Racial discrimination is an underlying driver of health disparities that affects experiences across many aspects of everyday life as well as in health care settings. Repeated and ongoing exposure to racial discrimination can negatively affect individuals’ health and well-being, increasing risks of poor outcomes across multiple domains. Understanding how exposure to racial discrimination affects health can inform efforts to reduce health disparities. Racial and ethnic health and health care disparities result in higher rates of illness and death across a wide range of health conditions and are costly to the health care system, resulting in excess medical care costs and lost productivity, as well as additional economic losses due to premature deaths each year. Amid current federal efforts to reduce resources and initiatives focused on addressing disparities, identifying and understanding the continued evidence base about the role of racial discrimination in contributing to negative health outcomes remains important.

This brief provides an overview of the relationship between racial discrimination and health and highlights research published since 2015 examining mechanisms underlying health outcomes linked to self-reported experiences of racial discrimination, including biological changes, chronic stress, mental health, substance use, pregnancy-related outcomes, and sleep. Other research has also identified how structural racism negatively impacts health but is beyond the scope of this brief.

A large body of research conducted over several decades prior to 2015 has linked experiences of racial discrimination to negative health outcomes. While not exhaustive, this brief builds on past analyses by capturing more recent literature, including large-scale longitudinal studies and those based on methodological advances that study genetic, protein, and brain imaging biomarkers to better understand biological changes linking experiences of racial discrimination to health outcomes. Criteria for inclusion included studies conducted among U.S. populations that used validated measures of racial discrimination experiences and examined associations with biomarkers or health outcomes by race. Key takeaways include the following:

• Recent research builds upon earlier evidence that racial discrimination is associated with worse health across multiple domains, which may contribute to health disparities. Research linked self-reported experiences of racial discrimination to a greater risk of chronic disease, mental health disorders, substance use, adverse pregnancy outcomes, and sleep problems among people of color compared to White people. For example, Black and Hispanic people who reported experiencing racial discrimination had elevated risk for cardiovascular disease compared to those who did not report discrimination. Exposure to racial discrimination also is associated with higher rates of preterm births and low birth weight among infants born to Black women compared to White women.
• Emerging studies suggest racial discrimination may impact health outcomes through biological mechanisms linked to stress, inflammation, and changes in the brain. Recent findings associated experiences of racial discrimination with elevated stress and inflammation, shortened telomere length, and changes in brain structure and activity that can increase the risk of chronic disease, poor mental health outcomes, and shortened lifespans.
• Some research gaps and limitations remain. Most studies relied on self-reported experiences of discrimination, which researchers identified as challenging to measure. Moreover, most research focused primarily on Black populations and therefore gaps remain in understanding impacts for other groups who experience ongoing discrimination. Some studies controlled for a more robust set of potential confounding factors, such as age, gender, income, and education, than others, largely due to limitations in sample size. Additionally, studies had mixed findings on the protective social and coping factors that mitigate the negative effects of racial discrimination.

Future research into how experiences of racial discrimination impact health may be limited due to actions by Trump administration, including executive orders eliminating federal diversity, equity, inclusion, and accessibility (DEIA) programs and related initiatives. A major impact of these efforts has been a reduction in federal support for health disparities research, which may limit the information available to track disparities and better understand the underlying factors affecting health outcomes.

Racism and discrimination at all levels contribute to differences in experiences across many aspects of everyday life which can negatively impact people’s health and well-being. It contributes to underlying inequities in social and economic factors that reflect historical and contemporary policies and drive racial and ethnic disparities in health, including access to housing, food, and economic and educational opportunities. However, racial health disparities persist even when controlling for differences in socioeconomic status. Many people of color continue to report experiences with daily discrimination. KFF survey data from 2023 found that at least half of American Indian or Alaska Native (AIAN) (58%), Black (54%), Hispanic adults (50%), and about 4 in 10 Asian adults (42%) say they experienced at least one type of interpersonal discrimination in daily life in the past year. These experiences included receiving poorer service than others at restaurants or stores; people acting as if they are afraid of them or as if they aren’t smart; being threatened or harassed; or being criticized for speaking a language other than English. 

