Plans to Vaccinate Children for Coronavirus Disease 2019: A Survey of United States Parents

COVID-19 Vaccine Hesitancy in Caregivers of Hospitalized Children From 2020 Through 2023

OBJECTIVES

Data on US caregiver perceptions on coronavirus disease 2019 (COVID-19) and COVID-19 vaccination are limited. We identified trends in and associations with COVID-19 vaccine hesitancy in caregivers of hospitalized children.

METHODS

Cross-sectional surveys on pediatric COVID-19 disease and vaccine attitudes, behaviors, and beliefs were administered across study years (December 8, 2020-April 5, 2021, November 30, 2021-March 15, 2022, and October 26, 2022-March 15, 2023). English and Spanish-speaking caregivers of hospitalized children ages 6 months to 11 years were included. General vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey.

RESULTS

Of 1268 caregivers from diverse backgrounds, one-third vaccinated or intended to vaccinate their child. Half endorsed fear of their child receiving the COVID-19 vaccine and were concerned the vaccine was new. Over time, more believed "the COVID-19 vaccine does not work" and fewer agreed "children who are otherwise healthy can die from COVID-19." Study season (2022-2023), older child age, higher income, child receipt of influenza vaccine, caregiver receipt of COVID-19 vaccine, and not being worried about vaccine novelty were positively associated with child vaccination. Intent to vaccinate was negatively associated with study season (2022-2023), Parent Attitudes about Childhood Vaccines score ≥50, lack of child influenza and caregiver COVID-19 vaccination, lack of fear of their child "getting COVID-19" and being "worried that the COVID-19 vaccine is new." The majority who intended to vaccinate were willing to immunize before discharge.

CONCLUSIONS

Vaccine novelty and perceived lack of need were associated with refusal. Caregiver COVID-19 and child influenza vaccine acceptance were positively associated with COVID-19 vaccine acceptance. The inpatient setting offers the opportunity to improve vaccine uptake.

Understanding Parental Adherence to Early Childhood Domestic Injury Prevention: A Cross-Cultural Test of the Integrated Behavior-Change Model

Unintentional injuries pose a significant risk to children in early years globally. In particular, toddlers and preschoolers are vulnerable to injuries that occur at home. Despite the availability of preventive measures that can greatly reduce the risks of domestic injuries, some caregivers (e.g., parents) of children in early childhood may not fully implement these safety measures due to poor behavioral adherence or low awareness of the risk of domestic injury. Therefore, it is crucial to understand how caregivers in different cultural contexts approach injury prevention in the home environment. In this multi-cultural study, we investigated the motivational and belief processes underlying childhood domestic injury prevention among a total of 2059 primary caregivers (parents/guardians) of infant and toddlers (aged 2 to 6 years) across four societies, Australia (AU; N = 500), the United States (US; N = 500), Singapore (SG; N = 507), and Hong Kong (HK; N = 552), by applying the integrated model of self-determination theory (SDT) and theory of planned behavior (TPB). Our results support the key tenets of the integrated model and demonstrated cultural invariance model pathways across the four societies studied. In particular, the positive relationships among psychological need support, autonomous motivation, socio-cognitive beliefs, intention, and behavior adherence remained constant across societies. With a multi-cultural sample, this study provides valuable insights into the similarities and differences in motivation and beliefs surrounding childhood domestic injury prevention across these four societies.

Social Processes and COVID-19 Vaccination of Children of Hesitant Mothers

OBJECTIVE

Investigate relationships between pediatric COVID-19 vaccination and social processes of healthcare provider recommendations and school encouragement to provide insights into social processes that may support pediatric COVID-19 vaccination among hesitant mothers.

METHODS

We analyzed survey data from a subsample (n = 509) of vaccine-hesitant mothers to child patients (ages 2 to 17) in regional clinics across Arkansas. Data were collected between September 16th and December 6th, 2022. Full information maximum likelihood multivariable logistic regression was conducted to evaluate associations with pediatric COVID-19 vaccination.

RESULTS

Adjusted odds of pediatric COVID-19 vaccination were more than three times greater when a child's healthcare provider recommended vaccination compared to when they did not (aOR = 3.52; 95% CI[2.06, 6.01]). Adjusted odds of pediatric COVID-19 vaccination were 85% greater when a child's school encouraged parents to vaccinate compared to when the school did not (aOR = 1.85; 95% CI[1.13, 3.03]).

CONCLUSIONS

For pediatric COVID-19 vaccination, having a personal healthcare provider is not significantly different from having no personal healthcare provider if they do not recommend the child be vaccinated.

PRACTICE IMPLICATIONS

Clinical and public health interventions should consider social processes of healthcare provider recommendations and school encouragement.

Exploring the relationship between vaccine hesitancy and mothers' perspectives on COVID-19 vaccines for children ages 5-11 years during the omicron predominant period 2021-2022: a qualitative study

Background

The United States Food and Drug Administration authorized COVID-19 vaccines for children ages 5-11 years in October 2021 during the Omicron predominant period. Parental vaccine hesitancy was prevalent during this time, resulting in low childhood COVID-19 vaccine uptake. Most studies exploring factors influencing parental vaccine hesitancy have focused on racial and ethnic minorities and lower socioeconomic populations; however, there is little knowledge of the drive drivers of vaccine hesitancy among White parents with higher education and socioeconomic statuses.

Methods

We conducted semi-structured interviews with a sample of 15 White mothers of children ages 5-11 years in Atlanta, GA, between October-December 2021. Thematic analysis was performed using NVivo 12.

Results

Mothers were college-educated, homeowners, and fully vaccinated against COVID-19. Key findings included decreased pediatrician's recommendations for COVID-19 vaccines, reliance on information from specialized doctors and scientists, distrust in public health authorities, high risk-perception of COVID-19 vaccines, and low risk-perception of COVID-19 disease. Factors related to vaccine acceptance were altruism and practicality.

Conclusion

This study adds to the sparse literature on reasons for vaccine hesitancy among White mothers of children ages 5-11 years with higher educational and socioeconomic status. Improving vaccine uptake among this group is critical for protecting the health of their children and other vulnerable populations. Tailored vaccine messaging and intervention are warranted to address their unique attitudes, beliefs, and behaviors. An enhanced understanding of the factors influencing subpopulations of parents can help vaccine policymakers and healthcare providers improve efforts to reduce vaccine hesitancy, particularly for new vaccines.

Exploring Hesitancy, Motivations, and Practical Issues for COVID-19 Vaccination Among Vaccine-Hesitant Adopter Parents Using the Increasing Vaccination Model

INTRODUCTION

COVID-19 vaccination coverage among children remains low, and many parents report being hesitant to get their children vaccinated. This study explores factors influencing hesitancy and the facilitators that helped hesitant adopter parents choose to vaccinate their children against COVID-19 despite their hesitancy.

METHOD

We use a qualitative descriptive design with individual interviews (n = 20) to explore COVID-19 vaccine hesitancy and facilitators of vaccination among hesitant adopter parents. The Increasing Vaccination Model domains (thoughts and feelings, social processes, and practical issues) provided the framework for initial coding, and the research team identified nine emergent themes.

RESULTS

Findings document the factors influencing hesitancy and the facilitators motivating COVID-19 vaccination among hesitant adopter parents.

DISCUSSION

Findings fill the gap in the literature by providing hesitant adopters' lived experience, perspectives on vaccine hesitancy, and the influential factors that helped participants overcome their hesitancy and choose to vaccinate their children against COVID-19.

Descriptive cross-sectional study to evaluate perception, attitude, and practice of parents regarding COVID-19 vaccination in children 10-12 years of age-A step toward prevention of future COVID-19 outbreaks in India

Purpose

COVID-19 was declared a global pandemic and all age groups were equally affected. Coronavirus had devastating effects worldwide due to the emergence of new variants till vaccination was adopted to eradicate the transmission of the virus and restore normalcy. However, children were not included in the initial phase of vaccination. The purpose of the study was to assess the level of perception, attitude, and practice among parents toward the COVID-19 vaccination drive in children 10-12 years of age.

Design and Study

The present research is a cross-sectional questionnaire-based survey including parents of children aged 10-12 years as participants. The survey was conducted between May 2022 and July 2022 with a sample size of 320.

Results

A high willingness (80%) among parents was found for getting their children vaccinated. COVID-19 vaccines were perceived to be safe by the parents (59%) and efficacious (75%) for their children. Parents (67%) felt that the benefits of getting their children vaccinated against COVID-19 prevail over the risks of the vaccine. Parents 214 (67%) feel the need of getting their child vaccinated for sending them to school followed by availing of daycare facilities after school 54 (17%) among working parents. A significant association (P < 0.05) was seen between the variables of practice being followed by parents and their children as per COVID-19 norms. Parent's negative attitude toward COVID-19 vaccination was associated with availability of no/unclear safety information (36%), fear of adverse effects of vaccine (3%), and false belief of having long-term immunity due to natural infection (32%). The positive attitude of parents was due to trust in positive information/news about the vaccine (42%), belief in the safety and efficacy of the vaccine (5%), acceptability for mild adverse effects (1%), and the necessity of vaccine to send children to schools (1%).

