COVID-19 vaccine behaviors and intentions among a national sample of United States adults ages 18-45

Factors associated with human papillomavirus (HPV) patient-clinician communication and HPV vaccine uptake among adults in the United States

OBJECTIVE

Human papillomavirus (HPV) vaccine is approved for those aged 9-45 years. However, HPV vaccine uptake remains suboptimal in the United States (U.S.), particularly among young and mid-age adults. This paper describes HPV vaccine patient-clinician communication, clinician recommendation receipt, and HPV vaccine uptake among U.S. adults who were eligible for the HPV vaccine as adults.

METHODS

U.S. adults up to age 45 and who were aged 18+ when the HPV vaccine was approved were recruited for an online survey (n = 1107) between February-March 2021. Multivariable logistic regression analyses were used to assess: (1) clinician-patient HPV vaccination discussions; (2) ever having received an HPV vaccine recommendation from a clinician; and (3) HPV vaccine uptake.

RESULTS

Thirty-four percent of participants reported having prior HPV vaccine discussions with a clinician, 31.1 % reporting ever having received a clinician recommendation for the vaccine, and only 23.8 % reported receiving the vaccine. Receiving the HPV vaccine was positively associated with prior HPV vaccine discussions (aOR: 2.93; 95 % CI: 1.98-4.35) and ever receiving an HPV vaccine recommendation from a clinician (aOR: 10.64; 95 % CI: 7.14-15.88). Additional factors consistently associated with all three models (discussing, receiving a clinician recommendation, and vaccine uptake) include higher HPV vaccine knowledge and higher HPV vaccine embarrassment.

CONCLUSIONS

Unvaccinated age-eligible adults represent a missed opportunity for HPV-related cancer prevention. Interventions to support clinicians providing care to young and mid-age adults are needed to increase clinician discussions and recommendations of the HPV vaccine and patient uptake of the HPV vaccine.

Survival Analysis and Socio-Cognitive Factors in the Timing of COVID-19 Vaccination Among Mexican-Origin Youth

OBJECTIVE

The COVID-19 pandemic disproportionately affected ethnic minority populations and exacerbated preexisting health disparities. The current study aims to promote vaccine uptake among Mexican-origin youth from immigrant families by examining their time to COVID-19 vaccine uptake and assessing the influence of demographic, cognitive, and social factors on the incidence of COVID-19 vaccination.

METHODS

The study conducted Survival Analysis using a Cox proportional hazards model based on a sample of 202 Mexican-origin youth (61.39% female; Mage = 20.41) with data collected from August 2021 to January 2023 in central Texas.

RESULTS

The results show a critical time period for vaccine uptake (i.e., in the first six months after the vaccines were publicly available), evidenced by a surge decrease in COVID-19 unvaccination probability. In addition, more positive attitudes toward the COVID-19 vaccine (Hazard ratio/HR = 1.89, 95% Confidence Interval/CI = [1.64, 2.18]), greater motivation (HR = 2.29, 95% CI = [1.85, 2.85]), higher education levels (HR = 1.52, 95% CI = [1.24, 1.86]), and fewer general barriers to COVID-19 vaccine knowledge (HR = 0.75, 95% CI = [0.60, 0.94]) were associated with greater incidences of receiving COVID-19 vaccines at any given time point during the pandemic.

CONCLUSION

The findings suggest that COVID-19 vaccine uptake among Mexican-origin youth occurred primarily within the initial months of vaccines being publicly distributed. To encourage vaccination among Mexican-origin youth, sustained COVID-19 vaccine promotion efforts are needed by targeting their motivation and positive attitudes and reducing barriers to vaccine information, particularly for youth with lower education levels.

