title: Determinants of adult vaccination at inner-city health centers: a descriptive study.
abstract: BACKGROUND
  Pneumococcal polysaccharide vaccination rates among adults 65 years and older or less than 65 years with high risk medical conditions are still below Healthy People 2010 recommended levels of 90%. This study was designed to: 1) assess self-reported pneumococcal vaccination rates following health center level interventions to increase adult vaccination rates; and 2) determine factors associated with vaccination.
  
  
  METHODS
  Tailored interventions to increase immunizations were implemented at two inner-city health centers. We surveyed 375 patients 50 years of age and older. Multivariate logistic regression examines the predictors of 1) self-reported pneumococcal vaccination and 2) combined self-reported influenza and pneumococcal vaccination. Both of these models were stratified by age group (50-64 years and 65 years and older).
  
  
  RESULTS
  Pneumococcal vaccination rates were 45% by self-report, 55% by medical record review, 69% for patients 65 years old and older, 32% for patients 50-64 years; they did not differ by race. Receipt of the previous season's influenza vaccine was significantly related to pneumococcal vaccination among both younger and older patients. Receiving both the pneumococcal vaccine and the most recent influenza vaccine compared with receiving neither, among younger patients was related to unemployment, more frequent physician visits, and belief that those who do not receive the flu shot are more susceptible to the flu. For older patients, receipt of both vaccines was related to nonsmoking status, believing that friends/family think the patient should be vaccinated, seeing posters advertising flu shot clinics, and belief that those who do not receive the flu shot are more susceptible to the flu.
  
  
  CONCLUSIONS
  Our findings suggest that improving overall pneumococcal vaccination rates among eligible adults, has the potential to eliminate racial disparities. Interventions delivering vaccination messages specific to older and younger adult groups may be the best strategy for improving adult vaccination rates.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA. tnowalk@pitt.edu
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Melissa
authors.initials: M
authors.lastname: Tabbarah
authors.forename: Mahlon
authors.initials: M
authors.lastname: Raymund
authors.forename: Ilene K
authors.initials: IK
authors.lastname: Jewell
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000367:Age Factors; D000368:Aged; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010414:Pennsylvania; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012650:Self Disclosure; D012923:Social Class; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000458:organization & administration*; D044465:White People / Q000523:psychology*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines