How urban versus rural residency relates to COVID-19 vaccine hesitancy: A large-scale national Chinese study.

RATIONALE: Although urban-rural residency has been shown to influence individual COVID-19 vaccine hesitancy, the differences between urban and rural China have yet to be uncovered. OBJECTIVE: This study aims to assess the current prevalence and factors associated with COVID-19 vaccine hesitancy in urban and rural areas and explore whether the rural versus urban residency is associated with COVID-19 vaccine hesitancy. METHODS: A national, cross-sectional, online survey among Chinese urban and rural adults (≥18 years old) was conducted from 6th to August 9, 2021. A questionnaire was used to collect data on sociodemographic factors, perceptions of the COVID-19 pandemic and vaccination status. A multivariable logistic regression model was used to identify the factors that influence COVID-19 vaccine hesitancy. Propensity score matching (PSM) analysis was performed to explore the association between urban versus rural residency and COVID-19 vaccine hesitancy. RESULTS: In total, 29,925 participants (80.56% urban participants) were recruited. Urban participants had a higher COVID-19 vaccine hesitancy than their rural counterparts (9.39% vs. 4.26%). After adjusting for potential confounders, we found that COVID-19 vaccine hesitancy among females was lower than that in males in both urban (aOR = 0.78, 95% CI [0.69-0.88]) and rural areas (aOR = 0.54, 95% CI [0.39-0.75]). The lack of trust towards vaccine producers was found to be associated with vaccine hesitancy among the urban participants (aOR = 2.76, 95% CI [2.22-3.43]). The rural floating population had a lower COVID-19 vaccine hesitancy than the rural permanent residents (aOR = 0.58, 95% CI [0.42-0.80]). PSM analysis revealed a 2.38% difference in COVID-19 vaccine hesitancy between urban and rural participants. CONCLUSIONS: Urban participants were more hesitant to receive the COVID-19 vaccine than rural participants. Priority should be placed on boosting confidence in the healthcare system to reduce COVID-19 vaccine hesitancy among urban residents. Furthermore, we advocate for extra incentives and vaccination education for rural permanent residents.

The association between lifestyle and COVID-19 vaccine hesitancy in China: A large-scale cross-sectional survey.

OBJECTIVE: To assess the association between lifestyle and COVID-19 vaccine hesitancy among Chinese adults and provide recommendations for increasing vaccination rates. METHODS: From August 6, 2021 to August 9, 2021, we recruited 29,925 participants from 31 Chinese provinces via an online questionnaire. We designed a question to assess COVID-19 vaccine hesitancy and used 16 items to assess lifestyle by calculating lifestyle scores. Odds ratios (OR) with 95 % confidence intervals (CI) were used to estimate the association by using binary logistic regression models. RESULTS: The overall prevalence of COVID-19 vaccine hesitancy was 8.40 % (95 % CI: 8.09-8.72), and the median lifestyle score was 65.00 (interquartile range: 59.00-71.00). After adjusting for potential confounders, the COVID-19 vaccine hesitancy rate decreased significantly with an increase in lifestyle score (P for Trend <0.001). Low COVID-19 vaccine hesitancy rate was associated with lifestyle factors including adequate sleep, never smoking, intermittent drinking, good relationships, working and studying, using hand sanitizer, wearing masks, less gathering activities, and keeping social distance (P < 0.05). CONCLUSION: Our findings indicate that high lifestyle score is associated with low vaccine hesitancy rate among Chinese. The government should view the smokers (or the drinkers) as the key to further boosting the vaccination rate. In addition, the publicity and education about wearing masks and keeping social distance should be prioritized.

Guardians' willingness to vaccinate their teenagers against COVID-19 in China: A national cross-sectional survey.

OBJECTIVE: To investigate Chinese guardians' willingness to vaccinate teenagers (WVT) against COVID-19, we conducted a national wide survey in 31 provinces in mainland China. METHODS: We involved 16133 guardians from 31 provinces in Chinese Mainland from August 6th to 9th, 2021. The question "Are you willing to vaccinate teenagers of COVID-19 vaccine?" was designed to capture WVT. Odds ratios (OR) with 95% Confidence Intervals (CI) for potential factors of WVT were estimated using multiple logistic regression models. RESULTS: In total, 13327 (82.61%) of the respondents expressed positive WVT, 12.90% of the respondents were uncertain but inclined to vaccinate their teenagers. Meanwhile, 3.89% of the respondents were uncertain and inclined to reject, and 0.60% of the respondents rejected the vaccines. After adjusting for potential confounders, the married, total family income last year, reject to Categoly1 vaccines, access information about the COVID-19 vaccines from community workers, low COVID-19 vaccine conspiracy, guardian's vaccination behavior, and the importance of vaccinating teenagers were all independent factors that affected the guardians' likely to accept. Further, the current study found that lower trust in doctors and vaccine developers was associated with negative WVT. The reasons for negative WVT included teenagers' young age and guardians' worries on the safety and effectiveness of COVID-19 vaccines. CONCLUSION: This large-scale study assessed Chinese guardians' WVT against COVID-19, as well as its potential influencing factors, which is useful for international and national decision-makers.

