Predictors of COVID-19 vaccine uptake and preferences for service delivery among people who inject drugs accessing a syringe service program

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Multiple implementation adaptations have been proposed to address this gap, including offering the vaccines at syringe service programs (SSPs). To inform their implementation at an SSP in Miami, Florida, this study aimed to identify predictors of COVID-19 vaccine uptake and preferences for service delivery among PWID in our context. Methods Between June 2022 and July 2023, we administered a cross-sectional survey based on the Health Belief Model with PWID accessing services at an SSP in Miami, FL (n = 135). Differences in predictor variables were assessed by COVID-19 vaccination status (vaccinated and/or willing to be vaccinated vs. not vaccinated and not willing to be vaccinated) using bivariate analysis. Results Only 65% of participants had received at least one dose of the COVID-19 vaccine series. Predictors of COVID-19 vaccination included older age ( p = 0.01), having a primary healthcare provider ( p = 0.0136), requiring medical care for previous COVID-19 infections ( p = 0.0232), being confident in the US healthcare system (OR = 4.50, 95% CI: 1.96–10.29), and not believing multiple COVID-19 misconceptions ( p < 0.05). Perceived benefit was the only Health Belief Model domain with significantly increased odds of COVID-19 vaccination. Most participants (n = 116, 86%) preferred to receive the COVID-19 vaccine at the SSP, and suggestions for increasing uptake included offering compensation, providing information, utilizing peer outreach systems, providing reminders, and allowing for accelerated vaccination schedules. Discussion Our findings reiterate the potential of SSPs to increase uptake of COVID-19 and other vaccines among PWID and provide insight into implementation adaptations to optimize vaccine uptake, including emphasizing the benefit of vaccines in communication efforts, offering compensation, and leveraging the trusted relationship with SSP staff, particularly peer navigators. Together, this evidence reinforces SSPs’ unique ability to increase engagement with and utilization of preventative care services among PWID, within and beyond the COVID-19 pandemic. Introduction The COVID-19 pandemic, which began in March 2020, was the most disruptive public health event of the current era, causing nearly 7 million deaths as of December 2023 and leading to the largest global economic crisis in over a century ( 1 , 2 ). It is now well-established that people with comorbidities are at increased risk of morbidity and mortality due to COVID-19 ( 3 , 4 ), and there is resounding evidence that racial and ethnic minorities and those with low socioeconomic status are more vulnerable to COVID-19 ( 5 ). People who inject drugs (PWID) have a high burden of comorbidities, experience numerous and substantial barriers to care, and were particularly vulnerable to adverse outcomes in the context of harm reduction service disruptions ( 6 , 7 ). Despite their efficacy in preventing COVID-19 infection and decreasing mortality and morbidity, uptake of COVID-19 vaccines has been suboptimal globally and within the United States (US), with just 66 and 70 people per 100, respectively, receiving a complete primary series as of December 2023 ( 1 , 8 ). In a variety of contexts, vaccination rates have been shown to be associated with poverty, deprivation, race/ethnicity, education, and health insurance ( 9 , 10 ). Often experiencing multiple intersecting disadvantages, PWID are less likely to be vaccinated against COVID-19 and other infectious diseases, such as influenza, hepatitis A, and hepatitis B, compared to the general population ( 11 – 15 ). While COVID-19 vaccine hesitancy in the general US population has been driven by concerns about their safety and side effects, their rapid development, and uncertainty about their effectiveness ( 16 , 17 ), additional concerns among racial and ethnic minorities and those with low socioeconomic status include institutional mistrust, lack of perceived need, and structural barriers to vaccine access ( 18 ). Studies with PWID specifically have identified similar reasons for low vaccine uptake, including stigma and discrimination in healthcare services, competing priorities of higher-order needs, ambivalence regarding perceived susceptibility and severity, and concerns about vaccine side effects ( 12 , 13 , 19 – 25 ). Multiple implementation adaptations have been proposed to increase COVID-19 vaccine uptake among PWID, including offering the vaccines at syringe service programs (SSPs) ( 26 , 27 ). As one of the only culturally competent sources for care among PWID ( 28 ), evidence supports the ability of these programs to increase uptake of and adherence to preventative care. However, despite 87% of SSP leadership in the US believing it would be important to offer onsite vaccinations in 2021, only 44% of programs reported doing so, with many citing the need for additional structural, financial, and personnel support ( 29 – 31 ). To inform the implementation of COVID-19 vaccination services at an SSP in Miami, Florida, this study aimed to identify predictors of COVID-19 vaccine uptake and preferences for service delivery among PWID in our context. Methods Ethics This study was approved by the Institutional Review Board of the University of Miami (IRB#20220657). Informed consent was obtained from each participant. Study setting This study was conducted at the IDEA Miami SSP, which was established in 2016 as the first legal SSP in Florida ( 32 ). As of December 2023, it serves a racially and ethnically diverse population of over 2,300 PWID through its fixed site and mobile unit. The SSP aims to function as a “one-stop-shop” for its participants, supplementing its core syringe exchange services with access to comprehensive care options, including: substance use disorder treatment, if desired; HIV prevention, testing, and treatment; hepatitis C testing and treatment; wound care; medication management; appointment reminders; and support to access social services such as housing and health insurance enrollment ( 33 ). Data collection Between June 2022 and July 2023, a cross-sectional survey was administered to a convenience sample of 135 PWID accessing services at the SSP. Eligibility included 1) 18 years of age or older, 2) participant of the SSP, 3) currently living in Miami-Dade County, 4) able to complete the survey in English, and 5) able to provide informed consent. Participants were compensated $ 25 for completing the survey. The survey was developed based on the Health Belief Model, a psychosocial theory that explains and predicts health behaviors based on the constructs of perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action ( 34 ). The Health Belief Model has been widely utilized to predict COVID-19 preventive behaviors, in general, and COVID-19 vaccine uptake, specifically ( 35 – 37 ). The survey included questions on socio-demographic characteristics, previous COVID-19 infection, COVID-19 vaccination status, knowledge and attitudes, confidence in healthcare systems/institutions, preventative measures, domains of the Health Belief Model, relative concerns, and preferences for COVID-19 vaccine service delivery. Measures of previous COVID-19 infection, COVID-19 vaccination status, and knowledge and attitudes were drawn from the Centers for Disease Control and Prevention’s (CDC) Vaccine Confidence Survey ( 38 ). Measures of knowledge and attitudes were drawn from the Kaiser Family Foundation’s COVID-19 Vaccine Monitor ( 39 ). The measure used for reasons for not receiving a COVID-19 vaccine was drawn from the US Census Bureau’s Household Pulse Survey COVID-19 Vaccination Tracker ( 40 ). We used a total of 23 measures from the CDC’s Vaccine Confidence Survey to assess the Health Belief Model domains of perceived severity (n = 2), susceptibility (n = 3), benefits (n = 4), barriers (n = 11), self-efficacy (n = 1), and cues to action (n = 2) ( 38 ). Data analysis The sample was stratified by COVID-19 vaccination status (vaccinated or willing to be vaccinated vs. not vaccinated and not willing to be vaccinated). Differences in socio-demographic characteristics, knowledge, and attitudes were assessed by COVID-19 vaccination status using bivariate analysis, specifically chi-squared tests and Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. Odds ratios were used to examine the association between other measures and COVID-19 vaccination status. All analyses were performed using SAS University statistical software (Version 9.4; SAS Institute, Cary, NC), and all tests were performed at a significance level of 0.05. Results Socio-demographic characteristics and COVID-19 vaccination status Table 1 summarizes socio-demographic characteristics by COVID-19 vaccination status. The majority of participants were male (74%), straight or heterosexual (88%), had a high school education or higher (83%), were not stably employed (87%), and were unhoused or in temporary housing (83%). Older age (p = 0.0136), having a primary healthcare provider (p = 0.0208), and requiring higher levels of medical care for previous COVID-19 infections (p = 0.0232) were significantly associated with being vaccinated or willing to be vaccinated against COVID-19. Table 2 summarizes participants’ COVID-19 vaccination status. Most participants had received at least one dose of a COVID-19 vaccine (65%), the most common sources being the local SSP (44%) and pharmacies or drug stores (28%). Among participants who had not yet received the COVID-19 vaccines, 30% were probably or definitely willing to be vaccinated. Nearly half of those not yet vaccinated reported compensation as a potential motivator for receiving the vaccines. Table 1 Sociodemographic characteristics Total sample Not vaccinated and not willing to be vaccinated (n = 33) (n,%) Vaccinated or willing to be vaccinated (n = 102) (n,%) P-value Age (median, IQR) 40 ( 35 – 50 ) 37 ( 34 – 43 ) 42 ( 36 – 51 ) 0.0136 Biological sex (n,%) 0.2048 Male 99 (73.3) 27 (27.3) 72 (72.7) Female 36 (26.7) 6 (16.7) 30 (83.3) Sexual orientation (n,%) 0.7788 Straight or heterosexual 119 (88.2) 31 (26.0) 88 (74.0) Gay or lesbian 8 (5.9) 1 (12.5) 7 (87.5) Bisexual 7 (5.2) 1 (14.3) 6 (85.7) Something else 1 (0.7) 0 (0) 1 (100) Race (n,%) 0.8231 Non-Hispanic White 64 (47.4) 18 (28.1) 46 (71.9) Non-Hispanic Black 18 (13.3) 3 (16.7) 15 (83.3) Hispanic 48 (35.6) 11 (22.9) 37 (77.1) Other 5 (3.7) 1 (20.0) 4 (80.0) Highest level of education (n,%) 0.8405 <High school/GED 23 (17.0) 6 (26.1) 17 (73.9) ≥High school/GED 112 (83.0) 27 (24.1) 85 (75.9) Employment status (n,%) 0.7630 Stably employed 17 (12.6) 3 (17.7) 14 (82.4) Not stably employed 118 (87.4) 30 (25.4) 88 (74.6) Housing status (n,%) 0.6787 Unhoused 73 (54.1) 18 (24.7) 55 (75.3) Temporary housing 39 (28.9) 8 (20.5) 31 (79.5) Permanent housing 23 (17.0) 7 (30.4) 16 (69.6) Insurance status (n,%) 0.1444 Insured 84 (62.2) 17 (20.2) 67 (79.8) Uninsured or unsure 51 (37.8) 16 (31.4) 35 (68.6) Has a primary healthcare provider (n,%) 0.0208 Yes 56 (41.5) 8 (14.3) 48 (85.7) No or unsure 79 (58.5) 25 (31.7) 54 (68.4) Underlying health condition (n,%) 0.2528 Yes 87 (64.4) 24 (27.6) 63 (72.4) No 48 (35.6) 9 (18.8) 39 (81.2) Previous COVID-19 infection (n,%) 0.9923 Yes 41 (30.4) 10 (24.4) 31 (75.6) No or unsure 94 (69.6) 23 (24.5) 71 (75.5) Utilization of medical services for previous COVID-19 infection (n,%) 0.0232 Did not seek medical care 20 (48.8) 8 (40.0) 12 (60.0) Received medical care but was not hospitalized 12 (29.3) 0 (0) 12 (100) Was hospitalized 9 (21.9) 2 (22.2) 7 (77.8) Table 2 COVID-19 vaccination status Total sample (n,%) Vaccinated against COVID-19 (at least one dose) 88 (65.2) Number of doses 1 24 (27.3) 2 32 (36.4) 3 28 (31.8) 4 4 (4.5) Source of COVID-19 vaccine(s) SSP 39 (44.3) Pharmacy or drug store 25 (28.4) Health department clinic 9 (10.2) Pop-up vaccination site 5 (5.7) Hospital 4 (4.5) Primary care office 2 (2.3) County vaccination site 2 (2.3) Workplace 1 (1.1) Other 13 (14.8) Motivation for receiving the COVID-19 vaccine(s) To protect my health 58 (65.9) To protect the health of my family/friends 44 (50.0) To protect the health of my community 34 (38.6) Because my family/friends encouraged me 29 (32.9) Because a doctor, nurse, or other health provider encouraged me 25 (28.4) Because SSP staff encouraged me 24 (27.3) To resume social activities 20 (22.7) To resume travel 15 (17.0) To resume work/school 13 (14.8) To stay in temporary housing/a shelter 10 (11.4) Likely/very likely to recommend the COVID-19 vaccines to others 70 (79.5) Likely/very likely to get additional doses of the COVID-19 vaccines 63 (71.6) Not vaccinated against COVID-19 47 (34.8) Willingness to receive the COVID-19 vaccine(s) Definitely willing/probably willing 14 (29.8) Definitely not willing/probably not willing/uncertain 33 (70.2) Reasons for not receiving the COVID-19 vaccine(s) Don’t trust COVID-19 vaccines specifically 23 (48.9) Don’t believe I need the COVID-19 vaccines 21 (44.7) Concerned about feeling sick from side effects 17 (36.2) Don’t trust the government 13 (27.7) Don’t know if the COVID-19 vaccines would protect me 12 (25.5) Don’t trust any vaccines 11 (23.4) Potential motivations for receiving the COVID-19 vaccine(s) If I can get compensated 23 (48.9) To protect my health 20 (42.5) To protect the health of my family/friends 19 (40.4) If SSP staff encourages me 16 (34.0) Knowledge and beliefs A substantial percentage of participants believed that the government is exaggerating (40%) or hiding (47%) the number of deaths due to COVID-19 (Table S1). Likewise, many participants either believed or were unsure about the following: that COVID-19 vaccines can cause COVID-19 (66%), sudden death syndrome (67%) or infertility (72%), and that they should not be given to pregnant women (68%). Participants were significantly less likely to be vaccinated or willing to be vaccinated if they believed or were unsure about the following: that COVID-19 vaccines can cause sudden death syndrome (p = 0.0010) or infertility (p = 0.0024), should not be given to pregnant women (p = 0.0397), and contain microchips (p = 0.0082). Confidence in the US healthcare system and the local hospital system was low, with approximately one in three participants (34% and 30%, respectively) expressing a lack of confidence in the ability of the systems to care for their health (Table S2). Meanwhile, nearly all participants (97%) believed in the ability of the local SSP to care for their health. Participants who were fairly or very confident in the ability of the US healthcare system to care for their health (OR = 4.50, 95% CI: 1.96, 10.29) and that the US healthcare system would give them the best possible care (OR = 3.21, 95% CI: 1.39, 7.42) had higher odds of vaccination or willingness to be vaccinated. Health Belief Model constructs Table 3 describes the Health Belief Model domains, items, and associated odds ratios by COVID-19 vaccination status. Participants’ perceived susceptibility was low, with 5% and 36% of participants believing it was likely or very likely that they or someone they knew would get COVID-19 in the next 12 months, respectively. Perceived severity was high, with 30% and 40% of participants believing it was likely or very likely that they would have long-term health or economic consequences if they got COVID-19, respectively. Half of participants (50%) reported knowing someone who became seriously ill or died due to COVID-19. However, a majority of participants responded that they were more worried about the following than COVID-19: having a safe place to sleep (74%), getting attacked/assaulted/robbed (73%), developing a skin or soft tissue infection (69%), having enough food to eat (66%), experiencing an overdose (66%), getting arrested (64%), having enough new/unused syringes for each injection (59%), and acquiring pneumonia (56%), HIV (54%), and Hepatitis C (53%) (Table S3). Responses regarding perceived benefits were mixed, with 52% of participants believing it is likely or very likely that COVID-19 vaccines reduce the chance of infection, 62% percent and 63% of participants believed it is likely or very likely that COVID-19 vaccines reduce the chance of hospitalization and prevent people from spreading COVID-19 to others, respectively, and 68% believing it is likely or very likely that COVID-19 vaccines reduce the severity and chance of having complications. Perceived barriers were minimal, with 93% of participants reporting that they experienced (or would experience) no challenges in accessing the COVID-19 vaccines. Self-efficacy was correspondingly high, with 91% of participants reporting that it was easy (or would be easy) for them to access the COVID-19 vaccines. Cues to action were reported by the majority of participants, with 66% reporting enough information about the COVID-19 vaccines. Participants’ top three most trusted sources of information about COVID-19 vaccines were the local SSP (70%), doctors (62%), and the CDC (34%). The least frequently trusted sources of information were religious leaders (1%), employers (2%), and health insurance companies (6%). Table 3 Odds of vaccination and/or willingness to be vaccinated by Health Belief Model constructs Domain Item Not vaccinated and not willing to be vaccinated (n = 33) (n,%) Vaccinated or willing to be vaccinated (n = 102) (n,%) Odds ratio (95% CI) Perceived susceptibility It is likely/very likely that I will get COVID-19 in the next 12 months. 2 (6.1) 5 (4.9) 0.80 (0.15, 4.33) It is likely/very likely that someone I know will get COVID-19 in the next 12 months. 11 (33.3) 38 (37.3) 1.19 (0.52, 2.72) Perceived severity If I get COVID-19, it is likely/very likely that I will have long-term health consequences. 7 (21.2) 33 (32.4) 1.78 (0.70, 4.51) If I get COVID-19, it is likely/very likely that I will have long-term economic consequences. 15 (45.5) 39 (38.3) 0.74 (0.33, 1.64) I know someone who became seriously ill or died due to COVID-19. 18 (54.6) 49 (48.0) 0.77 (0.35, 1.69) Perceived benefits It is likely/very likely that COVID-19 vaccines reduce the chance of infection. 11 (33.3) 59 (57.8) 2.74 (1.20, 6.25) It is likely/very likely that COVID-19 vaccines reduce the severity and chance of having complications. 15 (45.5) 77 (75.5) 3.70 (1.63, 8.40) It is likely/very likely that COVID-19 vaccines reduce the chance of hospitalization. 14 (42.4) 72 (70.6) 3.26 (1.45, 7.33) It is likely/very likely that COVID-19 vaccines prevent people from spreading COVID-19 to others. 12 (36.4) 73 (71.6) 4.41 (1.92, 10.10) Perceived barriers Difficulty finding out where to get vaccinated. 2 (6.1) 2 (2.0) 0.31 (0.04, 2.29) Difficulty making an appointment. 1 (3.0) 7 (6.9) 2.36 (0.28, 19.91) Difficulty getting to the location on my own. 2 (6.1) 3 (2.9) 0.47 (0.08, 2.94) Long distance/travel time to the location. 2 (6.1) 3 (2.9) 0.47 (0.08, 2.94) Difficulty accessing transportation. 4 (12.1) 4 (3.9) 0.30 (0.07, 1.26) Inconvenient hours of operation. 2 (6.1) 1 (1.0) 0.15 (0.01, 1.75) Long waiting times. 3 (2.2) 8 (7.8) 0.85 (0.21, 3.41) Too busy. 2 (6.1) 10 (9.8) 1.68 (0.35, 8.11) Judgment/mistreatment at the service delivery point. 2 (6.1) 4 (3.9) 0.63 (0.11, 3.62) Substance use getting in the way. 8 (24.2) 17 (16.7) 0.63 (0.24, 1.62) Mental health getting in the way. 2 (6.1) 6 (5.9) 0.97 (0.19, 5.05) Self-efficacy It is easy/very easy to get the COVID-19 vaccine. 29 (87.9) 94 (92.2) 1.62 (0.46, 5.77) Cues to action I have enough information on the COVID-19 vaccines. 20 (60.6) 69 (67.7) 1.36 (0.60, 3.06) I know where to go to get accurate, timely information about COVID-19 vaccines. 