key: cord-0923298-f1qn9cie
authors: Dobbs, Page D.; Herrmann, Emily; Vidal, Charlie; Mena, Daniela Ameijeiras; Jones, Ches
title: Factors that influence Puerto Rican's intention to get the COVID-19 vaccine
date: 2022-01-22
journal: Explor Res Clin Soc Pharm
DOI: 10.1016/j.rcsop.2022.100106
sha: d8db5a138256f1e0bab8e7c3660ee2b7ea3cd826
doc_id: 923298
cord_uid: f1qn9cie

Despite Latino Americans having been found to be disproportionally affected by COVID-19, they report higher hesitancy to receive the COVID-19 vaccine than non-Hispanic whites. The purpose of this study was to examine factors that influence Puerto Rican's intentions to get the COVID-19 Vaccine. A sample (n = 173) of people who currently lived in Puerto Rico were recruited to complete an online, cross-sectional survey about their intention to receive the COVID-19 vaccine. Demographics and vaccine hesitancy were assessed, and logistic regressions explored relationships between variables and intention to get the COVID-19 vaccine when it became available. When controlling for covariates, 30–49-year-olds (aOR = 0.12) and those who had refused a vaccine in the past (aOR = 0.07) had lower odds of vaccine uptake than those between 18 and 29 years and who had not previously refused a vaccine, respectively. Those who had completed at least a 4-year college degree (aOR = 6.78) had greater odds of intending to get vaccinated than their counterparts. Health education campaigns about COVID-19 in Puerto Rico should be tailored to working-age adults who may mistrust information they have heard about the vaccine. Messages could be tailored to preferred communication channels to decrease vaccination hesitancy.

prevent this population from getting vaccinated. Thus, fear-based theoretical models and theories can help to understand what factors may impact behavioral intention and behavior.

While research has focused on preventative practices 24, 25 and morbidity/mortality 26,27 among predominately Latino populations (e.g., Puerto Ricans), there remains a gap in research regarding vaccination rates among Puerto Ricans and factors that might influence this vulnerable population's intention to receive the COVID-19 vaccine. Therefore, it was the purpose of this study to explore factors associated with Puerto Ricans' intentions to get the COVID-19 Vaccine.

Those who currently lived in Puerto Rico and were 18 years of age and older were invited to participate in an anonymous, online, cross-sectional survey between January 26 and March 17, 2021, around the time that vaccines were first available. Participants were recruited via social networks (e.g., Facebook, Twitter, Reddit). No incentives were used to recruit participants.

Informed consent was obtained before participants completed the survey, which was offered in both English and Spanish via Qualtrics. All study procedures were approved by the [Blinded for Review] Institutional Review Board.

J o u r n a l P r e -p r o o f Demographic items measured participants' age, sex, marital status, educational attainment, race/ethnicity and asked if the participant had any current chronic diseases or was a healthcare worker. These demographic items were identified from previous COVID-19 related research. 28, 29 Participants were also asked about the perceived risk of contracting COVID-19, vaccine hesitancy, and intention to get the COVID-19 vaccine. Marital status was dichotomized into -married‖ or -single‖ with those who were single, widowed, or divorce categorized as -single‖. Race/ethnicity was dichotomized into -Hispanic/Latino‖ and -Other‖; those who identified as White, Black or African American, Native American or American Indian, Asian/Pacific Islander, and Other were categorized as -Other‖ due to frequencies.

Vaccine hesitancy was assessed using two items used in previous research: (1) ‗‗Have you ever refused a vaccine for yourself or a child because you considered it as useless or dangerous?‖ and (2) ‗‗Have you ever postponed a vaccine recommended by a physician because of doubts about it?‖ 28 Participants provided yes/no dichotomous responses to each item.

