Purpose This study aimed to understand the potential barriers and facilitators to COVID-19 vaccination among youth. Methods Open-ended questions regarding COVID-19 vaccination were posed to a national cohort of 14- to 24-year-olds (October 30, 2020). Responses were coded through qualitative thematic analysis. Multivariable logistic regression tested the association of demographic characteristics with vaccination unwillingness. Results Among 911 respondents (response rate = 79.4%), 75.9% reported willingness to receive a COVID-19 vaccine, 42.7% had unconditional willingness, and 33.3% were conditionally willing, of which the majority (80.7%) were willing if experts deemed vaccination safe and recommended. Preferred vaccine information sources were medical organizations (42.3%; CDC, WHO) and health care professionals (31.7%). Frequent concerns with vaccination included side effects (36.2%) and efficacy (20.1%). Race predicted vaccination unwillingness (Black: odds ratio = 3.31; and Asian: odds ratio = .46, compared with white, p < .001). Conclusion Most youth in our national sample were willing to receive a COVID-19 vaccine when they believe it is safe and recommended. Public health experts and organizations must generate youth-centered materials that directly address their vaccination concerns.

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Recent increases in COVID-19 cases are associated to infections among a younger population in the US. 1 In a focused survey administered prior to vaccine emergency use authorizations (EUAs), 2 in 5 US youths reported willingness to vaccinate against COVID-19, whereas 1 in 3 were uncertain. 2 Since then, the US has implemented a mass immunization campaign. 3 Widespread vaccine uptake among youth is essential to achieve adequate community immunization levels to attenuate the COVID-19 pandemic. 4 We therefore collected the thoughts and opinions from a diverse sample of US youth after the initiation of mass immunization campaigns regarding COVID-19 vaccine acceptability, perceived barriers to vaccination, and anticipated changes in behavior. MethodsRespondents were part of the MyVoice Poll of Youth, a national text message survey that collects the perspectives of youth (aged 14-24 years) on health and policy issues. 5 Youths are recruited on a rolling basis to match national demographic benchmarks, including self-reported age, sex, race and ethnicity, education, and region of the country, based on weighted samples from the American Community Survey. This study was approved by the University of Michigan institutional review board, including a waiver of parental consent for minor participants. This study followed the American Association for Public Opinion Research (AAPOR) reporting guidelines. Online consent was obtained from all participants. Five open-ended questions were fielded on March 12, 2021, via text message regarding COVID-19 vaccination.The authors developed a codebook through qualitative thematic analysis of responses.Responses were independently coded by 2 investigators (S.M.G., E.J.B., J.R., M.W., X.A.) using discussion to reach consensus. When appropriate, close-ended questions were first categorized (eg, yes, no) and the associated open-ended questions ("Why or why not?") were then coded using thematic analysis to provide additional insight into these questions. Summary statistics of demographic data and code frequencies were calculated. Analyses were completed using Stata statistical software (version 16; StataCorp, LLC). ResultsOf 1155 participants, 1074 responded to at least 1 question (response rate, 93%). The demographic characteristics of these respondents are shown in Table 1. In brief, respondents most commonly identified as male (n = 526 [49.0%]), and non-Hispanic-White individuals (n = 661 [61.7%]), with a mean (SD) age of 19.3 (2.4) years.Table 2 summarizes the major themes, with representative quotes by question. Overall 797 of 1068 youth respondents (74.6%) were interested in getting vaccinated to protect themselves and return to normal ("Yes I will because I want to help stop the spread as well as get back to normal as soon as possible"). Of 1009 youth respondents, most were concerned about adverse effects ( 422[41.8%]) and the effectiveness if the vaccine (118 [11.7%]), whereas 324 (32.1%) had no concerns. Of 990 youth respondents, 721 (72.8%) believed the vaccines are safe and/or eff...