Latinx youth’s and parents’ covid-19 beliefs, vaccine hesitancy and vaccination rates: Longitudinal associations in a community sample

Namoonga M. Mantina; Maiya G. Block Ngaybe; Katharine H. Zeiders; Kayla M. Osman; Ada M. Wilkinson-Lee; Antoinette M. Landor; Lindsay T. Hoyt

doi:10.1371/journal.pone.0307479

Abstract

Introduction

The Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the United States and less than half of Latinx youth aged 5–17 years old completed their COVID-19 primary vaccination series as of September 2022. COVID-19 vaccine misinformation detrimentally impacts vaccination rates. In this study, we examined factors that predicted Latinx youth COVID-19 vaccine hesitancy and vaccination status.

Methods

A community-based sample of 290 Latinx parent and adolescent dyads from a Southwestern metropolitan area of the United States who were recruited to complete an online survey at baseline at T1 (August 2020 –March 2021) and one year later. We tested a longitudinal mediation model in which we examined individual and family factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time.

Results

Youth’s pandemic disbelief (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) predicted greater youth’s COVID-19 vaccine hesitancy, and in turn, a lower likelihood of youth’s COVID-19 vaccination. Youth’s pandemic disbelief also predicted greater parent’s vaccination hesitancy which, in turn, predicted greater youth’s vaccination hesitancy and a lower likelihood of COVID-19 vaccination. Parents’ pandemic disbelief predicted their own COVID-19 hesitancy, but not youth hesitancy.

Discussion

Our study findings provide initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx families. The study contributes to the limited research investigating COVID-19 vaccination in the Latinx community and among Latinx youth, further aiding how COVID-19 vaccine disparities can be mitigated among racial/ethnic populations.

Citation: Mantina NM, Ngaybe MGB, Zeiders KH, Osman KM, Wilkinson-Lee AM, Landor AM, et al. (2024) Latinx youth’s and parents’ covid-19 beliefs, vaccine hesitancy and vaccination rates: Longitudinal associations in a community sample. PLoS ONE 19(7): e0307479. https://doi.org/10.1371/journal.pone.0307479

Editor: Jim P. Stimpson, UT Southwestern: The University of Texas Southwestern Medical Center, UNITED STATES OF AMERICA

Received: February 8, 2024; Accepted: July 5, 2024; Published: July 24, 2024

Copyright: © 2024 Mantina et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data are currently coded and will not be fully de-identified until the close of the study. Per our IRB agreement, the study will not publicly share data until the study is closed. The Institutional Review Board at the University of Arizona can be reached at vpr-irb@email.arizona.edu. A de-identified data set will be provided on request.

Funding: This research is supported by the National Science Foundation (Grant# 1917702, PIs: Zeiders & Wilkinson-Lee; #1917704, PI: Hoyt). The funder did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript https://www.nsf.gov/.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The Hispanic/Latino/Latinx [1] community makes up 19% of the United States population yet accounted for 24.5% of SARS-CoV-2 (COVID-19) cases, second highest only to non-Hispanic Whites [1, 2]. Although 84% of Latinx adults over 18 years had completed the primary series of COVID-19 vaccines by March 2023 [3], this community has been impacted by systemic inequities that have resulted in disproportionate health outcomes. The Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the US [2]. Although vaccine hesitancy, defined as the delay, refusal, or reluctance to get vaccinated, existed before the COVID-19 pandemic [4], COVID-19 detrimentally impacted the administration of longstanding routine childhood immunizations globally [5–7]. In the US, the COVID-19 pandemic was associated with increases in general vaccine hesitancy and childhood vaccine hesitancy among parents [8]. Additionally, the COVID-19 pandemic exacerbated vaccination misinformation and conspiracy theories [9], in part because of political rhetoric that introduced a new politicization context for vaccination hesitancy and behavior [10]. Indeed, political affiliation in parents has been shown to be related to parents’ intention to vaccinate their child against COVID-19 [11], but very little work has examined the relation of COVID-19 vaccine-related conspiracy theories and politicization in youth alongside parental factors. Given this, the current study explored the pathways linking parents’ and youth’s disbelief of COVID-19 (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) early in the pandemic (from August 2020) to vaccine hesitancy and vaccination rates one year later (2021) among a community-based sample of Latinx families.

COVID-19 vaccines were approved under Emergency Use Authorization for children ages 5 to 17 years old by October 2021 [12–14]. However, COVID-19 vaccination rates among adolescents were lower than desired. In September 2022, only 47.2% of youth 5–17 years had received at least one COVID-19 dose and 43.3% received two or more doses [15]. There are many factors that relate to children’s vaccination rates, with the most salient being parental vaccination decisions, but other factors include safety concerns, fear of long-term side effects, and potential negative reactions to the vaccine [16]. Parents with lower income have also reported greater hesitancy about their child receiving a COVID-19 vaccine compared to those with higher income [17, 18]. Parental COVID-19 vaccine hesitancy has been found to vary across racial/ethnic groups. Latinx and Black parents have reported more hesitancy about their child receiving the COVID-19 vaccine compared to White parents [17, 19]. Factors associated with greater vaccine hesitancy among racial/ethnic populations include perceived risk of COVID-19, vaccine beliefs, vaccination history, and concerns for safety, efficacy of the vaccine, medical mistrust, and history of racial discrimination [19, 20].

Notably, family decisions about vaccinations are not one-directional—children can also influence the values, beliefs, and attitudes of their parents [21]. Although parents are the key decision makers for their child’s medical care, adolescents are not always passive observers in these processes. For instance, in a study examining parents and sons’ vaccinations, researchers found that when parents included adolescents in decisions about the human papillomavirus vaccination (HPV), there was greater open communication, shared decision making and increases in adolescents’ vaccination uptake [22, 23].

Outside of familial influences, additional societal factors can influence vaccine uptake, including misinformation, conspiracy theories, and political climate. General childhood vaccine misinformation has been found to relate to parental vaccine hesitancy and, as a result, has been shown to influence vaccine attitudes with conservative individuals more likely to believe in conspiracy theories about vaccines than liberal individuals [24]. More conservative parents are less likely to hold pro-vaccine beliefs and are less likely to vaccinate their children for recommended childhood vaccines [25, 26]. The politics, misinformation, vaccine rumors, and conspiracy theories surrounding the COVID-19 vaccine have been found to relate to COVID-19 vaccine hesitancy [27–30] across multiple racial and ethnic groups [19]. Further, parents who are more prone to believe in conspiracy theories are more hesitant in getting their children vaccinated for COVID-19 [31]. Within immigrant communities and among foreign-born Hispanic individuals specifically, increasing fears and concerns relating to documentation and deportation have also been found to impact COVID-19 vaccinations [19, 30–32]. Much of this prior research has been conducted outside the US, highlighting global patterns. This study focuses on these factors within a southwestern US state (that has a high percentage of Hispanic/Latinx immigrants), considering the local context and political climate around vaccination. Although it is critical to understand parental beliefs about adolescent COVID-19 vaccination, it is also imperative to study young people’s experiences. There is, however, a dearth of research investigating adolescents’ conspiracy beliefs about the COVID-19 pandemic. One study found that 14% of their sample of German adolescents endorsed at least one COVID-19 conspiracy belief [33]. A qualitative study revealed several beliefs held among a sample of South African youth such as COVID-19 being human-made to harm people [34]. Given the prominence of COVID-19 conspiracy theories and misinformation, understanding the COVID-19 beliefs among parents and adolescents may be essential for understanding the disparities seen in adolescent COVID-19 vaccination rates.

