Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Survey Development and Measures
2.2.1. Demographic and Health-Related Characteristics
2.2.2. Experience with COVID-19
2.2.3. COVID-19 Vaccine Acceptance Groups
2.2.4. Vaccine Hesitancy
2.2.5. Determinants of Vaccination
2.2.6. Other Items
2.3. Reliability of Survey
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic [Mean ± SD or n (%)] | Overall n = 789 | Acceptors n = 644 (85.3%) | Hesitant n = 71 (9.4%) | Refusers n = 40 (5.3%) | p-Value 2 |
---|---|---|---|---|---|
Age | 0.03 | ||||
18–29 | 106 (13.5) | 87 (13.6) | 6 (8.5) | 8 (20.0) | |
30–49 | 412 (52.4) | 322 (50.2) | 50 (70.4) | 21 (52.5) | |
50–64 | 246 (31.3) | 210 (32.8) | 15 (21.1) | 11 (27.5) | |
65+ | 22 (2.8) | 22 (3.4) | 0 (0) | 0 (0) | |
Gender | <0.0001 | ||||
Female | 624 (79.2) | 500 (77.8) | 66 (93.0) | 37 (92.5) | |
Male | 153 (19.4) | 138 (21.5) | 3 (4.2) | 2 (5.0) | |
Non-Binary | 1 (0.1) | 1 (0.2) | 0 (0) | 0 (0) | |
Prefer Not to Answer | 10 (1.3) | 4 (0.6) | 2 (2.8) | 1 (2.5) | |
Marital Status | 0.7 | ||||
Single | 191 (24.4) | 157 (24.5) | 13 (18.6) | 12 (30.0) | |
Married, civil union, living with a partner | 495 (63.2) | 404 (63.1) | 49 (70.0) | 23 (57.5) | |
Previously married (divorced, separated, widowed) | 97 (12.4) | 79 (12.3) | 8 (11.4) | 5 (12.5) | |
Race/Ethnicity | 0.16 | ||||
Non-Hispanic White | 282 (37.7) | 239 (38.1) | 22 (36.7) | 14 (40.0) | |
Asian | 97 (13.0) | 91 (14.5) | 2 (3.3) | 2 (5.7) | |
Black | 66 (8.8) | 51 (8.1) | 7 (11.7) | 1 (2.9) | |
Hispanic | 275 (36.8) | 221 (35.3) | 27 (45.0) | 17 (48.6) | |
Other (Native Hawaiian/Pacific Islander, Native American/Alaskan Native, mixed race, other) | 28 (3.7) | 25 (4.0) | 2 (3.3) | 1 (2.9) | |
Educational level | <0.0001 | ||||
Less than college | 315 (40.3) | 234 (36.6) | 46 (65.7) | 18 (45.0) | |
College degree | 245 (31.3) | 210 (32.8) | 13 (18.6) | 16 (40.0) | |
Higher than college degree | 222 (28.4) | 196 (30.6) | 11 (15.7) | 6 (15.0) | |
Annual Household Income | 0.025 | ||||
Less than $50,000 | 123 (16.4) | 84 (13.6) | 18 (26.9) | 11 (28.9) | |
$50,000 to $89,000 | 176 (23.4) | 150 (24.3) | 13 (19.4) | 7 (18.4) | |
$90,000 to $119,000 | 146 (19.4) | 118 (19.1) | 13 (19.4) | 8 (21.1) | |
$120,000 or above | 307 (40.8) | 265 (43.0) | 23 (34.3) | 12 (31.6) | |
Job Classification | 0.003 | ||||
Nurse, Nursing Assistant, Medical Assistants | 296 (38.1) | 245 (38.4) | 27 (39.7) | 18 (45.0) | |
Doctor, PA, NP | 66 (8.5) | 61 (9.6) | 0 (0) | 2 (5.0) | |
Allied Health Personnel; Laboratory, respiratory therapy, radiology personnel | 102 (13.1) | 95 (14.9) | 3 (4.4) | 3 (7.5) | |
Administration or non-direct clinical support/Admissions and Collections Clerk | 272 (35.1) | 200 (31.4) | 37 (54.4) | 16 (40.0) | |
