Acceptance of COVID-19 Vaccine Among High-Risk Occupations in a Port City of China and Multifaceted Strategies for Increasing Vaccination Coverage: A Cross-Sectional Study

Figures & data

Figure 1 The wide and multilevel strategies were instituted during the COVID-19 immunization campaign. With planning based on organization, health education and communication, incentives, the campaign was promoted by local authorities in collaboration with schools, hospitals, enterprises and institutions.

Table 1 Characteristics of Different Occupations Who Were Enrolled in the Study

Subjects Characteristics	Public Places and Commercial Service Staff (%)	Blue-Collar Workers (%)	Transportation Industry Staff (%)	Front-Line Port Workers (%)	Healthcare Workers (%)	Teachers (%)
Age
18–29	14.84	11.42	11.11	40.13	29.44	10.57
30–39	38.77	48.22	45.37	39.47	41.12	36.12
40–49	33.53	27.41	34.26	14.47	21.39	37.44
50+	12.86	12.95	9.26	5.93	8.05	15.87
Sex
Male	12.36	66.24	87.04	90.13	24.50	23.35
Female	87.64	33.76	12.96	9.87	75.50	76.65
Schooling level
High school or below	80.12	47.72	37.04	18.42	6.32	2.64
Associates degree	15.92	32.23	26.85	26.97	31.08	13.22
Bachelor degree	3.66	19.29	33.33	49.34	54.89	56.83
Post-graduate degree	0.30	0.76	2.78	5.27	7.71	27.31
Personal income (CNY/year)
<50,000	84.37	43.15	14.81	11.84	45.54	16.30
50,000–100,000	13.25	53.55	77.78	67.11	49.78	71.81
>100,000	2.38	3.30	7.41	21.05	4.68	11.89
Knowledge score about COVID-19 and COVID-19 vaccine
Poor	44.31	40.61	26.85	22.37	19.74	23.35
Good	55.69	59.39	73.15	77.63	80.26	76.65
Perceived risk of COVID-19 infection while on the job
High	67.95	46.95	67.59	75.00	70.13	45.37
Fair	26.21	43.40	30.56	23.68	27.62	48.02
Low	5.84	9.65	1.85	1.32	2.25	6.61
Perceived current situation of the COVID-19 epidemic
Very dangerous	86.55	89.09	93.52	90.13	85.97	88.55
Moderately dangerous	11.97	9.64	6.48	9.21	13.77	11.01
Not dangerous	1.48	1.27	0.00	0.66	0.26	0.44
Perceived likelihood of controlling COVID-19 epidemic by vaccine
Very likely	63.80	73.35	82.41	87.50	84.42	75.77
Somewhat likely	6.43	4.57	4.63	5.26	5.28	7.05
Not likely	0.89	0.76	0.00	0.00	0.17	0.88
Not sure	28.88	21.32	12.96	7.24	10.13	16.30
Other vaccines uptake in the last 3 years
Yes	8.90	7.11	5.56	7.24	34.55	23.35
No	91.10	92.89	94.44	92.76	65.45	76.65
Total	100.00	100.00	100.00	100.00	100.00	100.00

Table 2 Willingness to Accept COVID-19 Vaccine by Different Characteristics of Participants

