The association between attitudes toward vaccination and vaccine uptake among adolescents Open Access

Abstract

Recently, the ACIP expanded its recommended immunization schedule for
adolescents to include three new vaccines (Tdap, HPV, MCV), and annual influenza
vaccination. Little is known about the role adolescents' attitudes play in determining
vaccine uptake. The purpose of this research was: 1) To conduct a systematic literature
review of the evidence-base regarding adolescents' attitudes toward vaccination, and 2)
To conduct a study assessing the association between attitudes toward influenza
vaccination and vaccine uptake among rural adolescents.
Of 1,348 studies screened in the systematic review, 32 met inclusion criteria.
Findings suggest that the evidence-base regarding adolescents' attitudes toward
vaccinations is limited. Most studies examined adolescent's attitudes toward vaccination
against HPV and other STIs, were cross-sectional with moderately-sized samples, and
combined data from adolescents and young adults. No studies assessed adolescents'
attitudes towards influenza vaccination. Despite limitations, the literature revealed that
perceived risk of disease, perceived benefits and barriers to vaccination, fear of needles,
and normative beliefs are salient factors in adolescents' acceptance of HPV/STI vaccines.
Second, adolescents were recruited from two counties participating in a school-
based influenza vaccination intervention in rural Georgia (n=337). Surveys were
distributed to adolescents at pre- and post-intervention time points to assess demographic,
behavioral, and attitude variables. A cross-sectional analysis of baseline data revealed
intention to receive an influenza vaccination was associated with perceived barriers
(OR=0.77), injunctive norms (OR=1.23), and receipt of influenza vaccination last year
(OR=6.21).
A four-step mediation analysis was used to test whether changes in psychosocial
variables from baseline to follow-up mediated the relationship between study condition
and influenza vaccine uptake. Step 1 of the analysis revealed a significant relationship
between study condition and vaccine uptake (OR=1.77). Step 2 revealed a significant
relationship between study condition and changes in psychosocial variables from baseline
to follow-up. Steps 3 and 4 revealed that there was full mediation of the relationship
between study condition and receipt of an influenza vaccination by intention to receive an
influenza vaccination.
Research findings suggest that adolescents' attitudes, particularly perceived
barriers and social norms, may impact vaccine uptake. Interventions to increase
adolescent vaccination coverage may benefit from addressing adolescents' attitudes
toward vaccination.

Table of Contents

Table of Contents

CHAPTER 1: Introductory Literature Review 1

New adolescent vaccinations 1

Barriers to vaccinating adolescents 2

The role of adolescents' attitudes toward vaccination 3

Influenza vaccination 5

The importance of vaccinating school-age children against influenza 6

Influenza vaccination among rural, low-income, and minority populations 8

School-based influenza vaccination 9

The role of adolescents' attitudes toward influenza vaccination 11

Conceptual framework 13

Significance of the proposed study 14

References 16

CHAPTER 2: Adolescents' attitudes toward vaccinations: A systematic review 24

Abstract 24

Introduction 26

Methods 29

Results 30

Discussion 38

References 46

CHAPTER 3: Psychosocial correlates of intention to receive an influenza vaccination among rural adolescents 67

Abstract 67

Introduction 68

Methods 72

Results 75

Discussion 78

References 85

CHAPTER 4: Adolescents' attitudes toward influenza vaccination and vaccine uptake in a school-based vaccination intervention: A mediation analysis 93

Abstract 93

Introduction 95

Methods 97

Results 103

Discussion 105

References 110

CHAPTER 5: Summary and Conclusion 117

References 122

LIST OF FIGURES

Figure 1.1: Theoretical framework based on the Health Belief Model and Integrated Behavioral Model 23

LIST OF TABLES

Table 2.1: Basic Information about studies included in the systematic review 50

Table 2.2: Adolescents' attitudes toward vaccination assessed as predictor variables 53

Table 2.3: Adolescents' attitudes toward vaccination assessed descriptively 59

Table 3.1: HBM and IBM based psychosocial factors and intention to receive an influenza vaccination next year (n=324) 89

Table 3.2: Factors associated with intention to receive an influenza vaccination among rural adolescents 91

Table 4.1: Survey items and measurement characteristics for study variables 113

Table 4.2: Demographic information and distribution of psychosocial variables at baseline 114

Table 4.3: Logistic regression analysis of the effects of the influenza vaccination intervention and psychosocial mediators on receipt of an influenza vaccination 115

Table 4.4: Adjusted group means ANCOVA statistics for change in psychosocial variables from baseline to follow-up, controlling for age, gender, race, and habit 116

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Keyword	vaccine influenza adolescent attitudes
Committee Chair / Thesis Advisor	Diclemente, Ralph Joseph, Emory University
Committee Members	Windle, Michael, Emory University Wingood, Gina M, Emory University Sales, Jessica, Emory University

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