COVID-19 Vaccine Coverage and Hesitancy Among New York City Parents of Children Aged 5–11 Years

Chloe A. Teasdale, PhD; Scott Ratzan, MD, MPA, MA; Lauren Rauh, MPH; Hannah Stuart Lathan, MPH; Spencer Kimball, JD; Ayman El-Mohandes, MD, MPH, MBBCH

Disclosures

Am J Public Health. 2022;112(6):931-936.

Abstract and Introduction

Abstract

Objectives: To measure vaccine uptake and intentions among New York City (NYC) parents of children aged 5 to 11 years following emergency use authorization.

Methods: We conducted a survey of 2506 NYC parents of children aged 5 to 11 years. We used survey weights to generate prevalence estimates of vaccine uptake and intentions. Multivariable Poisson regression models generated adjusted prevalence ratios (APRs) of vaccine hesitancy, defined as parents who reported being not very likely or not at all likely to vaccinate their children, or unsure about whether to do so.

Results: Overall, 11.9% of NYC parents reported that their child was vaccinated; 51.0% were very or somewhat likely to vaccinate; 8.0% were not sure; 29.1% were not very likely or not at all likely to vaccinate their child. Among vaccine-hesitant parents, 89.9% reported safety concerns and 77.8% had concerns about effectiveness. In multivariable models, more vaccine hesitancy was expressed by non-Hispanic Black parents than by non-Hispanic White parents (APR = 1.41; 95% confidence interval [CI] = 1.17, 1.72) and by parents who were not themselves vaccinated than by parents who were vaccinated (APR = 1.53; 95% CI = 1.32, 1.77).

Conclusions: In a survey conducted after authorization of COVID-19 vaccines for children aged 5 to 11 years, significant hesitancy among parents was observed. (Am J Public Health. 2022;112(6):931–936. https://doi.org/10.2105/AJPH.2022.306784)

Introduction

In October 2021, the Centers for Disease Control and Prevention (CDC) recommended use of the Pfizer BioNTech COVID-19 vaccine for children aged 5 to 11 years,^[1] prompting concerns about parental acceptability and uptake. National polls conducted before authorization found that only one third of US parents planned to vaccinate their 5- to 11-year-old child right away, and the same proportion planned not to.^[2]

Vaccination is critical for protecting children from SARS-Cov-2 infection, which can cause severe disease, prolonged symptoms, and death.^[3,4] High pediatric vaccination coverage will also help contain the COVID-19 pandemic.^[5] New York City (NYC), the first epicenter of the pandemic in the United States, has the nation's largest public school system. High vaccination coverage among school-age children will keep students and staff safe, lead to fewer educational disruptions, and lower the risk of community spread. We measured parent-reported COVID-19 vaccination intentions for children aged 5 to 11 years following emergency use authorization.

