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Using the "3Cs" vaccine hesitancy framework which categorizes determinants of vaccine hesitancy across three dimensions-confidence, complacency, and convenience-we identify factors that shape COVID-19 vaccination intake and intention among Black and white residents in Southeast Michigan. We consider both historical discrimination in medicine and contemporary health and environmental crises (i.e., the Flint Water Crisis) as potential correlates. This study uses data from an online survey conducted between March-April 2021 in Flint and surrounding counties. we find that while historical mistreatment of Black people in healthcare and the Flint Water Crisis were of concern, those factors did not directly impact vaccination intention. Rather, concerns over safety, efficacy, and structural barriers related to access and occupation emerge as responsible for lower vaccination rates among Black residents. Effective vaccination programs require that public health authorities consider multiple factors, including the structural realities faced by racial ethnic minority groups which shape their vaccination decisions., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness., Competing Interests: The authors have declared that no competing interests exist.

As a pharmaceutical intervention, vaccines remain a major public health strategy for mitigating the effects of COVID-19. Yet, vaccine intake has been affected by various cognitive and cultural factors. We examine how a selected set of factors (i.e., knowledge, concern, media, peer influence, and demographics) shaped COVID-19 vaccination intention in the early phase of the pandemic (Fall 2020). Using a survey conducted in three US states (Idaho, Texas, and Vermont) just prior to the rollout of the first vaccines against COVID-19, we find that COVID-19 concern was the primary driver of vaccination intention. Concern was shaped mainly by two factors: political ideology and media sources. Yet, ideology and media were much more important in affecting concern for those who leaned politically conservative, as opposed to those who leaned liberal or remained moderate. The results from our structural equation models affirm that the information politically conservative respondents were receiving reinforced the effects of their ideology, leading to a greater reduction in their concern. We discuss the potential implications of these findings for future pandemic preparedness. [ABSTRACT FROM AUTHOR]