Who has not been vaccinated, fully vaccinated, or boosted for COVID-19?

Health and human services regions are defined as the following: Region 1 – Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; Region 2 – New Jersey, and New York; Region 3 – Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; Region 4 – Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; Region 5 – Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Region 6 – Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region 7 – Iowa, Kansas, Missouri, and Nebraska; Region 8 – Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; Region 9 – Arizona, California, Hawaii, and Nevada,; Region 10 – Alaska, Idaho, Oregon, and Washington.

Employment status was assessed by the following question: “In the last 7 days, did you do any work for either pay or profit?” (yes/no).

Essential worker status was assessed by the following questions: “In the last 7 days, have you worked or volunteered outside your home?” (yes/no). If respondents answered “yes,” they were asked the following question: “Since January 1, 2021, which best describes the primary location/setting where you worked or volunteered outside your home?” Based on definitions from the U.S. Department of Homeland Security's Cybersecurity and Infrastructure Security Agency's (CISA), respondents were categorized as healthcare personnel (HCP) if their response falls in one of the following three primary location/work settings: 1) healthcare (such as hospital, doctor, dentist or mental health specialist office, outpatient facility, long-term care, home health care, pharmacy, and medical laboratory), 2) social service (such as child, youth, family, elderly, disability services), or 3) death care (such as funeral home, crematory, cemetery). Respondents were categorized as school if they replied with either one of the following settings: 1) education (pre-K, K-12 school) or childcare, or 2) other education (such as business or technical school, college, university). Furthermore, respondents were categories as non-healthcare frontline essential workers if respondents replied with one of the following 8 settings: 1) first responder (such as police or fire protection, emergency relief services), 2) correctional facility (such as jail, prison, detention center, reformatory), 3) food and beverage store (such as grocery store, warehouse club, supercenters, convenience store, specialty food store, bakery, liquor store), 4) agriculture, forestry, fishing, or hunting, 5) food manufacturing facility (such as meat-processing, produce packing, food or beverage manufacturing), 6) non-food manufacturing facility (such as metals, equipment and machinery, electronics), 7) public transit (such as bus, commuter rail, subway, school bus), or 8) United States Postal Service. Respondents were categorized as “other essential workers” if they reported that they were employed in another work setting classified as “essential” during the COVID-19 pandemic. Although not specified in the survey, these categories may include workers in transportation and logistics, food service, energy, water and wastewater, shelter and housing, public safety, IT and communication, news media, public safety, public health workers, finance, legal, and others. Respondents in either HCP, frontline, or other essential worker workers were categorized as “essential workers.” For all other workers, respondents were categorized as non-essential workers if they reported other work settings not classified as “essential” or if they reported that they currently work for either pay or profit but did not work or volunteer outside the home.

Employment type was assessed by the following question, “Are you employed by the government, by a private company, a nonprofit organization or are you self-employed or working in a family business?” Response options were 1) government, 2) private company, 3) non-profit organization including tax exempt and charitable organizations, 4) self-employed, or 5) working in a family business. Due to small sample sizes, respondents that work in a family business were combined with those who were self-employed.

Questions on disability and functional status were derived from previously established measures: 1) Do you have difficulty seeing, even when wearing glasses? 2) Do you have difficulty hearing, even when using a hearing aid? 3) Do you have difficulty remembering or concentrating?, and 4) Do you have difficulty walking or climbing stairs? Response options were 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, and 4) cannot do at all. Those who answered “a lot of difficulty” or “cannot do at all” were categorized as having the specific disability pertaining to that question (e.g., hearing disability). This produced four non-mutually exclusive groups for disability. An overall disability status variable was created for those who reported any of the four categories of disability.

Questions on anxiety and depression were derived from a validated two-item Patient Health Questionnaire (PHQ-2) and the two-item Generalized Anxiety Disorder (GAD-2) scale. The questions were: 1) “Over the last 2 weeks, how often have you been bothered by … having little interest or pleasure in doing things? Would you say not at all, several days, more than half the days, or nearly every day?” 2) “Over the last 2 weeks, how often have you been bothered by … feeling down, depressed, or hopeless? Would you say not at all, several days, more than half the days, or nearly every day?” Questions from the GAD-2 were: “Over the last 2 weeks, how often have you been bothered by the following problems … Feeling nervous, anxious, or on edge? Would you say not at all, several days, more than half the days, or nearly every day?” 2) “Over the last 2 weeks, how often have you been bothered by the following problems … Not being able to stop or control worrying? Would you say not at all, several days, more than half the days, or nearly every day?” For each scale, responses were assigned a numerical value: not at all=0, several days=1, more than half the days=2, and nearly every day=3. The two responses for each scale were summed and a score equal to three or greater on the PHQ-2 was categorized as symptoms of depression (hereafter referred to as depression) . A sum equal to three or greater on the GAD-2 was categorized as symptoms of anxiety (hereafter referred to as anxiety). Adults who had either symptoms of anxiety or depression were categorized as having either disorder.

Full vaccination was defined as receiving ≥1 dose of the Johnson and Johnson (Janssen vaccine), ≥2 doses of Pfizer-Biontech or Moderna vaccine, or ≥2 doses of “one of the brands that requires two initial shots, but not sure which brand”

Booster vaccination was defined as receiving ≥2 dose of the Johnson and Johnson (Janssen vaccine), ≥3 doses of Pfizer-Biontech or Moderna vaccine, or ≥3 doses of “one of the brands that requires two initial shots, but not sure which brand,” among adults who are fully vaccinated for COVID-19.

The data that support the findings of this study are openly available at https://www.census.gov/programs-surveys/household-pulse-survey/datasets.html.