Workplace availability, risk group and perceived barriers predictive of 2016-17 influenza vaccine uptake in the United States: A cross-sectional study.

Seasonal influenza, though mostly self-limited in the healthy adult, may lead to severe disease and/or complications in subpopulations. Annual influenza vaccination is available in many countries with coverage goals rarely being met. We conducted a cross-sectional study of influenza vaccine uptake and explored socio-demographic, economic, and psychological factors that explained vaccine uptake. The survey was administered via Amazon Mechanical Turk (MTurk) to United States residents in January 2017, using the Qualtrics platform. Using principal axis factor analysis, we reduced the 25 items theory-based psychological determinants into the primary constructs they measure if/when internal consistency was sufficient (Cronbach's alpha >0.60). Logistic regression models were used to quantify the association of socio-demographic, economic, and psychological factors with reported vaccine behavior in the 2016-17 flu season. 1007 participants completed the survey, sex distribution was even, 67% had 25-44years of age, and 61% annual household income of $30-99 thousand United States dollars. About 25% had the flu shot offered at their workplace and 20% reported belonging to a group for whom the flu shot is recommended. Vaccine uptake was 31.5%. Eight predictors remained in the final adjusted model (R2=0.489), having the vaccine offered at the workplace, belonging to a group for whom the vaccine is recommended, and higher perceived barriers were the strongest predictors of vaccine uptake, increasing (and decreasing in the case of barriers) the odds by >3-fold. Additionally, higher household income, higher perceived susceptibility and higher perceived benefits also independently predicted vaccine uptake. We found evidence that perceived barriers significantly impaired vaccine uptake to the same extent that having the vaccine offered at the workplace or belonging to a group for whom the vaccine is recommended facilitated uptake. Ideally, a better understanding of drivers of vaccine hesitancy will result in improved interventions to increase vaccine uptake.

Luz PM ，Johnson RE ，Brown HE 《-》

Parental perceptions of childhood seasonal influenza vaccination in Singapore: A cross-sectional survey.

Seasonal influenza vaccination is recommended in children aged 6-59months, but little is known about child vaccination coverage and determinants in Asian settings. We report the results of a survey of knowledge, attitudes, practices, and determinants of child influenza vaccination in Singapore. In December 2015-March 2016, we conducted a survey of 332 parents of children aged 6months to 5years attending pre-schools. We assessed child influenza vaccine coverage and parental knowledge, attitudes, and practices of child influenza vaccination. We used multivariable regression and structural equation models to identify factors associated with child influenza vaccination. Knowledge about influenza, perceived benefit of vaccination, and willingness to vaccinate were high. However, only 32% of children had ever received influenza vaccine, and only 15% in the past year. Factors independently associated with child influenza vaccination included: being recommended influenza vaccine by a child's doctor (prevalence ratio (PR)=2.47, 95% CI: 1.75-3.48); receiving influenza vaccine information from a private general practitioner (PR=1.47, 95% CI: 1.05-2.04); regularly receiving pre-travel influenza vaccine (PR=1.64, 95% CI: 1.19-2.25); higher willingness to vaccinate (PR=1.58, 95% CI:1.24-2.04 per unit increase in willingness score); and feeling well-informed about influenza vaccine (PR=1.44, 95% CI: 1.04-1.99). Parents who obtained influenza vaccine information from television were less likely to have vaccinated their child (PR=0.44, 95% CI: 0.23-0.85). Path analysis indicated that being recommended vaccination by a child's doctor increased willingness to vaccinate and self-efficacy (feeling well-informed about influenza vaccine). Median willingness-to-pay for a dose of influenza vaccine was SGD30 (interquartile range: SGD20-SGD50), and was higher in parents of vaccinated compared with unvaccinated children (SGD45vs SGD30, p=0.0012). Knowledge and willingness to vaccinate was high in this parent population, but influenza vaccine uptake in children was low. Encouraging medical professionals to recommend vaccination of eligible children is key to improving uptake.