Intention to receive the vaccine was measured by asking participants' -Do you plan to receive the coronavirus vaccine when it is available to you?‖ Responses were measured on a 5-point Of the 285 participants who were recruited to complete the survey, 17 did not meet eligibility criteria, 63 did not provide consent to participate or did not continue to complete the survey after reading the consent page, and 30 did not complete relevant variables for the current analyses. During the analysis, we identified two participants who misinterpreted the open-ended item that asked their reason for not intending to get vaccinated by answering that they had already received it. Subsequently, we removed these two responses, and the final sample included 173 participants. Descriptive statics were reported, and logistic regressions examined relationships between independent variables (i.e., demographics variables, perceived risk of contracting COVID-19, and vaccine hesitancy) and intention to get the COVID-19 vaccine (dependent variable). After removing one item (afraid of COVID-19) for multicollinearity issues with the item that measured the risk of contracting COVID-19, we determined there to be no multicollinearity issues (tolerance ranged from .71-.93 and variance inflation factor [VIF] ranged from 1.05-1.4; numbers closer to 1 indicting stronger independence and less multicollinearity). 30 Odds ratios (OR) and adjusted odds ratios (aOR) were reported along with 95% confidence intervals (95% CI). All confounding factors included in the multivariate logistic regression model are reported in Table 2 Table 1 for frequencies.

When asked about COVID-19, 72.3% of the sample reported they were afraid of the disease, and 69.4% felt at risk for contracting it. Further, 35.3% of participants reported they had put off a vaccine recommended by their doctor in the past, and 13.9% of participants had refused a vaccine for themselves or their child because they thought it was useless or dangerous.

Variables associated with intention to get the COVID-19 vaccine included age, educational attainment, putting off getting a vaccine and refusing to get a vaccine. Those Table 2 ). Those who have previously postponed a vaccine (OR = 0.37; 95% CI = 0.15 -0.87) or had ever refused a vaccine (OR = 0.10; 95% CI = 0.04 -0.26) had lower odds of intending to receive the COVID-19 vaccine than their counterparts. Those who had completed a 4-year college degree or higher were over four times as likely (OR = 4.33; 95% CI = 1.78 -10.56) to intend to get vaccinated as those who completed less than a 4-year college degree.

Further, those who lived with someone who was 65 years of age or older (OR = 3.21; 95% CI = 1.30 -7.90) had higher odds of intending to get the vaccine than their counterparts.

After adjusting for all other variables, age, educational attainment, and vaccine refusal for oneself or child were found to be independently associated to intention to get the COVID- 

We sought to explore factors that influenced Puerto Ricans' intentions to get the COVID- 19 Vaccine. While studies are emerging about vaccine hesitancy and particular populations' intentions to get the vaccine, studies specific to Puerto Rico are limited to early interventions used to slow the spread of the virus, 25 prevention practices, 24 and morbidity, and mortality risks. 26, 34 Thus, understanding factors that may influence COVID-19 vaccine uptake intentions among this predominately Latino population is increasingly important, especially with U.S.

Latino adults reporting greater vaccine hesitancy than non-Hispanic whites. 12 Interestingly, we found the majority (85.5%) of our sample to report intention to receive the COVID-19 vaccine during a time when it was initially becoming available, findings that mirrored vaccine acceptance rates in Latin countries more than Latino populations living in the U.S. 14, 15 While vaccines have been recognized as one of the greatest public health accomplishments of the past 100 years, 35 the spread of false safety information about vaccines via the Internet has created devastating public health challenges even before the COVID-19 vaccine was made available to the public. 36 Consistent with previous studies among other populations, 39 we found that greater educational attainment was associated with increased intention to get the COVID-19 vaccine.

Further, similar to a study among working-age adults (defined as those 18-64), 40 we found 30 -49 year-olds were less likely than those less than 30 years to intend to receive the vaccine.

Working-age adults may be less likely than younger and older populations to intend to be vaccinated against COVID-19. However, among our sample, those living with someone who was 65 years of age and older were associated with increased odds of intending to get vaccinated; however, it was not significantly related to vaccine uptake intention when adjusting for all other factors. Thus, those working to increase vaccinations rates in Puerto Rico may consider emphasizing family-based messages to working adults.

Interestingly, when we asked those who intended to refuse the vaccine for reasons that would prevent them from getting vaccinated, the most common responses were due to trust.

Research suggests that U.S. Latino populations (and Black populations) report historical mistreatment in research (e.g., Tuskegee study) and feel as though their voice is ignored by medical professions, leading to mistrust in those developing and distributing the vaccine. 41 However, other research suggests health professionals, academic institutions, and government J o u r n a l P r e -p r o o f agencies were the most trusted sources of information about COVID-19 and were trusted more than news media, family/friends, and social media. 42 Although trust in sources sending information about the vaccine is important because of the influence it can have on intention to get vaccinated against COVID-19, 43 it is unknown how U.S. Latino populations perceive information sources reporting about COVID-19.

