ABSTRACT
Purpose Disparities in youth COVID-19 vaccine acceptance and uptake have been documented in several countries, yet few studies have explored the attitudes and perceptions underlying vaccine-related decision-making among adolescent populations with unique socio-cultural, environmental, and/or structural contexts that may influence vaccine uptake. Methods This study used data from surveys and semi-structured interviews collected between January and March 2022 as part of an ongoing community-based research project in two ethnoculturally diverse, lower-income neighbourhoods of Montreal, Canada. Youth researchers designed and conducted interviews with unvaccinated adolescents and thematic analysis was employed to explore attitudes and perceptions underlying vaccine-related decisions and opinions about vaccine passports. Survey data were used to describe sociodemographic and psychological determinants of COVID-19 vaccination. Results Among 315 survey participants aged 14-17 years, most (74%) were fully vaccinated against COVID-19. Prevalence ranged from 57% among Black adolescents to 91% among South and/or Southeast Asian adolescents (34% difference, 95% CI: 20-49). Qualitative and quantitative findings highlighted several misconceptions about the safety, effectiveness, and necessity of COVID-19 vaccines and adolescents' desire for trusted sources of information to address their concerns. Vaccine passports likely increased uptake;yet adolescents were strongly resistant to the policy, and, for some, it may have fuelled distrust of government and scientific institutions. Conclusion Strategies that increase the trustworthiness of institutions and foster genuine partnership with underserved youth may improve vaccine confidence and help ensure an effective, pro-equity recovery from COVID-19.