title: Factors associated with influenza vaccine receipt in community dwelling adults and their children.
abstract: BACKGROUND
  Factors associated with influenza vaccine receipt are well studied in healthcare personnel, pregnant women, and the elderly. There has been substantially less research in community dwelling adults and children, and none among entire households. Many studies determine vaccination status by self-report or behavioral intention, outcomes susceptible to misclassification. Given that vaccine is recommended for everyone over six months, re-evaluating these factors is warranted.
  
  
  METHODS
  The Household Influenza Vaccine Effectiveness (HIVE) study is a prospective cohort of households with children. In 2010-2011, 549 adults representing 312 households completed surveys evaluating knowledge, attitudes, and practices regarding influenza vaccination for themselves and their children. Using the health belief model (HBM) as a framework, we examined factors associated with documented seasonal influenza vaccine receipt using log-binomial regression models.
  
  
  RESULTS
  In multivariate models, cues to action such as doctor recommendation, (RR 1.62, 95% CI: 1.25-2.10), perceived benefits (RR 1.25, 95% CI: 1.04-1.50), and perceived susceptibility (RR 1.21, 95% CI: 1.03-1.42) were significantly associated with increased likelihood of vaccine receipt among adults while high perceived barriers were associated with decreased likelihood (RR 0.38, 95% CI: 0.25-0.59). Similarly, parents reporting higher barriers were less likely (RR 0.58, 95% CI: 0.42-0.79) and those perceiving greater benefits (RR 4.16, 95% CI: 2.28-7.59) and severity (RR 1.13, 95% CI: 1.00-1.27 were more likely to vaccinate their children. The observed effects of perceptions of susceptibility, severity, and benefits were more pronounced at low cues to action for children, as were the effects of perceptions of barriers and severity among adults.
  
  
  CONCLUSIONS
  Perceived benefits and barriers are most strongly associated with vaccine receipt. However, the effects of various factors were most pronounced in the absence of cues to action, which may be an important component of targeted interventions.
authors: University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Electronic address: rmalosh@umich.edu.
authors: Ryan
authors: R
authors: Malosh
authors: University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors: Suzanne E
authors: SE
authors: Ohmit
authors: University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors: Joshua G
authors: JG
authors: Petrie
authors: Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
authors: Mark G
authors: MG
authors: Thompson
authors: University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors: Allison E
authors: AE
authors: Aiello
authors: University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors: Arnold S
authors: AS
authors: Monto
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D033182:Intention; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010290:Parents; D011446:Prospective Studies; D012044:Regression Analysis; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Attitudes; Household vaccination; Influenza vaccination