Modification and validation of the teen vaccine hesitancy scale toward vaccines for adolescents

To modify an existing parent-administered Vaccine Hesitancy Scale to create a teen Vaccine Hesitancy Scale (tVHS) capturing vaccine hesitancy among adolescents.

We conducted a nationally representative survey of 725 parent-teen dyads to test and validate the tVHS. We performed exploratory factor analysis (EFA) to identify the latent structure of the tVHS, followed by confirmatory factor analysis (CFA) to confirm factor structure. We conducted structural equation modeling (SEM) to assess correlations between factors and vaccine intention (i.e., influenza/flu, HPV, COVID-19, and meningococcal vaccines). We ran logistic regression to examine the association between the tVHS scores and intentions to receive recommended adolescent vaccines.

The final teen vaccine hesitancy scale (tVHS) included 14 items capturing a three-factor structure: vaccine confidence (factor 1), perceived vaccine risks (factor 2), and lack of trust in government (factor 3). Factor 1 was correlated with intention to receive the HPV vaccine (β = -0.35, p < 0.01), flu vaccine (β = -0.32, p < 0.01), and meningococcal vaccine (β = -0.51, p < 0.001). Factors 2 and 3 were correlated with the intention to receive flu vaccine (β = -0.13, p < 0.05 and β = -0.25, p < 0.05, respectively) and COVID-19 vaccination (β = -0.14, p < 0.01 and β = -0.61, p < 0.001, respectively). The SEM model fit data well (RMSEA = 0.073, CFI = 0.965, TLI = 0.954, SRMR = 0.077). As tVHS scores increased, the percentage of adolescents who reported lower intention to receive recommended vaccines also increased, indicating good construct validity.

The tVHS can be used to evaluate changes in vaccine hesitancy over time among adolescents and better guide programs and policies to improve adolescent vaccination uptake.