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Longitudinal Trends in Perceptions of COVID-19, Vaccination, and Barriers to COVID-19 Vaccination among College Students

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Title: Longitudinal Trends in Perceptions of COVID-19, Vaccination, and Barriers to COVID-19 Vaccination among College Students
Language: English
Authors: Matthew Lovesky, Laura Merrell (ORCID 0000-0003-0226-6454), Suzanne Grossman, Dayna Henry
Source: Journal of American College Health. 2025 73(4):1681-1686.
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: 6
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: COVID-19, Pandemics, Immunization Programs, Student Attitudes, College Students, Barriers, Communicable Diseases, Safety, Health, Age, Risk, Attitude Change, Health Behavior
DOI: 10.1080/07448481.2024.2361324
ISSN: 0744-8481
1940-3208
Abstract: Objective: To assess changes in perceptions of COVID-19 worry and perceived severity, changes in COVID-19 vaccination status, and barriers to COVID-19 vaccination among college students. Participants: 2,252 participants were recruited from a personal wellness course across four academic semesters at a large public university. Methods: Participants completed an anonymous online survey. Changes between groups were analyzed to capture changing perceptions and behaviors related to COVID-19. Results: COVID-19 related worry, perceived severity, and vaccination against COVID-19 significantly decreased over time. However, flu vaccination status did not decrease. The top three cited reasons for vaccination hesitation were concerns about side effects, being healthy and young, and at low risk for getting infected. Conclusion: Given the likely endemic nature of COVID-19, it is important for universities to continue to provide health education regarding transmission prevention, promote COVID-19 vaccination, and reduce myths regarding side-effects and risk perception.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1472880
Database: ERIC
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  Value: <anid>AN0184444285;acl01apr.25;2025Apr15.05:17;v2.2.500</anid> <title id="AN0184444285-1">Longitudinal trends in perceptions of COVID-19, vaccination, and barriers to COVID-19 vaccination among college students </title> <p>Objective: To assess changes in perceptions of COVID-19 worry and perceived severity, changes in COVID-19 vaccination status, and barriers to COVID-19 vaccination among college students. Participants: 2,252 participants were recruited from a personal wellness course across four academic semesters at a large public university. Methods: Participants completed an anonymous online survey. Changes between groups were analyzed to capture changing perceptions and behaviors related to COVID-19. Results: COVID-19 related worry, perceived severity, and vaccination against COVID-19 significantly decreased over time. However, flu vaccination status did not decrease. The top three cited reasons for vaccination hesitation were concerns about side effects, being healthy and young, and at low risk for getting infected. Conclusion: Given the likely endemic nature of COVID-19, it is important for universities to continue to provide health education regarding transmission prevention, promote COVID-19 vaccination, and reduce myths regarding side-effects and risk perception.</p> <p>Keywords: COVID-19; college students; prevention; vaccine hesitancy; vaccination status</p> <hd id="AN0184444285-2">Introduction</hd> <p>In March 2020, a federal state of emergency was declared in response to the growing COVID-19 pandemic.[<reflink idref="bib1" id="ref1">1</reflink>] As a result, most states instituted stay-at-home orders and enacted transmission reduction policies that limited the type and size of gatherings, implemented physical distancing, and required indoor masking measures. Additionally, most higher edu-cation institutions ceased in-person instruction for the remainder of the 2019–2020 academic year and moved instruction online. As COVID-19 case-counts increased and the virus continued to spread throughout the spring and summer of 2020, colleges and universities were forced to decide how they would return to instruction in the fall of 2020 and what COVID-19 prevention measures would be put into place. For the remainder of the semester, most U.S. colleges and universities implemented online or hybrid learning and a variety of transmission mitigation efforts such as social distancing, masking, surveillance testing, and quarantining.[<reflink idref="bib2" id="ref2">2</reflink>]<sups>,</sups>[<reflink idref="bib3" id="ref3">3</reflink>]</p> <p>Despite these efforts, in the first weeks of the fall 2020 semester, there was a surge of COVID-19 cases on many college and university campuses.