title: Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults.
abstract: Racial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors.
  
  
  
  We contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior.
  
  
  
  There were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge.
  
  
  
  Racial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.
authors.affiliation: Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA. Electronic address: scquinn@umd.edu.
authors.forename: Sandra Crouse
authors.initials: SC
authors.lastname: Quinn
authors.affiliation: Maryland Center for Health Equity, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA. Electronic address: ajam1@umd.edu.
authors.forename: Amelia
authors.initials: A
authors.lastname: Jamison
authors.affiliation: Center for Health and Risk Communication, University of Georgia, 120 Hooper Street, Athens, GA 30602, USA. Electronic address: freimuth@uga.edu.
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Freimuth
authors.affiliation: Department of Human Development and Quantitative Methodology, University of Maryland, 1230 Benjamin Building, 3942 Campus Drive, College Park, MD 20742, USA. Electronic address: jian12@umd.edu.
authors.forename: Ji
authors.initials: J
authors.lastname: An
authors.affiliation: Department of Human Development and Quantitative Methodology, University of Maryland, 1230 Benjamin Building, 3942 Campus Drive, College Park, MD 20742, USA. Electronic address: ghancock@umd.edu.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Hancock
authors.affiliation: University Center for Social and Urban Research, University of Pittsburgh, 3343 Forbes Avenue, Pittsburgh, PA 15260, USA. Electronic address: dmuc@pitt.edu.
authors.forename: Donald
authors.initials: D
authors.lastname: Musa
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D035502:Trust; D014481:United States; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data; D044465:White People
chemical_list: D007252:Influenza Vaccines
keywords: Adult immunization; African Americans; Racial disparities; Seasonal influenza; USA