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Assaf AM, Hammad EA, Haddadin RN. Influenza Vaccination Coverage Rates, Knowledge, Attitudes, and Beliefs in Jordan: A Comprehensive Study. Viral Immunol 2016; 29:516-525. [PMID: 27509083 DOI: 10.1089/vim.2015.0135] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Influenza vaccination is the most effective method in preventing influenza and its complications. This study's objectives were to investigate the vaccination coverage and frequency and to assess knowledge, attitudes, and practices toward influenza vaccination in Jordan during the year 2012 and the 5 years preceding it. Additionally, it aimed at identifying the barriers and motivations to receive the vaccine and the factors contributing to its uptake. In May 2012, a self-administered cross-sectional survey was distributed to 3,200 adults conveniently selected across Jordan to explore influenza vaccination status, knowledge, attitudes, and practices toward the influenza vaccine. The survey response rate was 98.3%. The overall coverage rate of seasonal influenza vaccination ranged from 9.9% to 27.5%. Results of the univariate analysis revealed that males, participants older than 45 years, business owners, and university students or graduates were more likely to take the vaccine. Healthcare workers (HCW) showed higher rates than non-HCW and those with concomitant chronic diseases were more committed to receive the vaccine. Knowledge about the influenza vaccine is considered high in the Jordanian population. Fear from side effects was the major barrier, while the fear of the virus spread and outbreak was the major reason to receive the vaccine. The coverage rates were low in Jordan compared to other countries. The need for influenza vaccine campaigns and on-going education in Jordan health schools is crucial to increase the rate and remove misconceptions and negative attitudes toward vaccination.
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Affiliation(s)
- Areej M Assaf
- Faculty of Pharmacy, The University of Jordan , Amman, Jordan
| | - Eman A Hammad
- Faculty of Pharmacy, The University of Jordan , Amman, Jordan
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Tetanus, diphtheria, and acellular pertussis vaccination among women of childbearing age-United States, 2013. Am J Infect Control 2016; 44:786-93. [PMID: 27372388 DOI: 10.1016/j.ajic.2016.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
Abstract
The incidence of pertussis in the United States has increased since the 1990s. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination of pregnant women provides passive protection to infants. Tdap vaccination is currently recommended for pregnant women during each pregnancy, but coverage among pregnant women and women of childbearing age has been suboptimal. Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) and 2013 National Health Interview Survey (NHIS) were used to determine national and state-specific Tdap vaccination coverage among women of childbearing age by self-reported pregnancy status at the time of the survey. Although this study could not assess coverage of Tdap vaccination received during pregnancy because questions on whether Tdap vaccination was received during pregnancy were not asked in BRFSS and NHIS, demographic and access-to-care factors associated with Tdap vaccination coverage in this population were assessed. Tdap vaccination coverage among all women 18-44 years old was 38.4% based on the BRFSS and 23.3% based on the NHIS. Overall, coverage did not differ by pregnancy status at the time of the survey. Coverage among all women 18-44 years old varied widely by state. Age, race and ethnicity, education, number of children in the household, and access-to-care characteristics were independently associated with Tdap vaccination in both surveys. We identified associations of demographic and access-to-care characteristics with Tdap vaccination that can guide strategies to improve vaccination rates in women during pregnancy.
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Koep TH, Jenkins S, M Hammerlund ME, Clemens C, Fracica E, Ekker SC, Enders FT, Huskins WC, Pierret C. Promotion of Influenza Prevention Beliefs and Behaviors through Primary School Science Education. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2016; 6:444. [PMID: 27525193 PMCID: PMC4982516 DOI: 10.4172/2161-0711.1000444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND School-based campaigns to improve student health have demonstrated short-term success across various health topics. However, evidence of the effectiveness of programs in promoting healthy beliefs and behaviors is limited. We hypothesized that educational curricula teaching the science behind health promotion would increase student knowledge, beliefs and adherence to healthy behaviors, in this case related to influenza. METHODS Integrated Science Education Outreach is a successful education intervention in Rochester, Minnesota public schools that has demonstrated improvements in student learning. Within this program, we designed novel curricula and assessments to determine if gains in knowledge extended to influenza prevention. Further, we coupled InSciEd Out programming with a clinical intervention, Influenza Prevention Prescription Education (IPPE), to compare students' attitudes, intentions and healthy behaviors utilizing surveys and hand hygiene monitoring equipment. RESULTS 95 students participated in (IPPE) in the intervention school. Talking drawings captured improvement in influenza prevention understanding related to hand washing [pre n=17(43%); post n=30(77%)] and vaccination [pre n=2(5%); post n=15(38%)]. Findings from 1024 surveys from 566 students revealed strong baseline understanding and attitudes related to hand washing and cough etiquette (74% or greater positive responses). Automated hand hygiene monitoring in school bathrooms and classrooms estimated compliance for both soap (overall median 63%, IQR 38% to 100%) and hand sanitizer use (0.04 to 0.24 uses per student per day) but did not show significant pre/ post IPPE differences. CONCLUSIONS Student understanding of principles of influenza prevention was reasonably high. Even with this baseline, InSciEd Out and IPPE improved students' unprompted knowledge of behaviors to prevent influenza, as reflected by talking drawings. This novel metric may be more sensitive in capturing knowledge among students than traditional assessment methods. However, IPPE did not produce further significant differences in student attitudes and behaviors regarding the flu.
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Affiliation(s)
- TH Koep
- Clinical and Translational Sciences, Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
- Department of Biology Teaching and Learning, University of MN, St. Paul, MN, USA
| | - S Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - ME M Hammerlund
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - C Clemens
- Clinical and Translational Sciences, Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - E Fracica
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - SC Ekker
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - FT Enders
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - WC Huskins
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Pierret
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
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Sevin AM, Romeo C, Gagne B, Brown NV, Rodis JL. Factors influencing adults' immunization practices: a pilot survey study of a diverse, urban community in central Ohio. BMC Public Health 2016; 16:424. [PMID: 27216805 PMCID: PMC4877755 DOI: 10.1186/s12889-016-3107-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/14/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Adult vaccination rates in the United States are well below recommendations with disparities in race, ethnicity, and education level resulting in even lower rates for these populations. This study aimed to identify the barriers to and perceptions of immunizations in adults in an urban, underserved, multicultural community. Understanding the factors that influence adults' decisions to receive routinely recommended vaccines will aid health care providers and public health officials to design programs to improve vaccination rates. METHODS This cross-sectional, survey-based study was conducted in January 2014 in Columbus, Ohio. Participants were recruited from four urban federally-qualified health centers and four grocery stores affiliated with those clinics. The survey gathered self-reported receipt of immunizations, knowledge about indications for immunizations, and factors influencing decisions to receive an immunization. Data was analyzed in 2014. Descriptive statistics were generated for all survey items and Chi-Square or Fisher's Exact tests were used as appropriate to test for associations between demographic characteristics and factors influencing immunization decisions. RESULTS The top five factors likely to affect the decision to receive an immunization among the 304 respondents were: "doctor's recommendation" (80.6 %), "knowing why I should get a vaccine" (78.2 %), "knowing which vaccines I need" (75.5 %), cost (54.2 %), and "concern about getting sick if I get a vaccine" (54.0 %). Significant differences in factors influencing the immunization decision exist among respondents based on ethnicity and education level. For those participants with self-identified diabetes, heart disease, or asthma, less than half were aware that certain immunizations could reduce the risk of complications associated with their disease(s). CONCLUSIONS Data from this study may inform and shape patient education programs conducted in clinics, retailers, and communities, as well as advocacy efforts for adult immunizations. Results from this study suggest that patients would respond to programs for promoting vaccine uptake if they focused on benefits and indications for vaccines. The results also highlighted the need for education regarding immunizations for patients with chronic diseases and special indications. The differences in perceptions found between groups can be used to create targeted interventions based on the needs of those patient populations.
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Affiliation(s)
- Alexa M Sevin
- Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 129C Parks Hall, 500W. 12th Avenue, Columbus, OH, 43210, USA
| | | | | | - Nicole V Brown
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Jennifer L Rodis
- Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 129C Parks Hall, 500W. 12th Avenue, Columbus, OH, 43210, USA.
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Sloan C, Chandrasekhar R, Mitchel E, Schaffner W, Lindegren ML. Socioeconomic Disparities and Influenza Hospitalizations, Tennessee, USA. Emerg Infect Dis 2016; 21:1602-10. [PMID: 26292106 PMCID: PMC4550146 DOI: 10.3201/eid2109.141861] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We examined population-based surveillance data from the Tennessee Emerging Infections Program to determine whether neighborhood socioeconomic status was associated with influenza hospitalization rates. Hospitalization data collected during October 2007-April 2014 were geocoded (N = 1,743) and linked to neighborhood socioeconomic data. We calculated age-standardized annual incidence rates, relative index of inequality, and concentration curves for socioeconomic variables. Influenza hospitalizations increased with increased percentages of persons who lived in poverty, had female-headed households, lived in crowded households, and lived in population-dense areas. Influenza hospitalizations decreased with increased percentages of persons who were college educated, were employed, and had health insurance. Higher incidence of influenza hospitalization was also associated with lower neighborhood socioeconomic status when data were stratified by race.
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Koep TH, Huskins WC, Clemens C, Jenkins S, Pierret C, Ekker SC, Enders FT. Influenza knowledge, attitude, and behavior survey for grade school students: design and novel assessment methodology. J Community Health 2016; 39:1231-40. [PMID: 24859735 DOI: 10.1007/s10900-014-9884-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the fact infectious diseases can spread readily in grade schools, few studies have explored prevention in this setting. Additionally, we lack valid tools for students to self-report knowledge, attitudes, and behaviors. As part of an ongoing study of a curriculum intervention to promote healthy behaviors, we developed and evaluated age-appropriate surveys to determine students' understanding of influenza prevention. Surveys were adapted from adolescent and adult influenza surveys and administered to students in grades 2-5 (ages 7-11) at two Rochester public schools. We assessed student understanding by analyzing percent repeatability of 20 survey questions and compared percent "don't know" (DK) responses across grades, gender, and race. Questions thought to be ambiguous after early survey administration were investigated in student focus groups, modified as appropriate, and reassessed. The response rate across all surveys was >87%. Survey questions were well understood; 16 of 20 questions demonstrated strong pre/post repeatability (>70%). Only 1 question showed an increase in DK response for higher grades (p < .0001). Statistical analysis and qualitative feedback led to modification of 3 survey questions and improved measures of understanding in the final survey administration. Grade-school students' knowledge, attitudes and behavior toward influenza prevention can be assessed using surveys. Quantitative and qualitative analysis may be used to assess participant understanding and refine survey development for pediatric survey instruments. These methods may be used to assess the repeatability and validity of surveys to assess the impact of health education interventions in young children.
