Injection fears and COVID-19 vaccine hesitancy
Open accessAbstract
Abstract Background When vaccination depends on injection, it is plausible that the blood-injection-injury cluster of fears may contribute to hesitancy. Our primary aim was to estimate in the UK adult population the proportion of COVID-19 vaccine hesitancy explained by blood-injection-injury fears. Methods In total, 15 014 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, took part (19 January–5 February 2021) in a non-probability online survey. The Oxford COVID-19 Vaccine Hesitancy Scale assessed intent to be vaccinated. Two scales (Specific Phobia Scale-blood-injection-injury phobia and Medical Fear Survey–injections and blood subscale) assessed blood-injection-injury fears. Four items from these scales were used to create a factor score specifically for injection fears. Results In total, 3927 (26.2%) screened positive for blood-injection-injury phobia. Individuals screening positive (22.0%) were more likely to report COVID-19 vaccine hesitancy compared to individuals screening negative (11.5%), odds ratio = 2.18, 95% confidence interval (CI) 1.97–2.40, p < 0.001. The population attributable fraction (PAF) indicated that if blood-injection-injury phobia were absent then this may prevent 11.5% of all instances of vaccine hesitancy, AF = 0.11; 95% CI 0.09–0.14, p < 0.001. COVID-19 vaccine hesitancy was associated with higher scores on the Specific Phobia Scale, r = 0.22, p < 0.001, Medical Fear Survey, r = 0.23, p = <0.001 and injection fears, r = 0.25, p < 0.001. Injection fears were higher in youth and in Black and Asian ethnic groups, and explained a small degree of why vaccine hesitancy is higher in these groups. Conclusions Across the adult population, blood-injection-injury fears may explain approximately 10% of cases of COVID-19 vaccine hesitancy. Addressing such fears will likely improve the effectiveness of vaccination programmes.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
About 10% of CoV-19 vaccine hesitancy can be explained by blood-injection-injury fears.
“a 2021 study from the United Kingdom in 15.014 adults found that about 10% of CoV-19 vaccine hesitancy can be explained by blood-injection-injury fears (41).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [41]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
Principles and Practice of Structural Equation Modeling
Tabri, N., & Elliott, C. M. (2012) · Canadian Graduate Journal of Sociology and Criminology · doi:10.15353/cgjsc.v1i1.3787 · Cited by 39,065 · see citing works
(1998) · Cited by 36,049 · see citing works
<b>lavaan</b> : An <i>R</i> Package for Structural Equation Modeling
Rosseel, Y. (2012) · Journal of Statistical Software · doi:10.18637/jss.v048.i02 · Cited by 27,955 · see citing works
A Simple Sequentially Rejective Multiple Test Procedure
(1979) · Scandinavian Journal of Statistics · doi:10.2307/4615733 · Cited by 21,526 · see citing works
Statistical Analysis With Missing Data
Lahiff, M., Little, R. J. A., & Rubin, D. B. (1989) · Journal of the American Statistical Association · doi:10.2307/2289883 · Cited by 17,384 · see citing works
RUBIN, D. B. (1976) · Biometrika · doi:10.1093/biomet/63.3.581 · Cited by 9,925 · see citing works
Confidence Limits for the Indirect Effect: Distribution of the Product and Resampling Methods
MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr3901_4 · Cited by 7,806 · see citing works
Enders, C., & Bandalos, D. (2001) · Structural Equation Modeling: A Multidisciplinary Journal · doi:10.1207/s15328007sem0803_5 · Cited by 4,978 · see citing works
Statistical Analysis With Missing Data
Lazar, N. A. (2003) · Technometrics · doi:10.1198/tech.2003.s167 · Cited by 2,479 · see citing works
Psychological Testing: A Practical Approach to Design and Evaluation
Kline, T. (2005) · doi:10.4135/9781483385693 · Cited by 1,588 · see citing works
Attitudes to vaccination: A critical review
Yaqub, O., Castle-Clarke, S., Sevdalis, N., & Chataway, J. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.04.018 · Cited by 1,089 · see citing works
The occurrence of lung cancer in man.
Ml, L. (1953) · PubMed · Cited by 945 · see citing works
Enders, C. K. (2001) · Psychological Methods · doi:10.1037/1082-989x.6.4.352 · Cited by 942 · see citing works
Freeman, D. H., Loe, B. S., Chadwick, A., Vaccari, C., Waite, F., Rosebrock, L. E., Jenner, L., Petit, A., Lewandowsky, S., Vanderslott, S., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720005188 · Cited by 764 · see citing works
Self-citationIntroduction to mediation analysis with structural equation modeling.
