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. 2022 Jun 9;22(3):276–290. doi: 10.1177/15381927221099091

Lessons to Build an Educational Model for Higher Education Institutions Defined as Anchor Institutions to Tackle Public Health Crises: A Pilot Study on COVID-19 Vaccine Hesitancy Among Faculty and Students in Hebert L. College in the Bronx, NY

Maria Isabel Roldós 1,2,3,✉, Kate G Burt 1,2,3, Jake Eubank 1,2,3
PMCID: PMC10258650  PMID: 37323136

Abstract

Coronavirus disease 2019 exacerbated health inequities in Bronx Communities. This study explored vaccine hesitancy among a random sample of faculty and students from Hebert Lehman College. Findings suggest faculty are largely vaccinated (87%), while 59% of students are unvaccinated. Significant gaps in information were found related to safety and complications. This suggests universities need to adopt an educational model with a multipronged social support strategy to gain students’ trust and a greater sense of belonging.

Keywords: COVID vaccine hesitancy, Lehman College, Anchor Higher Education Institutions, minority populations

Introduction

Leadership from Higher Education Institutions defined as Anchor Institutions (HEdAI) located in communities disproportionally affected by the coronavirus disease 2019 (COVID-19) pandemic is greatly needed to address vaccine hesitancy. HEdAI have traditionally been charged with improving the conditions of the broader community through socialization and civic engagement (Dewey, 1903; Miner, 2020). These institutions are best positioned to engage with community-based organizations; provide services (e.g., music and arts events; health services; employment opportunities) that promote community development (Birch et al., 2013; Koh et al., 2021); and include the community perspective in programs, projects, and interventions. In New York City, the neighborhoods hit the hardest by the pandemic were in the Bronx borough affecting minority populations disproportionately (New York City Department of Health and Mental Hygiene, 2020; Wadhera et al., 2020; Yancy, 2020). Research suggests immigrants and persons of low socioeconomic status are less likely to be tested and at the same time more likely to test positive; and neighborhoods with households with more than four members and Non-Hispanic African Americans or black residents are also more likely to test positive and suffer complications (Borjas, 2020; Bunch, 2021; Wadhera et al., 2020; Yancy, 2020).

HEdAI are uniquely positioned to lead community engagement around COVID-19 safety. Previous research suggests that HEdAI are important levers of social support, particularly for low-income students of color during the COVID-19 pandemic (Burt & Eubank, 2021). Social support may take many forms (e.g., emotional, instrumental, informational, and appraisal assistance), which includes disseminating information about vaccinations and addressing emotional and physical concerns influencing vaccine hesitancy (Glanz et al., 2015).

Hebert H. Lehman College (HLC) is the only senior college of City University of New York (CUNY) system located in the Bronx. HLC is a Hispanic-serving Institution and a HEdAI that primarily serves Bronx residents with close to 60% of students residing in the Bronx and located in South Fordham/University Heights (Lehman College, 2020)—one of the hardest-hit neighborhoods according to NYS Department of Health and Hygiene. (New York City Department of Health and Mental Hygiene, 2020)

This study explored overall concerns regarding COVID-19 and the vaccine; beliefs and barriers to access the vaccine; motivators to get vaccinated; reasons for hesitancy and sources of information among a random sample of faculty and students from HLC when the vaccine became available to the general population in New York City (April 2021; Gold, 2021).

Method

This is a pilot cross-sectional study of COVID-19 vaccine hesitancy among faculty and students at CUNY's HLC conducted in April 2021. The questions related to vaccine hesitancy for this study were inserted in the parent longitudinal study titled: “Examining the psychometric properties of a refined perceived stress scale during the COVID-19 pandemic.” The parent study is a longitudinal investigation of stress and readiness launched at the onset of the pandemic in April 2020 with planned data collection periods in October 2020 and April 2021. Findings from the parent study can be found elsewhere (Eubank et al., 2021).

Sample

With Institutional Review Board approval an online invitation was sent to HLC’s part-time and full-time faculty and student’s listservs via LimeSurvey. LimeSurvey is a free and open source online statistical survey web app written in PHP based on a MySQL, SQLite, PostgreSQL, or MSSQL database, distributed under the GNU General Public License (Engard, 2009). Those that completed the survey were offered a choice to participate in a raffle to receive a US$50 Amazon gift card.

