Although early in the COVID-19 pandemic, the majority of hospitalizations and deaths occurred among adults,
since the rise of the delta variant in the US, hospitalizations among adolescents have steadily increased.
Between June and August 2021, the hospitalization rate for adolescents with COVID-19 increased five-fold. In
addition to the direct health consequences of COVID-19, adolescents are a key group for mitigating the
transmission of the SARS-CoV-2 virus. The reopening of middle and high-schools creates additional
opportunities for sustained transmission of COVID-19 in the community, making prevention of adolescent
infection a public health priority for COVID-19 control.
COVID-19 vaccination is recommended for all individuals 12 years and older and reduces the risk of infection
and adolescent hospitalization with COVID-19. Despite the public health benefits, immunization rates are
suboptimal among US adolescents. As of July 31, 2021, 42% of US adolescents aged 12-17 years old have
received =1 dose of the COVID-19 vaccine and 32% were fully vaccinated. These rates fall well below the
national average of 76% of the US population =12 years of age with =1 dose of the COVID-19 vaccine and the
65% fully vaccinated. Historically, interventions to improve adolescent vaccine coverage have almost
exclusively targeted parents. As a result, we currently have a poor understanding of vaccine hesitancy among
adolescents and how this relates to vaccine decision-making. Given a) poor COVID-19 immunization rates
observed among adolescents, b) the fact that more than 30% of adolescents report being involved in vaccine
decision-making, and c) the recent expansion of state policies to allow adolescent consent to vaccination,
examination of joint and independent adolescent and parental vaccine attitudes and how these attitudes drive
vaccine acceptance is critically needed to more effectively control the spread of COVID-19.
Through an innovative approach to data collection and novel application of an existing statistical framework,
we aim to i) validate a measurement tool for monitoring COVID-19 vaccine hesitancy in adolescents and their
parents, ii) identify how this hesitancy correlates between adolescents and their parents and iii) evaluate how
adolescent and parental vaccine hesitancy interacts in the decision to vaccinate against COVID-19.
Interventions that exclusively target parents are less likely to be effective compared to multilevel interventions
targeting both adolescents and their parents. Evidence generated by this application will be used to develop
such interventions. In future, this framework could be applied to improve uptake of other recommended