1 2 3 4 5

Next Section

Table 1. Characteristics of Children Aged 5–11 Years and Their Parents or Caregivers, Estimated Prevalence of Intention to Have Children Vaccinated for COVID-19, and Prevalence Ratios for Vaccine Hesitancy: New York City (NYC), November 10–18, 2021
Characteristic	No. (%)^a	Child Already Vaccinated, % (95% CI)^b	Parent Very Likely or Somewhat Likely to Vaccinate Child, % (95% CI)^b	Parent Not Sure Whether to Vaccinate Child, % (95% CI)^b	Parent Not Very Likely or Not at All Likely to Vaccinate Child, % (95% CI)^b	APR for Vaccine Hesitancy^c (95% CI)
Total sample	2506 (100.0)	11.9 (10.6, 13.2)	51.0 (47.7, 54.3)	8.0 (6.0, 9.9)	29.1 (26.2, 32.0)
Child characteristics
Age, y
5–8	1528 (56.8)	12.5 (10.7, 14.3)	50.4 (46.1, 54.6)	7.7 (5.3, 10.2)	29.4 (25.5, 33.3)	1.12 (0.75, 1.32)
9–11	978 (43.2)	11.1 (9.2, 13.0)	51.9 (46.8, 57.1)	8.3 (5.1, 11.4)	28.7 (24.3, 33.1)	1 (Ref)
Gender
Female	1230 (46.4)	13.4 (11.4, 15.4)	49.0 (44.5, 53.5)	7.8 (5.5, 10.1)	29.8 (25.8, 33.9)	1.00 (0.86, 1.17)
Male	1276 (53.6)	10.6 (8.9, 12.3)	52.8 (48.0, 57.6)	8.1 (5.1, 11.2)	28.5 (24.4, 32.6)	1 (Ref)
Race/ethnicity^e,f
Non-Hispanic Black	366 (23.2)	7.5 (5.2, 9.8)	46.2 (39.0, 53.5)	13.0 (8.1, 17.8)	33.3 (26.4, 40.2)**
Asian	196 (14.5)	18.2 (12.6, 23.7)	61.6 (52.8, 70.5)	6.5 (1.7, 11.3)	13.7 (7.5, 20.0)
Hispanic	450 (28.9)	8.0 (5.9, 10.1)	60.3 (53.4, 67.1)	7.9 (3.7, 12.1)	23.8 (17.9, 29.7)
Non-Hispanic White	1243 (23.5)	19.1 (16.8, 21.3)	44.8 (40.3, 49.3)	4.0 (1.9, 6.2)	32.1 (28.0, 36.2)
Other non-Hispanic	98 (4.3)	5.4 (1.8, 8.9)	27.5 (15.5, 39.4)	5.5 (0.0, 11.0)	61.7 (48.8, 74.6)
Multiple	153 (5.6)	8.9 (3.9, 13.8)	40.1 (29.3, 50.8)	9.4 (0.8, 18.0)	41.7 (31.2, 52.2)
Child up-to-date with routine vaccines
Yes	2254 (90.0)	12.8 (11.3, 14.2)	51.6 (48.1, 55.1)	7.6 (5.6, 9.6)	28.0 (24.9, 31.0)*	1 (Ref)
No	190 (8.0)	2.9 (1.0, 4.7)	48.0 (37.2, 58.9)	9.1 (1.3, 16.8)	40.0 (29.2, 50.8)	1.18 (0.91, 1.54)
Not sure^d	62 (2.0)
Child influenza vaccine status
Received	1255 (44.0)	20.7 (17.9, 23.4)	55.3 (50.4, 60.3)	6.2 (3.3, 9.1)	17.8 (13.7, 22.0)**	1 (Ref)
Will get	685 (28.6)	8.4 (6.4, 10.5)	70.3 (65.0, 75.5)	5.5 (2.4, 8.6)	15.8 (11.7, 19.9)	0.87 (0.66, 1.16)
Will not get	465 (22.3)	1.6 (0.7, 2.6)	22.0 (15.7, 28.3)	8.2 (4.3, 12.1)	68.2 (61.5, 74.8)	2.09 (1.67, 2.62)
Not sure	101 (5.1)	0.8 (0.1, 1.6)	33.2 (19.6, 46.8)	35.6 (22.2, 49.0)	30.4 (18.9, 41.8)	2.16 (1.62, 2.88)
Parent characteristics
Age, y