Conclusion and Recommendations

The awareness of parents regarding COVID-19 vaccination for children was limited, high level of acceptance for vaccination was seen in our study. We recommend to continuing educational programs through mass campaigns to increase increasing awareness among parents for getting COVID-19 vaccination for their children. Vaccine hesitancy including vaccine safety concerns of parents should be addressed by presenting myths and facts related to COVID-19 vaccine using television, radio, and social media platforms.

Short term safety of BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine among children aged 5-11 years, a nationwide parental survey

PURPOSE

SARS-CoV-2 vaccine safety is of major interest worldwide, and transparent information about potential side effects is essential to decrease vaccine hesitancy. The aim of this study was to assess SARS-CoV-2 BNT162b2 vaccine short-term side effects among children aged 5-11 years.

METHODS

An observational, cross sectional study of vaccine side-effects using electronic surveys sent to parents one week post administration of BNT162b2 vaccine to their child in a large health maintenance organization in Israel.

RESULTS

First dose and second dose surveys were filled for 5,842 and 6,126 children, respectively, with a response rate of 32.1% and 24.8%. Local side effects were reported by 68.7% and 69.1% of the first and second survey respondents, and general side effects were reported by 20.8% and 34.5% of them. The symptoms most frequently reported were fatigue, headache and myalgia. Duration of symptoms lasted three days or less among 86.5% and 81.5% of first and second dose survey respondents. Most respondents (92%) reported that their child did not need any medical consultation following vaccination.

CONCLUSIONS

We found further support for the BNT162b2 SARS-CoV-2 vaccine short- term safety among children aged 5-11 years. With ongoing pandemic and future booster COVID-19 vaccines, these findings can encourage vaccine confidence for parents and providers.

"Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine

COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.

Motivations for Adolescent COVID-19 Vaccination: A Comparative Study of Adolescent and Caregiver Perspectives in Germany

Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines.

Parental motivated helplessness in vaccinating children against COVID-19: Its association with fear, effectiveness and willingness to vaccinate

According to the motivated helplessness hypothesis, parental feelings of helplessness regarding vaccinating children against COVID-19 may serve a protective function against vaccine fear and hesitancy. Two correlational studies conducted among Israelis (Study 1) and an international sample (Study 2), examined whether self-reported perceived helplessness in vaccinating children may be related to lower vaccine-fear, and higher perceived vaccine-effectiveness, trust in authorities' recommendations and willingness to vaccinate. Results indicated parents who felt they had no other choice but to vaccinate their children, exhibited less vaccine-fear, higher vaccine-effectiveness and greater intentions to vaccinate. Additionally, the relationships between vaccine-helplessness, vaccine-effectiveness and willingness to vaccinate were partially mediated by vaccine-fear. In Study 2, vaccine-helplessness was found related to higher trust in authorities' recommendations, which was partially mediated by vaccine-fear. The implications of these findings for research on the psychological function of helplessness in the parental decision-making process of vaccinating children during a pandemic are discussed.

COVID-19 vaccination attitudes, values, intentions: US parents for their children, September 2021

OBJECTIVES

To compare vaccine-related attitudes and values of parents of children 2-17 years old to other adults, examine intentions to vaccinate their children, and identify factors associated with intending to vaccinate children.

METHODS

A nationally representative survey was conducted in September 2021 (just before the EUA for children 5-11 years old) using Ipsos KnowledgePanel, a probability-based web panel. The survey measured COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities among US adults. Scale response options to survey items were dichotomized, and cross-tabulations and logistic regressions were performed.

RESULTS

Parents had lower odds of reporting being vaccinated against COVID-19 than other adults even after adjusting for associated sociodemographic characteristics such as age (aOR: 0.66; 95 %CI: 0.50-0.87). The most prevalent parental concerns about COVID-19 vaccines included the speed of their development (88 %), potential side effects (78 %), suspicion of government (77 %), and suspicion of pharmaceutical companies (72 %). Fewer than half (42 %) of parents intended to vaccinate their children 5-11 years old, while 38 % were uncertain and 20 % were unlikely to ever vaccinate their children. Vaccinated parents had higher odds than unvaccinated parents of intending to vaccinate their children (OR: 675.51; 95 %CI: 106.46-4286.12). Discussions with healthcare providers who encouraged COVID-19 vaccination were positively associated with intent to vaccinate children (OR: 11.29; 95 %CI: 2.60-49.02).

CONCLUSIONS

We found parental vaccination and conversations with providers were positively associated with intent to vaccinate children. Decisions about childhood vaccination need to be supported by healthcare providers and a public health system that makes vaccine access and related information equitable and accessible. Vaccination-related decision making should be guided by healthcare providers and provide information about safety and risk to children.

Systematic review: Impact of parental decision on paediatric COVID-19 vaccination

OBJECTIVE

The objective was to carry out a systematic review on the acceptance of parents to vaccinate their children against COVID-19 and the factors that contribute for vaccination hesitancy.

METHODS

The Preferred Reporting Items for Systematic Re- views and Meta-Analyses (PRISMA) guidelines and the Patient, Intervention, Comparison and Outcome (PICO) strategy were followed. A search was carried out in the VHL Regional Portal, PubMed, Scielo, Web of Science, Embase and Scopus databases. We included articles that assessed the rate of acceptance and/or hesitation of parents and the factors that affect the decision about vaccination against COVID-19 for their children in cross-sectional studies. Laboratory studies, animal models, tests and case reports that elected other aspects related to COVID-19 were excluded. The methodological quality of the studies was based on the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data, developed by the Joanna Briggs Institute.

RESULTS

From the 708 articles found, 237 studies remained after removal of duplicates. Titles and abstracts of these publications were evaluated and, applying the exclusion criteria, 56 articles were selected. Inclusion criteria were employed and 28 studies were eligible. Overall average vaccination acceptance rate was 55.81%, and the main reasons for vaccine hesitancy were uncertainty of vaccine efficacy and safety, concerns about side effects, and lack of access to relevant information.

CONCLUSION

The research results can be useful for the development of health education and parental awareness strategies in order to promote greater adherence to vaccination against COVID-19.

Parents' Uptake and Willingness towards Recommended Vaccinations for Their Children with Underlying Chronic Medical Conditions in Italy

This cross-sectional survey was conducted to investigate the willingness and uptake of recommended vaccinations against influenza, meningococcal B and ACWY, pneumococcal, rotavirus and the influencing factors among 565 parents of children aged 6 months to 5 years with chronic medical conditions in Italy. Only 34.9% of the sample received all vaccinations. Parents whose selected child was vaccinated against the five diseases were those who had received recommendations from physicians, who did not believe that children should get fewer vaccinations at the same time, those whose child was aged 2-3 and 4-5 years compared to 6 months-1 year, and those who acquired information from physicians. Only 17.9% were willing to vaccinate their child. Parents with a university degree, those who acquired information from physicians, and those whose child had a more recent diagnosis were more likely to be willing to vaccinate their child. Parents who believed that children should get fewer vaccines at the same time, those without a university degree, and those who did not acquire information from physicians were more likely to not have vaccinated their child because they were concerned about vaccines' side effects. Public health policymakers should provide efforts to promote the uptake for an adequate protection of this high-risk group.

Coronavirus Disease-2019 Vaccine Hesitancy

Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, before coronavirus disease-2019 (COVID-19) vaccines were authorized, surveys began tracking public acceptance of a hypothetical COVID-19 vaccine. As vaccines became more widely available, the focus shifted from evaluating premeditative thoughts about COVID-19 vaccines to observing behaviors, measuring uptake, and characterizing factors associated with acceptance. A wealth of peer-reviewed literature examining the complexities of COVID-19 vaccine acceptance has emerged, but our understanding of COVID-19 vaccine acceptance is constantly evolving. In this article, we review the current state of knowledge regarding COVID-19 vaccine hesitancy, with an emphasis on pediatric vaccination.

Factors associated with US caregivers' uptake of pediatric COVID-19 vaccine by race and ethnicity

OBJECTIVES

To assess differences in willingness to vaccinate children against COVID-19, and factors that may be associated with increased acceptance, among US caregivers of various racial and ethnic identities who presented with their child to the Emergency Department (ED) after emergency use authorization of vaccines for children ages 5-11.

