Regional Disparities in COVID-19 Vaccine Hesitancy: The Moderating Role of Social Distancing and Vaccine Rollout in the U.S.

Abstract

This study examines the relationship between statewide contexts and individuals’ COVID-19 vaccine hesitancy by using the Household Pulse Survey, a national and near real-time data timely deployed by the U.S. Census Bureau. Controlling for the individual- and state-level variables in addition to temporal effect, this study finds that racial and ethnic minorities and COVID-19-infected people are more hesitant than their counterparts to receive a vaccine. Individuals who reside in a state where more stringent social distancing measures – particularly mask mandate – are implemented and vaccine rollout conditions are better appear to be less hesitant to receive a COVID-19 vaccine. Vulnerable subpopulation groups such as people of color and COVID-19-infected individuals are more hesitant to vaccine uptake even if regional circumstances are equal. These findings suggest that the continuation and extension of vaccine campaigns at the regional as well as individual levels are all important for expediting COVID-19 vaccination and reducing vaccine hesitancy as the world is in the middle of the third year of the pandemic.

Keywords

Coronavirus (COVID-19) pandemic vaccine hesitancy social distancing vaccine rollout regional disparities

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References

Adhikari

Cheah

P. Y

. 2021. “Vaccine Hesitancy in the COVID-19 Era.” The Lancet Infectious Diseases 21, 8: 1086. doi:10.1016/S1473-3099(21)00390-X.

Alhalaseh

Fayoumi

Khalil

2020. “The Health Belief Model in predicting healthcare workers' intention for influenza vaccine uptake in Jordan.” Vaccine 38 (46): 7372–7378. doi:10.1016/j.vaccine.2020.09.002.

Anderson

File

Marshall

Mcelrath

Scherer

2021. How Do COVID-19 Vaccination and Vaccine Hesitancy Rates Vary Over Time? (America Counts: Stories Behind the Numbers). Washington, D.C.: U.S. Census Bureau. https://www.census.gov/library/stories/2021/04/how-do-covid-19-vaccination-and-vaccine-hesitancy-rates-vary-over-time.html?utm_campaign=20210414msacos1ccstors&utm_medium=email&utm_source=govdelivery

Arroyo

Mars

Ruiz

2021. “Activity Participation and Wellbeing During the Covid-19 Lockdown in Spain.” International Journal of Urban Sciences: 1–30. doi:10.1080/12265934.2021.1925144.

Bailey

Clark

Colombelli

Corradini

De Propris

Derudder

Fratesi

Fritsch

Harrison

Hatfield

Kemeny

Kogler

D. F.

Lagendijk

Lawton

Ortega-Argilés

Otero

C. I.

Usai

2020. “Regions in a Time of Pandemic.” Regional Studies 54 (9): 1163–1174. doi:10.1080/00343404.2020.1798611.

Bailey

Crescenzi

Roller

Anguelovski

Datta

Harrison

2021. “Regions in Covid-19 Recovery.” Regional Studies 55 (12): 1955–1965. doi:10.1080/00343404.2021.2003768.

Bauer

Pitts

Ruffini

Schanzenbach

D. W.

2020. The Effect of Pandemic EBT on Measures of Food Hardship. Washington, D.C.: Brookings. https://www.brookings.edu/wp-content/uploads/2020/07/P-EBT_LO_7.30.pdf

Bhin

Son

2021. “Reduction and Reallocation of Bus Use Under COVID-19: An Analysis of Bus Card Data of Gyeonggi Province, South Korea.” International Journal of Urban Sciences: 1–21. doi:10.1080/12265934.2021.1936137.

Bogart

L. M.

Ojikutu

B. O.

Tyagi

Klein

D. J.

Mutchler

M. G.

Dong

Lawrence

S. J.

Thomas

D. R.

Kellman

2021. “COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV.” JAIDS Journal of Acquired Immune Deficiency Syndromes 86 (2): 200–207. doi:10.1097/QAI.0000000000002570.

10.

Bourdin

Jeanne

Nadou

Noiret

2021. “Does Lockdown Work? A Spatial Analysis of the Spread and Concentration of Covid-19 in Italy.” Regional Studies 55 (7): 1182–1193. doi:10.1080/00343404.2021.1887471.

11.

Callen

2021a. Majority of Small Businesses Not Requiring Employees Get Tested or Vaccinated (America Counts: Stories Behind the Numbers). Washington, D.C.: U.S. Census Bureau. https://www.census.gov/library/stories/2021/03/majority-of-small-businesses-not-requiring-employees-get-tested-or-vaccinated.html

12.