Those living in Latin America who were identified as optimists were found to have lower levels of fear about COVID-19 while pessimists had higher levels of fear, which was found to be related to all information sources. 44 While this helps to explain that excessive information about COVID may instill fear, 44 this has not been explored among Latino populations living in American states and territories. Latino Americans who have been hospitalized report receiving misinformation about COVID-19, which may have put them at an increased disadvantage for not getting the vaccine and contracting COVID-19. 45 Alternatively, as of September 2021, vaccination rates among Hispanic Americans had increased to rates similar to those of their non-Hispanic white counterparts. 46 These findings may suggest that Latino Americans are gaining trust in the vaccine.

Due to convenience sampling, no generalizations can be made about those living in Puerto Rico. Of our sample, 78.3% reported having a 4-year degree or higher, which is substantially higher than the 27.2% of Puerto Ricans reported to have a bachelor's degree or higher, 47 further emphasizing the lack of generalizability of the data. Further, because all J o u r n a l P r e -p r o o f participants had social media, findings are not representative of consumers in the population without social media accounts. Participants were not recruited from local health centers, departments of health, and pharmacies due to COVID restrictions that prevented the research team from distributing materials in locations where participants would normally have waited; however, researchers should consider such methods as locations for advertising similar research when possible. Due to the cross-sectional nature of this study, findings do not imply causality.

Some odds ratios had wide confidence intervals; thus, these results may be interpreted with caution.

Among our sample, age, educational attainment, and previous refusal of a vaccine were associated with intention to get the COVID-19 vaccine when it became available. Similar to other populations, working-age Puerto Ricans may be less likely to trust information about the vaccine, which could affect uptake. However, more research is needed to understand vaccine hesitancy among Latino populations as well as what type of information this population does trust. Further, higher educational attainment was associated with greater intentions to get the vaccine. Thus, those creating education material to increase vaccine uptake among those living in Puerto Rico should ensure health campaigns about the vaccine use appropriate literacy levels to increase trust among those with less education and are tailored to address concerns of disparate populations and those most hesitant to receive the vaccine. 

Coronavirus resource center: COVID-19 dashboard by the center for systems science and engineering (CSSE)

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Puerto Rico Department of Health. COVID-19 Cases in Puerto Rico

Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans -United States

Chronic Disease and the Latinx Population: Threats, Challenges, and Opportunities. In: New and Emerging Issues in Latinx Health

Racial Disparities in COVID-19 Impacts and Vaccinations for Children

Latest Data on COVID-19 Vaccinations by Race/Ethnicity

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Latest Data on COVID-19 Vaccinations by Race/Ethnicity.; 2021

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Assessment of early mitigation measures against COVID-19 in Puerto Rico

Estimating and Characterizing COVID-19

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Awareness and perceptions related to COVID-19 among cancer patients: A survey in oncology department

Multicollinearity and Regression Analysis

IBM SPSS Statistics for Windows

College students' reasons for using different ecigarette products: A mixed methods analysis. J Am Coll Heal

College Students' Reasons for Using JUULs

The COVID-19 pandemic in the USA: what might we expect?

Ten great public health acheivements-United States

Opportunities and challenges of Web 2.0 for J o u r n a l P r e -p r o o f Journal Pre-proof vaccination decisions

Lessons from an online debate about measles-mumps-rubella (MMR) immunization

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Determinants of COVID-19 vaccine acceptance in the US

COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics

COVID-19 Vaccine Acceptance and Access Among Black and Latinx Communities

Source Trust and COVID-19 Information Sharing: The Mediating Roles of Emotions and Beliefs About Sharing

Trust in a COVID-19 vaccine in the U.S.: A social-ecological perspective

Optimism-pessimism, conspiracy theories and general trust as factors contributing to COVID-19 related behavior -A cross-cultural study

Experiences of Latinx Individuals Hospitalized for COVID-19: A Qualitative Study

Kaiser Family Foundation. COVID-19 Vaccinations by Race/Ethnicity: Differences and Limitations Across Measures

Educational Attainment in Puerto Rico American Community Survey 1-Year Estimates Subject Tables