title: Health-related behaviors and effectiveness of trivalent inactivated versus live attenuated influenza vaccine in preventing influenza-like illness among young adults.
abstract: BACKGROUND
  Vaccination is the preferred preventive strategy against influenza. Though health behaviors are known to affect immunity and vaccine delivery modes utilize different immune processes, data regarding the preferred influenza vaccine type among adults endorsing specific health-related behaviors (alcohol use, tobacco use, and exercise level) are limited.
  
  
  METHODS
  The relative effectiveness of two currently available influenza vaccines were compared for prevention of influenza-like illness during 2 well-matched influenza seasons (2006/2007, 2008/2009) among US military personnel aged 18-49 years. Relative vaccine effectiveness was compared between those self-reporting and not reporting recent smoking history and potential alcohol problem, and by exercise level using Cox proportional hazard modeling adjusted for sociodemographic and military factors, geographic area, and other health behaviors.
  
  
  RESULTS
  28,929 vaccination events and 3936 influenza-like illness events over both influenza seasons were studied. Of subjects, 27.5% were smokers, 7.7% had a potential alcohol-related problem, 10.5% reported minimal exercise, and 4.4% reported high exercise levels. Overall, the risk of influenza-like illness did not significantly differ between live attenuated and trivalent inactivated influenza vaccine recipients (hazard ratio, 0.98; 95% confidence interval, 0.90-1.06). In the final adjusted model, the relative effectiveness of the 2 vaccine types did not differ by smoking status (p = 0.10), alcohol status (p = 0.21), or activity level (p = 0.11).
  
  
  CONCLUSIONS
  Live attenuated and trivalent inactivated influenza vaccines were similarly effective in preventing influenza-like illness among young adults and did not differ by health-related behavior status. Influenza vaccine efforts should continue to focus simply on delivering vaccine.
authors.affiliation: Operational Infectious Diseases, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Woolpert
authors.affiliation: Deployment Health Research, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Phillips
authors.affiliation: Deployment Health Research, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Carter
authors.initials: C
authors.lastname: Sevick
authors.affiliation: Deployment Health Research, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.affiliation: Operational Infectious Diseases, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Blair
authors.affiliation: Operational Infectious Diseases, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Dennis
authors.initials: D
authors.lastname: Faix
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology; D016016:Proportional Hazards Models; D012621:Seasons; D057566:Self Report; D012907:Smoking / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States; D014611:Vaccination / Q000523:psychology*; D014613:Vaccines, Attenuated; D015164:Vaccines, Inactivated; D022223:Vaccines, Subunit
chemical_list: D007252:Influenza Vaccines; D014613:Vaccines, Attenuated; D015164:Vaccines, Inactivated; D022223:Vaccines, Subunit