Callen

2021b. Phase 3.1 of Household Pulse Survey Now Asks How COVID Vaccines Affect Recipients’ Behavior (America Counts: Stories Behind the Numbers). Washington, D.C.: U.S. Census Bureau. https://www.census.gov/library/stories/2021/05/household-pulse-survey-now-asks-how-covid-vaccines-affect-recipients-behavior.html?utm_campaign=20210504msacos1ccstors&utm_medium=email&utm_source=govdelivery

13.

Carico

R. “Ron

Sheppard

Thomas

C. B.

2021. “Community Pharmacists and Communication in the Time of COVID-19: Applying the Health Belief Model, 1987–1984.” Research in Social and Administrative Pharmacy 17 (1): 1984. doi:10.1016/j.sapharm.2020.03.017.

14.

Casas

Delmelle

Varela

2010. “A Space-Time Approach to Diffusion of Health Service Provision Information.” International Regional Science Review 33 (2): 134–156. doi:10.1177/0160017609354760.

15.

Centers for Disease Control and Prevention . 2021. Estimates of Vaccine Hesitancy for COVID-19. Washington, D.C.: Centers for Disease Control and Prevention. https://data.cdc.gov/stories/s/cnd2-a6zw

16.

Chen

Clark

W. A. V.

Shi

2022. “What Affects Perceived Health Risk Attitude During the Pandemic: Evidence From Migration and Dining Behavior in China.” International Regional Science Review: 016001762211061. doi:10.1177/01600176221106126.

17.

Chervenak

F. A.

McCullough

L. B.

Bornstein

Johnson

Katz

McLeod-Sordjan

Nimaroff

Rochelson

B. L.

Tekbali

Warman

Williams

Grünebaum

2021. “Professionally Responsible Coronavirus Disease 2019 Vaccination Counseling of Obstetrical and Gynecologic Patients.” American Journal of Obstetrics and Gynecology. S000293782100082X. doi:10.1016/j.ajog.2021.01.027.

18.

Costa

M. F.

2020. “Health Belief Model for Coronavirus Infection Risk Determinants.” Revista de saude publica 54: 47. doi:10.11606/s1518-8787.2020054002494.

19.

Dabla-Norris

Khan

Lima

Sollaci

2021. Who Doesn’t Want to be Vaccinated? Determinants of Vaccine Hesitancy During COVID-19 (IMF Working Paper WP/21/130). Washington, D.C.: International Monetary Fund.

20.

Dubé

Gagnon

Dominique

MacDonald

Noni

Bocquier

Aurélie

Peretti-Watel

Patrick

Verger

Pierre

. 2018. “Underlying Factors Impacting Vaccine Hesitancy in High Income Countries: A Review of Qualitative Studies.” Expert Review of Vaccines 17 (11): 989–1004. doi:10.1080/14760584.2018.1541406.

21.

Ekwebelem

O. C.

Yunusa

Onyeaka

Ekwebelem

N. C.

Nnorom-Dike

2021. “COVID-19 Vaccine Rollout: Will it Affect the Rates of Vaccine Hesitancy in Africa?” Public Health 197: e18–e19. doi:10.1016/j.puhe.2021.01.010.

22.

Federal Election Commission . 2021. Official 2020 Presidential General Election Results. Washington, D.C.: Federal Election Commission (FEC). chrome-extension.//efaidnbmnnnibpcajpcglclefindmkaj/. https://www.fec.gov/resources/cms-content/documents/2020presgeresults.pdf

23.

File

Mohanty

2021. Around Half of Unvaccinated Americans Indicate They Will “Definitely” Get COVID-19 Vaccine (America Counts: Stories Behind the Numbers). Washington, D.C.: U.S. Census Bureau. https://www.census.gov/library/stories/2021/01/around-half-of-unvaccinated-americans-indicate-they-will-definitely-get-covid-19-vaccine.html

24.

Finney Rutten

L. J.

Zhu

Leppin

A. L.

Ridgeway

J. L.

Swift

M. D.

Griffin

J. M.

St Sauver

J. L.

Virk

Jacobson

R. M.

2021. “Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy.” Mayo Clinic Proceedings 96 (3): 699–707. doi:10.1016/j.mayocp.2020.12.024.

25.

