December 12, 2017
As the 2017-2018 flu season kicks off to an early start this year, experts are putting out their annual appeal for Americans to get their flu shots. Yearly flu vaccination is now recommended for all individuals six months and older who do not have any contraindications, and can be critical for high-risk populations. Yet immunization rates during 2015–16 flu season were low, with only 46% of high-risk adults age 18–64, and 63% of all adults over age 65 getting a flu shot. 
 
A new study in Vaccine led by Professor Sandra C. Quinn (Family Science) explores racial disparities in immunization among high-risk groups. In their article, "Determinants of influenza vaccination among high-risk Black and White adults," Quinn and her colleagues report on immunization attitudes and behaviors among black and white adults at higher risk for influenza-related complications. Specifically, they explored vaccine behaviors in the past five years for these groups and examined racial, demographic, and psychosocial factors that influence vaccine behavior.
 
Receiving the flu vaccine can be especially important for adults with certain chronic diseases because they are at greater risk for influenza-related complications, including hospitalizations and death and getting the flu can exacerbate cardiovascular diseases, resulting in increased cardiac dysfunction and heart failure, worsen type II diabetes, and further complicate breathing for those with asthma and other lung conditions. 
 
Research on immunizations for high-risk groups is limited, however, and investigation into racial disparities in immunization among high-risk groups is even less well understood. Yet minority populations shoulder a disproportionate burden of many chronic diseases, placing them at greater risk for influenza-related complications. Dr. Quinn’s research group, which includes Amelia Jamison, Ji An, and Gregory Hancock (University of Maryland) and Vicki Freimuth (University of Georgia), has explored racial differences in attitudes and behaviors towards vaccination broadly in other studies and turned their attention in this paper to understanding vaccination decisions among high risk groups which can help inform how health care providers communicate about the vaccine’s importance with this group. 
 
The study’s main findings include:
Demographic, racial, and psychosocial predictors are significant factors in flu vaccine uptake for high-risk adults.
Predictors for vaccination are significantly different by past vaccine behavior and by race.
Black high-risk adults are less likely to be immunized than white high-risk adults.
 
The authors conclude their article by pointing out how their results can not only advance our understanding of vaccine behavior in high-risk adults, but also how heath care professionals can adjust their approach to address specific concerns of their patients and help increase vaccine uptake. Not only does their study “examine vaccine uptake for a five-year period, which is a more robust measure than the typical measure of vaccine uptake one year,” but their “ability to examine beliefs, attitudes, vaccine hesitancy and confidence, and norms provides us with clear evidence to distinguish between high-risk patients, including the critical importance of understanding the key variables affecting Black and White adults whose health conditions demand annual vaccination.” Finally, they note, “with the subtle distinctions between vaccine behavior groups by attitudes, beliefs and knowledge, health care providers and public health professionals can more effectively target both interpersonal communication between the providers and the patients, and more broadly, campaigns at the population level.”
 
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Determinants of influenza vaccination among high-risk Black and White adults

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Sandra C. Quinn