Vaccination Behavior Research Articles

HPV Vaccine Awareness, Past Behaviors, and Future Intentions Among a Diverse Sample of Fathers Aged 27 to 45 Years: A National Survey.

Men aged 27 to 45 are eligible for human papillomavirus (HPV) vaccination as of 2019, yet relatively little is known about whether they have received or intend to receive it. We conducted a cross-sectional, online survey among fathers aged 27 to 45 between March and April 2022, to assess associations between HPV vaccination awareness, behaviors, intentions, and psychosocial constructs from the Health Belief Model. We examined the characteristics of those who had (a) heard of the HPV vaccine, (b) already received ≥ 1 dose, and (c) intentions for future vaccination among those who had never been vaccinated. Among 400 men who completed the survey, 32% were not aware of the HPV vaccine. Among those who were aware, 41% had received ≥ 1 dose. Sixty-three percent of unvaccinated men reported that they intended to get vaccinated in the future. Multivariable logistic regression analyses revealed that age and race/ethnicity were associated with having been vaccinated previously. Among the unvaccinated, multivariable logistic regression analyses revealed that those with a higher perceived risk of HPV-associated cancer had 3.73 greater odds of reporting they would seek vaccination compared to those with lower perceived risk (95% confidence interval [CI] = [1.28, 12.3]). We did not find perceived benefits, barriers, or decision self-efficacy to be related to future vaccine intentions. Since recommendations for this group include shared clinical decision-making, public health efforts should focus on raising awareness of vaccine eligibility, emphasizing risk factors for HPV-associated cancers so that individuals have an accurate perception of risk, and encouraging conversation between men and their providers.

Examination of Predicting Factors for COVID-19 Vaccination Behaviors of University Students Utilizing the Theory of Planned Behavior.

This study aimed to examine the predictive factors of COVID-19 vaccination behavior by evaluating the moderating effect of perceived behavioral control on the theory of planned behavior. Data were collected from August 6 to August 31, 2022 from 235 college students (aged 20~29 years) across 12 universities using a structured web-based survey. Statistical analyses were conducted using the SPSS and AMOS software. Attitudes toward COVID-19 vaccination, subjective norms, and intention to be vaccinated significantly influenced COVID-19 vaccination behavior. Attitudes and subjective norms indirectly affected COVID-19 vaccination behavior through intention to vaccinate, whereas intention to vaccinate had a direct effect. The moderating effect of perceived behavioral control on the relationship between subjective norms and intention to vaccinate was significant. Interventions that foster a positive attitude toward COVID-19 vaccination and bolster subjective norms and perceived behavioral control can boost the intention to be vaccinated and facilitate the uptake of COVID-19 vaccination.

Perceptions of HPV-Linked Oropharyngeal Cancer Risk Messages Among a Sample of Young Adult Men in the US: A Pilot Study.

Awareness of risk for oropharyngeal cancer from oral human papillomavirus (HPV) infection is low among men in the United States. This pilot study tested messages communicating oral HPV and oropharyngeal cancer risk among a sample of U.S. young adult men (aged 18-26). Six oral HPV and cancer risk messages were tested in an online survey. Participants (N = 68) were randomly assigned to one of two message sets, each containing three unique text-based messages. Participants evaluated messages separately based on various measures (e.g., perceived message effectiveness [PME], novelty). One-way repeated measures ANOVAs were used to assess evaluation differences within message sets. Participants provided open-ended feedback about each message, which were synthesized into overarching themes. Participants were receptive to the risk messages, rating them high on PME (mean range = 3.72-4.25 out of 5) and other measures. Analyses identified three high-performing messages. For example, participants rated a message about HPV-linked oropharyngeal cancer risk rates in men versus women higher on attention and novelty than two other messages in the same set (both ps < .05). Participants were shown three messages (instead of all six) in each message set to minimize survey fatigue. Common themes from open-ended feedback were that participants liked the short-form structure of the messages and that the messages used gender-tailored language. In conclusion, oral HPV and oropharyngeal cancer risk messages may be useful for increasing risk awareness among men in the U.S. Further work should test such messages in rigorous experimental contexts to assess their efficacy in modifying other health outcomes, such as HPV vaccination behaviors.