Fisher

K. A.

Bloomstone

S. J.

Walder

Crawford

Fouayzi

Mazor

K. M.

2020. “Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults.” Annals of Internal Medicine 173 (12): 964–973. doi:10.7326/M20-3569.

26.

Forsyth

2020. “Speaking to the Future: COVID-19 and the Planning Community.” Journal of the American Planning Association 86, 3: 281–283. doi:10.1080/01944363.2020.1760002.

27.

Frank

L. D.

Engelke

2005. “Multiple Impacts of the Built Environment on Public Health: Walkable Places and the Exposure to Air Pollution.” International Regional Science Review 28 (2): 193–216. doi:10.1177/0160017604273853.

28.

Garcia-López

M.-À

. 2022. Why face-to-face still matters: The persistent power of cities in the post-pandemic era: by Jonathan Reades and Martin Crookston. Bristol: Bristol University Press, 2021. vi + 246 pp., £19.99 (pbk), ISBN 978-1-5292-1600-4. https://bristoluniversitypress.co.uk/why-face-to-face-still-matters-2. Regional Studies, 1–1. doi:10.1080/00343404.2021.2013632

29.

Green

M. S.

Abdullah

Vered

Nitzan

2021. “A Study of Ethnic, Gender and Educational Differences in Attitudes Toward COVID-19 Vaccines in Israel – Implications for Vaccination Implementation Policies.” Israel Journal of Health Policy Research 10, 1: 26. doi:10.1186/s13584-021-00458-w.

30.

Grünebaum

McCullough

L. B.

Litvak

Chervenak

F. A.

2021. “Inclusion of Pregnant Individuals Among Priority Populations for Coronavirus Disease 2019 Vaccination for all 50 States in the United States.” American Journal of Obstetrics and Gynecology. S0002937821000818. doi:10.1016/j.ajog.2021.01.026.

31.

2021. “COVID-19 Projections Using Machine Learning.” https://covid19-projections.com/

32.

Habib

M. A.

Anik

M. A. H.

2021. “Examining the long term impacts of COVID-19 Using an Integrated Transport and Land-Use Modelling System.” International Journal of Urban Sciences: 1–24. DOI: 10.1080/12265934.2021.1951821.

2020. “Does Density Aggravate the COVID-19 Pandemic?: Early Findings and Lessons for Planners.” Journal of the American Planning Association 86 (4): 495–509. doi:10.1080/01944363.2020.1777891.

34.

Henderson

J. V.

1999. “Overcoming the Adverse Effects of Geography: Infrastructure, Health, and Agricultural Policies.” International Regional Science Review 22 (2): 233–237. doi:10.1177/016001799761012271

35.

Hermann

Cornelissen

2020. “Using the Census Bureau’s Household Pulse Survey to Assess the Economic Impacts of COVID-19 on America’s Households.” Harvard JCHS’s Housing Perspectives. https://www.jchs.harvard.edu/blog/using-the-census-bureaus-household-pulse-survey-to-assess-the-economic-impacts-of-covid-19-on-americas-households

36.

Hsing

J. C.

Barrero-Castillero

Jani

S. G.

Pulendran

U. P.

Lin

B.-J.

Thomas-Uribe

Wang

C. J.

2021. “Influence of Health Beliefs on Adherence to COVID-19 Preventative Practices: International, Social Media–Based Survey Study.” Journal of Medical Internet Research 23 (2): e23720. doi:10.2196/23720.

37.

Ivory

Leatherby

Gebeloff

2021. Least Vaccinated U.S. Counties Have Something in Common: Trump Voters. New York: New York Times. https://www.nytimes.com/interactive/2021/04/17/us/vaccine-hesitancy-politics.html. April 17.

38.

Janz

N. K.

Becker

M. H.

1984. “The Health Belief Model: a decade later.” Health Education Quarterly 11, 1: 1–47. doi:10.1177/109019818401100101.

39.

Kang

Choi

Kim

Lee

K. O.

Lee

Park

I. K.

Park

Seo

2020. “COVID-19 Impact on City and Region: What’s Next After Lockdown?” International Journal of Urban Sciences: 1–19. doi:10.1080/12265934.2020.1803107.

40.

Kim

Lauria

D. T.

Whittington

2014. “Selecting Optimal Prices and Outpost Locations for Rural Vaccination Campaigns.” International Regional Science Review 37 (4): 436–458. doi:10.1177/0160017612461505.

41.

Kim

M.-H.

Lee

Gim

T.-H. T.