23 (69.7) 82 (80.4) 1.78 (0.73, 4.34) Preferences for COVID-19 vaccine service delivery Of the total 135 participants, 116 (86%) preferred to receive the COVID-19 vaccines at the local SSP than at other service delivery locations. The most common reasons for preferring the local SSP were trust in the SSP (45%), the SSP’s friendly and/or non-judgmental staff (39%), and participants went there often for other reasons (38%). Most participants suggested that COVID-19 vaccines be offered on-demand (80%) and at both the fixed site and on the mobile unit (89%). Additional suggestions for improving COVID-19 vaccine uptake included offering compensation (66%), providing more information (59%), using a peer outreach system (44%), calling/texting people to remind them to get additional doses (32%), and allowing for an accelerated/abbreviated vaccination schedule (26%). Discussion In this study, conducted during implementation of onsite COVID-19 vaccine services at an SSP in Miami, FL, only 65% of PWID had received at least one dose of the COVID-19 vaccines compared to 81% of the general US population ( 41 ), yet 30% of unvaccinated participants were probably/definitely willing to receive the vaccine. In contrast to previous research among marginalized populations in which structural barriers to vaccine access were a major contributor to low vaccine uptake ( 18 ), participants in our study reported low perceived barriers and high self-efficacy to accessing COVID-19 vaccines. Instead, reasons for not receiving the vaccines centered around trust and confidence in their safety and efficacy. Meanwhile, participants expressed high levels of confidence in the ability of the local SSP to care for their health and a strong preference for receiving the COVID-19 vaccines at the SSP as opposed to other locations, thus demonstrating the potential of SSPs to bridge this healthcare service utilization gap. While the urgency around COVID-19 has waned with the pandemic’s evolution, it remains a useful case study to examine risk perception and engagement with novel healthcare interventions through the lens of the Health Belief Model. Three interesting observations emerge from this analysis. First, of the model’s six domains, perceived benefit was the only significant predictor of COVID-19 vaccine uptake among PWID in our setting. This aligns with existing literature, wherein this domain is the most frequently significant predictor of both COVID-19 preventive behavior and vaccine hesitancy ( 35 , 36 ), and with our findings that belief in various COVID-19 vaccine misconceptions was associated with lower odds of vaccination and/or willingness to be vaccinated. Second, our findings suggest that PWID in our setting may overestimate the accuracy of their knowledge about COVID-19, since many participants reported having sufficient cues to action (i.e., information about the COVID-19 vaccines and accurate and timely information sources), despite believing or being unsure about multiple COVID-19 vaccine misconceptions. Third, PWID’s perceived susceptibility was low and divergent between self and others despite their increased risk for adverse outcomes ( 6 , 7 ), demonstrating the bias blind spot, where individuals perceive others as more susceptible to risk than themselves ( 42 ). Likewise, although many participants required hospitalization for previous COVID-19 infections (22%), believed they would likely have long-term health and economic consequences (30% and 40% respectively), and knew someone who became seriously ill or died due to COVID-19 (50%), perceived severity was not associated with an increased odds of being vaccinated or willing to be vaccinated. We hypothesize that this discordance may be a result of the numerous other significant threats that PWID face daily, as exemplified by the many sources of concern they prioritized over COVID-19 and by the “marked ambivalence” towards COVID-19 identified in other studies with PWID ( 12 , 19 ). Beyond the context of COVID-19, this study reiterates the untapped potential of SSPs in increasing vaccine uptake among PWID, more generally. As one of the only trusted sources of care among PWID ( 43 ), SSPs are positioned to meet PWID needs and preferences and increase vaccine uptake, with the added potential of reducing gaps in health equity ( 44 , 45 ) and burden on the healthcare system ( 46 – 48 ). More than 30 years of programmatic experience demonstrate the feasibility and acceptability of offering vaccines for hepatitis A, hepatitis B, influenza, pneumococcus, and meningitis to PWID at SSPs ( 29 , 48 – 52 ). Likewise, studies have identified numerous implementation adaptations to optimize onsite vaccination services, including offering modest financial incentives and accelerated vaccination schedules ( 53 – 56 ). Our findings add to this evidence base by echoing the call for these implementation adaptations and by contributing additional suggestions, such as offering them on-demand at fixed and mobile SSP sites, providing more information focused on the benefits of vaccination, using peer outreach systems, and calling/texting people to remind them to get additional doses. Despite this evidence and strong consensus among SSP leadership of the importance of offering onsite vaccination services, only 44% of SSPs in the US did so in 2021( 29 ). Nearly all these SSPs offered COVID-19 vaccines (91%); approximately three quarters offered the hepatitis A (76%), influenza (73%), and hepatitis B vaccines (71%); and more than half offered tetanus vaccines (57%). The SSPs rarely received grants to cover vaccine costs; instead, most received their vaccines from the health department. The majority of SSPs were able to access their state’s immunization information system to review participants’ vaccination histories and submit vaccine administration data. The most reported staffing need was for personnel licensed to administer vaccines, and the most reported resource need was reminder/recall systems for vaccines with multidose series. Given PWID’s increased risk for hepatitis A and B and their increased likelihood of experiencing adverse outcomes with infections like influenza, pneumococcus, and meningitis due to their high burden of comorbidities and barriers to care, there is a clear need for technical and financial assistance to support more SSPs to implement onsite vaccination services, including for COVID-19, and to optimize and sustain onsite vaccination services at SSPs post-implementation. Several limitations should be considered within this study. Participants were recruited from a single SSP site in Miami, FL and were limited to English speakers in a particularly diverse area ( 57 ), potentially excluding different perspectives and lived experiences. The SSP also received dedicated funding to support implementation of onsite COVID-19 vaccination services, a notable facilitator within SSPs due to their historic lack of resources ( 58 – 60 ). Finally, data collection for this project was completed between June 2022 and July 2023, during which pandemic fatigue ( 61 ) and the Department of Health and Human Services (HHS) official end to the COVID-19 Public Health Emergency ( 62 ) led to relaxed utilization of COVID-19 preventative measures, which may have skewed participant responses ( 63 ). Though SSP program operations and regulations vary by state and county, potentially limiting generalizability, the positioning of SSPs as a trusted source for stigma-free care among patients is generally consistent due to the nature of harm reduction work ( 43 , 64 , 65 ). Conclusions The findings from this survey reiterate the potential of SSPs to increase uptake of COVID-19 and other vaccines among PWID and provide insight into implementation adaptations to optimize vaccine uptake, including emphasizing the benefit of vaccines in communication efforts, offering compensation, and leveraging the trusted relationship with SSP staff, particularly peer navigators. Together, this evidence reinforces SSP’s unique ability to increase engagement and utilization of preventative care services among PWID, within and beyond the COVID-19 pandemic. Abbreviations CDC Centers for Disease Control and Prevention COVID-19 Coronavirus disease 2019 PWID People who inject drugs SSP Syringe services program US United States Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of the University of Miami (IRB # 20220452). Informed consent was obtained from all participants included in this study. Consent for publication Not applicable. Availability of data and materials Data and materials are available upon request to the corresponding author. Competing interests The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: TSB and HET receive research funding from Gilead Sciences. Funding This work was supported by the Department of Health & Human Services / NASTAD (Grant no. NU38OT000285; PI: Tyler Bartholomew). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health & Human Services / NASTAD. Authors' contributions TSB, HET, and MP designed the study. TSB, HET, MP, and MF designed and led study recruitment. MF administered the survey and MP analyzed the survey responses. MP, ES, and SSS prepared a draft of the manuscript. TSB, HET, and MF reviewed the manuscript and provided substantial feedback. All authors read and approved the final manuscript. Acknowledgements We would like to express heartfelt thanks to the staff and participants of the IDEA Miami SSP for their contributions to this study, and for being an inspiration for all our work at IDEA. References World Health Organization. WHO Coronavirus (COVID-19) Dashboard Geneva: World Health Organization; [Available from: https://covid19.who.int/. World Bank. World Development Report 2022. Washington DC: World Bank; 2023. Russell CD, Lone NI, Baillie JK. 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Tookes H, Bartholomew TS, St Onge JE, Ford H. The University of Miami Infectious Disease Elimination Act Syringe Services Program: A Blueprint for Student Advocacy, Education, and Innovation. Acad Med. 2021;96(2):213-7. Bartholomew TS, Andraka-Cristou B, Totaram RK, Harris S, Doblecki-Lewis S, Ostrer L, et al. "We want everything in a one-stop shop": acceptability and feasibility of PrEP and buprenorphine implementation with mobile syringe services for Black people who inject drugs. Harm Reduct J. 2022;19(1):133. Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Health Education Monographs. 1974;2(4):354-86. Zewdie A, Mose A, Sahle T, Bedewi J, Gashu M, Kebede N, et al. The health belief model's ability to predict COVID-19 preventive behavior: A systematic review. SAGE Open Med. 2022;10:20503121221113668. Limbu YB, Gautam RK, Pham L. The Health Belief Model Applied to COVID-19 Vaccine Hesitancy: A Systematic Review. Vaccines (Basel). 2022;10(6). Yenew C, Dessie AM, Gebeyehu AA, Genet A. Intention to receive COVID-19 vaccine and its health belief model (HBM)-based predictors: A systematic review and meta-analysis. Hum Vaccin Immunother. 2023;19(1):2207442. Centers for Disease Control and Prevention (CDC). COVID-19 Vaccine Confidence: Rapid Community Assessment Tool. Atlanta: U.S. Department of Health and Human Services. Kaiser Family Foundation. KFF COVID-19 Vaccine Monitor. San Francisco: Kaiser Family Foundation. National Center for Health Statistics. Household Pulse Survey: COVID-19 Vaccination Tracker. Washington D.C.: United States Census Bureau; 2021. Prevention CfDCa. COVID Data Tracker. Pronin E, Lin DY, Ross L. The Bias Blind Spot: Perceptions of Bias in Self Versus Others. Personality and Social Psychology Bulletin. 2002;28(3):369-81. Des Jarlais DC. Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduct J. 2017;14(1):51. Brownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implementation Science. 2021;16(1):28. Estrada LV, Levasseur JL, Maxim A, Benavidez GA, Pollack Porter KM. Structural Racism, Place, and COVID-19: A Narrative Review Describing How We Prepare for an Endemic COVID-19 Future. Health Equity. 