COVID-19 Vaccine Coverage and General Vaccine Hesitancy in Rural Areas in the United States

PROJECT SUMMARY Two issues related to adolescent vaccination have recently come to the forefront of public health in the United States (US): coronavirus disease 2019 (COVID-19) vaccination and general vaccine hesitancy (i.e., a delay or refusal of any vaccination despite availability). These issues are especially important for adolescents in rural areas, as these areas experience several vaccine-related disparities. A necessary starting point in this novel line of research is to gain an in-depth understanding of these health outcomes via two types of epidemiological data. First, we need to quantify COVID-19 vaccine coverage and the prevalence of general vaccine hesitancy in rural areas. Second, we need to identify multi-level factors associated with each outcome in rural areas. In producing these epidemiological data, it is critical to do so in a way that accounts for the heterogeneity of rural areas. However, a key and recurring limitation of past vaccine-related research is that rural areas have been aggregated into a single, homogeneous group. This approach obscures the heterogeneity of rural areas and can actually create "hidden" disparities between different types of rural areas. Rural-Urban Continuum Codes (RUCCs) are a measurement approach that avoids this limitation and examines rurality in a nuanced manner by classifying each US county into one of nine categories that span the continuum of urbanicity/rurality. Our long-term goal is to understand how rurality affects COVID-19 vaccine coverage and general vaccine hesitancy and then apply this understanding to improve these outcomes in rural areas. The proposed study will take the first step toward achieving this goal by generating the epidemiological data described above. We will analyze existing data from the 2022-2023 National Immunization Survey-Teen (NIS-Teen) on both COVID-19 vaccine coverage among a large national sample of adolescents (estimated n=40,650) and general vaccine hesitancy among their parents. In doing so, we will use RUCC categories to examine rurality during analyses. Specifically, the proposed study will determine how rurality affects COVID-19 vaccine coverage among adolescents (Aim 1), multi-level factors associated with COVID-19 vaccine coverage (Aim 2), general vaccine hesitancy among parents (Aim 3), and multi-level factors associated with general vaccine hesitancy among parents (Aim 4). Each aim will address a unique research question and together will provide the most comprehensive data to date on rurality, COVID-19 vaccine coverage, and general vaccine hesitancy. Findings will provide highly novel data that impact future interventions to increase COVID-19 vaccine coverage and decrease general vaccine hesitancy in rural areas (e.g., results will identify priority rural areas for interventions to target and highlight strategies that interventions can use to improve these health outcomes).