Who Do You Trust? Demographic Patterns in Vaccine Hesitancy among Older Adults in a Rural State.

Older adults are at increased risk for complications from vaccine-preventable diseases, yet many remain undervaccinated. This study examined demographic variability in vaccination hesitancy among older adults in a rural state and the potentially mediating role of trust uncertainty. A cross-sectional survey of a random sample of 739 adults aged 65+ in North Dakota was conducted from May to July 2022. Using bootstrapped mediation analyses, we assessed whether trust uncertainty mediated the relationships between demographic characteristics and vaccine hesitancy and acceptance. Results showed uncertainty about whom to trust was a significant predictor of both higher vaccine hesitancy and lower vaccine acceptance. Uncertainty about whom to trust fully mediated the relationship between rurality and vaccine hesitancy, and between education and vaccine acceptance. Political leaning and physical health were also partially mediated through uncertainty about whom to trust. These findings highlight the role of trust in shaping vaccine attitudes and the need for tailored communication strategies that address information uncertainty.