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COVID-19 Vaccine Acceptance among College Students in South Carolina: Do Information Sources and Trust in Information Matter?

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Title: COVID-19 Vaccine Acceptance among College Students in South Carolina: Do Information Sources and Trust in Information Matter?
Language: English
Authors: Shan Qiao (ORCID 0000-0003-1834-1834), Daniela B. Friedman, Cheuk Chi Tam (ORCID 0000-0003-2612-0564), Chengbo Zeng (ORCID 0000-0002-3512-1115), Xiaoming Li
Source: Journal of American College Health. 2024 72(3):859-868.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 11
Publication Date: 2024
Sponsoring Agency: National Institutes of Health (NIH) (DHHS)
Contract Number: R01MH01123763S1
R01AI1272034S1
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: COVID-19, Pandemics, Trust (Psychology), Immunization Programs, Pharmacy, Industry, Student Attitudes, College Students, Information Sources, Mass Media, Public Health, Social Networks, Social Media, Public Agencies, Scientists
Geographic Terms: South Carolina
DOI: 10.1080/07448481.2022.2059375
ISSN: 0744-8481
1940-3208
Abstract: Background: For college students who are exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play a role in shaping the vaccine acceptance spectrum (refusal, hesitancy, and acceptance). Methods: Based on an online survey among 1,062 college students in South Carolina, we investigated vaccine information sources among college students and examined how COVID-19 vaccine acceptance was associated with information source and trust level in each source. Results: The top three sources of COVID-19 vaccine information were health agencies, mass media, and personal social networks. Trust in mass media, health agencies, scientists, and pharmaceutical companies was negatively associated with vaccine refusal. Trust in government and scientists was negatively associated with vaccine hesitancy. Discussion: Our findings highlight the importance of restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1421287
Database: ERIC
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  Value: <anid>AN0176635058;acl01apr.24;2024Apr18.06:34;v2.2.500</anid> <title id="AN0176635058-1">COVID-19 vaccine acceptance among college students in South Carolina: do information sources and trust in information matter? </title> <p>For college students who are exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play a role in shaping the vaccine acceptance spectrum (refusal, hesitancy, and acceptance). Based on an online survey among 1,062 college students in South Carolina, we investigated vaccine information sources among college students and examined how COVID-19 vaccine acceptance was associated with information source and trust level in each source. The top three sources of COVID-19 vaccine information were health agencies, mass media, and personal social networks. Trust in mass media, health agencies, scientists, and pharmaceutical companies was negatively associated with vaccine refusal. Trust in government and scientists was negatively associated with vaccine hesitancy. Our findings highlight the importance of restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era.</p> <p>Keywords: College students; COVID-19; health and science communication; trust; vaccine acceptance</p> <hd id="AN0176635058-2">Introduction</hd> <p>The COVID-19 pandemic has severely disrupted normal societal and economic activities worldwide and is expected to continue imposing strains and burden on health systems in most countries. COVID-19 vaccination is among the most promising strategies to reducing the burden of disease and controlling the pandemic.[<reflink idref="bib1" id="ref1">1</reflink>] Although the vaccines are already available, policy makers need to ensure a successful large-scale uptake of COVID-19 vaccines to achieve community immunization. Vaccine hesitancy, referred as "a delay in acceptance or refusal of vaccination despite availability of vaccination services"[<reflink idref="bib2" id="ref2">2</reflink>] has been recognized as one of the top ten global health threats since 2019.[<reflink idref="bib3" id="ref3">3</reflink>] Existing studies regarding COVID-19 vaccine uptake suggest that a considerable proportion of people are reluctant to get vaccination against COVID-19. According to Centers for Disease Control and Prevention (CDC) reports, only 55% of adults in the US have been fully vaccinated as of September 2021, which does not reach the 67% necessary for achieving population immunity.[<reflink idref="bib4" id="ref4">4</reflink>]</p> <p>Extant literature shows that the determinants of vaccine acceptance are multiple and complex, and health information could significantly affect vaccine acceptance.[<reflink idref="bib5" id="ref5">5</reflink>],[<reflink idref="bib6" id="ref6">6</reflink>] Specifically, both the source of health information and the degree to which the information source is trusted can have a markable impact on vaccine acceptance.[<reflink idref="bib7" id="ref7">7</reflink>] Sources of health information may play an important role in the message content people can obtain as well as the manner and frequency of being exposed to the information. Trust or doubt about the information source directly relates to people's perceived credibility of the information and further shape their attitudes, perceptions, and potential actions they take (such as vaccine uptake).[[<reflink idref="bib8" id="ref8">8</reflink>], [<reflink idref="bib10" id="ref9">10</reflink>]]</p> <p>Growing literature focuses on sources and perceived credibility of vaccine information as well as their impacts on vaccine acceptance. One study on (HPV) vaccine uptake in Georgia, United States (U.S.) suggested that sources of information about HPV vaccine were associated with parental vaccine acceptance and further influenced vaccine uptake among adolescents.[<reflink idref="bib11" id="ref10">11</reflink>] Hearing relevant information from doctors/medical professional was most frequently reported among parents and positively associated with adolescents' vaccine uptake.[<reflink idref="bib11" id="ref11">11</reflink>] Another study conducted in France showed that vaccine acceptance was higher when patients reported getting information from healthcare providers rather than from the Internet or relatives.[<reflink idref="bib12" id="ref12">12</reflink>] Moran and colleagues investigated the association between information sources, trust in sources, and vaccine safety concerns among women of different ethnicities in Los Angeles, U.S. reporting that both the information sources and trust in health information resources were associated with vaccine safety concerns, but the patterns of these associations varied by ethnicity.[<reflink idref="bib13" id="ref13">13</reflink>] Generally, trust in healthcare provider was associated with decreased vaccine safety concerns, while talking with other people as a source of health information was associated with increased vaccine safety concerns. Mexican Americans who talked to other people for health information and trusted one's mother for health information showed stronger vaccine safety concerns; however, for non-Hispanic Whites, trust in one's healthcare provider and trust in one's mother for health information were both associated with decreased vaccine safety concern.[<reflink idref="bib13" id="ref14">13</reflink>]</p> <p>Researchers have expressed concerns regarding the infodemic that has emerged during the COVID-19 outbreak[<reflink idref="bib14" id="ref15">14</reflink>],[<reflink idref="bib15" id="ref16">15</reflink>] and empirical studies suggest that misinformation and conspiratorial beliefs spreading through various channels have considerably reduced COVID-19 vaccine acceptance among general population.