Pharmacist, Pharm Tech | 31 (4.0) | 28 (4.4) | 1 (1.5) | 1 (2.5) | |
Other | 9 (1.2) | 9 (1.4) | 0 (0) | 0 (0) | |
Exposure to COVID on weekly basis | 0.14 | ||||
no direct exposure | 177 (22.7) | 141 (22.1) | 19 (27.1) | 8 (20.0) | |
minimal exposure | 228 (29.2) | 172 (26.9) | 25 (35.7) | 17 (42.5) | |
moderate exposure | 200 (25.6) | 176 (27.5) | 12 (17.1) | 7 (17.5) | |
high exposure | 176 (22.5) | 150 (23.5) | 14 (20.0) | 8 (20.0) | |
They or someone they know tested positive for COVID-19 | 0.09 | ||||
Yes | 604 (89.0) | 518 (89.5) | 58 (90.6) | 28 (77.8) | |
No | 75 (11.1) | 61 (10.5) | 6 (9.4) | 8 (22.2) | |
Number of Chronic Conditions 1 | 0.72 | ||||
0 | 470 (64.1) | 378 (62.6) | 39 (60.0) | 29 (76.3) | |
1 | 198 (27.0) | 172 (28.5) | 19 (29.2) | 6 (15.8) | |
2 | 44 (6.0) | 36 (6.0) | 5 (7.7) | 2 (5.3) | |
≥ 3 | 21 (2.9) | 8 (3.0) | 2 (3.1) | 1 (2.6) | |
Hypertension | 0.01 | ||||
Yes | 186 (24.5) | 168 (26.8) | 12 (18.2) | 3 (7.7) | |
No | 573 (75.5) | 458 (73.2) | 54 (81.8) | 36 (92.3) | |
Diabetes | 0.99 | ||||
Yes | 56 (7.5) | 48 (7.8) | 5 (7.5) | 3 (7.7) | |
No | 695 (92.5) | 571 (92.3) | 62 (92.5) | 36 (92.3) | |
Asthma | 0.05 | ||||
Yes | 126 (16.7) | 99 (16.0) | 19 (27.1) | 5 (12.8) | |
No | 628 (83.3) | 519 (84.0) | 51 (72.9) | 34 (87.2) | |
BMI | 0.22 | ||||
Underweight/Normal (<24.9) | 202 (28.0) | 168 (28.1) | 20 (31.7) | 11 (31.4) | |
Overweight (25–29.9) | 244 (33.8) | 198 (33.1) | 27 (42.9) | 9 (25.7) | |
Obese (30 and above) | 276 (38.2) | 233 (38.9) | 16 (25.4) | 15 (42.9) | |
Receive Flu Vaccine Annually | <0.0001 | ||||
Yes | 540 (78.7) | 501 (85.5) | 33 (51.6) | 6 (16.7) | |
No | 62 (9.0) | 25 (4.3) | 16 (25.0) | 21 (58.3) | |
Skip some Years | 84 (12.2) | 60 (10.2) | 15 (23.4) | 9 (25.0) | |
Important to have children vaccinated against childhood diseases? 5 | <0.0001 | ||||
No | 14 (2.8) | 6 (1.4) | 0 (0) | 8 (27.6) | |
Yes | 474 (93.1) | 412 (96.9) | 47 (85.5) | 15 (51.7) | |
Not Sure | 21 (4.1) | 7 (1.7) | 8 (14.5) | 6 (20.7) | |
COVID Symptom Knowledge (score, range 0–10) 3 | 8.8 ± 1.6 | 8.8 ± 1.5 | 8.8 ± 1.8 | 9.0 ± 2.0 | 0.77 |
COVID Disease Knowledge (score, range 0–6) 3 | 5.3 ± 0.7 | 5.4 ± 0.7 | 5.0 ± 1.0 | 5.3 ± 0.6 | 0.0003 |
Vaccine Hesitancy Scale (score, range 11–55) 4 | 21.7 ± 7.9 | 19.8 ± 6.4 | 29.8 ± 6.0 | 37.2 ± 7.4 | <0.0001 |
Univariate (Unadjusted) | Multivariate (Adjusted) | |||
---|---|---|---|---|
Characteristic | β [SE (β)] | p-Value | β [SE (β)] | p-Value |
Age | [0.35] | - | - | |
18–29 | Ref4 | - | - | - |
30–49 | 0.16 (0.93) | 0.86 | - | - |
50–64 | −0.38 (0.99) | 0.70 | - | - |
65+ | −3.16 (1.96) | 0.11 | - | - |
Gender | [<0.0001] | - | - | |
Female | Ref | - | - | |
Male | −2.77 (0.77) | 0.0003 | - | - |