Instruments

The COVID-19 hesitancy vaccine survey used in this study was developed by the Centers for Disease Control—CDC Division of Infectious Diseases—Vaccinate with Confidence Group. All questions were tested and fielded among racial and ethnic minorities and used in several sites across the United States under the guidance of CDCs Immunization Services Division and published elsewhere (Nguyen et al., 2021).

Two questions were asked to assess vaccination status and intention to vaccinate: “Have you received a COVID-19 vaccine?” and “Did you receive (or do you plan to receive) all required doses?” Answers to these questions included: “Yes, received all required doses or plan to receive all required doses,” and “No, don’t plan to receive all required dose.” Among those that responded that they do not intend to vaccinate, three questions were asked regarding the reasons why, and belief and barriers associated with a checklist of options (see all options in “Results” section). Examples of this checklist include: I am concerned about possible side effects of a COVID-19 vaccine; I am concerned about having an allergic reaction to a COVID-19 vaccine; I don’t know if a COVID-19 vaccine will work; I don’t believe I need a COVID-19 vaccine; I don’t like needles; I plan to wait and see if it is safe and may get it later; I think other people need it more than I do right now; I am concerned about the cost of a COVID-19 vaccine; I don’t trust COVID-19 vaccines; I don’t think COVID-19 is that big of a threat.

The survey ranked respondents’ perception of barriers to access the vaccine and the main motivators to get the vaccine, via the following questions: “Which of the following, if any, are reasons that make you unsure about getting the vaccine”; “Why do you believe that you don’t need a COVID-19 vaccine?” and “What, if anything, makes it difficult for you to get a COVID-19 vaccine?” and “Which of the following will make you to get a COVID-19 vaccine?”

Overall concerns around COVID-19 and the vaccine were assessed with two general questions: “How concerned are you about getting COVID-19?” and “How concerned are you about having any side effects from the COVID-19 vaccine?” Responses were assessed in a four-Likert-type scale from “very concerned” to “not concerned.”

Perception of having information and trusted sources was assessed with a four-Likert-type-scale from “unsure if you have enough information” to “have too much information” with the following prompt: Do you feel you have enough information about . . . for: “Where you can get a COVID-19 vaccine?”; “When to get a COVID-19 vaccine?”; “Safety of COVID-19 vaccines”; and “How well the COVID-19 vaccine protects you from getting sick with COVID-19”; and “Which of the following sources do you trust for accurate information about the COVID-19 vaccine?

Analyzes

Descriptive statistics and contingency table analyses were used to compare socio-demographic descriptors between vaccination status and constructs of general concerns to the infection of COVID-19 and general and specific concerns with the vaccine; beliefs and barriers to access the vaccine; motivators to get vaccinated; reasons for hesitancy; and sources of information. Pearson's chi-square test was used to test independence in contingency tables. All analyses were performed using R version 4.0.4 (R Core Team, 2021). Rankings were constructed to illustrate respondent’s perceptions related to barriers of access, perceived difficulties and motivators to get vaccinated, based on the frequency of answers.

Results

A total of 147 full-time and part-time faculty and 686 undergraduate and graduate students completed the hesitancy vaccination questionnaire. Table 1 provides a description of the studied population. Among faculty, 70% identified as female, 65% as non-Hispanic white; 17% of as non-Hispanic black or African American, and only 19% identified their ethnicity as Hispanic. Among faculty, the quantiles of age suggest 22% are younger than 45 years of age; 26% are between 45 and 55 years of age; and 23% and 28% reported being 56 to 65 and over ≥65 years of age, respectively. The mean and median age of faculty is of 56 years of age. Among students, most of the respondents were female (80%); 34% were classified as Non-Hispanic black or African American; 55% self-identified as Hispanic regardless of race. Students reported: 21% younger than 20 years of age; 20% between 21 and 27 years of age; 32% between 22 and 28 years of age; and 28% older than 29 years of age. The mean age was 26 years of age and the median was 22 years of age. A t-test comparison between the mean age across faculty and students suggests a statistical difference at a p < .001

Table 1.

