Reasons for Low Pandemic H1N1 2009 Vaccine Acceptance within a College Sample

Exploring strategies to increase college students' motivation to receive their annual influenza vaccine

OBJECTIVE

To evaluate college students' awareness of an educational initiative to increase campus influenza vaccination rates and strategies to improve it.

PARTICIPANTS

Students attending a large public comprehensive university.

METHODS

An investigator-developed, online survey evaluated awareness of the initiative, the students' perception of incentives, and other motivations to receive seasonal influenza vaccine.

RESULTS

The vaccination rate was 43%, despite low awareness of the initiative (28%). Awareness was significantly higher among vaccinated students (p = 0.0013). Having knowledge that appointments to receive vaccine were not needed increased the motivation of vaccinated students more than unvaccinated students (p = 0.0001). Personal influencers increased motivation of vaccinated students only when they were aware of the initiative (p = 0.04). Tangible incentives did not motivate students.

CONCLUSIONS

Campus vaccination rates increased despite low initiative awareness. Improvements to the initiative should include strategies to increase emphasis on vaccination program conveniences like accessibility and perhaps engage personal influencers more.

College students' influenza vaccination adoption: Self-reported barriers and facilitators

OBJECTIVE

Influenza attack rates among college students are high. However, little is known about the determinants of students' flu vaccine adoption from their own perspectives. To fill this gap, this study aims to investigate barriers and facilitators to college students' flu vaccine adoption.

METHODS

A total of 545 students offered complete answers to an online survey. Thematic analysis was used for analyzing open-ended questions.

RESULTS

Students' flu vaccine adoption was hindered by their fear associated with the flu vaccine, lack of pertinent knowledge, perceived lack of necessity, negative social influence, and time constraints and convenience concerns. Students were motivated to adopt the flu vaccine for their interest in self-care, positive experience with the flu vaccine adoption, good flu vaccine habits, and recommendations from trusted sources.

CONCLUSIONS

Understanding determinants of students' flu vaccine adoption provides the first step in developing tailored health interventions that may increase students' flu vaccine adoption rates.

Seasonal and 2009 Pandemic H1N1 Vaccine Acceptance as a Predictor for COVID-19 Vaccine Acceptance

The emergence of COVID-19 also began an unprecedented production and distribution of several novel COVID-19 vaccines to combat the pandemic. Unfortunately, with the history of vaccine hesitancy in the United States and abroad, concern remains regarding the ability to vaccinate enough of the population to achieve herd immunity. In this study, 101 adults were surveyed about their vaccine experience in the waiting room of their visit to a Med-Peds clinic in Albany County, NY, to gauge interest in the upcoming rollout of COVID-19 vaccines. Questions included their opinions on seasonal influenza vaccines, the 2009 H1N1 vaccine, and the COVID-19 vaccine. The results of our survey are consistent with previous studies where gaps in acceptance were notable in black populations, lower education, and individuals with public health insurance. Furthermore, 92.9% of respondents who denied getting the 2009 H1N1 pandemic vaccine also did not plan to receive the COVID-19 vaccine (p<0.05), therefore a strong correlation was found between receipt of the previous 2009 H1N1 pandemic vaccine and the COVID-19 vaccine acceptance. The qualitative results of our study revealed that COVID-19 precautions deterred people from receiving the seasonal influenza vaccine, and a lack of information on the COVID-19 vaccine caused hesitancy to receive the vaccine on behalf of patients.