Race/Ethnicity | [0.05] | [0.09] | ||
Non-Hispanic White | Ref | Ref | ||
Asian | 0.55 (0.98) | 0.57 | 1.63 (0.87) | 0.06 |
Black | 1.41 (1.16) | 0.23 | −0.57 (1.08) | 0.60 |
Hispanic | 2.01 (0.70) | 0.004 | 0.84 (0.62) | 0.17 |
Other (Native Hawaiian/Pacific Islander, Native American/Alaskan Native, mixed race, other) | 2.34 (1.57) | 0.14 | 2.71 (1.40) | 0.05 |
Marital Status | [0.09] | [0.05] | ||
Single | Ref | Ref | ||
Married, civil union, living with a partner | −0.70 (0.73) | 0.34 | −0.39 (0.69) | 0.57 |
Previously married (divorced, separated, widowed) | −2.33 (1.06) | 0.03 | −2.35 (0.96) | 0.02 |
Educational level | [<0.0001] | - | - | |
Less than college | Ref | - | - | |
College degree | −1.68 (0.71) | 0.02 | - | - |
Greater than college degree | −4.24 (0.74) | <0.0001 | - | - |
Annual Household Income | [<0.0001] | |||
Less than 49,999 | Ref | - | - | |
$50,000 to $89,000 | −3.14 (1.01) | 0.002 | - | - |
$90,000 to $119,000 | −2.13 (1.07) | 0.05 | - | - |
$120,000 or above | −4.01 (0.93) | <0.0001 | - | - |
Job Classification | [<0.0001] | [0.004] | ||
Doctor, physician assistant, nurse practitioner | Ref | Ref | ||
Nurse, nursing assistant, medical assistant | 4.68 (1.15) | <0.0001 | 3.42 (1.01) | 0.001 |
Allied health personnel; laboratory, respiratory therapy, radiology personnel | 3.83 (1.32) | 0.004 | 3.16 (1.18) | 0.008 |
Administration or non-direct clinical support, admissions and collections clerk | 6.85 (1.16) | <0.0001 | 4.34 (1.05) | <0.0001 |
Pharmacist, pharmacy technician | 2.72 (1.80) | 0.13 | 2.92 (1.61) | 0.07 |
Other | 4.48 (2.78) | 0.11 | 5.05 (2.62) | 0.05 |
Exposure to COVID-19 on a weekly basis | [0.003] | - | - | |
no direct exposure | Ref | - | - | |
minimal exposure | 0.64 (0.85) | 0.45 | - | - |
moderate exposure | −1.69 (0.87) | 0.04 | - | - |
high exposure | −1.90 (0.90) | 0.03 | - | - |
They or someone they know tested positive for COVID-19 | [0.84] | - | - | |
Yes | Ref | - | - | |
No | 0.20 (0.98) | - | - | |
BMI | [0.41] | - | - | |
Underweight/Normal (<24.9) | Ref | - | - | |
Overweight (25–29.9) | 0.32 (0.80) | 0.69 | - | - |
Obese (30 and above) | 1.00 (0.78) | 0.20 | - | - |
Number of Chronic Conditions 1 | 0.25 (0.42) | [0.56] | - | - |
Diabetes | [0.31] | - | - | |
No | Ref | - | - | |
Yes | 1.18 (1.16) | - | - | |
Hypertension | [0.28] | - | - | |
No | Ref | - | - | |
Yes | −0.77 (0.71) | - | - | |
Asthma | [0.16] | - | - | |
No | Ref | - | - | |
Yes | 1.15 (0.81) | - | - | |
Serious heart condition | [0.94] | - | - | |
No | Ref | - | - | |
Yes | −0.19 (2.44) | - | - | |
Chronic lung disease | [0.63] | - | - | |
No | Ref | - | - | |
Yes | −1.75 (3.60) | - | - | |
Chronic kidney disease | [0.42] | - | - | |
No | Ref | - | - | |
