Understanding the shift in COVID-19 vaccine hesitancy and its associated factors for primary and booster doses among university students: A cross-sectional study
Bibliographic record
Abstract
BACKGROUND: Vaccine hesitancy (VH) poses a major challenge to achieving high COVID-19 vaccination rates. Universities, with mandatory primary dose policies but optional boosters, offer a unique setting to study VH dynamics. This study aimed to estimate COVID-19 VH prevalence and identify key factors influencing VH across primary and booster doses among university students. METHODS: In this cross-sectional study, all actively enrolled students at the University of Waterloo, Ontario, Canada, during Winter 2024 were invited to complete an online survey. Means and standard deviations were calculated for VH scores and proportions were calculated for the binary VH. Differences were compared using paired t-tests and chi-square. Generalized Estimating Equations was applied to model changes in VH scores from primary to boosters and identify key predictors of VH. Interaction terms were tested to evaluate dose-specific effects on VH. RESULTS: Among 4453 respondents, VH prevalence increased from 17 % for primary doses to 33.4 % for boosters, with higher VH scores for boosters (Mean ± SD: 10.9 ± 8.1) than primary doses (Mean ± SD: 7.3 ± 7.1). Women (aOR = 1.06, 95 % CI 1.01-1.11) and younger students (aOR = 1.62, 95 % CI 1.25-2.10) showed the largest VH increases, especially for boosters. Students with low perceived risk, negative perceptions of boosters' safety and effectiveness, low intention to follow government recommendations, and no prior flu or meningococcal vaccination exhibited the greatest VH increases when shifting from primary to booster doses. Conversely, students with no religious affiliation and those whose decisions were unaffected by mandates showed smaller changes in VH. CONCLUSION: The rise in VH from primary to booster doses appears driven by demographic, psychological, and behavioral factors. Tailored interventions that promote clear communication, improve access, and strengthen confidence in booster recommendations rather than reliance on mandates are critical for reducing VH and sustaining vaccine uptake in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".