COVID-19 Vaccine Acceptance among People who Smoke in Rural Southwest Georgia: Perspectives and Influencing Factors.

Background: The COVID-19 vaccine is a critical tool in reducing COVID-19 related morbidity and mortality. Unfortunately, vaccine hesitancy is an ongoing public health challenge, especially in certain geographic areas and sub-populations. This study assessed factors associated with COVID-19 vaccine uptake and hesitancy among individuals who smoke in rural communities in southwest Georgia, one of the first COVID-19 "hot spots" in the U.S. Methods: We conducted qualitative interviews (n=23) using a semi-structured interview guide, informed by the Integrated Behavioral Model (IBM), that assessed vaccine-related behavior, intention to be vaccinated, perceived risk, social norms, attitudes, and environmental barriers and facilitators influencing vaccine hesitance and uptake. Results: Participants were 46 years old on average (SD=9.9; range: 25-63), 82.6% female, 60.9% Black, and 43.5% with an annual income <$25,000. Slightly over half (56.5%) had received at least one dose of the vaccine, 17.4% planned to, and 26.1% were unsure or did not plan to. Generally, participants acknowledged that those who smoke were at risk for worse COVID-19 related outcomes. Positive attitudes toward vaccination included reduced stress or concern about contracting and/or spreading the virus, less worry about becoming severely ill and/or dying from the virus, and reduced stress about socializing and inviting people over. Negative attitudes commonly focused on the speed of vaccine development and unknown long-term side effects, but also included distrust of government, fear of getting the virus from the vaccine, fear of needles, conspiracy theories, and dislike of mandates. Normative influences, most often from family members, were especially salient in the decision to get the vaccine, as was "doing research." Conclusions: Current results uncovered several salient factors aligning with IBM that should be considered when addressing vaccine uptake and hesitancy among priority populations, particularly those in rural areas who smoke, and improving vaccination outreach efforts.