Trust and COVID-19 vaccine hesitancy.

This article uses novel data collected on a weekly basis covering more than 35,000 individuals in the EU to analyze the relationship between trust in various dimensions and COVID-19 vaccine hesitancy. We found that trust in science is negatively correlated, while trust in social media and the use of social media as the main source of information are positively associated with vaccine hesitancy. High trust in social media is found among adults aged 65+, financially distressed and unemployed individuals, and hesitancy is largely explained by conspiracy beliefs among them. Finally, we found that the temporary suspension of the AstraZeneca vaccine in March 2021 significantly increased vaccine hesitancy and especially among people with low trust in science, living in rural areas, females, and financially distressed. Our findings suggest that trust is a key determinant of vaccine hesitancy and that pro-vaccine campaigns could be successfully targeted toward groups at high risk of hesitancy.

Public trust is earned: Historical discrimination, carceral violence, and the COVID-19 pandemic.

OBJECTIVE: To assess whether knowledge of Tuskegee, the U.S. Immigration and Customs Enforcement (ICE) agency's detainment of children, and satisfaction with the George Floyd death investigation were associated with trust in actors involved in the development and distribution of coronavirus vaccines. DATA SOURCES AND STUDY SETTING: National survey with a convenience sample of Black (n = 1019) and Hispanic (n = 994) adults between July 1 and 26, 2021. STUDY DESIGN: Observational study using stratified adjusted logistic regression models to measure the association between ratings of the trustworthiness of actors involved in the development and distribution of coronavirus vaccines. PRINCIPAL FINDINGS: Among Black respondents, lower satisfaction with the George Floyd death investigation was associated with lower trustworthiness ratings of pharmaceutical companies (ME: -0.09; CI: -0.15, 0.02), the FDA (ME: -0.07; CI: -0.14, -0.00), the Trump Administration (ME: -0.09; CI: -0.16, -0.02), the Biden Administration (ME: -0.07, CI: -0.10, 0.04), and elected officials (ME: -0.10, CI: -0.18, -0.03). Among Hispanic respondents, lower satisfaction was associated with lower trustworthiness ratings of the Trump Administration (ME: -0.14, CI: -0.22, -0.06) and elected officials (ME: -0.11; CI: -0.19, -0.02). Greater knowledge of ICE's detainment of children and families among Hispanic respondents was associated with lower trustworthiness ratings of state elected officials (ME: -0.09, CI: -0.16, 0.01). Greater knowledge of the US Public Health Service Study of Syphilis in Tuskegee was associated with higher trustworthiness ratings of their usual source of care (ME: 0.09; CI: 0.28, 0.15) among Black respondents (ME: 0.09; CI: 0.01, 0.16). CONCLUSIONS: Among Black respondents, lower satisfaction with the George Floyd death investigation was associated with lowered levels of trust in pharmaceutical companies, some government officials, and administrators; it was not associated with the erosion of trust in direct sources of health care delivery, information, or regulation. Among Hispanic respondents, greater knowledge of the ICE detainments was associated with lower trustworthiness ratings of elected state officials. Paradoxically, higher knowledge of the Study of Syphilis in Tuskegee was associated with higher trustworthiness ratings in usual sources of care.

Trust in science and belief in misinformation mediate the effects of political orientation on vaccine hesitancy and intention to be vaccinated.

In previous studies, anti-vaccination attitudes have been attributed either to far-right voters or to both far-left and far-right voters. The present study investigated the associations of political orientation with vaccine hesitancy and intention to be vaccinated against COVID-19, and the potential mediating roles of trust in science and belief in misinformation. A total of 750 Italian respondents completed an online questionnaire in the period between the second and the third wave of COVID-19 (from 9th March to 9th May 2021). The results showed that political orientation had both direct and indirect associations with vaccine hesitancy and vaccine intention, mediated by trust in science and belief in misinformation. Specifically, right-wing adherents were less trustful of scientists and believed in COVID-19-related misinformation more than left-wing adherents, and these two factors accounted for their higher vaccine hesitancy and reduced willingness to receive an anti-COVID-19 vaccination. Our findings are in line with the predictions of the mindsponge theory and suggest that communicative campaigns aimed at improving the rates of vaccine acceptance in right-wing adherents should be specifically focused on enhancing trust in science and reducing belief in misinformation.

Reliability and validity evaluation of the chinese revision of the attitude towards adult vaccination scale.

