Abstract
PURPOSE: To examine the vaccine-related beliefs and behaviors associated with likely hesitancy toward vaccination against coronavirus disease 2019 (COVID-19) among nonelderly adults. METHODS: A cross-sectional survey was conducted in June 2020. Responses were sought from Tennessee adults 18 to 64 years of age who were not healthcare providers. The survey instrument focused on vaccine-related beliefs, prior and planned influenza and pneumococcal vaccine use, and attitudes toward receiving a COVID-19 vaccination. Inferential statistics assessed survey responses, and logistic regression determined predictors of the likelihood of COVID-19 vaccination. RESULTS: A total of 1,000 completed responses were analyzed (a 62.9% response rate), and respondents were mostly White (80.1%), insured (79.6%), and/or actively working (64.2%); the sample was well balanced by gender, age, income, and political leaning. Approximately one-third (34.4%) of respondents indicated some historical vaccine hesitancy, and only 21.4% indicated always getting a seasonal influenza vaccination. More than half (54.1%) indicated at least some hesitancy toward vaccination against COVID-19, with 32.1% citing lack of evidence of vaccine effectiveness as the leading reason. COVID-19 vaccine hesitancy was more likely among those with more moderate (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.749-3.607) or conservative (OR, 3.01; 95% CI, 2.048-4.421) political leanings, Black Americans (OR, 1.80; 95% CI, 1.182-2.742), and residents of nonmetropolitan areas (OR, 1.99; 95% CI, 1.386-2.865). CONCLUSION: Subgroups of the population may prove more challenging to vaccinate against COVID-19, requiring targeted approaches to addressing hesitancy to ensure more-vulnerable populations are adequately covered.