title: Adolescent attitudes toward influenza vaccination and vaccine uptake in a school-based influenza vaccination intervention: a mediation analysis.
abstract: BACKGROUND
  School-based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school-based influenza vaccination intervention and vaccine uptake.
  
  
  METHODS
  Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N = 337). Data were collected from surveys distributed to adolescents at pre- and post-intervention time points and from documents indicating vaccine uptake. Guided by the Health Belief Model and the Integrated Behavioral Model, surveys assessed demographic, behavioral, and psychosocial variables. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow-up mediated the relationship between study condition and influenza vaccine uptake.
  
  
  RESULTS
  Controlling for background variables, step 1 of the mediation analysis revealed a significant relationship between study condition and vaccine uptake (odds ratio = 1.77, p = .038). Step 2 of the mediation analysis revealed a significant relationship between study condition and changes in psychosocial variables from baseline to follow-up. Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between study condition and receipt of an influenza vaccination by intention to receive an influenza vaccination.
  
  
  CONCLUSIONS
  Findings suggest that the success of our school-based influenza vaccination intervention in increasing vaccine uptake was mediated by adolescents' intention to receive an influenza vaccination. Future influenza vaccination efforts geared toward rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine.
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health and Emory Vaccine Center, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. jellenb@emory.edu
authors: Julia E
authors: JE
authors: Painter
authors: Jessica M
authors: JM
authors: Sales
authors: Karen
authors: K
authors: Pazol
authors: Gina M
authors: GM
authors: Wingood
authors: Michael
authors: M
authors: Windle
authors: Walter A
authors: WA
authors: Orenstein
authors: Ralph J
authors: RJ
authors: DiClemente