A survey was distributed nationally as part of a study, Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases. US residents aged 18 years and older, both US-born and non–US-born, were our target population. Inclusion of racial and ethnic groups was our main priority, including Hispanic/Latino, White, Black, Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander participants. Low income (ie, less than US $25,000 in annual household income) and being a rural resident were oversampled among non-Hispanic White, non-Hispanic Black, Hispanic, and non–US-born participants. Qualtrics (Qualtrics LLC) was contracted to facilitate the recruitment and distribution of the web-based survey across the US. Qualtrics distributed 10,000 surveys between May 13, 2021, and January 9, 2022. After expert review for fraud detection by Qualtrics, 5938 surveys were received by the research team. Montiel Ishino et al [7] describe further information on the survey design, participant recruitment, and implementation. A total of 5404 participants who completed the 116-item survey were included in this study, which cut across multiple domains, including, but not limited to, COVID-19 symptoms, testing and prevention, pandemic economic impact, and sociodemographics.

The Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases study was directed by author FW. Web-based informed consent was obtained from participants before they took part in the survey as part of the recruitment process by Qualtrics. If participants decided to take part, we reassured them that their responses would be kept confidential and that their participation was completely voluntary. As such, participants could choose to stop taking part in the study at any time or not answer any questions they did not want to without fear of repercussion. Participants received a US $10 gift card after the completion of the survey as compensation for 30 minutes of their time. Participants were provided the contact information of the principal investigator (FW) and the phone number of the National Institutes of Health (NIH) Institutional Review Board.

The research protocol for this study was reviewed by the NIH Intramural Research Program Institutional Review Board, Human Research Protection Program, and Office of Human Subjects Research Protections and received an exemption on December 23, 2020 (000308). The NIH, Intramural Research Program Institutional Review Board, Human Research Protection Program, and Office of Human Subjects Research Protections determined that our protocol did not involve human participants and was excluded from institutional review board review.

Proportionally, the majority of US-born and non–US-born individuals that reported COVID-19 vaccination were observed to be women, reported an income of $75,000 or more, and were unemployed or taking part in nontraditional work. The sample of non–US-born vaccinated individuals was primarily Hispanic/Latino, followed closely by Asian people, whereas White people were the highest proportion in the US-born group. One distinction between the groups was that among the non–US-born vaccinated group, those reporting having a bachelor’s degree had the highest proportion of being vaccinated, followed by those with a master’s or higher degree. This is in contrast to the US-born vaccinated group, which primarily had education at the college, associate degree, or vocational/technical level, followed by the bachelor’s degree level.

While the US-born sample showed similarities between those who were vaccinated and not vaccinated, the unvaccinated overall were young (ie, between the ages of 18 to 35 years) and reported an income of less than US $25,000. These findings regarding lower income status have also been seen in previous studies that explored vaccination and socioeconomic factors [8-10]. Both the vaccinated and unvaccinated US-born participants were also similar that in the largest proportion of reported educational attainment was some college education, an associate degree, or vocational or technical training; however, the groups differed in that the second-largest proportion of reported educational attainment was having a high school diploma or GED test. The largest proportion of US-born vaccinated participants were those with some college education, an associate degree, or vocational or technical training, whereas non–US-born vaccinated participants most often reported having a bachelor’s degree. The non–US-born unvaccinated sample had a greater proportion of participants with a bachelor’s, master’s, or higher degree than the US-born sample. The unvaccinated US-born sample was observed to have the second highest proportion of Black/African American participants. This agrees with prior research that indicates that Black/African American people are more likely to be hesitant to take the COVID-19 vaccine and, due to limited access, less likely to receive it [11]. Proportionally, at approximately 35%, non–US-born Hispanic/Latino people had similar proportions of COVID-19 vaccination and nonvaccination.

Overall, the highest proportion of participants who were nonbinary, transgender, or reported having a gender of “other” was observed among those who were unvaccinated and non–US-born. More research is needed to understand if this observation is due to liminal identities or possible disparities in access or informational needs. Future studies need to focus on oversampling medically underserved and underrepresented groups, particularly among non–US-born subpopulations. For instance, there may be salient interventions that can be tailored and developed for non–US groups. We observed that while unvaccinated US-born participants were more proportionally skewed to be “not at all likely” followed by “slightly to moderately likely” to seek a COVID-19 vaccine, non–US-born participants were almost equally distributed in their likelihood of seeking vaccination. Non–US-born participants, if provided the correct intervention, may elect to seek the COVID-19 vaccine and those in the “slightly to moderately likely” group may be swayed to the “extremely likely” group.

We conducted the cross-sectional study Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases using a nationally distributed survey to understand multiple factors behind COVID-19 vaccination. Our findings indicate that the majority of our participants were vaccinated and that those who were not vaccinated were highly unlikely to seek vaccination. The results also indicate that socioeconomic factors such as income affect vaccination uptake. The results from this study can be used as evidence and as an initial step for further analysis to promote health equity among vulnerable groups.