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Affiliation(s)
- Tyler H Koep
- Clinical and Translational Sciences, Mayo Graduate School, Mayo Clinic, Rochester, MN, 55905, USA
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Suryadevara M, Bonville CA, Rosenbaum PF, Domachowske JB. Influenza vaccine hesitancy in a low-income community in central New York State. Hum Vaccin Immunother 2016; 10:2098-103. [PMID: 25424822 DOI: 10.4161/hv.28803] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Influenza vaccine (IV) coverage rates remain suboptimal among US adults. Socioeconomic disparities exist in IV coverage. We describe influenza vaccine attitudes among a low-income community in central New York. METHODS Adults attending a Salvation Army function during December 2012 were surveyed regarding IV including their intention to be immunized. On-site IV was offered to eligible participants. RESULTS The 1041 participants included Whites (non-Hispanics), African Americans, Hispanics, Native Americans, and multi-racial ethnicities. At time of enrollment, 386 (37%) participants had already received 2012-13 IV. Of the 655 unimmunized participants, 299 (46%) stated intent to receive IV, evenly distributed by age, gender, and ethnicity. Of the 312 participants who declined IV, 46% did so because of IV misperceptions. Of the 299 participants who intended to receive vaccine but had not yet done so, 284 (95%) stated the reason for delay was difficult access to vaccine. Intent to receive vaccine was strongly associated with the belief that IV is safe and/or effective (P < 0.05). CONCLUSION IV misperceptions regarding IV efficacy and safety result in suboptimal vaccine uptake in this low-income community, regardless of age, gender, or ethnicity.
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Affiliation(s)
- Manika Suryadevara
- a Department of Pediatrics; State University of New York; Upstate Medical University; Syracuse, NY USA
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Williams WW, Lu PJ, O'Halloran A, Kim DK, Grohskopf LA, Pilishvili T, Skoff TH, Nelson NP, Harpaz R, Markowitz LE, Rodriguez-Lainz A, Bridges CB. Surveillance of Vaccination Coverage Among Adult Populations - United States, 2014. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2016; 65:1-36. [PMID: 26844596 DOI: 10.15585/mmwr.ss6501a1] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PROBLEM/CONDITION Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. REPORTING PERIOD August 2013-June 2014 (for influenza vaccination) and January-December 2014 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). DESCRIPTION OF SYSTEM The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. RESULTS Compared with data from the 2013 NHIS, increases in vaccination coverage occurred for Tdap vaccine among adults aged ≥19 years (a 2.9 percentage point increase to 20.1%) and herpes zoster vaccine among adults aged ≥60 years (a 3.6 percentage point increase to 27.9%). Aside from these modest improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013 (for influenza coverage, similar to the 2012-13 season). Influenza vaccination coverage among adults aged ≥19 years was 43.2%. Pneumococcal vaccination coverage among high-risk persons aged 19-64 years was 20.3% and among adults aged ≥65 years was 61.3%. Td vaccination coverage among adults aged ≥19 years was 62.2%. Hepatitis A vaccination coverage among adults aged ≥19 years was 9.0%. Hepatitis B vaccination coverage among adults aged ≥19 years was 24.5%. HPV vaccination coverage among adults aged 19-26 years was 40.2% for females and 8.2% for males. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance were significantly less likely than those with health insurance to report receipt of influenza vaccine (aged ≥19 years), pneumococcal vaccine (aged 19-64 years with high-risk conditions and aged ≥65 years), Td vaccine (aged ≥19 years), Tdap vaccine (aged ≥19 years and 19-64 years), hepatitis A vaccine (aged ≥19 years overall and among travelers), hepatitis B vaccine (aged ≥19 years, 19-49 years, and 19-59 years with diabetes), herpes zoster vaccine (aged ≥60 years and 60-64 years), and HPV vaccine (females aged 19-26 years and males aged 19-26 years). Adults who reported having a usual place for health care generally were more likely to receive recommended vaccinations than those who did not have a usual place for health care, regardless of whether they had health insurance. Vaccination coverage was significantly higher among those reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, 23.8%-88.8% reported not having received vaccinations that were recommended either for all persons or for those with some specific indication. Overall, vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents with few exceptions (influenza vaccination [adults aged 19-49 years], hepatitis A vaccination [adults aged ≥19 years], hepatitis B vaccination [adults with diabetes aged ≥60 years], and HPV vaccination [males aged 19-26 years]). INTERPRETATION Overall, increases in adult vaccination coverage are needed. Although modest gains occurred in Tdap vaccination coverage among adults aged ≥19 years and herpes zoster vaccination coverage among adults aged ≥60 years, coverage for other vaccines and risk groups did not improve, and racial/ethnic disparities persisted for routinely recommended adult vaccines. Coverage for all vaccines for adults remained low, and missed opportunities to vaccinate adults continued. Although having health insurance coverage and a usual place for health care are associated with higher vaccination coverage, these factors alone do not assure optimal adult vaccination coverage. PUBLIC HEALTH ACTIONS Assessing associations with vaccination is important for understanding factors that contribute to low coverage rates and to disparities in vaccination, and for implementing strategies to improve vaccination coverage. Practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination to be improved among those least likely to be up-to-date on recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits.
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Affiliation(s)
- Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
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SteelFisher GK, Blendon RJ, Kang M, Ward JRM, Kahn EB, Maddox KEW, Lubell KM, Tucker M, Ben-Porath EN. Adoption of preventive behaviors in response to the 2009 H1N1 influenza pandemic: a multiethnic perspective. Influenza Other Respir Viruses 2016; 9:131-42. [PMID: 25688806 PMCID: PMC4415697 DOI: 10.1111/irv.12306] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 11/27/2022] Open
Abstract
Background As public health leaders prepare for possible future influenza pandemics, the rapid spread of 2009 H1N1 influenza highlights the need to focus on measures the public can adopt to help slow disease transmission. Such measures may relate to hygiene (e.g., hand washing), social distancing (e.g., avoiding places where many people gather), and pharmaceutical interventions (e.g., vaccination). Given the disproportionate impact of public health emergencies on minority communities in the United States, it is important to understand whether there are differences in acceptance across racial/ethnic groups that could lead to targeted and more effective policies and communications. Objectives This study explores racial/ethnic differences in the adoption of preventive behaviors during the 2009 H1N1 influenza pandemic. Patients/Methods Data are from a national telephone poll conducted March 17 to April 11, 2010, among a representative sample of 1123 white, 330 African American, 317 Hispanic, 268 Asian, and 262 American Indian/Alaska Native adults in the USA. Results People in at least one racial/ethnic minority group were more likely than whites to adopt several behaviors related to hygiene, social distancing, and healthcare access, including increased hand washing and talking with a healthcare provider (P-values <0·05). Exceptions included avoiding others with influenza-like illnesses and receiving 2009 H1N1 and seasonal influenza vaccinations. After we controlled the data for socioeconomic status, demographic factors, healthcare access, and illness- and vaccine-related attitudes, nearly all racial/ethnic differences in behaviors persisted. Conclusions Minority groups appear to be receptive to several preventive behaviors, but barriers to vaccination are more pervasive.
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Goto T, Yoshida K, Tsugawa Y, Camargo CA, Hasegawa K. Infectious Disease-Related Emergency Department Visits of Elderly Adults in the United States, 2011-2012. J Am Geriatr Soc 2015; 64:31-6. [PMID: 26696501 DOI: 10.1111/jgs.13836] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the frequency of infectious disease (ID)-related emergency department (ED) visits of elderly adults in the United States. DESIGN Cross-sectional analysis. SETTING Nationwide emergency department sample in 2011-12. PARTICIPANTS Individuals in the ED aged 65 and older with a primary diagnosis of an ID. MEASUREMENTS ID-related ED visits, hospitalizations, hospital-based mortality. RESULTS During 2012, a weighted estimate of 3,123,909 ED visits for IDs was calculated in elderly U.S. adults. This accounted for 13.5% (3.1 million visits) of all ED visits of elderly adults; this burden was higher than that for myocardial infarction and congestive heart failure combined. The rate of ID-related ED visits was 7,231 per 100,000 elderly adults. The most-common diagnoses were lower respiratory infections (26.2%; 95% confidence interval (CI)=25.7-26.6%), urinary tract infections (25.3%, 95% CI=25.0-25.7%), and septicemia (18.9%, 95% CI=18.3-19.6%). Of all ID-related ED visits, 1,786,657 (57.2%, 95% CI=56.6-57.7%) resulted in hospitalization. The leading cause of hospitalization was septicemia, accounting for 32.2% (95% CI=31.1-33.3%) of all ID-related hospitalizations through EDs, followed by lower respiratory infections (27.8%, 95% CI=27.2-28.4%). Overall, 123,894 individuals (4.0%, 95% CI=3.8-4.1%) died during their ED visit or hospitalization. Of these, septicemia was the leading cause of mortality (74.7%, 95% CI=73.8-75.6%), followed by lower respiratory infections (15.2%, 95% CI=14.6-15.9%). Analysis of the 2011 data gave similar results for the burden of ID-related ED visits, hospitalizations, and mortality. CONCLUSION Using a nationally representative sample, it was found that the public health burden of IDs in elderly U.S. adults was substantial, as measured by ED visits, subsequent hospitalizations, and hospital-based mortality.
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Affiliation(s)
- Tadahiro Goto
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kazuki Yoshida
- Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Yusuke Tsugawa
- Harvard Interfaculty Initiative in Health Policy, Harvard University, Boston, Massachusetts
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Lu PJ, O'Halloran A, Williams WW, Lindley MC, Farrall S, Bridges CB. Racial and Ethnic Disparities in Vaccination Coverage Among Adult Populations in the U.S. Am J Prev Med 2015; 49:S412-25. [PMID: 26297451 PMCID: PMC5824643 DOI: 10.1016/j.amepre.2015.03.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/27/2015] [Accepted: 03/06/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Reducing racial/ethnic disparities in immunization rates is a compelling public health goal. Disparities in childhood vaccination rates have not been observed in recent years for most vaccines. The objective of this study is to assess adult vaccination by race/ethnicity in the U.S. METHODS The 2012 National Health Interview Survey was analyzed in 2014 to assess adult vaccination by race/ethnicity for five vaccines routinely recommended for adults: influenza, tetanus, pneumococcal (two vaccines), human papilloma virus, and zoster vaccines. Multivariable logistic regression analysis was performed to identify factors independently associated with all adult vaccinations. RESULTS Vaccination coverage was significantly lower among non-Hispanic blacks, Hispanics, and non-Hispanic Asians compared with non-Hispanic whites, with only a few exceptions. Age, sex, education, health insurance, usual place of care, number of physician visits in the past 12 months, and health insurance were independently associated with receipt of most of the examined vaccines. Racial/ethnic differences narrowed, but gaps remained after taking these factors into account. CONCLUSIONS Racial and ethnic differences in vaccination levels narrow when adjusting for socioeconomic factors analyzed in this survey, but are not eliminated, suggesting that other factors that are associated with vaccination disparities are not measured by the National Health Interview Survey and could also contribute to the differences in coverage. Additional efforts, including systems changes to ensure routine assessment and recommendations for needed vaccinations among adults for all racial/ethnic groups, are essential for improving vaccine coverage.
