Multilevel Factors Associated with Reported Seasonal 2012-2013 Influenza Vaccination Among Older African Americans in Atlanta, Georgia Open Access

Niyibizi, Nyiramugisha (2015)

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Objective: Influenza vaccination coverage in the US is below CDC-recommended levels of 80%, especially among elderly African Americans. There is an urgent need for interventions to promote vaccination. The purpose of this analysis is to explore multilevel factors, including those at the individual and neighborhood-levels,to explore influences on influenza vaccination decisions among older African Americans ages 50-89 years. This study also describes if and how these factors work as facilitators and barriers to seasonal influenza immunization among this group.

Methods: Study subjects were recruited from faith-based settings, were aged 50 and over, and were Black/African American. Participants were enrolled in the Dose of Hope study, where they completed questionnaires that assessed demographics, health attitudes, knowledge, and behaviors. Influenza vaccination in the 2012-2013 season was the outcome of interest. Models used hierarchical linear model procedures to assess census-tract level factors including a neighborhood deprivation index specific to Atlanta, violent crime rates, neighborhood racial makeup, vehicle availability, and vacant housing. The models also included individual educational attainment level, gender, age, perception of neighborhood security, and attitudes toward vaccinations.

Results: Participants' older age was found to be significantly associated with influenza vaccination, along with their perceived security of their own neighborhood and their attitudes toward vaccination. At the neighborhood-level, the percentage of vehicles functioned as a proxy for area affluence and transportation ease and corresponded with participants' perceived residential area physical security. This factor also was significantly associated with influenza vaccination after adjusting for knowledge and attitudes toward vaccinations.

Conclusion: The findings indicate that neighborhood-level factors play an important role in motivating influenza vaccination decision-making among older African Americans. The study described an important pathway that linked distal neighborhood-level factors to individual characteristics and perceived security. The findings suggest that higher neighborhood affluence, transportation ease, and perceived neighborhood security influence seasonal influenza immunization uptake among vulnerable older African Americans. Further study of other neighborhood and individual-level effects in this population are needed to understand how to design effective interventions and more effectively address vaccine-preventable disease disparities.

Table of Contents

Chapter I: Introduction/Research Questions...1

Chapter II: Literature Review...4

Chapter III: Methods...14

Figure 1...20

Chapter IV: Results...21

Table 1...22

Table 2...24

Table 3...26

Table 4...28

Chapter V: Discussion...29

Strengths and Limitations...31


Public Health Implications...34

Future Directions...35


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