Barriers to influenza immunization in a low-income urban population

• Published in: American journal of preventive medicine 2001, Vol.20 (1), p.21-25
• Main Authors: Armstrong, Katrina, Berlin, Michelle, Schwartz, J.Sanford, Propert, Kathleen, Ubel, Peter A
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Attitude to Health; Cross-Sectional Studies; Female; Humans; immunization; Immunization - economics; Immunization - standards; Immunization - trends; influenza; Influenza Vaccines - administration & dosage; Influenza, Human - epidemiology; Influenza, Human - prevention & control; Male; Multivariate Analysis; Patient Compliance; Philadelphia - epidemiology; Population Surveillance; Poverty; Probability; Risk Assessment; Sampling Studies; socioeconomic factors; Urban Population
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/S0749-3797(00)00263-4

Background: Athough influenza immunization significantly reduces mortality from influenza, over one third of elderly Americans are not immunized each year. Low rates of immunization are particularly concerning among African-American low-income populations. Preliminary interviews suggested that fear of undisclosed ingredients in the influenza vaccine may impede vaccine acceptance in this vulnerable population. Objectives: To assess the role of concern about vaccine contents and other factors in the use of influenza immunization among a predominantly African-American low-income urban population. Methods: Cross-sectional, health-system-population–based, telephone survey of a random sample of West Philadelphia residents aged ≥65 years. Results: Of 659 eligible individuals, 486 (73.8%) were successfully interviewed. Concern about undisclosed shot contents was reported by 132 (20%) respondents and was inversely associated with vaccine receipt (OR 0.49, 95% CI 0.26–0.91). This association was similar among African Americans and Caucasians. In addition, receipt of influenza vaccine was inversely associated with belief that immunization is inconvenient (OR 0.14, 95% CI 0.05–0.36), belief that immunization is painful (OR 0.21, 95% CI 0.08–0.54), and history of previous side effects (OR 0.33, 95% CI 0.18–0.60), and positively associated with physician recommendation (OR 3.22, 95% CI 1.76–5.93). Conclusions: In a low-income urban population, concern about undisclosed vaccine contents appears to impede acceptance of influenza immunization among both African Americans and Caucasians. Directly addressing this concern offers a new approach to increasing immunization in this vulnerable population.