title: Barriers to influenza immunization in a low-income urban population.
abstract: BACKGROUND
  Although 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.
  
  
  OBJECTIVE
  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 > or =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.
authors.affiliation: Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, USA. karmstro@mail.med.upenn.edu
authors.forename: K
authors.initials: K
authors.lastname: Armstrong
authors.forename: M
authors.initials: M
authors.lastname: Berlin
authors.forename: J S
authors.initials: JS
authors.lastname: Schwartz
authors.forename: K
authors.initials: K
authors.lastname: Propert
authors.forename: P A
authors.initials: PA
authors.lastname: Ubel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007114:Immunization / Q000191:economics* / Q000592:standards* / Q000639:trends; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D015143:Philadelphia / Q000453:epidemiology; D011159:Population Surveillance; D011203:Poverty; D011336:Probability; D018570:Risk Assessment; D012494:Sampling Studies; D014505:Urban Population
chemical_list: D007252:Influenza Vaccines