Assessing the State of Published Research Concerning COVID-19 and Transgender and Nonbinary People in the United States via a Scoping Review: Lessons Learned for Future Public Health Crises

Purpose: Transgender and nonbinary people (TNB) experienced a disproportionate burden of poor health and socioeconomic outcomes resulting from the coronavirus disease 2019 (COVID-19) pandemic, largely driven by increased vulnerability due to pervasive structural discrimination. To characterize the extent and nature of TNB inclusivity within COVID-19 research, we conducted a scoping review of studies published in English from 2019-2022 reporting COVID-19 pandemic impacts on TNB individuals in the United States. Methods: We searched PubMed (PubMed.gov), Embase (Elsevier), PsycInfo (EBSCO), Sociological Abstracts (ProQuest), and CINAHL (EBSCO), and TNB-focused organizational websites using search concepts 1) COVID-19, 2) TNB people. Studies were systematically reviewed for inclusion. Findings were extracted then summarized using systematic narrative synthesis. Results: Our search identified 1518 studies; 80 articles (65 peer-reviewed, 15 gray literature) met eligibility criteria. Most studies collected data early in the pandemic (69%) utilizing quantitative methods (79%), survey data (81%), and convenience sampling methods (65%); geographic foci varied. Many studies lacked transparent reporting on TNB involvement (80%), race/ethnicity of TNB subsamples (67%), and gender measurement (30%). The findings addressed COVID-19 (39%), mental health (29%), socioeconomics (26%), health care access (24%), physical health (13%), substance use (11%), violence/discrimination (8%), resiliency/coping (5%), gender identity/expression (5%), and sexual health (4%). Conclusions: A substantial amount of COVID-19 research inclusive of TNB people was conducted during the initial 2.5 years of the pandemic. However, there were key methodological (e.g., standardized measurement, enhanced community involvement) and topical gaps (e.g., social and structural resiliencies), which should be addressed in future research and practice to reduce TNB health disparities related to COVID-19 and future public health crises.

The geography of COVID-19 vaccine completion by age in North Carolina, U.S

BACKGROUND

Geographic variation in COVID-19 vaccination can create areas at higher risk of infection, complications, and death, exacerbating health inequalities. This ecological study examined geographic patterns of COVID-19 vaccine completion, using age and sociodemographic characteristics as possible explanatory mechanisms.

METHODS AND FINDINGS

Using 2020-2022 data from the North Carolina COVID-19 Vaccination Management System and U.S. Census Bureau American Community Survey, at the Zip code-level, we evaluated completion of the primary COVID-19 vaccine series across age groups. We examined geographic clustering of age-specific completion by Zip code and evaluated similarity of the age-specific geographic patterns. Using unadjusted and adjusted spatial autoregressive models, we examined associations between sociodemographic characteristics and age-specific vaccine completion. COVID-19 vaccine completion was moderately geographically clustered in younger groups, with lower clustering in older groups. Urban areas had clusters of higher vaccine completion. Younger and middle-aged groups were the most similar in completion geographically, while the oldest group was most dissimilar to other age groups. Higher income was associated with higher completion in adjusted models across all age groups, while a higher percent of Black residents was associated with higher completion for some groups.

CONCLUSIONS

COVID-19 vaccination completion is more variable among younger age groups in North Carolina, and it is higher in urban areas with higher income. Higher completion in areas with more Black residents may reflect the success of racial equity efforts in the state. The findings show a need to reach younger populations and lower income areas that were not prioritized during early vaccination distribution.

Sex and gender differences in adverse events following influenza and COVID-19 vaccination

INTRODUCTION

Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. In a predominately young adult female population of healthcare workers, we sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized.

METHODS

This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the mandatory annual fall 2019-2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination for bivalent COVID-19 and influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients.

RESULTS

Females were more likely to report local AEs after either influenza (OR = 2.28, p = 0.001) or COVID-19 (OR = 2.57, p = 0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after either influenza (OR = 1.18, p = 0.552) or COVID-19 (OR = 0.96, p = 0.907) vaccination. Hormonal birth control use did not impact the rates of reported AEs following influenza vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs.

