Date of Award

Fall 2022

Degree Type

Restricted to Claremont Colleges Dissertation

Degree Name

Public Health, DPH


School of Community and Global Health

Advisor/Supervisor/Committee Chair

Deborah Freund

Dissertation or Thesis Committee Member

Jay Orr

Dissertation or Thesis Committee Member

Bin Xie

Dissertation or Thesis Committee Member

Judi Nightingale

Terms of Use & License Information

Terms of Use for work posted in Scholarship@Claremont.

Rights Information

© 2022 Deborah Kupferwasser


COVID-19, Vaccine Hesitancy


Background: Essential workforce members such as those employed by hospitals were among the first populations to be offered the Emergency Use Authorized COVID-19 vaccines. Factors and the psychological drivers associated with vaccine hesitancy have not been well characterized for this population pre-vaccine rollout. Methods: To this extent, we performed a cross-sectional survey conducted from September through December 2020 at Los Angeles County USC Hospital to assess vaccine hesitancy. Adult employees with both non-patient roles and patient roles were included in this study. A total of 1327 participants were enrolled in the study with 1235(96%) completing the survey. Hierarchical logistic regression models were constructed to predict our outcome variable of vaccine hesitancy. Demographic factors and attitudes about the hypothetical COVID-19 vaccine were included in our hierarchical logistic models. Attitudes were assessed based on 7-point Likert-type questions developed utilizing the Health Belief Model constructs of perceived susceptibility, threat, and self-efficacy. We included the California-based Healthy Places Index as a community-level variable to assess the influence Social Determinates of Health have on vaccine hesitancy. Results: A total of 1327 healthcare workers participated. Based on expressed COVID-19 vaccine intent, 78% were categorized as vaccine acceptors and 22% as vaccine-hesitant. In our multivariable model, factors associated with vaccine hesitancy are Female gender [OR = 2.09; (CI 1.44–3.05, p = 0.001)], African American [OR = 4.32; (CI 2.16–8.62, p ≤ 0.001)] or LatinX [OR = 2.47; (CI 1.51–4.05, p = 0.01)] race, and a history of not or sometimes receiving Influenza vaccination (OR = 4.39; (CI 2.98–6.48), p ≤ 0.001). Conclusions: Vaccine hesitancy was associated with unique factors. These factors are female gender, identifying as African American or LatinX, and a history of not or sometimes receiving the Influenza vaccination. Among employees of a large urban safety net hospitable, COVID-19 vaccine hesitancy was associated with demographic factors and Influenza vaccination history but was not associated with the psychological based constructs of perceived susceptibility, threat, and self-efficacy. The results of our study contribute to a better understanding of drivers of vaccine hesitancy that can be targeted for public health initiatives designed to increase vaccine uptake.