Barriers Associated with Seasonal Influenza Vaccination among College Students

Undergraduate-level biology students' application of central dogma to understand COVID mRNA vaccines

The coronavirus disease 2019 (COVID-19) pandemic has underscored the importance of mRNA vaccines. The mechanism for how such vaccines work is related to the core biology topic of the central dogma, which students often misunderstand despite its importance. Therefore, we wanted to know whether students can apply their biology knowledge of central dogma to the real-world issue of how mRNA COVID vaccines work. Accordingly, we asked college biology students of different expertise levels how the COVID vaccine worked. Later, we cued them by telling them the vaccine contains mRNA and asked them what the mRNA does. We used thematic analysis to find common ideas in their responses. In the uncued condition, fewer than half of the students used central dogma-related ideas to explain what was in the vaccine or how the vaccine worked. Inaccurate ideas were present among all groups of biology students, particularly entering biology majors and non-biology majors, including the idea that the COVID vaccines contain a weakened, dead, or variant form of the COVID virus. After students were cued, many more students in all expertise groups expressed central dogma-related themes, showing that students could apply the knowledge of central dogma if prompted. Advanced biology majors were much more likely to state that the vaccines code for a viral protein, indicating their advanced application of central dogma concepts. These results highlight inaccurate ideas common among students and show changes in the ability to apply knowledge with student expertise level, which could inform future interventions to support student learning about vaccines and central dogma.

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.

What College Biology Students Know about How Vaccines Work

Vaccines are an important and societally relevant biology topic, but it is unclear how much college biology students know about how vaccines work and what inaccurate ideas they have about that process. Therefore, we asked more than 600 college students taking biology courses at various levels to explain, "How does a vaccine work?" in a free-response format. Based on authoritative sources and responses from immunology and other biology faculty, we created a rubric to gauge the basic knowledge and accuracy present in student responses. Basic knowledge was defined as knowing that vaccines mimic the pathogen, elicit an active immune response, and provide protection against future infection. Accuracy was defined as the absence of scientifically inaccurate ideas. We found that advanced biology majors score significantly higher in basic knowledge and accuracy when compared with all other student groups, but there were no differences between entering biology majors, pre-health majors, and non-pre-health majors. We also uncovered a variety of inaccurate ideas, with the most common being that vaccines contain the original, unmodified pathogen. These results provide a new way to gauge college student understanding of how a vaccine works and enrich our understanding of what college students know about this process.

Evaluation of knowledge and barriers of influenza vaccine uptake among university students in Saudi Arabia; a cross-sectional analysis

Background

Influenza vaccine hesitancy is a significant threat to global maneuvers for reducing the burden of seasonal and pandemic influenza. This study estimated the vaccine uptake, barriers, and willingness for influenza vaccines among university students in Saudi Arabia.

Methods

A cross-sectional survey was conducted among health science (HS) and non-health science (NHS) university students. A 31-item questionnaire was used to ascertain the vaccination rate, barriers, and willingness for the flu vaccine.

Results

This study included 790 students (mean age: 21.40 ± 1.94 years), 246 (31.1%) from HS and 544 (68.9%) from NHS disciplines. About 70% did not take flu shots before the arrival of the winter. The mean knowledge score was 7.81 ± 1.96, where 20.4%, 67.6%, and 12% of respondents had good, moderate, and poor knowledge regarding flu vaccines. The relative importance index (RII) analysis showed a lack of recommendation from physicians (51.5%, RI ranked: 1) was a top-ranked barrier to vaccine uptake, followed by negative perceptions and accessibility issues. Only 36.6% of the participants were willing to get vaccinated every year, 70% were willing to receive a vaccine on their doctor's recommendations, and 46% agreed to vaccinate if vaccines were freely available in the university. The knowledge, barriers, and willingness widely varied across students from two disciplines.

Conclusions

Our analysis underscored low flu vaccine uptake among university students. In addition, the study participants' knowledge was unsatisfactory, and they were less inclined to receive the flu vaccine in the future. Lack of recommendation from the physicians, negative perceptions towards the flu vaccine, and difficult accessibility were found as significant barriers to the vaccine uptake. A multidimensional approach at educational institutes to cover the knowledge gap and address the barriers curtailing the vaccination rate among students is recommended.