CONCLUSIONS

Our findings highlight the need for sex- and gender-inclusive policies to inform more effective mandatory occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers, a predominately female population, and to more fully characterize the post-vaccination behavioral differences between men and women.

A Consolidated Framework for Implementation Research-based process to develop theoretically-informed human papillomavirus vaccination educational materials for young adults

OBJECTIVE

To develop theory-informed human papillomavirus (HPV) vaccine education materials that appeal to 18-26-year-olds.

METHODS

First, draft materials informed by Theory of Planned Behavior (TPB) and Health Belief Model (HBM) were developed. Next, an initial set of Consolidated Framework for Implementation Research (CFIR)-guided interviews were conducted with 18-26-year-old participants to receive feedback about content, format, appeal, implementation facilitators and barriers, and potential delivery modalities. Then, interviews were transcribed, coded, and analyzed using thematic analysis. Next, materials were modified based upon feedback. Finally, another set of interviews was conducted.

RESULTS

Most participants (n = 15) were female (93%), White (60%), and non-Hispanic (93%). All (100%) had heard of HPV and the HPV vaccine, and 80% reported having received the vaccine. Participant feedback on materials included emphasizing vaccine benefits and efficacy, rewording to enhance comprehension, and adding images represent diversity beyond race/ethnicity and sexual orientation. Suggested delivery methods included social media, print materials, and posters.

CONCLUSION

Qualitative interviews with young adults suggest that HPV education materials targeted to 18-26-year-olds should include health behavior theory-aligned messaging, inclusive imagery, and be disseminated through multiple modalities.

PRACTICE IMPLICATIONS

Providers should consider utilizing theory-based education materials that are relevant and appealing to young adults.

Sociodemographic Trends and Correlation between Parental Hesitancy towards Pediatric COVID-19 Vaccines and Routine Childhood Immunizations in the United States: 2021-2022 National Immunization Survey-Child COVID Module

Multiple factors may influence parental vaccine hesitancy towards pediatric COVID-19 vaccines and routine childhood immunizations (RCIs). Using the United States National Immunization Survey-Child COVID Module data collected from parents/guardians of children aged 5-11 years, this cross-sectional study (1) identified the trends and prevalence estimates of parental hesitancy towards pediatric COVID-19 vaccines and RCIs, (2) examined the relationship between hesitancy towards pediatric COVID-19 vaccines and RCIs, and (3) assessed trends in parental hesitancy towards RCIs by sociodemographic characteristics and behavioral and social drivers of COVID-19 vaccination. From November 2021 to July 2022, 54,329 parents or guardians were interviewed. During this 9-month period, the proportion of parents hesitant about pediatric COVID-19 vaccines increased by 15.8 percentage points (24.8% to 40.6%). Additionally, the proportion of parents who reported RCIs hesitancy increased by 4.7 percentage points from November 2021 to May 2022 but returned to baseline by July 2022. Over nine months, parents' concerns about pediatric COVID-19 infections declined; however, parents were increasingly worried about pediatric COVID-19 vaccine safety and overall importance. Furthermore, pediatric COVID-19 vaccine hesitancy was more prevalent among parents of children who were White (43.2%) versus Black (29.3%) or Hispanic (26.9%) and those residing in rural (51.3%) compared to urban (28.9%) areas. In contrast, RCIs hesitancy was higher among parents of children who were Black (32.0%) versus Hispanic (24.5%) or White (23.6%). Pediatric COVID-19 vaccine hesitancy was 2-6 times as prevalent among parents who were RCIs hesitant compared to those who were RCIs non-hesitant. This positive correlation between parental hesitancy towards pediatric COVID-19 vaccines and RCIs was observed for all demographic and psychosocial factors for unadjusted and adjusted prevalence ratios. Parent-provider interactions should increase vaccine confidence, shape social norms, and facilitate behavior change to promote pediatric vaccination rates.

Sex and gender differences in adverse events following receipt of influenza and COVID-19 vaccination among healthcare workers

Introduction

Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. We sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized.

