key: cord-0292426-eanzrq01
authors: Lee, R. C.; Hu, H.; Kawaguchi, E. S.; Kim, A. E.; Soto, D. W.; Shanker, K.; Klausner, J. D.; Van Orman, S.; Unger, J. B.
title: COVID-19 booster vaccine attitudes and behaviors among university students and staff: the USC Trojan Pandemic Research Initiative
date: 2021-12-11
journal: nan
DOI: 10.1101/2021.12.09.21267545
sha: cb3210826987914fee777c6a2769077d2cd85101
doc_id: 292426
cord_uid: eanzrq01

Introduction: Although COVID-19 vaccines significantly reduce morbidity and mortality, recent evidence suggests that immunity wanes after 6-9 months, and that a third vaccine dose could further reduce COVID-19 transmission and severe illness. However, previous studies have not assessed attitudes about getting booster doses. This study examined COVID-19 booster vaccine attitudes and behaviors among university students and staff in the fall of 2021. Methods: Participants responded to an email invitation and completed electronic surveys. Results: In our sample, 96.2% of respondents indicated willingness to get a COVID-19 booster shot at least once per year. In both bivariate and multivariate analyses higher trust in science was associated with having higher odds of booster willingness. Those who identify as Black, on average, reported trusting science less than other racial/ethnic groups. Conclusions: Our findings demonstrate high willingness to receive a COVID-19 booster shot and highlight the importance of educational and motivational messages that focus on trust in science to increase willingness to get the COVID-19 booster. More research is needed to better understand the impact of cultural beliefs on booster willingness and vaccine hesitancy. This understanding will help determine what messages and populations to target to increase booster willingness in the future.

Although the Pfizer and Moderna COVID-19 vaccines significantly reduce morbidity and 28 mortality, recent evidence suggests that immunity wanes after 6-9 months, and that a third 29 vaccine dose could further reduce COVID-19 transmission and severe illness. 1 for more hesitant groups. Using data from an ongoing survey of university students and staff, we 38 assessed attitudes toward third vaccine doses and the demographic correlates of these attitudes. 39

We hypothesized an overall high willingness to get a COVID-19 booster shot because the sample 40 was from a population of college students and staff/faculty in Los Angeles, where vaccination 41 rates were relatively high. However, we also hypothesized some sub-groups may have lower 42 booster willingness compared to others. For example, the high level of vaccine hesitancy among 43

Black Americans (referred to as Blacks in the remaining part of this paper) may suggest there 44 will be a lower booster willingness as well. 6 45 46 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The survey assessed demographic characteristics including self-identified race and ethnicity, 61 gender identity, age, and student/staff status. We also assessed self-reported prior COVID-19 62 infection status and self-reported vaccination status. We assessed respondents' trust in science 63 using Nadelson's Trust in Science Scale. 7 As the main outcome variable, the survey asked how 64 often participants would be willing to get a COVID-19 booster vaccination. Booster willingness 65 was coded as "willing" (any response other than "never") and "unwilling" ("never"). 66 67 Data analysis 68 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. once per year, and nearly two-thirds were willing to get boosters as often as necessary (after 77 removing those with missing data) ( Table 1 ). In bivariate analyses, those without prior COVID-78 19 infections had higher odds of booster willingness compared to those with self-reported prior 79 COVID-19 infection (OR = 1.99; 95% CI = 1.24-3.07), and higher trust in science was 80 associated with having higher odds of booster willingness (OR = 8.36; 95% CI = 6.10-11.60) 81 (Table 2) . 82 83 In multivariate analyses, controlling for confounding by the other variables in the model, Asians 84 had over twice the odds of reporting being willing to get at least one COVID-19 booster 85 compared to Whites (OR =2.45; 95% CI = 1.46-4.18) and stronger trust in science was 86 associated with higher odds (OR = 8.73; 95% CI = 6.29-12.30) ( Table 2) . Notably, we did not 87 detect a significant association between Black race and booster willingness in both the bivariate 88 and multivariate analyses, despite our original hypothesis. To examine any racial and ethnic 89 differences in trust in science, we conducted a post hoc Kruskal Wallace test (p<0.001). Blacks 90 reported lower trust in science than other racial/ethnic groups (Figure 1) . Additionally, those 91 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2021. ; https://doi.org/10.1101/2021.12.09.21267545 doi: medRxiv preprint who were willing to get a booster trusted science more, on average, than those who were not 92 willing among all race/ethnicity groups (Figure 2) . preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2021. ; https://doi.org/10.1101/2021.12.09.21267545 doi: medRxiv preprint preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 

All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2021. ; https://doi.org/10.1101/2021.12.09.21267545 doi: medRxiv preprint Figure 2 

Willingness Status. On average, those who were willing to get a booster shot trusted 171 science more than those who were not willing among all race/ethnicity groups.

All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted December 11, 2021. ; https://doi.org/10.1101/2021.12.09.21267545 doi: medRxiv preprint

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