title: Influenza vaccination acceptance among diverse pregnant women and its impact on infant immunization.
abstract: OBJECTIVE
  We examined pregnant women's likelihood of vaccinating their infants against seasonal influenza via a randomized message framing study. Using Prospect Theory, we tested gain- and loss-frame message effects and demographic and psychosocial correlates of influenza immunization intention. We also explored interactions among pregnant women who viewed "Contagion" to understand cultural influences on message perception.
  
  
  METHODS
  Pregnant women ages 18-50 participated in a randomized message framing study from September 2011 through May 2012 that included exposure to intervention or control messages, coupled with questionnaire completion. Venue-based sampling was used to recruit racial and ethnic minority female participants at locations throughout Atlanta, Georgia. Bivariate and multivariate analyses were conducted to evaluate key outcomes.
  
  
  RESULTS
  The study population (n = 261) included many lower income (≤ $20,000/yearly household earnings) pregnant participants (69.2%, n = 171) inclusive of Black/African Americans (88.5%, n = 230), Hispanic/Latinas (7.3%, n = 19), and Other/Multicultural women (4.2%, n = 11). Both gain [OR = 2.13, 90% CI: (1.120, 4.048)] and loss-frame messages [OR = 2.02, 90% CI: (1.083, 3.787)] were significantly associated with infant influenza vaccination intention compared with the control condition. Intention to immunize against influenza during pregnancy had a strong effect on intent to immunize infants [OR = 10.83, 90%CI: (4.923, 23.825)]. Those who had seen the feature film "Contagion" (n = 54, 20.69%) viewed gain- and loss-framed messages as appealing (x (2) = 6.03, p = 0.05), novel (x (2) = 6.24, p = 0.03), and easy to remember (x (2) = 16.33, P = 0.0003).
  
  
  CONCLUSIONS
  In this population, both gain- and loss-framed messages were positively associated with increased maternal intent to immunize infants against influenza. Message resonance was enhanced among those who saw the film "Contagion." Additionally, history of immunization was strongly associated with infant immunization intention. :
authors.affiliation: Division of Infectious Diseases; Department of Medicine; Emory University School of Medicine; Decatur, GA USA; Department of Behavioral Sciences and Health Education; Rollins School of Public Health; Emory University; Decatur, GA USA.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Frew
authors.affiliation: Division of Infectious Diseases; Department of Medicine; Emory University School of Medicine; Decatur, GA USA; Department of Epidemiology; Rollins School of Public Health; Emory University; Decatur, GA USA.
authors.forename: Siyu
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Division of Infectious Diseases; Department of Medicine; Emory University School of Medicine; Decatur, GA USA; Hubert Department of Global Health; Rollins School of Public Health; Emory University; Decatur, GA USA.
authors.forename: Diane S
authors.initials: DS
authors.lastname: Saint-Victor
authors.affiliation: Division of Allied Health; Emory University School of Medicine; Decatur, GA USA.
authors.forename: Ashley C
authors.initials: AC
authors.lastname: Schade
authors.affiliation: Division of Infectious Diseases; Department of Medicine; Emory University School of Medicine; Decatur, GA USA; Department of Epidemiology; Rollins School of Public Health; Emory University; Decatur, GA USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Benedict
authors.affiliation: Division of Infectious Diseases; Department of Medicine; Emory University School of Medicine; Decatur, GA USA; Department of Behavioral Sciences and Health Education; Rollins School of Public Health; Emory University; Decatur, GA USA.
authors.forename: Maral
authors.initials: M
authors.lastname: Banan
authors.affiliation: Division of Infectious Diseases; Department of Medicine; Emory University School of Medicine; Decatur, GA USA; Department of Epidemiology; Rollins School of Public Health; Emory University; Decatur, GA USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Ren
authors.affiliation: Hubert Department of Global Health; Rollins School of Public Health; Emory University; Decatur, GA USA.
authors.forename: Saad B
authors.initials: SB
authors.lastname: Omer
mesh_terms: D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005845:Georgia; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D037841:Pregnant People; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: contagion; immunization coverage; influenza vaccination; message framing; pregnant women; prospect theory; racial/ethnic minorities