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Affiliation(s)
- Peng-jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
| | - Alissa O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Megan C Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Susan Farrall
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Carolyn B Bridges
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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Worasathit R, Wattana W, Okanurak K, Songthap A, Dhitavat J, Pitisuttithum P. Health education and factors influencing acceptance of and willingness to pay for influenza vaccination among older adults. BMC Geriatr 2015; 15:136. [PMID: 26503289 PMCID: PMC4620638 DOI: 10.1186/s12877-015-0137-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 10/19/2015] [Indexed: 11/29/2022] Open
Abstract
Background The influenza vaccine is recommended in older population. However the immunization coverage varies globally. It has been reported as low as 10–20 % in some countries. This study explored the acceptance of and willingness to pay for influenza vaccination, comparing acceptance and willingness to pay before and after health education. Methods The study was conducted with 2693 older people in Bangkok, Thailand. Participants were divided into an education group (n = 1402) and a control group (n = 1291). A validated questionnaire measuring acceptance of and willingness to pay for vaccination was administered during semi-structured interviews before and after education. Data on factors influencing acceptance were analyzed. Results Participants’ mean age was 69.5 years, 80 % were women and 82.1 % had at least one co-morbidity. Of the participants, 43.5 % had previously received vaccination more than once, although 92.8 % expressed acceptance of vaccination. Acceptance was associated with a positive attitude toward vaccination (OR 2.1, 95 % CI 1.5–2.9) and a history of receiving vaccination (OR 4.1, 95 % CI 2.8–6.1). At baseline, there were no differences between the education and control groups in terms of work status (p = 0.457), co-morbidities (p = 0.07), medical status (p = 0.243), and previous vaccination (p = 0.62), except for educational background (p = 0.004). Acceptance of vaccination increased to 95.8 % (p < 0.001) after education and willingness to pay increased to 82.1 % (p < 0.001). Education significantly affected those with primary school-level education and no previous vaccination history, with acceptance increasing from 83.3 to 92.6 % (p < 0.001); more than twice as high as the control group (OR 2.4, 95 % CI 1.2–4.7). Viewing an educational video increased the proportion of participants with a high level of knowledge from 29.2 to 49.2 % (p < 0.001), and increased the proportion of participants with a positive attitude from 52.4 to 70.7 % (p <0.001). No significant difference was found in any parameter between the first and second assessment in the control group. Conclusions The strategies to increase positive attitudes may enhance the acceptance of vaccination. Health education using an educational video demonstrated a significant impact on acceptance, willingness to pay, knowledge and attitude in older people. This may lead to increased sustainability of the immunization program in older people.
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Affiliation(s)
- Rawipun Worasathit
- Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Wantanee Wattana
- Bangkok Metropolitan Administration (BMA), Mitmaitree Road, Dindang, Bangkok, 10400, Thailand.
| | - Kamolnetr Okanurak
- Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Archin Songthap
- Sirindhorn College of Public Health, 89 Moo2 Thanon Trang-Kantang Thambon Kuanthani Amphoe Kantang, Trang Province, 92000, Trang, Thailand.
| | - Jittima Dhitavat
- Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Punnee Pitisuttithum
- Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.
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Allen CL, Hammerback K, Harris JR, Hannon PA, Parrish AT. Feasibility of Workplace Health Promotion for Restaurant Workers, Seattle, 2012. Prev Chronic Dis 2015; 12:E172. [PMID: 26447549 PMCID: PMC4599055 DOI: 10.5888/pcd12.150093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Restaurant workers are a large population at high risk for tobacco use, physical inactivity, and influenza. They are difficult to reach with health care interventions and may be more accessible through workplaces, yet few studies have explored the feasibility of workplace health promotion in this population. This study sought to identify barriers and facilitators to promotion of tobacco cessation, physical activity, and influenza vaccination in restaurants. Methods Moderators conducted 7 focus groups, 3 with restaurant owners and managers, 2 with English-speaking workers, and 2 with Spanish-speaking workers. All groups were recorded, and recordings were transcribed and uploaded to qualitative-analysis software. Two researchers coded each transcript independently and analyzed codes and quotations for common themes. Results Seventy people from the restaurant industry participated. Barriers to workplace health promotion included smoking-break customs, little interest in physical activity outside of work, and misinformation about influenza vaccinations. Facilitators included creating and enforcing equitable break policies and offering free, on-site influenza vaccinations. Spanish-speakers were particularly amenable to vaccination, despite their perceptions of low levels of management support for health promotion overall. Owners required a strong business case to consider investing in long-term prevention for their employees. Conclusion Tobacco cessation and influenza vaccinations are opportunities for health promotion among restaurant workers, whereas physical activity interventions face greater challenges. Promotion of equitable breaks, limited smoking-break policies, and free, on-site influenza vaccinations could improve health for restaurant workers, who often do not have health insurance. Workplace interventions may be particularly important for Hispanic workers who have additional access barriers.
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Affiliation(s)
- Claire L Allen
- Health Promotion Research Center, University of Washington, Department of Health Services, 1107 NE 45th St, Suite 200, Seattle, WA 98105. Telephone: 206-543-5750.
| | | | - Jeffrey R Harris
- School of Public Health, University of Washington, Seattle, Washington
| | - Peggy A Hannon
- School of Public Health, University of Washington, Seattle, Washington
| | - Amanda T Parrish
- School of Public Health, University of Washington, Seattle, Washington
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O’Halloran AC, Lu PJ, Pilishvili T. Pneumococcal vaccination coverage among persons ≥65 years—United States, 2013. Vaccine 2015; 33:5503-5506. [DOI: 10.1016/j.vaccine.2015.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 11/30/2022]
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MacDougall DM, Halperin BA, MacKinnon-Cameron D, Li L, McNeil SA, Langley JM, Halperin SA. The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers. BMJ Open 2015; 5:e009062. [PMID: 26419683 PMCID: PMC4593142 DOI: 10.1136/bmjopen-2015-009062] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Vaccine coverage for recommended vaccines is low among adults. The objective of this study was to assess the knowledge, attitudes, beliefs and behaviours of adults and healthcare providers related to four vaccine-preventable diseases and vaccines (diphtheria-tetanus-pertussis, zoster, pneumococcus and influenza). DESIGN We undertook a survey and focus groups of Canadian adults and healthcare providers (doctors, nurses, pharmacists). A total of 4023 adults completed the survey and 62 participated in the focus groups; 1167 providers completed the survey and 45 participated in the focus groups. RESULTS Only 46.3% of adults thought they were up-to-date on their vaccines; 30% did not know. In contrast, 75.6% of providers reported being up-to-date. Only 57.5% of adults thought it was important to receive all recommended vaccines (compared to 87.1-91.5% of providers). Positive attitudes towards vaccines paralleled concern about the burden of illness and confidence in the vaccines, with providers being more aware of disease burden and confident in vaccine effectiveness than the public. Between 55.0% and 59.7% of adults reported willingness to be vaccinated if recommended by their healthcare provider. However, such recommendations were variable; while 77.4% of the public reported being offered and 52.8% reported being recommended the influenza vaccine by their provider, only 10.8% were offered and 5.6% recommended pertussis vaccine. Barriers and facilitators to improved vaccine coverage in adults, such as trust-mistrust of health authorities, pharmaceutical companies and national recommendations, autonomy versus the public good and logistical issues (such as insufficient time and lack of vaccination status tracking), were identified by both the public and providers. CONCLUSIONS Despite guidelines for adult vaccination, there are substantial gaps in knowledge and attitudes and beliefs among both the public and healthcare providers that lead to low vaccine coverage. A systematic approach that involves education, elimination of barriers and establishing and improving infrastructure for adult immunisation is required.
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Affiliation(s)
- D M MacDougall
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada School of Nursing, St. Francis Xavier University, Nova Scotia, Canada
| | - B A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada School of Nursing, Dalhousie University, Nova Scotia, Canada Department of Pediatrics, Dalhousie University, Nova Scotia, Canada
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada
| | - Li Li
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada
| | - S A McNeil
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - J M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada Department of Pediatrics, Dalhousie University, Nova Scotia, Canada Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - S A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada Department of Pediatrics, Dalhousie University, Nova Scotia, Canada Department of Microbiology & Immunology, Dalhousie University, Nova Scotia, Canada
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Ding H, Black CL, Ball S, Donahue S, Fink RV, Williams WW, Kennedy ED, Bridges CB, Lu PJ, Kahn KE, Dean AK, Grohskopf LA, Ahluwalia IB, Devlin R, DiSogra C, Walker DK, Greby SM. Influenza Vaccination Coverage Among Pregnant Women — United States, 2014–15 Influenza Season. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:1000-5. [DOI: 10.15585/mmwr.mm6436a2] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Betsch C, Böhm R. Detrimental effects of introducing partial compulsory vaccination: experimental evidence. Eur J Public Health 2015; 26:378-81. [PMID: 26297722 DOI: 10.1093/eurpub/ckv154] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During outbreaks of vaccine-preventable diseases, compulsory vaccination is sometimes discussed as a last resort to counter vaccine refusal. Besides ethical arguments, however, empirical evidence on the consequences of making selected vaccinations compulsory is lacking. Such evidence is needed to make informed public health decisions. This study therefore assesses the effect of partial compulsory vaccination on the uptake of other voluntary vaccines. METHOD A total of 297 (N) participants took part in an online experiment that simulated two sequential vaccination decisions using an incentivized behavioural vaccination game. The game framework bases on epidemiological, psychological and game-theoretical models of vaccination. Participants were randomized to the compulsory vaccination intervention (n = 144) or voluntary vaccination control group (n = 153), which determined the decision architecture of the first of two decisions. The critical second decision was voluntary for all participants. We also assessed the level of anger, vaccination attitude and perceived severity of the two diseases. RESULTS Compulsory vaccination increased the level of anger among individuals with a rather negative vaccination attitude, whereas voluntary vaccination did not. This led to a decrease in vaccination uptake by 39% in the second voluntary vaccination (reactance). CONCLUSION Making only selected vaccinations compulsory can have detrimental effects on the vaccination programme by decreasing the uptake of voluntary vaccinations. As this effect occurred especially for vaccine hesitant participants, the prevalence of vaccine hesitancy within a society will influence the damage of partial compulsory vaccination.