A qualitative analysis of an online teaching intervention to encourage favorable attitudes toward influenza vaccine among community college students

Objective: To promote influenza vaccine acceptance among community college students during the Fall 2020 semester to reduce the incidence of a "twin-demic" occurring of influenza and COVID-19. Participants: A convenience sample of 185 students enrolled in an entry level health course. Methods: Non-experimental cross-sectional design that used a self-paced, online teaching intervention. Qualitative data in the form of online discussion board posts were collected and analyzed assessing attitudes, normative references, and knowledge. Results: High rates of favorable attitudes toward influenza vaccine, evidence of subjective normative references toward science-based information, and an increase in participant knowledge. Conclusions: An online teaching intervention can be effective in changing attitudes, referencing subjective norms related to scientific information, and increasing knowledge.

Interprofessional Collaboration Improves Uptake of Flu Vaccines on a College Campus

In spite of an increased risk of transmission of influenza on college campuses, only 20% or fewer of college students in the United States receive the flu vaccine. This project evaluated an existing university program for flu vaccination, resulting in a collaboration pilot program in which a pharmacy conducted a mobile health clinic on campus. The percentage of students who obtained a flu vaccine from this initiative rose from about 4% to 9.46%, a 131% increase over the historical average.

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.

Understanding vaccine knowledge, attitudes, and decision-making through college student interviews

Objective: We aimed to explore knowledge, attitudes, and beliefs about vaccines required for college-entry and vaccine-related behaviors among college students. Participants: Thirty-three full-time undergraduate students, ≥ 18 years old, enrolled at public (2) and private (3) colleges and universities in metropolitan Philadelphia in fall 2016. Methods: We conducted semistructured interviews, which were double-coded with 5,015 comments overall and 99.3% intercoder reliability (κ = 0.779) using NVivo 11 software. Results: Six key themes emerged: (1) low knowledge about vaccines and requirements; (2) mixed attitudes about required vs. recommended vaccines; (3) high trust in medical professionals; (4) low perceived risk for vaccine-preventable disease outbreaks; (5) substantial parental influence on students' decision-making; and (6) low utilization of Student Health Services. Conclusions: This study revealed lack of knowledge about and low prioritization of vaccination despite overall positive attitudes towards vaccines. Prematriculation education of college students is critical to increasing vaccine knowledge and use.

Effects of Patient-Centered Communication on Influenza Vaccination and Self-Reported General Health Status among Asian Americans: A Comparison Model for Young/Middle-Aged and Older Adults

Objectives: Asian American subgroups’ influenza vaccination is still below the US standards. This study examined the effects of patient-centered communication (PCC) on influenza vaccination and the general health (GH) of Chinese, Vietnamese, and Korean Americans. A group difference between younger and older adults was investigated. Methods: The 2014–2016 California Health Interview Surveys were merged (Chinese [ N = 1,680], Korean [ N = 514], and Vietnamese [ N = 644]; age 18+; younger = 1,629 and older = 1,209). Two path models (PCC [measured by physicians’ careful listening], vaccination, and GH; PCC [measured by physicians’ clear explanation], vaccination, and GH) were evaluated. Regression maximum likelihood was applied for missing values. Results: Both the first and second models showed good model fit scores (comparative fit index [CFI] = .95, root mean square error of approximation [RMSEA] = .04, and standardized root mean residual [SRMR] = .03; CFI = .93, RMSEA = .04, and SRMR = .03). There were direct effects of PCC on vaccination among younger adults. PCC directly influenced GH for both age-groups. Discussion: A PCC manual for physicians in local or community health centers could enhance both younger and older adults’ influenza vaccination.

Increasing Intent to Vaccinate for Seasonal Influenza

Background: The community college student is not currently armed with the resources or prevention information regarding influenza. Less than twenty percent of the college population receives influenza immunization annually.Purpose: The purpose of the project was to evaluate if an evidenced-based influenza and vaccine education intervention will affect nursing students' intent to vaccinate for influenza by increasing knowledge of the influenza vaccine using Zingg and Siegrist's Knowledge Scale.Methods: Participants were recruited voluntarily from their attendance at orientation for incoming nursing students on a specific date and time. Utilizing a computer survey, all seventy-seven participants completed an online pretest before an educational intervention, and then, the results were compared following the educational intervention with a posttest. Parametric tests such as a paired t-test, Pearson's correlation coefficient, one-way analysis of variance (ANOVA), and percent change were utilized to determine whether an educational intervention was effective in improving influenza knowledge and whether there was a change in vaccination intention.Outcomes and Results: The educational intervention in this project resulted in enhancement of influenza knowledge. The implications of this project demonstrated the value of providing an educational intervention to improve knowledge, intent, and willingness to vaccinate for influenza for nursing students at a community college.