Exploring pre-pandemic patterns of vaccine decision-making with the 5C model: results from representative surveys in 2016 and 2018.

The 5C psychological antecedents of vaccination (Confidence, Complacency, Constraints, Calculation, and Collective Responsibility) facilitate understanding vaccination decisions in specific target groups as well as the general public's informational needs. This study aims to explain pre-pandemic vaccination behaviour (a) in general, (b) for specific vaccines such as influenza, and (c) for certain target groups (e.g. people over the age of 59years, parents, healthcare workers), using the 5C model and sociodemographic variables. The intention to get an influenza vaccination was also analysed for target groups. The 5C, self-reported vaccination behaviour and the intention to vaccinate were collected in two representative telephone surveys in Germany - one in 2016 (n1 = 5,012) and another in 2018 (n2 = 5,054). Parents, people over the age of 59years, chronically ill people, people with a migratory background, pregnant women and healthcare workers were target groups. Overall, the 5C model had higher explanatory power than sociodemographic variables. The pattern of vaccine hesitancy slightly differed between vaccinations and target groups. Confidence in safety and effectiveness was always a significant predictor. Complacency (the underestimation of disease risks) and Constraints were significant predictors as well. Calculation (of risks and benefits) was important for influenza vaccination intentions. This work builds an important benchmark for understanding potential changes in vaccine acceptance due to the pandemic. The benchmark can be used in research on potential effects of the pandemic on vaccination behaviours. Intervention designers can also use the results to understand specific audiences and their vaccination decisions.

Acceptance to take COVID-19 vaccine and its relation to COVID-19 infection

One of the biggest global health threats is vaccine hesitancy and it remains a global issue. The speed at which vaccines are developed and media misinformation contribute to vaccine reluctance. This study examined the relationship between vaccine acceptance and COVID-19 infection. A cross-sectional study was used with a sample of 1388 subjects including students and academic staff. Data were collected using the self-administered COVID-19 Vaccine Acceptance Behavior questionnaire, which has nine dimensions and 42 items and asks about COVID-19 infection frequency and timing. The mean COVID-19 vaccine behavior scores of hesitant subjects were low. Low trust in COVID-19 vaccines (25.4%) was the main reason for hesitancy. COVID-19 vaccine hesitancy is positively correlated with increased infection rates (P≤0.001). Acceptance of the COVID-19 vaccine can reduce infection rates, protect vulnerable populations, and aid public health efforts to control the virus.

Impact of Educational Intervention on Cervical Cancer and HPV Vaccine Knowledge, Attitudes, and Acceptance among First-Year Medical Students of Birat Medical College

Introduction: Cervical cancer poses a significant health burden, particularly in developing nations, with notable incidence and mortality rates. However, there exists a notable gap in understanding the knowledge, attitudes, and acceptance surrounding cervical cancer and the Human Papillomavirus (HPV) Vaccine. This study aims to evaluate the current awareness, attitudes, and acceptance levels of HPV Vaccine among first-year medical students, alongside assessing the effectiveness of an educational intervention on these aspects. Objectives: To evaluate current knowledge, attitude and acceptance of cervical cancer and HPV Vaccine and evaluate the impact of educational intervention. Methodology: 2 An analytical cross-sectional study was conducted among 96 first-year medical students at a medical college in Nepal from December 24, 2023, to February 28, 2024, after receiving Ethical Approval. Total enumeration sampling technique was applied, and a structured self- administered questionnaire, validated for data collection, was employed. Data were collected at baseline and after an educational intervention class to assess the impact on the knowledge, attitude, and acceptance toward cervical cancer and the HPV Vaccine. Result: Pre-intervention scores (mean=5.90, SD=1.73) significantly increased after the intervention (mean=11.65, SD=1.44) with p&lt;0.001, indicating a 97.46% increase. Willingness to receive HPV vaccination increased from 47.9% to 88.5%, and willingness to recommend vaccination increased from 88.54% to 96.88%. No significant differences were found in vaccination willingness. Conclusion: Educational interventions significantly enhanced medical students' willingness to receive and recommend HPV vaccination, suggesting potential for future healthcare provider influence on vaccination behaviors.