A large body of research conducted over several decades has consistently documented strong associations between self-reported experiences of racial discrimination and negative health outcomes. These outcomes include poor mental health, such as depression, anxiety, and psychological distress. In addition, numerous studies have linked racial discrimination to physical health outcomes, such as hypertension, cardiovascular disease, obesity, asthma, and breast cancer, underscoring its broad impact on both physical and psychological well-being. Two conceptual frameworks help explain the mechanisms through which these associations may arise. The weathering hypothesis describes how chronic exposure to social and economic adversity, including racism and socioeconomic disadvantages, can accelerate health deterioration and contribute to racial health disparities. Allostatic load theory similarly focuses on cumulative physiologic “wear and tear” from repeated or chronic stress activation, which is associated with poorer health outcomes. Allostatic load is typically measured using various indicators, including blood pressure, cardiometabolic indicators, and other biomarkers. Research has found elevated allostatic load among adults who experienced various types of discrimination, including childhood racial discrimination.

Building on existing research, studies since 2015 have sought to replicate previous studies to confirm and extend findings by applying existing theories to more subgroups and outcomes and using new tools. The research often relies on associating health outcomes and biological indicators with self-reported experiences of racial discrimination, most commonly captured using validated survey instruments which measure individuals’ exposure to racial discrimination, such as the Experiences of Discrimination Scale. As this is an evolving body of research, several research limitations exist. Nearly all research studies utilize self-reported experiences of racial discrimination, which may underestimate actual exposure due to social desirability bias, recall errors, or confounds with other intersectional social factors. Some survey instruments that assess perception of racial discrimination may not perform equivalently across different racial and socioeconomic groups, which could affect cross-group comparisons. Most studies focus on Black people, while studies including populations such as AIAN and Native Hawaiian and Pacific Islander (NHPI) people are limited, reducing the generalizability of findings to these and other groups, such as Hispanic and Asian people, who experience ongoing racism. While most studies also analyzed interactions and effects due to variables other than exposure to racial discrimination, such as age, gender, income, and education, some used a less robust set of potential confounding factors due to limitations in sample size.

Impacts on Chronic Disease, Biological Changes, and Stress

Multiple studies find that racial discrimination is associated with a higher risk of chronic diseases and other conditions that may increase mortality risk. Research suggests that racial discrimination is associated with higher risk for cardiovascular and metabolic diseases, including high blood pressure, obesity, diabetes, chronic kidney disease, and other health conditions. A study found that people who reported experiencing racial discrimination had a 5% elevated risk for cardiovascular disease compared to those who did not report discrimination, with the strongest association between racial discrimination and cardiovascular disease risk seen among Asian and Latino people and among women compared to men. Additionally, exposure to experiences of racial discrimination during childhood among Black adults was associated with poorer cardiovascular health outcomes in adulthood compared to those who did not report discrimination. Other studies have highlighted a connection between racial discrimination and higher rates of obesity among women, as well as other health outcomes, including lupus and organ damage among Black women. One study found that experiencing discrimination was associated with an increase in mortality risk due to cardiovascular disease among Black people regardless of health behaviors, clinical risk factors, or social factors such as gender or racial and ethnic residential segregation. Another study found that experiencing racial discrimination was associated with higher risk of mortality due to any cause among Black adults ages 50 and older, even when controlling for health, behavioral, and economic factors.

Experiencing racial discrimination is associated with biological changes that increase inflammation and stress, which may increase the risk of developing chronic conditions and shorten lifespan. Inflammation is a natural response to injury and illness, but chronic inflammation that occurs in the absence of injury or illness can lead to various health issues, including cardiovascular disease, diabetes, and immune function. A longitudinal study found that elevated inflammation and higher levels of cumulative lifespan stress, which included experiences of discrimination, partly accounted for the shorter lifespans seen among Black participants compared to those who were White. Recent studies showed that individuals who experienced discrimination, including racial discrimination, exhibited higher levels of inflammation biomarkers compared to those who did not report discrimination. For example, one study found that Black people experienced more stress than White people across various measures, including due to racial discrimination, and that stress exposure was strongly associated with higher levels of a protein associated with inflammation. Research also found a similar pattern among pregnant Black women who reported experiencing racial discrimination compared to those who had not. Further, research at the genetic level, including the mechanisms that control inflammation levels, found that Black study participants had higher inflammatory signaling than White participants, and that racial discrimination explained over half of the race-related differences in expression of genes that promote inflammation. Another study of Black and White adults found that, among participants reporting high perceived discrimination, Black adults had a higher expression of a different set of genes linked to immune function and inflammation compared with White participants, suggesting a unique gene expression linked to experiences of racial discrimination.