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Affiliation(s)
- Cornelia Betsch
- 1 Department of Psychology and Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany
| | - Robert Böhm
- 2 School of Business and Economics, RWTH Aachen University, Aachen, Germany
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Healy CM, Ng N, Taylor RS, Rench MA, Swaim LS. Tetanus and diphtheria toxoids and acellular pertussis vaccine uptake during pregnancy in a metropolitan tertiary care center. Vaccine 2015; 33:4983-7. [PMID: 26192356 DOI: 10.1016/j.vaccine.2015.07.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/19/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Tetanus, diphtheria and acellular pertussis (Tdap) vaccine is recommended during each pregnancy, but national uptake is poor. We assessed Tdap uptake in a tertiary referral hospital served by university-affiliated and private obstetrical offices. METHODS Review of women delivering at Texas Children's Hospital Pavilion for Women, Houston, Texas, during April 2013-June 2014. RESULTS 6577 deliveries occurred during the study period. Mean maternal age was 29.8 years (range 13-49); race/ethnicity was 43.6% White, 27% Hispanic, 21% Black, 7.1% Asian, and 1.3% other. 252 were multiple gestations; 229 sets of twins, 21 triplets and 2 quadruplets. 3678 (56%) women received Tdap during pregnancy, 249 (3.8%) postpartum and 100 (1.5%) received Tdap pre-conception only. Tdap uptake during pregnancy increased from 36% in April 2013 to a sustained uptake of greater than 61% since November 2013, with increases noted coincidental with presentations highlighting Tdap maternal immunization recommendations at faculty and staff meetings, and the release of the ACOG "toolkit". When antenatal Tdap vaccine was administered, mean gestation at receipt of Tdap was 31.4 weeks and 95% of vaccinated women received Tdap at the recommended gestation interval of 27-36 weeks, 71.6% during the 28-32 week window believed optimal for placental transport and 98.5% at least 7 days before delivery. Of 19 women with two pregnancies during the study period, four (21%) had Tdap during both. Black women were less likely to receive antenatal Tdap than women of other race/ethnicity (41% versus 60%; P<0.001). CONCLUSIONS Sustained antenatal Tdap uptake rates exceeding 61% were achieved after strategies to increase awareness of recommendations were introduced and 95% of women were immunized at a gestation optimal for efficient maternal antibody placental transport. Further increases in uptake will require system changes such as best practice alerts in electronic medical records.
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Affiliation(s)
- C Mary Healy
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, TX, USA.
| | - Nancy Ng
- Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, TX, USA
| | - Ruston S Taylor
- Pharmacy Department, Texas Children's Hospital, Houston, TX, USA
| | - Marcia A Rench
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Laurie S Swaim
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Ojha RP, Stallings-Smith S, Flynn PM, Adderson EE, Offutt-Powell TN, Gaur AH. The Impact of Vaccine Concerns on Racial/Ethnic Disparities in Influenza Vaccine Uptake Among Health Care Workers. Am J Public Health 2015; 105:e35-41. [PMID: 26180953 DOI: 10.2105/ajph.2015.302736] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored whether collective concerns about the safety, effectiveness, and necessity of influenza vaccines mediate racial/ethnic disparities in vaccine uptake among health care workers (HCWs). METHODS We used a self-administered Web-based survey to assess race/ethnicity (exposure), concerns about influenza vaccination (mediator; categorized through latent class analysis), and influenza vaccine uptake (outcome) for the 2012 to 2013 influenza season among HCWs at St. Jude Children's Research Hospital in Memphis, Tennessee. We used mediation analysis to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the total, direct, and indirect effects of race/ethnicity on influenza vaccine uptake. RESULTS Non-Hispanic Blacks had lower influenza vaccine uptake than non-Hispanic Whites (total effect: PR = 0.87; 95% CI = 0.75, 0.99), largely mediated by high concern about influenza vaccines (natural indirect effect: PR = 0.89; 95% CI = 0.84, 0.94; controlled direct effect: PR = 0.98; 95% CI = 0.85, 1.1). Hispanic and Asian HCWs had modestly lower uptake than non-Hispanic Whites, also mediated by high concern about influenza vaccines. CONCLUSIONS Racial/ethnic disparities among HCWs could be attenuated if concerns about the safety, effectiveness, and necessity of influenza vaccines were reduced.
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Affiliation(s)
- Rohit P Ojha
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Sericea Stallings-Smith
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Patricia M Flynn
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Elisabeth E Adderson
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Tabatha N Offutt-Powell
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
| | - Aditya H Gaur
- Rohit P. Ojha and Sericea Stallings-Smith are with the Department of Epidemiology and Cancer Control, and Patricia M. Flynn, Elisabeth E. Adderson, and Aditya H. Gaur are with the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN. Tabatha N. Offutt-Powell is with the Data and Informatics Section, Division of Public Health, Delaware State Health Services, Dover
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Mendoza-Sassi RA, Cesar JA, Cagol JM, Duarte IA, Friedrich LM, Santos VKD, Zhang L. 2010 A(H1N1) vaccination in pregnant women in Brazil: identifying coverage and associated factors. CAD SAUDE PUBLICA 2015. [PMID: 26200372 DOI: 10.1590/0102-311x00084514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We studied vaccination coverage and its associated factors in the 2010 pandemic influenza vaccination of Brazilian pregnant women. A cross-sectional study of pregnant women who had given birth was performed in a municipality in southern Brazil, in 2010. Data about vaccination against A(H1N1) and sociodemographic characteristics, morbidities and prenatal care were collected. Statistical analysis was performed using a Poisson regression. Coverage was 77.4%. Most were vaccinated in the public sector (97.6%) and in the second trimester (47%). Associated factors that increased vaccination were marriage, older age, first income quartile, prenatal care and influenza before pregnancy. Education and skin color were not significantly associated with vaccination. The vaccination campaign was extensive and exhibited no inequality. Prenatal care was the factor that most affected vaccination coverage, reflecting its importance for vaccination campaign success.
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Affiliation(s)
| | | | - Jussara Maria Cagol
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brasil
| | | | | | | | - Linjie Zhang
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brasil
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Alqahtani AS, Sheikh M, Wiley K, Heywood AE. Australian Hajj pilgrims' infection control beliefs and practices: Insight with implications for public health approaches. Travel Med Infect Dis 2015; 13:329-34. [PMID: 26028307 DOI: 10.1016/j.tmaid.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hajj is one of the largest annual mass gatherings around the world. Although the Saudi Arabian health authority recommends vaccination and other infection control measures, studies identified variable uptake of these measures among pilgrims, and the reasons behind this variability remain unclear. This qualitative study aimed to addresses this knowledge gap. METHODS In-depth interviews were conducted with pilgrims over 18 years of age. RESULTS A total of 10 participants took part in the study. There was low perception of the potential severity of respiratory conditions and the need for influenza vaccination during Hajj. Different attitudes were found by age group with elderly participants believing that they were under Allah's protection, and were fatalistic about the risk of illness. While younger participants described the impact infections would have on their worship. Facemask use was infrequent with discomfort; difficulty in breathing and a feeling of isolation were commonly cited barriers to use of facemasks. Participants accepted and trusted preventative health advice from travel agents and friends who had previously undertaken the Hajj more so than primary care practitioners. CONCLUSIONS This study extended our understanding of how health beliefs influence uptake of preventive measures during the Hajj, and the gaps in the provision of Hajj-specific health information to pilgrims.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Mohamud Sheikh
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kerrie Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Differences in adult influenza vaccine-seeking behavior: the roles of race and attitudes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 20:246-50. [PMID: 23715220 DOI: 10.1097/phh.0b013e318298bd88] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Racial/ethnic disparities in influenza vaccination among adults are longstanding, and research suggests they result from multiple factors. Influenza vaccine-seeking behavior may be an important aspect to consider when evaluating disparities in vaccination coverage. OBJECTIVE To determine whether there are differences between blacks and whites in influenza vaccine-seeking behavior among adults 65 years and older. METHODS Data were analyzed from a national sample of 3138 adults 65 years and older collected through the adult module of the 2007 National Immunization Survey, a random digit dialing telephone survey, which included an oversample of non-Hispanic blacks. Analysis included influenza vaccination rate, location of vaccination, and whether vaccinated individuals specifically went to the location to receive the vaccine (vaccine seekers) by race. The relationship between attitudes about influenza vaccination and vaccine-seeking behavior by race was also examined. RESULTS White adults 65 years and older were significantly more likely to receive influenza vaccine than blacks, during the 2006-2007 influenza season (68% ± 4% vs 54% ± 3%, respectively), and a significantly higher proportion of vaccinated whites reported seeking out the vaccine than vaccinated blacks (66% ± 4% vs 47% ± 4%, respectively). Blacks were less likely to be vaccine seekers, regardless of education or poverty levels. Among persons vaccinated in a doctor's office, 52% of whites specifically went there to get vaccinated, compared with 37% of blacks. Among persons who believe the vaccine is very effective, 66% ± 5% of whites versus 50% ± 6% of blacks were vaccine seekers. CONCLUSIONS This study points to the importance of improving our understanding of what factors, in addition to beliefs about vaccination, lead to vaccine seeking and reinforces the need for systematically offering vaccine.
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Lochner KA, Wynne MA, Wheatcroft GH, Worrall CM, Kelman JA. Medicare claims versus beneficiary self-report for influenza vaccination surveillance. Am J Prev Med 2015; 48:384-91. [PMID: 25700653 DOI: 10.1016/j.amepre.2014.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/15/2014] [Accepted: 10/23/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although self-reported influenza vaccination status is routinely used in surveillance to estimate influenza vaccine coverage, Medicare data are becoming a promising resource for influenza surveillance to inform vaccination program management and planning. PURPOSE To evaluate the concordance between self-reported influenza vaccination and influenza vaccination claims among Medicare beneficiaries. METHODS This study compared influenza vaccination based upon Medicare claims and self-report among a sample of Medicare beneficiaries (N=9,378) from the 2011 Medicare Current Beneficiary Survey, which was the most recent year of data at the time of analysis (summer 2013). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using self-reported data as the referent standard. Logistic regression was used to compute the marginal mean proportions for whether a Medicare influenza vaccination claim was present among beneficiaries who reported receiving the vaccination. RESULTS Influenza vaccination was higher for self-report (69.4%) than Medicare claims (48.3%). For Medicare claims, sensitivity=67.5%, specificity=96.3%, positive predictive value=97.6%, and negative predictive value=56.7%. Among beneficiaries reporting receiving an influenza vaccination, the percentage of beneficiaries with a vaccination claim was lower for beneficiaries who were aged <65 years, male, non-Hispanic black or Hispanic, and had less than a college education. CONCLUSIONS The classification of influenza vaccination status for Medicare beneficiaries can differ based upon survey and claims. To improve Medicare claims-based surveillance studies, further research is needed to determine the sources of discordance in self-reported and Medicare claims data, specifically for sensitivity and negative predictive value.
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Affiliation(s)
- Kimberly A Lochner
- Centers for Medicare & Medicaid Services, Sam Nunn Atlanta Federal Center, Atlanta, Georgia; Office of Information Products and Data Analytics, Baltimore, Maryland.
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Driedger SM, Maier R, Furgal C, Jardine C. Factors influencing H1N1 vaccine behavior among Manitoba Metis in Canada: a qualitative study. BMC Public Health 2015; 15:128. [PMID: 25884562 PMCID: PMC4334920 DOI: 10.1186/s12889-015-1482-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/27/2015] [Indexed: 11/11/2022] Open
Abstract
Background During the first wave of the H1N1 influenza pandemic in 2009, Aboriginal populations in Canada experienced disproportionate rates of infection, particularly in the province of Manitoba. To protect those thought to be most at-risk, health authorities in Manitoba listed all Aboriginal people, including Metis, among those able to receive priority access to the novel vaccine when it first became available. Currently, no studies exist that have investigated the attitudes, influences, and vaccine behaviors among Aboriginal communities in Canada. This paper is the first to systematically connect vaccine behavior with the attitudes and beliefs that influenced Metis study participants’ H1N1 vaccine decision-making. Methods Researchers held focus groups (n = 17) with Metis participants in urban, rural, and remote locations of Manitoba following the conclusion of the H1N1 pandemic. Participants were asked about their vaccination decisions and about the factors that influenced their decisions. Following data collection, responses were coded into the broad categories of a social-ecological model, nuanced by categories stemming from earlier research. Responses were then quantified to show the most influential factors in positively or negatively affecting the vaccine decision. Results Media reporting, the influence of peer groups, and prioritization all had positive and negative influential effects on decision making. Whether vaccinated or not, the most negatively influential factors cited by participants were a lack of knowledge about the vaccine and the pandemic as well as concerns about vaccine safety. Risk of contracting H1N1 influenza was the biggest factor in positively influencing a vaccine decision, which in many cases trumped any co-existing negative influencers. Conclusions Metis experiences of colonialism in Canada deeply affected their perceptions of the vaccine and pandemic, a context that health systems need to take into account when planning response activities in the future. Participants felt under-informed about most aspects of the vaccine and the pandemic, and many vaccine related misconceptions and fears existed. Recommendations include leveraging doctor-patient interactions as a site for sharing vaccine-related knowledge, as well as targeted, culturally-appropriate, and empowering public information strategies to supply reliable vaccine and pandemic information to potentially at-risk Aboriginal populations.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Canada.
| | - Ryan Maier
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Canada.
| | - Chris Furgal
- Indigenous Environment Studies Program, Trent University, 1600 West Bank Drive, Peterborough, Canada.
| | - Cindy Jardine
- School of Public Health, University of Alberta, 11405 - 87 Ave, Edmonton, Canada.
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Lu PJ, O'Halloran A, Ding H, Greby SM, Williams WW. Current status and uptake of influenza vaccination over time among senior adults in the United States. Hum Vaccin Immunother 2015; 11:2849-51. [PMID: 26697974 PMCID: PMC5054791 DOI: 10.1080/21645515.2015.1075108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/10/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
Abstract
Influenza is a major cause of morbidity and mortality among older adults in the United States, who may also have chronic medical conditions that place them at high risk for complications from influenza. The U.S. Public Health Service recommended influenza vaccination of adults ≥ 65 y and chronically ill persons since 1961 and beginning with the 2010-11 influenza season, the Advisory Committee on Immunization Practices (ACIP) has expanded its recommendation to vaccinate all persons 6 months of age and older. Medicare coverage for influenza vaccination began in 1993. However, despite the presence of a safe and effective vaccine, long-standing recommendations on vaccination, and federal financial support for vaccination, vaccination levels among adults ≥ 65 y are not optimal. Studies have shown that influenza vaccination coverage among U.S. adults ≥ 65 y steadily increased from 30.1% in 1989 to 64.2% in 1997, but plateaued near 65% from 1998 to 2013. Increasing influenza vaccination coverage among older adults in the United States will require more cooperation among health-care providers, professional organizations, vaccine manufacturers, and public health departments to raise public awareness about the benefits of influenza vaccination and to ensure continued administration of vaccinations throughout the influenza season.
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Affiliation(s)
- Peng-jun Lu
- Immunization Services Division; National Center for Immunization and Respiratory Diseases (NCIRD); CDC; Atlanta, GA USA
| | - Alissa O'Halloran
- Immunization Services Division; National Center for Immunization and Respiratory Diseases (NCIRD); CDC; Atlanta, GA USA
| | - Helen Ding
- Immunization Services Division; National Center for Immunization and Respiratory Diseases (NCIRD); CDC; Atlanta, GA USA
| | - Stacie M Greby
- Immunization Services Division; National Center for Immunization and Respiratory Diseases (NCIRD); CDC; Atlanta, GA USA
| | - Walter W Williams
- Immunization Services Division; National Center for Immunization and Respiratory Diseases (NCIRD); CDC; Atlanta, GA USA
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76
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Factors affecting the uptake of vaccination by the elderly in Western society. Prev Med 2014; 69:224-34. [PMID: 25456809 DOI: 10.1016/j.ypmed.2014.10.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/09/2014] [Accepted: 10/13/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the results of a literature review on factors related to vaccine uptake by elderly persons. METHODS A systematic literature search was performed using Medline, Embase, and SciSearch to collect all publications available on factors related to vaccine uptake from 1966 until October 2012 for West European and North American societies. In total, 1001 articles were identified and 60 were included in the review. RESULTS We identified six main themes that influence the willingness to be vaccinated: 1) attitudes and beliefs regarding vaccination in general including positive and negative attitudes and beliefs; 2) perceived risk and severity including knowledge, perceived susceptibility and severity and personal experience; 3) vaccine characteristics including side-effects, effectiveness, content of the vaccine and knowledge; 4) advice and information including influence of the healthcare worker and relatives and the information source and format; 5) general health-related behavior including previous vaccinations, visiting GP or senior center and other preventive behaviors; and 6) accessibility and affordability including logistics, combinations of vaccines and costs. CONCLUSION The most important factors related to vaccine uptake are people's attitudes and beliefs regarding vaccination (especially their negative attitudes), recommendations of healthcare workers, side effects and effectiveness of the vaccine, and perceived susceptibility.
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Can routine offering of influenza vaccination in office-based settings reduce racial and ethnic disparities in adult influenza vaccination? J Gen Intern Med 2014; 29:1624-30. [PMID: 25155638 PMCID: PMC4242874 DOI: 10.1007/s11606-014-2965-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/21/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Influenza vaccination remains below the federally targeted levels outlined in Healthy People 2020. Compared to non-Hispanic whites, racial and ethnic minorities are less likely to be vaccinated for influenza, despite being at increased risk for influenza-related complications and death. Also, vaccinated minorities are more likely to receive influenza vaccinations in office-based settings and less likely to use non-medical vaccination locations compared to non-Hispanic white vaccine users. OBJECTIVE To assess the number of "missed opportunities" for influenza vaccination in office-based settings by race and ethnicity and the magnitude of potential vaccine uptake and reductions in racial and ethnic disparities in influenza vaccination if these "missed opportunities" were eliminated. DESIGN National cross-sectional Internet survey administered between March 4 and March 14, 2010 in the United States. PARTICIPANTS Non-Hispanic black, Hispanic and non-Hispanic white adults living in the United States (N = 3,418). MAIN MEASURES We collected data on influenza vaccination, frequency and timing of healthcare visits, and self-reported compliance with a potential provider recommendation for vaccination during the 2009-2010 influenza season. "Missed opportunities" for seasonal influenza vaccination in office-based settings were defined as the number of unvaccinated respondents who reported at least one healthcare visit in the Fall and Winter of 2009-2010 and indicated their willingness to get vaccinated if a healthcare provider strongly recommended it. "Potential vaccine uptake" was defined as the sum of actual vaccine uptake and "missed opportunities." KEY RESULTS The frequency of "missed opportunities" for influenza vaccination in office-based settings was significantly higher among racial and ethnic minorities than non-Hispanic whites. Eliminating these "missed opportunities" could have cut racial and ethnic disparities in influenza vaccination by roughly one half. CONCLUSIONS Improved office-based practices regarding influenza vaccination could significantly impact Healthy People 2020 goals by increasing influenza vaccine uptake and reducing corresponding racial and ethnic disparities.
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Goldfarb IT, Little S, Brown J, Riley LE. Use of the combined tetanus-diphtheria and pertussis vaccine during pregnancy. Am J Obstet Gynecol 2014; 211:299.e1-5. [PMID: 24858200 DOI: 10.1016/j.ajog.2014.05.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 04/14/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A recent increase in pertussis cases prompted the Advisory Committee on Immunization Practices to recommend administering the perinatal tetanus, diphtheria, and pertussis (Tdap) vaccine during each pregnancy. We sought to describe uptake of Tdap and identify predictors of vaccination in pregnancy. STUDY DESIGN We conducted a retrospective study of all women delivering at a university hospital between February and June 2013. Demographic, pregnancy, and vaccination data were abstracted from the medical record. The relationship between maternal age, parity, gestational age, race/ethnicity, marital status, prenatal provider/site, insurance, influenza vaccination status, and Tdap vaccine was described by univariate analysis. Independent predictors were identified by multivariable logistic regression. RESULTS In our cohort of 1467 women, 1194 (81.6%) received a Tdap vaccine. After adjusting for potential confounders, 3 factors were found to be independent predictors of receiving the vaccine. Patients were more likely to receive Tdap if they had been vaccinated against influenza during this pregnancy (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.4-2.3). Black women were less likely to receive Tdap when compared with other women (aOR, 0.42; 95% CI, 0.27-0.67). Also, women who delivered preterm were less likely to receive the Tdap vaccine (aOR, 0.33; 95% CI, 0.22-0.48). CONCLUSION A high overall Tdap vaccination rate was observed following implementation of the Advisory Committee on Immunization Practices guidelines. Black women, however, had significantly lower vaccine uptake than other women. Further research is needed to understand and minimize this disparity. Women who delivered prematurely also had a decreased rate of Tdap vaccination; vaccinating earlier should be considered to better capture this population.