Are People Optimistically Biased about the Risk of COVID-19 Infection? Lessons from the First Wave of the Pandemic in Europe

Unrealistic optimism, the underestimation of one's risk of experiencing harm, has been investigated extensively to understand better and predict behavioural responses to health threats. Prior to the COVID-19 pandemic, a relative dearth of research existed in this domain regarding epidemics, which is surprising considering that this optimistic bias has been associated with a lack of engagement in protective behaviours critical in fighting twenty-first-century, emergent, infectious diseases. The current study addresses this gap in the literature by investigating whether people demonstrated optimism bias during the first wave of the COVID-19 pandemic in Europe, how this changed over time, and whether unrealistic optimism was negatively associated with protective measures. Taking advantage of a pre-existing international participative influenza surveillance network (n = 12,378), absolute and comparative unrealistic optimism were measured at three epidemic stages (pre-, early, peak), and across four countries-France, Italy, Switzerland and the United Kingdom. Despite differences in culture and health response, similar patterns were observed across all four countries. The prevalence of unrealistic optimism appears to be influenced by the particular epidemic context. Paradoxically, whereas absolute unrealistic optimism decreased over time, comparative unrealistic optimism increased, suggesting that whilst people became increasingly accurate in assessing their personal risk, they nonetheless overestimated that for others. Comparative unrealistic optimism was negatively associated with the adoption of protective behaviours, which is worrying, given that these preventive measures are critical in tackling the spread and health burden of COVID-19. It is hoped these findings will inspire further research into sociocognitive mechanisms involved in risk appraisal.

Herd immunity at what price? Using auctions to estimate what university students must be paid to get the flu vaccine

There is significant resistance to vaccinations. Fewer than half of adults get a flu shot in the United States in a typical year, and a large minority of Americans say they will not get vaccinated against COVID-19. This resistance to vaccines creates challenges for both public health and the economy. The academic literature needs to consider potential policy solutions that might increase vaccination rates. In this study, we use experimental auctions to estimate how much university students need to be paid in exchange for agreeing to get a flu shot. These were real auctions where winners received compensation to get the flu shot. As found in prior research, the perceived stakes of such auctions incentivize participants to estimate the price at which they would engage in the auctioned behavior – in this instance, receiving a flu shot. We find that 50% require less than $1, and an additional 30% would get vaccinated for a payment of $20 or less. We also use a tobit regression to estimate bids as a function of participants’ demographic characteristics. If low levels of compensation increase vaccination rates, this has significant public health implications. The government may be able to achieve higher vaccination rates at a relatively low cost, particularly in comparison with the economic harms caused by illness. This study demonstrates that experimental auctions may be useful for estimating how much a larger, more representative sample would need to be paid in exchange for agreeing to receive flu or COVID-19 vaccinations.

Monitoring COVID-19 Vaccine Acceptance in Kuwait During the Pandemic: Results from a National Serial Study

Background

With COVD-19 cases on the rise globally and two approved vaccines, determining vaccine acceptance is imperative to avoid low inoculation rates. The aim of this study was to evaluate the changes and determinants of vaccine acceptance among citizens and non-citizens, over time during the pandemic in Kuwait.

Methods

Data were obtained from the COVID-19 Snapshot Monitoring (COSMO Kuwait) study that was implemented according to the WHO tool for behavioral insights on COVID-19. Data was collected online, every two weeks throughout the pandemic. Individuals living in Kuwait during the pandemic were surveyed, representing an independent sample of the population during each data collection wave.

Results

A total of 7241 adults living in Kuwait participated. Sixty-seven percent of those participating agreed to take a vaccine if it was available and recommended. However, the proportion of vaccine acceptance drastically dropped overtime as COVID-19 related restrictions were eased, among citizens (73 to 47%) and noncitizens (80 to 60%). Some factors associated with increased odds of agreeing to take the COVID-19 vaccine, among citizens and non-citizens, included increased frequency of informing oneself about the virus (OR, 1.34–1.83; 95% confidence interval 1.16–2.55), having high versus low confidence in doctors (OR, 1.79–2.11; CI 1.17–3.80), increased agreement with containment policies (OR, 1.11–1.27; CI 1.05–1.41), expressing more fears and worries (OR, 1.05–1.12; 1.01–1.24), and the increased perceived likelihood of getting infected with influenza (OR, 1.3–1.4; CI 1.03–1.84). Decreased odds of agreement were associated with increased age (OR, 0.37–0.61; CI 0.26–0.95), being female (OR, 0.56–0.62; CI 0.43–0.73), and not taking the influenza vaccine in 2019 (OR, 0.61; CI 0.43–0.87).