Yes | 2.70 (3.28) | - | - | |
Liver disease | [0.68] | - | - | |
No | Ref | - | - | |
Yes | 1.34 (3.27) | - | - | |
Weakened immune system (immunocompromised) | [0.24] | [0.03] | ||
No | Ref | Ref | ||
Yes | 1.50 (1.28) | 2.36 (1.10) | ||
Receive flu vaccine annually | [<0.0001] | [<0.0001] | ||
Yes | Ref | Ref | ||
No | 12.13 (0.93) | <0.0001 | 8.23 (1.04) | <0.0001 |
Skip some Years | 6.28 (0.82) | <0.0001 | 4.49 (0.84) | <0.0001 |
Important to have children vaccinated against childhood diseases? 3 | [<0.0001] | |||
Yes | Ref | Ref | ||
No | 17.25 (1.94) | <0.0001 | 12.98 (1.99) | <0.0001 |
Not Sure | 13.04 (1.59) | <0.0001 | 9.21 (1.76) | <0.0001 |
Knowledge of COVID Symptoms, score 2 | −0.03 (0.19) | [0.88] | - | - |
Knowledge of COVID Disease, score 2 | −2.23 (0.45) | [<0.0001] | - | - |
Univariate/Unadjusted OR (95% CI) | Multivariate/Adjusted OR (95% CI) | |||||||
---|---|---|---|---|---|---|---|---|
Characteristic | Hesitant | Refusers | Hesitant | Refusers | ||||
Age | ||||||||
18–29 | Ref4 | Ref4 | - | - | - | - | ||
30–49 | 2.23 | 0.92, 5.37 | 0.72 | 0.31, 1.67 | - | - | - | - |
50+ | 0.88 | 0.33, 2.36 | 0.47 | 0.18, 1.23 | - | - | - | - |
Gender | ||||||||
Female | Ref | Ref | Ref | Ref | ||||
Male | 0.17 | 0.05, 0.53 | 0.2 | 0.05, 0.82 | 0.12 | 0.02, 0.91 | 0.17 | 0.02, 1.29 |
Race/Ethnicity | ||||||||
Non-Hispanic White | Ref | Ref | - | - | - | - | ||
Hispanic | 1.33 | 0.74, 2.41 | 1.32 | 0.64, 2.74 | - | - | - | - |
Others | 0.72 | 0.34, 1.53 | 0.41 | 0.13, 1.27 | - | - | - | - |
Marital Status | ||||||||
Single | Ref | Ref | - | - | - | - | ||
Married /Civil Union/Living with a partner | 1.45 | 0.76, 2.75 | 0.75 | 0.37, 1.55 | - | - | - | - |
Previously married (divorced, separated, widowed) | 1.22 | 0.49, 3.07 | 0.66 | 0.21, 2.12 | - | - | - | - |
Educational level | ||||||||
Less than college | Ref | Ref | Ref | Ref | ||||
College degree or higher | 0.31 | 0.18, 0.52 | 0.74 | 0.39, 1.43 | 0.44 | 0.22, 0.89 | 0.92 | 0.40, 2.13 |
Annual Household Income | ||||||||
Less than $89,000 | Ref | Ref | - | - | - | - | ||
$90,000 and above | 0.71 | 0.43, 1.18 | 0.72 | 0.37, 1.40 | - | - | - | - |
Job Classification | ||||||||
Clinical | Ref | Ref | Ref | Ref | ||||
Non-clinical | 2.36 | 1.42, 3.92 | 1.27 | 0.65, 2.47 | 2.31 | 1.16, 4.59 | 1.16 | 0.50, 2.71 |
Exposure to COVID-19 on a weekly basis | ||||||||
no direct exposure | Ref | Ref | - | - | - | - | ||
minimal exposure | 1.15 | 0.60, 2.20 | 2.01 | 0.81, 5.0 | - | - | - | - |
moderate exposure | 0.53 | 0.25, 1.15 | 0.8 | 0.28, 2.34 | - | - | - | - |
high exposure | 0.74 | 0.36, 1.55 | 1.09 | 0.39, 3.08 | - | - | - | - |
They or someone they know tested positive for COVID-19 | ||||||||
Yes | Ref | Ref | - | - | - | - | ||