[<reflink idref="bib16" id="ref17">16</reflink>] Being part of a generation exposed to multimedia, college students may be more influenced by online information and social media in their decision as to whether to get vaccinated against COVID-19. Although college students have high risk of COVID-19 infection since they are susceptible to health-compromising behaviors due to a sense of invulnerability,[<reflink idref="bib17" id="ref18">17</reflink>] comparative optimism, and a perception that COVID-19 is not a serious health threat,[<reflink idref="bib18" id="ref19">18</reflink>] they do not show much enthusiasm in vaccine uptake for multiple reasons such as vaccine hesitancy and availability issues. Existing vaccination uptake data for December 14, 2020 to May 22, 2021 in the U.S. suggests that the uptake rate of COVID-19 vaccines among young adults is much lower than among elders (57% vs. 80%),[<reflink idref="bib19" id="ref20">19</reflink>] while the proportion of young adults accounting for COVID-related hospitalization is increasing.[<reflink idref="bib20" id="ref21">20</reflink>] A great number of young adults could have been able to protect themselves from COVID-19 infection and relevant health consequences if they had taken the vaccine. Numerous studies have explored the intervention strategies to change health beliefs, increase vaccine acceptance, and promote vaccination uptake (e.g., through online communication),[<reflink idref="bib21" id="ref22">21</reflink>],[<reflink idref="bib22" id="ref23">22</reflink>] and studies suggest that the sources of information about COVID-19 vaccines and trust in vaccine information sources could be important correlates of vaccine acceptance.[<reflink idref="bib23" id="ref24">23</reflink>] In the context of COVID-19, it is important to engage young adults such as college students in vaccine campaigns and understand where they see vaccine-related information and who their trusted sources of COVID-19 vaccine information are. In addition, college students are not homogeneous in terms of vaccine acceptance. Different vaccine acceptance groups may show various characteristics in vaccine information sources and trust in these vaccine information sources. We need to advance understanding of the needs of different groups to provide tailored intervention for vaccine uptake promotion.</p> <p>Therefore, the current study aims to explore the information sources of COVID-19 vaccine among college students, assess their trust in different information sources, and examine how the sources of COVID-19 vaccine information and trust in these sources are associated with the acceptance of a COVID-19 vaccine after controlling for key demographics.</p> <hd id="AN0176635058-3">Methods</hd> <p></p> <hd id="AN0176635058-4">Participants and procedure</hd> <p>An online survey was conducted between September and October 2020 among college students in South Carolina. The participants were recruited through a convenience sampling approach with inclusion criteria including: (<reflink idref="bib1" id="ref25">1</reflink>) being 18 years of age or older; and (<reflink idref="bib2" id="ref26">2</reflink>) being currently a full-time student enrolled in a university. Specifically, an email invitation was distributed to student listservs by various colleges (e.g., School of Public Health, School of Nursing, School of Social Work, etc.) and departments on campus. The invitation email included a weblink of the survey and an online consent covering study purposes, procedure, voluntary nature, and confidentiality protection. The survey was developed using RedCap,[<reflink idref="bib24" id="ref27">24</reflink>] a widely used online platform in health surveys. The self-administered and anonymous survey typically took about 20 minutes to complete. The participants were also encouraged to share the invitation and the survey link with other students.</p> <p>All participants were provided with an option to enter a prize drawing to win a $25 Amazon e-gift card. Ten e-gift cards were given away through a random drawing. A total of 1,370 college students participated in the survey. Data from 308 participants were removed due to incomplete responses (i.e., finishing less than half of the survey). The final sample size of the current study was 1,062.</p> <p>Most of the participants were from University of South Carolina. The university is a full-service, state-assisted large research university, with a total full-time student body population of more than 50,000. It offers a broad spectrum of educational opportunities with 14 colleges and schools that encompass 311 undergraduate and graduate degree-granting programs. The university confers 25% of all bachelors, graduate, and professional degrees awarded at institutions of higher education in South Carolina. The research protocol was approved by the Institutional Review Board (IRB) at the University of South Carolina.</p> <hd id="AN0176635058-5">Measures</hd> <p></p> <hd id="AN0176635058-6">Sociodemographic characteristics</hd> <p>Participants were asked to provide their sociodemographic characteristics including gender, age, race/ethnicity, college year, type of program, major (health science majors: biological science, public health, medicine, nursing, pharmacy, and social work; non-health-science majors), and annual family income. Given that certain categories included very few participants (< 5%), four variables were dichotomized, including gender (0 = Female, 1 = Male), race/ethnicity (0 = non-Caucasian, 1 = Caucasian), major (0 = non-health science, 1 = health science), and type of program (0 = undergraduate program, 1 = graduate program) for data analyses.</p> <hd id="AN0176635058-7">Flu shot uptake in the past year</hd> <p>Participants answered one item asking if they had taken a flu shot in the past year ("Did you get a flu shot/vaccine in 2019?") (Yes = 1, No = 0).</p> <hd id="AN0176635058-8">Health literacy</hd> <p>An 11-item scale composed of three subscales from the European Health Literacy Survey Questionnaire[<reflink idref="bib25" id="ref28">25</reflink>] was used to assess health literacy. Questions in this scale asked the extent to which participants were confident in understanding health-related issues or topics in three domains, including health care (e.g., "understand the leaflets that come with your medicine"), health promotion (e.g., "understand information in the media on how to get healthier"), and disease prevention (e.g., "understand why you need vaccination"). Participants rated each item on a four-option scale from 1 (very easy) to 4 (very difficult). In the current study, we reversed the scores for all items and then calculated a total score, with a higher score indicating a greater level of health literacy. This scale had good internal consistency for the study sample (Cronbach's alpha = 0.90).</p> <hd id="AN0176635058-9">Vaccine acceptance</hd> <p>One question was used to assess participants' likelihood to get a COVID-19 vaccine (i.e., "How likely are you get a COVID-19 vaccine when it is available"). Participants responded to this question on a five-point Likert scale (1 = definitely not take it, 2= not likely to take it, 3 = I don't know, 4 = likely to take it, and 5 = definitely take it). In line with the World Health Organization guidance on vaccine acceptance/hesitancy,[<reflink idref="bib26" id="ref29">26</reflink>] we categorized participants into three groups based on their responses: (<reflink idref="bib1" id="ref30">1</reflink>) refusal group (participants with answers of "1"); (<reflink idref="bib2" id="ref31">2</reflink>) hesitancy group (participants with answers of "2," "3," or "4"); and (<reflink idref="bib3" id="ref32">3</reflink>) acceptance group (participants with answers of "5").</p> <hd id="AN0176635058-10">Sources of COVID-19 vaccine information</hd> <p>Participants were asked where they would typically obtain information about the COVID-19 vaccine. The response items were: 1) I do not get any information from anywhere; 2) social media; 3) mass media (TV, newspapers); 4) government; 5) health agencies; 6) scientists; 7) pharmaceutical companies (e.g., vaccine producers); 8) my healthcare providers; 9) my personal social network (friends, classmates, or teachers); and 10) other source. The response option was "yes" or "no" for each item.</p> <hd id="AN0176635058-11">Trust in information sources about the COVID-19 vaccine</hd> <p>Participants were asked about their levels of trust in COVID-19 vaccine information from each of the following sources: social media, mass media, government, health agencies, scientists, pharmaceutical companies, their healthcare providers, and their personal social network. For each information source, participants could respond on a five-point scale ranging from "Not trust at all" (<reflink idref="bib1" id="ref33">1</reflink>) to "Always trust" (<reflink idref="bib5" id="ref34">5</reflink>).