Role of Perceived Social Support in COVID-19 Vaccine Uptake Among U.S. Adults

The study investigates whether perceived social support is associated with COVID-19 vaccine uptake among U.S. adults. Motivated by documented disparities in vaccination coverage and evidence linking social support to a range of health outcomes and preventive behaviors, the authors hypothesized that vaccination coverage would be lower among respondents reporting lower levels of perceived social support compared with those reporting higher levels. The work addresses gaps in prior research that often focused on specific populations (e.g., healthcare workers) and were not generalizable to the U.S. adult population.

Prior studies have linked social support to numerous health outcomes including mortality, mental health, depression, suicidality, substance use, obesity, and infectious disease spread. Evidence on social support and vaccine uptake (influenza, HPV, shingles) generally shows positive associations. Emerging research during COVID-19 suggests social support relates to testing and vaccination intent/uptake, mediates burnout and booster willingness among nurses, and influences hesitancy among older adults, though most studies are in specific subgroups or local contexts. Additional literature documents disparities in COVID-19 vaccination by race/ethnicity and socioeconomic factors, with hesitancy not fully explaining disparities. The authors identify a need for nationally representative analysis focusing on perceived level of social support rather than only source/type.

Design and data source: Cross-sectional analysis of the 2021 National Health Interview Survey (NHIS), a nationally representative survey of the U.S. civilian non-institutionalized population. The Sample Adult response rate was 50.9%. The analytic sample included 21,107 adults with available data on COVID-19 vaccination and perceived social support. Measures: Outcome was self-reported receipt of at least one dose of a COVID-19 vaccine (binary). Key explanatory variable was perceived social support based on the question: How often do you get the social and emotional support you need? Responses were categorized as strong (always/usually), some (sometimes), and weak (rarely/never). Covariates included demographics (age, sex, race/ethnicity), socioeconomic factors (marital status, education, household income relative to FPL, insurance coverage, employment), and contextual controls (urban–rural classification, U.S. Census region, interview month fixed effects). Statistical analysis: Adjusted Wald tests compared vaccination prevalence across social support levels. Binomial logistic regression estimated odds of vaccination with strong support as the reference. Models were estimated for the full sample and age subgroups (18–24, 25–49, 50–64, ≥65 years). Complex survey weights accounted for NHIS stratified cluster sampling. Analyses were conducted in Stata 17.0.

- Sample composition: >80% reported strong social support, 11% some, ~7% weak. - Overall vaccination: 71.7% vaccinated; among vaccinated, 87.5% received more than one dose. - Prevalence differences by support: Vaccination rate among strong support was 72.5%. It was lower by 2.8 percentage points (95% CI: 0.3, 5.2) for some support and by 7.1 percentage points (95% CI: 3.9, 10.2) for weak support. - By age category: Overall vaccination was 87.5% for ≥65 years vs 67.1% for <65 years. Within both <65 and ≥65 groups, strong vs weak support differences were 6.7 pp (95% CI: 2.9, 10.6) and 7.4 pp (95% CI: 3.2, 11.7), respectively. Differences between strong and some support were not statistically significant. - Unadjusted logistic regression: Weak support associated with 28.2% lower odds of vaccination vs strong support. - Adjusted models (demographic and socioeconomic controls): Weak support associated with 21.1% lower odds of vaccination compared with strong support. - Age-stratified adjusted results: Except ages 18–24, weak support was associated with significantly lower odds: ages 25–49 AOR=0.66 (95% CI: 0.52, 0.85); ages 50–64 AOR=0.67 (95% CI: 0.50, 0.90); ages ≥65 AOR=0.56 (95% CI: 0.41, 0.75). - Inclusion of socioeconomic variables attenuated some associations, suggesting overlap between perceived social support and socioeconomic conditions. - All demographic and socioeconomic covariates showed significant relationships with vaccination in adjusted models (details in Table 2).

Findings indicate that lower perceived social support is associated with reduced COVID-19 vaccine uptake in a nationally representative U.S. sample, aligning with broader evidence that social support promotes health-protective behaviors. Potential mechanisms include social influence and comparison, social control, belonging/companionship, self-esteem, and sense of control. Psychosocial determinants of vaccine acceptance (e.g., trust, fear/anxiety, perceived safety/effectiveness, political ideology, and culturally congruent information) may be shaped or moderated by social support. The association was stronger among older adults, who already show higher vaccine acceptance, suggesting perceived support plays a notable role in this group. Adjustment for socioeconomic factors attenuated associations, implying interrelations between social support and SES. Results are consistent with ecological findings on social capital and vaccination disparities and with individual-level studies linking social capital/support to vaccination attitudes and behaviors across countries. Targeting perceived social support may enhance vaccine uptake, especially among groups at elevated risk from COVID-19.

Perceived social support is positively associated with COVID-19 vaccination among U.S. adults. Adults reporting weak social support were significantly less likely to be vaccinated, with notable effects across most age groups except 18–24 years. Enhancing perceptions of social support may be a promising strategy to increase vaccine uptake, particularly among older adults and populations at higher risk of severe COVID-19 outcomes. Future research should elucidate causal pathways and mechanisms, explore interventions that bolster perceived support, and examine factors pertinent to younger adults where support effects were less evident.

- Social support question lacked a specific time frame, potentially introducing measurement variability. - Cross-sectional design precludes causal inference between perceived social support and vaccination. - Absence of state identifiers limited the ability to control for state-level policy and contextual variation. Despite these limitations, the study leverages nationally representative data to examine perceived social support levels and vaccination uptake.