Research articleThe Role of Attitudes in Understanding Disparities in Adult Influenza Vaccination
Introduction
In 2003, 69% of whites aged 65 years and older in the United States reported having received an influenza vaccine within the past 12 months, compared with 48% of African Americans.1 The persistence of racial disparities in adult vaccination, coupled with suboptimal influenza vaccine coverage among adults aged 65 and older, underscores the importance of identifying predictors of vaccination in this population.
Racial/ethnic differences in influenza vaccination rates persist after adjusting for provider visits,2, 3, 4, 5, 6, 7, 8 access to care,2, 6, 8 socioeconomic status,2, 4, 6, 7, 8 health insurance,2, 5, 6, 7, 8 perceived health,4, 5, 6, 8 chronic disease,2, 4, 6, 7, 8 and demographic characteristics.2, 3, 5, 6, 7, 8 It has been hypothesized that differences in attitude toward vaccination play an important role in these disparities.2, 4, 5, 6 While a number of studies have examined attitudes toward influenza vaccination,9, 10, 11, 12, 13, 14, 15, 16, 17 none included sufficient numbers of African Americans to compare attitudes of vaccinated and unvaccinated individuals across groups or to assess the extent to which disparities can be attributed to differences in attitude.
The purpose of this study was to examine attitudes toward influenza vaccination among unvaccinated and vaccinated respondents in a large, racially/ethnically diverse sample of older adults and to determine the effect of these attitudes on racial disparities in influenza vaccination coverage.
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Study Design and Population
The Racial and Ethnic Adult Disparities in Immunization Initiative (READII) was a 3-year demonstration project funded by the Centers for Disease Control and Prevention and other federal partners at five U.S. sites: San Antonio TX, Chicago IL, Milwaukee WI, Rochester NY, and 19 counties in the Mississippi Delta region. Data-collection methods and eligibility criteria for READII have been previously described.3, 18 Briefly, Medicare beneficiaries aged ≥65 years residing in project areas were
Response Rate
To calculate response rate, it was assumed that telephone numbers with unknown responses (no answer, busy signal, answering machine) would produce eligible respondents proportionally to numbers with known responses. A total of 4988 interviews were completed among beneficiaries with available telephone numbers, for an overall response rate of 50.8%. Respondents missing the outcome of interest (current influenza vaccination status, n =139) were excluded from analysis. Since the analysis was
Discussion and Conclusions
This is the first published study to examine attitudes toward vaccination among vaccinated and unvaccinated respondents in a large, racially/ethnically diverse sample of older adults. African Americans in this sample were significantly less likely than whites to report positive attitudes toward influenza vaccination, both among unvaccinated and vaccinated respondents. The substantial gap in influenza vaccination coverage between older African-American and white Medicare beneficiaries remained
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