COVID-19 vaccine acceptance differences among unvaccinated foreign- and united states-born persons: A cross-sectional study, 2021.

Purpose: To investigate the association between nativity and COVID-19 vaccine acceptance and its interaction with race/ethnicity, education, and English proficiency.

Methods: Differences in vaccine acceptance among propensity-score matched foreign- and US-born persons using 2021 California Health Interview Survey Data were measured using a survey-weighted multivariable logistic regression model with interaction terms and average predicted probabilities between nativity and: race/ethnicity, education, English proficiency.

Results: A total of 4,234,655 survey-weighted persons (8504 unweighted) met inclusion criteria; 2251,279 (53 %) were foreign-born (1,983,376 US-born), and 55 % of all persons were Hispanic/Latino, 22 % were Non-Hispanic White, 17 % were Non-Hispanic Asian/Pacific Islander, 3.6 % were Non-Hispanic Black/African American, and 2.5 % were categorized as 'Other'. Foreign-born status was significantly associated with greater odds of acceptance (adjusted odds ratio [aOR], 2.81 [95 %CI, 1.16-6.83]). Foreign-born Hispanic persons had a significantly greater probability of acceptance compared to their US-born counterparts (average probability difference, +0.11 [95 %CI, +0.023, +0.20]). Foreign-born persons with poor English proficiency had a lower probability of acceptance versus US-born persons (APD, -0.081, [95 %CI, -0.43, 0.27]).

Conclusions: Nativity was significantly associated with COVID-19 vaccine acceptance, and this relationship varied by race/ethnicity and English proficiency. These findings may be used to direct future interventions aimed at improving COVID-19 vaccination rates.