</p> <hd id="AN0176635058-12">Data analysis</hd> <p>Descriptive statistics were conducted for sociodemographic variables, flu shot uptake in the past year, health literacy, sources of vaccine information, and trust in sources by vaccine acceptance groups (refusal, hesitancy, and acceptance). Several bivariate tests were performed across three vaccine acceptance groups. Chi-square tests were employed to examine the differences of categorical demographics variables (i.e., gender, race/ethnicity, annual family income, school year), flu shot uptake in the past year, and sources of vaccine information between COVID-19 acceptance groups. In terms of continuous and ordinal variables (i.e., age, health literacy, and trust of information sources), Welch's <emph>F</emph>-tests were utilized to test the group differences given that homogeneity of variance was violated.[<reflink idref="bib27" id="ref35">27</reflink>] Tukey's Honest Significant Difference (HSD) tests were then used for post-hoc analyses.</p> <p>Multinomial logistic regression was utilized to model the associations of information sources and trust in information sources with the membership in the three vaccine acceptance groups, controlling for socio-demographics and flu shot uptake in the past year. Prior to the analyses, Pearson's (for continuous variables) and point biserial correlations (for categorical variables) were used to examine multicollinearity among independent variables in the multinomial logistic regression model. Results suggested small-to-medium correlations (<emph>r</emph>s = −0.168 to 0.511), indicating that the model was unlikely to be affected by multicollinearity. In this model, "acceptance group" was specified as the reference group. The model fit was determined in accordance with the −2 log likelihood estimate and Nagelkerke <emph>R</emph>-square. Two binary logistic regressions were then run for two comparisons (refusal group vs. acceptance group; hesitancy group vs. acceptance group). Regression coefficients (b-weight; <emph>b</emph>), odd ratios (OR), and 95% confidence interval (CI) were reported for each predictor in the logistic models. All statistical analyses were performed using SPSS software version 26.[<reflink idref="bib21" id="ref36">21</reflink>] The alpha level of 0.05 was used to determine the significance of results.</p> <hd id="AN0176635058-13">Results</hd> <p></p> <hd id="AN0176635058-14">Descriptive statistics</hd> <p>As shown in Table 1, participants were 23.83 ± 6.66 years of age on average. Most participants were female (<emph>n</emph> = 848, 79.8%), Caucasian (<emph>n</emph> = 912, 85.9%), and in a medicine/health-related major (<emph>n</emph> = 937, 88.4%). About 40% of participants reported their annual family income was more than $100,000 (<emph>n</emph> = 417, 39.8%, national average one was $117,080 among college students' family as of 2017).[<reflink idref="bib28" id="ref37">28</reflink>] More than half of the participants were undergraduates (<emph>n</emph> = 556, 52.4%), followed by doctoral students (<emph>n</emph> = 294, 27.6%) and master's students (<emph>n</emph> = 207, 19.5%). A majority of participants reported that they had taken a flu shot in the past year (<emph>n</emph> = 775, 73.0%). The mean health literacy score for the study sample was 40.07 (<emph>standard deviation</emph> [<emph>SD</emph>] = 4.52).</p> <p>Table 1. Demographic analyses between COVID-19 vaccination acceptance groups (<emph>n</emph> = 1062).</p> <p> <ephtml> <table><thead><tr><td /><td> Overall</td><td>Refusal group</td><td>Hesitancy group</td><td>Acceptance group</td><td>Group comparisons</td></tr><tr><td><bold>Welch's <italic>F</italic></bold></td><td><italic>Chi-square</italic></td><td><italic>p</italic>-value</td></tr></thead><tbody valign="top"><tr><td><italic>n</italic></td><td char=".">1062</td><td char=".">123 (11.6%)</td><td char=".">662 (62.3%)</td><td char=".">277 (26.1%)</td><td /><td /><td /></tr><tr><td>Age, <italic>Mean</italic>+<italic>SD</italic></td><td char=".">23.83 + 6.66</td><td char=".">24.95 + 7.67</td><td char=".">23.64 + 6.47</td><td char=".">23.75 + 6.59</td><td char=".">1.95</td><td /><td char=".">0.142</td></tr><tr><td>Gender, <italic>n</italic> (% within group)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Female</td><td char=".">848(80.1%)</td><td char=".">106(86%)</td><td char=".">535(81%)</td><td char=".">207(75%)</td><td /><td><bold>7.73</bold><xref ref-type="table-fn" rid="tfn6">*</xref></td><td char=".">0.021</td></tr><tr><td>Male</td><td char=".">211(19.9%)</td><td char=".">17(13.8%)</td><td char=".">125(18.9%)</td><td char=".">69(25.0%)</td><td /><td /><td /></tr><tr><td>Race/Ethnicity<xref ref-type="table-fn" rid="tfn1">a</xref>, <italic>n</italic> (% within group)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>White/Caucasian</td><td char=".">912(85.9%)</td><td char=".">103(83.7%)</td><td char=".">568(85.8%)</td><td char=".">241(87.0%)</td><td /><td char=".">0.76</td><td char=".">0.685</td></tr><tr><td>Non-White/non-Caucasian</td><td char=".">150(14.1%)</td><td char=".">20(16.3%)</td><td char=".">94(14.2%)</td><td char=".">36(13.0%)</td><td /><td /><td /></tr><tr><td>Black/Africa American</td><td char=".">71(6.7%)</td><td /><td /><td /><td /><td /><td /></tr><tr><td>Hispanic/Latino</td><td char=".">32(3.0%)</td><td /><td /><td /></tr><tr><td>Asian</td><td char=".">85(8.0%)</td><td /><td /><td /></tr><tr><td>American Indian/Alaskan Native</td><td char=".">6(0.6%)</td><td /><td /><td /></tr><tr><td>Native Hawaiian/ other Pacific Islander</td><td char=".">3(0.3%)</td><td /><td /><td /></tr><tr><td>Other</td><td char=".">6(0.6%)</td><td /><td /><td /></tr><tr><td>Annual family income, <italic>n</italic> (% in group)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td char=".">< $10,000</td><td char=".">63(6.0%)</td><td char=".">7(5.7%)</td><td char=".">44(6.8%)</td><td char=".">12(4.4%)</td><td char=".">14.82</td><td /><td char=".">0.063</td></tr><tr><td>$10,000 to $24,999</td><td char=".">102(9.7%)</td><td char=".">7(5.7%)</td><td char=".">64(9.8%)</td><td char=".">31(11.3%)</td><td /><td /><td /></tr><tr><td>$25,000 to $49,999</td><td char=".">161(15.3%)</td><td char=".">26(21.1%)</td><td char=".">104(16.0%)</td><td char=".">31(11.3%)</td><td /><td /><td /></tr><tr><td>$50,000 to $100,000</td><td char=".">306(29.2%)</td><td char=".">43(35.0%)</td><td char=".">179(27.5%)</td><td char=".">84(30.5%)</td><td /><td /><td /></tr><tr><td char=".">>$100,000</td><td char=".">417(39.8%)</td><td char=".">40(32.5%)</td><td char=".">260(39.9%)</td><td char=".">117(42.5%)</td><td /><td /><td /></tr><tr><td>School year<xref ref-type="table-fn" rid="tfn2">b</xref>, <italic>n</italic> (% within group)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Undergraduate</td><td char=".">556(52.4%)</td><td char=".">66(53.7%)</td><td char=".">353(53.7%)</td><td char=".">137(49.5%)</td><td /><td char=".">1.49</td><td char=".">0.475</td></tr><tr><td>Freshman</td><td char=".">130(12.2%)</td><td /><td /><td /><td /><td /><td /></tr><tr><td>Sophomore</td><td char=".">112(10.5%)</td><td /><td /><td /></tr><tr><td>Junior</td><td char=".">132(12.4%)</td><td /><td /><td /></tr><tr><td>Senior</td><td char=".">182(17.1%)</td><td /><td /><td /></tr><tr><td>Graduate</td><td char=".">501(47.2%)</td><td char=".">66(53.7%)</td><td char=".">353(53.7%)</td><td char=".">137(49.5%)</td><td /><td /><td /></tr><tr><td>Master's student</td><td char=".">207(19.5%)</td><td /><td /><td /><td /><td /><td /></tr><tr><td>Doctoral student</td><td char=".">294(27.6%)</td><td /><td /><td /></tr><tr><td>Health science major<xref ref-type="table-fn" rid="tfn3">c</xref></td><td char=".">937(88.4%)</td><td char=".">107(87.0%)</td><td char=".">590(89.4%)</td><td char=".">240(86.6%)</td><td /><td char=".">1.71</td><td char=".">0.426</td></tr><tr><td>Ever taken a flu shot in 2019</td><td char=".">775(73.0%)</td><td char=".">59(48.0%)</td><td char=".">486(73.4%)</td><td char=".">230(83.0%)</td><td /><td><bold>53.78</bold><bold>***</bold></td><td char=".">< 0.001</td></tr><tr><td>Health literacy<xref ref-type="table-fn" rid="tfn4">d</xref>, <italic>Mean</italic>+<italic>SD</italic></td><td