2021. “How Did Travel Mode Choices Change According to Coronavirus Disease 2019? Lessons from Seoul, South Korea.” International Journal of Urban Sciences: 1–18. doi:10.1080/12265934.2021.1951823.

42.

Larson

H.J.

Jarrett

Eckersberger

Smith

D.M.D.

Paterson

2014. “Understanding Vaccine Hesitancy Around Vaccines and Vaccination from a Global Perspective: A SYStematic review of Published Literature, 2007–2012.” Vaccine 32 (19): 2150–2159.

43.

Latkin

C. A.

Dayton

Konstantopoulos

Boodram

2021. “Trust in a COVID-19 vaccine in the U.S.: A social-ecological perspective.” Social Science & Medicine 270: 113684. doi:10.1016/j.socscimed.2021.113684.

44.

Lee

Park

Gordon

Moore

J. E.

Richardson

H. W.

2012. “Estimating the State-by-State Economic Impacts of a Foot-and-Mouth Disease Attack.” International Regional Science Review 3 (1): 26–47. doi:10.1177/0160017610390939.

45.

Leonhardt

2021. The Morning: The state of Covid. New York: New York Times. https://www.nytimes.com/2021/05/12/briefing/the-state-of-the-pandemic-fourth-wave.html. May 12.

46.

Liu

Gross

2021. “Is Travel Behaviour An Equity Issue? Using GPS Location Data to Assess the Effects of Income and Supermarket Availability on Travel Reduction During the COVID-19 Pandemic.” International Journal of Urban Sciences: 1–20. doi:10.1080/12265934.2021.1952890.

47.

Lobinska

Pauzner

Traulsen

Pilpel

Nowak

M. A.

2022. “Evolution of Resistance to COVID-19 Vaccination with Dynamic Social Distancing.” Nature Human Behaviour 6 (2): 193–206. doi:10.1038/s41562-021-01281-8.

48.

MacDonald

N. E.

2015. “Vaccine Hesitancy: Definition, Scope and Determinants.” Vaccine 33 (34): 4161–4164. doi:10.1016/j.vaccine.2015.04.036.

49.

Manville

Monkkonen

Lens

Green

2020. COVID-19 and Renter Distress: Evidence from Los Angeles. Los Angeles, CA: UCLA Lewis Center for Regional Policy Studies and USC Lusk Center for Real Estate.

50.

McCann

Ortega-Argilés

Sevinc

Cepeda-Zorrilla

2021a. “Rebalancing UK Regional and Industrial Policy Post-Brexit and Post-COVID-19: Lessons Learned and Priorities for the Future.” Regional Studies 1–13. doi:10.1080/00343404.2021.1922663.

51.

McCann

Ortega-Argilés

Yuan

P.-Y.

2021b. “The Covid-19 shock in European regions.” Regional Studies 1–19. doi:10.1080/00343404.2021.1983164.

52.

Muhajarine

Adeyinka

D. A.

McCutcheon

Green

K. L.

Fahlman

Kallio

2021. “COVID-19 Vaccine Hesitancy and Refusal and Associated Factors in an Adult Population in Saskatchewan, Canada: Evidence from Predictive Modelling.” PloS One 16 (11): e0259513. doi:10.1371/journal.pone.0259513.

53.

Office of the Assistant Secretary for Planning and Evaluation . 2021. COVID-19 Vaccine Hesitancy: Demographic Factors, Geographic Patterns, and Changes Over Time, 27. Washington, D.C.: U.S. Department of Health and Human Services.

54.

Pak

S.-I.

Lee

Sin

Park

2020. “Identifying High-risk Areas of Foot-and-mouth Disease Outbreak Using a Spatiotemporal Score Statistic: A Case of South Korea.” International Regional Science Review 43 (5): 477–500. doi:10.1177/0160017620931581.

55.

Park

2021. “Who is hardest hit by a pandemic? Racial disparities in COVID-19 hardship in the U.S.” International Journal of Urban Sciences 25 (2): 149–177. doi:10.1080/12265934.2021.1877566

56.

Park

Ahn

2022. “Government Employees’ Experience and Expectation of COVID-19 Hardships: The Moderating Role of Gender and Race in the United States.” American Review of Public Administration 52 (1): 15–35. doi:10.1177/02750740211049280

57.