Conclusion

Vaccine acceptance was multifactorial, heterogenous among citizens and non-citizens, and changed over time. While acceptance was relatively high, it decreased throughout the pandemic and as restrictions in the country loosened. This increase in vaccine hesitancy reveals a challenge in achieving high inoculation levels, and the need for effective vaccine-promotion campaigns and increased health education in the country.

Effects of Health Beliefs on Flu Vaccination and Physical Health among Under/Graduate Students in the U.S.: Racial Differences (Whites, African Americans, Hispanics, and Asians)

Physicians highlight that annual flu vaccination is the best strategy for preventing seasonal flu and flu-associated complications and it reduces the burden of infectious diseases. Path analyses were used to understand whether health beliefs (barriers, benefits, susceptibility, severity) influence flu vaccinations, in turn, enhance self-rated health of White, African American, Hispanic, and Asian adults in the U.S. (N = 446). Multiple-group analyses were performed to see whether given paths vary across the four groups. Regardless of race, perceived barriers and benefits significantly influenced flu vaccination. There was a group variance in the path-model of the perceived barriers, flu vaccination, and self-rated health. Although the direct effect of perceived barriers on flu vaccination was shown for all racial groups, the direct effect of perceived barriers on self-rated health was shown only for Asians. Social workers and healthcare providers should be educated to appropriately interpret different meanings of health beliefs of diverse racial groups.

Willingness to Pay for a Hypothetical COVID-19 Vaccine in the United States: A Contingent Valuation Approach

Our objective was to estimate the individual willingness to pay (WTP) for a COVID-19 vaccine and evaluate its predictors in the United States. A double-bounded dichotomous choice contingent valuation with open-ended question technique was implemented based on the responses to a national survey administered during the first week of November 2020. The final sample size was 1285. The results showed that individual WTP values increased with income, whether a household member had any pre-existing condition, and perceived threat of the virus. The vaccine efficacy rate and duration of protection were found to be important factors for the respondents. The mean WTP for a vaccine with a 95 percent efficacy rate and 3-year protection (US$318.76) was approximately 35 percent greater than the vaccine with a 50 percent efficacy rate and 1-year protection (US$236.85). The initial aggregate direct benefit of the current vaccination program was estimated to be between 20 and 35.6 billion US dollars depending on the vaccine protection duration.

Young Adults' COVID-19 Testing Intentions: The Role of Health Beliefs and Anticipated Regret

PURPOSE

Young adults are at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and transmission due to their social behaviors. The purpose of this study was to determine their attitudes toward coronavirus disease 2019 (COVID-19) testing, an important approach for minimizing infection and transmission.

METHODS

One hundred seventy eight US individuals aged 19-25 years completed an online survey measuring COVID-19 health beliefs and testing intentions. Multivariable logistic regression evaluated the association of heath belief measures (perceived COVID-19 susceptibility, COVID-19 severity, barriers and benefits to testing, and social concerns) with testing intentions.

RESULTS

Most respondents (86.0%) intended to accept a COVID-19 test if recommended by a health professional. High social concern and low perceived obstacles were associated with intent to get tested.

CONCLUSIONS

In this sample, most young adults intended to accept COVID-19 testing. Health beliefs predicted testing intention and point to possible intervention approaches to increase willingness to accept COVID-19 testing.

Influenza Vaccination Among U.S. College or University Students: A Systematic Review

OBJECTIVE

Influenza is one of the major causes of morbidity. This study summarized major components that influence college/university students' use of the vaccination using Ecological System Theory; and evaluated racial differences in key predictors of influenza vaccination/intention.