char=".">40.07 + 4.52</td><td char=".">40.43 + 5.08</td><td char=".">39.71 + 4.63</td><td char=".">40.78 + 3.86</td><td><bold>6.86</bold><bold>**</bold></td><td /><td char=".">0.001</td></tr><tr><td>Information sources, <italic>n</italic> (% in group)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Social Media</td><td char=".">404(38.0%)</td><td char=".">40(32.5%)</td><td char=".">268(40.5%)</td><td char=".">96(34.7%)</td><td /><td char=".">4.61</td><td char=".">0.100</td></tr><tr><td> Mass media</td><td char=".">526(49.5%)</td><td char=".">49(39.8%)</td><td char=".">327(49.4%)</td><td char=".">150(54.2%)</td><td /><td><bold>6.99</bold><xref ref-type="table-fn" rid="tfn6">*</xref></td><td char=".">0.030</td></tr><tr><td> Government</td><td char=".">205(19.3%)</td><td char=".">31(25.2%)</td><td char=".">121(18.3%)</td><td char=".">53(19.1%)</td><td /><td char=".">3.20</td><td char=".">0.202</td></tr><tr><td> Health agencies</td><td char=".">613(57.7%)</td><td char=".">70(56.9%)</td><td char=".">379(57.3%)</td><td char=".">164(59.2%)</td><td /><td char=".">0.34</td><td char=".">0.842</td></tr><tr><td> Scientists</td><td char=".">349(32.9%)</td><td char=".">45(36.6%)</td><td char=".">194(29.3%)</td><td char=".">110(39.7%)</td><td /><td><bold>10.46</bold><bold>**</bold></td><td char=".">0.005</td></tr><tr><td> Pharmaceutical companies</td><td char=".">187(17.6%)</td><td char=".">31(25.2%)</td><td char=".">106(16.0%)</td><td char=".">50(18.1%)</td><td /><td><bold>6.09</bold><xref ref-type="table-fn" rid="tfn6">*</xref></td><td char=".">0.048</td></tr><tr><td> Healthcare providers</td><td char=".">206(19.4%)</td><td char=".">25(20.3%)</td><td char=".">135(20.4%)</td><td char=".">46(16.6%)</td><td /><td char=".">1.87</td><td char=".">0.393</td></tr><tr><td> My personal social networks</td><td char=".">430(40.5%)</td><td char=".">43(35.0%)</td><td char=".">275(41.5%)</td><td char=".">112(40.4%)</td><td /><td char=".">1.87</td><td char=".">0.394</td></tr><tr><td>Trust of information sources, <italic>Mean</italic>+<italic>SD</italic></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Social Media</td><td char=".">1.95 + 0.76</td><td char=".">1.83 + 0.79</td><td char=".">1.98 + 0.75</td><td char=".">1.96 + 0.76</td><td char=".">1.83</td><td /><td char=".">0.163</td></tr><tr><td> Mass media</td><td char=".">2.32 + 0.86</td><td char=".">1.93 + 0.84</td><td char=".">2.31 + 0.84</td><td char=".">2.51 + 0.88</td><td><bold>19.09</bold>***</td><td /><td char=".">< 0.001</td></tr><tr><td> Government</td><td char=".">2.62 + 0.87</td><td char=".">2.42 + 0.94</td><td char=".">2.57 + 0.83</td><td char=".">2.82 + 0.89</td><td><bold>10.91</bold>***</td><td /><td char=".">< 0.001</td></tr><tr><td> Health agencies</td><td char=".">3.79 + 0.77</td><td char=".">3.33 + 0.96</td><td char=".">3.76 + 0.70</td><td char=".">4.09 + 0.72</td><td><bold>37.73</bold>***</td><td /><td char=".">< 0.001</td></tr><tr><td> Scientists</td><td char=".">4.06 + 0.69</td><td char=".">3.77 + 0.81</td><td char=".">3.99 + 0.65</td><td char=".">4.36 + 0.61</td><td><bold>44.62</bold>***</td><td /><td char=".">< 0.001</td></tr><tr><td> Pharmaceutical companies</td><td char=".">3.03 + 0.92</td><td char=".">2.60 + 1.03</td><td char=".">3.02 + 0.89</td><td char=".">3.25 + 0.88</td><td><bold>19.20</bold>***</td><td /><td char=".">< 0.001</td></tr><tr><td> Healthcare providers</td><td char=".">3.90 + 0.73</td><td char=".">3.57 + 0.88</td><td char=".">3.87 + 0.68</td><td char=".">4.11 + 0.69</td><td><bold>21.91</bold>***</td><td /><td char=".">< 0.001</td></tr><tr><td> My personal social networks</td><td char=".">2.69 + 0.81</td><td char=".">2.57 + 0.89</td><td char=".">2.70 + 0.80</td><td char=".">2.73 + 0.81</td><td char=".">1.53</td><td /><td char=".">0.218</td></tr></tbody></table> </ephtml> </p> <p>1 Race/Ethnicity was dichotomized into 0 (White/Caucasian) and 1 (non-White/Caucasian) for analyses.</p> <ulist> <item>2 School year was dichotomized into 0 (undergraduate) and 1 (graduate) for analyses.</item> <item>3 Health science major included biological science, public health, medicine, nursing, pharmacy, and social work.</item> <item>4 Health literacy was measured using the European Health Literacy Survey Questionnaire, which evaluated the confidence level in understanding health-related issues such as health care, health promotion, and disease prevention.</item> <item>5 <emph>SD</emph> = <emph>Standard Deviation</emph>.</item> <item>6 <emph>p</emph> <.05;. <emph>**p</emph> <.01;. <emph>***p</emph> <.001.</item> <item>7 <emph>Chi-square</emph> tests and <emph>Welch's F</emph> tests were used to examine differences in demographic factors, information sources, and trust of information sources between three vaccination acceptance groups.</item> </ulist> <p>In terms of COVID-19 vaccine acceptance, about one in four participants reported that they would definitely get a vaccine (<emph>n</emph> = 277, 26.1%; acceptance group), a large number of participants reported that they were hesitant to take a COVID-19 vaccine (<emph>n</emph> = 662, 62.3%; hesitancy group), and about one in ten reported that they would definitely not get a vaccine (<emph>n</emph> = 123, 11.6%). Recent national data collected by CDC from March to May 2021 reveal that, among young adults in the U.S., 49.9% have been vaccinated or are planning to get vaccinated, 28.3% are unsure or would possibly get vaccinated, and 24.9% would probably or definitely not get vaccinated.[<reflink idref="bib29" id="ref38">29</reflink>]</p> <p>The top three information sources about the vaccine were health agencies (<emph>n</emph> = 613, 57.7%), mass media (<emph>n</emph> = 526, 49.5%), and personal social networks (<emph>n</emph> = 430, 40.5%), followed by social media (<emph>n</emph> = 404, 38%), scientists (<emph>n</emph> = 349, 32.9%), healthcare providers (<emph>n</emph> = 206, 19.4%), government (<emph>n</emph> = 205, 19.3%), and pharmaceutical companies (<emph>n</emph> = 187, 17.6%). In terms of the trust level for each information source, participants reported the highest score on scientists (<emph>Mean</emph> = 4.06 ± 0.69, followed by healthcare providers (<emph>Mean</emph> = 3.90 ± 0.73), health agencies (<emph>Mean</emph> = 3.79 ± 0.77), pharmaceutical companies (<emph>Mean</emph> = 3.03 ± 0.92), personal social networks (<emph>Mean</emph> = 2.69 ± 0.81), government (<emph>Mean</emph> = 2.62 ± 0.87), mass media (<emph>Mean</emph> = 2.32 ± 0.86), and social media (<emph>Mean</emph> = 1.95 ± 0.76). Rankings of information sources and trust level were similar across three groups (i.e., acceptance, hesitancy, and refusal).</p> <hd id="AN0176635058-15">Bivariate analyses</hd> <p>Results of bivariate analyses are presented in Table 1. In terms of demographic variables, bivariate analyses suggested no significant differences by COVID-19 acceptance groups on age, race/ethnicity, annual family income, and school year (see Table 1). However, chi-square test indicated statistically significant differences regarding gender (<emph>χ</emph>2 [<reflink idref="bib2" id="ref39">2</reflink>, _I_n_i_ = 1059] = 7.73, <emph>p</emph> = 0.021) and flu shot uptake in the past year (<emph>ꭓ</emph>2 [<reflink idref="bib2" id="ref40">2</reflink>, _I_n_i_ = 1062] = 53.78, <emph>p</emph> < 0.001). Welch's <emph>F</emph>-test suggested that health literacy differed across three COVID-19 acceptance groups (<emph>F</emph> [<reflink idref="bib2" id="ref41">2</reflink>, 296.57] = 6.86, <emph>p</emph> =.001). The health literacy score was lower in the hesitancy group (39.71) compared with the refusal group (40.43) and acceptance group (40.78).</p> <p>Chi-square tests for information sources indicated significant differences regarding mass media (<emph>ꭓ</emph>2 [<reflink idref="bib2" id="ref42">2</reflink>, 1062] = 6.99, <emph>p</emph> = 0.030), scientists (<emph>ꭓ</emph>2 [<reflink idref="bib2" id="ref43">2</reflink>, _I_n_i_ = 1062] = 10.46, <emph>p</emph> = 0.005), and pharmaceutical companies (<emph>ꭓ</emph>2 [<reflink idref="bib2" id="ref44">2</reflink>, _I_n_i_ = 1062] = 6.09, <emph>p</emph> = 0.048). Follow-up tests suggested that the refusal group was significantly more likely to report seeing information from pharmaceutical companies than the hesitancy group (<emph>ꭓ</emph>2 [<reflink idref="bib1" id="ref45">1</reflink>, _I_n_i_ = 785] = 6.82, <emph>p</emph> = 0.014). the acceptance group was more likely to report seeing information from mass media than the refusal group (<emph>ꭓ</emph>2 [<reflink idref="bib1" id="ref46">1</reflink>, _I_n_i_ = 400] = 6.98, <emph>p</emph> = 0.008) and more likely to report seeing from scientists than the hesitancy group (<emph>ꭓ</emph>2 [<reflink idref="bib1" id="ref47">1</reflink>, _I_n_i_ = 939] = 9.66 <emph>p</emph> = 0.002). No group differences were found for social media, government, health agencies, health providers, and personal social networks (see Figure 1).