[<reflink idref="bib4" id="ref4">4</reflink>] Several COVID-19 vaccines were developed and made available in December 2020, prioritizing distribution to those with high risk factors and first-responder status. After these vaccines became widely available to the public in spring and summer of 2021, many institutions of higher education required proof of COVID-19 vaccination for the return to in-person learning in fall 2021, with few exemptions.[<reflink idref="bib5" id="ref5">5</reflink>] Given the heightened political and social discourse around COVID-19 vaccination, these decisions were met with controversy and resistance. Mask mandates were lifted in most universities by spring 2022, and since then, prevention measures (such as masking, limits on the size of gatherings, and vaccination requirements) for COVID-19 have been relaxed or mitigated in both university and non-university settings.</p> <p>COVID-19 vaccination has been found to significantly lower the risk of severe illness, hospitalization, and death.[<reflink idref="bib6" id="ref6">6</reflink>] People ages 5-64 are considered up to date with their COVID-19 vaccine regimen if they have received at least one updated COVID-19 vaccine for the general population, with an additional updated dose of the vaccine at least 2 months later for those who are moderately or severely immunocompromised.[<reflink idref="bib7" id="ref7">7</reflink>] Despite the known benefits of vaccination, as of April 29, 2023, just over 80% of the U.S. adult population has received at least one COVID-19 vaccine, while only 17% of adults over the age of 18 has received an updated booster dose.[<reflink idref="bib8" id="ref8">8</reflink>] A national survey of college students in 2022 found they had a slightly higher vaccine uptake than the general population, with approximately 82% being fully vaccinated, and 3% being partially vaccinated.[<reflink idref="bib9" id="ref9">9</reflink>]</p> <p>While it is important for U.S. adults to maintain vaccination status to prevent future outbreaks and to protect those who are immunocompromised; it is especially important for young adults. As they start to make their own health-related decisions, it is crucial to also understand how vaccination prevents/reduces symptomatic illness and the importance of becoming vaccinated for all vaccine preventable illnesses. Therefore, with the decrease but not eradication of COVID-19 cases, COVID-19 vaccination and transmission mitigation efforts are likely to continue within higher education institutions and may be expanded to any future vaccine efforts. To support health education and promotion efforts among student populations, the aim of this research study was to explore the changing landscape of perceptions of COVID-19 infection and COVID-19 vaccination at one large, public university, in the mid-Atlantic region.</p> <p>This study sought to answer the following research questions:</p> <p></p> <ulist> <item> How have perceptions of COVID-19 changed in college students over time?</item> <p></p> <item> How has COVID-19 vaccination status changed in college students over time?</item> <p></p> <item> What barriers to COVID-19 vaccination are most salient among college students?</item> </ulist> <hd id="AN0184444285-3">Materials and methods</hd> <p>Data for this study were collected anonymously online <emph>via</emph> Qualtrics software, as part of a larger study of college student health at a large mid-Atlantic university with an undergraduate population of approximately 20,000 students. The original 100-item survey was developed by principal investigators to capture a broad spectrum of health-related behaviors. After receiving IRB approval (IRB #21-2204), the original survey was pilot tested in the 2018-2019 academic year, after which the survey was revised. COVID-19 related questions were added to the survey in August 2021 as in-person instruction resumed after online instruction from March 2020 through August 2021.</p> <p>Data collection for the current study took place across four collection waves in fall and spring semesters from fall 2021 to spring 2023. In each wave of data collection, the survey was administered to students enrolled in an introductory-level personal wellness course, which is one of two course options to fulfill the general education personal wellness requirement. Since most students opt (65%) to take this personal wellness class to fulfill the requirement, this represented a practical strategy to obtain a representative sample of the student population at the institution. Students were given the option to take the survey for extra credit or opt to complete an alternative assignment for the same credit. Approximately 40% of students opted to take the survey for extra credit. Course instructors had no access to student data; student identity for receiving credit was separate from their survey answers, reducing the impact of coercion on participant answers. Each wave of data collection was made up of new students in the personal wellness class, therefore we were able to identify changing trends among cohorts of college students.