18–29	230 (13.1)	10.3 (6.7, 13.9)	48.6 (38.9, 58.2)	7.1 (2.3, 11.8)	34.0 (24.4, 43.7)	1.19 (0.91, 1.57)
30–39	1155 (42.3)	12.7 (10.6, 14.7)	54.5 (49.6, 59.5)	7.2 (4.1, 10.3)	25.6 (21.5, 29.7)	1 (Ref)
≥ 40	1121 (44.6)	11.6 (9.7, 13.6)	48.4 (43.4, 53.4)	9.0 (6.0, 11.9)	31.0 (26.7, 35.4)	1.07 (0.89, 1.29)
Gender
Male	1204 (36.1)	18.6 (15.9, 21.3)	48.1 (42.9, 53.3)	6.4 (3.2, 9.5)	26.9 (22.3, 31.6)**	1 (Ref)
Female	1252 (61.6)	8.4 (6.9, 9.8)	53.3 (49.0, 57.6)	9.1 (6.5, 11.7)	29.2 (25.5, 33.0)	1.08 (0.89, 1.30)
Transgender/other^d	50 (2.3)
Race/ethnicity^f
Non-Hispanic Black	361 (22.8)	7.2 (5.0, 9.4)	47.0 (39.7, 54.3)	12.9 (7.9, 17.9)	32.9 (26.1, 39.7)**	1.41 (1.17, 1.72)
Asian	204 (15.3)	17.6 (12.3, 22.9)	58.7 (49.7, 67.6)	5.0 (0.9, 9.0)	18.7 (11.5, 26.0)	0.97 (0.69, 1.35)
Hispanic	462 (29.6)	8.3 (6.2, 105)	60.8 (54.1, 67.5)	8.3 (4.1, 12.5)	22.6 (16.9, 28.2)	0.96 (0.76, 1.21)
Non-Hispanic White	1317 (26.3)	18.1 (16.0, 20.2)	43.9 (39.5, 48.3)	5.8 (3.1, 8.5)	32.2 (28.2, 36.4)	1 (Ref)
Other non-Hispanic	102 (3.7)	5.3 (1.7, 8.8)	26.9 (14.9, 38.9)	6.4 (0.0, 12.8)	61.4 (48.4, 74.5)	1.03 (0.84, 1.27)
Multiple^d	60 (2.3)
Education (highest completed)
High school or less	353 (39.2)	9.4 (6.8, 12.0)	51.5 (44.7, 58.3)	10.6 (6.4, 14.8)	28.5 (22.6, 35.0)**	1.06 (0.87, 1.29)
Some college or tech school	387 (20.7)	5.2 (3.6, 6.8)	50.9 (44.4, 57.4)	8.1 (4.7, 11.6)	35.8 (29.7, 41.8)	1.22 (1.02, 1.44)
Completed college or more	1734 (38.6)	18.5 (16.6, 20.4)	50.2 (46.6, 53.8)	5.0 (3.1, 6.8)	26.3 (23.2, 29.5)	1 (Ref)
Missing^d	32 (1.5)
Household income, US$
< 50 000	527 (40.1)	7.2 (5.4, 9.1)	56.2 (50.1, 62.3)	11.5 (7.5, 15.5)	25.1 (19.9, 30.2)**	0.85 (0.68, 1.06)
50 000–99 999	558 (21.5)	11.6 (8.8, 14.5)	54.8 (48.7, 60.8)	7.2 (3.4, 10.9)	26.4 (21.1, 31.5)	0.84 (0.68, 1.02)
≥ 100 000	1256 (28.3)	20.0 (17.5, 22.5)	42.8 (38.3, 47.3)	2.8 (1.2, 4.4)	34.4 (29.7, 39.0)	1 (Ref)
Not sure/missing	165 (10.1)	8.1 (3.9, 12.3)	45.7 (34.3, 57.1)	9.9 (3.8, 16.0)	36.3 (26.2, 46.3)	0.85 (0.64, 1.11)
Parent COVID-19 vaccination status
Vaccinated	1899 (84.5)	13.5 (12.0, 15.1)	58.3 (54.7, 61.9)	7.3 (5.1, 9.4)	20.9 (17.9, 24.0)**	1 (Ref)
Not vaccinated	518 (11.6)	2.2 (1.4, 3.1)	11.6 (7.9, 15.2)	9.7 (5.3, 14.1)	76.5 (71.0, 82.0)	1.53 (1.32, 1.77)
Prefer not to answer^d	89 (3.9)
Parent concerned child will become sick from COVID-19
Very or somewhat worried	1578 (63.6)	13.4 (11.7, 15.1)	60.4 (56.4, 64.4)	7.8 (5.4, 10.2)	18.4 (15.0, 21.8)**	1 (Ref)