Healthcare Students' Flu Vaccine Uptake in the Last 5 Years and Future Vaccination Acceptance: Is There a Possible Association?

Background: Despite the free-of-charge offer of influenza vaccines to at-risk subgroups, vaccine coverage remains low and far from the target, probably due to the false myths and misperceptions. We aimed to explore the healthcare students’ vaccination behavior and beliefs to find any association between vaccination uptake during the last 5 years and future vaccination acceptance.

Study design: A multicentre cross-sectional study.

Methods: From Oct 2017 to Nov 2018, the Italian healthcare students from 14 different universities in 2017/2018 were enrolled, through an online and anonymous questionnaire previously validated. Absolute and relative frequencies were calculated and Pearson's Chi-square test was used. A multinomial logistic regression model was performed. Results are expressed as relative Risk Ratio (RR) with 95% Confidence Intervals (95% CI). The level of significance chosen was P-value <0.05.

Results: A total of 3137 students were enrolled and 3131 questionnaires were analysed. 82.7% of the sample declared they had not received any flu vaccination during the last 5 years. Students who received flu vaccination 4 times or more during the last 5 years were more likely to do it again next year as well (95.1% vs 4.9%). The regression model showed that having received flu vaccination over the last 5 years was statistically associated with the intention of getting vaccinated during next season.

Conclusions: Frequency of flu vaccination is predictive for future acceptance among healthcare students. This association could have both implications for the organization of vaccination campaigns and improve educational strategies for this category of students.

Attitudes and barriers associated with seasonal influenza vaccination uptake among public health students; a cross-sectional study

Background

Although research has explored influenza vaccination uptake among medical and college students, there is a dearth of research in understanding influenza vaccination uptake and attitudes toward the vaccine among future public health practitioners. Undergraduate public health students represent future public health practitioners who may be a significant educational resource for health information, including the importance of vaccinations.

Methods

This cross-sectional study utilized survey data from 158 undergraduate public health students attending a large public university in Southern California. The survey assessed public health students’ attitudes and beliefs towards the seasonal influenza vaccine and seasonal vaccination rates among this population.

Results

Over 88% of respondents reported having been encouraged to receive the seasonal influenza vaccine, while only 43.0% reported receipt. Of the students who reported not receiving the vaccine, 49.4% believed it may give them the flu, 30.4% believed there may be dangerous side effects, and 28.9% believed they were not at risk for contracting the flu. Access to health care practitioners (OR: 3.947, 95% CI [1.308–11.906]) and social encouragement (OR: 3.139, 95% CI [1.447–6.811]) were significantly associated with receipt of the seasonal influenza vaccine.

Conclusion

As public health program curriculum includes information about seasonal influenza vaccination and 68% of the sample were seniors soon to be exiting the program with an undergraduate degree in public health education, this low seasonal influenza vaccination rate is disturbing. This study may add to the body of data demonstrating how knowledge of the vaccine does not always guarantee vaccine uptake. Results of the current study suggest that it may be beneficial to provide additional information targeted to public health students, aimed at mediating safety concerns and increasing social pressure to assist in improving vaccine acceptance and rates in this population. Maximizing seasonal influenza vaccination uptake by addressing attitudes, barriers and misperceptions may not only improve vaccination rates among public health students, but also in communities served by these future public health practitioners.

Freshman Flu Vaccination Behavior and Intention During a Nonpandemic Season

Objective. To examine predictors of flu vaccination and vaccination intention among college freshmen during a nonpandemic influenza season using the health belief model (HBM). Participants. A total of 184 college freshmen at a single institution participated in a mixed-mode (paper or online) survey in October-November 2015. Method. Flu vaccination and intention to vaccinate were predicted using binomial logistic regression on HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action, and availability), prior flu vaccination history, family and peer reference behaviors, and demographics. Results. Overall, 31.5% of participants received the seasonal flu vaccine by mid-November, and 25% intended to receive it. In full models, history of past flu vaccination (adjusted odds ratio [aOR] = 7.90; 95% confidence interval [CI] = 2.55-24.49) was significant for vaccination while availability (aOR = 2.00; 95% CI = 1.32-3.01) and family intention (aOR = 250.59; 95% CI = 3.77 to >999) were positively associated with intent to vaccinate. Significant confounding by past behavior and family intentions existed for both outcomes. Conclusions. Past flu vaccination behavior and family member intentions to vaccinate were better predictors of annual flu vaccination behavior and intention than HBM constructs among college freshmen. College campuses may enhance flu vaccine coverage by highlighting benefits and availability to students and families.