Socio Demographic Description—Vaccine Hesitancy Study—Lehman Faculty 2021 (n = 147) and Students (n = 686).

Socio demographic description of faculty and study samples - Lehman College - April 2021 Faculty
 Students
n % n %
Gender n = 110/n = 448
 Female 76 69 357 80%
 Male 34 31 81 18%
 Transgender 3 1%
 Other 7 2%
Race n = 110/n = 416
 American Indian or Alaska Native 1 1 3 1%
 Asian 6 5 52 13%
 Black of African American 19 17 140 34%
 Native Hawaiian or Other Pacific Islander 0 5 1%
 White 72 65 84 20%
 Other a 12 11 132 32%
Ethnicity n = 111/n = 457
 Hispanic 21 19 253 55%
 Non-Hispanic 90 81 204 45%
Age b n = 107/n = 468
 <20 96 21%
 21–27 95 20%
 22–28 148 32%
 ≥29 129 28%
 <45 24 22
 45–55 28 26
 56–65 25 23
 ≥65 30 28
Essential worker c
 Healthcare essential worker 8 7 151 33%
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a

Self-identified. bAge categories are determined by quartiles. cState of New York Executive order 202.6 Guidance—October 23, 2020.

Overall, 33% of students qualify as healthcare essential worker as per State of New York Executive order 202.6 Guidance from October 23, 2020.

Overall Vaccination and Intend to Vaccinate

Two questions were applied to understand faculty and students’ vaccination rate and intent to get vaccinated. Overall, Lehman’s faculty are largely vaccinated with 87% of the faculty reported being vaccinated as of April 27, 2021, while only 41% of students report being vaccinated. There are no statistical differences between faculty and students in the vaccination rates between faculty and students (p ≤ 0.85).

Among the faculty self-identified as Hispanic, 76% reported being vaccinated as of the date cut-off of this study, 81% of them received two doses of the vaccine. No statistical differences were found between Hispanic and non-Hispanic faculty. Furthermore, among all Faculty 50% reported being very concerned or somewhat concerned about getting COVID-19. Among the faculty self-identified as Hispanic, 95% reported being slightly to very concerned of the vaccine. The biggest concern with the vaccine was related to safety and side effects, for both Hispanic and non-Hispanic faculty. No statistical differences were found between Hispanic and non-Hispanic faculty

When it came to the students, among the vaccinated students, only 37.5% of students self-identified as Hispanic were vaccinated at the time of the survey and 50% of them had at least one vaccination, compared with those self-reported as non-Hispanic. No statistical differences were found between Hispanic and non-Hispanic students.

When students were asked about their predisposition to get vaccinated, once the vaccine was available, 43% of Hispanic students were not sure or were not planning to get vaccinated. Furthermore, results suggest that 85% of Hispanic students are from slightly to very concerned with the vaccine, being side effects of the vaccine the biggest concern. Finally, when asked about mask use, students that reported being Hispanic, 96% reported always wearing a mask use in the previous week. No statistical differences were found between Hispanic and non-Hispanic students.

Sources and Trust of Information

Most faculty between (72%–87%) report having enough information about the COVID-19 vaccine; where to get vaccinated and facts about the vaccine. However, students report being unsured if they have enough information or stating not having enough information in the following categories: 31% for when to get vaccinated; 23% where to get vaccinated; 46% about the safety of COVID-19 vaccine; and 45% were unsure of the efficacy of the vaccine (see Table 2). Results suggest students self-identified as Hispanics, were 67% reported having enough information in the following domains: 67% where to get the vaccine; 50% about the safety of the vaccine; and 50% about the effectiveness of the vaccine. No statistical differences were found between Hispanic and non-Hispanic students.

Table 2.

Perception of Having Information and Most Trusted Sources of Information—HLC Faculty and students (April, 2021).