(2013) · PubMed Central · doi:10.3969/j.issn.1002-0829.2013.06.009 · Cited by 661 · see citing works
Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey
Ruiz, J. B., & Bell, R. A. (2021) · Vaccine · doi:10.1016/j.vaccine.2021.01.010 · Cited by 618 · see citing works
Maximum likelihood estimation of the attributable fraction from logistic models.
Greenland, S., & Drescher, K. (1993) · Biometrics · doi:10.2307/2532206 · Cited by 565 · see citing works
On the Meaning of within-Factor Correlated Measurement Errors
Gerbing, D. W., & Anderson, J. C. (1984) · Journal of Consumer Research · doi:10.1086/208993 · Cited by 526 · see citing works
Survey of the prevalence of immunization non-compliance due to needle fears in children and adults
Taddio, A., Ipp, M., Thivakaran, S., Jamal, A. M., Parikh, C., Smart, S., Sovran, J., Stephens, D., & Katz, J. D. (2012) · Vaccine · doi:10.1016/j.vaccine.2012.05.011 · Cited by 501 · see citing works
Sörbom, D. (1989) · Psychometrika · doi:10.1007/bf02294623 · Cited by 424 · see citing works
Barriers to Adult Immunization
Johnson, D. R., Nichol, K. L., & Lipczynski, K. (2008) · The American Journal of Medicine · doi:10.1016/j.amjmed.2008.05.005 · Cited by 371 · see citing works
Introduction to mediation analysis with structural equation modeling
Douglas, Gunzler, Tian, T., et al. (2013) · 上海精神医学 · Cited by 342 · see citing works
Issues in the Application of Covariance Structure Analysis: A Comment
Fornell, C. (1983) · Journal of Consumer Research · doi:10.1086/208938 · Cited by 321 · see citing works
STINSON, F. S., DAWSON, D. A., PATRICIA CHOU, S., SMITH, S., GOLDSTEIN, R. B., JUNE RUAN, W., & GRANT, B. F. (2007) · Psychological Medicine · doi:10.1017/s0033291707000086 · Cited by 320 · see citing works
Freeman, D. H., Loe, B. S., Yu, L., Freeman, J., Chadwick, A., Vaccari, C., Shanyinde, M., Harris, V., Waite, F., Rosebrock, L. E., et al. (2021) · The Lancet Public Health · doi:10.1016/s2468-2667(21)00096-7 · Cited by 264 · see citing works
Self-citationSaris, W. E., Revilla, M., Krosnick, J. A., & Shaeffer, E. M. (2009) · Survey research methods · doi:10.18148/srm/2010.v4i1.2682 · Cited by 256 · see citing works
The cross-national epidemiology of specific phobia in the World Mental Health Surveys
Wardenaar, K. J., Lim, C. C. W., Al-Hamzawi, A. O., Alonso, J., Andrade, L. H., Benjet, C., Bunting, B., de Girolamo, G., Demyttenaere, K., Florescu, S. E., et al. (2017) · Psychological Medicine · doi:10.1017/s0033291717000174 · Cited by 227 · see citing works
A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears
Van Houtem, C. M. H. H., Laine, M. L., Boomsma, D. I., Ligthart, L., van Wijk, A. J., & De Jongh, A. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.04.007 · Cited by 131 · see citing works
A history of the population attributable fraction and related measures
Poole, C. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.11.015 · Cited by 121 · see citing works
Useful Tools for Structural Equation Modeling [R package semTools version 0.5-3]
Jorgensen, T. D., Pornprasertmanit, S., Schoemann, A. M., & Rosseel, Y. (2020) · Cited by 109 · see citing works
Dahlqwist, E., Zetterqvist, J., Yudi Pawitan, Y., & Sjölander, A. (2016) · European Journal of Epidemiology · doi:10.1007/s10654-016-0137-7 · Cited by 107 · see citing works
McMurtry, C., Taddio, A., Noel, M., Antony, M. M., Chambers, C., Asmundson, G. R. G., Riddell, R. P. P., Shah, V., MacDonald, N. E., Rogers, J., et al. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1157204 · Cited by 98 · see citing works
Factors indicating intention to vaccinate with a COVID-19 vaccine among older U.S. adults
Nikolovski, J., Koldijk, M. H., Weverling, G. J., Spertus, J. A., Turakhia, M. P., Saxon, L. A., Gibson, C. M., Whang, J., Sarich, T. C., Zambon, R. A., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251963 · Cited by 91 · see citing works
Treatments for blood-injury-injection phobia: a critical review of current evidence
Ayala, E. S., Meuret, A. E., & Ritz, T. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2009.04.008 · Cited by 87 · see citing works
The structure of specific phobia symptoms among children and adolescents
