• Am J Manag Care · Jun 2023

    COVID-19 vaccine hesitancy and health literacy in US Southern states.

    • Hadii M Mamudu, Manik Ahuja, Esther Adeniran, Adekunle Oke, Bridget Hamilton, KariLynn Dowling-McClay, Rebecca A Fletcher, David W Stewart, JoAnne Collins, Janet Keener, Timir K Paul, and Florence M Weierbach.
    • College of Public Health, East Tennessee State University, Lamb Hall, Room 159, Box 70264, Johnson City, TN 37614. Email: mamudu@etsu.edu.
    • Am J Manag Care. 2023 Jun 1; 29 (6): 300306300-306.

    ObjectivesCOVID-19 vaccination in the United States has stalled, with some of the lowest rates in the South. Vaccine hesitancy is a primary contributor and may be influenced by health literacy (HL). This study assessed the association between HL and COVID-19 vaccine hesitancy in a population residing in 14 Southern states.Study DesignCross-sectional study using a web-based survey conducted between February and June 2021.MethodsThe outcome was vaccine hesitancy, and the main independent variable was HL, assessed as an index score. Descriptive statistical tests were performed, and multivariable logistic regression analysis was conducted, controlling for sociodemographic and other variables.ResultsOf the total analytic sample (n = 221), the overall rate of vaccine hesitancy was 23.5%. Vaccine hesitancy was more prevalent in those with low/moderate HL (33.3%) vs those with high HL (22.7%). The association between HL and vaccine hesitancy, however, was not significant. Personal perception of COVID-19 threat was significantly associated with lower odds of vaccine hesitancy compared with those without perception of threat (adjusted odds ratio, 0.15; 95% CI, 0.03-0.73; P = .0189). The association between race/ethnicity and vaccine hesitancy was not statistically significant (P = .1571).ConclusionsHL was not a significant indicator of vaccine hesitancy in the study population, suggesting that general low rates of vaccination in the Southern region may not be due to knowledge about COVID-19. This indicates a critical need for place-based or contextual research on why vaccine hesitancy in the region transcends most sociodemographic differences.

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