Racial discrimination is also associated with shortened telomere length, which contributes to accelerated biological aging. Telomeres, which protect the ends of chromosomes, naturally shorten over time and serve as an indicator of aging. Chronic stress can accelerate telomere shortening and is associated with earlier onset of age-related disease, such as heart disease and cancer. Research found that, among Black people, those who reported racial discrimination had faster telomere shortening over a ten-year period than those who did not, though a separate study observed this effect only among Black adults ages 50 and older due to everyday discrimination rather than racial discrimination specifically. Another study found that experiences of racial discrimination were associated with shorter telomere length among Black women, Black people with high socioeconomic status, Black adults under age 40, and White men under age 40, illustrating complex interactions between experiences of discrimination and other sociodemographic factors. One hypothesis for the association observed among younger White men is that younger White males feeling “targeted” due to perceptions of race-related disadvantages as a result of increases in diversity efforts. Such perceptions may be especially pronounced among younger adults navigating educational and career advancement, although additional research is needed to better understand these relationships.

Research also has identified mitigating social and coping factors that may limit the impact of racial discrimination on stress and allostatic load, but some findings on protective buffers are mixed. Research among Black youth ages 16–18 found that higher parental and peer emotional support was associated with lower allostatic loads. A study found that, among Black women who reported experiences of racial discrimination, those with higher education levels and lower poverty status had lower allostatic load regardless of how much racial discrimination they reported experiencing compared to those with lower education levels. However, a study comparing allostatic load between Black and White adults found that experiencing higher levels of racial discrimination was associated with higher allostatic load regardless of education level, income, or wealth. Another study found that “John Henryism” among Black people, a high-effort, active coping style in response to racism and sociodemographic challenges, was associated with fewer depressive episodes but higher allostatic load, suggesting that some social coping strategies may come at the expense of health. Similarly, research conducted on the “superwoman schema” among Black women, where resilience, self-reliance, and other social processes are central to coping with discrimination, found mixed results where some coping strategies limit stress while others exacerbate it.

Pregnancy and Birth Outcomes

Recent research expands on a large body of research that shows racial discrimination is associated with adverse pregnancy outcomes. Research has documented that racism and chronic stress contribute to poor maternal and infant health outcomes, including higher rates of pregnancy-related depression and preterm birth among Black women and higher rates of mortality among Black infants. Racial discrimination during pregnancy may contribute to disparities in maternal and infant health outcomes as research has found that women of color experienced greater stress from experiencing racial discrimination than White women. Pregnancy-specific stress and lifetime exposure to racial discrimination disproportionately affect Black women and other women of color, and racial discrimination is associated with increased risk of psychological distress and reduced social support during pregnancy. Exposure to racial discrimination is associated with higher rates of preterm births, small for gestational age, and low weight births among infants born to Black women compared to White women. Additionally, experiencing racial discrimination during pregnancy is associated with elevated stress-related inflammatory markers and poor sleep among Black women, which may negatively affect maternal and perinatal health outcomes. Research among Black women also links maternal experiences of racial discrimination to poor sleep health among their children.

Mental Health and Substance Use

Recent evidence builds upon prior literature linking racism and discrimination to negative mental health outcomes, including post-traumatic stress disorder (PTSD), depression, and anxiety. Racial discrimination is associated with depression, anxiety, post-traumatic stress symptoms, and suicidal ideation and attempts among Black people. Recent studies indicated that exposure to discrimination exacerbated PTSD symptoms following traumatic injuries, as the added stress of racial bias may compound the psychological impact of the original trauma. Additionally, research among Black adults found that higher experiences of racial discrimination were associated with non-remitting PTSD, or PTSD that does not improve over time. Among Black youth between ages 9–14, higher levels of racial discrimination were associated with a greater risk of developing depressive symptoms over time. A study of school-age youth between 6^th and 12^th grade found that experiences of racial discrimination were associated with serious psychological distress and suicidality, most prominently among Black, Asian, and multiracial students. Research among Black youth between ages 11–19 found associations between online racial discrimination, PTSD symptoms, and suicidal ideation.