Muris, P., Schmidt, H. G., & Merckelbach, H. L. G. J. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00201-0 · Cited by 71 · see citing works
Development and Initial Validation of the Medical Fear Survey–Short Version
Olatunji, B. O., Ebesutani, C. K., Sawchuk, C. N., McKay, D., Lohr, J. M., & Kleinknecht, R. A. (2011) · Assessment · doi:10.1177/1073191111415368 · Cited by 48 · see citing works
Doubly robust estimation of attributable fractions
Sjölander, A., & Vansteelandt, S. (2010) · Biostatistics · doi:10.1093/biostatistics/kxq049 · Cited by 38 · see citing works
Validation of the Multidimensional Blood/Injury Phobia Inventory: Evidence for a Unitary Construct
Wenzel, A. E., & Holt, C. S. (2003) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/a:1023529108350 · Cited by 29 · see citing works
The structure of genetic and environmental risk factors for fears and phobias
Loken, E. K., Hettema, J. M., Aggen, S. H., & Kendler, K. S. (2013) · Psychological Medicine · doi:10.1017/s0033291713003012 · Cited by 28 · see citing works
Ovanessian, M. M., Fairbrother, N., Vorstenbosch, V., McCabe, R. E., Rowa, K., & Antony, M. M. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9687-1 · Cited by 25 · see citing works
A topography of 21 phobic fears: network analysis in an epidemiological sample of adult twins
Kendler, K. S., Aggen, S. H., Werner, M. A., & Fried, E. I. (2020) · Psychological Medicine · doi:10.1017/s0033291720004493 · Cited by 17 · see citing works
Hiermeier, U. M., & Mofrad, L. (2020) · Cognitive Behaviour Therapy · doi:10.1017/s1754470x2000046x · Cited by 7 · see citing works
To look or not to look during vaccination: A pilot randomized trial
Mithal, P., Simmons, P., Cornelissen, T., Wong, H., Riddell, R. P., McMurtry, C. M., Burry, L. D., Stephens, D., & Taddio, A. (2017) · Canadian Journal of Pain · doi:10.1080/24740527.2017.1412254 · Cited by 5 · see citing works
Pain control at the vaccine injection site: new insights
Edwards, K. M., & Booy, R. (2019) · Journal of Travel Medicine · doi:10.1093/jtm/taz053 · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Cited by
Sorted by citations
von Mücke-Heim, I.-A., Walter, I., Nischwitz, S., & Erhardt, A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.915058 · Cited by 3 · see citing works
“014 adults found that about 10% of CoV-19 vaccine hesitancy can be explained by blood-injection-injury fears (41).”
Background
- Authors
- Freeman, D., Lambe, S., Yu, L.-M., Freeman, J., Chadwick, A., Vaccari, C., Waite, F., Rosebrock, L., Petit, A., Vanderslott, S., Lewandowsky, S., Larkin, M., Innocenti, S., McShane, H., Pollard, A. J., & Loe, B. S.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- University of Oxford (GB)
- Loughborough University (GB)
- University of Bristol (GB)
- Aston University (GB)
- University of Cambridge (GB)
- Corresponding author
- Freeman, Daniel
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-06-11
- Volume
- 53
- Issue
- 4
- Pages
- 1185-1195
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC8220023
- OpenAlex
- W3170284260
- Cited by
- 175
- References
- 45
- Citations by year
- 2026: 17 · 2025: 32 · 2024: 24 · 2023: 42 · 2022: 41 · 2021: 19
- FWCI
- 17.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Aston Publications Explorer (Aston University) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- Wellcome Trust (102176/B/13/Z, 102176, 102176/B/13)
- National Institute for Health and Care Research (NIHR202385, BRC-1215–20008, 102176/B/13/Z, II-C7-0117-20001, BRC‐1215‐20005, IS-BRC-1215-20008, IS-BRC-1215)
- Department of Health and Social Care
- European Commission (HORIZON2020, 964728)
- NIHR Oxford Biomedical Research Centre (20008, IS-BRC-1215–20008, 1215-20008, 102176/B/13/Z, BRC-1215-20008, IS-BRC-1215, BRC-1215–20005)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Emergency Medicine › Intramuscular injections and effects
- Keywords
- COVID-19 vaccine hesitancy, blood-injection-injury phobia, specific phobia, vaccination intention, population attributable fraction
- MeSH terms
- COVID-19, COVID-19 Vaccines, Adolescent, Adult, Fear, Humans, Phobic Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