The current study

The current study aimed to provide descriptive information about the COVID-19 vaccination rate and COVID-19 vaccine hesitancy among a community-based sample of Latinx youth and parents. Additionally, we tested a longitudinal mediation model in which we examined factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time. Specifically, we examined how youth and parents’ (dis)beliefs about the pandemic and individual (i.e., youth age; parent/youth gender and nativity) and family (i.e., family income) characteristics related to youth COVID-19 vaccination hesitancy and COVID-19 vaccination status one year later. Given that vaccine attitudes have been found to predict vaccination [35, 36], we tested for mediation, hypothesizing that beliefs, individual, and family characteristics would relate to parent/child vaccination via vaccination hesitancy.

Methods

Procedure

Data came from The Hijos Project, a large longitudinal research project on the experiences, stressors, and well-being of Latinx families with adolescent children during the COVID-19 pandemic. From August 1, 2020, to March 30, 2021, families were recruited through social media and local organizations. Families were eligible if one parent (or caregiver) and one adolescent, between the ages of 11 to 15 years, were of Latinx background. Families were screened for eligibility through follow-up phone calls in which bilingual study personnel validated the name of the parent and adolescent, and the adolescent’s age. Eligible, consenting parents and assenting adolescents received a link to complete a 30-to-45-minute online survey available in English or Spanish. Given the interest in both parent and youth vaccine status, the current study utilized data from families where both the adolescent and the parent completed the study at Time 1 (T1) (N = 290 parent-child dyads).

Families were followed up at approximately one year (Parent: M = 1.08 years, SD = .10 years; Youth: M = 1.09 years, SD = .10 years) after T1. Approximately 79% of parents and 78% of adolescents from T1 completed an online survey at Time 2 (T2), which occurred from November 1, 2021, to April 30, 3022. Parents and youth received a $25 and $10 e-gift card, respectively at T1 and a $30 and $25 e-gift card at T2. The University Institutional Review Board (IRB #2005739923; IRB #2108136675) approved the study.

Sample characteristics

At T1, parents were, on average, 39.8 years old (SD = 6.65); 90% of parents identified as women/female, and 9% as men/male (Table 1). Most parents were US-born (57.9%) and completed the survey in English (69%); among those who were foreign-born, the majority (41%) were born in Mexico and came to the US when they were, on average, 18.9 years old (SD = 10.2). Most parents identified as Mexican American (39.7%), reported ‘some college, vocational or technical school’ (20.7%) and reported a yearly household income of $50,000 or lower (56.9%). Adolescents were, on average, 13.7 years old (SD = 1.42) at T1; 50.3% of adolescents identified as boys/males, and 47.6% as girls/females. Almost all adolescents were US-born (95.2%) and chose to complete the survey in English (97.9%); those who were foreign-born came to the US when they were, on average, 7.4 years old (SD = 3.52) and the majority were born in Mexico. Most adolescents identified their ethnic background as Mexican American (58.6%).

Download:

Table 1. Characteristics of parent-adolescent dyad sample (n = 290).

https://doi.org/10.1371/journal.pone.0307479.t001

Measures

COVID-19 conspiracy beliefs (T1).

Similar to other studies who created new measures during the COVID-19 pandemic [37], we utilized a single item to ask parents and youth about their beliefs regarding the COVID-19 pandemic at T1. Parents were asked to rate their agreement with the statement, “The COVID-19 pandemic is a conspiracy” and youth rated their agreement with the statement, “The COVID-19 pandemic is fake or not real.” Responses ranged from 1 = Strongly Disagree to 5 = Strongly Agree.

Individual and family predictors (T1).

Parents were asked to report on their total family income. To assess income, response categories ranged from “less than $10,000” and “$150,000 or higher.” Adolescents reported on their gender, age, and nativity. Youth were asked to report their gender identity with the following question, “What is your current gender identity?” with the option to choose between 6 different gender identity responses as well as the option to write in their own response. Gender was coded as 0 (boy/male/transgender boy/male), 1 (girl/female/transgender girl/female), and non-binary youth (n = 5) were coded as missing. To assess nativity, both parents and adolescents were asked to specify their country of birth. Nativity was coded as 0 (foreign-born) and 1 (US-born).

Family COVID-19 hospitalizations or deaths (T2).

We accounted for families’ COVID-19 hospitalizations and deaths during the pandemic as these may act as proxies to perceived risk and relate to their own COVID-19 risk-related health beliefs. Parents were asked to report their familial experiences with COVID-19 related to hospitalization and family deaths with two items at T2. They reported on whether “Someone in the family was hospitalized for COVID-19” and if “Someone in the family died from COVID-19” (0 = No and 1 = Yes). A sum score was computed to indicate the total number of experiences, which could range from 0 to 2.

General vaccine hesitancy (T2).

Parents were asked to complete an adapted Vaccine Hesitancy Scale adapted from the Vaccine Hesitancy scale [38]. Using 7 items, parents rated their agreement with statements related to their perceptions of general children’s vaccines (e.g., “New vaccines carry more risks than older vaccines”). Responses ranged from 1 = Strongly Disagree to 5 = Strongly Agree. A mean was computed to create a total vaccine hesitancy score; higher scores reflected greater levels of hesitancy. The scale demonstrated strong reliability (α = .92).

COVID-19 vaccine hesitancy (T2).

Both parents and youth were asked to complete an adapted version of the Vaccine Hesitancy Scale [39] where items were specific to COVID-19 vaccines. Parents and youth rated their agreement with statements related to their perceptions of the COVID-19 vaccines (e.g., “I am concerned about serious adverse effects of the COVID-19 vaccine”). Responses ranged from 1 = Strongly Disagree to 5 = Strongly Agree. A mean was computed to create a total COVID-19 vaccine hesitancy score. Higher scores reflect greater levels of hesitancy. The scale demonstrated strong reliability for both parents (α = .92) and youth (α = .91).

COVID-19 vaccination (T2).

Both parents and youth were asked to report whether they had received the COVID-19 vaccine with a single item (i.e., “Have you gotten the COVID-19 vaccine?”; 0 = No and 1 = Yes). Those who responded “No” were asked “Are you planning on getting the COVID-19 vaccine?” (0 = No and 1 = Yes).

