• Kimberly E Bonner, Kushagra Vashist, Neetu S Abad, Jennifer L Kriss, Lu Meng, James T Lee, Elisabeth Wilhelm, Peng-Jun Lu, Rosalind J Carter, Kwanza Boone, Brittney Baack, Nina B Masters, Debora Weiss, Carla Black, Qian Huang, Sitaram Vangala, Christina Albertin, Peter G Szilagyi, Noel T Brewer, and James A Singleton.
• Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Oregon Health Authority Public Health Division, Oregon Health Authority, Portland, Oregon; COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: voq2@cdc.gov.
• Am J Prev Med. 2023 Jun 1; 64 (6): 865876865-876.

IntroductionCOVID-19 vaccines are safe, effective, and widely available, but many adults in the U.S. have not been vaccinated for COVID-19. This study examined the associations between behavioral and social drivers of vaccination with COVID-19 vaccine uptake in the U.S. adults and their prevalence by region.MethodsA nationally representative sample of U.S. adults participated in a cross-sectional telephone survey in August-November 2021; the analysis was conducted in January 2022. Survey questions assessed self-reported COVID-19 vaccine initiation, demographics, and behavioral and social drivers of vaccination.ResultsAmong the 255,763 respondents, 76% received their first dose of COVID-19 vaccine. Vaccine uptake was higher among respondents aged ≥75 years (94%), females (78%), and Asian non-Hispanic people (94%). The drivers of vaccination most strongly associated with uptake included higher anticipated regret from nonvaccination, risk perception, and confidence in vaccine safety and importance, followed by work- or school-related vaccination requirements, social norms, and provider recommendation (all p<0.05). The direction of association with uptake varied by reported level of difficulty in accessing vaccines. The prevalence of all of these behavioral and social drivers of vaccination was highest in the Northeast region and lowest in the Midwest and South.ConclusionsThis nationally representative survey found that COVID-19 vaccine uptake was most strongly associated with greater anticipated regret, risk perception, and confidence in vaccine safety and importance, followed by vaccination requirements and social norms. Interventions that leverage these social and behavioral drivers of vaccination have the potential to increase COVID-19 vaccine uptake and could be considered for other vaccine introductions.Published by Elsevier Inc.

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