Methods

This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the annual fall 2019-2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination (DPV) for bivalent COVID-19 and Influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients.

Results

Females were more likely to report local AEs after influenza (OR=2.28, p=0.001) or COVID-19 (OR=2.57, p=0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after influenza (OR=1.18, p=0.552) or COVID-19 (OR=0.96, p=0.907) vaccination. Exogenous hormones from birth control use did not impact the rates of reported AEs following COVID-19 vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs.

Conclusions

Our findings highlight the need for sex- and gender-inclusive policies to inform more effective occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers and to more fully characterize the post-vaccination behavioral differences between men and women.

KEY MESSAGE

What is already known on this topic: ⇒ Among diversely aged adults 18-64 years, females report more AEs to vaccines, including the influenza and COVID-19 vaccines, than males.⇒ Vaccine AEs play a role in shaping vaccine hesitancy and uptake.⇒ Vaccine uptake related to influenza and COVID-19 are higher among men than women.⇒ Research that addresses both the sex and gender disparities of vaccine outcomes and behaviors is lacking.What this study adds: ⇒ This prospective active reporting study uses both quantitative and qualitative survey data to examine sex and gender differences in AEs following influenza or COVID-19 vaccination among a cohort of reproductive-aged healthcare workers.How this study might affect research, practice, or policy: ⇒ Sex and gender differences in AEs and perceptions relating to vaccination should drive the development of more equitable and effective vaccine strategies and policies in occupational health settings.

COVID-19 vaccination willingness and uptake among low-income Black/African American, Latino, and White adults living in the U.S

The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between low-income and non-low-income adults and across race-ethnicity. We utilized data from the COVID-19's Unequal Racial Burden online survey, which included baseline (12/17/2020-2/11/2021) and 6-month follow-up (8/13/2021-9/9/2021) surveys. The sample included 1,500 Black/African American, Latino, and White low-income adults living in the U.S. (N = 500 each). A non-low-income cohort was created for comparison (n = 1,188). Multinomial logistic regression was used to assess differences in vaccine willingness and uptake between low-income and non-low-income adults, as well as across race-ethnicity (low-income adults only). Only low-income White adults were less likely to be vaccinated compared to their non-low-income counterparts (extremely willing vs. not at all: OR = 0.58, 95% CI = 0.39-0.86); low-income Black/African American and Latino adults were just as willing or more willing to vaccinate. At follow-up, only 30.2% of low-income adults who reported being unwilling at baseline were vaccinated at follow-up. White low-income adults (63.6%) appeared less likely to be vaccinated, compared to non-low-income White adults (80.9%), low-income Black/African American (70.7%), and low-income Latino adults (72.4%). Distrust in the government (46.6), drug companies (44.5%), and vaccine contents (52.1%) were common among those unwilling to vaccinate. This prospective study among a diverse sample of low-income adults found that low-income White adults were less willing and less likely to vaccinate than their non-low-income counterparts, but this difference was not observed for Black/African American or Latino adults. Distrust and misinformation were prevalent among those who remained unvaccinated at follow-up.

Impacts of a COVID-19 Educational Video: Evaluation of the Influence of Race, Gender, Political Affiliation, Study Major, and Age on Vaccine Acceptance among University Students

BACKGROUND

The World Health Organization (WHO) warns that vaccine hesitancy is an ongoing major global health threat. While vaccination against severe acute respiratory syndrome coronavirus (SARS-CoV-2) proves to be an effective strategy in protecting against the disease, vaccine hesitancy represents a major barrier to stopping the spread of the virus. Willingness for vaccination can be influenced by several factors, including education level and health literacy. Although several studies demonstrate the value of video educational programs in improving coronavirus disease 2019 (COVID-19) vaccine knowledge and acceptance, no studies to date have evaluated if race, gender, and other demographic factors impact the influence of an educational video on COVID-19 vaccine knowledge and hesitancy among university students in the United States (U.S.).