</p> <p>Graph: Figure 1. Types of information sources by vaccine acceptance groups.</p> <p>Welch's <emph>F</emph>-tests revealed significant group differences on trust levels of six information sources, including mass media (<emph>F</emph> [<reflink idref="bib2" id="ref48">2</reflink>, 308.56] = 19.09, <emph>p</emph> <.001), government (<emph>F</emph> [<reflink idref="bib2" id="ref49">2</reflink>, 297.75] = 10.91, <emph>p</emph> <.001), health agencies (<emph>F</emph> [<reflink idref="bib2" id="ref50">2</reflink>, 288.07] = 37.73, <emph>p</emph> <.001), scientists (<emph>F</emph> [<reflink idref="bib2" id="ref51">2</reflink>, 296.37] = 44.62, <emph>p</emph> <.001), pharmaceutical companies (<emph>F</emph> [<reflink idref="bib2" id="ref52">2</reflink>, 299.43] = 19.20, <emph>p</emph> <.001), and health providers (<emph>F</emph> [<reflink idref="bib2" id="ref53">2</reflink>, 291.07] = 21.91, <emph>p</emph> <.001). Results did not suggest significant group differences on trust levels regarding social media and personal social network (see Figure 2). Post-hoc Tukey's HSD tests suggested that compared to hesitancy and refusal groups, the acceptance group reported significantly higher trust on mass media (<emph>p</emph>s <.004), government (<emph>p</emph>s <.001), health agencies (<emph>p</emph>s <.001), scientists (<emph>p</emph>s <.001), pharmaceutical companies (<emph>p</emph>s <.001), and healthcare providers (<emph>p</emph>s <.001). In addition, relative to the refusal group, the hesitancy group reported higher trust on mass media (<emph>p</emph> <.001), health agencies (<emph>p</emph> <.001), scientists (<emph>p</emph> =.003), pharmaceutical companies (<emph>p</emph> <.001), and healthcare providers (<emph>p</emph> <.001).</p> <p>Graph: Figure 2. Trust level of information sources by vaccine acceptance groups.</p> <hd id="AN0176635058-16">Multinomial logistic regression</hd> <p>Table 2 presents the findings of multinomial logistic regression. Results suggested that the overall model was statistically significant (−2 <emph>Log Likelihood</emph> = 1534.72, <emph>ꭓ</emph>2 [<reflink idref="bib48" id="ref54">48</reflink>] = 239.40, <emph>p</emph> < 0.001). The Nagelkerke pseudo <emph>R</emph><sups>2</sups> suggested that the model accounted for approximately 25.7% of the total variance in COVID-19 vaccine acceptance.</p> <p>Table 2. Multinomial logistic regression on COVID-19 vaccine acceptance with types and trust of information sources among college students.</p> <p> <ephtml> <table><thead><tr><td /><td><bold>Model 1: Refusal Group</bold><xref ref-type="table-fn" rid="tfn8">+</xref></td><td><bold>Model 2: Hesitancy Group</bold><xref ref-type="table-fn" rid="tfn8">+</xref></td></tr><tr><td>Predictor variable</td><td><italic>b</italic></td><td><italic>SE</italic></td><td><italic>Odd Ratio</italic></td><td><italic>p</italic></td><td>95% <italic>CI</italic></td><td><italic>b</italic></td><td><italic>SE</italic></td><td><italic>Odd Ratio</italic></td><td><italic>p</italic></td><td>95% CI</td></tr></thead><tbody valign="top"><tr><td>Gender</td><td char=".">−0.74</td><td char=".">0.35</td><td><bold>0.48*</bold></td><td char=".">0.035</td><td char=".">0.24–0.95</td><td char=".">−0.25</td><td char=".">0.20</td><td char=".">0.78</td><td char=".">0.225</td><td char=".">0.53–1.16</td></tr><tr><td>Age</td><td char=".">0.05</td><td char=".">0.02</td><td><bold>1.05*</bold></td><td char=".">0.045</td><td char=".">1.00–1.10</td><td char=".">0.02</td><td char=".">0.02</td><td char=".">1.02</td><td char=".">0.372</td><td char=".">0.98–1.05</td></tr><tr><td>White/Caucasian</td><td char=".">0.42</td><td char=".">0.39</td><td char=".">1.52</td><td char=".">0.282</td><td char=".">0.71–3.25</td><td char=".">0.23</td><td char=".">0.24</td><td char=".">1.25</td><td char=".">0.355</td><td char=".">0.78–2.02</td></tr><tr><td>Annual family income</td><td char=".">−0.08</td><td char=".">0.11</td><td char=".">0.92</td><td char=".">0.462</td><td char=".">0.74–1.15</td><td char=".">−0.07</td><td char=".">0.07</td><td char=".">0.94</td><td char=".">0.339</td><td char=".">0.81–1.07</td></tr><tr><td>Graduates</td><td char=".">−0.23</td><td char=".">0.35</td><td char=".">0.80</td><td char=".">0.507</td><td char=".">0.41–1.56</td><td char=".">−0.07</td><td char=".">0.22</td><td char=".">0.93</td><td char=".">0.737</td><td char=".">0.61–1.42</td></tr><tr><td>Health science major</td><td char=".">0.24</td><td char=".">0.40</td><td char=".">1.28</td><td char=".">0.545</td><td char=".">0.58–2.81</td><td char=".">0.25</td><td char=".">0.25</td><td char=".">1.28</td><td char=".">0.323</td><td char=".">0.79–2.08</td></tr><tr><td>Ever taken a flu shot in 2019</td><td char=".">−1.78</td><td char=".">0.29</td><td><bold>0.17***</bold></td><td char="."><0.001</td><td char=".">0.10–0.30</td><td char=".">−0.58</td><td char=".">0.20</td><td><bold>0.56**</bold></td><td char=".">0.005</td><td char=".">0.38–0.84</td></tr><tr><td>Health literacy</td><td char=".">−0.01</td><td char=".">0.03</td><td char=".">0.99</td><td char=".">0.849</td><td char=".">0.93–1.06</td><td char=".">−0.05</td><td char=".">0.02</td><td><bold>0.95*</bold></td><td char=".">0.016</td><td char=".">0.91–0.99</td></tr><tr><td>Types of information sources</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Social Media</td><td char=".">−0.10</td><td char=".">0.32</td><td char=".">0.91</td><td char=".">0.753</td><td char=".">0.49–1.68</td><td char=".">0.14</td><td char=".">0.20</td><td char=".">1.15</td><td char=".">0.483</td><td char=".">0.78–1.69</td></tr><tr><td> Mass media</td><td char=".">−0.31</td><td char=".">0.29</td><td char=".">0.73</td><td char=".">0.281</td><td char=".">0.42–1.29</td><td char=".">−0.18</td><td char=".">0.18</td><td char=".">0.84</td><td char=".">0.314</td><td char=".">0.59–1.19</td></tr><tr><td> Government</td><td char=".">0.76</td><td char=".">0.35</td><td><bold>2.15*</bold></td><td char=".">0.027</td><td char=".">1.09–4.22</td><td char=".">0.25</td><td char=".">0.23</td><td char=".">1.29</td><td char=".">0.261</td><td char=".">0.83–2.00</td></tr><tr><td> Health agencies</td><td char=".">−0.14</td><td char=".">0.29</td><td char=".">0.87</td><td char=".">0.626</td><td char=".">0.49–1.54</td><td char=".">0.10</td><td char=".">0.18</td><td char=".">1.11</td><td char=".">0.572</td><td char=".">0.77–1.59</td></tr><tr><td> Scientists</td><td char=".">−0.43</td><td char=".">0.31</td><td char=".">0.65</td><td char=".">0.160</td><td char=".">0.36–1.19</td><td char=".">−0.37</td><td char=".">0.19</td><td char=".">0.69</td><td char=".">0.058</td><td char=".">0.48–1.01</td></tr><tr><td> Pharmaceutical companies</td><td char=".">0.74</td><td char=".">0.35</td><td><bold>2.09*</bold></td><td char=".">0.036</td><td char=".">1.05–4.15</td><td char=".">0.01</td><td char=".">0.24</td><td char=".">1.01</td><td char=".">0.952</td><td char=".">0.64–1.61</td></tr><tr><td> Healthcare providers</td><td char=".">0.57</td><td char=".">0.34</td><td char=".">1.76</td><td char=".">0.097</td><td char=".">0.90–3.44</td><td char=".">0.47</td><td char=".">0.22</td><td><bold>1.60*</bold></td><td char=".">0.032</td><td char=".">1.04–2.46</td></tr><tr><td> My personal social networks</td><td char=".">−0.39</td><td char=".">0.29</td><td char=".">0.68</td><td char=".">0.177</td><td char=".">0.38–1.19</td><td char=".">−0.18</td><td char=".">0.18</td><td char=".">0.83</td><td char=".">0.300</td><td char=".">0.59–1.18</td></tr><tr><td>Trust of information sources</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Social Media</td><td char=".">0.42</td><td char=".">0.22</td><td char=".">1.52</td><td char=".">0.063</td><td char=".">0.98–2.35</td><td char=".">0.18</td><td char=".">0.14</td><td char=".">1.20</td><td char=".">0.189</td><td char=".">0.92–1.57</td></tr><tr><td> Mass media</td><td char=".">−0.65</td><td char=".">0.20</td><td><bold>0.52**</bold></td><td char=".">0.001</td><td char=".">0.36–0.77</td><td char=".">−0.13</td><td char=".">0.12</td><td char=".">0.88</td><td char=".">0.254</td><td char=".">0.70–1.10</td></tr><tr><td> Government</td><td char=".">−0.19</td><td char=".">0.17</td><td char=".">0.83</td><td char=".">0.277</td><td char=".">0.59–1.16</td><td char=".">−0.31</td><td char=".">0.11</td><td><bold>0.74**</bold></td><td char=".">0.005</td><td char=".">0.59–0.91</td></tr><tr><td> Health agencies</td><td char=".">−0.58</td><td char=".">0.22</td><td><bold>0.56**</bold></td><td char=".">0.008</td><td char=".">0.36–0.86</td><td char=".">−0.18</td><td char=".">0.15</td><td char=".">0.84</td><td char=".">0.240</td><td char=".">0.63–1.12</td></tr><tr><td> Scientists</td><td char=".">−0.58</td><td char=".">0.25</td><td><bold>0.56*</bold></td><td char=".">0.021</td><td char=".">0.34–0.92</td><td char=".">−0.80</td><td char=".">0.17</td><td><bold>0.45***</bold></td><td char="."