title: Trends in reasons for non-receipt of influenza vaccination during pregnancy in Georgia, 2004-2011.
abstract: BACKGROUND
  Considerable research has identified barriers to antenatal influenza vaccination, yet no research has explored temporal trends in reasons for non-receipt.
  
  
  OBJECTIVE
  To examine trends in reasons for non-receipt of influenza vaccination during pregnancy.
  
  
  METHODS
  Serial cross-sectional analyses using 8 years of Georgia Pregnancy Risk Assessment Monitoring Survey (PRAMS) data were conducted. Weighted logistic regression was used to examine trends in the prevalence of citing reasons for non-receipt over time.
  
  
  RESULTS
  Between 2004 and 2011, 8300 women reported no influenza vaccination during or immediately before pregnancy. Proportions of women citing "doctor didn't mention vaccination," "in first trimester during influenza season," and "not pregnant during influenza season" decreased significantly over time (Doctor didn't mention: 48.0% vs. 27.1%, test for trend p<0.001; in first trimester: 26.8% vs. 16.3%, test for trend p<0.001; not influenza season: 24.2% vs. 12.7%, test for trend p=0.001). Safety concerns increased over 2004 proportions in 2010 (concern about side effects for me: 40.2% vs. 28.5%, prevalence ratio (PR): 1.41, 95% confidence interval (CI): 1.16, 1.71; concern about harming my baby: 38.9% vs. 31.0%, PR=1.26, 95% CI: 1.04, 1.53) and 2011 (concern about side effects for me: 39.0% vs. 28.5%, PR=1.37, 95% CI: 1.13, 1.65; concern about harming my baby: 38.8% vs. 31.0%, PR=1.25, 95% CI: 1.04, 1.50). Following the 2009/2010 H1N1 pandemic, more Hispanic women cited concern about vaccination harming their baby than other women; in 2011, their concern remained elevated relative to non-Hispanic white women (63% vs. 35%; adjusted PR=1.79, 95% CI: 1.23, 2.61).
  
  
  CONCLUSIONS
  Examining trends in reasons for non-receipt of antenatal influenza vaccination can reflect successes related to vaccine promotion and areas for improvement. By highlighting differential impacts of the 2009/2010 H1N1 pandemic, we reveal opportunities for additional research on tailoring vaccine promotion efforts to specific types of women.
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 3047, Atlanta, GA 30322, USA. Electronic address: allison.chamberlain@emory.edu.
authors: Allison T
authors: AT
authors: Chamberlain
authors: Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, CNR Room 3045, Atlanta, GA 30322, USA. Electronic address: rberkel@emory.edu.
authors: Ruth L
authors: RL
authors: Berkelman
authors: Department of Gynecology and Obstetrics, School of Medicine, Emory University, 1365 Clifton Road, Building A, 4th Floor, Atlanta, GA 30322, USA. Electronic address: kault2@kumc.edu.
authors: Kevin A
authors: KA
authors: Ault
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR Room 472, Atlanta, GA 30322, USA. Electronic address: esrose2@emory.edu.
authors: Eli S
authors: ES
authors: Rosenberg
authors: Division of Infectious Diseases, School of Medicine, Emory University, 1462 Clifton Rd. NE, Room 446, Atlanta, GA 30322, USA. Electronic address: worenst@emory.edu.
authors: Walter A
authors: WA
authors: Orenstein
authors: Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 7017, Atlanta, GA 30322, USA. Electronic address: somer@emory.edu.
authors: Saad B
authors: SB
authors: Omer
mesh_terms: D000328:Adult; D005260:Female; D005845:Georgia; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control*; D016015:Logistic Models; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Antenatal; H1N1 pandemic; Influenza; Non-receipt; Pregnancy; Trends; Vaccination