Family Norms, Not Coworkers, Drove COVID-19 Vaccine Uptake Among Latino Day Laborers

When the COVID-19 pandemic upended daily life, few workers faced greater uncertainty than Latino day laborers, the predominantly foreign-born men who gather each morning at hiring corners across the United States waiting for informal, cash-paid jobs in construction, landscaping, and moving services. Cut off from reliable institutional health information, lacking consistent public health outreach in Spanish, and working without formal employment protections, these jornaleros could not simply tune in to official guidance when deciding whether to get vaccinated. A new study published in the Journal of Behavioral Medicine reveals that in this informational vacuum, one social voice rose above all others: the family. Even when family members were thousands of miles away, likely residing outside the United States, their perceived behaviors and expectations proved the decisive force shaping whether these workers rolled up their sleeves for a COVID-19 vaccine.

The research, led by Nanjun Chen, Karen Del Rio, Vahed Maroufy, and Maria Eugenia Fernández-Esquer at The University of Texas Health Science Center at Houston, draws on data from the Vale+Tu Salud cluster-randomized trial, which promoted preventive behaviors among Latino day laborers in Houston, Texas. The team conducted two cross-sectional surveys at fourteen hiring corners: Phase 1 in 2021 with 199 participants and Phase 2 from late 2023 into early 2024 with 359 participants. Trained Spanish-speaking outreach team members approached workers at the corners, screened them for eligibility, obtained informed consent, and administered tablet-based interviews entirely in Spanish, reflecting the very limited English proficiency documented in this population. Eligible participants were adults who self-identified as Latino and had a history of seeking work at a corner.

At the heart of the study lies a careful theoretical distinction drawn from decades of social norms research. Descriptive norms capture what trusted others actually do, the perceived prevalence of a behavior such as noticing that most family members have been vaccinated. Injunctive norms reflect what others say one should do, the behaviors that important referents approve or disapprove of. Normative beliefs, a construct rooted in the Theory of Planned Behavior, measure how much specific referents are perceived to care about or be invested in an individual’s behavior. The researchers assessed all three constructs across multiple reference groups: family, friends, neighbors, coworkers, fellow day laborers at the corner, employers, and church members. Crucially, rather than collapsing these influences into a single aggregate measure of what people around you do, as most COVID-19 studies have done, the team modeled each norm type and each referent separately.

The primary outcome was vaccine compliance, defined as having received at least one dose of the COVID-19 vaccine within the twelve months prior to the interview. Participants were asked whether they had received at least one dose and, if so, to provide the vaccination date, allowing the researchers to code compliance precisely. The analysis employed three distinct multivariable logistic regression models, each adjusted for age, years of education, time in the United States, and time seeking work at the corner. The first model examined individual norm items, the second assessed cumulative norm-type scores across referents, and the third, feasible only in Phase 2 where referent measures were aligned, evaluated referent-specific norm scores combining descriptive norms and normative beliefs for each group.

The Phase 1 results delivered a strikingly clear message. Family descriptive norms, the perception that family members were getting vaccinated, were significantly associated with vaccine compliance, with an adjusted odds ratio of 1.976, meaning each unit increase in perceived family vaccination nearly doubled the odds that a worker was compliant. The cumulative descriptive norm score across all referents was also significant, with an adjusted odds ratio of 2.443. In unadjusted individual-item analyses, descriptive norms from both family and friends showed strong associations with compliance, and family influence was pervasive, appearing across all three norm types. Work-related referents such as coworkers and employers showed some associations, but these proved less consistent than family-related norms once the full models were estimated.