2022;6(1):356-66. Coye AE, Bornstein KJ, Bartholomew TS, Li H, Wong S, Janjua NZ, et al. Hospital Costs of Injection Drug Use in Florida. Clin Infect Dis. 2021;72(3):499-502. Bornstein KJ, Coye AE, St Onge JE, Li H, Muller A, Bartholomew TS, et al. Hospital admissions among people who inject opioids following syringe services program implementation. Harm Reduct J. 2020;17(1):30. Hu Y, Grau LE, Scott G, Seal KH, Marshall PA, Singer M, et al. Economic evaluation of delivering hepatitis B vaccine to injection drug users. Am J Prev Med. 2008;35(1):25-32. Stancliff S, Salomon N, Perlman DC, Russell PC. Provision of influenza and pneumococcal vaccines to injection drug users at a syringe exchange. J Subst Abuse Treat. 2000;18(3):263-5. Weiss D, Stern EJ, Zimmerman C, Bregman B, Yeung A, Das D, et al. Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in Brooklyn, New York. Clin Infect Dis. 2009;48(7):894-901. Update: syringe exchange programs--United States, 1998. MMWR Morb Mortal Wkly Rep. 2001;50(19):384-7. Alanko Blomé M, Björkman P, Flamholc L, Jacobsson H, Widell A. Vaccination against hepatitis B virus among people who inject drugs - A 20 year experience from a Swedish needle exchange program. Vaccine. 2017;35(1):84-90. Des Jarlais DC, Fisher DG, Newman JC, Trubatch BN, Yancovitz M, Paone D, et al. Providing hepatitis B vaccination to injection drug users: referral to health clinics vs on-site vaccination at a syringe exchange program. Am J Public Health. 2001;91(11):1791-2. Altice FL, Bruce RD, Walton MR, Buitrago MI. Adherence to hepatitis B virus vaccination at syringe exchange sites. J Urban Health. 2005;82(1):151-61. Topp L, Day CA, Wand H, Deacon RM, van Beek I, Haber PS, et al. A randomised controlled trial of financial incentives to increase hepatitis B vaccination completion among people who inject drugs in Australia. Prev Med. 2013;57(4):297-303. Bowman S, Grau LE, Singer M, Scott G, Heimer R. Factors associated with hepatitis B vaccine series completion in a randomized trial for injection drug users reached through syringe exchange programs in three US cities. BMC Public Health. 2014;14:820. Carter PM, Lynch A. Multilingual Miami: Current Trends in Sociolinguistic Research. Language and Linguistics Compass. 2015;9(9):369-85. Facente SN, Humphrey JL, Akiba C, Patel SV, Wenger LD, Tookes H, et al. Funding and Delivery of Syringe Services Programs in the United States, 2022. American Journal of Public Health. 2024;114(4):435-43. Akiba CF, Smith J, Wenger LD, Morris T, Patel SV, Bluthenthal RN, et al. Financial barriers, facilitators, and strategies among syringe services programs in the U.S., and their impact on implementation and health outcomes. SSM - Qualitative Research in Health. 2024;5:100421. Wenger LD, Kral AH, Bluthenthal RN, Morris T, Ongais L, Lambdin BH. Ingenuity and resiliency of syringe service programs on the front lines of the opioid overdose and COVID-19 crises. Transl Res. 2021;234:159-73. Haktanir A, Can N, Seki T, Kurnaz MF, Dilmaç B. Do we experience pandemic fatigue? current state, predictors, and prevention. Curr Psychol. 2022;41(10):7314-25. Affairs ASfP. HHS Secretary Xavier Becerra Statement on End of the COVID-19 Public Health Emergency U.S. Department of Health and Human Services2023 [updated May 11, 2023. Available from: https://www.hhs.gov/about/news/2023/05/11/hhs-secretary-xavier-becerra-statement-on-end-of-the-covid-19-public-health-emergency.html. Hita MLR, Grégoire Y, Lussier B, Boissonneault S, Vandenberghe C, Sénécal S. An extended health belief model for COVID-19: understanding the media-based processes leading to social distancing and panic buying. Journal of the Academy of Marketing Science. 2023;51(1):132-52. Biancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, et al. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug and Alcohol Dependence. 2019;198:80-6. Moore KE, Wyatt JP, Phillips S, Burke C, Bellamy C, McKee SA. The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis. Health Justice. 2023;11(1):25. Additional Declarations No competing interests reported. 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Tookes","email":"","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hansel","middleName":"E.","lastName":"Tookes","suffix":""},{"id":492013232,"identity":"b2fde90f-a589-4392-ae54-1e4c29b87c6e","order_by":5,"name":"Tyler S. Bartholomew","email":"","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tyler","middleName":"S.","lastName":"Bartholomew","suffix":""}],"badges":[],"createdAt":"2025-07-21 17:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7179978/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7179978/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12954-026-01431-z","type":"published","date":"2026-03-15T16:00:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104740957,"identity":"de20e70b-430e-4b59-8ebd-c6991898ebbe","added_by":"auto","created_at":"2026-03-16 16:19:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1225986,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7179978/v1/c174b85b-4444-42f2-b395-2b83ac1ae8bc.pdf"},{"id":88021468,"identity":"d3d0fc33-aa53-4c57-af2f-fe8a69ed7763","added_by":"auto","created_at":"2025-07-31 13:54:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20916,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-7179978/v1/0edb7200047a50fc2a170cc0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictors of COVID-19 vaccine uptake and preferences for service delivery among people who inject drugs accessing a syringe service program","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe COVID-19 pandemic, which began in March 2020, was the most disruptive public health event of the current era, causing nearly 7\u0026nbsp;million deaths as of December 2023 and leading to the largest global economic crisis in over a century (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is now well-established that people with comorbidities are at increased risk of morbidity and mortality due to COVID-19 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), and there is resounding evidence that racial and ethnic minorities and those with low socioeconomic status are more vulnerable to COVID-19 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). People who inject drugs (PWID) have a high burden of comorbidities, experience numerous and substantial barriers to care, and were particularly vulnerable to adverse outcomes in the context of harm reduction service disruptions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite their efficacy in preventing COVID-19 infection and decreasing mortality and morbidity, uptake of COVID-19 vaccines has been suboptimal globally and within the United States (US), with just 66 and 70 people per 100, respectively, receiving a complete primary series as of December 2023 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In a variety of contexts, vaccination rates have been shown to be associated with poverty, deprivation, race/ethnicity, education, and health insurance (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Often experiencing multiple intersecting disadvantages, PWID are less likely to be vaccinated against COVID-19 and other infectious diseases, such as influenza, hepatitis A, and hepatitis B, compared to the general population (\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile COVID-19 vaccine hesitancy in the general US population has been driven by concerns about their safety and side effects, their rapid development, and uncertainty about their effectiveness (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), additional concerns among racial and ethnic minorities and those with low socioeconomic status include institutional mistrust, lack of perceived need, and structural barriers to vaccine access (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Studies with PWID specifically have identified similar reasons for low vaccine uptake, including stigma and discrimination in healthcare services, competing priorities of higher-order needs, ambivalence regarding perceived susceptibility and severity, and concerns about vaccine side effects (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMultiple implementation adaptations have been proposed to increase COVID-19 vaccine uptake among PWID, including offering the vaccines at syringe service programs (SSPs) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). As one of the only culturally competent sources for care among PWID (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), evidence supports the ability of these programs to increase uptake of and adherence to preventative care. However, despite 87% of SSP leadership in the US believing it would be important to offer onsite vaccinations in 2021, only 44% of programs reported doing so, with many citing the need for additional structural, financial, and personnel support (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e–\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). To inform the implementation of COVID-19 vaccination services at an SSP in Miami, Florida, this study aimed to identify predictors of COVID-19 vaccine uptake and preferences for service delivery among PWID in our context.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEthics\u003c/span\u003e\u003c/p\u003e\u003cp\u003e This study was approved by the Institutional Review Board of the University of Miami (IRB#20220657). Informed consent was obtained from each participant.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStudy setting\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted at the IDEA Miami SSP, which was established in 2016 as the first legal SSP in Florida (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). As of December 2023, it serves a racially and ethnically diverse population of over 2,300 PWID through its fixed site and mobile unit. The SSP aims to function as a “one-stop-shop” for its participants, supplementing its core syringe exchange services with access to comprehensive care options, including: substance use disorder treatment, if desired; HIV prevention, testing, and treatment; hepatitis C testing and treatment; wound care; medication management; appointment reminders; and support to access social services such as housing and health insurance enrollment (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData collection\u003c/span\u003e\u003c/p\u003e\u003cp\u003eBetween June 2022 and July 2023, a cross-sectional survey was administered to a convenience sample of 135 PWID accessing services at the SSP. Eligibility included 1) 18 years of age or older, 2) participant of the SSP, 3) currently living in Miami-Dade County, 4) able to complete the survey in English, and 5) able to provide informed consent. Participants were compensated \u003cspan\u003e$\u003c/span\u003e25 for completing the survey.