title: Pre-deployment vaccinations and perception of risk among US military personnel.
abstract: BACKGROUND
  Vaccination programs have significantly reduced the incidence of numerous infectious diseases; however, public attitudes toward immunization oftentimes remain contentious. Concerns over vaccine safety and effectiveness, compounded with reduced perceived risk of disease, influence decision making and frequently override public health recommendations. Although vaccinations are compulsory for US military personnel, their concerns mirror the general population, resulting in sub-optimal coverage.
  
  
  RESULTS
  Demographics of the 1,757 respondents: 83.3% male, 71.1% Army, 87.5% enlisted, mean age of 29.2 years (standard deviation: 8.3). The majority (89.3%) reported receiving all pre-deployment vaccines; 17.1% stated they would decline if given the opportunity. Factors associated with an increased likelihood of declining vaccines included a perception that the vaccines were not safe (odds ratio [OR]: 3.7; p < 0.001) and rarely/never believing information from the military command (OR: 2.2; p < 0.001). Those with a perceived risk for the diseases targeted by the vaccines were less likely to decline (OR: 0.6; p < 0.001).
  
  
  CONCLUSIONS
  In US military personnel, negative perceptions of pre-deployment vaccines exist. These attitudes appear to be associated with negative perceptions of vaccine safety and low perceived disease risk. Targeted interventions, focusing on the drivers of negative perceptions toward vaccines, and accounting for the source of the educational material, may influence attitudes and improve vaccination perceptions.
  
  
  METHODS
  A self-administered questionnaire was completed by a convenience sample of US military personnel deployed to Iraq, Afghanistan and surrounding regions. Questions solicited demographic information and assessed agreement with statements in an attempt to identify factors associated with declining pre-deployment vaccines.
authors.affiliation: Uniformed Services University of the Health Sciences, Department of Preventive Medicine and Biometrics, Bethesda, MD, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polak
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
authors.forename: Adam W
authors.initials: AW
authors.lastname: Armstrong
authors.forename: Manal
authors.initials: M
authors.lastname: Mostafa
authors.forename: Chad K
authors.initials: CK
authors.lastname: Porter
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs; D008297:Male; D032541:Mass Vaccination; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*