BACKGROUND: Although vaccination is one of the critical interventions to address global health issues, inadequate vaccination rates has become an international challenge. Vaccine hesitancy is the key to affecting inadequate vaccination rates. According to the WHO SAGE working group's definition, vaccine hesitancy refers to delaying or refusing vaccination and has been ranked as one of the top 10 health threats. There has yet to be a scale that evaluates vaccination attitudes among Chinese adults. However, an attitude quantity, the adult vaccination attitude scale, has been developed to assess adult vaccination attitudes and reasons for vaccine hesitancy. OBJECTIVE: The Adult Attitudes to Vaccination Scale (ATAVAC) was initially developed by Professor Zoi Tsimtsiou et al. This study aimed to analyze the structure of the Chinese version of the ATAVAC and explore the relationship between adult vaccination attitudes, e-health literacy, and medical distrust. METHODS: After obtaining author permission for the initial scales, the study was translated using the Brislin back-translation method. 693 adults were enrolled to the study. To validate this hypothesis, participants finished the socio-demographic questionnaire, the Chinese version of the ATAVAC, the electronic Health Literacy Scale (e-HEALS) and the Medical Mistrust Index (MMI). The exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the underlying structure of the factors of the Chinese version of the Adult Vaccination Attitude Scale and to measure its reliability and validity. RESULTS: The Cronbach's alpha coefficient for the Chinese version of the ATAVAC was 0.885, with Cronbach's alpha coefficients ranging from 0.850 to 0.958 for each dimension. The content validity index was 0.90, and the retest reliability was 0.943. The exploratory factor analysis (EFA) supported the 3-factor structure of the translation instrument, and the scale had good discriminant validity. The confirmatory factor analysis (CFA) revealed a degree of freedom of 1.219, a model fit index (GFI) of 0.979, a normative fit index (NFI) of 0.991, a Tucker-Lewis index (TLI) of 0.998, a comparability index (CFI) of 0.998 and a root mean square error of approximation (RMSEA) of 0.026. CONCLUSION: The results show that the Chinese version of the ATAVAC has demonstrated good reliability and validity. Hence, it can be used as an effective tool to assess vaccination attitudes among Chinese adults.

Perceived Influence of Incentives on COVID-19 Vaccination Decision-making and Trust.

This survey study examines the prevalence of incentive receipt for COVID-19 vaccination and the association of various sociodemographic characteristics with perspectives on incentives' influence on trust in the COVID-19 vaccine.

A qualitative study on COVID-19 pandemic impacts on parental attitudes and intentions for routine adolescent vaccinations: The role of trust.

INTRODUCTION: The COVID-19 pandemic has contributed to declines in routine childhood and adolescent vaccination coverage globally. While the declines in Australia have been less, they are a concern, given steady increases in coverage prior to the pandemic. Given limited evidence on how the experiences of parents during the pandemic affected their attitudes about and intentions towards adolescent vaccinations, with this study we aimed to explore these. METHODS: This was a qualitative study. We invited parents of adolescents eligible for school-based vaccinations in 2021 from metropolitan, regional and rural areas of New South Wales and Victoria (the most affected States) and South Australia (less affected) to half hour-long online semi-structured interviews. We analysed data thematically and applied a conceptual model of trust in vaccination. RESULTS: In July 2022 we interviewed 15 accepting, 4 hesitant and two parents who refused adolescent vaccinations. We identified three themes: 1. Pandemic impacting on professional and personal lives and routine immunisations; 2. Pandemic strengthening preexisting vaccine hesitancy, with perceived lack of clarity in governmental information about vaccination and stigma around non-vaccinating as contributing factors; 3. Pandemic raising awareness of the benefits of COVID-19 and routine vaccinations, with communication campaigns and one's trusted doctor's vaccination recommendations as contributing factors. CONCLUSIONS: For some parents, experiences of poor system readiness and growing distrust towards health and vaccination systems strengthened their pre-existing vaccine hesitancy. We offer recommendations on how trust in the health system and immunisation can be optimised post-pandemic to increase uptake of routine vaccines. These include improving access to vaccination services and clear, timely information about vaccines; supporting immunisation providers in their immunisation consultations; working alongside communities, and building capacity of vaccine champions.

Trust and virtual communication during the COVID-19 pandemic for adults with asthma from low-income neighborhoods: What have we learned?