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Thomas RE, Lorenzetti DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev 2014; 2014:CD005188. [PMID: 24999919 PMCID: PMC6464876 DOI: 10.1002/14651858.cd005188.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The effectiveness of interventions to increase the uptake of influenza vaccination in people aged 60 and older is uncertain. OBJECTIVES To assess access, provider, system and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community. SEARCH METHODS We searched CENTRAL (2014, Issue 5), MEDLINE (January 1950 to May week 3 2014), EMBASE (1980 to June 2014), AgeLine (1978 to 4 June 2014), ERIC (1965 to June 2014) and CINAHL (1982 to June 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions to increase influenza vaccination uptake in people aged 60 and older. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study quality and extracted influenza vaccine uptake data. MAIN RESULTS This update identified 13 new RCTs; the review now includes a total of 57 RCTs with 896,531 participants. The trials included community-dwelling seniors in high-income countries. Heterogeneity limited meta-analysis. The percentage of trials with low risk of bias for each domain was as follows: randomisation (33%); allocation concealment (11%); blinding (44%); missing data (49%) and selective reporting (100%). Increasing community demand (32 trials, 10 strategies)The interventions with a statistically significant result were: three trials (n = 64,200) of letter plus leaflet/postcard compared to letter (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15); two trials (n = 614) of nurses/pharmacists educating plus vaccinating patients (OR 3.29, 95% CI 1.91 to 5.66); single trials of a phone call from a senior (n = 193) (OR 3.33, 95% CI 1.79 to 6.22), a telephone invitation versus clinic drop-in (n = 243) (OR 2.72, 95% CI 1.55 to 4.76), a free groceries lottery (n = 291) (OR 1.04, 95% CI 0.62 to 1.76) and nurses educating and vaccinating patients (n = 485) (OR 152.95, 95% CI 9.39 to 2490.67).We did not pool the following trials due to considerable heterogeneity: postcard/letter/pamphlets (16 trials, n = 592,165); tailored communications (16 trials, n = 388,164); customised letter/phone-call (four trials, n = 82,465) and client-based appraisals (three trials, n = 4016), although several trials showed the interventions were effective. Enhancing vaccination access (10 trials, six strategies)The interventions with a statistically significant result were: two trials (n = 2112) of home visits compared to clinic invitation (OR 1.30, 95% CI 1.05 to 1.61); two trials (n = 2251) of free vaccine (OR 2.36, 95% CI 1.98 to 2.82) and one trial (n = 321) of patient group visits (OR 24.85, 95% CI 1.45 to 425.32). One trial (n = 350) of a home visit plus vaccine encouragement compared to a home visit plus safety advice was non-significant.We did not pool the following trials due to considerable heterogeneity: nurse home visits (two trials, n = 2069) and free vaccine compared to no intervention (two trials, n = 2250). Provider- or system-based interventions (17 trials, 11 strategies)The interventions with a statistically significant result were: two trials (n = 2815) of paying physicians (OR 2.22, 95% CI 1.77 to 2.77); one trial (n = 316) of reminding physicians about all their patients (OR 2.47, 95% CI 1.53 to 3.99); one trial (n = 8376) of posters plus postcards (OR 2.03, 95% CI 1.86 to 2.22); one trial (n = 1360) of chart review/feedback (OR 3.43, 95% CI 2.37 to 4.97) and one trial (n = 27,580) of educational outreach/feedback (OR 0.77, 95% CI 0.72 to 0.81).Trials of posters plus postcards versus posters (n = 5753), academic detailing (n = 1400) and increasing staff vaccination rates (n = 26,432) were non-significant.We did not pool the following trials due to considerable heterogeneity: reminding physicians (four trials, n = 202,264) and practice facilitators (three trials, n = 2183), although several trials showed the interventions were effective. Interventions at the societal level We identified no RCTs of interventions at the societal level. AUTHORS' CONCLUSIONS There are interventions that are effective for increasing community demand for vaccination, enhancing access and improving provider/system response. Heterogeneity limited pooling of trials.
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Affiliation(s)
- Roger E Thomas
- University of CalgaryDepartment of Family Medicine, Faculty of MedicineUCMC#1707‐1632 14th AvenueCalgaryCanadaT2M 1N7
| | - Diane L Lorenzetti
- Faculty of Medicine, University of CalgaryDepartment of Community Health Sciences3rd Floor TRW3280 Hospital Drive NWCalgaryCanadaT2N 4Z6
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Lu PJ, O'Halloran A, Bryan L, Kennedy ED, Ding H, Graitcer SB, Santibanez TA, Meghani A, Singleton JA. Trends in racial/ethnic disparities in influenza vaccination coverage among adults during the 2007-08 through 2011-12 seasons. Am J Infect Control 2014; 42:763-9. [PMID: 24799120 PMCID: PMC5822446 DOI: 10.1016/j.ajic.2014.03.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Annual influenza vaccination is recommended for all persons aged ≥6 months. The objective of this study was to assess trends in racial/ethnic disparities in influenza vaccination coverage among adults in the United States. METHODS We analyzed data from the 2007-2012 National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS) using Kaplan-Meier survival analysis to assess influenza vaccination coverage by age, presence of medical conditions, and racial/ethnic groups during the 2007-08 through 2011-12 seasons. RESULTS During the 2011-12 season, influenza vaccination coverage was significantly lower among non-Hispanic blacks and Hispanics compared with non-Hispanic whites among most of the adult subgroups, with smaller disparities observed for adults age 18-49 years compared with other age groups. Vaccination coverage for non-Hispanic white, non-Hispanic black, and Hispanic adults increased significantly from the 2007-08 through the 2011-12 season for most of the adult subgroups based on the NHIS (test for trend, P < .05). Coverage gaps between racial/ethnic minorities and non-Hispanic whites persisted at similar levels from the 2007-08 through the 2011-12 seasons, with similar results from the NHIS and BRFSS. CONCLUSIONS Influenza vaccination coverage among most racial/ethnic groups increased from the 2007-08 through the 2011-12 seasons, but substantial racial and ethnic disparities remained in most age groups. Targeted efforts are needed to improve coverage and reduce these disparities.
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Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Alissa O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Leah Bryan
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin D Kennedy
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Helen Ding
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Samuel B Graitcer
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tammy A Santibanez
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ankita Meghani
- National Vaccine Program Office, US Department of Health and Human Services, Washington, DC
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Kharbanda EO, Parker ED, Nordin JD, Hedblom BD, Rolnick SJ. Influenza and pertussis vaccination coverage among privately insured women of reproductive age. Matern Child Health J 2014; 17:1631-7. [PMID: 23108738 DOI: 10.1007/s10995-012-1176-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An increasing number of vaccines are now designated as maternal vaccines, recommended prior to, during, or immediately following pregnancy. The influenza and pertussis (Tdap) vaccines have the potential to improve the health of women and their offspring. Among privately insured women of reproductive age, goals of this study were to describe influenza and Tdap vaccination coverage and to explore variation in coverage by age and race/ethnicity. This cross-sectional, observational study included women 18-44 years of age with continuous enrollment from 1 January 2007-31 March 2011 in a single, Midwestern health insurance plan and at least one visit to a plan affiliated practice. Data on vaccine coverage came from insurance claims, supplemented by electronic medical record data. Primary outcomes were: receipt of Tdap ever, receipt of Tdap or Tetanus vaccination (Td) in the past 10 years, and receipt of influenza vaccination during the 2010-2011 influenza season. Coverage was compared by race/ethnicity. Among 12,657 women with continuous private insurance, 45.5 % had received Tdap ever, 82.5 % had received Td or Tdap in the past 10 years, and 39.8 % received the influenza vaccine in the 2010-2011 season. Marked disparities in influenza vaccination coverage by race/ethnicity were observed, only 30.0 % of African American women received influenza vaccine compared to 40.7 % of white, non-Hispanic women (p < .0001). Among insured women of reproductive age, there is a need for interventions to increase Tdap and influenza vaccination uptake. Further research is needed to understand and address disparities in influenza vaccination coverage in this population.
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Affiliation(s)
- Elyse Olshen Kharbanda
- HealthPartners Institute for Education and Research, PO Box 1524, MS 21111R, Minneapolis, MN, 55425, USA,
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Simonetti JA, Fine MJ, Chen YF, Simak D, Hess R. Racial comparisons of diabetes care and intermediate outcomes in a patient-centered medical home. Diabetes Care 2014; 37:993-1001. [PMID: 24255103 PMCID: PMC3964485 DOI: 10.2337/dc13-1332] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess racial differences in diabetes processes and intermediate outcomes of care in an internal medicine, patient-centered medical home (PCMH) group practice. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of 1,457 adults with diabetes receiving care from 89 medical providers within a PCMH-designated academic practice between 1 July 2009 and 31 July 2010. We used mixed models to assess independent associations between patient race (non-Hispanic white or black) and 1) receipt of processes of care (A1C and LDL testing, foot and retinal examination, and influenza and pneumococcal vaccination) and 2) achievement of intermediate outcomes (LDL <100 mg/dL, blood pressure [BP] <140/90 mmHg, A1C <7.0% [<53 mmol/mol], and A1C >9.0% [>75 mmol/mol]), controlling for sociodemographic factors, health status, treatment intensity, and clinical continuity. RESULTS Compared with non-Hispanic white patients, black patients were younger, were more often single, had lower educational attainment, and were less likely to have commercial insurance. In unadjusted analyses, fewer black patients received a retinal examination and influenza vaccination during the study period or any lifetime pneumococcal vaccination (P < 0.05 [all comparisons]). Fewer black patients achieved an LDL <100 mg/dL, BP <140/90 mmHg, or A1C <7.0% (<53 mmol/mol), while more black patients had an A1C >9.0% (>75 mmol/mol) (P < 0.05 [all comparisons]). In multivariable models, black patients were less likely to receive A1C testing (odds ratio [OR] 0.57 [95% CI 0.34-0.95]) or influenza vaccination (OR 0.75 [95% CI 0.57-0.99]) or to achieve an LDL <100 mg/dL (OR 0.74 [95% CI 0.55-0.99]) or BP <140/90 mmHg (OR 0.64 [95% CI 0.49-0.84]). CONCLUSIONS Racial differences in processes and intermediate outcomes of diabetes care were present within this PCMH-designated practice, controlling for differences in sociodemographic, clinical, and treatment factors.