STUDY DESIGN

A multicenter, cross-sectional survey of caregivers presenting to 11 pediatric EDs in the United States in November-December 2021. Caregivers were asked about their identified race and ethnicity and if they planned to vaccinate their child. We collected demographic data and inquired about caregiver concerns related to COVID-19. We compared responses by race/ethnicity. Multivariable logistic regression models served to determine factors that were independently associated with increased vaccine acceptance overall and among racial/ethnic groups.

RESULTS

Among 1916 caregivers responding, 54.67% planned to vaccinate their child against COVID-19. Large differences in acceptance were noted by race/ethnicity, with highest acceptance among Asian caregivers (61.1%) and those who did not specify a listed racial identity (61.1%); caregivers identifying as Black (44.7%) or Multi-racial (44.4%) had lower acceptance rates. Factors associated with intent to vaccinate differed by racial/ethnic group, and included caregiver COVID-19 vaccine receipt (all groups), caregiver concerns about COVID-19 (White caregivers), and having a trusted primary provider (Black caregivers).

CONCLUSIONS

Caregiver intent to vaccinate children against COVID-19 varied by race/ethnicity, but race/ethnicity did not independently account for these differences. Caregiver COVID-19 vaccination status, concerns about COVID-19, and presence of a trusted primary provider are important in vaccination decisions.

Knowledge on Parental Hesitancy toward COVID-19 Vaccination of Children 5–11 Years Old

Although vaccines are the safest and the most effective measure to prevent disease, disability, and death from various pediatric infectious diseases, parental vaccine hesitancy is a common and increasing phenomenon worldwide. To contribute to improving our knowledge on parental willingness and hesitancy toward COVID-19 vaccine administration in children aged 5–11 years, an anonymous online questionnaire was disseminated in Italy after the COVID-19 vaccine’s authorization for this age group. An online survey was conducted using the Crowd Signal platform from 15 December 2021 to 15 January 2022 in Italy among parents of children 5–11 years old. A total of 3433 questionnaires were analyzed. Overall, a “Favorable” position was observed in 1459 (42.5%) parents, a “Doubtful” one in 1223 (35.6%) and a “Hesitant/Reluctant” one in 751 (21.9%). The univariate multinomial logistic regression analysis and the multivariate multinomial logistic regression analysis showed that the Hesitant/Reluctant parents were younger than 40 years of age, mostly female, with a secondary or middle school degree, an annual income below EUR 28,000, more than one child in the age range from 5 to 11 years, an underestimated consideration of the severity of COVID-19’s effects, and concern regarding the COVID-19 vaccines in general. These results show that in Italy, most parents of children aged 5 to 11 were doubtful or hesitant/reluctant to vaccinate their children against the COVID-19 virus. Poor trust in health institutions as well as poor consideration of the epidemiological and clinical relevance of COVID-19 in children seem to have played the biggest roles in forming these attitudes. Moreover, the negative attitude of several parents who previously agreed to immunize their children against other childhood illnesses according to the official national pediatric immunization schedule clearly indicates that only the COVID-19 vaccine was put in doubt or rejected. All these findings lead us to conclude that to improve COVID-19 vaccination coverage in children aged 5 to 11, health authorities should increase parental education on the true clinical relevance of COVID-19 and on the importance of its prevention to hinder the evolution of the pandemic in pediatric subjects and the emergence of new variants, and its relative weight in influencing the efficacy of vaccines.

Willingness to vaccinate children against COVID-19 declined during the pandemic

OBJECTIVES

To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3).

RESULTS

Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively).

CONCLUSIONS

COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

Worldwide Estimation of Parental Acceptance of COVID-19 Vaccine for Their Children: A Systematic Review and Meta-Analysis

Currently, the best method to well control the spread of COVID-19 without severe mental health problems is to reach herd immunity. Therefore, the vaccination rate of the COVID-19 vaccine is critical. Among the populations, children are the vulnerable ones to get vaccinated; therefore, it is important to assess parents’ and guardians’ willingness to have their children vaccinated. The present systematic review and meta-analysis synthesized evidence to estimate the parents’ acceptance rate of COVID-19 vaccination toward their children. Additionally, factors explaining the acceptance rate were investigated. Four academic databases (PubMed, Scopus, Web of Science, and ProQuest) together with Google Scholar were searched, and the references of the included publications were searched as well. Using the PECO-S framework (population, exposure, comparison, outcome, and study design), observational studies of cross-sectional, cohort, or case-control studies were included. The outcome was parents’ or guardians’ willingness to let their children be vaccinated. The studies included in the present review were restricted to English and peer-reviewed papers published between December 2019 and July 2022. A total of 98 papers across 69 different countries with 413,590 participants were included. The mean age of the parents was 39.10 (range: 18–70) years and that of their children was 8.45 (range: 0–18) years. The pooled estimated prevalence of parental acceptance to vaccinate their children with the COVID-19 vaccine was 57% (98 studies, 95% CI: 52–62%, I2: 99.92%, τ2: 0.06). Moreover, data collection time was a significant factor explaining parental willingness in the multivariable meta-regression, with a 13% decrease in parental willingness by each month increase in time, explaining 11.44% of variance. Qualitative synthesis results showed that parents’ COVID-19 vaccine knowledge, trust in theCOVID-19 vaccine, and facilitators in vaccination (e.g., low cost, good vaccine accessibility, and government incentive) were significant factors for higher willingness, while mental health problems (e.g., having worries and psychological distress) were significant factors for lower willingness. Given that the acceptance rate was relatively low (57%) and does not achieve the requirement of herd immunity (i.e., 70%), governments and healthcare authorities should try to elevate parents’ knowledge and trust in the COVID-19 vaccine, facilitate in vaccination, and reduce their mental difficulties to improve the overall vaccination rate among children.

Effect of COVID-19 Pandemic Response and Parental Adverse Childhood Experiences on Child Health and Well-Being

Family responses to crises such as COVID-19 are driven by parents' experiences. Parental history of adverse childhood experiences (ACEs) might play an important role in predicting resilience, coping capacity, and parenting practices during the COVID-19 pandemic response. The purpose of this review is to examine the impact of COVID-19 pandemic disruption on child health and well-being as influenced by the previous history of ACEs in the parents. Scopus, Google Scholar, PubMed, and PsychInfo were searched for peer-reviewed articles using the keywords "COVID-19", "Parents or Maternal Adverse Childhood Experiences", and "child health" or "child well-being". Data were extracted using a literature review matrix template. Title, abstract, and full article-level reviews were conducted by two reviewers. The association between COVID-19 disruption, negative parenting, and child behavioral and emotional problems was stronger for parents with younger children with a history of high ACE scores. Parents with high ACE scores were more likely to cope poorly with childcare duties and engage in child neglect, verbal abuse, and reduced feeding frequency, specifically during the COVID-19 pandemic. The review findings support the framework of inadequate resilience and coping skills of adults with a history of ACEs during periods of stress and unpredictability such as the COVID-19 pandemic. The negative effects of these parental stressors on a child's health and well-being are modifiable and could be mitigated by targeted interventions. Trauma-informed care should be adopted to contribute to optimum child health.

Recommending COVID-19 vaccination for adolescents in primary care

BACKGROUND

COVID-19 vaccines are available for adolescents in the United States, but many parents are hesitant to have their children vaccinated. The advice of primary care professionals strongly influences vaccine uptake.

OBJECTIVE

We examined the willingness of primary care professionals (PCPs) to recommend COVID-19 vaccination for adolescents.

METHODS

Participants were a national sample of 1,047 US adolescent primary care professionals. They participated in an online survey in early 2021, after a COVID-19 vaccine had been approved for adults but before approval for adolescents. Respondents included physicians (71%), advanced practice providers (17%), and nurses (12%). We identified correlates of willingness to recommend COVID-19 vaccination for adolescents using logistic regression.

RESULTS

The majority (89%) of respondents were willing to recommend COVID-19 vaccination for adolescents, with advanced practice providers and nurses being less likely than paediatricians to recommend vaccination (84% vs. 94%, aOR 0.47, 95% CI 0.23-0.92). Respondents who had received at least one dose of a COVID-19 vaccine were more likely to recommend adolescent vaccination (92% vs. 69%, aOR 4.20, 95% CI 2.56-6.87) as were those with more years in practice (94% vs. 88%, aOR 2.93, 95% CI 1.79-4.99). Most respondents (96%) said they would need some measure of support in order to provide COVID-19 vaccination to adolescents, with vaccine safety and efficacy information being the most commonly cited need (80%).

CONCLUSION

Adolescent primary care professionals were generally willing to recommend COVID-19 vaccination. However, most indicated a need for additional resources to be able to administer COVID-19 vaccines at their clinic.

