Examining Factors of COVID-19 Vaccine Hesitancy for College Students in the Mid-South

Overview: Coronavirus (COVID-19) vaccine hesitancy is a critical threat to higher education. This study conducted a cross-sectional survey to examine factors associated with COVID-19 vaccine hesitancy among college students at a public university in the Mid-South. The findings suggest social work practice and research for promoting COVID-19 vaccinations in college students.Proposal text: The coronavirus (COVID-19) pandemic has drastically impacted higher education across the United States (U.S.), yet disproportionately universities with limited resources.1 To prevent the spread of COVID-19, the universities have encouraged their students and faculty/staff to get fully vaccinated and wear a mask.2 Despite such encouragement and high rates of COVID-19-associated hospitalization and death, the Mid-south and Southeastern U.S. has reported low rates of COVID-19 vaccination.3,4

The World Health Organization and health experts have identified vaccine hesitancy as a leading barrier to recommended vaccinations.5–10 The COVID-19 pandemic has fueled increased levels of hesitancy for vaccines.11 National data also indicate that the Mid-south and Southeastern U.S. has high rates of COVID-19 vaccine hesitancy,12–15 while less than half (43%) of young adults aged 18 to 29 years were hesitant to receive a COVID-19 vaccine.16 However, little is known about what factors contribute to the vaccine hesitancy especially among college students in this region. This study aimed to examine factors associated with COVID-19 vaccine hesitancy among college students in the Mid-South.

A cross-sectional online survey was conducted to collect quantitative data regarding COVID-19 vaccine hesitancy among college students at a public university in the Mid-South between March and May 2021. Simple random sampling was performed to recruit enrolled undergraduate students. A total of 384 undergraduate students completed the online survey on information of sociodemographics, medical insurance, self-report health status, a number of chronic conditions, needs for mental health services during the pandemic, annual flu vaccination, attitudes toward wearing a mask, and COVID-19 vaccine hesitancy.

Descriptive analyses showed that the mean age of the participants was 21 years old (SD=1.80); 76.3% (n=293) were female; 45.3% (n=174) were non-Hispanic whites; 75.0% (n=288) reported that religion is important; 85.4% (n=328) had medical insurance; 24.2% (n=93) reported excellent health; 24.5% (n=94) had at least one chronic condition; 34.1% (n=131) reported needs for mental health services during the pandemic; 26.0% (n=100) had flu vaccination annually; and 34.1% (n=131) reported a negative attitude toward wearing a mask (i.e., “wearing a mask is harmful to my health”). The multiple logistic regression analysis showed that participants reporting the negative attitude toward wearing a mask were more likely than those reporting the positive one to be hesitant to receive COVID-19 vaccines (OR=2.91; 95% CI=1.68-5.04), holding other variables constant.

The findings provide several implications for social work practice and research. Social workers should employ comprehensive approaches that address hesitancy for COVID-19 vaccines among college students. In collaboration with a student health center, social workers should develop campus-wide campaigns aimed at improving attitudes toward wearing a mask and COVID vaccine hesitancy. Future research should investigate the mechanism underlying the association between wearing a mask and vaccine hesitancy. Mixed-methods studies are needed to evaluate important factors contributing to COVID-19 vaccine hesitancy for college students in other regions. Social work can play a critical role in lowering vaccine hesitancy to increase the vaccination rates, leading to reducing disparities in COVID-19-associated mortality rates and advancing quality of higher education.