BACKGROUND: Low-income and marginalized adults disproportionately bear the burden of poor asthma outcomes. One consequence of the structural racism that preserves these inequities is decreased trust in government and health care institutions. OBJECTIVE: We examined whether such distrust extended to health care providers during the pandemic. METHODS: We enrolled adults living in low-income neighborhoods who had required a hospitalization, an emergency department visit, or a prednisone course for asthma in the prior year. Trust was a dichotomized measure derived from a 5-item questionnaire with a 5-point Likert scale response. The items were translated to the binary variable "strong" versus "weak" trust. Communication was measured using a 13-item questionnaire with a 5-point Likert scale. Logistic regression was used to examine the association between communication and trust, controlling for potential confounders. RESULTS: We enrolled 102 patients, aged 18 to 78 years; 87% were female, 90% were Black, 60% had some post-high school education, and 57% were receiving Medicaid. Of the 102 patients, 58 were enrolled before the March 12, 2020, pandemic start date, and 70 (69%) named doctors as their most trusted source of health information. Strong trust was associated with a negative response to the statement "It is hard to reach a person in my doctor's office by phone." There was no evidence of an association between the overall communication scores and trust. Satisfaction with virtual messaging was weaker among those with less trust. CONCLUSIONS: These patients trust their physicians, value their advice, and need to have accessible means of communication.

BFT-IoMT: A Blockchain-Based Trust Mechanism to Mitigate Sybil Attack Using Fuzzy Logic in the Internet of Medical Things.

Numerous sensitive applications, such as healthcare and medical services, need reliable transmission as a prerequisite for the success of the new age of communications technology. Unfortunately, these systems are highly vulnerable to attacks like Sybil, where many false nodes are created and spread with deceitful intentions. Therefore, these false nodes must be instantly identified and isolated from the network due to security concerns and the sensitivity of data utilized in healthcare applications. Especially for life-threatening diseases like COVID-19, it is crucial to have devices connected to the Internet of Medical Things (IoMT) that can be believed to respond with high reliability and accuracy. Thus, trust-based security offers a safe environment for IoMT applications. This study proposes a blockchain-based fuzzy trust management framework (BFT-IoMT) to detect and isolate Sybil nodes in IoMT networks. The results demonstrate that the proposed BFT-IoMT framework is 25.43% and 12.64%, 12.54% and 6.65%, 37.85% and 19.08%, 17.40% and 8.72%, and 13.04% and 5.05% more efficient and effective in terms of energy consumption, attack detection, trust computation reliability, packet delivery ratio, and throughput, respectively, as compared to the other state-of-the-art frameworks available in the literature.

Protecting public's wellbeing against COVID-19 infodemic: The role of trust in information sources and rapid dissemination and transparency of information over time.

Objectives: This study examined how trust in the information about COVID-19 from social media and official media as well as how the information was disseminated affect public's wellbeing directly and indirectly through perceived safety over time. Methods: Two online surveys were conducted in China, with the first survey (Time1, N = 22,718) being at the early stage of the pandemic outbreak and the second one (Time 2, N = 2,901) two and a half years later during the zero-COVID policy lockdown period. Key measured variables include trust in official media and social media, perceived rapid dissemination and transparency of COVID-19-related information, perceived safety, and emotional responses toward the pandemic. Data analysis includes descriptive statistical analysis, independent samples t-test, Pearson correlations, and structural equation modeling. Results: Trust in official media, perceived rapid dissemination and transparency of COVID-19-related information, perceived safety, as well as positive emotional response toward COVID-19 increased over time, while trust in social media and depressive response decreased over time. Trust in social media and official media played different roles in affecting public's wellbeing over time. Trust in social media was positively associated with depressive emotions and negatively associated with positive emotion directly and indirectly through decreased perceived safety at Time 1. However, the negative effect of trust in social media on public's wellbeing was largely decreased at Time 2. In contrast, trust in official media was linked to reduced depressive response and increased positive response directly and indirectly through perceived safety at both times. Rapid dissemination and transparency of COVID-19 information contributed to enhanced trust in official media at both times. Conclusion: The findings highlight the important role of fostering public trust in official media through rapid dissemination and transparency of information in mitigating the negative impact of COVID-19 infodemic on public's wellbeing over time.

Trust in healthcare before and during the COVID-19 pandemic.

