title: Factors affecting hepatitis vaccination refusal at a sexually transmitted disease clinic among men who have sex with men.
abstract: BACKGROUND
  Men who have sex with men (MSM) attending sexually transmitted disease (STD) clinics should be considered candidates for hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination. However, vaccination rates in STD clinics remain less than optimal.
  
  
  OBJECTIVE
  The goal was to identify factors that affect HAV and HBV vaccination refusals.
  
  
  METHODS
  A survey was administered to MSM eligible for the vaccinations attending an STD clinic. Vaccines were offered at the end of the clinic visit.
  
  
  RESULTS
  Rates of refusal of HAV (RefuseA) and HBV (RefuseB) vaccinations were 36% and 38%. Health motivation was associated with acceptance, while clinical barriers such as "want to test first for immunity," and "want to talk to own doctor first" were associated with refusal. "Not enough time this evening" was most strongly predictive of refusal, relative to strongly disagree (risk ratios [RRstrongly agree] and 95% confidence limits for RefuseA and RefuseB were 2.69 [1.43, 5.05] and 2.02 [1.05, 3.87], respectively).
  
  
  CONCLUSIONS
  To increase acceptance, patients less health-motivated should be identified for prevaccination counseling. Some perceived barriers such as time may be a partial excuse; staff should identify and address other perceptions that may be influencing patients' decisions.
authors.affiliation: Departments of Health Services and Epidemiology, UCLA, School of Public Health, 650 Charles E. Young Drive South, Box 951772, Los Angeles, CA 90095-1772, USA. egrudy@earthlink.net
authors.forename: Ellen T
authors.initials: ET
authors.lastname: Rudy
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Wendy
authors.initials: W
authors.lastname: Douglas
authors.forename: Sander
authors.initials: S
authors.lastname: Greenland
mesh_terms: D000293:Adolescent; D000328:Adult; D006506:Hepatitis A / Q000517:prevention & control*; D006509:Hepatitis B / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014611:Vaccination; D017778:Vaccines, Combined / Q000008:administration & dosage; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage*
chemical_list: D017778:Vaccines, Combined; D014761:Viral Hepatitis Vaccines