Association between caregiver opposition to topical fluoride and COVID-19 vaccines

PURPOSE

Caregivers who oppose topical fluoride in dental settings may be opposed to other preventive health treatments, including COVID-19 vaccines. The study objective was to examine the association between caregiver opposition to topical fluoride and COVID-19 vaccines.

METHODS

The study took place at the University of Washington in Seattle, WA. English-speaking caregivers of children aged < 18 years were eligible to participate. An 85-item REDCap survey was administered from February to September 2021. The predictor variable was topical fluoride opposition (no/yes). The outcome was COVID-19 vaccine opposition (no/yes). The models included the following covariates: child and caregiver age; caregiver race and ethnicity, education level, dental insurance type, parenting style, political ideology, and religiosity; and household income. Logistic regression models generated odds ratios (OR) and 95 % confidence intervals (α = 0.05).

RESULTS

Six-hundred-fifty-one caregivers participated, and 403 caregivers with complete data were included in the final regression model. Mean child age was 8.5 years (SD 4.2), mean caregiver age was 42.1 years (SD 9.1), 53.0 % of caregivers were female, 57.3 % self-reported as white, and 65.5 % were insured by Medicaid. There was a significant positive association between topical fluoride and COVID-19 vaccine opposition (OR = 3.13; 95 % CI: 1.87, 5.25; p < 0.001). Other factors associated with COVID-19 vaccine opposition included conservative political views (OR = 2.77; 95 % CI: 1.26, 6.08; p < 0.011) and lower education (OR = 3.47; 95 % CI: 1.44, 8.38; p < 0.006).

CONCLUSIONS

Caregivers opposed to topical fluoride in dental settings were significantly more likely to oppose COVID-19 vaccines for their child. Future research should identify ways to address both topical fluoride and vaccine opposition to prevent diseases in children.

The Reasons behind COVID-19 Vaccination Hesitancy among the Parents of Children Aged between 5 to 11 Years Old in Saudi Arabia

Simultaneously with the development of the COVID-19 vaccination plan for minors, it is critical to understand the reasons related to parental COVID-19 vaccination hesitancy. This study aims to determine the reasons associated with vaccination hesitancy among parents, and the prevalence and the characteristics of the parents who are hesitant to allow their children aged between 5 to 11 years old to be administered the COVID-19 vaccines. A web-based questionnaire was used to perform this study between May 2022 to September 2022 in Saudi Arabia (SA). Several factors, personal and social, affected the participants' willingness to vaccinate their children with the COVID-19 vaccines. The age of the parents was found to have a significant impact on their decision to vaccinate their children. Those between the age of 40-49 years of age were the most willing to vaccinate (almost 41%) compared to those 50 years or older who were most resistant to vaccination. Female participants were more resistant to vaccinating their children compared to their male counterparts. Saudis were more resistant to vaccinating their children compared to the non-Saudi participants. Those private sector-employed parents were the most willing to vaccinate (16.6%), followed by those working in the governmental sector (13.8%). About 40.7% of non-healthcare workers were resistant to vaccinating their minor compared to healthcare workers (8.7%). In conclusion, the study presents several factors that affect the parental willingness to vaccinate their children in SA. These factors should be properly addressed when developing public health strategies to promote the COVID-19 vaccination of children in SA.

Education level modifies parental hesitancy about COVID-19 vaccinations for their children

It is important to encourage parental acceptance of children's vaccination against COVID-19 to ensure population immunity and mitigate morbidity and mortality. This study drew upon protection motivation theory (PMT) to explore the factors of parental hesitancy about vaccinating their children. A national online survey was performed in China. A total of 2054 Chinese parents of children aged 6-12 years were included in this study. They reported on measures that assessed hesitancy about children's vaccination against COVID-19, PMT constructs (susceptibility, severity, response efficacy, self-efficacy, and response costs) and sociodemographic characteristics. Chinese parents reported a hesitancy rate of 29.4% for children's vaccination. Parents with higher level education were more likely to hesitate to vaccinate their children against COVID-19. After controlling for parents' and children's demographic variables, logistic regression showed that parents' hesitancy about their children's vaccination increased if parents had lower levels of susceptibility, response efficacy or self-efficacy, as well as higher levels of response costs. In addition, a high educational level can significantly increase the promotive effect of response cost and the protective effect of response efficacy on vaccine hesitancy. In conclusion, our findings suggested that PMT can explain parents' vaccine hesitancy and that education level can modify the effect of copying appraisal, but not threat appraisal, on parental hesitancy. This study will help public health officials send targeted messages to parents to improve the rate of COVID-19 vaccination in children aged 6-12 years and thus reach a higher level of immunity in the population.

Parental intentions to vaccinate children against COVID-19: Findings from a U.S. National Survey

We examined parents' COVID-19 vaccination intentions for their children, reasons for not vaccinating, and the potential impact of a school/daycare vaccination requirement or pediatrician's recommendation on vaccination intentions. Two online surveys were conducted in June-July and September-October 2021, before pediatric COVID-19 vaccines were authorized for emergency use in children age < 12 years, with an internet-based, non-probability sample of U.S. adults. Respondents with children (age < 18 years) in the household were asked about their intention (likelihood) of vaccinating these children against COVID-19. Weighted Chi-square tests using a Rao-Scott correction were performed. Vaccinated (45.7 %) versus unvaccinated (6.9 %) parents were almost seven times more likely to have vaccinated their 12-17-year-old children against COVID-19. Approximately 58.4 % of respondents with unvaccinated children ages 2-11 years and 42.4 % of those with children < 2 years said they are "very" or "extremely likely" to vaccinate these children against COVID-19. Female parents were significantly more likely (p < .01 to p < .001) to express lower levels of COVID-19 vaccine intentions. Across all age groups of children unvaccinated against COVID-19, parental vaccine intentions increased with increased household income and education levels. COVID-19 vaccine side effects and safety concerns were primary reasons for not vaccinating children. Strategies including school vaccination requirements and recommendations from pediatricians were shown to increase parental COVID-19 vaccination intentions for some. More research is needed on factors that increase/hinder COVID-19 pediatric vaccine uptake.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

Vaccine hesitancy and the willingness to recommend the COVID-19 vaccine to children in a rural country on the United States-Mexico border

Introduction

As of October 26, 2022, only 9% of children in the United States aged 6 months to 4 years have received at least one dose of COVID-19 vaccine despite FDA approval since June 17, 2022. Rates are better yet still low for children aged 5 to 11 years as nearly 30% were fully vaccinated as of August 23, 2022. Vaccine hesitancy among adults is one of the major factors affecting low vaccine uptake rates in children against COVID-19, yet most studies examining vaccine hesitancy have targeted school-age and adolescent children.

Methods

With the aim of assessing the willingness to recommend the COVID-19 vaccination to children under 5 years compared to children 5 to 12 years of age, a county-wide survey was conducted between January 11 and March 7, 2022, among adults on the United States-Mexico border.

Results

Among the 765 responses, 72.5% were female and 42.3% were Latinx. The most significant factor associated with likelihood to recommend the COVID-19 vaccine to children less than 5 years and 5-12 years of age was adult vaccination status. Ordinal logistic regression also indicated that ethnicity, primary language, being a parent, previous COVID-19 infection, and concern about getting COVID-19 in the future were significantly associated with likelihood of COVID-19 vaccine recommendation to children < 5 years and 5-12 years old.

Discussion

This study found high consistency among respondents in their willingness to vaccinate children aged < 5 years compared with children aged 5-12 years. Our findings support public health strategies that target adult vaccinations as an avenue to improve childhood vaccinations for young children.

Mothers' Intention to Vaccinate Their Children Aged 5-11 Against COVID-19: A Cross-sectional Survey

Objectives

COVID-19 vaccines lower the risk of infection hospitalization, and death. Despite the safety and effectiveness of COVID-19 vaccines, some caregivers are hesitant to vaccinate their children against COVID-19. In this study, we explored the factors that influence Omani mothers' intentions to vaccinate their 5^-11 year-old children.

Methods

Of the 954 mothers approached, 700 (73.4%) participated in a cross-sectional face-to-face interviewer-administered questionnaire in Muscat, Oman, between 20 February and 13 March 2022. Data on age, income, level of education, trust in doctors, vaccine hesitancy, and intention to vaccinate their children were collected. Logistic regression was used to assess determinants of mothers' intention to vaccinate their children.

Results

Most mothers had 1-2 children (n = 525, 75.0%), had a college degree or higher education (73.0%), and were employed (70.8%). More than half (n = 392, 56.0%) reported that they were likely or very likely to get their children vaccinated. The intention to get children vaccinated was associated with older age (odds ratio (OR) = 1.05, 95% CI: 1.02-1.08; p =0.003), trust in their doctor (OR = 2.12, 95%, CI: 1.71-2.62; p < 0.001), and low vaccine hesitancy (OR = 25.91, 95% CI: 16.92-39.64; p < 0.001).