AIMS

This study was conducted to determine the impact of an educational video on U.S. university undergraduate students' COVID-19 vaccine perception and acceptance. It also aims to evaluate whether demographic factors affect the influence of the video.

METHODS

An online survey was used to measure perceived understanding and acceptance of COVID-19 vaccines before and after viewing a video regarding the effectiveness and safety of COVID-19 vaccinations. The impact of demographic factors on the Video Influence Score was analyzed.

KEY RESULTS

After viewing the video, respondents' (n = 285) perceived awareness and acceptance of COVID-19 vaccines significantly increased (p < 0.05). In addition, gender, political party affiliation, age, study major, and influenza vaccination history did not significantly impact the Video Influence Score (p > 0.05). However, African American/Black respondents (3.81 ± 4.24) were significantly more influenced by the video compared to respondents of other races (p < 0.05), such as White/Caucasian (1.91 ± 3.75), Hispanic/Latino (0.17 ± 3.67), Asian (0.29 ± 1.53), and Indigenous American (0.64 ± 2.52).

CONCLUSIONS

This study suggests the potential impact of an educational video on COVID-19 vaccine perception and acceptance among university students. Despite limitations such as a modest survey response rate, this study provides valuable insight concerning the influential factors affecting vaccine acceptance in diverse student populations. Future studies are warranted to explore how student response to vaccine educational videos may vary depending on students' racial and cultural backgrounds.

IMPLICATIONS

A targeted educational video to promote vaccine acceptance is a valuable tool for public health campaigns to combat vaccine hesitancy. The study also highlights the importance of tailoring interventions to specific demographic groups such as considering racial factors to maximize the impact of educational interventions on vaccine attitudes.

Factors related to human papillomavirus vaccine uptake and intentions among adults aged 18-26 and 27-45 years in the United States: A cross-sectional study

BACKGROUND

The current study examined self-reported human papillomavirus (HPV) vaccination uptake and intentions, and associations with psychosocial constructs among United States adults aged 18 to 26 and 27 to 45 years.

METHODS

Data were collected via an online survey from participants recruited from a research panel. Outcomes were HPV vaccination uptake and intentions. Multivariable binary and ordered logistic regression models were used to examine associations between HPV vaccination outcomes and psychosocial constructs, sociodemographics, and previous health behaviors.

RESULTS

HPV vaccination uptake in both age cohorts (N =  2722) was associated with multiple variables, including but not limited to: provider recommendation (adjusted odds ratio [aOR], 11.63 [95% CI, 7.70-17.56] and aOR, 14.26 [95% CI, 9.52-21.38], for those aged 18 to 26 and 27 to 45 years, respectively) and positive HPV vaccine attitudes (aOR, 2.40 [95% CI, 1.70-3.40] and aOR, 1.46 [95% CI,1.06-2.02]). Among those who did not report or were unsure of prior HPV vaccination (N =1894), only 4.6% and 8.1% (aged 18-26 and 27-45 years, respectively) reported being very likely to receive the HPV vaccine in the next year. Increased intentions were associated with more positive vaccine attitudes (aOR, 2.45 [95% CI, 1.91-3.15] and aOR, 2.19 [95% CI, 1.72-2.78]) and provider recommendation (yes vs no; aOR, 1.97 [95% CI, 1.38-2.83] and aOR, 1.82 [95% CI, 1.31-2.52]; don't know/can't remember vs no; aOR, 1.38 [95% CI, 1.03-1.84] and aOR, 1.60 [95% CI, 1.17-2.18]). Sociodemographics and health behaviors associated with increased intentions differed for each age cohort.

CONCLUSIONS

Individual and interpersonal factors were associated with HPV vaccination uptake and intentions. Findings reveal the need for targeted interventions to improve HPV vaccination rates among these age groups.