COVID-19 Vaccination Acceptance Among Chinese Population and Its Implications for the Pandemic: A National Cross-Sectional Study

Objective To examine the COVID-19 vaccination rate among a representative sample of adults from 31 provinces on the Chinese mainland and identify its influencing factors. Methods We gathered sociodemographic information, data on people's awareness and behavior regarding COVID-19 and the COVID-19 vaccine, the accessibility of COVID-19 vaccination services, community environmental factors influencing people's awareness and behavior regarding the vaccination, information about people's skepticism on COVID-19 vaccine, and information about people's trust in doctors as well as vaccine developers through an online nationwide cross-sectional survey among Chinese adults (18 years and older). The odds ratios (OR) and 95% confidence intervals (CI) for the statistical associations were estimated using logistic regression models. Results A total of 29,925 participants (51.4% females and 48.6% males) responded. 89.4% of the participants had already received a COVID-19 vaccination. After adjusting for demographic characteristics, awareness of COVID-19 pandemic/ COVID-19 vaccine, community environmental factors, awareness and behavior of general vaccinations, we discovered that having no religious affiliation, having the same occupational status as a result of coronavirus epidemic, being a non-smoker, always engaging in physical activity, having a lower social status, perceiving COVID-19 to be easily curable, and having easier access to vaccination are all associated with high vaccination rate (all P <0.05). Conclusions 31 provinces in mainland China currently have a relatively high rate of COVID-19 vaccination. To further increase the rate of COVID-19 vaccination, we must remove barriers associated with the community context and improve access to COVID-19 vaccine services. In addition, taking proactive and effective measures to address the reasons for non-vaccination with COVID-19 will aid in epidemic prevention and control.

COVID-19 Vaccine Hesitancy Among Chinese Population: A Large-Scale National Study.

Globally, vaccine hesitancy is a growing public health problem. It is detrimental to the consolidation of immunization program achievements and elimination of vaccine-targeted diseases. The objective of this study was to estimate the prevalence of COVID-19 vaccine hesitancy in China and explore its contributing factors. A national cross-sectional online survey among Chinese adults (≥18 years old) was conducted between August 6, 2021 and August 9 via a market research company. We collected sociodemographic information; lifestyle behavior; quality of life; the knowledge, awareness, and behavior of COVID-19; the knowledge, awareness, and behavior of COVID-19 vaccine; willingness of COVID-19 vaccination; accessibility of COVID-19 vaccination services; skepticism about COVID-19 and COVID-19 vaccine; doctor and vaccine developer scale; and so on. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the associations by using logistic regression models. A total of 29,925 residents (48.64% men) were enrolled in our study with mean age of 30.99 years. We found an overall prevalence of COVID-19 vaccine hesitancy at 8.40% (95% CI, 8.09-8.72) in primary vaccination and 8.39% (95% CI, 8.07-8.70) in booster vaccination. In addition, after adjusting for potential confounders, we found that women, higher educational level, married residents, higher score of health condition, never smoked, increased washing hands, increased wearing mask, increased social distance, lower level of vaccine conspiracy beliefs, disease risks outweigh vaccine risk, higher level of convenient vaccination, and higher level of trust in doctor and developer were more willing to vaccinate than all others (all p < 0.05). Age, sex, educational level, marital status, chronic disease condition, smoking, healthy behaviors, the curability of COVID-19, the channel of accessing information of COVID-19 vaccine, endorsement of vaccine conspiracy beliefs, weigh risks of vaccination against risks of the disease, making a positive influence on the health of others around you, and lower trust in healthcare system may affect the variation of willingness to take a COVID-19 vaccine (all p < 0.05). The prevalence of COVID-19 vaccine hesitancy was modest in China, even with the slight resulting cascade of changing vaccination rates between the primary and booster vaccination. Urgent action to address vaccine hesitancy is needed in building trust in medical personnel and vaccine producers, promoting the convenience of vaccination services, and spreading reliable information of COVID-19 vaccination via the Internet and other media.

Prevalence and risk factors of worry among teachers during the COVID-19 epidemic in Henan, China: a cross-sectional survey.