><0.001</td><td char=".">0.32–0.63</td></tr><tr><td> Pharmaceutical companies</td><td char=".">−0.35</td><td char=".">0.16</td><td><bold>0.71*</bold></td><td char=".">0.033</td><td char=".">0.52–0.97</td><td char=".">−0.01</td><td char=".">0.10</td><td char=".">0.99</td><td char=".">0.935</td><td char=".">0.82–1.21</td></tr><tr><td> Healthcare providers</td><td char=".">−0.26</td><td char=".">0.22</td><td char=".">0.77</td><td char=".">0.237</td><td char=".">0.50–1.19</td><td char=".">−0.07</td><td char=".">0.14</td><td char=".">0.93</td><td char=".">0.626</td><td char=".">0.70–1.24</td></tr><tr><td> My personal social networks</td><td char=".">0.15</td><td char=".">0.18</td><td char=".">1.16</td><td char=".">0.406</td><td char=".">0.82–1.65</td><td char=".">0.14</td><td char=".">0.11</td><td char=".">1.15</td><td char=".">0.235</td><td char=".">0.92–1.43</td></tr></tbody></table> </ephtml> </p> <ulist> <item>8 Acceptance group was set as the reference group. General model results: −2 <emph>Log Likelihood</emph> = 1534.72, <emph>*</emph>2 [<reflink idref="bib48" id="ref55">48</reflink>] = 239.40, <emph>p</emph> < 0.001; <emph>Nagelkerke R<sups>2</sups></emph> = 0.26.</item> <item>9 <emph>SE</emph> = <emph>Standardized Error. 95% CI = 95% Confidence Interval.</emph> Source was dichotomous response to a checklist. Trust was continuous as a higher score indicating greater trust in an information source.*<emph>p</emph> <.05; **<emph>p</emph> <.01; ***<emph>p</emph> <.001.</item> </ulist> <p>Binary logistic regression on the membership between vaccine acceptance and refusal groups (model 1) revealed that, when controlling for the other factors, college students who were male (<emph>b</emph> = −0.74, <emph>OR</emph> = 0.48, <emph>p</emph> = 0.035, 95%<emph>CI</emph> = 0.24, 0.95) or had taken a flu shot (<emph>b</emph> = −1.78, <emph>OR</emph> = 0.17, <emph>p</emph> < 0.001, 95%<emph>CI</emph> = 0.10, 0.30) in the past year were less likely to refuse COVID-19 vaccine. In addition, participants who reported seeing COVID-19 vaccine information from government (<emph>b</emph> = 0.76, OR = 2.15, <emph>p</emph> = 0.027, 95%<emph>CI</emph> = 1.09, 4.22) or pharmaceutical companies (<emph>b</emph> = 0.74, OR = 2.09, <emph>p</emph> = 0.036, 95%<emph>CI</emph> = 1.05, 4.15) had a higher likelihood to refuse COVID-19 vaccine. Participants with higher levels of trust in mass media (<emph>b</emph> = −0.65, OR = 0.52, <emph>p</emph> = 0.001, 95%<emph>CI</emph> = 0.36, 0.77), health agencies (<emph>b</emph> = −0.58, OR = 0.56, <emph>p</emph> = 0.008, 95%<emph>CI</emph> = 0.36, 0.86), scientists (<emph>b</emph> = −0.58, OR = 0.56, <emph>p</emph> = 0.021, 95%<emph>CI</emph> = 0.34, 0.92), and pharmaceutical companies (<emph>b</emph> = −0.35, OR = 0.71, <emph>p</emph> = 0.033, 95%<emph>CI</emph> = 0.52, 0.97), were less likely to be classified as belonging to the vaccine refusal group.</p> <p>Results of binary logistic regression predicting the membership between acceptance and hesitancy groups suggested that, when controlling for the other factors, participants who had taken a flu shot in the past year (<emph>b</emph> = −0.58, OR = 0.56, <emph>p</emph> = 0.005, 95%<emph>CI</emph> = 0.38, 0.84) or reported higher levels of health literacy (<emph>b</emph> = −0.05, OR = 0.95, <emph>p</emph> = 0.016, 95%<emph>CI</emph> = 0.91, 0.99) were less likely to be classified as belonging to the hesitancy group. Participants who reported seeing information from healthcare providers (<emph>b</emph> = 0.47, OR = 1.60, <emph>p</emph> = 0.032, 95%<emph>CI</emph> = 1.04, 2.46) had a higher likelihood to exhibit vaccine hesitancy. Participants who showed higher trust levels in government (<emph>b</emph> = −0.31, OR = 0.74, <emph>p</emph> = 0.005, 95%<emph>CI</emph> = 0.59, 0.91) or scientists (<emph>b</emph> = −0.80, OR = 0.45, <emph>p</emph> < 0.001, 95%<emph>CI</emph> = 0.32, 0.63) were less likely to be classified as belonging to the vaccine hesitancy group.</p> <hd id="AN0176635058-17">Discussion</hd> <p>Although there is increasing literature on COVID-19 vaccine acceptance and factors that are associated with people's willingness to get vaccinated when the vaccine is available, the current study is one of the first efforts to investigate information sources of COVID-19 vaccines, levels of trust in those different information sources, and the impact of those information sources and trust levels on vaccine acceptance among college students in South Carolina. Our findings show that college students have multiple information sources for learning about COVID-19 vaccines (e.g., health agencies to personal networks to social media). The sources of information and the trust level in those information sources are associated with different vaccine acceptance groups in various ways after controlling for sociodemographic factors and other key factors (e.g., flu shot uptake and health literacy). Reporting seeing information from government and pharmacies was significantly related to refusing vaccination but trust in government and scientists was related to lower likelihood of vaccine hesitancy.</p> <p>The current study suggests that college students in South Carolina mainly obtained vaccine information from health agencies. This finding is aligned with existing studies that reported health authorities as a dominant information source for parents regarding childhood vaccination.[<reflink idref="bib22" id="ref56">22</reflink>] However, other authorities and key stakeholders of vaccine development and distribution including scientists, healthcare providers, and government were not main information sources of COVID-19 vaccine. This pattern may indicate limited availability or widespread dissemination of vaccine-related scientific messaging by healthcare providers and government. In addition, mass media and personal social networks rather than social media were among the top information sources of COVID-19 vaccine, suggesting that we should not discount the role of this more traditional communication among young adults even in the digital era.</p> <p>It is notable that the rank of information sources about COVID-19 vaccines (e.g., health agencies, mass media, personal social networks, social media, scientists, healthcare workers, government, pharmaceutical companies) is not fully in accordance with the trust level in these information sources (e.g., scientists, healthcare workers, health agencies, pharmaceutical companies, personal social network, government, mass media, social media). For example, a majority of the participants expressed a high level of trust in scientists and healthcare providers even they were not listed as main information sources regarding vaccines. Despite obtaining information about COVID-19 vaccines from personal social networks and mass media, participants reviewed the two sources as less trustworthy. This finding is inconsistent with literature regarding trust and information sources, which argues that people trust sources of health information to which they are always exposed.[<reflink idref="bib7" id="ref57">7</reflink>],[<reflink idref="bib30" id="ref58">30</reflink>] However, studies on prostate cancer communication among African American men show that it is not uncommon for people to use one information source (e.g., newspaper, family members) but trust others (doctors and health educators).