title: Cross-sectional survey: risk-averse French general practitioners are more favorable toward influenza vaccination.
abstract: OBJECTIVE
  We tested the following hypotheses: (i) risk-averse general practitioners (GPs) are more likely to be vaccinated against influenza; (ii) and risk-averse GPs recommend influenza vaccination more often to their patients. In risk-averse GPs, the perceived benefits of the vaccine and/or the perceived risks of the infectious disease might indeed outweigh the perceived risks of the vaccine.
  
  
  METHODS
  In 2010-2012, we conducted a cross-sectional survey of a nationwide French representative sample of 1136 GPs. Multivariate analyses adjusted for four stratification variables (age, gender, urban/suburban/rural practice location and annual patient consultations) and for GPs' characteristics (group/solo practice, and occasional practice of alternative medicine, e.g., homeopathy) looked for associations between their risk attitudes and self-reported vaccination behavior. Individual risk attitudes were expressed as a continuous variable, from 0 (risk-tolerant) to 10 (risk-averse).
  
  
  RESULTS
  Overall, 69% of GPs reported that they were very favorable toward vaccination in general. Self-reported vaccination coverage was 78% for 2009/2010 seasonal influenza and 62% for A/H1N1 pandemic influenza. Most GPs (72%) reported recommending the pandemic influenza vaccination to at-risk young adults in 2009, but few than half (42%) to young adults not at risk. In multivariate analyses, risk-averse GPs were more often vaccinated against seasonal (marginal effect=1.3%, P=0.02) and pandemic influenza (marginal effect=1.5%, P=0.02). Risk-averse GPs recommended the pandemic influenza vaccination more often than their more risk-tolerant colleagues to patients without risk factors (marginal effect=1.7%, P=0.01), but not to their at-risk patients and were more favorable toward vaccination in general (marginal effect=1.5%, P=0.04).
  
  
  CONCLUSIONS
  Individual risk attitudes may influence GPs' practices regarding influenza vaccination, both for themselves and their patients. Our results suggest that risk-averse GPs may perceive the risks of influenza to outweigh the potential risks related to the vaccine.
authors.affiliation: Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France; Université d'Artois, LEM, UMR 8179, Arras, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Massin
authors.affiliation: Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France; CNRS, U6579 (greqam) , Marseille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Ventelou
authors.affiliation: Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France; INRA, UR 1303 ALISS, Ivry-sur-Seine, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Nebout
authors.affiliation: Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verger
authors.affiliation: Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France; CHU de Nancy, Service de Maladies Infectieuses, Nancy, France; Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, Nancy, France. Electronic address: celine.pulcini@univ-lorraine.fr.
authors.forename: Céline
authors.initials: C
authors.lastname: Pulcini
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D058005:General Practitioners; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: Immunization; Pandemic influenza; Primary care; Risk aversion; Seasonal influenza; Vaccine