BACKGROUND: Public trust is often advantageous for health authorities during crises such as the COVID-19 pandemic. Norwegian health authorities used the public´s high trust to control the pandemic, resulting in relatively few casualties. METHODS: We wanted to describe and compare the Norwegian public trust in GPs, public healthcare, information and treatment in hospitals before and during the early phases of the COVID-19 pandemic. Further, we wanted to investigate the relationship between somatic or mental illness, and trust in GPs and public health information, and to develop a theoretical understanding of the relationship between trust in healthcare institutions, generalised trust and the societal situation caused by the COVID-19 pandemic. We performed two surveys, the first in December 2019; the second in May 2020, thus providing two snapshots of the Norwegian public's trust in healthcare and healthcare actors before and during the COVID-19 pandemic. RESULTS: There was statistically significant increased trust in public healthcare, in treatment at hospital and in information at hospital after the outbreak of the COVID-19 pandemic. There was a non-significant rise in trust in GPs. We found that trust in public health information was not related to mental health nor having a chronic, somatic disease. CONCLUSION: The findings confirm that the Norwegian public's trust in healthcare and healthcare actors is high. The trust levels are also relatively stable, and even show an increase during the early phases of the pandemic. We suggest that there is a dynamic relationship between trust in public health information, healthcare institutions, generalised trust and a societal crisis situation such as the COVID-19 pandemic. However, the GP-patient trust seems less affected by a crisis situation, than the public´s trust in healthcare institutions. This difference may be explained by the relative stability caused by mandates of trust obtained from the patient.

Hesitant or not: A cross-sectional study of socio-demographics, conspiracy theories, trust in public health information, social capital and vaccine hesitancy among older adults in Ghana.

Vaccination is an effective strategy to reduce the coronavirus disease 2019 (COVID-19) burden, but its effectiveness hinges on timely vaccine uptake. Addressing concerns among vaccine-hesitant individuals is critical to preventing the immunization program from failing. This study analyzes the determinants of vaccine hesitance among older adults (aged 50 years and older) in Ghana. We adopted a cross-sectional survey with a quantitative approach that accessed data from 400 older adults from the Accra and Kumasi metropolitan areas using purposive and snowball sampling techniques. Multivariate logistic regressions were used to estimate the socio-demographic, social capital, conspiracy theories about COVID-19, and public health information factors associated with vaccine hesitance within the sample. The study found that only minority (5%) of respondents had been vaccinated, with 79% indicating willingness to be vaccinated. The study found that females (AOR: 0.734, CI: 0.019-0.036, p = .027) and those who have retired (AOR: 0.861, CI: 0.003-0.028, p = .034) were significantly less likely to engage in COVID-19 vaccine hesitance. Furthermore, the study revealed that participants who trust public health information (AOR: 0.065, CI: 0.022-0.049, p = .031) and have social capital (AOR: 0.886, CI: 0.017-0.032, p = .001) were significantly less likely to present COVID-19 vaccine hesitance. Finally, participants who believe in conspiracy theories about COVID-19 and vaccines (AOR: 3.167, CI: 1.021-2.043, p = .004) were significantly more likely to engage in COVID-19 vaccine hesitance. Efforts to convey vaccination benefits and address issues through evidence-based information are needed to strengthen and preserve the public's trust in vaccines in Ghana.

At the intersection of trust and mistrust: A qualitative analysis of motivators and barriers to research participation at a safety-net hospital.

INTRODUCTION: The underrepresentation of Black, Indigenous, and People of Color (BIPOC) individuals in healthcare research limits generalizability and contributes to healthcare inequities. Existing barriers and attitudes toward research participation must be addressed to increase the representation of safety net and other underserved populations. METHODS: We conducted semi-structured qualitative interviews with patients at an urban safety net hospital, focusing on facilitators, barriers, motivators, and preferences for research participation. We conducted direct content analysis guided by an implementation framework and used rapid analysis methods to generate final themes. RESULTS: We completed 38 interviews and identified six major themes related to preferences for engagement in research participation: (1) wide variation in research recruitment preferences; (2) logistical complexity negatively impacts willingness to participate; (3) risk contributes to hesitation toward research participation; (4) personal/community benefit, interest in study topic, and compensation serve as motivators for research participation; (5) continued participation despite reported shortcomings of informed consent process; and (6) mistrust could be overcome by relationship or credibility of information sources. CONCLUSION: Despite barriers to participation in research studies among safety-net populations, there are also facilitators that can be implemented to increase knowledge and comprehension, ease of participation, and willingness to join research studies. Study teams should vary recruitment and participation methods to ensure equal access to research opportunities. PATIENT/PUBLIC CONTRIBUTION: Our analysis methods and study progress were presented to individuals within the Boston Medical Center healthcare system. Through this process community engagement specialists, clinical experts, research directors, and others with significant experience working with safety-net populations supported data interpretation and provided recommendations for action following the dissemination of data.

