Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study

Abstract

Background Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. Objective To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. Methods We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. Results Roughly 28 (19%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one’s own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54%) and mistrust of vaccine safety (n=13, 46%), of effectiveness (n=12, 43%), and of the government’s involvement with vaccines (n=12, 43%). Experiences of discrimination (n=60, 40%) and mistrust of vaccines (n=54, 36%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. Conclusions Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation.

Prevalence and Assessment of Factors Associated with COVID-19 Vaccine Hesitancy in an Ethnic Minority Oncology Patient Population

“…Overall, a large majority of our patients—79%—perceived that COVID-19 was risky and dangerous, and 65% considered the vaccines to be safe, similar to prior results in cancer patient studies [ 25 , 28 , 29 , 30 , 33 , 35 , 41 , 42 , 43 , 44 ]. Other self-reported reasons for being vaccinated stated by our participants included protecting themselves, family, and friends, the collective good of ending the pandemic, and trust in the vaccine and science; again, these were very similar to previous studies in cancer patients and ethnic minorities [ 23 , 25 , 28 , 29 , 31 , 35 , 50 ]. Participants who had self-reported a fair or excellent health at the time of the survey were seen to have a significantly higher likelihood of being vaccinated, 22 times more likely compared with those who self-reported poor health, according to our multivariable logistic regression and multinomial logistic regression models ( Table 2 and Table 3 ); this represents another factor to consider when examining future vaccine uptake studies in this population.…”

“…This concern is further amplified if a patient with COVID-19 is not only unvaccinated but also has comorbidities such as cancer, predisposing them to higher risk of morbidity and mortality. COVID-19 vaccine hesitancy has been studied previously in cancer patients worldwide [ 25 , 26 , 27 , 28 , 29 , 30 , 32 , 39 , 40 , 41 , 42 , 43 , 44 ] and in the United States [ 31 , 33 , 35 , 36 , 45 ], including multiple studies of ethnic minorities in the US [ 21 , 22 , 23 , 24 , 46 , 47 , 48 , 49 , 50 , 51 ], but no known research exists specifically examining ethnic minority cancer patients and their views on the COVID-19 vaccine. This study helps address this gap in the knowledge by uniquely examining two different time-points of vaccination status 6-months post-initial survey, employing a vaccine knowledge score composite and exploring a brief educational intervention to raise patients’ awareness, to gain valuable insight into this distinctly disadvantaged population in the US.…”

“…Additionally, a positive predictor of vaccination uptake as seen previously was having access to information about COVID-19 vaccines [ 26 , 33 , 44 ], and trusting medical advice on vaccination [ 29 , 35 , 39 ]. Yet, only 60% trusted the information they had received, reflecting wide prior research [ 25 , 27 , 28 , 29 , 33 , 43 , 45 ], and highlighting concerns around the need to acquire more information [ 21 , 46 , 47 , 49 , 50 , 51 ]. These results present another avenue where increased awareness of the issue can help alleviate this problem, and suggest that a focus on correcting misinformation may help increase vaccination rates.…”

“…The long-standing healthcare disparities have been stated in various studies on COVID-19 vaccine hesitancy in ethnic minority groups, referring to accessibility and equity concerns, mistrust in the healthcare system and government [ 21 , 46 , 47 , 49 , 50 , 51 ], structural, interpersonal, historical, and contemporary racism and anti-immigration [ 47 , 48 , 50 ], barriers in transport and technology [ 21 , 46 , 47 , 48 ], housing insecurity [ 24 ], and English as a second language [ 47 ]. In our study, about 41% of participants felt that some ethnic and religious groups in the community had difficulty getting vaccinations, and only 60% trusted the information they received, although neither employment nor race and ethnicity significantly determined vaccine uptake in our study.…”

Digital Storytelling Methods to Empower Young Black Adults in COVID-19 Vaccination Decision-Making: Feasibility Study and Demonstration

“…Digital storytelling workshop participants were recruited through an online survey fielded in the larger study (N=150) from August 2021 to November 2021 and described elsewhere [ 21 ]. Respondents all self-identified as Black in survey demographic questions in the larger study from which workshop participants were identified.…”