The COVID-19 pandemic has led to a mis/disinformation ecosystem that promotes divergentviews of vaccine efficacy, as well as the legitimacy of science and medicine. Individualsare confronted with vaccine-related information from a multitude of sources, posing achallenge to identifying inaccurate information. COVID-19 vaccine uptake is lower amongpeople with anxiety and depression than in the general population, due in part to higherlevels of vaccine hesitancy. The prevalence of anxiety and depressive symptoms among USadults increased significantly during the COVID pandemic and has remained elevated.Interventions capable of mitigating the impact of vaccine hesitancy andmis/disinformation among undervaccinated people with anxiety or depression are thereforean urgent priority. Emerging evidence suggests that reasons for vaccine hesitancy and theimpact of conventional vaccination messaging differ between those with and without mentalhealth symptoms. There may also be added challenges overcoming logistical barriers tovaccination for people with anxiety or depressive symptoms.The investigators aim to determine the effectiveness of two different brief digitalintervention strategies compared with conventional public health messaging for increasingvaccine uptake in undervaccinated adults with and without anxiety or depressive symptoms.Attitudinal inoculation is a brief, scalable strategy that leverages the power ofnarrative, values, and emotion to strengthen resistance to mis/disinformation and reducehesitancy. Though this approach has been shown to decrease COVID-19 vaccine hesitancyamong US adults, the extent to which this approach increases COVID-19 vaccination remainsunknown. Cognitive-behavioral therapy (CBT) is an evidence-based intervention for anxietyand depression. However, the efficacy of incorporating CBT-informed messaging in avaccine promotion intervention has not been tested. The investigators hypothesize thatboth attitudinal inoculation and CBT-style communication will be more effective thanconventional public health messaging to increase COVID-19 vaccination. The investigatorsalso hypothesize that the CBT-informed intervention will be more effective than theattitudinal inoculation intervention for increasing COVID-19 vaccination amongparticipants with symptoms of anxiety or depression.
The project will recruit undervaccinated participants with and without symptoms of
anxiety or depression from the CHASING COVID Cohort, a large and geographically diverse
community-based US cohort, to tailor and test the effectiveness of two brief digital
interventions to increase vaccine uptake among adults with anxiety or depressive
symptoms. The investigators will assign undervaccinated cohort participants, with and
without symptoms of anxiety or depression, to: 1) an attitudinal inoculation
intervention; 2), a CBT-informed intervention; or 3) a conventional public health
messaging intervention without attitudinal inoculation or CBT-informed content. The
investigators will examine the outcome of COVID-19 vaccination at 4 weeks
post-intervention, conducting intent-to-treat comparisons between arms.
Behavioral: Attitudinal inoculation
A brief video focused on bolstering resistance to mis/disinformation about the COVID
vaccine. Participants will receive two messages via text or email (1 and 3 days after the
inoculation intervention). These messages will include reminders to get vaccinated.
Behavioral: Cognitive-behavioral therapy-informed intervention
A brief video using a CBT-informed approach and focused on addressing barriers to
COVID-19 vaccination. Participants will receive two messages via text or email (1 and 3
days after the inoculation intervention). These messages will include reminders to get
vaccinated.
Behavioral: Conventional public health messaging
A brief video conveying conventional public health messaging adapted from a review of
public health public service announcements with no inoculation messaging. Participants
will receive two messages via text or email (1 and 3 days after the inoculation
intervention). These messages will include reminders to get vaccinated.
Inclusion Criteria:
  -  Recently engaged in the CHASING COVID Cohort study (i.e., started ≥ 1 survey since
     December 7, 2022)
- Last COVID-19 vaccine dose prior to September 11, 2023
- Current residence in the US or a US territory
- Comprehension of written English
Exclusion Criteria:
- No dose of a COVID-19 vaccine
- Had a SARS-CoV-2 infection in the past 3 months
CUNY Graduate School of Public Health & Health Policy
New York	5128581, New York	5128638, United States
Denis Nash, PhD, Principal Investigator
 CUNY Institute for Implementation Science in Population Health