An Investigation into Community Behaviors, Socioeconomic Factors, and Breakthrough COVID-19 Infections Among Vaccinated Individuals: A Cross-Sectional Study
Authors: McDonald Matthew , Vajravelu Bathri Narayan 
Published: June 2024

Background
The onset of COVID-19 in late 2019 prompted widespread disruptions and over 1.1 million deaths in the United States, leading to swift implementation of public health measures. COVID-19 transmission, primarily respiratory, is influenced by various factors, including contact type, duration, host immunity, and environmental conditions. Initial CDC tracking focused on new cases, but a shift in 2023 prioritized hospitalizations, fatalities, and variant monitoring, leading to the relaxation of stringent restrictions. Ongoing research aims to identify behaviors, settings, and socioeconomic factors associated with COVID-19 transmission, informing tailored prevention strategies for policymakers and public health experts. This study focuses on understanding breakthrough infections among vaccinated individuals and socioeconomic determinants of COVID-19 susceptibility to guide effective public health interventions.
Methods
A 31-question voluntary survey was distributed using convenience sampling through the Qualtrics online survey platform. Log-binomial regression model was used to estimate the Relative Risk (RR) and 95% CI to measure the association between testing COVID positive and the different activities and behaviors. Personal protection (use of masks/social distancing), respondent demographics, and vaccination status were also analyzed to see if these measures had any significant association with COVID-19 infection.
Results
Among the vaccinated individuals, those who tested positive were 11.103 times more likely to engage in going to a restaurant or bar compared to those who tested negative (p = 0.010). There was a significant difference in practicing social distancing and mask wearing between the age groups of the participants (p = 0.015) with 100% of the participants above 70 years old practicing it followed by 96.8% of the 18–29 years old. Among the different age groups who responded to the survey, we found the infection rates were the lowest in the above 70 years age group (27.5%) and 18–29 years age group (40.7%) compared to the other age groups although the difference did not achieve statistical significance. Moreover, the 18–29 age group demonstrated notable associations with practising social distancing and mask-wearing in various settings, including attending indoor church or religious gatherings, going to restaurants or bars, visiting coffee shops, using public transportation, travelling via aeroplane, going to an office setting, going to a gym or fitness centre, and visiting a salon or barber.
Conclusions
The survey findings suggest that compliance with social distancing and mask-wearing was higher among older and younger participants, and non-compliance with social distancing and mask wearing was associated with a higher positivity rate. Activities like going to a restaurant or bar was significantly associated with a positive COVID-19 PCR test in vaccinated individuals. These findings underscore the importance of continuing to practice preventive measures such as social distancing, mask-wearing, and avoiding crowded indoor spaces even after vaccination. The study highlights the need for ongoing surveillance of vaccine effectiveness and behaviour patterns to control the spread of COVID-19.