Statistical analysis

Analyses were performed in SPSS V 28.0 and MPlus Version 8.1 [40]. For path models, multiple fit indices—chi-squared test, comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR)—were used to assess model fit; good model fit is reflected by a non-significant chi-squared test, CFI greater than .95, RMSEA less than .05, and SRMR less than .05 [41]. The hypothesized model (Fig 1) was specified in MPlus. Specifically, T1 youth COVID-19 vaccine status was regressed on T2 parent COVID-19 vaccine status and T2 parent and youth COVID-19 vaccine hesitancy. T2 Parent COVID-19 vaccine status was regressed on T2 parent and youth COVID-19 vaccine hesitancy. Given that both T2 youth and parent COVID-19 vaccine status were dichotomous variables, theses estimations were logistic regressions (and thus, coefficients represent log odds). T2 Parent COVID-19 vaccine hesitancy was regressed on T1 parent and youth pandemic disbelief, as well as T1 individual and family predictors (i.e., family income, youth gender, youth age, parent, and youth nativity). T2 youth COVID-19 vaccine hesitancy was regressed on T2 parent vaccine hesitancy, T1 parent and youth pandemic disbelief and T1 individual and family predictors. Given that we were testing mediation, all direct paths were specified as well (e.g., youth and parent COVID-19 vaccines status regressed on parent and youth pandemic disbelief). Additionally, covariates were included in the model; specifically, paths from T2 parental general vaccine hesitancy to T2 parent and youth COVID-19 vaccine status was specified and paths from T2 family COVID-19 hospitalizations/deaths to T2 youth and parent vaccine hesitancy and youth COVID-19 vaccine status were specified. Missing data were accounted for using full information maximum likelihood (FIML) [42] and mediation was tested using the multivariate delta method [43].

Download:

Fig 1. Path model linking COVID-19 disbelief to youth COVID-19 vaccination via COVID-19 vaccine hesitancy.

Youth and parent pandemic disbelief, individual, and familial factors at Time 1 (August 2020 to March 2021) predicting youth and parent COVID-19 vaccine hesitancy and COVID-19 vaccination status 1 year later (Time 2, November 2021 to April 2022), controlling for parent general vaccination hesitancy and family COVID-19 hospitalizations and deaths. Model fit: χ2 (3) = 1.65, ns; CFI = 1.00, RMSEA = .00, SRMR = .01. * p < .05, ** p < .01, *** p < .001. Paths bolded are significant; dashed paths are non-significant. Unstandardized coefficients (and standard errors) are first reported; standardized coefficients are presented after the dash. Note that all paths to the following constructs are log odds: Parent COVID-19 Vaccine and Youth COVID-19 Vaccines. Youth gender coded 0 = boy; 1 = girl, Parent and youth nativity coded 0 = born outside of US, 1 = born in the US. Youth COVID-19 Vaccine r² = .68; Parent COVID-19 Vaccine r² = .56; Parent COVID-19 Vaccine Hesitancy r² = .13; Youth COVID-19 Vaccine Hesitancy r² = .20.

https://doi.org/10.1371/journal.pone.0307479.g001

Results

The first set of descriptive results includes all participants with complete data on T2 vaccination status (i.e., T2 parent-adolescent dyad sample), which includes 228 youth and 231 parents. Nearly 80.9% of these youth reported receiving at least one vaccination for COVID-19 at T2 (Table 2); of those who reported not being vaccinated, 45.5% reported that they intend to receive the vaccination. Most parents (88.4%) reported receiving at least one COVID-19 vaccination (Table 2); of those parents who reported not being vaccinated, 33.3% reported that they intended to be vaccinated. We also examined family dyad vaccination rates (i.e., parent and youth within the same family); 77.9% of families included vaccinated youth and parents, 7.9% of families reported neither the parent nor child were vaccinated, 3.5% of families reported only the parent was vaccinated, and finally, 11.4% of families reported that only the child was vaccinated. As for COVID-19 vaccine hesitancy, both parents and youth reported relatively low hesitancy (M = 2.18, SD = 0.9; M = 2.16, SD = 1.0 respectively). COVID-19 vaccine hesitancy did not differ across US and foreign-born parents, t = .77(229), p = .44, nor did they differ across US and foreign-born youth, t = .32 (227), p = .09.

Download:

Table 2. Percentages of COVID-19 vaccination rates among T2 parent-adolescent dyad sample.

https://doi.org/10.1371/journal.pone.0307479.t002

In terms of differences by nativity, COVID-19 vaccine rates were higher among US-born youth (81.6%) compared to foreign-born youth (63.6%), but not statistically different, χ2 (1) = 2.16, p = .14 (Table 3). There was also no significant difference in youth vaccination status by parents’ nativity, χ2 (1) = .14, p = .71; that is, youths’ COVID-19 vaccine rates were 79.8% for youth whose parent was born in the US and 81.8% for youth whose parent was born outside of the US. Among parents, 87.2% US-born parents and 89.8% of foreign-born parents reported COVID-19 vaccination and these percentages were not significantly different χ2 (1) = .36, p = .55.

Download:

Table 3. Percentages of T2 COVID-19 vaccination rates by nativity among the T2 parent-adolescent dyad sample.

https://doi.org/10.1371/journal.pone.0307479.t003

Table 4 presents correlations and descriptive information among study constructs.

Download:

Table 4. Correlations and descriptive statistics for study variables.

https://doi.org/10.1371/journal.pone.0307479.t004

Fig 1 presents path modeling analysis results using the full sample of 290 parent-adolescent dyads, accounting for missing data with FIML; both unstandardized and standardized estimates are presented in the figure for linear regressions; for paths that were logistic regressions, both log odds and standardized log odds are presented. The model demonstrated good fit, χ2 (3) = 1.65, ns; CFI = 1.00, RMSEA = .00, SRMR = .01., and suggested that youth’s pandemic disbelief at T1 predicted youth’s and parents’ greater COVID-19 vaccine hesitancy at T2. Parents’ pandemic disbelief predicted their own COVID-19 hesitancy, but not youth’s hesitancy. At T2, youth’s COVID-19 vaccine hesitancy predicted youth’s own COVID-19 vaccination status, and parent’s COVID-19 vaccine hesitancy predicted parent’s COVID-19 vaccination status. Additionally, parents’ COVID-19 vaccine hesitancy predicted youth’s greater COVID-19 vaccine hesitancy; and parent’s COVID-19 vaccination predicted youth’s COVID-19 vaccination in the expected direction. Greater T1 family income related to lower T2 COVID-19 vaccination hesitancy among parents and a higher likelihood of parents’ T2 COVID-19 vaccination; no other family factor was statistically significant.

Mediational tests revealed five significant mediational pathways. First, youth’s T2 COVID-19 vaccine hesitancy significantly mediated the link between youths’ T1 disbelief and youth’s T2 COVID-19 vaccination, b_{indirect effect(ie)} = -.08, SE = .04, p < .05. Additionally, parents’ and youths’ T2 COVID-19 vaccine hesitancy significantly mediated the link between youth’s T1 pandemic disbelief and youth’s T2 COVID-19 vaccination, b_ie = -.04, SE = .02, p < .05. Similarly, parents and youths’ vaccine hesitancy significantly mediated the link between parents’ T1 pandemic disbelief and youths’ T2 COVID-19 vaccinations, b_ie = -.03, SE = .01, p < .05. In terms of parents’ COVID-19 vaccination rates, parents’ T2 vaccine hesitancy significantly mediated the link between parents T1 disbelief and their T2 COVID-19 vaccinations, b_ie = .23, SE = .11, p < .05 and the link between youth’s T1 pandemic disbelief related and parents’ T2 COVID-19 vaccination, b_ie = -.32, SE = .15, p < .05.