Predicting future vaccination habits: The link between influenza vaccination patterns and future vaccination decisions among old aged adults in China

BackgroundAnnual influenza vaccination is crucially recommended for the elderly to maintain humoral immunity. Insufficient coverage requires us to understand the determinants of their influenza behaviors and how these patterns impact vaccination choices. MethodsData from 540 Beijing residents aged over 65 were collected through interviews, capturing vaccination history and sociodemographic details. Individual influenza vaccination records from 2016 to 2020 were obtained from China’s Immunization Information Systems. A latent class model identified three vaccination patterns. Multinomial logistic regression assessed relative risk ratios (RRRs) for vaccination based on sociodemographic factors. Vaccination patterns were used to predict future vaccination likelihood. ResultsThe analysis revealed three groups: sporadically vaccinated (63.33%), occasionally vaccinated (18.71%), and frequently vaccinated (17.96%). Factors associated with frequent vaccination included age over 70 (RRR = 2.81), lower income (RRR = 0.39), higher vaccine hesitancy (RRR = 3.10), multiple chronic conditions (RRR = 2.72), and rural residence (RRR = 2.48). The frequently vaccinated group was more likely to sustain regular vaccination habits in subsequent years compared to the occasionally vaccinated group. ConclusionsOnly 17.96% of Beijing’s older population exhibited a consistent influenza vaccination pattern. Older age, rural residency, and chronic diseases correlated with repeated influenza vaccination. Segmenting the population based on past vaccination behavior can aid in designing targeted interventions to improve vaccination rates.

The Impact of Expert Opinions in COVID-19 News Coverage on Vaccination During the Fifth Outbreak in Hong Kong: A Time Series Analysis

ABSTRACT The role of experts in news coverage has become increasingly prominent, but the evidence regarding the effectiveness of expert opinions in affecting public behavior remains mixed. This study seeks to examine the influence of expert opinions covered in the news on the public’s response to public health crises. By adopting a macro-level framing perspective, we investigated how framing consistency, a macro-level concept indicating the agreement between expert opinions in news coverage and government policies or among peer experts, evolves over time and its temporal causal relationship with public behavior. Specifically, this study collected all press news coverage in Hong Kong over four months during the fifth outbreak, including 1,416 articles with 650 expert opinions, as well as the vaccination data that paralleled with this period. We constructed time series of expert opinions and vaccination behavior, and then conducted Vector Autoregressive (VAR) models with Granger causality analysis to examine how framing consistency of expert opinions in news coverage influenced vaccination. The results indicate that the consistent framing between expert opinions and government policies increased COVID-19 vaccination during the fifth outbreak in Hong Kong, while conflicting opinions responding to government policies had no significant effect on vaccination. Opinions among medical experts on COVID-19 issues also did not significantly impact vaccination. The implications for designing communication strategies and enhancing public behavioral support during public health crises are discussed.

Evolving Altruistic Attitudes towards Vaccination Post COVID-19 Pandemic: A Comparative Analysis across Age Groups.