Conclusions

Understanding the factors that influence caregivers' intentions to vaccinate their children against COVID-19 is important for the development of evidence-based vaccine campaigns. To increase and sustain high vaccination rates for COVID-19 vaccination in children, it is critical to address the factors that cause caregiver hesitation about vaccines.

Global caregiver perspectives on COVID-19 immunization in childhood cancer: A qualitative study

Introduction

SARS-CoV-2 has led to an unprecedented pandemic where vulnerable populations, such as those with childhood cancer, face increased risk of morbidity and mortality. COVID-19 vaccines are a critical intervention to control the pandemic and ensure patient safety. This study explores global caregiver's perspectives related to COVID-19 immunization in the context of pediatric cancer management.

Methods

A mixed methods survey was developed based on consensus questions with iterative feedback from global medical professional and caregiver groups and distributed globally to caregivers of childhood cancer via electronic and paper routes. We present qualitative findings through inductive content analysis of caregiver free-text responses.

Results

A total of 184 participants provided qualitative responses, 29.3% of total survey respondents, with a total of 271 codes applied. Codes focused on themes related to safety and effectiveness (n = 95, 35.1%), logistics (n = 69, 25.5%), statements supporting or opposing vaccination (n = 55, 20.3%), and statements discussing the limited availability of information (n = 31, 11.4%). Within the theme of safety and effectiveness, safety itself was the most commonly used code (n = 66, 24.4% of total segments and 69.5% of safety and effectiveness codes), followed by risks versus benefits (n = 18, 18.9% of safety and effectiveness codes) and efficacy (n = 11, 11.6%).

Discussion

This study provides insights to guide healthcare professionals and caregiver peers in supporting families during the complex decision-making process for COVID-19 vaccination. These findings highlight the multidimensionality of concerns and considerations of caregivers of children with cancer regarding COVID-19 vaccination and suggest that certain perspectives transcend borders and cultures.

COVID-19 vaccination hesitancy for children: A pilot assessment of parents in the United States

Background: Coronavirus disease 2019 (COVID-19) vaccine hesitancy has remained a significant concern among adults worldwide. However, not much is known about parental vaccine hesitancy for getting children vaccinated for COVID-19 in the U.S. Thus, the purpose of this study was to conduct a national assessment of parents' preferences for COVID-19 vaccination of children using the evidence-based Multi-Theory Model (MTM) and explore the predictors of vaccine hesitancy. Methods: To participate in this study, a national random sample of parents (n=263) took a valid and reliable online questionnaire based on the MTM. Independent samples t test, chi-square test, multiple logistic regression was utilized to analyze data. Results: More than two-fifths (42%) of the participating parents were not willing to get their children vaccinated for COVID-19. Parental vaccination status, booster dose acceptance, education, and political affiliation were significant predictors of willingness to get children vaccinated for COVID-19. In the multiple logistic regression analyses, behavioral confidence and participatory dialogue (i.e., perceived advantages versus disadvantages) were statistically significant predictors of COVID-19 vaccination hesitancy for children among the participating parents. Conclusion: Given the multiple factors that were found influential in parental hesitancy for COVID-19 vaccination among children, multimodal and evidence-based interventions are needed to increase the uptake of COVID-19 vaccines among children by influencing the parents' perceptions, increasing their confidence, dispelling misinformation, and reducing constraints for vaccination. Such interventions should emphasize communication and messaging that is truthful, interactive, scientifically correct, and to be delivered in a variety of community-based settings.

COVID-19 vaccination and race – A nationwide survey of vaccination status, intentions, and trust in the US general population

BACKGROUND: COVID-19 vaccine hesitancy for adults and children varies depending on societal factors, race, and trust ascribed to the source of vaccine information. OBJECTIVE: To assess COVID-19 vaccination rates and trust levels for vaccine information by race at 2 time points. METHODS: Online cross-sectional data from US adults were collected in February/March 2021 (T1) and November 2021 (T2). Questions included vaccination status, reasons for vaccine refusal, trust levels for vaccine information and the Wake Forest Physician Trust Scale. At T2, parents were asked about vaccination status of children aged 12-18 years and intent for children aged 5-11 years. Vaccination rates and trust levels for vaccine information were measured. Multivariable logistic regression was used to identify characteristics predictive of receiving COVID-19 vaccination. RESULTS: Vaccination rates were 20.2% and 70.8% at T1 and T2, respectively. At T1 and T2, higher proportions of White (23.2% and 72.0%) and Other race (14.4% and 75.2%) respondents were vaccinated relative to Black respondents (9.6% and 64.4%) (P < 0.05). In descending order, respondents' doctors, family members, and pharmacists were the most trusted information sources. Black parents, relative to White and Other parents with unvaccinated children aged 12-18 years or who were not very likely to vaccinate younger children, reported lowest physician trust (P < 0.01). At T1, being married, college educated, and older and having greater Wake Forest Physician Trust Scale scores and a higher number of comorbidities predicted a higher likelihood of being vaccinated. Being Black, having a median household income less than $100,000, and residing in the Northeast or Midwest, relative to the West, predicted a decreased likelihood of being vaccinated. At T2, race and comorbidities were no longer predictive of vaccination. CONCLUSIONS: Racial variation in vaccination status decreased from T1 to T2. Physician trust predicted vaccination status and intent regardless of race. Respondents' doctors, family members, and pharmacists are trusted sources of vaccine information, and targeting these influencers may reduce vaccination hesitancy. DISCLOSURES: Dr Brown reports personal fees from Taiho Oncology, outside the submitted work. Dr Morlock reports personal fees from Johnson and Johnson, Heron Therapeutics, Evofem Biosciences, Horizon Therapeutics, and Taiho Oncology, outside the submitted work. Amy Morlock reports personal fees from both AbbVie (formerly Allergan) and Ironwood, outside the submitted work. Drs Blakolmer and Heidari have nothing to disclose.

Assessing Parents' Knowledge, Attitudes, and Practices Toward Vaccinating Children (Five to 15 Years Old) Against COVID-19 in the United Arab Emirates

Background  Since the approval of the Coronavirus disease 2019 (COVID-19) vaccine for children in 2021, there had been ongoing debates about the necessity of vaccinating children, owing to the seemingly mild nature of the infection in children, despite causing significant morbidity and mortality in the 5-11 age group in 2020-2021, and its association with complications such as Multisystem Inflammatory Syndrome in Children (MIS-C). This sparked the need to evaluate parents' perceptions, knowledge, and the effect of information sources on their decision-making. It is important to understand the various drivers and concerns expressed by parents locally, to shape vaccination campaigns to address such issues. While numerous studies across the world have extensively investigated parental willingness and intention to vaccinate children against COVID-19, it is important to acknowledge that these studies have been conducted before COVID-19 vaccines became approved for children in the respective countries. There is an obvious scarcity of data on the parental knowledge, attitudes, and acceptance of the vaccine for children after the respective countries have approved and provided the vaccine. The present study aims to provide data that could reveal possible barriers to vaccine uptake such as deficits in knowledge, negative attitudes, and poor practices towards the COVID-19 pandemic, and hence address these factors to make the ongoing COVID-19 vaccination campaign, as well as future childhood vaccination campaigns, more successful. Methods This is a cross-sectional online-based survey targeting parents living in the United Arab Emirates (UAE) with children aged 5-15 years. Data collected from June 23 to July 20, 2022 were analyzed using IBM SPSS (Statistical Package for Social Sciences) 28 software. The survey included questions concerning parental and children demographics, parents' level and sources of knowledge about COVID-19 infection and vaccine, attitudes of parents about the COVID-19 pandemic and vaccines, and finally parental practices concerning pandemic preventive measures and COVID-19 vaccine uptake. Results Out of 437 participants, 212 (48.5%) vaccinated their children against COVID-19, and of those who did not, only 22 (9.8%) intended to vaccinate. The most commonly cited reason by parents for vaccinating their children was to reduce complications. The most frequent concern was the novelty and lack of information, and consequently, getting more information was the most selected driver to vaccinate as well as being advised by a doctor. Significant predictors were acceptance of childhood and influenza vaccines, trust in vaccine safety and trust in information provided by health authority websites, and lastly, exposure to positive information on social media. Conclusion A considerable proportion of parents have vaccinated their children against COVID-19; however, concerns about novelty and lack of information persist, leading to a high level of vaccine hesitancy. It is imperative that public health efforts maintain momentum, and that pediatricians incorporate parental education on the COVID-19 vaccine for children, which could potentially play a major role in combating vaccine hesitancy.