</p> <hd id="AN0184444285-4">Measures</hd> <p>The current study utilized four demographic questions (age, sex assigned at birth, race/ethnicity, and academic year), seven items measuring perceptions of COVID-19 (which included COVID-19 related worry as well as perceived COVID-19 severity), two items that captured vaccination status, and 11 items that captured barriers to COVID-19 vaccination.</p> <p>COVID-19 related worry was measured using Head et al.'s[<reflink idref="bib10" id="ref10">10</reflink>] three-item, five-point Likert-type scale. The three items were "the possibility of getting infected in the future with COVID concerns me", "I am scared about getting infected with COVID-19", and "I don't really worry about getting infected with COVID-19", where 1 = strongly disagree and 5 = strongly agree. The third item was reverse-coded, and the three items were averaged together to create a COVID-19 related worry score for each participant, where higher scores are associated with higher COVID-19 related worry (Cronbach's Alpha =.89).</p> <p>Perceived COVID-19 severity was adapted from Head et al.'s[<reflink idref="bib10" id="ref11">10</reflink>] four-item, five-point Likert-type scale. Items included "I am afraid that I may get seriously ill or die if I contract COVID-19"; "If I contract COVID-19, I could pass it to my family and friends who may get seriously ill or die"; "I am at greater risk of serious illness/death if I contract COVID-19 because of my general health/pre-existing conditions", where 1= strongly disagree and 5 = strongly agree. The final item stated, "If you got infected with COVID-19, how threatening would it be to your physical health?" where 1 = not at all and 5 = extremely. All items were averaged to create a perceived severity score for each participant, where higher scores indicated higher perceived COVID-19 severity (Cronbach's Alpha =.73).</p> <p>Perceived barriers to COVID-19 vaccination were adopted from Ruiz and Bell[<reflink idref="bib11" id="ref12">11</reflink>]. Participants chose any/all of ten statements that applied to them, including "The vaccine might have dangerous side effects", "I might be allergic to the vaccine", "the vaccine probably would not work", "I prefer developing immunity through infection", "I am healthy and at low risk for infection", "I hate needles and injections", "I am already immune from a past COVID-19 infection", "I am young and at a low risk for infection", "If I got infected I would not become seriously ill", and "I am/was not hesitant" (Cronbach's Alpha =.70).</p> <p>Descriptive statistics for the survey items were conducted. Frequencies and percents were reported for demographics and vaccine barrier variables, while means and standard deviations were calculated for the COVID-19 perception measures of worry and perceived severity. To address research question 1, a one-way between subject's ANOVA was run for both COVID-19 Perception dependent measures (worry and severity) across the four different collection waves. Due to the failed assumption of homogeneity of variance, Welch's statistic was interpreted as a robust alternative to F. A Chi-square test for independence was used to determine whether COVID-19 vaccination status was related to collection wave to answer research question 2. Post-hoc analyses consisted of z-tests with Bonferroni adjusted p-values to account for multiple (<reflink idref="bib8" id="ref13">8</reflink>) comparisons. Further, we also examined how flu vaccination intention has changed across cohorts, as there has been some support for spillover effects of COVID-19 vaccine hesitancy on flu vaccine uptake.[<reflink idref="bib12" id="ref14">12</reflink>] To address research question 3, frequencies and percents were analyzed to order the top barriers to vaccination for college students. All descriptive and inferential analyses were run using SPSS version 28, and statistical significance was set at an alpha of.05.[<reflink idref="bib13" id="ref15">13</reflink>]</p> <hd id="AN0184444285-5">Results</hd> <p>A total of 2,252 participants completed surveys across all data collection waves. See Table 1 for participant demographics. On average, participants were white and female (reflective of the university as a whole), 18.96 years old, and a first-year student. Demographics were further broken down by collection wave, and it was observed that the proportions of each demographic remained stable across collection waves. The mean COVID-19 related worry composite score was 2.76 out of 5, with a range of 1-5 and SD of 1.1. The mean for perceived COVID-19 severity was 2.46 out of 5, with a range of 1-5 and a SD of.76.