Discussion

Youth COVID-19 vaccination rates have been disproportionately low, triggering a critical need to understand the factors that influence their vaccination uptake to ensure adolescents continue to be protected from COVID-19. This study contributes to the limited research investigating COVID-19 vaccination in the Latinx community. Our results revealed that Latinx youth in our sample were almost twice as likely to be vaccinated than estimates from national sample of Latinx youth (80.7% vs 43.5%) [15]. Further, our study provides initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx parents and youth, and that youth and parent pandemic disbelief together help us understand vaccine hesitancy within families. Our findings underscore the importance of larger socio-historical contexts in vaccination efforts and the specific need to address COVID-19 myths and misinformation to boost vaccination uptake and reduce vaccination disparities.

Within our sample of Latinx families, over 88% of parents and 80% youth received at least one dose of the COVID-19 vaccine. These results are higher than previously reported vaccination rates in Latinx population, particularly with studies that compare vaccination rates across multiple races [44]. Interestingly, compared to studies that research the Hispanic population exclusively, our high COVID-19 vaccination results are consistent [45]. It is plausible that sampling bias due to convenience sampling may be underpinning the high COVID-19 vaccination results we observed.

One of the most prominent findings of the study was that pandemic disbelief emerged as a driving factor in COVID-19 vaccine hesitancy, and ultimately, vaccination rates within Latinx families. For both youth and parents, their own pandemic disbelief predicted their likelihood of receiving the COVID-19 vaccine via their own COVID-19 hesitancy. This finding is consistent with previous studies which demonstrated the mediating effect of vaccine hesitancy on the relationship between the quality of information or conspiracy theories and the outcome of vaccination against COVID-19 [30, 46].

Interestingly, in addition to youth pandemic disbelief predicting their own vaccine hesitancy, youth’s disbelief also predicted their parents’ vaccine hesitancy (but parents’ pandemic disbelief did not predict youth hesitancy). These results lend support to the bidirectional influences within a parent-child relationship regarding vaccination, and the unique role of adolescents in shaping familial views on vaccinations. Parents are often thought of as the key decision maker for children under the age of 18, and although the final decision may rest with them, our findings suggest that their child’s perspective, particularly around disbelief, may be part of this decision-making process. Indeed, research has shown that parents in general who consider their child’s perceived desire to get vaccinated were more likely to want their child vaccinated [47]. And for our study specifically, in reference to Latinx cultural values related to familism and the importance of family members in decisions making, it may be that Latinx parents are taking cues from their children related to the COVID-19 pandemic—whether their child believed it was fake or not real—and then forming their own opinions and hesitancies, which in turn predicted their children’s hesitancy and both family members vaccination decision. These findings highlight the need to not only address misinformation and the way that it shapes vaccine hesitancy and rates, but to do so in age-specific and culturally appropriate ways to address COVID-19 vaccination disparities.

There are a few additional findings worth noting. First, it was notable that family income was the only demographic factor that related to parent vaccine hesitancy and parent vaccination status. This finding was consistent with other research suggesting that greater income was related to lower vaccine hesitancy (in parents) and a greater likelihood of COVID-19 vaccination (in parents) [17]. We found that nativity was unrelated to COVID-19 vaccine hesitancy, and this is in line with some previous work that suggests no difference in vaccine hesitancy between foreign-born Hispanics and US-born Whites [48, 49]. Although our study sample was entirely Hispanic/Latinx, it is plausible that other factors may offset differences in COVID-19 hesitancy between US-born and foreign-born participants.

In summary, the study utilized a community-based Latinx sample–a population historically underrepresented in research–and explored the ways disbelief and vaccine hesitancy related to COVID-19 vaccination rates. Using a longitudinal design, we examined prospective changes over time in both parents and adolescents, facilitating an understanding of COVID-19 vaccination behavior and attitudes within a family context. This is one of the first known studies that explores adolescents’ COVID-19 beliefs and their association with COVID-19 vaccination hesitancy in a sample of US-based Latinx adolescents.

Study findings should be interpreted with some limitations in mind. First, we did not inquire about the number of shots they received in our vaccination measure. This limits our ability to assess any differences in vaccine initiation versus vaccine series completion for full protection from COVID-19. Similarly, the study did not access families’ to COVID-19 vaccination, a reported barrier to COVID-19 vaccination uptake [50]. Additionally, the one-item pandemic disbelief measure may not have captured the full scope or subtleties of COVID-19 pandemic perceptions or beliefs. Indeed, previous research has tied political affiliation and religious beliefs to COVID-19 beliefs [51]. Understanding the ways that beliefs, misinformation, and politics intersect is needed. Related, we did not assess explicit decision-making processes among adolescents and parents. Given that adolescence is a period in which autonomy increases in the context of greater extrafamilial relationships and influence, future research should examine the ways these co-occur to impact parent-child decision making around vaccines. Finally, we relied upon a convenience sample of Latinx families from Southern Arizona. Given the geographic location, cultural influences that may be unique to this region, and that Hispanic/Latinx experiences are not monolithic, our results may not be generalizable across the broader population of Latinx communities across the US and globally.

Despite the limitations, this study contributes to our understanding COVID-19 vaccination hesitancy and vaccination uptake within a Latinx sample, further aiding how COVID-19 vaccine disparities can be mitigated among ethnic populations. Our results highlight the affect youth beliefs have on parents’ vaccination attitudes for themselves and their children. School or community-based interventions may be useful in educating youth on disease risk reduction and prevention strategies, with special attention to parent-child relationships and addressing misinformation. Additionally, Latinx families are known to have strong family ties, and within the context of a family social network, there may be opportunities to intervene with key individuals that may provide benefit to the whole family network. Such factors are important when designing future interventions, policies, and health messaging to promote and ensure effective vaccination uptake in the future.

Acknowledgments

We would like to acknowledge the work of our research team including Bianca Solis, Selena Carbajal, Daniela Cruz Casterona, Elizabeth Elias, Alexandra Kubela, Bianca Levario, Kevin Molina, Iriana Munoz, Rachael Perez, Jenna Racon, Kayla Osman, Stefanie Martinez-Fuentes, and Evelyn Sarsar. Additionally, we are grateful for participating families and the guidance our Community Advisory Board: Martha Haro Ochoa, Maria Velasco, Frank Rosthenhausler, Maria Federico Brummer, Usiel Barrios, and Itzel Rosales Cozamayotl.