A little or not at all worried	905 (34.9)	9.3 (7.2, 11.4)	34.9 (29.5, 40.3)	6.8 (4.1, 9.5)	49.0 (43.7, 54.2)	1.13 (0.91, 1.42)
Not sure^d	23 (1.5)
Parent concerned child will infect others family members
Very or somewhat worried	1586 (64.1)	13.8 (12.0, 15.6)	61.7 (57.8, 65.7)	7.8 (5.4, 10.1)	16.7 (13.5, 19.9)**	1 (Ref)
A little or not at all worried	898 (34.2)	8.5 (6.6, 10.4)	31.1 (25.6, 36.6)	6.9 (4.1, 9.7)	53.5 (48.1, 58.9)	1.50 (1.18, 1.91)
Not sure^d	35 (1.7)
Vote in 2021 mayoral election
Did not vote	786 (51.7)	7.6 (5.8, 9.3)	51.4 (46.4, 56.4)	10.3 (7.1, 13.6)	30.7 (26.2, 35.1)**	1.41 (1.13, 1.76)
Eric Adams (Democrat)	1112 (32.1)	19.9 (17.2, 22.6)	55.8 (50.9, 60.7)	6.4 (3.6, 9.2)	17.9 (13.8, 22.0)	1 (Ref)
Curtis Sliwa (Republican)	397 (14.0)	9.4 (6.6, 12.3)	39.0 (29.2, 48.7)	1.8 (0.1, 3.4)	49.8 (40.9, 58.7)	1.27 (1.03, 1.57)
Other	211 (2.2)	12.8 (8.4, 17.2)	50.2 (39.1, 61.4)	12.6 (4.6, 20.4)	24.4 (15.9, 32.9)	1.29 (0.96, 1.72)
NYC borough
Bronx	396 (21.0)	6.8 (4.6, 8.9)	56.7 (49.3, 64.1)	8.1 (4.1, 12.1)	28.4 (21.7, 35.2)**	1.07 (0.78, 1.47)
Brooklyn	743 (33.5)	10.8 (8.7, 12.9)	49.3 (43.7, 54.8)	8.6 (5.1, 12.2)	31.3 (26.3, 36.2)	1.09 (0.82, 1.46)
Manhattan	671 (13.5)	28.4 (23.1, 33.7)	45.1 (37.5, 52.7)	5.8 (2.1, 9.6)	20.7 (12.8, 28.6)	1 (Ref)
Queens	482 (26.1)	10.2 (7.5, 12.9)	56.5 (49.6, 63.5)	7.7 (3.4, 11.9)	25.6 (19.9, 31.3)	1.01 (0.74, 1.38)
Staten Island	214 (5.9)	5.9 (3.1, 8.7)	30.4 (20.9, 39.8)	9.8 (2.5, 17.1)	53.9 (43.8, 64.0)	1.44 (1.05, 1.98)

Note. APR = adjusted prevalence ratio; CI = confidence interval.
^aSurvey weights applied to sample to represent NYC population of parents by race, ethnicity, education, and borough.
^bWeighted percentages are prevalence estimates of NYC parents reporting vaccination plans for their youngest child aged 5 to 11 years.
^cAdjusted models compare parents who were unsure, not very likely, and not at all likely to vaccinate children with parents of vaccinated children and parents very or somewhat likely to vaccinate children; models include all variables shown in the table except child race/ethnicity (see footnote e).
^dCategories are not presented in the table as they yielded unreliable standard error estimates.
^eChild's race/ethnicity excluded from adjusted models because of collinearity with parent's race/ethnicity.
^fSurvey respondents could indicate 1 option for race/ethnicity from the following options: African American or Black, Asian, Hispanic or Latino/a, Caucasian/White, multiple, and other.
*P < .05; **P < .001.