COVID-19 Vaccines for Children with Developmental Disabilities: Survey of New York State Parents' Willingness and Concerns

OBJECTIVE

While 1 in 6 US children have a developmental disability (DD), and such children are disproportionately affected by COVID-19, little is known about their vaccination status. We surveyed New York State parents of children with DDs to ascertain willingness and concerns regarding COVID-19 vaccines.

METHODS

An online survey was distributed to statewide DD networks from June to September 2021 (vaccines were authorized for adolescents in May 2021). We report associations between vaccine willingness and concerns and race/ethnicity, child age, in-person schooling, routine/flu vaccinations, and DD diagnoses. Willingness was categorized as "got/will get ASAP" (high), "wait and see/only if required," or "definitely not."

RESULTS

A total of 352 parents (49.1% White) responded. Willingness differed by age ( p < 0.001). High willingness was reported for 73.9%, 50.0%, and 36.0% of children aged 12 to 17, 6 to 11, and 0 to 5 years, respectively. Willingness differed by autism diagnosis ( p < 0.01) and routine and flu vaccination status ( p < 0.001). Predominant concerns included side effects (89%) and children with disabilities not being in trials (80%). Less common concerns were COVID not serious enough in children to warrant vaccine (23%) and misinformation (e.g., microchips, 5G, DNA changes) (24%). Concerns about vaccine safety differed by age ( p < 0.01) and were highest for older and then the youngest children. In age-stratified adjusted models, attention-deficit/hyperactivity disorder was negatively associated with high willingness for age 5 or younger (OR = 0.02, 95% confidence interval, <0.001-0.622).

CONCLUSION

Parents of children with DD in New York seemed highly willing for them to receive COVID-19 vaccines. Although few factors predicted willingness to vaccinate, addressing safety and developmental concerns regarding young children is warranted. Given their increased vulnerability, improved COVID-19 surveillance for children with DD is warranted.

Parents' attitudes, knowledge and practice towards vaccinating their children against COVID-19: a cross-sectional study

The question of whether children should be vaccinated against COVID-19 is currently being argued. The risk-benefit analysis of the vaccine in children has been more challenging because of the low prevalence of acute COVID-19 in children and the lack of confidence in the relative effects of the vaccine and the disease. One of the most convincing arguments for vaccinating healthy children is to protect them from long-term consequences. The aim of this study was to assess Jordanian parents' intention to vaccinate their children. This is an Internet-based cross-sectional survey. The researchers prepared a Google Forms survey and shared the link with a number of Jordanian Facebook generic groups. Data were gathered between September and November 2021. In this study, convenience sampling was used. Knowledge about COVID-19 and preventive practices against COVID-19 were calculated for each participant. A total of 819 participants completed the survey (female = 70.9%). Of these, 274 (30.2%) participants intended to vaccinate their children, whereas the rest were either unsure 176 (21.5%) or intended not to vaccinate their children 396 (48.4%). The variables that increased the odds of answering "No" vs "Yes" to "will you vaccinate your children against COVID-19" included not willing to take the vaccines themselves (OR 3.75; CI, 1.46-9.62) and low protective practice group (OR 1.73;CI, 1.12-2.68). Participants had significant levels of refusal/hesitancy. Several barriers to vaccination were identified; attempts to overcome these should be stepped up.

Determinants of the willingness of medical staff to vaccinate their children with a booster dose of the COVID-19 vaccine in Taizhou, China

The study aimed to determine the willingness of medical staff to have their children vaccinated with a COVID-19 booster in Taizhou, China. From March 21 to April 19, 2022, an online questionnaire survey was conducted to assess the willingness of medical staff to vaccinate their children with a booster dose of the COVID-19 vaccine. Of the 1,252 medical staff in a tertiary grade hospital in Taizhou who were invited to answer the structured questionnaire, 514 (41.1%) samples had valid information for further data analysis. Four hundred thirty-seven medical staff (85.0%) were willing to have their children receive vaccine boosters. After adjustments for confounding factors, the opinion ('Do you think your child needs a booster vaccination against COVID-19?') (yes vs. no, OR = 6.91, 95% CI: 3.29-14.54), the viewpoint ('What are your thoughts the effectiveness of COVID-19 vaccine boosters for children?' (≥12 vs. <12, OR = 13.81, 95% CI: 4.03-), and the attitude ('Your attitude to whether your child is boosting the Covid-19 vaccine?') (yes vs. no, OR = 4.66, 95% CI: 2.30-9.44) were significantly associated with their willingness to have their children receive a COVID-19 vaccine booster. A moderate percentage of the respondents expressed willingness to have their children receive booster vaccines. The findings implied that factors affecting medical staffs' willingness to vaccinate their children with a COVID-19 vaccine booster included viewpoint, opinion, and attitudes.

Parental attitudes in the pediatric emergency department about the COVID-19 vaccine

BACKGROUND

COVID-19 vaccinations are now recommended in the United States (U.S.) for children ≥ 6 months old. However, pediatric vaccination rates remain low, particularly in the Hispanic/Latinx population.

OBJECTIVE

Using the 4C vaccine hesitancy framework (calculation, complacency, confidence, convenience), we examined parental attitudes in the emergency department (ED) towards COVID-19 vaccination, identified dimensions of parental vaccine hesitancy, and assessed parental willingness to have their child receive the COVID-19 vaccine.

METHODS

As part of a larger multi-methods study examining influenza vaccine hesitancy, we conducted interviews that included questions about COVID-19 vaccine authorization for children. We used directed content analysis to extract qualitative themes from 3 groups of parents in the ED: Hispanic/Latinx Spanish speaking (HS), Hispanic/Latinx English speaking (HE), non-Hispanic/non-Latinx White English speaking (WE). Themes were triangulated with the Parent Attitudes about Childhood Vaccines (PACV) survey, where higher scores indicate increased vaccine hesitancy.

RESULTS

Factors influencing vaccine hesitancy were mapped to the 4C framework from 58 sets of interviews and PACVs. HE and HS parents, compared to WE parents, had less knowledge about COVID-19 and its vaccine, and more beliefs in COVID-19 vaccine myths. However, both HS and HE parent groups were more inclined to endorse COVID-19 vaccine effectiveness as a reason to have their children vaccinated. HS parents felt that COVID-19 increased their fear of illnesses in general and were worried about confusing COVID-19 with other infections. Median PACV scores of HS (Mdn = 20) and HE (Mdn = 20) parent groups were higher than of WE parents (Mdn = 10), but parental willingness to have their child receive COVID-19 vaccination was similar across groups.

CONCLUSIONS

Higher COVID-19 vaccine hesitancy among HS and HE parents compared to WE parents may be attributed to insufficient knowledge about COVID-19, its vaccine, along with COVID-19 vaccine myths. Efforts to provide targeted vaccine education to different populations is warranted.

COVID-19 Pediatric Vaccination Attitudes Among Parents in Ohio

INTRODUCTION

This study aimed to examine factors associated with parental intention to vaccinate children against COVID-19 in Ohio following pediatric vaccine approval in October 2021.

METHOD

Online anonymous surveys were distributed between November 2021 and January 2022 to parents in Ohio.

RESULTS

Surveys were completed by 581 parents of whom 43.5% reported they intended to vaccinate their children against COVID-19, whereas 56.5% did not intend to vaccinate their children. Perceiving a lack of support by health care providers was significantly associated with not intending to vaccinate children against COVID-19 (p < .001).

DISCUSSION

Survey results from parents in Ohio indicate that perceived health care provider support and parents' attitudes about pediatric COVID-19 vaccination influenced their intent to vaccinate their children. Hence, health care providers working with families need to focus on educating parents regarding the importance and safety of vaccination.

Parental refusal and hesitancy of vaccinating children against COVID-19: Findings from a nationally representative sample of parents in the U.S

The uptake rate of COVID-19 vaccines among children remains low in the U.S. This study aims to 1) identify sociodemographic and behavioral factors influencing parental refusal of vaccinating children, and 2) quantify the relative importance of vaccine characteristics in parental hesitancy of vaccinating children. An online survey was conducted from October to November 2021 among a probability-based, representative sample of 1456 parents with children under age 18. The survey included a discrete choice experiment asking parents to choose between two hypothetical COVID-19 vaccine alternatives with varying levels of characteristics in 10 hypothetical scenarios. Logistic regressions were used to estimate parental refusal (refused to choose any vaccine alternatives in all hypothetical scenarios) and random parameter logit regressions were used to estimate parental hesitancy (choice of vaccine alternatives depended on vaccine characteristics) of vaccinating children. About 20% parents refused to vaccinate children. The refusal is predicted by parents' sociodemographic characteristics, political orientation, vaccination status, and parents' and children's previous exposure with COVID-19. Among parents who were willing to consider vaccinating children, the most important vaccine characteristics are risk of severe side effects (31.2% relative importance) and effectiveness (30.7%), followed by protection duration (22.6%), local coverage (9.4%), and hospitalization rate of unvaccinated children (6.1%). Our findings imply that policymakers and public health professionals could develop outreach programs at community level to encourage specific subgroups and focus on vaccination depoliticization. Effectively communicating the low risk of severe side effects and high effectiveness of the vaccines may relieve some of the parental hesitancy.