Faculty
 Students
Unsure if you have enough information Do not have enough information Have enough information Have too much information Unsure if you have enough information Do not have enough information Have enough information Have too much information
When to get a COVID-19 vaccine 3 (3%) 2 (2%) 94 (87%) 9 (8%) 59 (13%) 80 (18%) 285 (63%) 30 (7%)
Where to get a COVID-19 vaccine 2 (2%) 7 (6%) 92 (85%) 7 (6%) 40 (9%) 63 (14%) 319 (70%) 31 (7%)
Safety of COVID-19 vaccines for you 1 (1%) 18 (17%) 82 (76%) 7 (6%) 66 (15%) 141 (31%) 229 (50%) 18 (4%)
How well the COVID-19 vaccine protects you from getting sick with COVID-19 7 (6%) 18 (16%) 79 (72%) 6 (5%) 70 (15%) 134 (30%) 226 (50%) 22 (5%)
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Two questions were asked about trust of the sources of information. Findings suggest that the most trusted sources of information about the COVID-19 vaccine among faculty and students regardless of vaccination status are Centers for Disease Control and Prevention; Primary care providers (such as doctor, physician assistant, nurse practitioner) and Food and Drug Administration. Hispanic and non-Hispanic students and faculty, also overwhelmingly reported these federal agencies as the most trusted sources of information.

Beliefs, Barriers, and Hesitancy Toward the COVID-19 Vaccine

Table 3 illustrates the top 3 rankings of categories related to reasons and beliefs of hesitancy; barriers to access the vaccine and scenarios that would persuade them to get vaccinated.

Table 3.

Top Reasons and Beliefs Related to Hesitancy and Barriers and Motivators to Get Vaccinated—Lehman College Faculty (n = 15); Students (n = 258).

Reasons for hesitancy to get vaccine once available to them
Faculty Students
I am concerned about possible side effects of a COVID-19 vaccine 2 1
I am concerned about having an allergic reaction to a COVID-19 vaccine 3
I do not know if a COVID-19 vaccine will work 3
I do not believe I need a COVID-19 vaccine
I do not like needles
I plan to wait and see if it is safe and may get it later 1 2
I think other people need it more than I do right now
I am concerned about the cost of a COVID-19 vaccine
I do not trust COVID-19 vaccines
I do not think COVID-19 is that big of a threat
There are obstacles that may prevent me from getting a vaccine
Other people in my community are choosing not to get vaccinated
Beliefs preventing them from getting the vaccine
I already had COVID-19
I am not a member of the groups currently recommended to get the COVID-19 vaccine
I do not spend time with any high-risk people 2
I am not a member of a high-risk group 3
I plan to use masks or other precautions instead 1 1
I do not believe COVID-19 is a serious illness
I do not think vaccines are beneficial
I think my immune system is strong enough 1
COVID-19 is not a problem in my community
Faculty Students
Barriers to access the vaccine
I cannot go on my own (I have a physical limitation)
It is too far away or I do not have transportation
I do not know where to go to get vaccinated 2
I do not think there is enough supply of vaccine for me to get vaccinated 3
I am not in a group prioritized to get a COVID-19 vaccine (e.g., I do not qualify yet)
I have a medical reason that makes me ineligible to get vaccinated (e.g., I have had a severe allergy to vaccines in the past)
The lines are too long at the vaccination site 2
It is difficult to find or make an appointment 1 1
I am too busy to get vaccinated 3
It is difficult to arrange childcare
I don’t have time off work
Motivations to get a COVID-19 vaccine
If more people I personally know got seriously ill or died from COVID-19
If cases of COVID-19 got more severe
If there were a big increase in COVID-19 cases in my area
If more information showing COVID-19 vaccines are safe was available 1 1
If more information showing COVID-19 vaccines are effective was available 2
If it would prevent me from spreading COVID-19 to family and friends
If it would reduce the spread of COVID-19 in my community
If it would allow me to get back to work or school
If it would allow me to resume or do more social activities
If it would allow me to travel
If it would help children get back to school
If it was recommended to me by a healthcare provider
If it was recommended to me by a family member or friend
If I see people in my community getting vaccinated
If my workplace or school requires it 3
None of the above
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Discussion

The main finding from this study suggests that as of April 27, 2021 HLC faculty was largely vaccinated (87%), while only 41% of students reported being vaccinated. At the time of data collection (April 2021), the vaccine was rolled out by New York State’s authorities to all those eligible (Gold, 2021); and therefore our findings reflect faculty and student readiness and intent to receive the vaccine. Results from this study did not find significant differences between faculty and students who self-reported as Hispanic versus those that report being non-Hispanic in the questions related to vaccination status and hesitancy.