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Lu PJ, Singleton JA, Euler GL, Williams WW, Bridges CB. Seasonal influenza vaccination coverage among adult populations in the United States, 2005-2011. Am J Epidemiol 2013; 178:1478-87. [PMID: 24008912 PMCID: PMC5824626 DOI: 10.1093/aje/kwt158] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The most effective strategy for preventing influenza is annual vaccination. We analyzed 2005-2011 data from the National Health Interview Survey (NHIS), using Kaplan-Meier survival analysis to estimate cumulative proportions of persons reporting influenza vaccination in the 2004-2005 through 2010-2011 seasons for persons aged ≥18, 18-49, 50-64, and ≥65 years, persons with high-risk conditions, and health-care personnel. We compared vaccination coverage by race/ethnicity within each age and high-risk group. Vaccination coverage among adults aged ≥18 years increased from 27.4% during the 2005-2006 influenza season to 38.1% during the 2010-2011 season, with an average increase of 2.2% annually. From the 2005-2006 season to the 2010-2011 season, coverage increased by 10-12 percentage points for all groups except adults aged ≥65 years. Coverage for the 2010-2011 season was 70.2% for adults aged ≥65 years, 43.7% for adults aged 50-64 years, 36.7% for persons aged 18-49 years with high-risk conditions, and 55.8% for health-care personnel. In most subgroups, coverage during the 2010-2011 season was significantly lower among non-Hispanic blacks and Hispanics than among non-Hispanic whites. Vaccination coverage among adults under age 65 years increased from 2005-2006 through 2010-2011, but substantial racial/ethnic disparities remained in most age groups. Targeted efforts are needed to improve influenza vaccination coverage and reduce disparities.
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84
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Factors associated with human papillomavirus vaccination among young adult women in the United States. Vaccine 2013; 31:2937-46. [PMID: 23643629 DOI: 10.1016/j.vaccine.2013.04.041] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/11/2013] [Accepted: 04/17/2013] [Indexed: 11/22/2022]
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85
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Santibanez TA, Singleton JA, Santibanez SS, Wortley P, Bell BP. Socio-demographic differences in opinions about 2009 pandemic influenza A (H1N1) and seasonal influenza vaccination and disease among adults during the 2009-2010 influenza season. Influenza Other Respir Viruses 2013; 7:383-92. [PMID: 22568588 PMCID: PMC5779826 DOI: 10.1111/j.1750-2659.2012.00374.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In April 2009, a novel influenza A virus emerged in the United States. By the end of July, influenza A (H1N1) 2009 monovalent (2009 H1N1) vaccine had been developed, licensed, and recommended by the Advisory Committee on Immunization Practices. Initial target groups for vaccination were identified and the first vaccine was publicly available in early October 2009. OBJECTIVE This study examines socio-demographic differences in opinions about 2009 pandemic influenza A (H1N1) (pH1N1) and seasonal influenza disease and vaccines and the association with receipt of influenza vaccinations during the 2009-2010 influenza season. Changes in opinions over the course of the pH1N1 pandemic were also examined. METHODS Data from the 2009 National H1N1 Flu Survey (NHFS) were analyzed. The NHFS was a CDC-sponsored telephone survey initiated in response to the 2009 pH1N1 pandemic to obtain weekly within-season estimates of vaccination coverage, opinions, and other information. RESULTS Opinions about influenza vaccine and disease varied significantly by race/ethnicity, income, and education level. In multivariable logistic regression analysis, adjusted 2009 H1N1 vaccination coverage was most strongly associated with opinions about the effectiveness of the vaccine and personal risk of disease, varying from 7 to 11% among adults who believed the vaccine to have low effectiveness and themselves at low risk of influenza, to 50-53% among those who thought vaccine effectiveness to be high and themselves at high risk of influenza. CONCLUSION Improving communication about personal risk and the effectiveness of influenza vaccines may improve vaccination coverage. The findings of difference in opinions could be used to target communication.
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Affiliation(s)
- Tammy A Santibanez
- Centers for Disease Control and Prevention, 1600 Clifton Road, NE; Mailstop A-19, Atlanta, GA 30333, USA.
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86
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Wooten KG, Wortley PM, Singleton JA, Euler GL. Perceptions matter: beliefs about influenza vaccine and vaccination behavior among elderly white, black and Hispanic Americans. Vaccine 2012; 30:6927-34. [PMID: 22939908 DOI: 10.1016/j.vaccine.2012.08.036] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination. OBJECTIVE To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population. METHODS Data from a national telephone survey conducted in 2004 were used for this study. Responses for 3875 adults ≥ 65 years of age were analyzed using logistic regression methods. RESULTS Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p<0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics. CONCLUSIONS Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups.
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Affiliation(s)
- Karen G Wooten
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, 1600 Clifton Road MS-A19, Atlanta, GA 30030, USA.
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Risk perceptions, worry, or distrust: what drives pregnant women's decisions to accept the H1N1 vaccine? Matern Child Health J 2012; 15:1203-9. [PMID: 20936337 DOI: 10.1007/s10995-010-0693-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To determine how risk perceptions, worry, and distrust relate to pregnant women's intentions to accept the H1N1 vaccine. Cross-sectional survey of 173 pregnant women recruited from two OB/GYN practices at an urban academic medical center. Survey items were adapted from validated measures of risk, worry, and health care distrust. Vaccination intention was analyzed as a dichotomous variable. Analyses were with student's t tests, chi squared tests, and logistic regression. Study participants were, on average, 25.6 years old with parity=2.8. 55% of respondents were Black; 32% completed a high school diploma or less; and half were publically or un- insured. 63% of the respondents reported that they "definitely" or "probably" would accept the H1N1 vaccine. Intention to receive the H1N1 vaccine did not vary by sociodemographic factors nor by source of health information. In univariate analysis, intention was related to higher risk perceptions about probability of and susceptibility to H1N1 influenza (57.9 vs. 31.8%, P=.001 and 67.0 vs. 45.3%, P=.005, respectively), worry about getting H1N1 influenza (48.1 vs. 15.6%, P=<.001), and less distrust in the health care system (mean score 1.07 vs. 1.51, P<.001). In multivariable analysis, only worry about getting H1N1 was related to vaccination intention (OR=3.43, P=.04). Worry about acquiring disease was a stronger predictor of vaccine intention than risk perceptions, distrust, or worry about vaccine safety. With growing numbers of vaccines being offered during pregnancy and immediately postpartum, these results have important implications for future vaccination intervention, education, and messaging efforts in urban settings.
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88
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A pathway to leadership for adult immunization: recommendations of the National Vaccine Advisory Committee: approved by the National Vaccine Advisory Committee on June 14, 2011. Public Health Rep 2012; 127 Suppl 1:1-42. [PMID: 22210957 PMCID: PMC3235599 DOI: 10.1177/00333549121270s101] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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89
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Abstract
Background A well targeted flu vaccine strategy can ensure that vaccines go to those who are at the highest risk of getting infected if unvaccinated. However, prior research has not explicitly examined the association between the risk of flu infection and vaccination rates. Purpose This study examines the relationship between the risk of flu infection and the probability of getting vaccinated. Methods Nationally representative data from the US and multivariate regression models were used to estimate what individual characteristics are associated with (1) the risk of flu infection when unvaccinated and (2) flu vaccination rates. These results were used to estimate the correlation between the probability of infection and the probability of getting vaccinated. Separate analyses were performed for the general population and the high priority population that is at increased risk of flu related complications. Results We find that the high priority population was more likely to get vaccinated compared to the general population. However, within both the high priority and general populations the risk of flu infection when unvaccinated was negatively correlated with vaccination rates (r = −0.067, p<0.01). This negative association between the risk of infection when unvaccinated and the probability of vaccination was stronger for the high priority population (r = −0.361, p<0.01). Conclusions There is a poor match between those who get flu vaccines and those who have a high risk of flu infection within both the high priority and general populations. Targeting vaccination to people with low socioeconomic status, people who are engaged in unhealthy behaviors, working people, and families with kids will likely improve effectiveness of flu vaccine policy.
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Affiliation(s)
- Qian Gu
- KNG Health Consulting. Rockville, Maryland, United States of America
| | - Neeraj Sood
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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90
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Haroon SMM, Barbosa GP, Saunders PJ. The determinants of health-seeking behaviour during the A/H1N1 influenza pandemic: an ecological study. J Public Health (Oxf) 2011; 33:503-10. [PMID: 21460370 PMCID: PMC7313879 DOI: 10.1093/pubmed/fdr029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This is an ecological study that examines the relationship between antiviral drug collection during the 2009/2010 A/H1N1 influenza pandemic, and area-level ethnicity, socioeconomic deprivation and distance from an antiviral collection point (ACP). METHODS Age-standardized antiviral collection rates (ACR) were calculated for each super output area (geographic areas representing a population of ∼1500) in Sandwell, UK for all residents who received an antiviral drug for influenza-like illness between 23 July 2009 and 7 February 2010. Multivariable regression was used to examine the relationship between ACR and ethnicity (percentage population non-white), socioeconomic deprivation (index of multiple deprivation, IMD) and distance from an ACP. RESULTS Socioeconomic deprivation, ethnicity and distance from an ACP were independently associated with a reduction in ACR. Each one-point increase in the IMD score was associated with a drop in the ACR of 15.7 prescriptions per 100 000 population (P= 0.013). CONCLUSIONS Socioeconomic deprivation, ethnicity and distance from an ACP may have influenced health-seeking behaviour during the 2009/2010 influenza pandemic. This suggests possible inequalities in access to antivirals during the most recent influenza pandemic. Qualitative research is needed to examine the reasons for this. Individual-level data on ethnicity should be routinely collected in the event of a future pandemic.
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Affiliation(s)
- Shamil M M Haroon
- Department of Public Health, Sandwell Primary Care Trust, Kingston House, 438 High Street, West Bromwich, West Midlands B70 9LD, UK.
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91
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Dee DL, Bensyl DM, Gindler J, Truman BI, Allen BG, D'Mello T, Pérez A, Kamimoto L, Biggerstaff M, Blanton L, Fowlkes A, Glover MJ, Swerdlow DL, Finelli L. Racial and ethnic disparities in hospitalizations and deaths associated with 2009 pandemic Influenza A (H1N1) virus infections in the United States. Ann Epidemiol 2011; 21:623-30. [PMID: 21737049 DOI: 10.1016/j.annepidem.2011.03.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 02/04/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Concerns have been raised regarding possible racial-ethnic disparities in 2009 pandemic influenza A (H1N1) (pH1N1) illness severity and health consequences for U.S. minority populations. METHODS Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, Emerging Infections Program Influenza-Associated Hospitalization Surveillance, and Influenza-Associated Pediatric Mortality Surveillance, we calculated race-ethnicity-specific, age-adjusted rates of self-reported influenza-like illness (ILI) and pH1N1-associated hospitalizations. We used χ(2) tests to evaluate racial-ethnic disparities in ILI-associated health care-seeking behavior and pH1N1 hospitalization. To evaluate pediatric deaths, we compared racial-ethnic proportions of deaths against U.S. population distributions. RESULTS Prevalence of self-reported ILI was lower among Hispanics (6.5%), higher among American Indians/Alaska Natives (16.2%), and similar among non-Hispanic blacks (7.7%) compared with non-Hispanic whites (8.5%). No racial-ethnic differences were identified in ILI-associated health care-seeking behavior. Age-adjusted pH1N1-associated Emerging Infections Program hospitalization rates were higher among all minority populations (range: 8.1-10.9/100,000 population) compared with non-Hispanic whites (3.0/100,000). The proportion of pH1N1-associated pediatric deaths was higher than expected among Hispanics (31%) and lower than expected among non-Hispanic whites (45%) given the proportions of the U.S. population they comprise (22% and 58%, respectively). CONCLUSIONS Racial-ethnic disparities in pH1N1-associated hospitalizations and pediatric deaths were identified. Vaccination remains the primary intervention for preventing influenza.