Investigating Attitudes, Motivations and Key Influencers for COVID-19 Vaccination Uptake among Late Adopters in Urban Zimbabwe

The rapid development of vaccines in response to the COVID-19 pandemic has provided an effective tool for the management of COVID-19. However, in many African countries there has been a poor uptake of COVID-19 vaccines with only 32.5% first vaccine dose coverage compared to the WHO global target of 70%. As vaccine access improves, one of the important drivers of low uptake has been vaccine hesitancy, driven by levels of confidence, convenience, and complacency. Between 4 January-11 February 2022, we conducted a survey of vaccine late adopters to assess factors that influenced adults in Harare, Zimbabwe to present for their first COVID-19 vaccine dose almost 12 months after the vaccination program began. Of the 1016 adults enrolled, 50% were female and 12.4% had HIV co-infection. Binary logistic regression models were developed to understand factors associated with vaccine confidence. Women were more likely to have negative views about the COVID-19 vaccine compared to men (OR 1.51 (95%CI 1.16, 1.97, p = 0.002). Older adults (≥40 years) compared with youth (18-25 years) were more likely to have 'major concerns' about vaccines. When asked about their concerns, 602 (59.3%) considered immediate side effects as a major concern and 520 (52.1%) were concerned about long-term health effects. People living with HIV (PLWH) were more likely to perceive vaccines as safe (OR 1.71 (95%CI: 1.07, 2.74, p = 0.025) and effective (1.68 (95%CI: 1.07, 2.64, p = 0.026). Internet users were less likely to perceive vaccines as safe (OR 0.72 (95% CI: 0.55, 0.95, p = 0.021) compared to non-Internet users; and social media was a more likely source of information for youth and those with higher education. Family members were the primary key influencers for 560 (55.2%) participants. The most important reason for receiving the COVID-19 vaccine for 715 (70.4%) participants was the protection of individual health. Improving vaccine coverage will need targeted communication strategies that address negative perceptions of vaccines and associated safety and effectiveness concerns. Leveraging normative behavior as a social motivator for vaccination will be important, as close social networks are key influences of vaccination.

Does the COVID-19 Vaccination Rate Change According to the Education and Income: A Study on Vaccination Rates in Cities of Turkey between 2021-September and 2022-February

BACKGROUND

The increase in the coronavirus disease 2019 (COVID-19) vaccination rates in Turkey and in the world plays a key role in reducing the number of deaths and cases from COVID-19. Investigating the underlying causes of COVID-19 vaccine hesitations seems to be a guide in reducing the negative effects of the pandemic.

METHODS

We analyzed the correlations between double COVID-19 vaccination rates of all cities in Turkey between 1 September 2021 and 1 February 2022 and their per capita income values and their education level percentages.

RESULTS

Overall, there was a negative correlation between the vaccination rates of cities and the percentages of illiterate, literate without a diploma, and secondary school graduates for both genders. However, there was a positive correlation between city vaccination rates and the percentages of primary school and college graduates. City income values per capita values were positively correlated with double vaccination rates of cities.

CONCLUSION

Our findings suggest that not only low levels of education, but also interruption of education at some point make a significant contribution to vaccination hesitancy and ultimately to vaccination levels. In order to end the pandemic and reach a sufficient percentage of vaccines, it may be necessary to address some special groups and raise awareness of these groups about vaccination.

Longitudinal Serological Surveillance for COVID-19 Antibodies after Infection and Vaccination