[<reflink idref="bib31" id="ref59">31</reflink>] One potential interpretation is that the acquisition of COVID-19 vaccine information occurs along with other escalating information about COVID-19 from various sources during a relatively short time period. While some participants might actively seek out COVID-19 vaccine information, a considerable amount of information is encountered in a more passive and less deliberate way. College students who were exposed to an information source may not necessarily trust the specific COVID-19 vaccine information disseminated through this source. Future studies are needed to further examine potential factors that influence their judgment such as health beliefs and social norms.[<reflink idref="bib32" id="ref60">32</reflink>]</p> <p>Another interesting finding is that obtaining COVID-19 vaccine information from pharmaceutical companies was associated with a higher likelihood to refuse vaccine uptake. There were numerous unverifiable, unaccountable, and often mixed information from pharmaceutical companies regarding the vaccine during the earlier stages of the pandemic. The accelerated pace of vaccine development may further exaggerate public anxieties, confusion, and doubt.[<reflink idref="bib26" id="ref61">26</reflink>] Pharmaceutical companies might be viewed as a negative source on COVID-19 vaccine and impede people's vaccine acceptance.</p> <p>Consistent with other studies on vaccine acceptance or vaccine safety concern,[<reflink idref="bib13" id="ref62">13</reflink>] our findings highlight the critical role of trust in decision making regarding vaccination.[[<reflink idref="bib33" id="ref63">33</reflink>], [<reflink idref="bib35" id="ref64">35</reflink>]] Biomedical science and research act as a foundation for vaccine development; pharmaceutical companies develop and produce the vaccines; and health authorities such as the Food and Drug Administration and the CDC regulate vaccine production and promote vaccination. Trust in key stakeholders along the vaccine development continuum was significantly associated with higher levels of vaccine acceptance (i.e., lower likelihood to refuse vaccination or to be hesitant about vaccination) among college students. Trust in the health care system, science and technology, and healthcare professionals could be stronger drivers of vaccine acceptance during public health emergencies such as the COVID-19 pandemic when people have to face partial, inconsistent, conditional, and even contradictory information and knowledge about a new virus.[<reflink idref="bib30" id="ref65">30</reflink>] In addition, trust in different information sources may play different roles in the vaccine acceptance spectrum from total refusal, to hesitation, and acceptance. For example, college students who reported higher levels of trust in mass media, health agencies, scientists, and pharmaceutical companies were less likely to totally refuse vaccination, and those who showed a high level of trust in government and scientists were less likely to be hesitant about vaccination.</p> <p>The current study is subject to several limitations. First, its cross-sectional design limits the exploration of the complicated causal pathways between information sources, trust, and vaccine acceptance. The data collection was conducted prior to the dissemination of safe and efficacious COVID-19 vaccine, which should be interpreted carefully. Second, a convenience sample of participants in the current study showed a high level of homogeneity in demographics in terms of race (most were Caucasian), gender (mostly female), major (most were medicine/health sciences majors), affiliation (most were from the same university), degree (high proportion of graduate degrees). This group is likely to have a higher level of health literacy and health-related knowledge than other young adults or college students.[<reflink idref="bib36" id="ref66">36</reflink>],[<reflink idref="bib37" id="ref67">37</reflink>] Existing literature demonstrates racial differences in trust relationships with health authorities due to historical events and narratives,[<reflink idref="bib33" id="ref68">33</reflink>],[<reflink idref="bib38" id="ref69">38</reflink>] however, our data analysis did not suggest a racial/ethnic difference in COVID-19 vaccine acceptance. Given that majority of the participants (∼86%) in our study were Caucasian, we did not have sufficient power to stratify the data analysis by ethnic and racial groups. Comparison studies are warranted for further exploration of the role of race/ethnicity in relation to trust in various information sources and vaccine acceptance. Third, due to the brevity of the online survey, data were not available on some other factors that may either mediate or moderate the association between trust in sources of vaccine information and vaccine acceptance. For example, some studies have indicated a potential association between political orientation and vaccine hesitancy.[<reflink idref="bib39" id="ref70">39</reflink>] As for the measurement instrument of information sources, we did not include Internet/online search engines as a response option. In addition, receiving information from social media and social networks could be overlapped in daily life, especially in the circumstances that members within existing social networks share information via social media. We were not able to provide detailed definition and examples in the online survey to clearly differentiate the two types of information sources. Similarly, we did not ask clarifying question on the survey to differentiate participants who "follow" scientists on social media and those who receive information from strangers. Also, the measurement of information sources could be limited by binary responses. Future research would benefit from using a more sensitive measure (e.g., a Likert scale of frequency). Fourth, the sample in the current study was from one college in one southeastern state and findings may not be generalized to other college populations elsewhere. Although growing literature on trust and vaccine hesitancy suggests some commonalities, the relationship may vary by population, vaccine, and region.[<reflink idref="bib40" id="ref71">40</reflink>]</p> <p>Despite these limitations, the current study identified the pattern of sources regarding COVID-19 vaccine information and trust in these information sources among college students in South Carolina as well as explored the impacts of trust on vaccine acceptance, which can inform specific strategies for COVID-19 vaccine promotion among this group. First, we need to increase the coverage of authorized health communication on COVID-19 vaccine among young adults. Scientists and healthcare providers were both trusted sources for vaccine information for college students, yet they were not their main sources of vaccine information. In addition, our results suggest that receiving information from healthcare providers was associated with higher likelihood to be hesitant about vaccination. This discrepancy implies a gap in critical communication and education by trusted sources. Scientists and healthcare professionals should have the opportunity to play an active role in disseminating their research findings and dispelling misinformation and conspiratorial messages about COVID-19 vaccination.</p> <p>Second, as the developer and producer of vaccines, pharmaceutical companies have the responsibility to provide clear and accurate communication to reduce confusion and doubt and rebuild a trusting relationship with the public. Tarnished reputations of pharmaceutical companies have fueled the anti-vaccine movement.[<reflink idref="bib41" id="ref72">41</reflink>],[<reflink idref="bib42" id="ref73">42</reflink>] Playing a positive role in health communication and partnering with health care agencies and scientists on this communication will help address distrust issues with the public.</p> <p>Third, we need to build increased trust in government in terms of vaccine communication. According to our results, government was neither a main nor a trusted source of COVID-19 vaccine information. Public hesitancy may be intensified by contradictory information from federal and state governments and politicization of vaccine development and approvals. A transparent and evidence-based policy is required to strengthen the public's trust in government.