Phase 2 revealed a subtle but theoretically important shift. By this later stage, when vaccine compliance in the sample had dropped from 50.6 percent to 25.6 percent, normative beliefs had overtaken descriptive norms as the primary significant factor. The cumulative normative beliefs score across referents was significantly associated with compliance, with an adjusted odds ratio of 1.347, and a subsequent referent-specific analysis confirmed that this effect was driven exclusively by family norms, which carried an adjusted odds ratio of 1.677. Norms from friends, neighbors, and fellow day laborers at the corner were not significantly associated with vaccination in these models. The dominant form of normative influence had migrated from what family does to how much family cares, suggesting that as vaccines became familiar and public discourse intensified, decisions shifted from observing others’ actions to responding to perceived expectations and accountability.

The authors interpret this temporal shift through the lens of social norms theory. Early in the pandemic, amid uncertainty and limited institutional guidance, observing others’ behavior served as a practical heuristic for action, a pattern consistent with longitudinal evidence showing that descriptive norms most strongly drive protective behavior during periods of heightened uncertainty. Later, as vaccination became routine and remaining noncompliance reflected structural barriers, accumulated mistrust, and entrenched hesitancy, individual norm items lost some discriminatory power, producing the broader but weaker pattern of associations observed in Phase 2. The researchers caution that the two phases were analyzed separately and the norm measures were not fully parallel, so the shift should be interpreted as suggestive rather than definitive.

Perhaps the most theoretically provocative finding concerns the referents that did not matter. Coworkers and fellow day laborers share occupational risk, physical space, and daily interaction with these workers, and social norms theory would predict substantial influence from such contextually salient groups. Yet their effects attenuated once family norms were considered simultaneously, suggesting that normative influence among day laborers may be hierarchical rather than additive, with family obligations taking precedence over situational workplace cues. This finding resonates with the cultural construct of familismo, the Latino value system emphasizing strong emotional attachment, loyalty, and reciprocal obligation within the family unit, which prior research has consistently linked to health decision-making. It also aligns with social identity theory: referents exert stronger normative pull when they are psychologically meaningful ingroup members, and for these workers, family represents the primary locus of identity and long-term accountability regardless of geographic distance. In effect, local dominance operated emotionally and culturally rather than spatially.

The public health implications are concrete. Messaging that emphasizes generalized community behavior may be insufficient for this population, particularly as a crisis evolves. Strategies that recognize family-centered decision-making and frame preventive behaviors as consistent with family expectations and responsibilities may outperform approaches relying solely on peer or workplace norms, a proposition supported by a community-partnered intervention that delivered family-oriented vaccine messaging to Spanish-speaking immigrant Latino families and produced measurable improvements in vaccination outcomes. The study has limitations: vaccination status and norms were self-reported, the cross-sectional design of each phase limits causal inference, and measurement differences across phases constrained direct longitudinal comparison. Still, the consistency of family effects across individual-item, composite, and referent-specific models suggests a robust pattern rather than a measurement artifact.

Beyond its immediate findings, the study issues a call for culturally grounded research and sustained investment in the Latino public health workforce. It demonstrates that under conditions of compounded economic, health, and social uncertainty, the influence of social norms depends not only on the type of norm but on whose expectations are perceived as meaningful. For marginalized worker populations navigating informal labor markets and transnational family ties, the most powerful public health messenger may not be a nearby coworker or an official campaign, but a mother, sibling, or cousin whose concern crosses borders. Understanding and leveraging these kin-based normative channels, the authors argue, could transform how future interventions reach populations that institutional messaging has too often left behind.

Subject of Research: The influence of family-centered social norms on COVID-19 vaccine compliance among Latino day laborers

Article Title: Beyond social cues: the normative influence of social referents on COVID-19 vaccine compliance among Latino day laborers

Article References: Beyond social cues: the normative influence of social referents on COVID-19 vaccine compliance among Latino day laborers. (n.d.). https://doi.org/10.1007/s10865-026-00709-8

Image Credits: AI Generated

DOI: 10.1007/s10865-026-00709-8

Keywords: Latino day laborers, COVID-19 vaccination, descriptive norms, injunctive norms, normative beliefs, familismo, social norms, health behavior, Houston, public health, vaccine compliance, Journal of Behavioral Medicine