	Willingness to Accept COVID-19 Vaccine						p value^a
	Accept		Refuse		Not Sure
	n	%	n	%	n	%
Age
18–29	477	75.47	16	2.53	139	21.99	0.381
30–39	886	70.99	34	2.72	328	26.28
40–49	618	73.75	20	2.39	200	23.87
50+	250	75.99	7	2.13	72	21.88
Sex
Male	773	81.11	24	2.52	156	16.37	<0.001
Female	1458	69.63	53	2.53	583	27.84
Schooling level
High school or below	722	63.06	40	3.49	383	33.45	<0.001
Associates degree	579	77.51	14	1.87	154	20.62
Bachelor degree	806	81.66	20	2.03	161	16.31
Post-graduate degree	124	73.81	3	1.79	41	24.40
Occupation
Public places and commercial service staff	584	57.76	36	3.56	391	38.67	<0.001
Blue-collar workers	272	69.04	12	3.05	110	27.92
Transportation industry staff	86	79.63	1	0.93	21	19.44
Front-line port workers	133	87.50	1	0.66	18	11.84
Healthcare workers	999	86.49	25	2.16	131	11.34
Teachers	157	69.16	2	0.88	68	29.96
Personal income (CNY/year)
<50,000	1110	68.52	44	2.72	466	28.77	<0.001
50,000–100,000	987	77.78	30	2.36	252	19.86
>100,000	134	84.81	3	1.90	21	13.29
Knowledge score about COVID-19 and COVID-19 vaccine
Poor	627	65.86	35	3.68	290	30.46	<0.001
Good	1604	76.56	42	2.00	449	21.43
Perceived risk of COVID-19 infection while on the job
High	1488	75.46	46	2.33	438	22.21	<0.05
Fair	646	69.24	25	2.68	262	28.08
Low	97	68.31	6	4.23	39	27.46
Perceived current situation of the COVID-19 epidemic
Very dangerous	1960	73.74	61	2.29	637	23.97	<0.05
Moderately dangerous	257	70.60	14	3.85	93	25.55
Not dangerous	14	56.00	2	8.00	9	36.00
Perceived likelihood of controlling COVID-19 epidemic by vaccine
Very likely	1903	82.63	36	1.56	364	15.81	<0.001
Somewhat likely	103	59.54	8	4.62	62	35.84
Not likely	7	43.75	2	12.50	7	43.75
Not sure	218	39.28	31	5.59	306	55.14
Other vaccines uptake in the last 3 years
Yes	498	84.84	6	1.02	83	14.14	<0.001
No	1733	70.45	71	2.89	656	26.67
Total	2231	73.22	77	2.53	739	24.25

Notes: ^a p value is calculated by Chi-square test or Fisher’s exact test.

Table 3 Factors Associated with Intentions to Accept COVID-19 Vaccination When It is Available

(“Not Sure” as Reference)	Willingness to Accept COVID-19 Vaccine
	Accept		Refuse
	aOR	95% CI	aOR	95% CI
Sex
Male	1.71	(1.31, 2.23)	1.86	(0.97, 3.57)
Female	Reference		Reference
Schooling level
High school or below	1.99	(1.19, 3.34)	2.19	(0.51, 9.37)
Associates degree	1.59	(0.98, 2.56)	1.35	(0.34, 5.37)
Bachelor degree	1.52	(0.97, 2.36)	1.60	(0.43, 5.85)
Post-graduate degree	Reference		Reference
Occupation
Public places and commercial service staff	0.57	(0.37, 0.89)	2.50	(0.49, 12.78)
Blue-collar workers	0.78	(0.50, 1.24)	2.20	(0.42, 11.46)
Transportation industry staff	1.00	(0.53, 1.89)	0.87	(0.07, 10.97)
Front-line port workers	1.55	(0.82, 2.94)	1.02	(0.08, 12.61)
Healthcare workers	2.51	(1.71, 3.68)	1.18	(0.59, 2.36)
Teachers	Reference		Reference
Personal income (CNY/year)
<50,000	0.59	(0.34, 1.02)	0.53	(0.14, 2.03)
50,000–100,000	0.54	(0.32, 0.92)	0.70	(0.19, 2.54)
>100,000	Reference		Reference
Knowledge score about COVID-19 and COVID-19 vaccine^Citation1
Poor	0.91	(0.74, 1.11)	1.34	(0.81, 2.21)
Good	Reference		Reference
Perceived risk of COVID-19 infection while on the job
High	1.08	(0.70, 1.66)	0.80	(0.31, 2.09)
Fair	0.74	(0.48, 1.14)	0.64	(0.24, 1.69)
Low	Reference		Reference
Perceived current situation of the COVID-19 epidemic
Very dangerous	1.07	(0.42, 2.71)	0.40	(0.08, 2.00)
Moderately dangerous	0.82	(0.31, 2.15)	0.60	(0.11, 3.24)
Not dangerous	Reference		Reference
Perceived likelihood of controlling COVID-19 epidemic by vaccine
Very likely	5.91	(4.74, 7.36)	0.84	(0.49, 1.42)
Somewhat likely	1.91	(1.31, 2.80)	1.21	(0.52, 2.80)
Not likely	1.67	(0.56, 5.00)	2.16	(0.41, 11.51)
Not sure	Reference		Reference
Other vaccines uptake in the last 3 years
Yes	1.54	(1.16, 2.04)	0.53	(0.21, 1.30)
No	Reference		Reference