References

1. Borrell LN, Echeverria SE. The use of Latinx in public health research when referencing Hispanic or Latino populations. Social Science & Medicine. 2022;302:114977. pmid:35504084
- View Article
- PubMed/NCBI
- Google Scholar
2. CDC. Demographic Trends of COVID-19 cases and deaths in the US reported to CDC 2023 [updated March 16, 2023. https://covid.cdc.gov/covid-data-tracker/#demographics.
3. CDC. Trends in Demographic Characteristics of People Receiving COVID-19 Vaccinations in the United States 2023 [https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends.
4. Jolley D, Douglas KM. The effects of anti-vaccine conspiracy theories on vaccination intentions. PloS one. 2014;9(2):e89177. pmid:24586574
- View Article
- PubMed/NCBI
- Google Scholar
5. Murthy BP, Zell E, Kirtland K, Jones-Jack N, Harris L, Sprague C, et al. Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations—10 US jurisdictions, March–September 2020. Morbidity and Mortality Weekly Report. 2021;70(23):840.
- View Article
- Google Scholar
6. Dinleyici EC, Borrow R, Safadi MAP, van Damme P, Munoz FM. Vaccines and routine immunization strategies during the COVID-19 pandemic. Human vaccines & immunotherapeutics. 2021;17(2):400–7. pmid:32845739
- View Article
- PubMed/NCBI
- Google Scholar
7. Kiely M, Mansour T, Brousseau N, Rafferty E, Paudel YR, Sadarangani M, et al. COVID-19 pandemic impact on childhood vaccination coverage in Quebec, Canada. Human Vaccines & Immunotherapeutics. 2022;18(1):2007707. pmid:34920686
- View Article
- PubMed/NCBI
- Google Scholar
8. He K, Mack WJ, Neely M, Lewis L, Anand V. Parental perspectives on immunizations: impact of the COVID-19 pandemic on childhood vaccine hesitancy. Journal of community health. 2022:1–14. pmid:34297272
- View Article
- PubMed/NCBI
- Google Scholar
9. Roozenbeek J, Schneider CR, Dryhurst S, Kerr J, Freeman AL, Recchia G, et al. Susceptibility to misinformation about COVID-19 around the world. Royal Society open science. 2020;7(10):201199. pmid:33204475
- View Article
- PubMed/NCBI
- Google Scholar
10. Peretti-Watel P, Seror V, Cortaredona S, Launay O, Raude J, Verger P, et al. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. The Lancet infectious diseases. 2020;20(7):769–70. pmid:32445713
- View Article
- PubMed/NCBI
- Google Scholar
11. Szilagyi PG, Shah MD, Delgado JR, Thomas K, Vizueta N, Cui Y, et al. Parents’ intentions and perceptions about COVID-19 vaccination for their children: results from a national survey. Pediatrics. 2021;148(4).
- View Article
- Google Scholar
12. FDA. FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Children 5 through 11 Years of Age: FDA News Release; 2021 [updated October 29, 2021. https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age.
13. FDA. Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic: FDA News Release; 2021 [https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use.
14. FDA. FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine: FDA News Release; 2020 [updated December 11, 2020. https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19.
15. Valier MR, Elam-Evans LD, Mu Y, Santibanez TA, Yankey D, Zhou T, et al. Racial and Ethnic Differences in COVID-19 Vaccination Coverage Among Children and Adolescents Aged 5–17 Years and Parental Intent to Vaccinate Their Children—National Immunization Survey–Child COVID Module, United States, December 2020–September 2022. Morbidity and Mortality Weekly Report. 2023;72(1):1–8. pmid:36602930
- View Article
- PubMed/NCBI
- Google Scholar
16. Byrne A, Thompson LA, Filipp SL, Ryan K. COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout. Vaccine. 2022;40(46):6680–7. pmid:36220714
- View Article
- PubMed/NCBI
- Google Scholar
17. Alfieri NL, Kusma JD, Heard-Garris N, Davis MM, Golbeck E, Barrera L, et al. Parental COVID-19 vaccine hesitancy for children: vulnerability in an urban hotspot. BMC Public Health. 2021;21:1–9.
- View Article
- Google Scholar
18. Kempe A, Saville AW, Albertin C, Zimet G, Breck A, Helmkamp L, et al. Parental hesitancy about routine childhood and influenza vaccinations: a national survey. Pediatrics. 2020;146(1). pmid:32540985
- View Article
- PubMed/NCBI
- Google Scholar
19. Khubchandani J, Macias Y. COVID-19 vaccination hesitancy in Hispanics and African-Americans: a review and recommendations for practice. Brain, behavior, & immunity-health. 2021;15:100277. pmid:34036287
- View Article
- PubMed/NCBI
- Google Scholar
20. Allen JD, Fu Q, Shrestha S, Nguyen KH, Stopka TJ, Cuevas A, et al. Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample US adults. SSM-Population Health. 2022;20:101278.
- View Article
- Google Scholar
21. Knafo A, Galansky N. The influence of children on their parents’ values. Social and personality psychology compass. 2008;2(3):1143–61.
- View Article
- Google Scholar
22. Alexander AB, Stupiansky NW, Ott MA, Herbenick D, Reece M, Zimet GD. Parent-son decision-making about human papillomavirus vaccination: a qualitative analysis. BMC pediatrics. 2012;12(1):1–9. pmid:23241217
- View Article
- PubMed/NCBI
- Google Scholar
23. Dorell C, Yankey D, Kennedy A, Stokley S. Factors that influence parental vaccination decisions for adolescents, 13 to 17 years old: National Immunization Survey–Teen, 2010. Clinical pediatrics. 2013;52(2):162–70. pmid:23221308
- View Article
- PubMed/NCBI
- Google Scholar
24. Featherstone JD, Bell RA, Ruiz JB. Relationship of people’s sources of health information and political ideology with acceptance of conspiratorial beliefs about vaccines. Vaccine. 2019;37(23):2993–7. pmid:31031028
- View Article
- PubMed/NCBI
- Google Scholar
25. Baumgaertner B, Carlisle JE, Justwan F. The influence of political ideology and trust on willingness to vaccinate. PloS one. 2018;13(1):e0191728. pmid:29370265
- View Article
- PubMed/NCBI
- Google Scholar
26. Rabinowitz M, Latella L, Stern C, Jost JT. Beliefs about childhood vaccination in the United States: Political ideology, false consensus, and the illusion of uniqueness. PloS one. 2016;11(7):e0158382. pmid:27391965
- View Article
- PubMed/NCBI
- Google Scholar
27. Islam MS, Kamal A-HM, Kabir A, Southern DL, Khan SH, Hasan SM, et al. COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence. PloS one. 2021;16(5):e0251605. pmid:33979412
- View Article
- PubMed/NCBI
- Google Scholar
28. Đorđević JM, Mari S, Vdović M, Milošević A. Links between conspiracy beliefs, vaccine knowledge, and trust: Anti-vaccine behavior of Serbian adults. Social Science & Medicine. 2021;277:113930.
- View Article
- Google Scholar
29. Hornsey MJ, Harris EA, Fielding KS. The psychological roots of anti-vaccination attitudes: A 24-nation investigation. Health psychology. 2018;37(4):307. pmid:29389158
- View Article
- PubMed/NCBI
- Google Scholar
30. Howard MC, Davis MM. The mediating role of vaccine hesitancy in the relations of COVID-19 conspiracy beliefs and vaccination outcomes: Which dimensions matter? Journal of Health Psychology. 2022:13591053221096013. pmid:35543352
- View Article
- PubMed/NCBI
- Google Scholar
31. Iannello P, Colautti L, Magenes S, Antonietti A, Cancer A. Black‐and‐white thinking and conspiracy beliefs prevent parents from vaccinating their children against COVID‐19. Applied Cognitive Psychology. 2022.
32. Clark EH, Fredricks K, Woc-Colburn L, Bottazzi ME, Weatherhead J. Preparing for SARS-CoV-2 vaccines in US immigrant communities: strategies for allocation, distribution, and communication. American Public Health Association; 2021. p. 577–81.
33. Goreis A, Pfeffer B, Zesch HE, Klinger D, Reiner T, Bock MM, et al. Conspiracy beliefs and COVID-19 guideline adherence in adolescent psychiatric outpatients: the predictive role of adverse childhood experiences. Child and Adolescent Psychiatry and Mental Health. 2023;17(1):1–12.
- View Article
- Google Scholar
34. Gittings L, Toska E, Medley S, Cluver L, Logie CH, Ralayo N, et al. ‘Now my life is stuck!’: Experiences of adolescents and young people during COVID-19 lockdown in South Africa. Global Public Health. 2021;16(6):947–63. pmid:33750269
- View Article
- PubMed/NCBI
- Google Scholar
35. Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PloS one. 2018;13(12):e0208601. pmid:30532274
- View Article
- PubMed/NCBI
- Google Scholar
36. De Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. The Lancet. 2020;396(10255):898–908. pmid:32919524
- View Article
- PubMed/NCBI
- Google Scholar
37. Uscinski JE, Enders AM, Klofstad C, Seelig M, Funchion J, Everett C, et al. Why do people believe COVID-19 conspiracy theories? Harvard Kennedy School Misinformation Review. 2020;1(3).
- View Article
- Google Scholar
38. Shapiro GK, Tatar O, Dube E, Amsel R, Knauper B, Naz A, et al. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine. 2018;36(5):660–7. pmid:29289384
- View Article
- PubMed/NCBI
- Google Scholar
39. Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine. 2015;33(34):4165–75. pmid:25896384
- View Article
- PubMed/NCBI
- Google Scholar
40. Muthén L, Muthén B. Mplus user’s guide, 7th Edn Los Angeles. CA: Muthén & Muthén[Google Scholar]. 1998.
41. Lt Hu, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1–55.
- View Article
- Google Scholar
42. Enders CK. Applied missing data analysis: Guilford Publications; 2022.
43. Sobel ME. Some new results on indirect effects and their standard errors in covariance structure models. Sociological methodology. 1986;16:159–86.
- View Article
- Google Scholar
44. Siegel M, Critchfield-Jain I, Boykin M, Owens A, Muratore R, Nunn T, et al. Racial/ethnic disparities in state-level COVID-19 vaccination rates and their association with structural racism. Journal of racial and ethnic health disparities. 2021:1–14.
- View Article
- Google Scholar
45. Scheiber A, Prinster TB, Stecko H, Wang T, Scott S, Shah SH, et al. COVID-19 vaccination rates and vaccine hesitancy among Spanish-speaking free clinic patients. Journal of Community Health. 2023;48(1):127–35. pmid:36315301
- View Article
- PubMed/NCBI
- Google Scholar
46. Lee SK, Sun J, Jang S, Connelly S. Misinformation of COVID-19 vaccines and vaccine hesitancy. Scientific reports. 2022;12(1):13681. pmid:35953500
- View Article
- PubMed/NCBI
- Google Scholar
47. Delgado JR, Szilagyi PG, Peralta JB, Shah MD, Thomas K, Vizueta N, et al. Influence of perceived adolescent vaccination desire on parent decision for adolescent COVID-19 vaccination. Journal of Adolescent Health. 2022;70(4):567–70. pmid:35305793
- View Article
- PubMed/NCBI
- Google Scholar
48. Frisco ML, Van Hook J, Thomas KJ. Racial/ethnic and nativity disparities in US Covid-19 vaccination hesitancy during vaccine rollout and factors that explain them. Social Science & Medicine. 2022;307:115183.
- View Article
- Google Scholar
49. Contreras-Pérez ME, Diaz-Martinez J, Langwerden RJ, Hospital MM, Morris SL, Wagner EF, et al. Preliminary Analysis of COVID-19 Vaccination Factors among Native and Foreign-Born Hispanic/Latine Adults Residing in South Florida, USA. International Journal of Environmental Research and Public Health. 2022;19(20):13225.
- View Article
- Google Scholar
50. Kuehn M, LaMori J, DeMartino JK, Mesa-Frias M, Doran J, Korrapati L, et al. Assessing barriers to access and equity for COVID-19 vaccination in the US. BMC Public Health. 2022;22(1):2263. pmid:36463172
- View Article
- PubMed/NCBI
- Google Scholar
51. Milligan MA, Hoyt DL, Gold AK, Hiserodt M, Otto MW. COVID-19 vaccine acceptance: Influential roles of political party and religiosity. Psychology, Health & Medicine. 2022;27(9):1907–17. pmid:34407721
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Borrell LN, Echeverria SE. The use of Latinx in public health research when referencing Hispanic or Latino populations. Social Science & Medicine. 2022;302:114977. pmid:35504084
View Article
PubMed/NCBI
Google Scholar