DATA SOURCE

Sixteen engines (e.g., PsycINFO, Academic Search Premier, Science Citation Index) were used to search for cross-sectional studies (2009-2019).

STUDY INCLUSION/EXCLUSION CRITERIA

PI/CO criteria were applied (U.S. students, multidimensional ecological system, influenza vaccination/intention).

DATA EXTRACTION

25 cross-sectional studies were included from the initial 810 citations. Four reviewers performed the cross-checking.

DATA SYNTHESIS AND RESULTS

Higher SES (e.g., education, vaccine affordability, healthcare resource) were positively associated with vaccination/intention. Under micro levels, both internal factors (e.g., positive beliefs, perceptions, attitudes) and external factors (e.g., supports/recommendations from physicians, families or peers, information, engagement in campus activities) enhanced influenza vaccination/intention of students. Meso level factors (private university, dorm-residence, or student housing) also influenced influenza vaccination/intention. Despite limited information on the effects of race on influenza vaccination, the current study synthesized the racial variances in vaccination behaviors of students.

CONCLUSIONS

Enhancing positive beliefs, perceptions, or attitudes toward influenza vaccination with students is critical. Information about the safety and effectiveness of vaccination could be provided for students through official media, medical sources/physicians, campaigns, or internet websites. Family-to-student or peer-to-peer awareness campaigns could facilitate the vaccination of students.

Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort

INTRODUCTION

This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations.

METHODS

This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students. A voluntary, anonymous questionnaire was administered to assess study objectives.

RESULTS

Vaccination rates were 39.9% for pandemic H1N1, 40.6% for seasonal influenza, and 32.6% for receiving both vaccinations. Age less than 25 and having a Reserve Officer Training Corps scholarship were associated with lower odds of receiving vaccinations, whereas entering the nursing field and simultaneous membership in the Army reserve forces were associated with higher odds of vaccination. There are 11.2% of respondents reported having an ILI, including 4.3% with severe ILI. There were 4184 reasons indicated for not attaining influenza vaccinations, which are listed in categorical groupings.

CONCLUSIONS

A historical anchor for vaccination rates and ILI is provided in a large cohort of college students following the 2009 H1N1 influenza pandemic. Influenza immunization locations were determined, as was self-reported obstacles to receiving vaccinations. These are important results for public health leaders seeking to increase vaccination rates during future influenza seasons.

Zika virus knowledge, attitudes, and vaccine interest among university students

BACKGROUND

Zika virus vaccine development is underway. We examined interest in receiving a Zika virus vaccine (after one becomes commercially available) among students at a large public university in Northern Virginia.

METHODS

An online survey of Zika virus-related knowledge, attitudes, and interest in receiving a Zika vaccine was completed by 619 undergraduate students in April, 2016. Stepwise logistic regression with backward elimination was used to identify the variables most strongly associated with interest in being vaccinated against Zika virus.

RESULTS

More than half of participants (52.8%) reported that they would be likely or very likely to be vaccinated against Zika virus. Vaccination interest was significantly higher among participants who received an influenza vaccine in the past year (p=0.002), had higher levels of knowledge about Zika virus (p=0.046), reported knowing where to access information about Zika virus (p=0.041), had higher perceived susceptibility to Zika virus (p<0.001), and believed that the U.S. Government should prioritize actions to control Zika virus (p=0.001).

CONCLUSIONS

Communication and intervention strategies encouraging vaccine uptake may benefit from increasing knowledge of Zika virus, addressing perceived susceptibility, and reaching students, travelers, and others who may be seeking information about prevention of Zika virus and other emerging infectious diseases.

Low uptake of influenza vaccine among university students: evaluating predictors beyond cost and safety concerns

INTRODUCTION

Annual influenza vaccine coverage for young adults (including college students) remains low, despite a 2011 US recommendation for annual immunization of all people 6 months and older. College students are at high risk for influenza morbidity given close living and social spaces and extended travel during semester breaks when influenza circulation typically increases. We evaluated influenza vaccine uptake following an on-campus vaccine campaign at a large, public New York State university.