</p> <p>Fourth, we need to develop strategies leveraging the potential positive role of mass media and personal social networks in vaccine communication. Both were reported as main sources of vaccine information among college students in our study, which implies that we should not discount the role of traditional communication sources among young adults even in this digital era. The participants in our study did not show high trust in mass media and personal social networks. Despite people's distrust in a particular information source, exposure to its content could still induce emotional reactions and sow confusion and doubt.[<reflink idref="bib43" id="ref74">43</reflink>] Therefore, we need to timely and efficiently identify misinformation in mass media and disseminate credible and fact-checking messages.[<reflink idref="bib44" id="ref75">44</reflink>] We also need to identify and engage opinion leaders either in communities or social networks in vaccine promotion campaigns.[<reflink idref="bib45" id="ref76">45</reflink>] Similarly, we also need to effectively track, monitor, and disperse misinformation in social media.[<reflink idref="bib46" id="ref77">46</reflink>]</p> <p>Finally, we found that different vaccine acceptance groups show different characteristics in terms of sources of information and trust level of the information sources, which suggests that we need more tailored intervention strategy in vaccine-related communication campaigns. For example, compared to the refusal group, a higher proportion of the hesitancy group reported seeing vaccine information from personal social networks. Peer educators/advocates may play more a critical role among the hesitancy group in vaccine promotion.</p> <p>In summary, our findings echo the call for restoring trust in the healthcare system, scientists, and biomedical industries.[<reflink idref="bib47" id="ref78">47</reflink>] Effective strategies are needed to improve trust in pharmaceutical companies, healthcare providers, and government regarding vaccine communication and encourage these entities to partner with sources already trusted by the public.</p> <hd id="AN0176635058-18">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of United States of America and received approval from the Institutional Review Board of University of South Carolina.</p> <hd id="AN0176635058-19">Funding</hd> <p>The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this publication was supported by the National Institutes of Health under Award Number of NIH R01MH0112376-3S1 and R01AI127203-4S1.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.</p> <ref id="AN0176635058-20"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> National Institute of Health. Promising interim results from clinical trial of NIH-moderna COVID-19 vaccine. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: COVID-19 Vaccine Acceptance among College Students in South Carolina: Do Information Sources and Trust in Information Matter?
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Shan+Qiao%22">Shan Qiao</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1834-1834">0000-0003-1834-1834</externalLink>)<br /><searchLink fieldCode="AR" term="%22Daniela+B%2E+Friedman%22">Daniela B. Friedman</searchLink><br /><searchLink fieldCode="AR" term="%22Cheuk+Chi+Tam%22">Cheuk Chi Tam</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2612-0564">0000-0003-2612-0564</externalLink>)<br /><searchLink fieldCode="AR" term="%22Chengbo+Zeng%22">Chengbo Zeng</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-3512-1115">0000-0002-3512-1115</externalLink>)<br /><searchLink fieldCode="AR" term="%22Xiaoming+Li%22">Xiaoming Li</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(3):859-868.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institutes of Health (NIH) (DHHS)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: R01MH01123763S1<br />R01AI1272034S1
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Pandemics%22">Pandemics</searchLink><br /><searchLink fieldCode="DE" term="%22Trust+%28Psychology%29%22">Trust (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Immunization+Programs%22">Immunization Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Pharmacy%22">Pharmacy</searchLink><br /><searchLink fieldCode="DE" term="%22Industry%22">Industry</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Information+Sources%22">Information Sources</searchLink><br /><searchLink fieldCode="DE" term="%22Mass+Media%22">Mass Media</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Health%22">Public Health</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Networks%22">Social Networks</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Media%22">Social Media</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Agencies%22">Public Agencies</searchLink><br /><searchLink fieldCode="DE" term="%22Scientists%22">Scientists</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22South+Carolina%22">South Carolina</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2022.2059375
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: For college students who are exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play a role in shaping the vaccine acceptance spectrum (refusal, hesitancy, and acceptance). Methods: Based on an online survey among 1,062 college students in South Carolina, we investigated vaccine information sources among college students and examined how COVID-19 vaccine acceptance was associated with information source and trust level in each source. Results: The top three sources of COVID-19 vaccine information were health agencies, mass media, and personal social networks. Trust in mass media, health agencies, scientists, and pharmaceutical companies was negatively associated with vaccine refusal. Trust in government and scientists was negatively associated with vaccine hesitancy. Discussion: Our findings highlight the importance of restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1421287
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1421287
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2022.2059375
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 859
    Subjects:
      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: Pandemics
        Type: general
      – SubjectFull: Trust (Psychology)
        Type: general
      – SubjectFull: Immunization Programs
        Type: general
      – SubjectFull: Pharmacy
        Type: general
      – SubjectFull: Industry
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Information Sources
        Type: general
      – SubjectFull: Mass Media
        Type: general
      – SubjectFull: Public Health
        Type: general
      – SubjectFull: Social Networks
        Type: general
      – SubjectFull: Social Media
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      – SubjectFull: Public Agencies
        Type: general
      – SubjectFull: Scientists
        Type: general
      – SubjectFull: South Carolina
        Type: general
    Titles:
      – TitleFull: COVID-19 Vaccine Acceptance among College Students in South Carolina: Do Information Sources and Trust in Information Matter?
        Type: main
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    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Shan Qiao
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            NameFull: Daniela B. Friedman
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            NameFull: Cheuk Chi Tam
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            NameFull: Chengbo Zeng
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            NameFull: Xiaoming Li
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
            – Type: issn-electronic
              Value: 1940-3208
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              Value: 72
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              Value: 3
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            – TitleFull: Journal of American College Health
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