COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users

Nicolle M Krebs, Gail D'Souza, Candace Bordner, Sophia I Allen, Andrea L Hobkirk, Jonathan Foulds, Jessica M Yingst, Nicolle M Krebs, Gail D'Souza, Candace Bordner, Sophia I Allen, Andrea L Hobkirk, Jonathan Foulds, Jessica M Yingst

Abstract

Novel mRNA vaccines have been developed and were first distributed to high-risk individuals (including smokers) in the United States starting in December 2020 to combat the coronavirus (COVID-19) pandemic. Over one-half of the U.S. adult population has received at least 1 dose of a COVID-19 vaccine, but many others have reported hesitation about becoming vaccinated. We examined COVID-19 vaccine uptake and hesitancy from a convenience sample of Pennsylvanian adult smokers in April 2021, approximately 3 months after tobacco users were eligible to receive vaccination in the state. Participants (n = 231) were 23.4% male, 90.5% white, and had a mean age of 48.1 (SD = 11.9) years. All participants were current tobacco users, with the majority reporting current cigarette smoking (90.9%) with an average of 16 (SD = 8.1) cigarettes smoked per day. Nearly 60% (n = 137) reported receiving at least 1 dose of the vaccine and of those who did not (n = 94), 84% (n = 79) said they were somewhat or very unlikely to get a vaccine. Those who were unvaccinated were more likely to not consume news about COVID-19 (chi-square P-value < .01) and less likely to believe government news sources as reliable information for COVID-19 (chi-square P-value < .01). Qualitative responses among those who were vaccine hesitant expressed concerns about the lack of research on the vaccine, distrust of the safety of the vaccine, and fears about side effects. Understanding vaccine hesitancy among tobacco users can help develop targeted communication strategies and directly address concerns to promote vaccination among this population who may be at an increased risk of severe complications from COVID-19.

Keywords: COVID-19; hesitancy; smoking; tobacco; vaccination.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.F. has done paid consulting for Pfizer regarding smoking cessation medications. The other authors have no disclosures to report related to this publication.

© The Author(s) 2021.