[2] View Article

[3] PubMed/NCBI

[4] Google Scholar

[ref2] 2. CDC. Demographic Trends of COVID-19 cases and deaths in the US reported to CDC 2023 [updated March 16, 2023. https://covid.cdc.gov/covid-data-tracker/#demographics.

[ref3] 3. CDC. Trends in Demographic Characteristics of People Receiving COVID-19 Vaccinations in the United States 2023 [https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends.

[ref4] 4. Jolley D, Douglas KM. The effects of anti-vaccine conspiracy theories on vaccination intentions. PloS one. 2014;9(2):e89177. pmid:24586574
View Article
PubMed/NCBI
Google Scholar

[8] View Article

[9] PubMed/NCBI

[10] Google Scholar

[ref5] 5. Murthy BP, Zell E, Kirtland K, Jones-Jack N, Harris L, Sprague C, et al. Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations—10 US jurisdictions, March–September 2020. Morbidity and Mortality Weekly Report. 2021;70(23):840.
View Article
Google Scholar

[12] View Article

[13] Google Scholar

[ref6] 6. Dinleyici EC, Borrow R, Safadi MAP, van Damme P, Munoz FM. Vaccines and routine immunization strategies during the COVID-19 pandemic. Human vaccines & immunotherapeutics. 2021;17(2):400–7. pmid:32845739
View Article
PubMed/NCBI
Google Scholar

[15] View Article

[16] PubMed/NCBI

[17] Google Scholar

[ref7] 7. Kiely M, Mansour T, Brousseau N, Rafferty E, Paudel YR, Sadarangani M, et al. COVID-19 pandemic impact on childhood vaccination coverage in Quebec, Canada. Human Vaccines & Immunotherapeutics. 2022;18(1):2007707. pmid:34920686
View Article
PubMed/NCBI
Google Scholar

