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Despite increased risk of COVID-19 infection, severe complications, hospitalizations, and death, people with mental health disorders report greater vaccine hesitancy and have lower COVID vaccination levels than the general population. Individuals with mental health disorders are much more likely to endorse COVID-19 vaccine misinformation, which may mediate the relationship between mental health and vaccine hesitancy. Interventions capable of mitigating the impact of vaccine hesitancy, mis/disinformation, and logistical barriers among unvaccinated people with mental health disorders are an urgent priority. Attitudinal inoculation is a brief, scalable strategy to address mis/disinformation. In a quasi-experimental trial, our team found that a brief online attitudinal inoculation intervention specifically addressing COVID-19 vaccine mis/disinformation significantly decreased COVID-19 vaccine hesitancy and increased resistance to vaccine misinformation among unvaccinated US adults. However, its effectiveness among individuals with mental health disorders is unknown. Informed by inoculation theory, attitudinal inoculation leverages the power of narrative, values, and emotion to strengthen resistance to misinformation and reduce hesitancy and is well- suited for low-information audiences and ideologically polarized or conspiratorial groups. The proposed research project will leverage the infrastructure of the national CHASING COVID Cohort, a large and geographically diverse community-based US cohort, to tailor and test the effectiveness of a brief digital attitudinal inoculation intervention to increase vaccination among adults with anxiety or depression symptoms. Aim 1: Characterize the relationship between symptoms of anxiety and depression and vaccine/booster uptake, and other related determinants of vaccine uptake (including endorsement of COVID-19 misinformation and vaccine hesitancy) among those with and without anxiety/depression Aim 2: Adapt and pilot an evidence-based attitudinal inoculation intervention to increase COVID-19 vaccination and boosting among adults with symptoms of anxiety or depression. Aim 3: Determine the effectiveness of two brief digital attitudinal inoculation intervention strategies compared with conventional public health messaging for increasing vaccine uptake in un/undervaccinated and unboosted adults. This study directly addresses the priorities of the National Institute of Mental Health and the PAR: COVID-19 Mental Health Research (PAR-22-112) to conduct “intervention effectiveness research to address vaccine hesitancy, uptake, and implementation among mental health populations.” This research will rapidly generate evidence to inform the development and implementation of strategies to increase vaccination uptake and mitigate the impact of COVID-19 among mental health populations. Beyond the COVID pandemic, this research has direct applicability to future pandemics and routine vaccination campaigns.

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