Can delay discounting predict vaccine hesitancy 4-years later? A study among US young adults

ABSTRACT

Despite being a major threat to health, vaccine hesitancy (i.e., refusal or reluctance to vaccinate despite vaccine availability) is on the rise. Using a longitudinal cohort of young adults (N=1260) from Los Angeles County, California we investigated the neurobehavioral mechanisms underlying COVID-19 vaccine hesitancy. Data were collected at two time points during adolescence (12th grade;fall 2016;average age = 16.96 (±0.42)) and during young adulthood (spring 2021;average age = 21.33 (±0.49)). Main outcomes and measures were delay discounting (DD;fall 2016) and tendency to act rashly when experiencing positive and negative emotions (UPPS-P;fall 2016);self-reported vaccine hesitancy and vaccine beliefs/knowledge (spring 2021). A principal components analysis determined four COVID-19 vaccine beliefs/knowledge themes Collective Responsibility, Confidence and Risk Calculation, Complacency, and Convenience. Significant relationships were found between themes, COVID-19 vaccine hesitancy, and DD. Collective Responsibility (β=-1.158[-1.213,-1.102]) and Convenience (β=-0.132[-0.185,-0.078]) scores were negatively associated, while Confidence and Risk Calculation (β=0.283[0.230,0.337]) and Complacency (β=0.412[0.358,0.466]) scores were positively associated with COVID-19 vaccine hesitancy. Additionally, Collective Responsibility (β=-0.060[-0.101,-0.018]) was negatively associated, and Complacency (β=-0.063[0.021,0.105]) was positively associated with DD from fall 2016. Mediation analysis revealed immediacy bias during adolescence, measured by DD, predicted vaccine hesitancy 4 years later while being mediated by two types of vaccine beliefs/knowledge Collective Responsibility (β=0.069[0.022,0.116]) and Complacency (β=0.026[0.008,0.044]). These findings provide a further understanding of individual vaccine-related decision-making among young adults and inform public health messaging to increase vaccination acceptance.