Impact of COVID-19 on carers of children with tracheostomies.

OBJECTIVES: To explore the impact of the COVID-19 pandemic on the experiences of caregivers of children with tracheostomies. DESIGN: Qualitative semistructured interviews. SETTING: All participants were currently, or had previously cared for, a tracheostomised child who had attended a tertiary care centre in the North of England. Health professionals were purposively sampled to include accounts from a range of professions from primary, community, secondary and tertiary care. PARTICIPANTS: Carers of children with tracheostomies (n=34), including health professionals (n=17) and parents (n=17). INTERVENTIONS: Interviews were undertaken between July 2020 and February 2021 by telephone or video link. MAIN OUTCOME MEASURE: Qualitative reflexive thematic analysis with QSR NVivo V.12. RESULTS: The pandemic has presented an additional and, for some, substantial challenge when caring for tracheostomised children, but this was not always felt to be the most overriding concern. Interviews demonstrated rapid adaptation, normalisation and varying degrees of stoicism and citizenship around constantly changing pandemic-related requirements, rules and regulations. This paper focuses on four key themes: 'reconceptualising safe care and safe places'; 'disrupted support and isolation'; 'relationships, trust and communication'; and 'coping with uncertainty and shifting boundaries of responsibility'. These are described within the context of the impact on the child, the emotional and physical well-being of carers and the challenges to maintaining the values of family-centred care. CONCLUSIONS: As we move to the next phase of the pandemic, we need to understand the impact on vulnerable groups so that their needs can be prioritised.

No(cebo) Vax: COVID-19 Vaccine Beliefs Are Important Determinants of Both Occurrence and Perceived Severity of Common Vaccines' Adverse Effects.

This study highlights the role of psychological influences in triggering and amplifying the adverse effects of the COVID-19 vaccine (i.e., nocebo effects). Fear, beliefs, and expectations about the COVID-19 vaccine, trust in health and scientific institutions, and stable personality traits were measured in 315 adult Italian citizens (145 men) during the 15-min waiting time after vaccination. The occurrence and severity of 10 potential adverse effects were assessed 24 hr later. Nonpharmacological variables predicted nearly 30% of the severity of the vaccine's adverse effects. Expectations are important determinants of adverse effects from vaccines, and the results of the path analyses show that these expectations stem primarily from people's vaccine beliefs and attitudes, which can be changed. Implications for increasing vaccine acceptability and limiting the nocebo effect are discussed.

Trust in sources of information on COVID-19 at the beginning of the pandemic's first wave and incident persistent symptoms in the population-based CONSTANCES cohort: A prospective study.

OBJECTIVE: To examine the association between trust in different sources of information on COVID-19 at the beginning of the pandemic and the burden of incident persistent symptoms. METHODS: This prospective study used data from the SAPRIS and SAPRIS-Sérologie surveys nested in the French CONSTANCES population-based cohort. Trust in different information sources was measured between April 6 and May 4, 2020. Persistent symptoms that emerged afterwards were self-reported between December 2020 and January 2021. The associated psychological burden was measured with the somatic symptom disorder B criteria scale (SSD-12). The analyses were adjusted for gender, age, education, income, self-rated health, SARS-CoV-2 serology tests, and self-reported COVID-19. RESULTS: Among 20,985 participants [mean age (SD), 49.0 years (12.7); 50.2% women], those with higher trust in government/journalists at baseline had fewer incident persistent symptoms at follow-up (estimate (SE) for one IQR increase: -0.21 (0.03), p < 0.001). Participants with higher trust in government/journalists and medical doctors/scientists were less likely to have ≥1 symptom (odds ratio (95% confidence interval) for one IQR increase: 0.87 (0.82-0.91) and 0.91 (0.85-0.98), respectively). Among 3372 participants (16.1%) who reported ≥1 symptom, higher trust in government/journalists and medical doctors/scientists predicted lower SSD-12 scores (-0.39 (0.17), p = 0.02 and - 0.85 (0.24), p < 0.001, respectively), whereas higher trust in social media predicted higher scores in those with lower trust in government/journalists (0.90 (0.34), p = 0.008). These associations did not depend upon surrogate markers of infection with SARS-CoV-2. CONCLUSIONS: Trust in information sources on COVID-19 may be associated with incident persistent symptoms and associated psychological burden, regardless of infection with SARS-CoV-2.

