Abstract
Although COVID-19 vaccination is recommended for adolescents aged 12-17 years, they remain one of the least commonly vaccinated age groups. Therefore, studies investigating the factors associated with vaccine hesitancy among adolescents are needed. We conducted a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards from inception to October 23, 2022, for adolescent-reported factors associated with vaccine hesitancy. Titles and abstracts of articles were screened, full-text articles were reviewed for eligibility, and eligible articles were extracted by 2 independent reviewers. Results were summarized using a narrative synthesis. The review protocol was prospectively registered in PROSPERO (CRD42022363411). Of 4,140 articles screened, 302 were selected for full-text review, 27 of which met the eligibility criteria. Most studies evaluated age (n = 20 studies) and sex (n = 21 studies) in relation to COVID-19 vaccine hesitancy, yet these were uncommonly linked with vaccine hesitancy among adolescents. Adolescents consistently reported the impact of the pandemic on social activities, social and parental norms, and a sense of communal responsibility as reasons for vaccinating. Although fewer studies (n = 18 studies) evaluated theoretical-based factors, the studies conducted showed that perceived vaccine safety and efficacy (n = 6 studies), risks from vaccination (n = 5 studies), and social and parental norms (n = 3) were consistently linked with vaccine hesitancy. To address low vaccination rates, adolescent-engaged research remains needed that considers their perspectives on COVID-19 vaccines.