consequences of infection with the virus (69.3%). The proportion of unvaccinated respondents unwilling or undecided to get vaccinated was higher in the younger age groups compared to the higher age groups. Our findings contribute to improving public health policy communications, not only for future pandemics but also for routine vaccination campaigns. This will help reach those who are unwilling (26.7%) or undecided (15.1%) about vaccination and reinforce strategies that have successfully increased vaccination willingness.

Pauly L ，Residori C ，Bulut H ，Bulaev D ，Ghosh S ，O'Sullivan MP ，Fritz JV ，Vaillant M ，Rommes B ，Samuel R ，Satagopam VP ，Krüger R ，Leist AK ，CON-VINCE Consortium ，ORCHESTRA Working Group ... -  《-》