\u003c/p\u003e\u003cp\u003eThe survey was developed based on the Health Belief Model, a psychosocial theory that explains and predicts health behaviors based on the constructs of perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The Health Belief Model has been widely utilized to predict COVID-19 preventive behaviors, in general, and COVID-19 vaccine uptake, specifically (\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e–\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe survey included questions on socio-demographic characteristics, previous COVID-19 infection, COVID-19 vaccination status, knowledge and attitudes, confidence in healthcare systems/institutions, preventative measures, domains of the Health Belief Model, relative concerns, and preferences for COVID-19 vaccine service delivery. Measures of previous COVID-19 infection, COVID-19 vaccination status, and knowledge and attitudes were drawn from the Centers for Disease Control and Prevention’s (CDC) Vaccine Confidence Survey (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Measures of knowledge and attitudes were drawn from the Kaiser Family Foundation’s COVID-19 Vaccine Monitor (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The measure used for reasons for not receiving a COVID-19 vaccine was drawn from the US Census Bureau’s Household Pulse Survey COVID-19 Vaccination Tracker (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). We used a total of 23 measures from the CDC’s Vaccine Confidence Survey to assess the Health Belief Model domains of perceived severity (n = 2), susceptibility (n = 3), benefits (n = 4), barriers (n = 11), self-efficacy (n = 1), and cues to action (n = 2) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe sample was stratified by COVID-19 vaccination status (vaccinated or willing to be vaccinated vs. not vaccinated and not willing to be vaccinated). Differences in socio-demographic characteristics, knowledge, and attitudes were assessed by COVID-19 vaccination status using bivariate analysis, specifically chi-squared tests and Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. Odds ratios were used to examine the association between other measures and COVID-19 vaccination status. All analyses were performed using SAS University statistical software (Version 9.4; SAS Institute, Cary, NC), and all tests were performed at a significance level of 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSocio-demographic characteristics and COVID-19 vaccination status\u003c/span\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes socio-demographic characteristics by COVID-19 vaccination status. The majority of participants were male (74%), straight or heterosexual (88%), had a high school education or higher (83%), were not stably employed (87%), and were unhoused or in temporary housing (83%). Older age (p\u0026thinsp;=\u0026thinsp;0.0136), having a primary healthcare provider (p\u0026thinsp;=\u0026thinsp;0.0208), and requiring higher levels of medical care for previous COVID-19 infections (p\u0026thinsp;=\u0026thinsp;0.0232) were significantly associated with being vaccinated or willing to be vaccinated against COVID-19.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes participants\u0026rsquo; COVID-19 vaccination status. Most participants had received at least one dose of a COVID-19 vaccine (65%), the most common sources being the local SSP (44%) and pharmacies or drug stores (28%). Among participants who had not yet received the COVID-19 vaccines, 30% were probably or definitely willing to be vaccinated. Nearly half of those not yet vaccinated reported compensation as a potential motivator for receiving the vaccines.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal sample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot vaccinated and not willing to be vaccinated\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33) (n,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVaccinated or willing to be vaccinated\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;102) (n,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (median, IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (\u003cspan additionalcitationids=\"CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (\u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (\u003cspan additionalcitationids=\"CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49 CR50\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.0136\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBiological sex\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.2048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99 (73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (72.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (83.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSexual orientation\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.7788\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStraight or heterosexual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119 (88.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (26.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88 (74.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGay or lesbian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBisexual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSomething else\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRace\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.8231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic White\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46 (71.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic Black\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (83.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (77.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.8405\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;High school/GED\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (17.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (73.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;High school/GED\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e112 (83.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (24.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 (75.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.7630\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStably employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (82.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot stably employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118 (87.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (25.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88 (74.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousing status\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.6787\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnhoused\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (54.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55 (75.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTemporary housing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (79.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePermanent housing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (17.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsurance status\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.1444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsured\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (62.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (20.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 (79.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUninsured or unsure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (37.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHas a primary healthcare provider\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.0208\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (41.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo or unsure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUnderlying health condition\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.2528\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63 (72.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (81.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrevious COVID-19 infection\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.9923\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (75.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo or unsure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (75.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUtilization of medical services for previous COVID-19 infection\u003c/b\u003e (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.0232\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDid not seek medical care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReceived medical care but was not hospitalized\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWas hospitalized\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (77.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCOVID-19 vaccination status\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal sample (n,%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVaccinated against COVID-19 (at least one dose)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88 (65.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of doses\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (27.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32 (36.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (31.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of COVID-19 vaccine(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (44.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacy or drug store\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25 (28.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth department clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (10.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePop-up vaccination site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (5.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary care office\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCounty vaccination site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorkplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (1.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (14.