</p> <p>Table 1. Demographic characteristics of the sample (<emph>N</emph> = 2252).</p> <p> <ephtml> <table><thead><tr><td>Characteristic</td><td>N</td><td>(%)</td></tr></thead><tbody valign="top"><tr><td>Sex</td><td /><td /></tr><tr><td> Female</td><td char=".">1551</td><td char=".">68.9</td></tr><tr><td> Male</td><td char=".">697</td><td char=".">31</td></tr><tr><td> Other</td><td char=".">2</td><td char=".">0.1</td></tr><tr><td>Race/Ethnicity</td><td /><td /></tr><tr><td> American Indian or Alaska Native</td><td char=".">25</td><td char=".">1.1</td></tr><tr><td> Asian</td><td char=".">196</td><td char=".">8.6</td></tr><tr><td> Black or African American</td><td char=".">143</td><td char=".">6.3</td></tr><tr><td> Hispanic or Latino</td><td char=".">183</td><td char=".">8.1</td></tr><tr><td> Native Hawaiian or Other Pacific Islander</td><td char=".">16</td><td char=".">0.7</td></tr><tr><td> White</td><td char=".">1895</td><td char=".">83.7</td></tr><tr><td> Other</td><td char=".">62</td><td char=".">2.7</td></tr><tr><td> More than one race</td><td char=".">84</td><td char=".">3.7</td></tr><tr><td> Prefer not to answer</td><td char=".">29</td><td char=".">1.3</td></tr><tr><td>Academic Year</td><td /><td /></tr><tr><td> First Year</td><td char=".">1256</td><td char=".">55.8</td></tr><tr><td> Second Year</td><td char=".">754</td><td char=".">33.5</td></tr><tr><td> Third Year</td><td char=".">197</td><td char=".">8.8</td></tr><tr><td> Fourth Year</td><td char=".">42</td><td char=".">1.9</td></tr><tr><td>Age</td><td /><td /></tr><tr><td> 18</td><td char=".">850</td><td char=".">37.9</td></tr><tr><td> 19</td><td char=".">967</td><td char=".">43.1</td></tr><tr><td> 20</td><td char=".">292</td><td char=".">13</td></tr><tr><td> 21</td><td char=".">83</td><td char=".">3.7</td></tr><tr><td> 22+</td><td char=".">52</td><td char=".">2.2</td></tr><tr><td>I regularly get the flu vaccine</td><td /><td /></tr><tr><td> Yes</td><td char=".">1278</td><td char=".">58.5</td></tr><tr><td> No</td><td char=".">906</td><td char=".">41.5</td></tr><tr><td>Have you received the COVID-19 vaccine?</td><td /><td /></tr><tr><td> Yes</td><td char=".">2049</td><td char=".">91.1</td></tr><tr><td> No</td><td char=".">199</td><td char=".">8.9</td></tr></tbody></table> </ephtml> </p> <hd id="AN0184444285-6">Research question 1: How have perceptions of COVID-19 changed in college students over time?</hd> <p>An analysis of variance showed there was a significant effect of collection wave on the dependent measure of COVID-19 related worry, F(<reflink idref="bib3" id="ref16">3</reflink>, 2238) =32.0, <emph>p</emph> <.001. As the assumption of homogeneity of variance was not met, Welch's statistic was interpreted and reported as a robust alternative to F. Despite statistical significance, the strength of the relationship between collection wave and COVID-19 related worry was small (ɳ<sups>2</sups> =.04). Follow-up tests were conducted on the significant model to evaluate pairwise differences in means between collection waves. Significant relationships were found between the fall 2021 (wave 1) data collection and all subsequent collections (waves 2-4), however there were no significant pairwise comparisons between any of the collection periods after fall 2021 (waves 2-4). See Table 2 for COVID-19 Related Worry descriptive statistics and Figure 1 for a visual of the means and 95% confidence intervals.</p> <p>PHOTO (COLOR): Figure 1. Means and 95% confidence intervals for COVID19 related worry.</p> <p>Table 2. Descriptive statistics for COVID-19 related worry.</p> <p> <ephtml> <table><thead><tr><td /><td>N</td><td>Mean</td><td>SD</td></tr></thead><tbody valign="top"><tr><td>Fall 2021</td><td char=".">819</td><td char=".">3.05</td><td char=".">1.01</td></tr><tr><td>Spring 2022</td><td char=".">589</td><td char=".">2.59</td><td char=".">1.1</td></tr><tr><td>Fall 2022</td><td char=".">554</td><td char=".">2.6</td><td char=".">1.1</td></tr><tr><td>Spring 2023</td><td char=".">280</td><td char=".">2.5</td><td char=".">0.98</td></tr></tbody></table> </ephtml> </p> <p>Perceived COVID-19 severity was also significant, F(<reflink idref="bib3" id="ref17">3</reflink>,2234) =23.08, <emph>p</emph> <.001. However, the strength of the relationship between collection wave and perceived COVID-19 severity was small (ɳ<sups>2</sups> =.03). Once again, significant relationships were found between the fall 2021 (wave 1) data collection and all subsequent collections (<reflink idref="bib2" id="ref18">2-4</reflink>), however there were no significant pairwise comparisons between any of the collection periods after fall 2021 (waves 2-4). See Table 3 for COVID-19 Perceived Severity descriptive statistics and Figure 2 for a visual of the means and 95% confidence intervals.