The impact of COVID-19 misinformation and trust in institutions on preventive behaviors.

Misinformation related to coronavirus disease 2019 (COVID-19) has the potential to suppress preventive behaviors that mitigate the spread of COVID-19. Early research on the behavioral consequences of COVID-19 misinformation is mixed, and most rely on cross-sectional data. We examined whether believing in COVID-19 misinformation at one time point influences engaging in preventive behaviors later. In addition, we investigated the role of trust in institutions. We conducted a two-wave survey in South Korea and examined the association between belief in COVID-19 misinformation at Wave 1 and preventive behaviors at Wave 2 controlling for preventive behaviors at Wave 1. We also analyzed whether there is an interaction between belief in COVID-19 misinformation and trust in institutions. Belief in COVID-19 misinformation at Wave 1 significantly increased avoidance of preventive behaviors at Wave 2, but after accounting for trust in institutions, this effect disappeared. Rather, trust in institutions significantly decreased avoidance of preventive behaviors. In addition, misinformation increased avoidance of preventive behaviors among those who trusted institutions the most. Results suggest that building trust in institutions is essential in promoting COVID-19 preventive behaviors. Belief in COVID-19 misinformation may have harmful effects, but these effects were pronounced for those who highly trust institutions.

Self-perception and COVID-19 vaccination self-efficacy among Chinese adults: A moderated mediation model of mental health and trust.

BACKGROUND: Optimal Corona Virus Disease 2019 (COVID-19) vaccination coverage is necessary to achieve community protection, and self-efficacy independently predict vaccination behavior. The current study examined the effect of self-perception on COVID-19 vaccination self-efficacy as well as potential mechanisms among Chinese adults. METHODS: A cross-sectional survey was conducted from four cities in China (n = 6781). Models 4 and 8 in Hayes' PROCESS macro were used to test models. RESULTS: Self-perception (ß = 0.128, 95 % CI: 0.093, 0.163) and self-perception ∗ mental health (ß = 0.009, 95 % CI: 0.003, 0.014) were positively associated with trust in doctors and vaccine developers, while mental health was negatively related to trust in doctors and vaccine developers (ß = -0.483, 95 % CI: -0.629, -0.337). Self-perception (ß = 0.149, 95 % CI: 0.138, 0.161), trust in doctors and vaccine developers (ß = 0.185, 95 % CI: 0.177, 0.194) and self-perception ∗ mental health (ß = 0.003, 95 % CI: 0.002, 0.005) were positively associated with COVID-19 vaccination self-efficacy. Mental health was negatively related to COVID-19 vaccination self-efficacy (ß = -0.101, 95 % CI: -0.151, -0.051). LIMITATIONS: This cross-sectional study collected data through online questionnaires. CONCLUSIONS: Our results demonstrated that the relationship between self-perception and COVID-19 vaccination self-efficacy was partially mediated by trust in doctors and vaccine developers. Both the correlation between self-perception and COVID-19 vaccination self-efficacy, and the relationship between self-perception and trust in doctors and vaccine developers were moderated by mental health. Findings confirm that increasing COVID-19 vaccination self-efficacy would be facilitated by improvements in self-perception, mental health, and trust in doctors and vaccine developers.

Rural-Urban Differences in Vaccination and Hesitancy Rates and Trust: US COVID-19 Trends and Impact Survey on a Social Media Platform, May 2021-April 2022.

Objectives. To analyze rural-urban differences in COVID-19 vaccination uptake, hesitancy, and trust in information sources in the United States. Methods. We used data from a large survey of Facebook users. We computed the vaccination, hesitancy, and decline rates and the trust proportions among individuals hesitant toward COVID-19 information sources for rural and urban regions in each state from May 2021 to April 2022. Results. In 48 states with adequate data, on average, two thirds of states showed statistically significant differences in monthly vaccination rates between rural and urban regions, with rural regions having a lower vaccination rate at all times. Far fewer states showed statistically significant differences when comparing monthly hesitancy and decline rates for urban versus rural regions. Doctors and health professionals received the highest level of trust. Friends and family were also among the most trusted sources in rural areas where the vaccination uptake was low. Conclusions. Rural-urban difference in hesitancy rates among those still unvaccinated was much smaller than the rural-urban difference in vaccination rates, suggesting that access to vaccines may be another contributor to the lower vaccination rates in rural areas. (Am J Public Health. 2023;113(6):680-688. https://doi.org/10.2105/AJPH.2023.307274).