METHODS

Consecutive students visiting the University Health Center were recruited for a self-administered, anonymous, written survey. Students were asked about recent influenza vaccination, barriers to influenza vaccination, and willingness to get vaccinated to protect other vulnerable individuals they may encounter. Frequencies and proportions were evaluated.

RESULTS

Of 653 students approached, 600 completed surveys (92% response proportion); respondents were primarily female (61%) and non-Hispanic white (59%). Influenza vaccine coverage was low (28%). Compared to coverage among non-Hispanic white students (30%), coverage was similar among Hispanic (30%) and other race/ethnicity students (28%) and lowest among non-Hispanic black students (17%). Among the unvaccinated, the most commonly selected vaccination barriers were "Too lazy to get the vaccine" (32%) and "Don't need the vaccine because I'm healthy" (29%); 6% of unvaccinated students cited cost as a barrier. After being informed that influenza vaccination of young, healthy people can protect other vulnerable individuals (e.g., infants, elderly), 71% of unvaccinated students indicated this would increase their willingness to get vaccinated.

CONCLUSIONS

Influenza vaccine uptake among college students is very low. While making vaccine easily obtained may increase vaccine uptake, college students need to be motivated to get vaccinated. Typically healthy students may not perceive a need for influenza vaccine. Education about vaccinating healthy individuals to prevent the spread of influenza to close contacts, such as vulnerable family members, may provide this motivation to get vaccinated.

Healthy bodies, toxic medicines: college students and the rhetorics of flu vaccination

This article examines flu vaccination beliefs and practices produced during a survey of undergraduate students in Spring 2012 (IRB#10-732). This research uses the methods of rhetorical analysis - or the study of persuasive features and arguments used in language - to examine statements respondents made regarding flu and flu vaccine. In these responses, students generated unique categories of arguments about the perceived dangers of flu vaccination, including the assertion that vaccines cause disease (including illnesses and conditions other than flu), that vaccines are toxic medicines, and that vaccines carry unknown, population-wide risks that are inadequately acknowledged. This study provides insight into vaccination beliefs and rationales among a population at risk of flu (college students) and suggests that further study of this population may yield important keys to addressing flu vaccine concerns as expressed by college students. Rhetorical analysis also offers a useful set of methods to understanding vaccination beliefs and practices, adding to existing methods of study and analysis of vaccination practices and beliefs in medicine and public health.

Clinical differences between H3N2 and H1N1 influenza 2012 and lower respiratory tract infection found using a statistical classification approach

Background

Influenza A H1N1 and H3N2 are two influenza waves that have been identified in past years.

Methods

Data from 77 inpatients from three tertiary hospitals were included and statistical analysis was performed in three different clusters.

Results

Thirty-four patients (44.2%) had respiratory distress upon admission, 31.2% had a smoking history or were active smokers, 37.7% manifested disease symptoms, and 7.8% were obese (body mass index >41). The mean age of patients was 51.1 years. Cough was the most common symptom observed in 77.9% of the patients, accompanied by sputum production (51.9%) and fatigue (42.9%). Hemoptysis and vomiting were rarely recorded in the patients (9.1% and 16.9%, respectively). Oseltamivir administration varied between 0 and 10 days, giving a mean value of 2.2 days. In particular, 19 patients received no drug, 31 patients received drug for only for 1 day, 19 patients for 5 days, and 8 patients from 2 to 10 days.

Conclusion

Clusters of symptoms can be used to identify different types of influenza and disease severity. Patients with vaccination had pneumonia, whereas patients without vaccination had influenza A. Patients more than 54.5 years old had H3N2 and patients less than 54.5 years had H1N1. White blood cell count values increased from normal to elevated in H3N2 patients but still remained abnormal in lower tract infection and H1N1 patients.