Park

Choi

Kim

2022. “COVID-19 Pandemic and Mental Health Problems of Adults in United States: Mediating Roles of Cognitive Concerns and Behavioral Changes.” Social Psychiatry and Psychiatric Epidemiology 57 (8): 1557–1570. doi:10.1007/s00127-022-02265-3

58.

Park

Kim

2021. “Associations of Small Business Closure and Reduced Urban Mobility with Mental Health Problems in COVID-19 Pandemic: A National Representative Sample Study.” Journal of Urban Health 98 (1): 13–26. doi:10.1007/s11524-020-00511-0

59.

Park

Kim

Son

2022. “Disparities in Food Insecurity During the COVID-19 Pandemic: A Two-Year Analysis.” Cities 104003. doi:10.1016/j.cities.2022.104003

60.

Schanzenbach

Pitts

2020. Food Insecurity in the Census Household Pulse Survey Data Tables. Evanston, IL: Northwestern Institute for Policy Research.

61.

Sonn

J. W.

Kang

Choi

2020. “Smart City Technologies for Pandemic Control without Lockdown.” International Journal of Urban Sciences 24 (2): 149–151. doi:10.1080/12265934.2020.1764207.

62.

StataCorp . 2019. Stata Multilevel Mixed-Effects Reference Manual Release, Vol. 16. College Station, TX: StataCorp LLC.

63.

U.S. Census Bureau . 2020a. Household Pulse Survey: Measuring Social and Economic Impacts during the COVID-19 Pandemic. Washington, D.C.: U.S. Census Bureau. https://www.census.gov/programs-surveys/household-pulse-survey.html

64.

U.S. Census Bureau . 2020b. Household Pulse Survey Public Use File (PUF). Washington, D.C.: U.S. Census Bureau. https://www.census.gov/programs-surveys/household-pulse-survey/datasets.html

65.

U.S. Census Bureau . 2021. Source of the Data and Accuracy of the Estimates for the Household Pulse Survey – Phase 3.1. Washington, D.C.: U.S. Census Bureau. https://www.census.gov/programs-surveys/household-pulse-survey/technical-documentation.html#phase3.1

66.

U.S. Department of Housing and Urban Development . 2020. The Household Pulse Survey Provides Data Quickly During the Pandemic (Spotlight on PD&R Data). Washington, D.C.: U.S. Department of Housing and Urban Development. https://www.huduser.gov/portal/pdredge/pdr-edge-spotlight-article-061520.html?WT.mc_id=edge_June2020&WT.tsrc=Email

67.

Wang

Morales

M. M. R.

Husak

Kleinman

Parthasarathy

. 2021. In Communities We Trust: Institutional Failures and Sustained Solutions for Vaccine Hesitancy. University of Michigan's Technology Assessment Project Report. Ann Arbor: University of Michigan. https://stpp.fordschool.umich.edu/sites/stpp/files/2021-07/vaccine-hesitancy-STPP-TAP-2021-v5.pdf

68.

Wong

L. P.

Alias

Wong

P.-F.

Lee

H. Y.

AbuBakar

2020. “The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay.” Human Vaccines & Immunotherapeutics 16 (9): 2204–2214. doi:10.1080/21645515.2020.1790279

69.

World Health Organization . 2019. Ten threats to global health in 2019. Geneva: WHO. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

70.

Yao

Murray

A. T.

2014. “Locational Effectiveness of Clinics Providing Sexual and Reproductive Health Services to Women in Rural Mozambique.” International Regional Science Review 37 (2): 172–193. doi:10.1177/0160017614524227.

71.

Yilmazkuday

2021. “Unequal Welfare Costs of Staying at Home across Socioeconomic and Demographic Groups.” International Journal of Urban Sciences. doi:10.1080/12265934.2021.1951822.

72.

Zampetakis

L. A.

Melas

2021. “The Health Belief Model Predicts Vaccination Intentions Against COVID-19: A Survey Experiment Approach.” Applied Psychology: Health and Well-Being 13 (2): 469–484. doi:10.1111/aphw.12262.

73.

Zewdie

Mose

Sahle

Bedewi

Gashu

Kebede

Yimer

2022. “The health belief model's ability to predict COVID-19 preventive behavior: A systematic review.” SAGE Open Medicine 10: 20503121221113668. doi:10.1177/20503121221113668.

74.

Ziafati Bafarasat

2021. “Meta-Synthesis of COVID-19 Lessons: Charting Sustainable Management of Future Pandemics.” International Journal of Urban Sciences: 1–24. doi:10.1080/12265934.2021.1936136.

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