COVID-19 Vaccine Knowledge, Attitudes, and Practices in Alabama: The Case for Primary Health Care Providers

OBJECTIVE

To examine knowledge, attitudes, and practices about COVID-19 in Alabama, with a primary focus on vaccination perception and utilization.

DESIGN

We used a COVID-19 Knowledge, Attitudes, and Practices survey and recruited adult Alabama residents in April-May 2021.

PARTICIPANTS

Initial surveys from 1324 Alabamian participants were considered for analysis; after careful review of incomplete responses, 953 were ultimately included for analysis.

MAIN OUTCOME MEASURE

Vaccine behavior and hesitancy comprise a self-reported response contained in the survey instrument. Three primary vaccine groups were used to assess differences in demographic characteristics, health status, perception of susceptibility and severity of COVID-19, sources of information, and trust about COVID-19.

RESULTS

Of the 953 survey participants included for analysis, 951 had self-identified vaccine status in which 153 (16.1%) reported to have received the vaccine at the time of the survey, 375 (39.4%) were very likely or somewhat likely to get an approved COVID-19 vaccine if it was offered, and 423 (44.5%) were somewhat unlikely or very unlikely to get an approved COVID-19 vaccine. Health care providers were the most trusted sources of information, regardless of vaccine status. For participants unlikely to receive a vaccine, social media and local news sources were consistently more trusted and utilized than those who were vaccinated or were likely to be.

CONCLUSIONS

The perceptions among unvaccinated participants are actionable and provide teachable opportunities to decrease vaccine apprehension.

The Willingness of Parents to Vaccinate Their Children Aged from Five to under Twelve Years with COVID-19 Vaccines between February and March 2022 in Vietnam

The current study used data surveyed with 5357 parents/guardians (parents would be used to represent both 'parents' and 'guardians' hereafter) between February and March 2022 in Vietnam to examine their willingness to vaccinate their children with current COVID-19 vaccines. It applied the multinomial logistic regression model to examine the association between the willingness of parents and selected influential factors. In addition, the reasons that made parent hesitant or unwilling to vaccinate their children were investigated. Moreover, it identified parents' preferences for vaccine origins. Approximately, 75.4% of the parents were willing, 21.3% were hesitant and 3.3% were unwilling to vaccinate their children. The most common reasons that made the parents hesitant or unwilling to vaccinate their children were their concerns about the vaccine safety, efficacy and immunity. The most and the second most preferred vaccines were those developed/originated in the US and EU, respectively. Parents who were more likely to vaccinate their children included those whose children were insured, who regularly vaccinated their children, who belonged to the vaccine priority groups, who possessed sufficient knowledge about the ways to prevent the virus or about the herd immunity, and who perceived that their children might be infected with the virus and whose children were afraid of needles. Parents who were less likely to vaccinate their children included those who were the family main income source, who had savings, and who had tertiary education or higher.

COVID-19 Vaccine Acceptance Among US Parents: A Nationally Representative Survey

BACKGROUND

Little was known about US parental attitudes, beliefs, and intentions surrounding coronavirus disease 2019 (COVID-19) vaccines for children before their introduction.

METHODS

An online cross-sectional nationally representative survey of US parents/guardians of children < 18 years old via Ipsos KnowledgePanel, fielded from October 26, 2021 to November 30, 2021.

RESULTS

Response rate was 64.2% (3230/5034). For children ages 0-4 years, 51.5% of parents were likely to have their children vaccinated, and for ages 5-11 and 12-17, 54.0% and 69.7% of parents, respectively, reported they were likely to vaccinate or had already vaccinated their children. Among respondents with unvaccinated children, 25.2% (ages 0-4) and 22.0% (ages 5-11) reported they would seek COVID-19 vaccination for their children as soon as authorization occurred. Factors associated with willingness to have children receive a COVID-19 vaccine were: belief in benefits of COVID-19 vaccination (odds ratio [OR] = 6.44, 5.68, 4.57 in ages 0-4, 5-11, and 12-17 respectively), acceptance of routine childhood vaccines (OR = 6.42, 5.48, 1.76), parental COVID-19 vaccination (OR = 1.85, 3.70, 6.16), perceptions that pediatric COVID-19 is severe (OR = 1.89, 1.72, 1.35), Hispanic ethnicity (OR = 2.07, 2.29, 2.60), influenza vaccine acceptance (OR = 1.07, 0.88, 1.62), presence of children of another age group in the household (OR = 0.71, 0.71, 0.65), and attitudinal barriers to COVID-19 vaccination (OR = 0.30, 0.26, 0.49).

CONCLUSIONS

Belief in the benefits of COVID-19 vaccination and acceptance of routine childhood vaccines are the strongest predictors of intention to vaccinate children. Further research is needed to track how parental attitudes change as more data about pediatric COVID-19 vaccines become available and how intentions translate into pediatric vaccine uptake.

COVID-19 Vaccine Hesitancy among Parents of Children under Five Years in the United States

On 17 June 2022, the U.S. FDA authorized the Pfizer-BioNTech and Moderna COVID-19 (SARS-CoV-2) vaccines for emergency use (EUA) in children ages 6 months–4 years. Seroprevalence has increased during the current Omicron variant wave for children under 5 years, and the burden of hospitalization for this age group is similar or exceeds other pediatric vaccine-preventable diseases. Research following the October 2021 EUA for vaccines for children 5–11 indicates a high prevalence of parental vaccine hesitancy and low uptake, underscoring the urgency of understanding attitudes and beliefs driving parental COVID-19 vaccine rejection and acceptance for younger children. One month prior to FDA approval, in the present study 411 U.S. female guardians of children 1–4 years from diverse racial/ethnic, economic, and geographic backgrounds participated in a mixed method online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Only 31.3% of parents intended to vaccinate their child, 22.6% were unsure, and 46.2% intended not to vaccinate. Logistic regression indicated significant barriers to vaccination uptake including concerns about immediate and long-term vaccination side effects for young children, the rushed nature of FDA approval and distrust in government and pharmaceutical companies, lack of community and family support for pediatric vaccination, conflicting media messaging, and lower socioeconomic status. Vaccine-resistant and unsure parents were also more likely to believe that children were not susceptible to infection and that the vaccine no longer worked against new variants. Findings underscore the need for improved public health messaging and transparency regarding vaccine development and approval, the importance of community outreach, and increased pediatrician attention to parental concerns to better improve COVID-19 vaccine uptake for young children.

Parents' reasons to vaccinate their children aged 5–11 years against COVID-19 in Italy

Objectives

The aims of this cross-sectional study were to investigate why parents decide to vaccinate, as well as the determinants, their children aged 5–11 years against COVID-19 in Italy.

Methods

The survey was conducted from January through May 2022. All parents/guardians who came in randomly selected days to immunization centers for the administration of the first dose of the COVID-19 vaccine to their child were asked to complete a questionnaire about socio-demographic characteristics, attitudes toward COVID-19 infection and vaccination, reason(s) regarding their decision to vaccinate their child, and source(s) of information.

Results

A total of 358 questionnaires were collected. Parent's perception that COVID-19 is a severe illness for the child, assessed using a 10-point Likert scale, was 7.5. The overall mean scores of the risk perception for their child of having the COVID-19 before and after the vaccination were 8.1 and 6.3. A significantly higher parents' level of risk perception for their child of having the COVID-19 after the vaccination has been observed among those not having a university degree, those with the child having at least one chronic medical condition, and those who perceived that COVID-19 is a severe illness for the child. The mean value of respondent trust in the information provided by the pediatricians on a 10-point scale Likert type was 7.6. Female, not having a university degree, higher perception that COVID-19 is a severe disease, not having received information about the vaccination from pediatricians, and needing information had a significantly higher concern of side effects after the vaccination. The most common reasons for vaccinating their children included wanting to protect the child against COVID-19, to attend the school with less risk, to prevent the transmission to family members, and to practice sport and other activities with less risks. Participants with a university degree were more likely to have vaccinated their child for attending the school and practicing sport and other activities with less risks.

