This study examined whether COVID-19 vaccination status affected perceived importance of and adherence to six preventive behaviors (mask wearing, hand washing, social distancing, self-isolation when sick, avoiding hospitality venues, and avoiding gatherings) among 14,771 Canadians aged 18+ across five survey periods from May 2021 to June 2022 (iCARE study).
Vaccinated individuals had 5-fold higher odds of rating preventive behaviors as 'very important' (OR = 5.0, 95% CI = 4.4–5.7) and were more likely to adhere to most preventive behaviors (ORs = 0.9–2.2, 95% CI = 0.7–3.2) compared to unvaccinated individuals across all survey periods. Vaccination did not reduce adherence to or perceived importance of preventive measures.
- Online survey design may introduce self-selection bias; online panels may not fully represent unvaccinated or vaccine-hesitant groups. - Vaccination status was broadly dichotomized (unvaccinated vs. partially/fully vaccinated), which may obscure dose-specific behavioral differences. - Racial and ethnic diversity was not fully captured, limiting generalizability across all Canadian subpopulations.
Vaccination does not appear to cause risk compensation — vaccinated Canadians maintained or increased adherence to preventive behaviors. Clinicians and public health communicators should focus targeted, autonomy-supportive interventions on unvaccinated individuals, who cluster in both vaccine refusal and low uptake of other preventive measures.
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