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Affiliation(s)
- Deborah L Dee
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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92
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Redelings MD, Piron J, Smith LV, Chan A, Heinzerling J, Sanchez KM, Bedair D, Ponce M, Kuo T. Knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a low-income, public health clinic population. Vaccine 2011; 30:454-8. [PMID: 22044740 DOI: 10.1016/j.vaccine.2011.10.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 10/23/2011] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The Public Health Center Vaccine Survey (PHCVS) examines the knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a largely low-income, urban, public health clinic population in Los Angeles County, USA. DESIGN A cross-sectional survey of vulnerable individuals at risk for severe influenza infection was conducted in one of the nation's largest local public health jurisdictions. SUBJECTS A total of 1541 clinic patients were recruited in the waiting rooms of five large public health centers in Los Angeles County from June to August, 2010. RESULTS Among prospective respondents who met eligibility criteria, 92% completed the survey. The majority was black or Latino and most were between the ages of 18 and 44 years. More than half were unemployed; two-thirds had no health insurance; and nearly one-half reported having a high school education or less. About one-fifth reported they had received the H1N1 vaccine during the previous flu season. In comparative analyses, negative beliefs about vaccine safety and efficacy were highly predictive of H1N1 vaccination. Blacks were less likely than non-black respondents to report receiving the H1N1 vaccine (OR=0.7, 95% CI=0.6-1.0). Blacks were also less likely than other respondents to agree that vaccines can prevent disease (OR=0.4, 95% CI=0.3-0.5), that vaccines are safe (OR=0.5, 95% CI=0.4-0.6), and that they trust doctors/clinicians who recommend vaccines (OR=0.5, 95% CI=0.4-0.7). CONCLUSIONS Study findings provide a useful risk profile of vulnerable groups in Los Angeles County, which may be generalizable to other urban jurisdictions in the United States. They also describe real world situations that can be used to forecast potential challenges that vaccine beliefs may pose to national as well as local influenza pandemic planning and response, especially for communities with limited access to these preventive services.
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Affiliation(s)
- Matthew D Redelings
- Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, CA, USA
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93
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Sato H, Tomio J, Tanaka Y, Iwasaki E. The public acceptance of smallpox vaccination to fight bioterrorism in Japan: results of a large-scale opinion survey in Japan. Environ Health Prev Med 2011; 16:290-8. [PMID: 21431787 PMCID: PMC3156840 DOI: 10.1007/s12199-010-0199-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study examines the public acceptance of smallpox vaccinations in the event of a terrorist attack using smallpox. The article also provides public health professionals with the information necessary for such smallpox management. METHODS A questionnaire survey was conducted in a city in Japan asking about prospective action when smallpox vaccination is advised after a terrorist attack and factors that could influence individual decisions about such vaccination. RESULTS Only a tiny fraction of people (0.12%) expressed their rejection of vaccination. Of the respondents, 63.6% showed their intent to be vaccinated promptly when such a measure was required; 28.6% wanted to decide for themselves, having some reservations. Those in the younger age group, those suffering from hypertension/cardiac diseases, and those who considered the threat of smallpox terrorism less seriously were likely to reserve their vaccination decisions until after examining information. CONCLUSIONS Communication programs regarding smallpox vaccination should be well planned beforehand and should especially target those people who reserve their decisions at such times. Health professionals should also be well equipped with all information necessary for appropriate and effective smallpox management in the face of such a bioterrorism attack or the strong potential of one.
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Affiliation(s)
- Hajime Sato
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Japan.
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94
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Bennett KJ, Pumkam C, Probst JC. Rural–urban differences in the location of influenza vaccine administration. Vaccine 2011; 29:5970-7. [DOI: 10.1016/j.vaccine.2011.06.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 06/08/2011] [Accepted: 06/13/2011] [Indexed: 11/25/2022]
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95
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Uscher-Pines L, Maurer J, Harris KM. Racial and ethnic disparities in uptake and location of vaccination for 2009-H1N1 and seasonal influenza. Am J Public Health 2011; 101:1252-5. [PMID: 21566026 PMCID: PMC3110237 DOI: 10.2105/ajph.2011.300133] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2011] [Indexed: 11/04/2022]
Abstract
To learn more about racial and ethnic disparities in influenza vaccination during the 2009-H1N1 pandemic, we examined nationally representative survey data of US adults. We found disparities in 2009-H1N1 vaccine uptake between Blacks and Whites (13.8% vs 20.4%); Whites and Hispanics had similar 2009-H1N1 vaccination rates. Physician offices were the dominant location for 2009-H1N1 and seasonal influenza vaccinations, especially among minorities. Our results highlight the need for a better understanding of how communication methods and vaccine distribution strategies affect vaccine uptake within minority communities.
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96
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Huebner DM, Neilands TB, Rebchook GM, Kegeles SM. Sorting through chickens and eggs: a longitudinal examination of the associations between attitudes, norms, and sexual risk behavior. Health Psychol 2011; 30:110-8. [PMID: 21299299 DOI: 10.1037/a0021973] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from health threats. Within the realm of HIV-related sexual risk behavior, much of the research in support of this notion is cross-sectional, rather than longitudinal, particularly in studies of gay and bisexual men. Other psychological theories (e.g., self-perception or cognitive dissonance theories) suggest that the opposite could be true--that health-relevant attitudes and beliefs might change as a function of previous risk or precautionary behavior. Appreciating the complex nature of these associations is essential for modifying theory and developing appropriate interventions. DESIGN Using longitudinal data from gay and bisexual men (n = 1465), we used structural equation modeling to examine three possibilities--that perceived norms and attitudes about sexual risk would be (a) related to unprotected anal intercourse cross-sectionally, (b) related to unprotected anal intercourse at a subsequent time point, and/or (c) predicted from previous instances of unprotected anal intercourse. RESULTS Safe-sex norms and attitudes were related to unprotected anal intercourse cross-sectionally, but did not predict unprotected sex longitudinally. Rather, perceived norms and attitudes changed as a function of previous risk behavior. CONCLUSIONS These results raise the possibility that modified theoretical models might be necessary to adequately describe sexual risk behavior among gay and bisexual men.
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Affiliation(s)
- David M Huebner
- Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT 84122, USA.
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Thompson M, Williams J, Naleway A, Li DK, Chu S, Bozeman S, Hill HA, Cragan J, Shay DK. The Pregnancy and Influenza Project: design of an observational case-cohort study to evaluate influenza burden and vaccine effectiveness among pregnant women and their infants. Am J Obstet Gynecol 2011; 204:S69-76. [PMID: 21411050 DOI: 10.1016/j.ajog.2011.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022]
Abstract
The US Centers for Disease Control and Prevention is conducting an observational study of 300-500 women infected with influenza during pregnancy. Women are being recruited from members of the Kaiser Permanente health plan in 2 metropolitan areas before and during the 2010 through 2011 influenza season either following routine prenatal care visits or presentation with an acute respiratory infection. All enrolled mothers and their infants will be followed up through 1 month after delivery. Infants of mothers who had influenza during pregnancy and 1000 infants of mothers who were not diagnosed with influenza during pregnancy will be followed up for an additional 5 months. The Pregnancy and Influenza Project is focused on better understanding the burden of influenza during and after pregnancy and estimating the effectiveness of maternal influenza vaccination against influenza among women and their infants confirmed by real-time reverse transcription polymerase chain reaction assays.
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98
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SteelFisher GK, Blendon RJ, Bekheit MM, Mitchell EW, Williams J, Lubell K, Peugh J, DiSogra CA. Novel pandemic A (H1N1) influenza vaccination among pregnant women: motivators and barriers. Am J Obstet Gynecol 2011; 204:S116-23. [PMID: 21492827 DOI: 10.1016/j.ajog.2011.02.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/07/2011] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
Abstract
We sought to examine motivators and barriers related to monovalent 2009 influenza A (H1N1) vaccination among pregnant women. We conducted a national poll of pregnant women using a random online sample (237) and opt-in supplement (277). In all, 42% of pregnant women reported getting the vaccine. Vaccination was positively associated with attitudinal factors including believing the vaccine is very safe or benefits the baby, and with provider recommendations. Women in racial/ethnic minority groups, women with less education, and women <35 years were less likely to get the vaccine and had differing views and experiences. Despite H1N1 vaccination rates that are higher than past seasonal influenza rates, barriers like safety concerns may persist in a pandemic. Messaging from providers that encourages women to believe the vaccine is very safe and benefits their baby may be compelling. Messaging and outreach during future pandemics may require customization to increase vaccination among high-risk groups.
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99
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Vaughan E. Contemporary Perspectives on Risk Perceptions, Health-Protective Behaviors, and Control of Emerging Infectious Diseases. Int J Behav Med 2011; 18:83-7. [DOI: 10.1007/s12529-011-9160-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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100
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Painter JE, Sales JM, Pazol K, Wingood GM, Windle M, Orenstein WA, DiClemente RJ. Psychosocial correlates of intention to receive an influenza vaccination among rural adolescents. HEALTH EDUCATION RESEARCH 2010; 25:853-864. [PMID: 20603385 DOI: 10.1093/her/cyq037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recently expanded annual influenza vaccination recommendations to include all children 6 months through 18 years of age. Adolescent attitudes toward influenza vaccination may play a key role in reaching this newly added age group. This study examined the association between attitudes toward influenza vaccination and intention to be vaccinated among rural adolescents. Data were collected from baseline surveys distributed to adolescents in September/October 2008, prior to the H1N1 influenza pandemic, in two counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N = 337). Survey items were based on constructs from the Health Belief Model and the Integrated Behavioral Model. Approximately one-third of participants (33.8%) intended to receive an influenza vaccination, 33.5% did not intend to be vaccinated and 28.8% were unsure. Controlling for background factors, intention to receive an influenza vaccination was associated with low perceived barriers [odds ratio (OR) = 0.77, P < 0.001], injunctive norms (OR = 1.23, P = 0.002) and receipt of influenza vaccination in the past year (OR =6.21, P < 0.001). Findings suggest that perceived barriers and injunctive social norms may influence vaccination acceptance among rural adolescents. Future influenza vaccination efforts geared toward rural middle and high school students may benefit from addressing adolescent attitudes toward influenza vaccination.
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Affiliation(s)
- Julia E Painter
- Department of Behavioral Sciences and Health Education Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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