Self-Reported COVID-19 Vaccine and Booster Acceptance andHesitancy Among Autistic Adults in Pennsylvania:Cross-SectionalAnalysis of Survey Data

Background: The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverseCOVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but researchhas yet to document this population's perceptions and acceptance of COVID-19 boosters. Objective: This study aims to identify person-level and community characteristics associated with COVID-19 vaccination andbooster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding thisinformation is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the publichealth emergency for the COVID-19 pandemic. Methods: Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics,COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analysesand 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrencewas identified using phi coefficient correlation plots. Results: Most autistic adults (193/266, 72.6%) intended to receive or received the vaccine and booster, 15% (40/266) did notreceive or intend to receive any vaccine, and 12.4% (33/266) received or intended to receive the initial dose but were hesitant toaccept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences.The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort withothers not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the countythat voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasonsfor accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those whoaccepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereasthose who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someonethey trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would makethem feel unwell were the most often reported reasons Conclusions: Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults thanthe population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others,while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public healthopportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to bettersupport the already strained autism services and support system landscape. Vaccination uptake could be improved by leveragingpassive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 informationto better alleviate safety concerns