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMotivation for receiving the COVID-19 vaccine(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo protect my health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58 (65.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo protect the health of my family/friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44 (50.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo protect the health of my community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34 (38.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBecause my family/friends encouraged me\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (32.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBecause a doctor, nurse, or other health provider encouraged me\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25 (28.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBecause SSP staff encouraged me\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (27.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo resume social activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (22.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo resume travel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (17.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo resume work/school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (14.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo stay in temporary housing/a shelter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (11.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLikely/very likely to recommend the COVID-19 vaccines to others\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70 (79.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLikely/very likely to get additional doses of the COVID-19 vaccines\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63 (71.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNot vaccinated against COVID-19\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47 (34.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWillingness to receive the COVID-19 vaccine(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDefinitely willing/probably willing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14 (29.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDefinitely not willing/probably not willing/uncertain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (70.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReasons for not receiving the COVID-19 vaccine(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026rsquo;t trust COVID-19 vaccines specifically\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (48.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026rsquo;t believe I need the COVID-19 vaccines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21 (44.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConcerned about feeling sick from side effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (36.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026rsquo;t trust the government\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (27.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026rsquo;t know if the COVID-19 vaccines would protect me\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (25.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026rsquo;t trust any vaccines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (23.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePotential motivations for receiving the COVID-19 vaccine(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf I can get compensated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (48.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo protect my health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (42.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo protect the health of my family/friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (40.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf SSP staff encourages me\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (34.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eKnowledge and beliefs\u003c/span\u003e\u003c/p\u003e\u003cp\u003eA substantial percentage of participants believed that the government is exaggerating (40%) or hiding (47%) the number of deaths due to COVID-19 (Table S1). Likewise, many participants either believed or were unsure about the following: that COVID-19 vaccines can cause COVID-19 (66%), sudden death syndrome (67%) or infertility (72%), and that they should not be given to pregnant women (68%). Participants were significantly less likely to be vaccinated or willing to be vaccinated if they believed or were unsure about the following: that COVID-19 vaccines can cause sudden death syndrome (p\u0026thinsp;=\u0026thinsp;0.0010) or infertility (p\u0026thinsp;=\u0026thinsp;0.0024), should not be given to pregnant women (p\u0026thinsp;=\u0026thinsp;0.0397), and contain microchips (p\u0026thinsp;=\u0026thinsp;0.0082).\u003c/p\u003e\u003cp\u003eConfidence in the US healthcare system and the local hospital system was low, with approximately one in three participants (34% and 30%, respectively) expressing a lack of confidence in the ability of the systems to care for their health (Table S2). Meanwhile, nearly all participants (97%) believed in the ability of the local SSP to care for their health. Participants who were fairly or very confident in the ability of the US healthcare system to care for their health (OR\u0026thinsp;=\u0026thinsp;4.50, 95% CI: 1.96, 10.29) and that the US healthcare system would give them the best possible care (OR\u0026thinsp;=\u0026thinsp;3.21, 95% CI: 1.39, 7.42) had higher odds of vaccination or willingness to be vaccinated.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHealth Belief Model constructs\u003c/span\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e describes the Health Belief Model domains, items, and associated odds ratios by COVID-19 vaccination status.\u003c/p\u003e\u003cp\u003eParticipants\u0026rsquo; \u003cem\u003eperceived susceptibility\u003c/em\u003e was low, with 5% and 36% of participants believing it was likely or very likely that they or someone they knew would get COVID-19 in the next 12 months, respectively. \u003cem\u003ePerceived severity\u003c/em\u003e was high, with 30% and 40% of participants believing it was likely or very likely that they would have long-term health or economic consequences if they got COVID-19, respectively. Half of participants (50%) reported knowing someone who became seriously ill or died due to COVID-19. However, a majority of participants responded that they were more worried about the following than COVID-19: having a safe place to sleep (74%), getting attacked/assaulted/robbed (73%), developing a skin or soft tissue infection (69%), having enough food to eat (66%), experiencing an overdose (66%), getting arrested (64%), having enough new/unused syringes for each injection (59%), and acquiring pneumonia (56%), HIV (54%), and Hepatitis C (53%) (Table S3).\u003c/p\u003e\u003cp\u003eResponses regarding \u003cem\u003eperceived benefits\u003c/em\u003e were mixed, with 52% of participants believing it is likely or very likely that COVID-19 vaccines reduce the chance of infection, 62% percent and 63% of participants believed it is likely or very likely that COVID-19 vaccines reduce the chance of hospitalization and prevent people from spreading COVID-19 to others, respectively, and 68% believing it is likely or very likely that COVID-19 vaccines reduce the severity and chance of having complications.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePerceived barriers\u003c/em\u003e were minimal, with 93% of participants reporting that they experienced (or would experience) no challenges in accessing the COVID-19 vaccines. \u003cem\u003eSelf-efficacy\u003c/em\u003e was correspondingly high, with 91% of participants reporting that it was easy (or would be easy) for them to access the COVID-19 vaccines. \u003cem\u003eCues to action\u003c/em\u003e were reported by the majority of participants, with 66% reporting enough information about the COVID-19 vaccines. Participants\u0026rsquo; top three most trusted sources of information about COVID-19 vaccines were the local SSP (70%), doctors (62%), and the CDC (34%). The least frequently trusted sources of information were religious leaders (1%), employers (2%), and health insurance companies (6%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOdds of vaccination and/or willingness to be vaccinated by Health Belief Model constructs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDomain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot vaccinated and not willing to be vaccinated\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33) (n,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVaccinated or willing to be vaccinated\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;102) (n,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePerceived susceptibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is likely/very likely that I will get COVID-19 in the next 12 months.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5 (4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.80 (0.15, 4.33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is likely/very likely that someone I know will get COVID-19 in the next 12 months.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38 (37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.19 (0.52, 2.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePerceived severity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIf I get COVID-19, it is likely/very likely that I will have long-term health consequences.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33 (32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.78 (0.70, 4.51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIf I get COVID-19, it is likely/very likely that I will have long-term economic consequences.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39 (38.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.74 (0.33, 1.64)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI know someone who became seriously ill or died due to COVID-19.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18 (54.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49 (48.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.77 (0.35, 1.69)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003ePerceived benefits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is likely/very likely that COVID-19 vaccines reduce the chance of infection.