</p> <p>PHOTO (COLOR): Figure 2. Means and 95% confidence intervals for COVID19 perceived severity.</p> <p>Table 3. Descriptive statistics for perceived COVID-19 severity.</p> <p> <ephtml> <table><thead><tr><td /><td>N</td><td>Mean</td><td>SD</td></tr></thead><tbody valign="top"><tr><td>Fall 2021</td><td char=".">820</td><td char=".">2.63</td><td char=".">0.77</td></tr><tr><td>Spring 2022</td><td char=".">586</td><td char=".">2.35</td><td char=".">0.78</td></tr><tr><td>Fall 2022</td><td char=".">553</td><td char=".">2.37</td><td char=".">0.71</td></tr><tr><td>Spring 2023</td><td char=".">279</td><td char=".">2.35</td><td char=".">0.71</td></tr></tbody></table> </ephtml> </p> <hd id="AN0184444285-7">Research question 2: How has COVID-19 vaccination status changed in college students over tim...</hd> <p>To evaluate whether there was a relationship between collection wave and COVID-19 vaccination status, a Chi-square test of independence was run. Overall, when asked "Have you received the COVID-19 vaccine?", 91.4% answered "yes" in fall 2021, 94.2% answered "yes" in Spring 2022, (89.7%) said "yes" in fall 2022, and 86.8% said "yes" in spring 2023. Results of the test showed support for a significant relationship between collection wave and vaccination against COVID-19, X<sups>2</sups>(<reflink idref="bib3" id="ref19">3</reflink>,2248) =15.02, <emph>p</emph> <.05. Post-hoc comparisons revealed that students in the spring 2022 semester had a significantly greater proportion of students with the COVID-19 vaccination (94.2% vs. 86.8-91.4%) than other semesters (<emph>p</emph> =.002). A second Chi-square test for independence was run for the question that asked if you "regularly (yearly) get the flu vaccine?". The Chi-square failed to demonstrate a significant relationship between the collection period and flu vaccine intent, X<sups>2</sups> (<reflink idref="bib3" id="ref20">3</reflink>, 2184) =6.82, <emph>p</emph> =.078, where 60.8% answered "yes" in fall 2021, 60.4% answered "yes" in spring 2022, 55.2% said "yes" in fall 2022, and 54.3% said "yes" in spring 2023.</p> <hd id="AN0184444285-8">Research question 3: What barriers to vaccination are most salient with college students?</hd> <p>Frequencies and relative percents were calculated to determine which barriers to vaccination were most salient among the students. The most common reported reason for hesitancy was 'potentially dangerous side effects' followed by 'low perceived risk for COVID-19 infection'. Table 4 lists the reasons for vaccine hesitancy in descending order of magnitude based on weighted frequencies. It should be noted that many participants (<emph>n</emph> = 1344/59.4%) chose "I am/was not hesitant", with many also checking "I am/was not hesitant" in addition to choosing one or more of the other barriers. With that, the decision was made to exclude those who checked "I am/was not hesitant" from the table below to get a more accurate picture of barriers for those who were self-described as hesitant. Frequencies were also run with the those who checked "I am/was not hesitant" and the barriers to vaccination reported remained in the same order of importance.</p> <p>Table 4. Number and percent of responses when asked "if you were/are hesitant to get the COVID-19 vaccine, what were the reasons?" (<emph>N</emph> = 919).</p> <p> <ephtml> <table><thead><tr><td /><td>Fall 21</td><td>Spring 22</td><td>Fall 22</td><td>Spring 23</td></tr></thead><tbody valign="top"><tr><td>The vaccine might have dangerous side effects</td><td char=".">229 (70.9%)</td><td char=".">145 (67.5%)</td><td char=".">158 (62.9%)</td><td char=".">75 (63.0%)</td></tr><tr><td>I am healthy and at low risk for infection</td><td char=".">159 (49.2%)</td><td char=".">107 (49.8%)</td><td char=".">115 (45.8%)</td><td char=".">52 (43.7%)</td></tr><tr><td>I am young and at low risk for infection</td><td char=".">161 (49.8%)</td><td char=".">106 (49.3%)</td><td char=".">95 (37.8%)</td><td char=".">46 (38.7%)</td></tr><tr><td>If I got infected, I would not become seriously ill</td><td char=".">113 (35.0%)</td><td char=".">90 (41.9%)</td><td char=".">76 (30.3%)</td><td char=".">25 (21.0%)</td></tr><tr><td>I prefer to develop immunity through infection</td><td char=".">84 (26.0%)</td><td char=".">63 (29.3%)</td><td char=".">68 (27.0%)</td><td char=".">28 (23.5%)</td></tr><tr><td>the vaccine probably wouldn't work</td><td char=".">73 (22.6%)</td><td char=".">59 (27.4%)</td><td char=".">76 (30.3%)</td><td char=".">25 (21.0%)</td></tr><tr><td>I hate needles and injections</td><td char=".">75 (23.2%)</td><td char=".">43 (20.0%)</td><td char=".">60 (23.9%)</td><td char=".">27 (22.7%)</td></tr><tr><td>I am already immune from past COVID-19 infection</td><td char=".">72 (22.3%)</td><td char=".">34 (15.8%)</td><td char=".">48 (19.1%)</td><td char=".">20 (16.8%)</td></tr><tr><td>I might be allergic to the vaccine</td><td char=".">47 (14.6%)</td><td char=".">39 (18.1%)</td><td char=".">33 (13.1%)</td><td char=".">14 (11.8%)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0184444285-9">Discussion</hd> <p>The purpose of this study was to understand how perceptions of the COVID-19 vaccine, COVID-19 vaccine status, and barriers to COVID-19 vaccination have changed over time among college students. Results from this study contribute to existing research related to COVID-19 vaccine uptake and vaccine hesitancy in this population. These findings are consistent with existing research on the topic and reflect trends in laws and requirements related to COVID-19 vaccination at the university, state, and national levels.</p> <p>The first research question looked at changes in perceptions of COVID-19 over time among college students. During the first wave of data collection in fall 2021, there were lower hospitalizations and deaths in the local and general population than in the second data collection wave in spring 2022.[[<reflink idref="bib14" id="ref21">14</reflink>], [<reflink idref="bib16" id="ref22">16</reflink>]] However, COVID-19 related worry and perceived severity were higher during the first collection than in subsequent data collection times. There are several hypotheses which could explain this. First, participants may have experienced mild or moderate COVID infection and recovered without significant long-term negative health effects, thus they may have decreased perceived risk related to COVID-19 infection. Further, there was much more uncertainty about the in-person meetings during the first collection wave. The first collection period (fall 2021) occurred over a year after the initial lockdown, and after two semesters of failed attempts at a return to in-person learning. The fall 2021 semester was the first semester where students were largely back on campus and fully attending in-person classes, which was accompanied with uncertainty and worry of the unknown. Additionally, the difference could also be explained by health communication messages spread across the different time periods. For example, in fall 2021, masks were still required at the university and there was concern and fear about contracting the virus. During and after spring 2022, as COVID-19 precautions were lifted and as students became more accustomed to being back in the classroom and on campus, this worry was lower.</p> <p>The second research question in this study looked at changes in vaccine status among college students over time. Our findings reflected that the vaccination level was highest among students in the first collection periods and then got lower with time. Once again, there are several hypotheses which could explain this drop in vaccination rates. First, the vaccination rate was highest when the university had a vaccine requirement for enrollment in in-person classes and living in on-campus housing. When the vaccine requirement policy was lifted, vaccine uptake went down. Further, students may have experienced pandemic fatigue, which has been described as "distress that can result in demotivation to follow the recommended protective behaviors, emerging gradually over time and being affected by a few emotions, experiences, and perceptions".[<reflink idref="bib17" id="ref23">17</reflink>] As students experienced more exposure to infection and illness, and as their perceptions shifted around COVID, their adherence to public health measures such as vaccination, decreased. Additionally, although there wasn't a statistical relationship between collection period and intent to vaccinate against the flu, intent fell from roughly 60% in the first two collection periods to about 55% in the latter collection periods. This downward trend echoes what has been observed in flu vaccination coverage overall among children and adults since the pandemic, and merits more observation.[<reflink idref="bib18" id="ref24">18</reflink>]<sups>,</sups>[<reflink idref="bib19" id="ref25">19</reflink>]</p> <p>The third research question looked at barriers to the COVID-19 vaccine among students who reported hesitancy. Throughout all waves of data collection, reasons for vaccine hesitancy remained relatively consistent. The main concern among students was adverse side effects of the vaccine. According to the literature, the rapid speed at which the vaccine was perceived to have been developed, was a leading cause for concern about adverse side effects.