The impact of COVID-19 is still felt around the world, and more information is needed regarding infection risk, vaccination responses, and the timing of booster vaccinations. We aimed to evaluate the association of vaccination with closely followed, longitudinal antibody titers and COVID-19 infection events. We conducted a natural history study in a convenience cohort in an ambulatory research unit. We measured anti-nucleocapsid and anti-spike antibody levels every 3 months for 1 year and captured weekly reports of medically confirmed COVID-19 infections. We analyzed the association of antibody titers with infection events as well as the association of the decision to receive vaccination with social, medical, and behavioral characteristics. 629 subjects were followed for 1 year, and 82.8% of them were vaccinated. 90 cases of medically confirmed COVID-19 infection were reported. Notable findings from our study include: an association of vaccination choice with social distancing, a qualitatively different anti-spike response in participants receiving the Ad26.COV2.S vaccine compared to those receiving mRNA vaccines, a muted anti-nucleocapsid response in breakthrough infections compared to unvaccinated infections, and the identification of a low antibody titer threshold associated with the risk of breakthrough infections. We conclude that, in a real-life setting, vaccination and social distancing behavior are positively correlated. The observed effect of vaccination in preventing COVID-19 may include both vaccine-mediated protection and the associated more cautious behavior exhibited by vaccinated individuals. In addition, we identified an antibody threshold associated with breakthrough infections in mRNA vaccinees, and this threshold may be used in medical decision-making regarding the timing of booster vaccinations. Therefore, our data may aid in the refinement of vaccination strategies during the COVID-19 pandemic. IMPORTANCE The COVID-19 pandemic continues to impact societies and health care systems worldwide and is continuously evolving. Immunity via vaccination or prior infection is the first and most important line of defense against COVID-19. We still do not have complete information on how vaccination-induced or infection-induced antibody titers change with time or on how this information can be used to guide decisions regarding booster vaccination. In a longitudinal observational study of a cohort of 629 subjects, 82% of breakthrough infections in vaccinees occurred when their anti-spike antibody titers were below 3,000 AU/mL. Our findings suggest that there may be an antibody threshold associated with breakthrough infections and that this threshold could possibly be used to aid decision-making regarding booster vaccinations. In addition, the use of anti-nucleocapsid antibody tiers may significantly underestimate the prevalence of breakthrough infections in vaccinated individuals.

Strategies and Lessons Learned During Cleaning of Data From Research Panel Participants: Cross-sectional Web-Based Health Behavior Survey Study

Background

The use of web-based methods to collect population-based health behavior data has burgeoned over the past two decades. Researchers have used web-based platforms and research panels to study a myriad of topics. Data cleaning prior to statistical analysis of web-based survey data is an important step for data integrity. However, the data cleaning processes used by research teams are often not reported.

Objective

The objectives of this manuscript are to describe the use of a systematic approach to clean the data collected via a web-based platform from panelists and to share lessons learned with other research teams to promote high-quality data cleaning process improvements.

Methods

Data for this web-based survey study were collected from a research panel that is available for scientific and marketing research. Participants (N=4000) were panelists recruited either directly or through verified partners of the research panel, were aged 18 to 45 years, were living in the United States, had proficiency in the English language, and had access to the internet. Eligible participants completed a health behavior survey via Qualtrics. Informed by recommendations from the literature, our interdisciplinary research team developed and implemented a systematic and sequential plan to inform data cleaning processes. This included the following: (1) reviewing survey completion speed, (2) identifying consecutive responses, (3) identifying cases with contradictory responses, and (4) assessing the quality of open-ended responses. Implementation of these strategies is described in detail, and the Checklist for E-Survey Data Integrity is offered as a tool for other investigators.

Results

Data cleaning procedures resulted in the removal of 1278 out of 4000 (31.95%) response records, which failed one or more data quality checks. First, approximately one-sixth of records (n=648, 16.20%) were removed because respondents completed the survey unrealistically quickly (ie, <10 minutes). Next, 7.30% (n=292) of records were removed because they contained evidence of consecutive responses. A total of 4.68% (n=187) of records were subsequently removed due to instances of conflicting responses. Finally, a total of 3.78% (n=151) of records were removed due to poor-quality open-ended responses. Thus, after these data cleaning steps, the final sample contained 2722 responses, representing 68.05% of the original sample.

Conclusions

Examining data integrity and promoting transparency of data cleaning reporting is imperative for web-based survey research. Ensuring a high quality of data both prior to and following data collection is important. Our systematic approach helped eliminate records flagged as being of questionable quality. Data cleaning and management procedures should be reported more frequently, and systematic approaches should be adopted as standards of good practice in this type of research.