title: The impact of influenza vaccination requirements for hospital personnel in California: knowledge, attitudes, and vaccine uptake.
abstract: BACKGROUND
  Seasonal inﬂuenza infections are a leading cause of illness, death, and lost productivity. Vaccinating health care personnel (HCP) can reduce transmission of influenza virus to patients and reduce influenza-related absenteeism, enabling the health care system to meet elevated demand for care during influenza outbreaks.
  
  
  OBJECTIVE
  We evaluated the impact of California's 2006 influenza vaccination requirement for hospital workers (requiring vaccination or signed declinations) on uptake and vaccination-related attitudes, beliefs, and knowledge among hospital HCP.
  
  
  METHODS
  We used a causal difference-in-differences approach to compare changes over the prior 10 years in the self-reported frequency of influenza vaccination for California hospital HCP and those from other states without similar laws using data from a stratified sample (N = 3,529) of HCP drawn from online survey panels. We also examined cross-sectional differences in awareness of vaccination policies, promotion efforts, and attitudes toward influenza vaccination. All analyses used propensity score weighting to balance the observable characteristics of the 2 samples.
  
  
  RESULTS
  We found that compared with their counterparts in other states, California hospital HCP were (1) more likely to report working under a formal written policy for influenza vaccination, (2) no more likely to be vaccinated, and (3) less likely to report working for an employer who provided financial incentives for vaccination or rewarded or recognized employees for being vaccinated.
  
  
  CONCLUSIONS
  Our results suggest that state-level vaccination requirements such as those enacted by California, may not be sufficient to increase uptake among hospital HCP.
authors.affiliation: RAND Corporation, Arlington, VA. Electronic address: kharris@rand.org.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Harris
authors.affiliation: RAND Corporation, Arlington, VA.
authors.forename: Lori
authors.initials: L
authors.lastname: Uscher-Pines
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: Bing
authors.initials: B
authors.lastname: Han
authors.affiliation: Centers for Disease and Prevention, Atlanta, GA.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Lindley
authors.affiliation: Centers for Disease and Prevention, Atlanta, GA.
authors.forename: Suchita A
authors.initials: SA
authors.lastname: Lorick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002140:California; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000517:prevention & control*; D010564:Personnel, Hospital; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Difference-in-difference; Hospitals; Immunization; State policy; Survey research