(A-353) Application of the Actor-Partner Interdependence Model to Understand COVID-19 Vaccine Decision-Making among Adolescents and their Parents

Background: Although adolescents are likely to play an increasing role in their medical decisions, including vaccine decision-making, few studies have considered adolescents' vaccine perceptions or their role in vaccine decision-making. The Actor-Partner Interdependence Model (APIM) offers an analytic framework to quantify actor and partner effects on health behaviors and could additionally be used to understand vaccine decision-making between adolescents (i.e., actor) and their parents (i.e., partner).

Objectives: To apply the APIM model to quantify actor and partner effects of vaccine hesitancy on adolescent COVID-19 vaccination.

Methods: We conducted a nationally representative survey of adolescents aged 12-17 years old and their parents (n=721 dyads). Parents completed an online survey and provided consent for their adolescent to participate. Adolescent participants separately assented to participate and completed a similar survey. Parental and adolescent surveys measured self-reported COVID-19 vaccination and self-rated vaccine hesitancy using a previously validated scale (i.e., Teen COVID-19 Vaccine Hesitancy Scale [tVHS-COVID]). tVHS-COVID scores ranged from 13 to 65, with higher scores indicating greater hesitancy. Structural equation modeling was used to fit the APIM and estimate actor and partner effects as odds ratios (OR) with 95% confidence intervals (CI). Models were fit overall and by adolescent age and sex. We interpreted results as actor-only, partner-only, or couple-oriented vaccination patterns based on the direction, magnitude, and significance of ORs.

Results: Nearly half (43%) of vaccinated adolescents felt the decision to vaccinate was made jointly, and 5.3% felt they had mostly made the decision themselves. In contrast, 34% of unvaccinated adolescents felt the decision was made jointly, and 19% felt they had made the decision themselves. Based on APIM fit, overall, we identified a couple-oriented pattern in COVID-19 vaccine decision-making, with both significant actor (OR 0.89 [95% CI 0.84, 0.92] and partner (OR 0.95 [95% CI 0.92, 0.99]) effects. We observed evidence for actor-only effects for adolescents 15-17 years old (actor OR 0.89 [95% CI 0.84, 0.94]; partner OR 0.97 [95% CI 0.92, 1.02]) and female adolescents (actor OR 0.85 [95% CI 0.78, 0.92]; partner OR 0.96 [95% CI 0.90, 1.02]).

Conclusions: Using a novel application of the APIM, we show that vaccine hesitancy expressed by adolescents and their parents both have negative influences on adolescent COVID-19 vaccination. For some adolescents, their own attitudes may more strongly influence vaccine uptake compared to their parents. These findings suggest that public health efforts to increase COVID-19 vaccination should target adolescents in addition to their parents.