Table 4 Reasons for COVID-19 Vaccine Refusal or Hesitancy Among Different Occupations

Occupations	Doubt of COVID-19 Vaccine Safety (n,%)^a	Doubt of COVID-19 Vaccine Effectiveness (n,%)^a	Previous Negative News About Vaccines (n,%)^a	Having no Time to Vaccinate on Weekdays (n,%)^a	Believing the Epidemic is Under Control, Vaccination is Unnecessary (n,%)^a	Total (n,%)
Public places and commercial service staff	350 (81.97)	250 (58.55)	195 (45.67)	52 (12.18)	29 (6.79)	427 (100.00)
Blue-collar workers	101 (82.79)	78 (63.93)	52 (42.62)	16 (13.11)	11 (9.02)	122 (100.00)
Transportation industry staff	18 (81.82)	12 (54.55)	9 (40.91)	6 (27.27)	1 (4.55)	22 (100.00)
Front-line port workers	15 (78.95)	7 (36.84)	6 (31.58)	7 (36.84)	3 (15.79)	19 (100.00)
Healthcare workers	113 (72.44)	68 (43.59)	36 (23.08)	66 (42.31)	12 (7.69)	156 (100.00)
Teachers	64 (94.11)	40 (57.14)	22 (31.43)	9 (12.86)	4 (5.71)	70 (100.00)
p value^b	<0.001	<0.001	<0.001	<0.001	<0.001
Total	661 (81.00)	455 (55.76)	320 (39.22)	156 (19.12)	60 (7.35)	816 (100.00)

Notes: ^a The number and percentage of those who choose that option. ^b p value is calculated by Chi-square test or Fisher’s exact test.

Table 5 COVID-19 Vaccination Uptake Among Different Occupations Before and After the Strategies

Occupation	Before the Strategies^a		After the Strategies^b		p value
	Total Staff	Vaccinated Staff (%)	Total Staff	Vaccinated Staff (%)
Public places and commercial service staff	409,327	2620 (0.64)	411,915	350,951 (85.20)	<0.001
Blue-collar workers	358,473	1112 (0.31)	356,195	311,314 (87.40)	<0.001
Transportation industry staff	29,196	5460 (18.70)	29,114	25,815 (88.67)	<0.001
Front-line port workers	19,231	12,047 (62.64)	18,560	18,040 (97.20)	<0.001
Healthcare workers	89,115	46,447 (52.12)	95,013	92,923 (97.80)	<0.001
Teachers	79,824	3457 (4.33)	79,399	71,935 (90.60)	<0.001
Total	985,166	71,143 (7.22)	990,196	870,978 (87.96)	<0.001

Notes: ^a The statistical data of transportation industry staff, front-line port workers and healthcare workers were as of January 31, 2021. Public places and commercial service staff, blue-collar workers and teachers were as of February 28, 2021. ^b The statistical data of all the occupations were as of May 31, 2021.

Figure 2 The vaccination rates of all occupations significantly increased over time (p for trend<0.05). 1, Local authorities mainly pushed forward the vaccination of front-line port workers, transportation industry staff and healthcare workers since December 15, 2020. 2, The vaccination of public places and commercial service staff, blue-collar workers in labour-intensive enterprises and teachers were vigorously promoted since March 2021 with multifaceted strategies.

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