OBJECTIVE: To evaluate the level of worry and its influencing factors during the COVID-19 epidemic among teachers in Henan Province in China. STUDY DESIGN: A cross-sectional study was conducted. METHODS: We designed a cross-sectional survey that included 88 611 teachers from three cities in Henan Province, China between 4 February 2020 and 12 February 2020. Level of worry was measured using a five-item Likert scale, with 1 being 'not worried' and 5 being 'very worried'. The OR and 95% CI of potential influencing factors for level of worry among study participants were estimated using ordinal logistic regression models. RESULTS: About 59% of teachers reported being 'very worried' about the COVID-19 epidemic. The proportion of female teachers was higher than of male teachers (60.33% vs 52.89%). In all age groups considered in this study, a 'very worried' condition accounted for the highest proportion. The age group 40-49 years had the lowest proportion of participants who were very worried, 52.34% of whom were men and 58.62% were women. After controlling for potential confounding factors, age, education level, type of teacher, school location, attention level, fear level, anxiety level and behaviour status were all related to level of worry (all p<0.05). CONCLUSION: During the COVID-19 epidemic, there was a high proportion of teachers who were 'very worried' about the situation in Henan Province, China. Our study may remind policymakers to consider factors including age, educational status, type of teacher, school location, source of information on COVID-19, attention level, anxiety level, fear level and behaviour status to alleviate worry.

Effects of mask wearing on anxiety of teachers affected by COVID-19: A large cross-sectional study in China.

OBJECTIVE: There is a limited information on mask wearing in relation to anxiety. The aim of this study was to evaluate the association between mask wearing practice and the risk of anxiety during the COVID-19 epidemic among teachers in Henan province, China. METHODS: We enrolled 88,611 teachers in an online cross-sectional survey across three cities of Henan Province in China. A total of 94.75% of study participants completed an online questionnaire between February 4, 2020 and February 12, 2020. Mask wearing practice was defined according to its type, how it is worn, and the behavior exhibited in relation to wearing a mask. We used the Generalized Anxiety Disorder tool (GAD-7) to assess anxiety levels among study participants. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the association between mask wearing practice and anxiety by using multivariable logistic regression models. RESULTS: A total of 67,357 registered teachers (25.91% men) were included in this study. After adjusting for potential confounders, participants who knew the wrong type of mask had 17% increased odds of having anxiety compared to those who knew the proper type (Aor = 1.17; 95%CI: 1.11-1.24). Odds for anxiety were higher for teachers who did not know the proper way of wearing mask compared to those who knew it properly (aOR = 1.18; 95%CI: 1.07-1.30). Not adhering to proper behavior of mask wearing was associated with 39% increased odds for anxiety (aOR = 1.39; 95%CI: 1.18-1.64). The odds for anxiety for teachers who did not adhere to all the three parameters of proper mask wearing was about 2.55 times as much compared to those who reported full compliance to the parameters (aOR = 2.55; 95%CI: 1.22-5.35). We observed similar ORs on stratified analyses across gender and age groups. CONCLUSION: Our findings suggest that improper mask wearing is another important attribute that play a significant role in increasing the risk of anxiety during the COVID-19 epidemic situation. However, these results should be considered as exploratory and hence interpreted with caution.

Prevalence and factors for anxiety during the coronavirus disease 2019 (COVID-19) epidemic among the teachers in China.

OBJECTIVE: To assess the prevalence of anxiety and explore its factors during the Coronavirus Disease 2019 (COVID-19) epidemic among the teachers in China. METHODS: We involved 88611 teachers (response rate: 94.75%) from three cities of Henan Province, China, during February 4, 2020 and February 12, 2020. Anxiety was assessed by using Generalized Anxiety Disorder tool (GAD-7). Odds ratios (OR) with 95% Confidence intervals (CI) for potential factors of anxiety were estimated using multiple logistic regression models. RESULTS: The overall prevalence of anxiety was 13.67%. The prevalence was higher for women than men (13.89% vs. 12.93%). The highest prevalence of anxiety was 14.06% (SE 2.51%) with age of 60 to 100 years in men, and 14.70% (SE 0.56%) with age of 50 to 60 years in women. Participants located in country-level city school had the lowest prevalence of anxiety across all age categories (12.01% for age of 18-30 years; 12.50% for age of 30-40 years; 12.13% for age of 40-50 years; 9.52% for age of 60-100 years). After adjusting for potential confounders, age, sex, education status, type of teachers, school location, information source, worried level, fear level, and behavior status were found to be associated with anxiety. CONCLUSIONS: This large-scale study assessed the prevalence of anxiety in teachers, as well as its potential influence of factors, which is useful for international and national decision-makers.