Emerging research also suggests that racial discrimination may contribute to changes to brain structure and activity that may increase risk of brain disorders and poor mental health outcomes. Brain structure plays a role in determining cognitive function and emotional regulation, with certain changes in brain volume, white matter integrity, and connectivity between different parts of the brain potentially increasing vulnerability to brain disorders and mental health conditions such as PTSD, depression, and anxiety. Research utilizing brain imaging methods has shown that experiencing racial discrimination is linked to reduced white matter integrity among Black adults 55 and older, which may increase the risk of stroke, dementia, and cognitive decline, and lower overall brain volume, which may be associated with depression. Among Black women, experiencing racial discrimination was associated with further reduced white matter integrity even when accounting for changes associated with trauma and PTSD. Research among Black youth found that coping with racial discrimination was associated with changes in brain activity that increased anxiety, depression, aggression, and rule-breaking symptoms. Research among trauma-exposed Black women also found that experiencing racial discrimination was associated with changes in connectivity between certain brain regions, including heightened activation in brain regions associated with threat vigilance and response, a state of chronic heightened stress. Another study among those who experienced a traumatic brain injury found that exposure to racial discrimination was associated with heightened connections in brain areas responsible for threat arousal, which is a state of heightened alertness that typically activates a stress response due to danger.

Experiencing racial discrimination is associated with an increased risk of substance use and alcohol use disorders. A review of studies found significant links between experiences of racial discrimination and both substance use and negative mental health outcomes. Experiences of racial discrimination were found to be associated with an increased risk for alcohol use disorder among AIAN, Black, Hispanic, and NHPI adults. Research also found that, among Hispanic college students, racial discrimination was a significant risk factor for the development of maladaptive alcohol use. A study of Black adults ages 18–24 found that experiences of racial discrimination were associated with past-year drug use and with frequent drug use, with a stronger association seen among those with a higher socioeconomic status compared to adults with lower socioeconomic status.

Sleep Disruption

Data suggest that racial discrimination is associated with sleep disruption, which may contribute to a range of negative health outcomes. Poor sleep is associated with a range of negative health outcomes, including increased inflammation, heightened risk for diabetes and obesity, and mental health issues such as depression and anxiety. Among youth ages 13–15, experiences of racial discrimination were linked to shorter sleep duration, more frequent disturbances, increased depressive symptoms, and lower levels of self-esteem. Additionally, research among college students found that experiences of racial discrimination contributed to greater increases in sleep problems among Black students compared to White students. Other research among people diagnosed with insomnia disorder found that experiences of racial discrimination were a significant factor in the link between race and insomnia severity for Black, Asian, and multiracial individuals.