Most faculty (between 72% and 87%) report having enough information about the COVID-19 vaccine, where to get vaccinated and facts about the vaccine, while students express, they do not have enough information related to the safety of COVID-19 vaccine (46%) and the efficacy of the vaccine (45%). Furthermore, among those who report not being vaccinated the top rankings that would motivate them to get vaccination was related to having more reliable information about the safety and efficacy of the vaccine. Faculty and students rely on the CDC and primary care providers as the most trusted sources of information. These findings suggest that despite reporting relying on CDC and primary care providers for information a substantial proportion of students report not having enough information, and no respondents reported universities, colleges or higher education institutions as a source of trusted information.

The divergence in hesitancy between faculty and students can be explained by a difference in socioeconomic status between faculty and students. Faculty have higher educational attainment and on average have higher income than students. Higher socioeconomic status is associated with higher vaccination uptake and less hesitancy (Nguyen et al., 2021). There is also a difference between faculty and students’ race and ethnicity. HLC faculty reported being mostly non-Hispanic white (65%) compared with 20% of student participants; 17% of HLC faculty report being non-Hispanic African American or black compared with 34% of students; and 81% of faculty are non-Hispanic, compared with 55% of the students self-identifying as Hispanic or Latino. Historic injustices, distrust of clinical research among communities of color combined with recent attention to the unjust treatment of communities of color (e.g., the Black Lives Matter movement) may have increased vaccine hesitancy. (Crooks et al., 2021; Gold, 2021; Opel et al., 2021). Best practices in cultural competence in health services administration suggest vaccine information should be widely disseminated in multiple languages, including subdialects, in both written and graphic formats; avoid stigmatization among those with initial low uptake, which can, in turn, cause more hesitancy and promote segregation, and use of active listening and nonjudgmental communication (De Figueiredo et al., 2020; Hanif et al., 2020). To this end, HEdAI, especially those servicing minority populations, have the greatest potential to create an inclusive academic or institutional environment that provides culturally tailored information to promote vaccination, as well as position the institution as source of trusted information to their students and the communities they serve.

Furthermore, when concerns of getting infected and safety of the vaccine were explored, HLC faculty and students reported differences. Among faculty 55% and 70% reported being very and somewhat concerned about getting sick, respectively; and 35% of the faculty and 74% of the students reported being very and somewhat concerned of having any side effects from the COVID-19 vaccine. These findings allude to differences in health literacy. Research on COVID-19-related health literacy suggest the reading grade level on websites with COVID-19 information is often high school level or higher, when best practices suggest fifth- to sixth-grade level for population-based health information campaigns (Basch et al., 2020; Szmuda et al., 2020; Treanor & Radonjic, 2020; Valizadeh-Haghi et al., 2021); website information is of poor quality (e.g., lack information on authorship, sources, conflicts of interest); the information may not address concerns of racial and ethnic minorities (e.g., distrust by African Americans and blacks due to history of scientific misconduct in United States) and may not be in an individual’s preferred language (e.g., English as a second language) (Brach et al., 2012; Bunch, 2021; Gramlich & Funk, 2020).

Overall, the implications of these findings may have serious ramifications for on-campus safety and transmission. Promoting testing and vaccination uptake is not a straightforward process, it requires to the minimum, understanding population key social determinants, such as race and ethnicity and ancestry background, family composition; health literacy competency; language preference; place and type of work; experience of segregation and discrimination; risk perceptions; among others (Müller & Rau, 2021). Therefore, HLC as an HEdAI needs to critically address how to improve information dissemination to reduce student hesitancy to vaccination and serve as facilitators of safety net services to address issues related to mental health, access barriers to primary care providers, and facilitate housing and food services.