[<reflink idref="bib20" id="ref26">20</reflink>] Future health communication in university settings should consider how messages, supported by scientific evidence, can be tailored to vaccine hesitant students to address vaccine hesitancy. Previous research has found that those who are vaccine hesitant may seek out information online that supports, rather than counters, their concerns.[<reflink idref="bib21" id="ref27">21</reflink>] Therefore, it is important to help students who are vaccine hesitant to trust and seek out reliable sources of information about vaccine safety. Promoting effective health information seeking among reliable sources of health information and combatting disinformation on college campuses and among the general population are essential to demonstrate that the vaccine is safe. As mRNA vaccines are reported to be an increasingly utilized technology for future vaccines, it is important for these messages to be spread to ensure high vaccination for COVID-19 as well as other diseases that use this technology.</p> <p>The second, third, and fourth reasons noted by participants for being concerned about getting the vaccine related to being young, healthy, and not concerned about serious infection if they contracted COVID-19. Previous research has found that college students who believed they were at low risk for infection were less likely to be vaccinated for COVID-19.[<reflink idref="bib22" id="ref28">22</reflink>] Thus it is important for college students, as well as the general population, to understand that being young and healthy are not reasons to not get vaccinated. While some messaging in the news and other outlets related to herd immunity and protecting more vulnerable populations through immunizations occurred during the COVID-19 pandemic, it is important to continue to spread these messages.[[<reflink idref="bib23" id="ref29">23</reflink>], [<reflink idref="bib25" id="ref30">25</reflink>]] In addition to messaging around societal and personal health benefits to vaccination, future messaging efforts could also discuss the ease of vaccination compared to other mitigation practices such as masking or having to miss classes due to illness or isolation.</p> <hd id="AN0184444285-10">Limitations</hd> <p>While this study has several strengths, including using longitudinal data collected over two years, having a large sample size, and being representative of the large institution where it was conducted, there are some limitations. First, the findings from this study are not representative of the general college student population outside of this single institution. Additionally, the items analyzed in this study were forced-choice, which did not leave room for students to provide additional explanation of their responses. Therefore, some student reasons for vaccine hesitancy may not have been captured. As policy changes at the university, local, state, and federal levels happened so quickly, we were unable to account for changing language and policies related to COVID-19. We were also not able to causally connect these policies with student responses in the survey. Finally, while we tried to clearly describe in the survey instructions that responses were anonymous and could not be connected to individual students, it is possible that students responded in a way they perceived to be socially desirable to their instructor and within their peer group. As these items were pulled from a larger survey with questions about other health behaviors, students did not know what would be asked, nor could they have predicted the research questions for this study.</p> <hd id="AN0184444285-11">Conclusion</hd> <p>This study found that student levels of COVID-19 vaccination were highest when vaccination was required for a return to in-person learning and reduced over time as requirements lifted. Further, the main concerns students identified about COVID-19 vaccination were related to side effects from the vaccine and those related to being young, healthy, and at low risk for severe outcomes from COVID-19. While cases of COVID-19 have reduced in recent months and there seems to be less risk of the disease, it is important for messages about COVID-19 and COVID-19 vaccination to continue to be spread in the general population and tailored to college students. Future research should consider different platforms (e.g., flyers, social media) to spread these messages as well as the content of these messages (e.g., social desirability of COVID-19 vaccination, convenience of vaccination, personal benefits, risks of long COVID-19) among college students to identify effective health communication campaigns to continue to keep cases of COVID-19 low and vaccination rates for the disease high within the population.