TY - JOUR T1 - Factors related to COVID-19 vaccine hesitancy among middle-income and low-income adults in the USA JF - Journal of Epidemiology and Community Health JO - J Epidemiol Community Health DO - 10.1136/jech-2021-218535 SP - jech-2021-218535 AU - Vu-Thuy Thi Nguyen AU - Yuan Huang AU - Minda Huang AU - Jack Tsai Y1 - 2023/03/08 UR - http://jech.bmj.com/content/early/2023/03/07/jech-2021-218535.abstract N2 - Background Vaccine hesitancy has been an ongoing challenge in campaigns, especially the rapid development and approval of the COVID-19 vaccines. The goal of this study was to understand the characteristics, perceptions and beliefs of COVID-19 vaccination prior to its widespread rollout among middle-income and low-income US adults.Methods Using a national sample of 2101 adults who completed an online assessment in 2021, this study examines the association of demographics, attitudes and behaviours related to COVID-19 vaccination intentions. Adaptive least absolute shrinkage and selection operator models were used to select these specific covariate and participant responses. Poststratification weights were generated using raking procedures and applied to improve generalisability.Results and conclusion Vaccine acceptance was high at 76% with 66.9% reporting intent to receive the COVID-19 vaccine when available. Only 8.8% of vaccine supporters screened positive for COVID-19-related stress compared with 9.3% among the vaccine hesitant. However, there were more people with vaccine hesitancy who screened positive for poor mental health and alcohol and substance misuse. The three main vaccine concerns were side effects (50.4%), safety (29.7%) and mistrust of vaccine distribution (14.8%).Factors influencing vaccine acceptance included age, education, children, region, mental health and social support, threat perception, opinion of governmental response, risk exposure and prevention activities and rejecting COVID-19 vaccine concerns. The results indicated acceptance was more strongly associated with beliefs and attitudes about the vaccine than sociodemographics, which are noteworthy and may lead to targeted interventions to increase COVID-19 vaccine acceptance among subgroups who are vaccine hesitant.Data are available upon reasonable request. ER -