Investigation of Community Behaviors, Socioeconomic Factors, and Breakthrough COVID-19 Infections Among Vaccinated Individuals: Cross-Sectional Study

Background: Despite widespread COVID-19 vaccination, breakthrough infections remain a public health concern, with transmission risks potentially linked to community behaviors and age-specific preventive practices. While mask-wearing and social distancing are well-established mitigation strategies, their adoption patterns across age groups, particularly among vaccinated individuals, are poorly understood. Objective: This study focuses on understanding breakthrough infections among vaccinated individuals, high-risk behaviors, and socioeconomic determinants of COVID-19 susceptibility to guide effective public health interventions. Methods: A 31-question voluntary survey was distributed using convenience sampling through the Qualtrics survey platform. All survey respondents reported receiving at least the primary vaccination against COVID-19 infection, and all survey responses were recorded between January 6, 2022, and September 26, 2022. Logistic regression analysis was used to estimate the odds ratio to measure the association between testing positive for COVID-19 and the different activities. Results: Among the vaccinated individuals, those who tested positive were 11.103 times more likely to engage in going to a restaurant or bar compared to those who tested negative (P=.01). There was a significant difference in practicing social distancing and mask-wearing between the different age groups (P=.02), with 100% (10/10) of the participants older than 70 years practicing it, followed by 96.8% (118/122) of the 18 to 29 year olds. The study found lower infection rates in the same age groups compared to the other age groups. Moreover, the 18 to 29 years age group demonstrated notable associations with practicing social distancing and mask-wearing in various settings. Conclusions: Compliance with social distancing and mask-wearing was higher among older and younger participants, and noncompliance with social distancing and mask-wearing was associated with a higher positivity rate. Activities such as going to a restaurant or bar were significantly associated with testing positive for COVID-19 among vaccinated individuals. These results provide valuable information to individuals, health care providers, and public health experts regarding the types of behaviors and community settings that are associated with COVID-19 infection and help enhance our understanding of the types of settings in which social distancing and masking may be beneficial or not necessary. This knowledge can also help local health departments develop tailored public health guidance based on the behaviors of individuals and the types of community settings in their localities.