Low MSF ，Tan H ，Hartman M ，Tam CC ，Hoo C ，Lim J ，Chiow S ，Lee S ，Thng R ，Cai M ，Tan Y ，Lock J ... -  《-》

Determinants of influenza vaccination among high-risk Black and White adults.

Adults with chronic conditions are at much greater risk of influenza-related morbidity and mortality, yet flu vaccine uptake remains suboptimal. Research focused on the high-risk population has been limited, particularly related to racial disparities in vaccination. We explore a broad range of demographic, racial, and psychosocial factors to identify predictors of vaccination among high-risk adults, with a focus on identify differences between Black and White adults. We conducted an online survey in March 2015, utilizing international research firm GfK's KnowledgePanel, for a nationally representative sample of Black and White adults (≥18, USA) and limited analysis adults with high-risk of influenza-related complications. Using two-way ANOVA, we assessed demographic, racial, and psychosocial predictors across vaccine uptake in the past five years and across racial group. 424 (52.2%) Black and 388 (47.8%) White respondents with high-risk complications completed the survey. 383 (47.3%) reported vaccination annually, 99 (12.2%) most years, 104 (12.9%) once/twice, and 223 (27.6%) never.ANOVA confirmed significant differences in vaccine behavior for most demographic predictors (except education), all racial factors (including racial fairness, experiences of discrimination, etc.), and most psychosocial factors (including vaccine attitudes, trust in the vaccine, etc.). ANOVA confirmed significant differences for most factors by race. We observed significant interaction effects between race and vaccine behavior for subjective social status, access to medical care, knowledge of vaccine recommendations, vaccine attitudes, perceived side effect risks, descriptive norms, subjective norms, flu vaccine hesitancy, and flu vaccine confidence, thus implying racial differences in the connection between vaccine uptake and key demographic, racial, and psychosocial factors. This study provides a novel examination of flu vaccine behavior among high-risk Blacks and Whites that identified factors influencing vaccine uptake.We found significant differences by race. Health care professionals can use this information to more effectively target high-risk adults during flu season.

Crouse Quinn S ，Jamison AM ，Freimuth VS ，An J ，Hancock GR ... -  《-》

Do superstitious beliefs affect influenza vaccine uptake through shaping health beliefs?

This study examined the impact of superstitious beliefs on influenza vaccine uptake and investigated the role of health beliefs as underlying psychological mechanisms. It is hypothesized that superstitious beliefs predict greater perceived risks in influenza and vaccines, which in turn affect influenza vaccine uptake. A cross-sectional survey of Singaporeans and Singapore Permanent Residents aged between 21 and 70 (N = 668) was conducted using computer-assisted telephone interviews. The survey covered beliefs in superstition, health beliefs in influenza and vaccines, and influenza vaccine uptake intention and behavior using the Health Belief Model. Path analysis was adopted to examine the hypothesized model. Approximately 60% of the sample had never obtained influenza vaccination. The path analysis found that superstitious beliefs significantly predicted higher perceived barriers and lower perceived benefits of vaccines, which in turn predicted a lower intention to take influenza vaccine in the next year and/or a lower probability of ever taking influenza vaccine. In contrast, superstitious beliefs predicted higher perceived susceptibility and severity of influenza that in turn predicted higher influenza vaccine uptake intention and/or probability. Examining demographic variables and past experience on influenza as control and confounding factors did not significantly affect the results. The findings imply that beliefs in superstitions can have mixed effects on vaccine uptake and intention through shaping beliefs of the disease and vaccines. Significant implications in health education and persuasion on vaccine uptake are discussed.

Lu J ，Luo M ，Yee AZH ，Sheldenkar A ，Lau J ，Lwin MO ... -  《-》

Identifying Associations Between Influenza Vaccination Status and Access, Beliefs, and Sociodemographic Factors Among the Uninsured Population in Suffolk County, NY.

Chen G ，Kazmi M ，Chen D ，Phillips J ... -  《-》