Insights of the Educational Model of HEdAI to Tackle Public Health Crises

Findings from this study suggest a need to adopt an educational model that includes a multipronged social support strategy. Social support related to COVID-19 may be in the form of emotional (addressing COVID vaccine fears), informational (providing data about vaccine safety or efficacy), or instrumental (pointing students to where they may obtain a vaccine). Other research on CUNY-wide students’ on COVID-19 in 2020 suggest that students experienced high rates of anxiety and depression, loss of income and expressed concerns about housing stability and food insecurity as a result of the COVID-19 pandemic (Jones et al., 2021). When social support was offered to CUNY students, research suggest students experience increased resilience to stress (Ozbay et al., 2007); and report positive experiences (e.g., optimism, resilience) while sheltering-in-place during the onset of the pandemic (Burt & Eubank, 2021). Another recent study conducted by Teachers College Columbia University suggests that students from minority backgrounds returned to Fall 2021 campuses with a disproportionate report of trauma. This trauma accrued unsolved issues related to racial injustice in previous years in addition to higher experience of pain and suffering related to the pandemic such as higher rates of mortality in their families and communities and experiences of discrimination associated with how the media is portraying minorities population’s hesitancy (Horsford et al., 2021).

A more supportive environment in which students experience trust and a sense of belonging may have positively affected students’ attitudes toward the COVID-19 vaccine. Sense of belonging in higher education can be defined as, “students’ perceived social support on campus, a feeling or sensation of connectedness, and the experience of mattering or feeling cared about, accepted, respected, valued by, and important to the campus community or others on campus such as faculty, staff, and peers” (Strayhorn, 2018). A strong sense of belonging among college students is associated with a wide range of positive outcomes such as improved mental health and well-being, improved academic success, a better likelihood they will be retained (return to the same school the following year), a better likelihood they will persist to graduation, and provides a better perception of social support (Duran et al., 2020; Morrow & Ackermann, 2012; Strayhorn, 2018). To address the level of trauma students returning to campus will have and be more responsive to students’ concerns and needs, colleges should develop policies to provide all forms of social support.

Limitations

Rankings were constructed with responses among those unvaccinated and therefore represent small numbers.

Conclusion

Findings from this study suggest that in order for HLC as a HEdAI to have a greater role in addressing public health emergencies, the institution needs to prioritize community-based participatory approaches to support communities within the Bronx; facilitate public–private partnership to coordinate messages, convey public health information, motivate citizen compliance; promote the study of health literacy gaps among students and their communities; and widely promote training for all levels of students, staff, faculty, and administration to discuss cultural competency-related issues.

Importantly, there are implications of these findings related to the HLC community and Bronx community-at-large given HLC’s role as an HEdAI. HEdAI academic spaces are generally white-led spaces, wrought with privilege about who generates knowledge and how the organizations are managed (Kamunge et al., 2018). Lehman, like all HEdAIs, is ethically obligated to act in a socially responsible way that promotes community health and low vaccination rates, including reducing potential community spread. To do so will require an acknowledgment of these limitations to engender a community that truly values differences and deference to the local community’s self-identified needs and concerns (Martinez-Acosta & Favero, 2018).

Acknowledgments

The authors thank the support of the Office of the President of Hebert Lehman College for providing funding for participant incentives.

Author Biographies

Dr. Maria Isabel Roldós is an Associate Professor with the Department of Health Sciences at Lehman College, and Director of CUNY Institute for Health Equity. Currently her focus is in the use of Health-Related Quality of Life (HRQoL) analyses to characterize populations that experience health disparities and in developing innovative methods to improve minorities’ participation in research, practice, and programs.

Dr. Kate G. Burt, is Associate Professor at the Department of Health Sciences at Lehman College, and her research in focused on improving the food environment through locally sourced food and sustainable agriculture and social justice and Dr.

Dr. Jake Eubank is the Undergraduate Director and Assistant Professor in the Recreation Education and Therapy Program in the Department of Health Sciences at Lehman College. His research focus is primarily on the impact of recreation and physical activity on the college student experience in the areas of stress, well-being, sense of belonging, academic success, and motivation.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: CUNY Institute for Health Equity Office of the President - Lehman College.

ORCID iD: Maria Isabel Roldós Inline graphichttps://orcid.org/0000-0003-2780-7018

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