Predictors of COVID-19 Vaccination Intention and Behavior Among Young People in a European Union Country With Low COVID-19 Vaccination Rates: Cross-Sectional Study
Authors: Atanasova Sara , Kamin Tanja , Perger Nina 
Published: January 2025

Background
Vaccination against COVID-19 is a critical measure for managing the pandemic and achieving herd immunity. In 2021, Slovenia had a significantly lower COVID-19 vaccination rate compared to the average rate in the European Union, with individuals aged younger than 37 years showing the highest hesitancy. Previous studies primarily explored vaccination willingness before vaccines were available to young people, leaving a gap in understanding the factors influencing vaccination behavior and differences within the population of young people.

Objective
This study aimed to investigate a wide set of predictors influencing COVID-19 vaccination intention and behavior among young people in Slovenia. Specifically, we aimed to compare vaccinated and unvaccinated young people, further categorizing the unvaccinated group into those who were hesitant, those who intended to vaccinate in the near future, and those who refused vaccination.

Methods
An integrated model, based on the health belief model and theory of planned behavior, was developed, and it included additional contextual factors (such as trust in science, trust in vaccines, conspiracy theory tendencies, etc) and health-related and sociodemographic characteristics. Data were collected in August 2021 via the online access survey panel JazVem (Valicon), targeting individuals aged 15-30 years in Slovenia. Quotas ensured that the sample (n=507) was quasi-representative according to age, gender, education, and region. Bivariate analyses and multinomial logistic regression were performed to explore the determinants of vaccination intention and behavior.

Results
Among respondents, 45.8% (232/507) were vaccinated, 30.0% (152/507) refused vaccination, 12.4% (63/507) were hesitant, and 11.8% (60/507) intended to undergo vaccination in the near future. Vaccinated individuals were predominantly aged 23-26 years, had higher education, and reported above-average material status. Refusers were more common among the youngest (15-18 years) and oldest (27-30 years) groups, had lower education, and showed higher conspiracy theory tendencies. Multinomial regression analysis revealed that unvaccinated respondents who perceived greater COVID-19–related health consequences were more likely to delay vaccination (adjusted odds ratio [aOR] 2.0, 95% CI 1.2-3.3) or exhibit hesitancy (aOR 1.9, 95% CI 1.1-3.2) compared with vaccinated respondents. Subjective norms were less influential among hesitant individuals (aOR 0.4, 95% CI 0.2-0.7) and refusers (aOR 0.3, 95% CI 0.2-0.7) than among vaccinated individuals. Self-efficacy in managing health problems was less evident among those who delayed vaccination to the near future (aOR 0.5, 95% CI 0.3-0.9) than among vaccinated individuals.

Conclusions
This study underscores the complexity of vaccination intentions and behaviors among young people, emphasizing the necessity for public health strategies promoting vaccination to be tailored to the specific reasons for nonvaccination within different subgroups. Interventions aimed at addressing vaccine hesitancy and delays should particularly focus on individuals with lower education and material disadvantages. By fostering trust and enhancing self-efficacy, these interventions could more effectively promote vaccine uptake.