Background
While there have been many devastations from COVID-19, a high prevalence of food insufficiency has been reported, even in developed countries such as the United States (US).4 Low and very low food sufficiency in the US has fluctuated during the COVID-19 pandemic, hitting record highs in December 2020 at 13.4% and bouncing between 8% and 10% thereafter.5 Some documented barriers of vaccination behaviors include social determinants of health (SDoH) such as lack of education and economic, food, or employment insecurity.1-3 Improving COVID-19 vaccination rates will require considerations of these SDoH. The purpose of this project is to examine the association of food insufficiency, a SDoH with vaccine hesitancy among adults in the US.
Methods
In response to the COVID-19 pandemic, Federal agencies created the biweekly, online Household Pulse Survey (HPS) to track social outcomes of the pandemic in the U.S.4 We performed cross-sectional analysis with data from the HPS collected between March 30, 2022, and April 11, 2022 (Week 44). Data on adults without missing data on food sufficiency or vaccine status or vaccine intent (N=56,680, weighted N=211,114,790) were used. In our study, vaccine hesitancy was measured based on two questions whether or not the individual received COVID-19 vaccine and intention to get vaccine. We classified individuals as "vaccine hesitant" if their responses for intention to get the vaccine were: probably, not sure, probably not, and definitely not receiving the vaccine. Individuals who received the vaccine and those who responded "definitely will get the vaccine" were classified as vaccine non-hesitant. Any food sufficiency was measured as a binary variable (Yes/no) based on the question that best described the food eaten in the household the last 7 days. Adults who reported "sometimes not enough," and "often not enough," were classified as food insufficient.7 Chi-square tests and multivariable logistic regressions were conducted using replicate weights with SAS. Multivariable logistic regressions adjusted for food insufficiency, sex, age, race and ethnicity, income, education, COVID-19 infection, health insurance, children under 17 years in the household, remote work, health worker status, functional status, and mental health.
Results: During March 30, 2022, and April 11, 2022, 11.2% reported food insufficiency.7 A higher percentage of adults with food insufficiency were vaccine hesitant (25.3% vs 12.3%, p < .01). After adjusting for sex, age, race, ethnicity, COVID-19 infection history, and marital status, those with food insufficiency were more likely to be vaccine hesitant (AOR = 1.69, 95% CI = 1.05, 2.73) compared to those with food sufficiency. However, when we controlled for education, the association became insignificant (AOR = 1.36, 95% CI = 0.83, 2.23). In the fully adjusted model, it remained insignificant (AOR = 1.23, 95% CI = 0.73-2.10).
Conclusion: Overall, more than 1 in 10 adults reported food insufficiency, which was associated with vaccine hesitancy. Education mediated the relationship between food insufficiency and vaccine hesitancy.
Implication: Policies and programs to improve vaccination rates need to also focus on food sufficiency.