Altruism plays an essential role in promoting vaccine uptake, an issue that came to the fore during the COVID-19 pandemic through discussions of herd immunity and altruistic motivations. In response, the primary objective of this cross-sectional survey was to explore how altruistic attitudes have evolved in the post-pandemic era and to assess their effectiveness in motivating vaccination behavior in different age groups. The study aimed to elucidate changes in altruistic motivations for vaccination and their implications for public health strategies. Using a representative sample of the adult population of South Tyrol, Italy, including 1388 participants, altruism was assessed in 2023 with the scales of the Elderly Care Research Center (ECRC) and the International Personality Item Pool (IPIP) subscale of the version 5F30F-R1. Its association with demographic variables, vaccination attitudes and personal beliefs in two age groups (18-69 years, 70+ years) was analyzed. The results reveal distinct predictors of altruism across these scales and age groups, suggesting a shift in altruistic attitudes towards vaccination when comparing data from a similar survey conducted in 2021 with the 2023 results. Consequently, the use of altruism scales for different age groups is warranted. This study highlights the need for further research in this field. It concludes that while promoting altruistic behavior to increase vaccine uptake appears to be effective primarily among the younger population, emphasizing personal safety is more appropriate for encouraging vaccination among older individuals.

Predicting COVID-19 Vaccination Intentions to Inform Evidence-Based Messaging for Building Vaccine Confidence Among Rural Americans.

Examine possible message topics to promote rural vaccination using psychosocial antecedents of vaccination. Cross-sectional survey administered by Research America, Inc. West Virginia (WV). 756 WV adults via convenience sample (n = 370; ∼2% response rate from online panel of ∼20 000 WV residents), and random digit dial of landlines (n = 174; ∼1% response rate from 18 432 numbers) and cellphones (n = 212; ∼1% response rate from 20 486 numbers). Outcome measures included self-reported vaccination intention and behavior. Predictor measures, rooted in theories of social and behavioral science that have been found to be predictive of vaccination outcomes (i.e., Reasoned Action Approach, Extended Parallel Process Model), included perceived severity and susceptibility, negative affect, instrumental and affective attitudes, social norms, self-efficacy, response efficacy, and perceived control. Multivariate linear regression for intention and logistic regression for behavior. Intention was positively predicted by affective attitude, β = .30, P < .05, instrumental attitude, β = .19, P < .05, response efficacy, β = .19, P < .05, negative affect, β = .16, P < .05, self-efficacy, β = .13, P < .05, and subjective norm, β = .13, P < .05, F(10, 267) = 30.12, Adj. R2 = .53. Vaccination status was predicted by instrumental attitude, exp(B) = 2.09, and subjective norm, exp(B) = 2.00, Pseudo R2 = .29, log likelihood = 125.11, χ2(10) = 38.34, P < .05. Promising message targets were instrumental attitude, M = 3.21, SD = 1.46, and subjective norms, M = 3.76, SD = 1.71. COVID-19 vaccine confidence messages should address (1) positive feelings and safety perceptions, (2) vaccination's effectiveness in preventing serious COVID-19, and (3) subjective vaccination norms.

Newborn vaccination game model with potentially periodic behavior

We explore the complex dynamics of epidemics, considering the significant effects of disease transmission, newborn individuals, and mortality rate. Employing an evolutionary game theory approach, we model the vaccination aspect for newborns, incorporating potential periodic behavior. The goal is to create an engaging simulation that underscores the criticality of timely infant vaccinations. By introducing periodic elements, the game adds complexity, fostering player participation and awareness of vaccination schedules. In contrast to traditional intervention game models focused on adult vaccine behavior, our approach recognizes the unique challenges posed by newborn vaccination. We address the limitations of existing models by developing a generalized compartmental model, accommodating infection duration distribution, and accurately capturing both periodic and non-periodic disease trajectories. The results show that higher efficacy in a newborn vaccine program can potentially eradicate the disease, but higher effectiveness and cost may deter vaccination. Increased motivation cost boosts vaccination rates without impacting epidemic size, whereas lower costs stabilize vaccination rates. Lower vaccine costs call for increased government investment to counter hesitancy. However, reduced efficacy and lower motivation lead to higher Vaccine Fear Scores, discouraging participation. Our work also offers a unique perspective on the dilemma of newborn vaccination, providing solutions with closed-form expressions that may exhibit periodic or non-periodic behavior. This approach facilitates disease modelers in exploring the potential periodicity of newborn vaccination programs, aiding efforts to prevent recurrent outbreaks.

