Sociodemographic and health-related predictors of COVID-19 booster uptake among fully vaccinated adults

Background: To control COVID-19 mutations and prevent further spread, periodic revaccination is essential. Despite the substantial evidence supporting vaccine efficacy, hesitancy towards COVID-19 booster doses persists. Methods: We examined factors associated with the booster vaccine uptake and the intention to receive a booster among fully vaccinated adults in Texas (N = 14,543), using a weighted telephone survey in 2022. We employed multiple logistic regression with Lasso-selected variables to identify sociodemographic, geographic, and healthrelated predictors of booster uptake and intentions. Results: Of the respondents, 9989 (70 %) respondents reported having received a booster dose. Booster uptake was higher among older (65 years and older), White, publicly insured, and financially stable individuals. It was also higher among those without a history of COVID-19 infection and those with comorbidities and concerns about the virus. Higher odds of being boosted were associated with older age, Asian race, Spanish language, three public health regions (PHR 11, 7, 9/10), and diabetes and HIV diagnoses. Lower odds were observed among smokers, the uninsured, and those experiencing financial struggles. Among those who had not received the booster, greater intentions to receive a booster were observed across all racial/ethnic groups compared to White individuals, Spanish speakers, and the uninsured. Those with diabetes expressed stronger intentions to receive a booster, while individuals previously infected with COVID-19 and males were less inclined to seek a booster. However, individuals expressing concerns about the infection had higher intention to be boosted. Conclusion: The findings highlighted disparities in booster vaccinations across geographic regions, racial/ethnic groups, and insurance status. Targeted educational initiatives about the importance of booster vaccination are needed, especially for underserved populations with limited access to healthcare. Public health efforts should also focus on countering misinformation and promoting the benefits of boosters through gain-framed messages to motivate vaccine uptake and mitigate the spread of COVID-19.