</p> <hd id="AN0184444285-12">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 the United States and received approval from the Institutional Review Board at James Madison University (IRB # 21-2204).</p> <ref id="AN0184444285-13"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Centers for Disease Control and Prevention. CDC museum COVID-19 timeline. https://<ulink href="http://www.cdc.gov/museum/timeline/covid19.html">www.cdc.gov/museum/timeline/covid19.html</ulink>. Published March 15, 2023. Accessed August 2, 2023.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Elias J, Troop D, Wescott D. Here's our list of colleges' reopening models. Chronicle of Higher Education. 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  Data: Longitudinal Trends in Perceptions of COVID-19, Vaccination, and Barriers to COVID-19 Vaccination among College Students
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22Matthew+Lovesky%22">Matthew Lovesky</searchLink><br /><searchLink fieldCode="AR" term="%22Laura+Merrell%22">Laura Merrell</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0226-6454">0000-0003-0226-6454</externalLink>)<br /><searchLink fieldCode="AR" term="%22Suzanne+Grossman%22">Suzanne Grossman</searchLink><br /><searchLink fieldCode="AR" term="%22Dayna+Henry%22">Dayna Henry</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2025 73(4):1681-1686.
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  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
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  Data: 6
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  Data: 2025
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  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="%22Immunization+Programs%22">Immunization Programs</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="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Communicable+Diseases%22">Communicable Diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Safety%22">Safety</searchLink><br /><searchLink fieldCode="DE" term="%22Health%22">Health</searchLink><br /><searchLink fieldCode="DE" term="%22Age%22">Age</searchLink><br /><searchLink fieldCode="DE" term="%22Risk%22">Risk</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+Change%22">Attitude Change</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink>
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  Data: 10.1080/07448481.2024.2361324
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  Data: 0744-8481<br />1940-3208
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  Label: Abstract
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  Data: Objective: To assess changes in perceptions of COVID-19 worry and perceived severity, changes in COVID-19 vaccination status, and barriers to COVID-19 vaccination among college students. Participants: 2,252 participants were recruited from a personal wellness course across four academic semesters at a large public university. Methods: Participants completed an anonymous online survey. Changes between groups were analyzed to capture changing perceptions and behaviors related to COVID-19. Results: COVID-19 related worry, perceived severity, and vaccination against COVID-19 significantly decreased over time. However, flu vaccination status did not decrease. The top three cited reasons for vaccination hesitation were concerns about side effects, being healthy and young, and at low risk for getting infected. Conclusion: Given the likely endemic nature of COVID-19, it is important for universities to continue to provide health education regarding transmission prevention, promote COVID-19 vaccination, and reduce myths regarding side-effects and risk perception.
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  Data: EJ1472880
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        PageCount: 6
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      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: Pandemics
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      – SubjectFull: Immunization Programs
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      – SubjectFull: Student Attitudes
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      – SubjectFull: Attitude Change
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      – SubjectFull: Health Behavior
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      – TitleFull: Longitudinal Trends in Perceptions of COVID-19, Vaccination, and Barriers to COVID-19 Vaccination among College Students
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