Understanding patient perspectives on vaccine decision making in adults with autoimmune bullous diseases: a qualitative study.

Patients with autoimmune bullous diseases are at an increased risk of infection, both from the underlying skin disease and from immunosuppressive treatments. Limited information is available on vaccine beliefs and behaviors in dermatology patients and adults with autoimmune bullous diseases in particular. To understand vaccine decision making, identify perceived risks and benefits of vaccinations, and discuss individual experiences in patients with autoimmune bullous diseases in the United States. A qualitative study was performed utilizing semi-structured interviews, and analysis was conducted on NVivo. Patterns were identified in the coded data, and representative quotations were recorded for each major theme. Interviews were conducted between February 15, 2022 and September 15, 2022. Twenty patients with a diagnosis of bullous pemphigoid, mucous membrane pemphigoid, pemphigus vulgaris, or pemphigus foliaceous were interviewed. Of the 20 participants, 14 (70%) were female, with a mean (SD, range) age of 64.8 (13.2, 34-83) years. Key themes that emerged from qualitative analysis of the interviews included patient concerns regarding their increased susceptibility to infection, potential exacerbation of skin disease following vaccination, and the effect of immunosuppressive medications on humoral response to vaccines. Lack of appointment availability, difficulty accessing vaccines, and cost were commonly identified barriers to vaccination. These findings provide valuable knowledge for dermatologists in regard to providing counseling specific to patient concerns and to improve communication surrounding vaccination in the dermatology setting.

Inferring COVID-19 testing and vaccination behavior from New Jersey testing data

Characterizing the relationship between disease testing behaviors and infectious disease dynamics is of great importance for public health. Tests for both current and past infection can influence disease-related behaviors at the individual level, while population-level knowledge of an epidemic's course may feed back to affect one's likelihood of taking a test. The COVID-19 pandemic has generated testing data on an unprecedented scale for tests detecting both current infection (PCR, antigen) and past infection (serology); this opens the way to characterizing the complex relationship between testing behavior and infection dynamics. Leveraging a rich database of individualized COVID-19 testing histories in New Jersey, we analyze the behavioral relationships between PCR and serology tests, infection, and vaccination. We quantify interactions between individuals' test-taking tendencies and their past testing and infection histories, finding that PCR tests were disproportionately taken by people currently infected, and serology tests were disproportionately taken by people with past infection or vaccination. The effects of previous positive test results on testing behavior are less consistent, as individuals with past PCR positives were more likely to take subsequent PCR and serology tests at some periods of the epidemic time course and less likely at others. Lastly, we fit a model to the titer values collected from serology tests to infer vaccination trends, finding a marked decrease in vaccination rates among individuals who had previously received a positive PCR test. These results exemplify the utility of individualized testing histories in uncovering hidden behavioral variables affecting testing and vaccination.

The 5 C model and Mpox vaccination behavior in Germany: a cross-sectional survey

BackgroundDue to the authorization of the Mpox vaccines, we aimed to identify determinants of the intention to get vaccinated, actively trying to receive vaccination, and for successfully receiving a vaccination in Germany employing the 5 C model of vaccination readiness.MethodsData stem from a cross-sectional online survey that was available online from August 13, 2022 to August 31, 2022. To assess the influence of the 5 C Model on vaccination behavior, we conducted a multinomial logistic regression.Results3,338 participants responded to the survey, with 487 already vaccinated and 2,066 intending to receive a vaccination. Confidence and collective responsibility were positively associated with intention to get vaccinated, while complacency was negatively correlated. A higher score on the calculation scale increased the odds of intention to receive vaccination but not with actively having tried to receive a vaccination. Fewer perceived constraints were associated with higher odds to be vaccinated. Patients in practices that focus on HIV treatment were more likely to intend to get vaccinated, to have tried to get vaccinated and to be vaccinated, regardless of indication. While level of education had no impact, having an indication to get vaccinated was a strong predictor of vaccination behavior in all groups.ConclusionFuture vaccination campaigns should aim to reduce specific constraints of the target group and make vaccines widely available in primary care institutions beyond HIV-focused practices.