No | 0.91 | 0.37, 2.19 | 2.41 | 1.05, 5.53 | - | - | - | - |
BMI | ||||||||
Underweight/Normal (<24.9) | Ref | Ref | Ref | Ref | ||||
Overweight (25–29.9) | 1.14 | 0.62, 2.10 | 0.76 | 0.30, 1.91 | 1.25 | 0.57, 2.74 | 1.51 | 0.51, 4.45 |
Obese (30 and above) | 0.54 | 0.27, 1.09 | 1.08 | 0.47, 2.46 | 0.35 | 0.14, 0.90 | 1.36 | 0.47, 3.97 |
Number of Chronic Conditions1 | 1.08 | 0.79, 1.48 | 0.73 | 0.42, 1.24 | - | - | - | - |
Diabetes | ||||||||
No | Ref | Ref | - | - | - | - | ||
Yes | 0.78 | 0.27, 2.22 | 1.01 | 0.30, 3.41 | - | - | - | - |
Hypertension | ||||||||
No | Ref | Ref | - | - | - | - | ||
Yes | 0.62 | 0.33, 1.20 | 0.23 | 0.07, 0.76 | - | - | - | - |
Asthma | ||||||||
No | Ref | Ref | - | - | - | - | ||
Yes | 2.02 | 1.14, 3.57 | 0.79 | 0.30, 2.07 | - | - | - | - |
Receive flu vaccine annually | ||||||||
Yes | Ref | Ref | - | - | - | - | ||
No/Skip some years | 5.49 | 3.17, 9.51 | 29.29 | 11.84, 72.48 | - | - | - | - |
Important to have children vaccinated against childhood diseases?3 | ||||||||
Yes | Ref | Ref | - | - | - | - | ||
No/Not sure | 4.8 | 1.82, 12.64 | 29.44 | 11.80, 73.42 | - | - | - | - |
COVID Symptom Knowledge, score2 | 1.02 | 0.87, 1.19 | 1.07 | 0.86, 1.34 | - | - | - | - |
COVID Disease Knowledge, score2 | 0.56 | 0.41, 0.76 | 0.84 | 0.53, 1.33 | - | - | - | - |
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Gatto, N.M.; Lee, J.E.; Massai, D.; Zamarripa, S.; Sasaninia, B.; Khurana, D.; Michaels, K.; Freund, D.; Nightingale, J.; Firek, A., on behalf of the Riverside University Health System (RUHS) Comparative Effectiveness and Clinical Outcomes Research Center (CECORC)-Claremont Graduate University (CGU) COVID-19 Research Group. Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey. Vaccines 2021, 9, 1152. https://doi.org/10.3390/vaccines9101152
Gatto NM, Lee JE, Massai D, Zamarripa S, Sasaninia B, Khurana D, Michaels K, Freund D, Nightingale J, Firek A on behalf of the Riverside University Health System (RUHS) Comparative Effectiveness and Clinical Outcomes Research Center (CECORC)-Claremont Graduate University (CGU) COVID-19 Research Group. Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey. Vaccines. 2021; 9(10):1152. https://doi.org/10.3390/vaccines9101152
Chicago/Turabian StyleGatto, Nicole M., Jerusha E. Lee, Donatella Massai, Susanna Zamarripa, Bijan Sasaninia, Dhruv Khurana, Kelsey Michaels, Deborah Freund, Judi Nightingale, and Anthony Firek on behalf of the Riverside University Health System (RUHS) Comparative Effectiveness and Clinical Outcomes Research Center (CECORC)-Claremont Graduate University (CGU) COVID-19 Research Group. 2021. "Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey" Vaccines 9, no. 10: 1152. https://doi.org/10.3390/vaccines9101152