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59 (57.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.74 (1.20, 6.25)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is likely/very likely that COVID-19 vaccines reduce the severity and chance of having complications.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77 (75.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.70 (1.63, 8.40)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is likely/very likely that COVID-19 vaccines reduce the chance of hospitalization.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (42.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72 (70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.26 (1.45, 7.33)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is likely/very likely that COVID-19 vaccines prevent people from spreading COVID-19 to others.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73 (71.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4.41 (1.92, 10.10)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e\u003cp\u003ePerceived barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDifficulty finding out where to get vaccinated.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.31 (0.04, 2.29)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDifficulty making an appointment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.36 (0.28, 19.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDifficulty getting to the location on my own.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3 (2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.47 (0.08, 2.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLong distance/travel time to the location.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3 (2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.47 (0.08, 2.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDifficulty accessing transportation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.30 (0.07, 1.26)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInconvenient hours of operation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.15 (0.01, 1.75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLong waiting times.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.85 (0.21, 3.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eToo busy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.68 (0.35, 8.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJudgment/mistreatment at the service delivery point.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.63 (0.11, 3.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubstance use getting in the way.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (24.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.63 (0.24, 1.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMental health getting in the way.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.97 (0.19, 5.05)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt is easy/very easy to get the COVID-19 vaccine.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (87.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e94 (92.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.62 (0.46, 5.77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCues to action\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI have enough information on the COVID-19 vaccines.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (60.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69 (67.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.36 (0.60, 3.06)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI know where to go to get accurate, timely information about COVID-19 vaccines.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23 (69.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e82 (80.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.78 (0.73, 4.34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePreferences for COVID-19 vaccine service delivery\u003c/span\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eOf the total 135 participants, 116 (86%) preferred to receive the COVID-19 vaccines at the local SSP than at other service delivery locations. The most common reasons for preferring the local SSP were trust in the SSP (45%), the SSP\u0026rsquo;s friendly and/or non-judgmental staff (39%), and participants went there often for other reasons (38%). Most participants suggested that COVID-19 vaccines be offered on-demand (80%) and at both the fixed site and on the mobile unit (89%). Additional suggestions for improving COVID-19 vaccine uptake included offering compensation (66%), providing more information (59%), using a peer outreach system (44%), calling/texting people to remind them to get additional doses (32%), and allowing for an accelerated/abbreviated vaccination schedule (26%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, conducted during implementation of onsite COVID-19 vaccine services at an SSP in Miami, FL, only 65% of PWID had received at least one dose of the COVID-19 vaccines compared to 81% of the general US population (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), yet 30% of unvaccinated participants were probably/definitely willing to receive the vaccine. In contrast to previous research among marginalized populations in which structural barriers to vaccine access were a major contributor to low vaccine uptake (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), participants in our study reported low perceived barriers and high self-efficacy to accessing COVID-19 vaccines. Instead, reasons for not receiving the vaccines centered around trust and confidence in their safety and efficacy. Meanwhile, participants expressed high levels of confidence in the ability of the local SSP to care for their health and a strong preference for receiving the COVID-19 vaccines at the SSP as opposed to other locations, thus demonstrating the potential of SSPs to bridge this healthcare service utilization gap.\u003c/p\u003e\u003cp\u003eWhile the urgency around COVID-19 has waned with the pandemic\u0026rsquo;s evolution, it remains a useful case study to examine risk perception and engagement with novel healthcare interventions through the lens of the Health Belief Model. Three interesting observations emerge from this analysis. First, of the model\u0026rsquo;s six domains, perceived benefit was the only significant predictor of COVID-19 vaccine uptake among PWID in our setting. This aligns with existing literature, wherein this domain is the most frequently significant predictor of both COVID-19 preventive behavior and vaccine hesitancy (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), and with our findings that belief in various COVID-19 vaccine misconceptions was associated with lower odds of vaccination and/or willingness to be vaccinated. Second, our findings suggest that PWID in our setting may overestimate the accuracy of their knowledge about COVID-19, since many participants reported having sufficient cues to action (i.e., information about the COVID-19 vaccines and accurate and timely information sources), despite believing or being unsure about multiple COVID-19 vaccine misconceptions. Third, PWID\u0026rsquo;s perceived susceptibility was low and divergent between self and others despite their increased risk for adverse outcomes (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), demonstrating the bias blind spot, where individuals perceive others as more susceptible to risk than themselves (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Likewise, although many participants required hospitalization for previous COVID-19 infections (22%), believed they would likely have long-term health and economic consequences (30% and 40% respectively), and knew someone who became seriously ill or died due to COVID-19 (50%), perceived severity was not associated with an increased odds of being vaccinated or willing to be vaccinated. We hypothesize that this discordance may be a result of the numerous other significant threats that PWID face daily, as exemplified by the many sources of concern they prioritized over COVID-19 and by the \u0026ldquo;marked ambivalence\u0026rdquo; towards COVID-19 identified in other studies with PWID (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBeyond the context of COVID-19, this study reiterates the untapped potential of SSPs in increasing vaccine uptake among PWID, more generally. As one of the only trusted sources of care among PWID (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), SSPs are positioned to meet PWID needs and preferences and increase vaccine uptake, with the added potential of reducing gaps in health equity (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) and burden on the healthcare system (\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). More than 30 years of programmatic experience demonstrate the feasibility and acceptability of offering vaccines for hepatitis A, hepatitis B, influenza, pneumococcus, and meningitis to PWID at SSPs (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR49 CR50 CR51\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Likewise, studies have identified numerous implementation adaptations to optimize onsite vaccination services, including offering modest financial incentives and accelerated vaccination schedules (\u003cspan additionalcitationids=\"CR54 CR55\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). Our findings add to this evidence base by echoing the call for these implementation adaptations and by contributing additional suggestions, such as offering them on-demand at fixed and mobile SSP sites, providing more information focused on the benefits of vaccination, using peer outreach systems, and calling/texting people to remind them to get additional doses.\u003c/p\u003e\u003cp\u003eDespite this evidence and strong consensus among SSP leadership of the importance of offering onsite vaccination services, only 44% of SSPs in the US did so in 2021(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Nearly all these SSPs offered COVID-19 vaccines (91%); approximately three quarters offered the hepatitis A (76%), influenza (73%), and hepatitis B vaccines (71%); and more than half offered tetanus vaccines (57%). The SSPs rarely received grants to cover vaccine costs; instead, most received their vaccines from the health department. The majority of SSPs were able to access their state\u0026rsquo;s immunization information system to review participants\u0026rsquo; vaccination histories and submit vaccine administration data. The most reported staffing need was for personnel licensed to administer vaccines, and the most reported resource need was reminder/recall systems for vaccines with multidose series. Given PWID\u0026rsquo;s increased risk for hepatitis A and B and their increased likelihood of experiencing adverse outcomes with infections like influenza, pneumococcus, and meningitis due to their high burden of comorbidities and barriers to care, there is a clear need for technical and financial assistance to support more SSPs to implement onsite vaccination services, including for COVID-19, and to optimize and sustain onsite vaccination services at SSPs post-implementation.