Vaccination Motivators and Deterrents Among Undervaccinated Older Adults in North Dakota.

Despite increased risk of morbidity and mortality among older adults due to preventable infectious diseases such as influenza, shingles, pneumonia, and COVID-19, many forego receiving some, if not all, of these vaccinations. This study examines vaccination motivators and deterrents for undervaccinated older adults in North Dakota (ND). Adults aged 65+ in ND were mailed a survey (n = 901) with questions gauging vaccination behaviors and perceptions, with 132 of these indicating not receiving certain vaccinations. Further questions assessed reasons they have not been vaccinated against the following diseases: influenza, shingles, pneumonia, and COVID-19 (e.g., "Concerned about side effects", "Vaccines are dangerous", "I'm healthy and I do not need it") and what would make it more likely to get a vaccine (e.g., "More information", "Doctor recommendation", "Easy access to vaccines"). Reasons for remaining unvaccinated varied by vaccine. For influenza and pneumococcal vaccines, respondents were more likely to indicate they are healthy and do not need the vaccine. For shingles and COVID-19, respondents were more likely to indicate concerns about side effects. Factors reported to motivate increasing the likelihood of getting a vaccine were receiving a doctor recommendation, receiving more information, and having a vaccine provided at no cost. These results contribute to our understanding of vaccination behaviors among older adults and underscore specific issues around which to frame interventions tailored to increase vaccine uptake for this population.

Coronavirus Disease 2019 Vaccination by Gender and Age in a Sample of Black Adults in Chicago.

Although vaccine behaviors differ greatly by gender and age, few studies have examined vaccination at the intersection of gender and age within the Black community. We examined COVID-19 vaccination by gender and age using a survey of over 500 Black adults in Chicago, Illinois, fielded from September 2021 to March 2022. Although 54% had received at least one COVID-19 vaccine, the proportion vaccinated was considerably lower for Black men (28%) and women (37%) under 40 years old than Black men (92%) and women (86%) over 40 years (p < .001). Concern about vaccine side effects was the most reported barrier for unvaccinated women (56%) and men (38%) under 40 years. Our results suggest that targeted efforts to improve COVID-19 vaccine uptake in the Black community in Chicago after the initial rollout should have focused on young adults, particularly young Black men, with emphasis on addressing concern about vaccine side effects.

Examining the roles of social media information exposure and seeking on COVID-19 vaccination through the S-O-R model: A two-wave panel in Hong Kong

This study draws upon the stimulus-organism-response (S–O-R) framework in examining the influence of stimulus factors (i.e., passive exposure to and active information seeking for COVID-19 vaccine information on social media) on users' internal psychological mechanisms (i.e., perceived information overload and psychological reactance) and vaccination behavior. We collected two-wave online panel data (W1 N = 411, W2 N = 264) in Hong Kong and tested our hypothesized model using structural equation modeling. The results showed that passive information exposure and active information seeking on social media were positively associated with both vaccination initiation (i.e., receiving the first dose) and full vaccination (i.e., completing the recommended 3-dose schedule at W2). We identified different mediation pathways from passive information exposure and active information seeking to vaccine skepticism through perceived information overload and psychological reactance. Specifically, a double-edged sword effect was found for active information seeking. Active information seeking was associated with lower vaccine skepticism both directly and indirectly through lower psychological reactance. On the other hand, active information seeking was associated with higher perceived information overload, which in turn was associated with higher psychological reactance and subsequently higher vaccine skepticism. Passive information exposure indirectly affected psychological state and vaccine skepticism through higher active information seeking. These findings contribute to the literature on the impact of social media use on vaccination behavior in the context of public health emergencies and offer practical implications for governments and social media platforms in risk communication and vaccination promotion.

