Mechanisms of Association of Maternal Education and Intent to Vaccinate Children Against COVID-19

Abstract

BACKGROUND Although higher maternal education is positively associated with many child health–promoting practices, it is more complicated for child vaccination, and the explanatory mechanisms remain unclear. We aimed to examine mechanisms underlying the association of maternal educational attainment and intent to vaccinate their child against COVID-19. METHODS Mothers of 173 kindergarten-aged children born between March 2015 and May 2016 at 16 US hospitals completed surveys in November 2021 to June 2022 (when the COVID-19 vaccine was newly available for adults and children aged 5 years and older) measuring aspects of maternal and child health and well-being. We examined potential mediators of the association between maternal education and intent to vaccinate their child against COVID-19. RESULTS Seventy-two (41.6%) mothers expressed intent to vaccinate their child when the vaccine was approved for their child’s age group. The total unadjusted association between maternal education (≥4-year college degree vs <4-year degree) and child COVID-19 vaccination intent was odds ratio 2.70 (95% CI 1.37–5.34), with odds of vaccine intent increasing with years of maternal education. In mediation analyses, maternal report of a parenting role model strengthened the association of education with child vaccination intent. Higher household income, although the largest pathway in magnitude, did not reach statistical significance in the final model. CONCLUSIONS The association linking maternal educational attainment with child COVID-19 vaccination intention is complicated and mediated by availability of parenting role models. Intervention strategies should take this into account.