Relationship between the Use of Nonpharmaceutical Interventions and COVID-19 Vaccination Among U.S. Child Care Providers: A Prospective Cohort Study
19 Pages Posted: 6 Dec 2021
Background: The relationship between the use of nonpharmaceutical interventions and COVID-19 vaccination among U.S. child care providers remains unknown. If unvaccinated child care providers are also less likely to employ nonpharmaceutical interventions, then a vaccine mandate across child care programs may have larger health and safety benefits.
Methods: To assess and quantify the relationship between the use of nonpharmaceutical interventions and COVID-19 vaccination among U.S. child care providers, we conducted a prospective cohort study of child care providers (N = 20,013) from all 50 states, the District of Columbia, and Puerto Rico. Child care providers were asked to complete a self-administered email survey in May-June 2020 assessing the use of nonpharmaceutical interventions (predictors) and a follow-up survey in May-June 2021 assessing COVID-19 vaccination (outcome). Nonpharmaceutical interventions were dichotomized as personal mitigation measures (e.g., masking, social distancing, handwashing) and classroom mitigation measures (e.g., temperature checks of staff/children, symptom screening for staff/children, cohorting).
Results: For each unendorsed personal mitigation measure during 2020, the likelihood of vaccination in 2021 decreased by 7% (Risk Ratio = 0.93 [95% 0.93 – 0.95]). No significant association was found between classroom mitigation measures and child care provider vaccination (Risk Ratio = 1.01 [95% CI 1.00-1.01]).
Conclusions: Child care providers who used less personal mitigation measures were also less likely to get vaccinated for COVID-19 as an alternative form of protection. The combined nonadherence to multiple types of preventative health behaviors, that is, both nonpharmaceutical interventions and vaccination, among some child care providers may support a role for mandatory vaccination to achieve pandemic control.
Funding Information: All phases of this study were supported by the Andrew & Julie Klingenstein Family Fund, Esther A. & Joseph Klingenstein Fund, Heising-Simons Foundation, W.K. Kellogg Foundation, Foundation for Child Development, Early Educator Investment Collaborative, Scholastic Inc, Yale Institute for Global Health, and Tobin Center for Economic Policy at Yale University. Dr. Patel is supported by the National Institute of Health.
Declaration of Interests: All authors report no conflicts of interest.
Ethics Approval Statement: All participants provided informed consent prior to data collection. The research protocol was approved by the Yale University Institutional Review Board (protocol number: 2000028232).
Keywords: COVID-19, vaccination, Child Care Providers, Nonpharmaceutical Interventions
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