Theoretical models for influenza vaccination behavior at the individual level

Influenza imposes a significant disease burden on society and individuals annually, and influenza vaccination is considered a significant public health measure to prevent influenza and reduce influenza-related severe disease and death. The low influenza vaccination rate in China is partly due to certain factors affecting the willingness and behavior of individuals to receive them. Scientific research and targeted interventions on these factors can effectively improve the vaccination situation. Commonly used individual-level theoretical models for influenza vaccination behavior include the health belief model, protection motivation theory, and theory of planned behavior. This study reviews theoretical models commonly employed in researching influenza vaccination willingness and behavior. An overview of these practical applications and challenges models is presented to provide references for relevant research and intervention programs in China.

Human papillomavirus vaccination uptake among 27-to-45-year-olds in the United States

ObjectiveThe human papillomavirus (HPV) vaccine prevents six types of cancer. Previously, this vaccine was only approved for 9–26-year-olds. However, in October 2018 the U.S. Food and Drug Administration approved the HPV vaccine for 27- to 45-year-olds (mid-adults). The current study aimed to assess HPV vaccination among a national sample of U.S adults aged 27–45 years. This study also assessed factors associated with HPV vaccine initiation after age 26. MethodsData were analyzed using the 2019 National Health Interview Survey. The study included two samples: (1) mid-adults aged 27–45 (n = 8556), and (2) mid-adults who self-reported they had initiated HPV vaccination within the 27–45 age range and those who were unvaccinated (n = 7307). The outcome variables were HPV vaccination status and HPV vaccine initiation. The independent variables represented constructs from Andersen's Behavioral Model of Health Services Use. The odds of HPV vaccination were estimated using weighted multivariable logistic regression models. ResultsOverall, 15.6% had ever received the HPV vaccine and 13.1% initiated their first dose of the vaccine after age 26. Hispanic (aOR = 0.73; 95% CI = 0.58, 0.92) and non-Hispanic Asian persons (aOR = 0.59; 95% CI = 0.41, 0.84) had lower odds of ever receiving the vaccine than non-Hispanic White persons. Females (aOR = 2.17; 95% CI = 1.42, 3.32) had higher odds of initiating the vaccine after age 26 than males. ConclusionsThe ACIP recommendation of shared clinical decision-making emphasizes the role of clinical interactions in HPV vaccine decision-making. Study findings highlight the need to further explore contextual factors that may influence HPV vaccine behavior among mid-adults.

Vaccination strategies in the disease–behavior evolution model

Previous studies on the co-evolving between vaccination strategies and epidemics mainly assumed that the vaccination strategies were made in the period between two spreading seasons. However, individual cognition during the spreading seasons might also alter the vaccination strategy and inversely influence the epidemic spreading. We propose a coupled disease–behavior model to describe the dynamic evolution of vaccination behavior during the spread of infectious diseases. The model integrates a susceptible–infected–vaccinated (SIV) model with the diffusion of vaccination behavior. We focus on the trade-off between perceptions of infection risk and the vaccination behaviors of neighbors, characterizing individual vaccination opinions. We introduce an opinion-critical value to map vaccination opinions into vaccination behavior. The vaccination coverage of the disease–behavior model is studied in network models and real-world networks. In addition, when societal costs are measured based on the degree of initial vaccinees, the cost of randomly selecting initial vaccinees is lower than selecting individuals with high or low degrees as vaccinees. Evaluating an individual’s ability to transmit vaccination behavior based on the neighbor’s number is inappropriate. We find that the impact of effective spreading rates on group vaccination is not one-sided and that reducing fear and highlighting the dangers of infectious diseases are crucial to increasing vaccination coverage.