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Key Takeaways

• With childhood vaccination rates in the U.S. continuing to decline as measles cases rise across the U.S., KFF’s latest Tracking Poll on Health Information and Trust shows that several commonly circulated vaccine myths remain pervasive among the public. Many adults say they have heard false claims about the measles and COVID-19 vaccines, including that the measles, mumps, and rubella (MMR) vaccines have been proven to cause autism in children (66%), that more people have died from the COVID-19 vaccines than the virus (46%), that mRNA vaccines can alter DNA (36%), or that measles vaccines are more dangerous than measles itself (29%).
• While many have heard of these myths, smaller shares are convinced they are true. Fewer than one in ten adults express ardent belief in each myth, while larger shares (between 31% and 44%) say each are “definitely false” and at least half fall in the “malleable middle,” saying each of these claims is either “probably true” or “probably false.”
• Adults who have a relationship with a trusted health care provider are less likely than those who don’t have such a relationship to believe or lean toward believing vaccine falsehoods. For instance, nearly half (46%) of adults who say they do not have a health care provider they trust to answer questions about their health say it is “probably” or “definitely true” that more people have died from COVID-19 vaccines than from the virus, which is nearly twice the share among those with a trusted provider (24%). While younger adults, Hispanic adults, and uninsured adults are more likely than their counterparts to say they don’t have a trusted provider, the connection between lacking a trusted provider and belief in vaccine myths holds even when controlling for factors like age, race and ethnicity, education, partisanship, and insurance coverage.
• Those who use social media and artificial intelligence (AI) chatbots for health information are also more likely to endorse many of these vaccine myths. For example, adults who use social media for health information at least weekly are more than twice as likely as those who don’t use social media for health to say the myth linking MMR vaccines to autism is “probably” or “definitely true” (37% v. 16%). Use of artificial intelligence (AI) for health information is also correlated with views on some of these myths, with adults who regularly use AI for health information more likely than non-users to believe or lean toward believing myths about the MMR and mRNA vaccines. While younger adults, Black and Hispanic adults, and those without a college degree are all more likely to use to social media for health information, the connection between frequent use and belief in vaccine myths holds even when controlling for factors like age, race and ethnicity, education, and partisanship.
• Parents’ views on vaccine myths are also correlated with their decisions about childhood vaccinations. Parents who report skipping or delaying recommended childhood vaccines are consistently at least 25 percentage points more likely than those who keep their children up-to-date to say vaccine myths are “definitely” or “probably true,” including the false claims that MMR vaccines cause autism in children (57% v. 30%), that more people died from COVID-19 vaccines than the virus itself (55% v. 29%), that mRNA vaccines alter DNA (52% v. 23%), and that measles vaccines are more dangerous than measles (43% v. 18%). This relationship remains significant even when controlling for factors like age, education, and partisanship.
• When looking at patterns of belief across the four false vaccine claims, a new analysis shows that some adults are consistent or leaned myth believers (8% who say all four claims are either “probably” or “definitely true”), or myth deniers (55% who deny all four claims, saying they are either “probably” or “definitely false”). At the same time, about three in ten (31%) fall in a “mixed middle” group, providing a range of true and false answers across the four vaccine myths and lacking certainty on at least half of the false claims. This group may be an important focus for those looking to counter vaccine misinformation and dispel confusion. Black adults, Hispanic adults, Republicans, younger adults, and those without a college degree are all more likely than their counterparts to fall into this “mixed middle” group, as are individuals who go to social media or AI for health information. Notably, nearly half of parents who report skipping or delaying recommended vaccines for their children fall in the “mixed middle,” indicating that these parents’ decisions may be driven, at least in part, by uncertainty and confusion.

Exposure to Common Vaccine Myths

The latest KFF Tracking Poll on Health Information and Trust examines the pervasiveness of several commonly circulated vaccine myths. These false or unproven claims about vaccines have remained persistent in terms of exposure over the past several years, with little change to the share of the public have heard most of these myths.

The false claim that MMR vaccines have been proven to cause autism in children – a myth associated with a since retracted study from the 1990s – remains one of the most widely heard vaccine myths, with two-thirds of adults saying they have heard or read this. Nearly half (46%) of adults say they have heard the false claim that more people have died from the COVID-19 vaccines than the virus itself, and about one third of adults (36%) say they have heard the myth that mRNA vaccines can change your DNA (mRNA is a vaccine technology utilized by some COVID-19 vaccines and others under development). About three in ten adults (29%) say they have heard the false claim that measles vaccines are more dangerous than measles infections.

Exposure to each of these false claims has been fairly steady in KFF polls over the past several years, though the share who report hearing the myth that mRNA vaccines can alter a person’s DNA dropped by 9 percentage points since April 2025 (from 45% to 36%). Exposure to the myth that measles vaccines are more dangerous than measles rose between 2024 and 2025, but has remained steady since then.

Uncertainty Surrounding False Vaccine Claims

While many report having heard some false claims about vaccines, very few adults are ardent believers in these myths, with larger shares (but fewer than half) stating the myths are “definitely false.” At the same time, and consistent with past KFF polling, at least half of adults fall into the “malleable middle” across the myths, expressing some uncertainty and saying these vaccine myths are either “probably true” or “probably false.” Across these four vaccine falsehoods, most parents fall into the malleable middle, expressing some uncertainty for each claim.