\u003c/p\u003e\u003cp\u003eSeveral limitations should be considered within this study. Participants were recruited from a single SSP site in Miami, FL and were limited to English speakers in a particularly diverse area (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), potentially excluding different perspectives and lived experiences. The SSP also received dedicated funding to support implementation of onsite COVID-19 vaccination services, a notable facilitator within SSPs due to their historic lack of resources (\u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). Finally, data collection for this project was completed between June 2022 and July 2023, during which pandemic fatigue (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e) and the Department of Health and Human Services (HHS) official end to the COVID-19 Public Health Emergency (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e) led to relaxed utilization of COVID-19 preventative measures, which may have skewed participant responses (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). Though SSP program operations and regulations vary by state and county, potentially limiting generalizability, the positioning of SSPs as a trusted source for stigma-free care among patients is generally consistent due to the nature of harm reduction work (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings from this survey reiterate the potential of SSPs to increase uptake of COVID-19 and other vaccines among PWID and provide insight into implementation adaptations to optimize vaccine uptake, including emphasizing the benefit of vaccines in communication efforts, offering compensation, and leveraging the trusted relationship with SSP staff, particularly peer navigators. Together, this evidence reinforces SSP\u0026rsquo;s unique ability to increase engagement and utilization of preventative care services among PWID, within and beyond the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCDC Centers for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003eCOVID-19 Coronavirus disease 2019\u003c/p\u003e\n\u003cp\u003ePWID People who inject drugs\u003c/p\u003e\n\u003cp\u003eSSP Syringe services program\u003c/p\u003e\n\u003cp\u003eUS United States\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of the University of Miami (IRB # 20220452). Informed consent was obtained from all participants included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eData and materials are available upon request to the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare the following financial interests/personal relationships which may be considered as potential competing interests: TSB and HET receive research funding from Gilead Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Department of Health \u0026amp; Human Services / NASTAD (Grant no. NU38OT000285; PI: Tyler Bartholomew). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health \u0026amp; Human Services / NASTAD.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors\u0026apos; contributions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTSB, HET, and MP designed the study. TSB, HET, MP, and MF designed and led study recruitment. MF administered the survey and MP analyzed the survey responses. MP, ES, and SSS prepared a draft of the manuscript. TSB, HET, and MF reviewed the manuscript and provided substantial feedback. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express heartfelt thanks to the staff and participants of the IDEA Miami SSP for their contributions to this study, and for being an inspiration for all our work at IDEA.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. WHO Coronavirus (COVID-19) Dashboard Geneva: World Health Organization; [Available from: https://covid19.who.int/.\u003c/li\u003e\n\u003cli\u003eWorld Bank. World Development Report 2022. Washington DC: World Bank; 2023.\u003c/li\u003e\n\u003cli\u003eRussell CD, Lone NI, Baillie JK. Comorbidities, multimorbidity and COVID-19. Nat Med. 2023;29(2):334-43.\u003c/li\u003e\n\u003cli\u003eJustino DCP, Silva DFO, Costa K, de Morais TNB, de Andrade FB. Prevalence of comorbidities in deceased patients with COVID-19: A systematic review. 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Available from: https://www.hhs.gov/about/news/2023/05/11/hhs-secretary-xavier-becerra-statement-on-end-of-the-covid-19-public-health-emergency.html.\u003c/li\u003e\n\u003cli\u003eHita MLR, Gr\u0026eacute;goire Y, Lussier B, Boissonneault S, Vandenberghe C, S\u0026eacute;n\u0026eacute;cal S. An extended health belief model for COVID-19: understanding the media-based processes leading to social distancing and panic buying. Journal of the Academy of Marketing Science. 2023;51(1):132-52.\u003c/li\u003e\n\u003cli\u003eBiancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, et al. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug and Alcohol Dependence. 2019;198:80-6.\u003c/li\u003e\n\u003cli\u003eMoore KE, Wyatt JP, Phillips S, Burke C, Bellamy C, McKee SA. The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis. Health Justice. 2023;11(1):25.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7179978/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7179978/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003ePeople who inject drugs (PWID) have lower rates of COVID-19 vaccine uptake, despite being disproportionately affected by the COVID-19 pandemic. Multiple implementation adaptations have been proposed to address this gap, including offering the vaccines at syringe service programs (SSPs). To inform their implementation at an SSP in Miami, Florida, this study aimed to identify predictors of COVID-19 vaccine uptake and preferences for service delivery among PWID in our context.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eBetween June 2022 and July 2023, we administered a cross-sectional survey based on the Health Belief Model with PWID accessing services at an SSP in Miami, FL (n\u0026thinsp;=\u0026thinsp;135). Differences in predictor variables were assessed by COVID-19 vaccination status (vaccinated and/or willing to be vaccinated vs. not vaccinated and not willing to be vaccinated) using bivariate analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOnly 65% of participants had received at least one dose of the COVID-19 vaccine series. Predictors of COVID-19 vaccination included older age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01), having a primary healthcare provider (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0136), requiring medical care for previous COVID-19 infections (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0232), being confident in the US healthcare system (OR\u0026thinsp;=\u0026thinsp;4.50, 95% CI: 1.96\u0026ndash;10.29), and not believing multiple COVID-19 misconceptions (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Perceived benefit was the only Health Belief Model domain with significantly increased odds of COVID-19 vaccination. Most participants (n\u0026thinsp;=\u0026thinsp;116, 86%) preferred to receive the COVID-19 vaccine at the SSP, and suggestions for increasing uptake included offering compensation, providing information, utilizing peer outreach systems, providing reminders, and allowing for accelerated vaccination schedules.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e\u003cp\u003eOur findings reiterate the potential of SSPs to increase uptake of COVID-19 and other vaccines among PWID and provide insight into implementation adaptations to optimize vaccine uptake, including emphasizing the benefit of vaccines in communication efforts, offering compensation, and leveraging the trusted relationship with SSP staff, particularly peer navigators. Together, this evidence reinforces SSPs\u0026rsquo; unique ability to increase engagement with and utilization of preventative care services among PWID, within and beyond the COVID-19 pandemic.\u003c/p\u003e","manuscriptTitle":"Predictors of COVID-19 vaccine uptake and preferences for service delivery among people who inject drugs accessing a syringe service program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 13:53:47","doi":"10.21203/rs.3.rs-7179978/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-01T12:33:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T20:45:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46148142209691531658131811783576364907","date":"2025-09-12T08:50:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25443177964901370538534093215857637231","date":"2025-09-11T13:48:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-10T23:24:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205955282650442447313587432814948001634","date":"2025-09-10T17:07:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202398044097032909306966909248329026485","date":"2025-09-08T18:34:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-28T13:11:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-22T13:44:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-22T13:43:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Harm Reduction Journal","date":"2025-07-21T17:29:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d3579153-91aa-4006-ad91-31a81f4ce577","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:18:24+00:00","versionOfRecord":{"articleIdentity":"rs-7179978","link":"https://doi.org/10.1186/s12954-026-01431-z","journal":{"identity":"harm-reduction-journal","isVorOnly":false,"title":"Harm Reduction Journal"},"publishedOn":"2026-03-15 16:00:26","publishedOnDateReadable":"March 15th, 2026"},"versionCreatedAt":"2025-07-31 13:53:47","video":"","vorDoi":"10.1186/s12954-026-01431-z","vorDoiUrl":"https://doi.org/10.1186/s12954-026-01431-z","workflowStages":[]},"version":"v1","identity":"rs-7179978","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7179978","identity":"rs-7179978","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}