Conclusions

More publicity should be promoted among parents of children aged 5–11 years which would increase the coverage rates and thus lower the transmission of SARS-CoV-2 and reduce the occurrence of COVID-19.

COVID-19 Vaccination Intentions, Concerns, and Facilitators Among US Parents of Children Ages 6 Months Through 4 Years

IMPORTANCE

Children aged 6 months through 4 years have become eligible for COVID-19 vaccination, but little is known about parental intentions regarding, concerns about, or facilitators to COVID-19 vaccination for this age group.

OBJECTIVES

To evaluate parental intentions, concerns, and facilitators for COVID-19 vaccination for children aged 6 months through 4 years and to help inform the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices' deliberations and recommendations for COVID-19 vaccination for children aged 6 months through 4 years.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study fielded an online survey from February 2 to 10, 2022, among a nonprobability sample of US parents of children aged 6 months through 4 years who were recruited through Qualtrics using quota-based sampling for respondent gender, race and ethnicity, and child age group.

MAIN OUTCOMES AND MEASURES

COVID-19 vaccination intentions, time to COVID-19 vaccination, COVID-19 vaccination concerns and facilitators, and trusted COVID-19 vaccination locations for children aged 6 months through 4 years.

RESULTS

The final weighted sample of 2031 participants (73.5% participation rate) had more respondents who identified as male (985; weighted percentage, 54.8%) or White (696; weighted percentage, 66.2%), were aged 25 to 49 years (1628; weighted percentage, 85.6%), had at least a bachelor's degree (711; weighted percentage, 40.0%), lived in a metropolitan area (1743; weighted percentage, 82.9%) or the South (961; weighted percentage, 43.4%), or received at least 1 dose of a COVID-19 vaccine (1205; weighted percentage, 59.8%). Half of respondents (645; weighted percentage, 45.6%) indicated that they "definitely" or "probably" will vaccinate their child aged 6 months through 4 years once they became eligible. However, only one-fifth (396; weighted percentage, 19.0%) indicated they would get a COVID-19 vaccine for their child in this age group within 3 months of them becoming eligible for vaccination. Vaccine safety and efficacy were parents' top concerns, and receiving more information about safety and efficacy were the top facilitators to COVID-19 vaccination for this age group. A doctor's office or clinic and local pharmacy were the most trusted COVID-19 vaccination locations for this age group.

CONCLUSIONS AND RELEVANCE

These results suggest that only a minority of parents of children in this age group are eager to vaccinate their children within the first few months of eligibility, with widespread concerns about COVID-19 vaccination for this age group. Thus, considerable efforts to increase parental COVID-19 vaccine confidence for children aged 6 months through 4 years may be needed to maximize COVID-19 vaccination for this age group in the United States.

Safety Messaging Boosts Parental Vaccination Intention for Children Ages 5-11

The COVID-19 vaccination rate among children ages 5-11 is low in the U.S., with parental vaccine hesitancy being the primary cause. Current work suggests that safety and side effect concerns are the primary reasons for such vaccine hesitancy. This study explores whether this hesitancy can be mitigated with information interventions. Based on theories of health decision making and persuasion, we designed four information interventions with varying contents and lengths. We wrote two messages on vaccine safety (a detailed safety-long message and a succinct safety-short message), explaining the vaccine's lower dosage, low rate of side effects, and the rigorous approval process. We also had two messages on protection effects (protect-family, protect-child). We combined these four messages with a vaccine-irrelevant control message and compared their effects on parental vaccine intention. We measured the parental vaccination intention using a 0-6 Likert scale question. Among the four intervention groups, we found that the short version of the safety message increased the average vaccination intention by over 1 point compared to the control arm, while the other three interventions failed to show significance. Specifically, these effects are particularly pronounced (around 2 points) for Republican parents who had a much lower initial intention to vaccinate their children. Our study highlights the importance of concise and to-the-point information rendering in promoting public health activities and therefore has important policy implications for raising vaccination intentions among parents, especially those leaning towards more conservative political affiliation.

The willingness of parents to vaccinate their children younger than 12 years against COVID-19: a cross-sectional study in Malaysia

BACKGROUND

The initiation of a new drug, for instance, the coronavirus disease 2019 (COVID-19) vaccine in children could be a source of major concern for parents. This study aims to determine the willingness of parents in Malaysia to vaccinate their children younger than 12 years against COVID-19.

METHODS

An online cross-sectional survey was conducted nationwide in Malaysia from August 29, 2021, to October 17, 2021. Parents with children younger than 12 years were enrolled via the snowball sampling method.

RESULTS

The analysis included data from 3,528 parents (79.5%) of the 4,438 survey responses received. Of these parents, 2,598 (73.6%) were willing, 486 (13.8%) were not willing, and 444 (12.6%) were still hesitant to vaccinate their children against COVID-19. Single parents (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.32-3.04; P = 0.001), parents with secondary or lower education (OR, 1.5; 95% CI, 1.21-1.96; P < 0.001), healthcare workers (OR, 1.7; 95% CI, 1.34-2.26; P < 0.001), parents who had significant contact with COVID-19 (OR, 1.3; 95% CI, 1.09-1.63; P = 0.006), and parents who had been vaccinated against COVID-19 (OR, 15.4; 95% CI, 9.76-24.33; P < 0.001) were found more willing to immunize their children. The common reasons for vaccination given by parents who were willing to immunize their children include protection of children (99.4%), protection of other family members (99.3%), and effectiveness (98.2%). The common reasons against vaccination given by parents who were not willing to immunize their children were uncertainty about the new vaccine (96.1%), concerns about vaccine contents (93.2%), limited vaccine information from physicians (82.3%), and the belief of vaccine was unsafe (79.8%).

CONCLUSIONS

In this study, nearly three-quarters of parents were willing to vaccinate their children younger than 12 years against COVID-19. The parents' history of COVID-19 vaccination was the strongest independent predictor of their willingness to vaccinate their children. Therefore, future health education for the COVID-19 vaccine should focus on parents who are prone to vaccine refusal or hesitation, address the common reasons for vaccine refusal, and highlight the vaccine's benefits.

COVID-19 Vaccine Coverage and Hesitancy Among New York City Parents of Children Aged 5-11 Years

Objectives. To measure vaccine uptake and intentions among New York City (NYC) parents of children aged 5 to 11 years following emergency use authorization. Methods. We conducted a survey of 2506 NYC parents of children aged 5 to 11 years. We used survey weights to generate prevalence estimates of vaccine uptake and intentions. Multivariable Poisson regression models generated adjusted prevalence ratios (APRs) of vaccine hesitancy, defined as parents who reported being not very likely or not at all likely to vaccinate their children, or unsure about whether to do so. Results. Overall, 11.9% of NYC parents reported that their child was vaccinated; 51.0% were very or somewhat likely to vaccinate; 8.0% were not sure; 29.1% were not very likely or not at all likely to vaccinate their child. Among vaccine-hesitant parents, 89.9% reported safety concerns and 77.8% had concerns about effectiveness. In multivariable models, more vaccine hesitancy was expressed by non-Hispanic Black parents than by non-Hispanic White parents (APR = 1.41; 95% confidence interval [CI] = 1.17, 1.72) and by parents who were not themselves vaccinated than by parents who were vaccinated (APR = 1.53; 95% CI = 1.32, 1.77). Conclusions. In a survey conducted after authorization of COVID-19 vaccines for children aged 5 to 11 years, significant hesitancy among parents was observed. (Am J Public Health. 2022;112(6):931-936. https://doi.org/10.2105/AJPH.2022.306784).

Factors that differentiate COVID-19 vaccine intentions among Indiana parents: Implications for targeted vaccine promotion

Given low rates of uptake of the COVID-19 vaccine for children 12-17 and 5-11 years old, research is needed to understand parental behaviors and behavioral intentions related to COVID-19 vaccination for their children. In the state of Indiana, we conducted a non-random, online survey of parents or caregivers (N = 10,266) about their COVID-19 vaccine intentions or behaviors, demographic characteristics, and potential motivating reasons for getting the vaccine. In terms of behaviors/intentions, 44.8% of participants indicated they were vaccine acceptors (i.e., had already had their children vaccinated or would as soon as it was possible), 13.0% indicated they were vaccine hesitators (i.e., wanted to wait and see), and 42.2% indicated they were vaccine rejecters (i.e., would not vaccinate or only would if mandated). Compared to vaccine rejecters, vaccine hesitators were more likely to be motivated by perceptions of vaccine safety and efficacy, normative influences such as close friends/family who had been vaccinated and a recommendation from a provider, as well as if they were vaccinated themselves. These findings have implications for the development of targeted vaccine promotion strategies, such as social norms messaging and a focus on vaccine safety, in order to increase COVID-19 vaccination for eligible children.