Factors Associated With COVID-19 Primary and Booster Vaccine Uptake Among New York City Public School Students.

Abstract

<b>Objectives.</b> To examine individual-, school-, and neighborhood-level factors associated with COVID-19 primary and booster vaccination among New York City public school students. <b>Methods.</b> We analyzed data from a population-based cohort study of 917 062 students aged 5 to 18 years enrolled in 2021/2022. Enrollment data were linked to the Citywide Immunization Registry, Medicaid claims, and neighborhood indicators (January 2020-July 2023). We assessed multivariable regression associations between vaccination status and demographic, clinical, school, and contextual characteristics. <b>Results.</b> Overall, 51.3% of all students completed the primary series and 10.8% received a booster. Uptake was highest among non-Hispanic Asian students (72.1%; 95% confidence interval [CI] = 71.9, 72.3) and lowest among non-Hispanic Black (42.2%; 95% CI = 42.0, 42.4) and non-Hispanic White students outside Manhattan (39.7%; 95% CI = 39.5, 40.0). Students with preexisting conditions were modestly more likely to have received vaccination than peers (54.9%; 95% CI = 54.8, 55.1 vs 49.8%; 95% CI = 49.7, 49.9). Uptake increased with older age and proximity to vaccination sites but was lower among Medicaid-enrolled students. <b>Conclusions.</b> Coverage in the largest US school district was lower than national pediatric estimates, with only modestly higher coverage among children at elevated medical risk, despite their prioritization in vaccination efforts. <b>Public Health Implications.</b> Children at elevated medical risk remained undervaccinated. Addressing barriers in insurance, neighborhood, and care delivery systems is critical to improving vaccine uptake. (<i>Am J Public Health</i>. Published online ahead of print August 6, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308604).