Over time, the share who fall in the “malleable middle” for these vaccine myths has been relatively stable, with at least half saying each is either “probably true” or “probably false.” At the same time, there have been some minor shifts in the share who view some of these myths as “definitely false” over the past few years, underscoring how the public’s willingness to endorse vaccine falsehoods is not completely static. Somewhat larger shares of adults now say it is “definitely false” that mRNA vaccines can change your DNA (31% now v. 24% in April 2025), and that measles vaccines are more dangerous than getting infected with measles (44% now v. 38% in March 2024). Conversely, the share of adults who think it is “definitely false” that more people have died from COVID-19 vaccines than from the virus has declined (39% now compared to 47% in June 2023) alongside a 5-percentage point jump in the share who say this myth is “probably true.” There have been no notable changes in views of the long-standing myth that MMR vaccines cause autism.

Belief in Vaccine Myths is Tied to Lacking a Trusted Health Care Provider And Use of Social Media and AI For Health Information

Previous KFF polls have shown that health care providers are the most trusted source of health information among the public, and this latest poll shows that individuals who have a trusted provider are less likely than those without a trusted provider to endorse vaccine-related myths. For example, among adults who say they do not have a doctor or health care provider they trust to answer questions about their health (16% of all adults), nearly half (46%) say it is either “definitely” or “probably true” that more people have died from COVID-19 vaccines than from the COVID-19 virus, compared to a quarter (24%) among those who say they have a trusted health care provider.

Unsurprisingly, adults who say they do not have a trusted health care provider to answer their health questions are much more likely to be uninsured than those who have a provider they trust (36% v. 7%). At the same time, lacking a trusted provider could be related to low trust in providers and doctors more broadly and not necessarily related to health care access. Across demographics, adults under age 50, LGBT adults, and Hispanic adults are all more likely than their counterparts to say they don’t have a provider they trust to answer questions about their health. However, the connection between not having a trusted provider and belief in vaccine myths remains significant even when controlling for factors like age, race and ethnicity, education, partisanship, and insurance coverage.

Frequent health information-seeking on social media and via artificial intelligence (AI) chatbots is also tied to a tendency to believe vaccine myths. Adults who say they use social media for health information and advice at least weekly (26% of all adults) are more likely than those who never use social media for health to say each false vaccine claim is “probably” or “definitely true.” Similarly, adults who report using AI tools or chatbots at least weekly for health advice (20% of all adults) are more likely than those who never use these chatbots to endorse myths about the measles vaccines and mRNA vaccines. For example, the share who say it is “probably” or “definitely true” that MMR vaccines have been proven to cause autism is higher among adults who seek health advice at least weekly from social media (37%) or AI (35%) compared to those who never use social media (16%) or AI (20%) for health advice.

The relationship between belief in vaccine myths and use of social media or AI for health information continues to be significant even when controlling for factors like age, race and ethnicity, education, and partisanship.

Belief in Vaccine Myths is Correlated with Parents’ Decisions to Skip or Delay Recommended Childhood Vaccines

Parents who skip or delay recommended vaccines for their children are about twice as likely as parents who keep their children up to date on vaccines to believe or lean toward believing false claims about the measles and COVID-19 vaccines, underscoring how false health claims may shape parents’ decisions.

Overall, at least three in ten parents say it is “probably” or “definitely true” that MMR vaccines have been proven to cause autism in children (36%), that more people have died from COVID-19 vaccines than the virus (35%), or that mRNA vaccines can alter DNA (29%). About one in four (23%) parents believe or lean toward believing the myth that measles vaccines are more dangerous than measles.

The tendency to endorse these false vaccine claims, however, rises substantially among parents who report not keeping their children up to date on recommended vaccines. Six in ten (57%) parents who report having skipped or delayed recommended childhood vaccines (excluding seasonal vaccines for COVID-19 and flu), say it is either “definitely true” or “probably true” that the MMR vaccines have been proven to cause autism in children, while around half believe or lean toward believing that the COVID-19 vaccines killed more people than the virus (55%), or that mRNA vaccines alter DNA (52%). About four in ten (43%) parents who skipped or delayed childhood vaccines say it is true that the measles vaccines are more dangerous than measles itself. Each of these shares is at least 25 percentage points higher than among parents who report keeping their children up to date on recommended childhood vaccines, a relationship that remains significant even when controlling for factors like age, education, and partisanship. 