References

    1. Johns Hopkins University . Coronavirus Resource Center. . . Accessed June 20, 2021.
    1. Diesel J, Sterrett N, Dasgupta S, et al. COVID-19 vaccination coverage among adults - United States, December 14, 2020-May 22, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(25):922-927. doi:10.15585/mmwr.mm7025e1.
    1. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine. N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577.
    1. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403-416. doi:10.1056/NEJMoa2035389.
    1. Thompson MG, Burgess JL, Naleway AL, et al. Interim estimates of vaccine effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines in preventing SARS-CoV-2 infection among health care personnel, first responders, and other essential and frontline workers - eight U.S. locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep. 2021;70(13):495-500. doi:10.15585/mmwr.mm7013e3.
    1. Bartsch SM, Wedlock PT, O'Shea KJ, et al. Lives and costs saved by expanding and expediting coronavirus disease 2019 vaccination. J Infect Dis. 2021;224:938-948. doi:10.1093/infdis/jiab233.
    1. Dror AA, Eisenbach N, Taiber S, et al. Vaccine hesitancy: The next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35(8):775-779. doi:10.1007/s10654-020-00671-y.
    1. Schernhammer E, Weitzer J, Laubichler MD, et al. Correlates of COVID-19 vaccine hesitancy in Austria: trust and the government. J Publ Health (Oxf). 2021. 10.1093/pubmed/fdab122..
    1. Kelly BJ, Southwell BG, McCormack LA, et al. Predictors of willingness to get a COVID-19 vaccine in the U.S. BMC Infectious Diseases. 2021;21(1):338. doi:10.1186/s12879-021-06023-9.
    1. Gatwood J, McKnight M, Fiscus M, Hohmeier KC, Chisholm-Burns M. Factors influencing likelihood of COVID-19 vaccination: A survey of Tennessee adults. Am J Health Syst Pharm : AJHP : official journal of the American Society of Health-System Pharmacists. 2021;78(10):879-889. doi:10.1093/ajhp/zxab099.
    1. Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated?. Vaccine. 2020;38(42):6500-6507. DOI: 10.1016/j.vaccine.2020.08.043.
    1. Barry V, Dasgupta S, Weller DL, et al. Patterns in COVID-19 vaccination coverage, by social vulnerability and urbanicity - United States, December 14, 2020-May 1, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(22):818-824. doi:10.15585/mmwr.mm7022e1.
    1. Murthy BP, Sterrett N, Weller D, et al. Disparities in COVID-19 vaccination coverage between urban and rural counties - United States, December 14, 2020-April 10, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(20):759-764. doi:10.15585/mmwr.mm7020e3.
    1. Simons D, Shahab L, Brown J, Perski O. The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: A living rapid evidence review with Bayesian meta-analyses (version 7). Addiction. 2021;116(6):1319-1368. doi:10.1111/add.15276.
    1. Farsalinos K, Barbouni A, Poulas K, Polosa R, Caponnetto P, Niaura R. Current smoking, former smoking, and adverse outcome among hospitalized COVID-19 patients: A systematic review and meta-analysis. Ther Adv Chronic Dis. 2020;11:204062232093576. doi:10.1177/2040622320935765.
    1. Paleiron N, Mayet A, Marbac V, et al. Impact of tobacco smoking on the risk of COVID-19: A large scale retrospective cohort study. Nicotine Tob Res. 2021;23:1398-1404. doi:10.1093/ntr/ntab004.
    1. Jose T, Croghan IT, Hays JT, Schroeder DR, Warner DO. Electronic cigarette use is not associated with COVID-19 diagnosis. J Primary Care Com Health. 2021;12:215013272110243. doi:10.1177/21501327211024391.
    1. Alqahtani JS, Oyelade T, Aldhahir AM, et al. Prevalence, severity and mortality associated with COPD and smoking in patients with COVID-19: A rapid systematic review and meta-analysis. PLoS One. 2020;15(5):e0233147. doi:10.1371/journal.pone.0233147.
    1. Zhang H, Ma S, Han T, et al. Association of smoking history with severe and critical outcomes in COVID-19 patients: A systemic review and meta-analysis. European journal of integrative medicine. 2021;43:101313. doi:10.1016/j.eujim.2021.101313.
    1. Jackson SE, Paul E, Brown J, Steptoe A, Fancourt D. Negative vaccine attitudes and intentions to vaccinate against Covid-19 in relation to smoking status: A population survey of UK adults. Nicotine Tob Res. 2021;23:1623-1628. doi:10.1093/ntr/ntab039.
    1. Luk TT, Zhao S, Wu Y, Wong JY, Wang MP, Lam TH. Prevalence and determinants of SARS-CoV-2 vaccine hesitancy in Hong Kong: A population-based survey. Vaccine. 2021;39(27):3602-3607. doi:10.1016/j.vaccine.2021.05.036.
