title: Predictors of influenza vaccination among emergency medical services personnel.
abstract: BACKGROUND
  Because of their frequent patient interactions, particularly with patients in long-term care facilities, emergency medical services (EMS) professionals are at risk of contracting and spreading influenza. However, influenza vaccination rates among EMS professionals are poorly quantified.
  
  
  OBJECTIVE
  We sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake.
  
  
  METHODS
  We conducted a cross-sectional survey of North Carolina EMS professionals after the 2007-2008 influenza season. The survey assessed vaccination status as well as beliefs regarding influenza illness and vaccine effectiveness similar to the constructs of the Health Belief Model. Prediction of vaccine uptake was modeled using logistic regression.
  
  
  RESULTS
  A total of 601 EMS professionals completed the survey. Among the respondents, 47.9% reported receiving the influenza vaccination; vaccination rates varied among rural, suburban, and urban respondents (p = 0.01). Significant differences were found between the vaccinated and unvaccinated groups regarding employer vaccine recommendation (odds ratio [OR] = 3.6, p < 0.01), employer-offered influenza training (OR = 1.5, p < 0.01), employer-offered vaccination (OR = 3.3, p < 0.01), and belief in vaccine safety (OR = 27.5, p < 0.01) and effectiveness (OR = 9.5, p < 0.01). Most respondents believed they were at higher risk for influenza, the risk of adverse reactions was outweighed by prevention of disease, the vaccine was safe and effective, and vaccination protected themselves and their patients; however, only 9.1% supported mandatory vaccination. Those who were not vaccinated cited reasons such as belief in personal health as a protector against influenza, concerns about vaccine effectiveness, and the lack of an employer mandate. Predictors of vaccination included previous influenza diagnosis, perceived higher risk compared with that in the general population, belief in vaccine effectiveness, belief of favorable risk benefit ratio, employer vaccine recommendation, and age.
  
  
  CONCLUSIONS
  In this multicenter evaluation of EMS professionals, influenza vaccination rates were unacceptably low. Previous influenza infection, employer vaccine recommendation, a perception of increased risk for contracting the illness, and favorable beliefs about vaccine effectiveness were all predictive of vaccination acceptance. Emergency medical services systems should focus their efforts on combating misinformation through employee educational campaigns as well as develop policies regarding immunization requirements and working while ill.
authors.affiliation: Emergency Medical Care Program, Western Carolina University, Cullowhee, North Carolina 28723, USA. mhubble@email.wcu.edu
authors.forename: Michael W
authors.initials: MW
authors.lastname: Hubble
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Zontek
authors.forename: Michael E
authors.initials: ME
authors.lastname: Richards
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D004634:Emergency Medical Technicians; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000009:adverse effects*; D007251:Influenza, Human / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D009657:North Carolina; D012307:Risk Factors
chemical_list: D007252:Influenza Vaccines