[19] View Article

[20] PubMed/NCBI

[21] Google Scholar

[ref8] 8. He K, Mack WJ, Neely M, Lewis L, Anand V. Parental perspectives on immunizations: impact of the COVID-19 pandemic on childhood vaccine hesitancy. Journal of community health. 2022:1–14. pmid:34297272
View Article
PubMed/NCBI
Google Scholar

[23] View Article

[24] PubMed/NCBI

[25] Google Scholar

[ref9] 9. Roozenbeek J, Schneider CR, Dryhurst S, Kerr J, Freeman AL, Recchia G, et al. Susceptibility to misinformation about COVID-19 around the world. Royal Society open science. 2020;7(10):201199. pmid:33204475
View Article
PubMed/NCBI
Google Scholar

[27] View Article

[28] PubMed/NCBI

[29] Google Scholar

[ref10] 10. Peretti-Watel P, Seror V, Cortaredona S, Launay O, Raude J, Verger P, et al. A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. The Lancet infectious diseases. 2020;20(7):769–70. pmid:32445713
View Article
PubMed/NCBI
Google Scholar

[31] View Article

[32] PubMed/NCBI

[33] Google Scholar

[ref11] 11. Szilagyi PG, Shah MD, Delgado JR, Thomas K, Vizueta N, Cui Y, et al. Parents’ intentions and perceptions about COVID-19 vaccination for their children: results from a national survey. Pediatrics. 2021;148(4).
View Article
Google Scholar

[35] View Article

[36] Google Scholar

[ref12] 12. FDA. FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Children 5 through 11 Years of Age: FDA News Release; 2021 [updated October 29, 2021. https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age.

[ref13] 13. FDA. Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic: FDA News Release; 2021 [https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use.

[ref14] 14. FDA. FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine: FDA News Release; 2020 [updated December 11, 2020. https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19.

[ref15] 15. Valier MR, Elam-Evans LD, Mu Y, Santibanez TA, Yankey D, Zhou T, et al. Racial and Ethnic Differences in COVID-19 Vaccination Coverage Among Children and Adolescents Aged 5–17 Years and Parental Intent to Vaccinate Their Children—National Immunization Survey–Child COVID Module, United States, December 2020–September 2022. Morbidity and Mortality Weekly Report. 2023;72(1):1–8. pmid:36602930
View Article
PubMed/NCBI
Google Scholar

[41] View Article

[42] PubMed/NCBI

[43] Google Scholar

[ref16] 16. Byrne A, Thompson LA, Filipp SL, Ryan K. COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout. Vaccine. 2022;40(46):6680–7. pmid:36220714
View Article
PubMed/NCBI
Google Scholar

[45] View Article

[46] PubMed/NCBI

[47] Google Scholar

[ref17] 17. Alfieri NL, Kusma JD, Heard-Garris N, Davis MM, Golbeck E, Barrera L, et al. Parental COVID-19 vaccine hesitancy for children: vulnerability in an urban hotspot. BMC Public Health. 2021;21:1–9.
View Article
Google Scholar

[49] View Article

[50] Google Scholar

[ref18] 18. Kempe A, Saville AW, Albertin C, Zimet G, Breck A, Helmkamp L, et al. Parental hesitancy about routine childhood and influenza vaccinations: a national survey. Pediatrics. 2020;146(1). pmid:32540985
View Article
PubMed/NCBI
Google Scholar

[52] View Article

[53] PubMed/NCBI

[54] Google Scholar

[ref19] 19. Khubchandani J, Macias Y. COVID-19 vaccination hesitancy in Hispanics and African-Americans: a review and recommendations for practice. Brain, behavior, & immunity-health. 2021;15:100277. pmid:34036287
View Article
PubMed/NCBI
Google Scholar

[56] View Article

[57] PubMed/NCBI

[58] Google Scholar

[ref20] 20. Allen JD, Fu Q, Shrestha S, Nguyen KH, Stopka TJ, Cuevas A, et al. Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample US adults. SSM-Population Health. 2022;20:101278.
View Article
Google Scholar

[60] View Article

[61] Google Scholar

[ref21] 21. Knafo A, Galansky N. The influence of children on their parents’ values. Social and personality psychology compass. 2008;2(3):1143–61.
View Article
Google Scholar

[63] View Article

[64] Google Scholar

[ref22] 22. Alexander AB, Stupiansky NW, Ott MA, Herbenick D, Reece M, Zimet GD. Parent-son decision-making about human papillomavirus vaccination: a qualitative analysis. BMC pediatrics. 2012;12(1):1–9. pmid:23241217
View Article
PubMed/NCBI
Google Scholar

[66] View Article

[67] PubMed/NCBI

[68] Google Scholar

[ref23] 23. Dorell C, Yankey D, Kennedy A, Stokley S. Factors that influence parental vaccination decisions for adolescents, 13 to 17 years old: National Immunization Survey–Teen, 2010. Clinical pediatrics. 2013;52(2):162–70. pmid:23221308
View Article
PubMed/NCBI
Google Scholar

[70] View Article

[71] PubMed/NCBI

[72] Google Scholar

[ref24] 24. Featherstone JD, Bell RA, Ruiz JB. Relationship of people’s sources of health information and political ideology with acceptance of conspiratorial beliefs about vaccines. Vaccine. 2019;37(23):2993–7. pmid:31031028
View Article
PubMed/NCBI
Google Scholar

[74] View Article

[75] PubMed/NCBI

[76] Google Scholar

[ref25] 25. Baumgaertner B, Carlisle JE, Justwan F. The influence of political ideology and trust on willingness to vaccinate. PloS one. 2018;13(1):e0191728. pmid:29370265
View Article
PubMed/NCBI
Google Scholar

[78] View Article

[79] PubMed/NCBI

[80] Google Scholar

[ref26] 26. Rabinowitz M, Latella L, Stern C, Jost JT. Beliefs about childhood vaccination in the United States: Political ideology, false consensus, and the illusion of uniqueness. PloS one. 2016;11(7):e0158382. pmid:27391965
View Article
PubMed/NCBI
Google Scholar

[82] View Article

[83] PubMed/NCBI

[84] Google Scholar

[ref27] 27. Islam MS, Kamal A-HM, Kabir A, Southern DL, Khan SH, Hasan SM, et al. COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence. PloS one. 2021;16(5):e0251605. pmid:33979412
View Article
PubMed/NCBI
Google Scholar

[86] View Article

[87] PubMed/NCBI

[88] Google Scholar

[ref28] 28. Đorđević JM, Mari S, Vdović M, Milošević A. Links between conspiracy beliefs, vaccine knowledge, and trust: Anti-vaccine behavior of Serbian adults. Social Science & Medicine. 2021;277:113930.
View Article
Google Scholar

[90] View Article

[91] Google Scholar

[ref29] 29. Hornsey MJ, Harris EA, Fielding KS. The psychological roots of anti-vaccination attitudes: A 24-nation investigation. Health psychology. 2018;37(4):307. pmid:29389158
View Article
PubMed/NCBI
Google Scholar

[93] View Article

[94] PubMed/NCBI

[95] Google Scholar

[ref30] 30. Howard MC, Davis MM. The mediating role of vaccine hesitancy in the relations of COVID-19 conspiracy beliefs and vaccination outcomes: Which dimensions matter? Journal of Health Psychology. 2022:13591053221096013. pmid:35543352
View Article
PubMed/NCBI
Google Scholar

[97] View Article

[98] PubMed/NCBI

[99] Google Scholar

[ref31] 31. Iannello P, Colautti L, Magenes S, Antonietti A, Cancer A. Black‐and‐white thinking and conspiracy beliefs prevent parents from vaccinating their children against COVID‐19. Applied Cognitive Psychology. 2022.

[ref32] 32. Clark EH, Fredricks K, Woc-Colburn L, Bottazzi ME, Weatherhead J. Preparing for SARS-CoV-2 vaccines in US immigrant communities: strategies for allocation, distribution, and communication. American Public Health Association; 2021. p. 577–81.

[ref33] 33. Goreis A, Pfeffer B, Zesch HE, Klinger D, Reiner T, Bock MM, et al. Conspiracy beliefs and COVID-19 guideline adherence in adolescent psychiatric outpatients: the predictive role of adverse childhood experiences. Child and Adolescent Psychiatry and Mental Health. 2023;17(1):1–12.
View Article
Google Scholar

[103] View Article

[104] Google Scholar

[ref34] 34. Gittings L, Toska E, Medley S, Cluver L, Logie CH, Ralayo N, et al. ‘Now my life is stuck!’: Experiences of adolescents and young people during COVID-19 lockdown in South Africa. Global Public Health. 2021;16(6):947–63. pmid:33750269
View Article
PubMed/NCBI
Google Scholar

[106] View Article

[107] PubMed/NCBI

[108] Google Scholar

[ref35] 35. Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PloS one. 2018;13(12):e0208601. pmid:30532274
View Article
PubMed/NCBI
Google Scholar

[110] View Article

[111] PubMed/NCBI

[112] Google Scholar

[ref36] 36. De Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. The Lancet. 2020;396(10255):898–908. pmid:32919524
View Article
PubMed/NCBI
Google Scholar

[114] View Article

[115] PubMed/NCBI

[116] Google Scholar

[ref37] 37. Uscinski JE, Enders AM, Klofstad C, Seelig M, Funchion J, Everett C, et al. Why do people believe COVID-19 conspiracy theories? Harvard Kennedy School Misinformation Review. 2020;1(3).
View Article
Google Scholar

[118] View Article

[119] Google Scholar

[ref38] 38. Shapiro GK, Tatar O, Dube E, Amsel R, Knauper B, Naz A, et al. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine. 2018;36(5):660–7. pmid:29289384
View Article
PubMed/NCBI
Google Scholar

[121] View Article

[122] PubMed/NCBI

[123] Google Scholar

[ref39] 39. Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine. 2015;33(34):4165–75. pmid:25896384
View Article
PubMed/NCBI
Google Scholar

[125] View Article

[126] PubMed/NCBI

[127] Google Scholar

[ref40] 40. Muthén L, Muthén B. Mplus user’s guide, 7th Edn Los Angeles. CA: Muthén & Muthén[Google Scholar]. 1998.

[ref41] 41. Lt Hu, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1–55.
View Article
Google Scholar

[130] View Article

[131] Google Scholar

[ref42] 42. Enders CK. Applied missing data analysis: Guilford Publications; 2022.

[ref43] 43. Sobel ME. Some new results on indirect effects and their standard errors in covariance structure models. Sociological methodology. 1986;16:159–86.
View Article
Google Scholar

[134] View Article

[135] Google Scholar

[ref44] 44. Siegel M, Critchfield-Jain I, Boykin M, Owens A, Muratore R, Nunn T, et al. Racial/ethnic disparities in state-level COVID-19 vaccination rates and their association with structural racism. Journal of racial and ethnic health disparities. 2021:1–14.
View Article
Google Scholar

[137] View Article

[138] Google Scholar

[ref45] 45. Scheiber A, Prinster TB, Stecko H, Wang T, Scott S, Shah SH, et al. COVID-19 vaccination rates and vaccine hesitancy among Spanish-speaking free clinic patients. Journal of Community Health. 2023;48(1):127–35. pmid:36315301
View Article
PubMed/NCBI
Google Scholar

[140] View Article

[141] PubMed/NCBI

[142] Google Scholar

[ref46] 46. Lee SK, Sun J, Jang S, Connelly S. Misinformation of COVID-19 vaccines and vaccine hesitancy. Scientific reports. 2022;12(1):13681. pmid:35953500
View Article
PubMed/NCBI
Google Scholar

[144] View Article

[145] PubMed/NCBI

[146] Google Scholar

[ref47] 47. Delgado JR, Szilagyi PG, Peralta JB, Shah MD, Thomas K, Vizueta N, et al. Influence of perceived adolescent vaccination desire on parent decision for adolescent COVID-19 vaccination. Journal of Adolescent Health. 2022;70(4):567–70. pmid:35305793
View Article
PubMed/NCBI
Google Scholar

[148] View Article

[149] PubMed/NCBI

[150] Google Scholar

[ref48] 48. Frisco ML, Van Hook J, Thomas KJ. Racial/ethnic and nativity disparities in US Covid-19 vaccination hesitancy during vaccine rollout and factors that explain them. Social Science & Medicine. 2022;307:115183.
View Article
Google Scholar

[152] View Article

[153] Google Scholar

[ref49] 49. Contreras-Pérez ME, Diaz-Martinez J, Langwerden RJ, Hospital MM, Morris SL, Wagner EF, et al. Preliminary Analysis of COVID-19 Vaccination Factors among Native and Foreign-Born Hispanic/Latine Adults Residing in South Florida, USA. International Journal of Environmental Research and Public Health. 2022;19(20):13225.
View Article
Google Scholar

[155] View Article

[156] Google Scholar

[ref50] 50. Kuehn M, LaMori J, DeMartino JK, Mesa-Frias M, Doran J, Korrapati L, et al. Assessing barriers to access and equity for COVID-19 vaccination in the US. BMC Public Health. 2022;22(1):2263. pmid:36463172
View Article
PubMed/NCBI
Google Scholar

[158] View Article

[159] PubMed/NCBI

[160] Google Scholar

[ref51] 51. Milligan MA, Hoyt DL, Gold AK, Hiserodt M, Otto MW. COVID-19 vaccine acceptance: Influential roles of political party and religiosity. Psychology, Health & Medicine. 2022;27(9):1907–17. pmid:34407721
View Article
PubMed/NCBI
Google Scholar

[162] View Article

[163] PubMed/NCBI

[164] Google Scholar

Figures

Abstract

Introduction

Methods

Results

Discussion

Introduction

The current study

Methods

Procedure

Sample characteristics

Measures

COVID-19 conspiracy beliefs (T1).

Individual and family predictors (T1).

Family COVID-19 hospitalizations or deaths (T2).

General vaccine hesitancy (T2).

COVID-19 vaccine hesitancy (T2).

COVID-19 vaccination (T2).

Statistical analysis

Results

Discussion

Acknowledgments

References