    1. Alqudeimat Y, Alenezi D, AlHajri B, et al. Acceptance of a COVID-19 vaccine and its related determinants among the general adult population in Kuwait. Med Princ Pract. 2021;30(3):262-271. doi:10.1159/000514636.
    1. Sethi S, Kumar A, Mandal A, et al. The UPTAKE study: A cross-sectional survey examining the insights and beliefs of the UK population on COVID-19 vaccine uptake and hesitancy. BMJ Open. 2021;11(6):e048856. doi:10.1136/bmjopen-2021-048856.
    1. Alibrahim J, Awad A. COVID-19 vaccine hesitancy among the public in Kuwait: A cross-sectional Survey. Int J Environ Res Publ Health. 2021;18(16):8836.
    1. Yang Y, Dobalian A, Ward KD. COVID-19 vaccine hesitancy and its determinants among adults with a history of tobacco or Marijuana use. J Community Health. 2021;46:1090-1098. doi:10.1007/s10900-021-00993-2.
    1. Andrew MK, McNeil S, Merry H, Rockwood K. Rates of influenza vaccination in older adults and factors associated with vaccine use: a secondary analysis of the Canadian Study of Health and Aging. BMC Public Health. 2004;4:36. doi:10.1186/1471-2458-4-36.
    1. Der-Martirosian C, Heslin KC, Mitchell MN, Chu K, Tran K, Dobalian A. Comparison of the use of H1N1 and seasonal influenza vaccinations between veterans and non-veterans in the United States, 2010. BMC Public Health. 2013;13:1082. doi:10.1186/1471-2458-13-1082.
    1. Pearson WS, Dube SR, Ford ES, Mokdad AH. Influenza and pneumococcal vaccination rates among smokers: Data from the 2006 behavioral risk factor surveillance system. Prevent Med. 2009;48(2):180-183. doi:10.1016/j.ypmed.2008.11.001.
    1. Pennsylvania Department of Health . COVID-19 Vaccine Distribution. . Accessed 8 July, 2021.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010.
    1. Usherwood T, LaJoie Z, Srivastava V. A model and predictions for COVID-19 considering population behavior and vaccination. Sci Rep. 2021;11(1):12051. doi:10.1038/s41598-021-91514-7.
    1. DuPre NC, Karimi S, Zhang CH, et al. County-level demographic, social, economic, and lifestyle correlates of COVID-19 infection and death trajectories during the first wave of the pandemic in the United States. Sci Total Environ. 2021;786:147495. doi:10.1016/j.scitotenv.2021.147495.
    1. Centers for Disease Control and Prevention . Selected Adverse Events Reported after COVID-19 Vaccination. . . Accessed 8 July, 2021.
    1. Rogers-Brown JS, Wanga V, Okoro C, et al. Outcomes among patients referred to outpatient rehabilitation clinics after COVID-19 diagnosis - United States, January 2020-March 2021. MMWR Morb Mortal Wkly Rep. 2021;70(27). doi:10.15585/mmwr.mm7027a2.
    1. Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236379survivors of COVID -19: A retrospective cohort study using electronic health records. Lancet Psychiatr. 2021;8(5):416-427. doi:10.1016/S2215-0366(21)00084-5.
    1. Hernandez-Romieu AC, Leung S, Mbanya A, et al. Health care utilization and clinical characteristics of nonhospitalized adults in an integrated health care system 28-180 days after COVID-19 diagnosis - Georgia, May 2020-March 2021. MMWR Morb Mortal Wkly Rep. 2021;70(17):644-650. doi:10.15585/mmwr.mm7017e3.
    1. Dooling K, Marin M, Wallace M, et al. The advisory committee on immunization practices’ updated interim recommendation for allocation of COVID-19 vaccine - United States, December 2020. MMWR Morb Mortal Wkly Rep. 2021;69(5152):1657-1660. doi:10.15585/mmwr.mm695152e2.
    1. Scobie HM, Johnson AG, Suthar AB, et al. Monitoring incidence of COVID-19 cases, hospitalizations, and deaths, by vaccination status - 13 U.S. Jurisdictions, April 4-July 17, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(37):1284-1290. doi:10.15585/mmwr.mm7037e1.
    1. National Academies of Sciences, Engineering, and Medicine . Communication Strategies for Building Confidence in COVID-19 Vaccines: Addressing Variants and Childhood Vaccinations. Washington, DC: The National Academies Press; 2021:23.
    1. Luk TT, Zhao S, Weng X, et al. Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong. Tobac Control. 2020;30:696-699. doi:10.1136/tobaccocontrol-2020-055960.
    1. Office of the Surgeon General . Publications and reports of the surgeon general. Confronting Health Misinformation: The US Surgeon General’s Advisory on Building a Healthy Information Environment. Washington, DC: US Department of Health and Human Services; 2021.
    1. Burke PF, Masters D, Massey G. Enablers and barriers to COVID-19 vaccine uptake: An international study of perceptions and intentions. Vaccine. 2021;39(36):5116-5128. DOI: 10.1016/j.vaccine.2021.07.056.

Source: PubMed

3
Sottoscrivi