Digging Deeper on The Malleable Middle: Patterns of Belief Across Vaccine Myths

While KFF polling has routinely found that at least half the public fall in the “malleable middle” when it comes to a wide variety of false health claims, there are nuances within this group that can be examined by looking at patterns of belief across multiple myths rather than examining a single question.

This new typology identified five groups based off patterns of belief across the four false vaccine claims included in this survey:

The “mixed middle” group, making up 31% of all adults, reflects a portion of the “malleable middle” that expresses the most uncertainty and does not routinely land on one side when it comes to commonly circulating vaccine falsehoods. The share who fall in the “mixed middle” differs by partisanship, education, race and ethnicity, and age. For example, four in ten Hispanic adults and about a third (35%) of Black adults are part of this group compared to fewer than three in ten white adults (28%). Republicans (44%) are more than twice as likely as Democrats (18%) to be part of this group, while independents (31%) fall in between the two. Those without a college degree (36%) are also 10 percentage points more likely than college graduates (23%) to fall into this mixed middle group. These findings suggest these groups who disproportionately fall in the “mixed middle” may be an important focus for those looking to counter vaccine misinformation and dispel confusion. 

Adults who are frequently using social media for health advice are also more likely to lack certainty across vaccine myths, providing a range of mixed answers and saying at least half of the four myths are either “probably true” or “probably false.” When looking at belief across different vaccine myths, adults who report using social media for health information on at least a weekly basis are twice as likely to fall in the “mixed middle” group as those who never use social media for health (41% v. 21%). Adults who use AI tools for health information at least occasionally are also somewhat more likely to fall into the “mixed middle” compared to those who never use AI for health, but the difference is smaller for AI than it is for social media use.

Nearly half (45%) of parentswho have skipped or delayed recommended vaccines for their children fall in this “mixed middle” group, underscoring the connection between confusion, uncertainty and parents’ decisions to forgo recommended vaccines for their children.

This KFF Tracking Poll on Health Information and Trust was designed and analyzed by public opinion researchers at KFF. The survey was conducted May 7 – 31, 2026, online and by telephone among a nationally representative sample of 2,480 U.S. adults in English (2,407) and Spanish (73).

The sample includes 1,977 who were reached through an address-based sample (ABS) and completed the survey online (1,819) or over the phone (158). An additional 503 respondents were reached through a random digit dial telephone (RDD) sample of prepaid (pay-as-you-go) cell phone numbers. Among this prepaid cell phone component, 223 were interviewed by phone and 280 were invited to the web survey via short message service (SMS). Marketing Systems Groups (MSG) provided both the ABS and RDD samples. All fieldwork was managed by SSRS of Glen Mills, PA; sampling design and weighting was done in collaboration with KFF.

Both the ABS and RDD sample frames included disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. The ABS was also stratified based on model-based prediction of household-members’ party identification (Republican, Democratic, or independent).

Respondents received a $15 incentive for their participation, with interviews completed by phone receiving a mailed check and web respondents receiving an electronic gift card incentive.

In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item nonresponse, or (3) had a length less than one quarter of the mean length by mode. Likewise, cases that were reached through ABS who reported a living in a different state than the sampled address were removed for quality assurance. Based on this criterion, 39 cases were removed.

The combined ABS and cell phone samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2025 Current Population Survey (CPS). The combined sample was weighted by gender by age, gender by education, age by education, race/ethnicity by education, education, race, census region, population density, frequency of internet usage, recalled 2024 vote by quintiles of the county-level 2024 vote share. The weights also take into account differences in the probability of selection for each sample type (ABS and prepaid cell phone). This includes adjustment for the sample design and geographic stratification of the samples, and within household probability of selection. The population density benchmark was from the 2026 Claritas Pop-Facts Premier. The internet frequency benchmarks was from the 2025 National Public Opinion Reference Survey (NPORS) data. The county-level 2024 vote share was from CNN-provided file of 2024 election results by county

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. The following questions included in this survey were designed, analyzed, and paid for by KFF. The demographic questions included in this study were developed and funded jointly by CNN and KFF, with each organization having independent editorial control over its portion of the survey. KFF Public Opinion and Survey Research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.