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Community Level Correlates of COVID-19 Booster Vaccine Hesitancy in the United States: A Cross-Sectional Analysis
1 , * 1 , 1 , 2 , 2 , 1
1  Kirk Kerkorian School of Medicine at UNLV
2  University of Nevada Las Vegas
Academic Editor: François Meurens



The COVID-19 vaccine was the first mRNA vaccine to receive full FDA approval. It has been shown that the novelty of mRNA vaccines significantly increases vaccine hesitancy, possibly due to the spread of misinformation on this technology. Additionally, previous research has indicated that individual-level socio-demographic factors contribute to vaccine hesitancy. However, it is unknown how community-level factors affect COVID-19 booster dose hesitancy. The current study aims to fill this knowledge gap by comparing data from a nation-wide survey on COVID-19 vaccine hesitancy with a community-level indicator i.e. Distressed Communities Index (DCI).


This cross-sectional study utilized a 48-item, psychometrically valid and reliable tool to measure attitudes toward vaccinations, vaccine literacy, COVID-19 vaccine confidence index, and trust in July 2021. A total of 2,138 survey participants residing in the United States were divided into quintiles of varying community distress levels (ranging from 1=prosperous to 5=distressed) based on their zip codes using the DCI. Data were analyzed through Chi-square, one-way ANOVA, and post-hoc analysis with Tukey’s test.


A significantly larger proportion of participants from the distressed communities had lower trust as opposed to their prosperous counterparts (26.6% vs. 37.6%, p<0.001). On the contrary, participants from the prosperous communities had the significantly higher mean scores of the vaccine confidence index as opposed to those who were living in distressed communities (2.22±1.13 vs. 1.70±1.01, p<0.001).


These findings affirm the importance of developing community-level interventions in these more vulnerable groups to promote trust in COVID-19 vaccinations, thereby increasing COVID-19 booster dose uptake. From these results, future studies can examine the efficacy of various community-level interventions in promoting vaccine confidence in communities with higher rates of vaccine hesitancy.

Keywords: COVID-19 Booster Hesitancy; COVID-19 Vaccine Hesitancy; community level; vaccine hesitancy; distressed community index; community level indicators