Whats Your Excuse I Didnt Get a Flu

What’s Your Excuse? I Didn’t Get a Flu Shot Because. . Influenza Risk Factors Associated with Reasons in a 2005 Survey Across San Diego County Robert Vryheid, Ph. D, MPH 1; Wendy Wang, MPH 1; Mark H. Sawyer, MD 1; Kathleen W. Gustafson, MPH 2; Michelle Picardal 1; Michelle De. Guire, MPH, MSW 1; Cynthia Leard, MPH 3; Kelly Rose, MPH 3 (1) San Diego Immunization Partnership, UC San Diego (2) Immunization Branch, County of San Diego (3) San Diego State University

Random Digit Dialing Telephone Survey Methods v Randomly selected telephone numbers v Multi-language interviewers v Adults’ immunization doses from recall v Infants’ immunization doses from recall and records

2005 San Diego County RDD Telephone Survey Sample Sizes Surveys conducted March - June 2005 ¨Infant Survey: 6 – 23 months (1, 120) ¨Adult Survey: 50 years and older (1, 446) 18 -49. 9 years (1, 576) High Risk Adults (847) Other Adults (729) S: PHSImmunI 3EVALRdd_2005presentationRDD 2005 NIC reasons why not flu vaccinated 2. ppt

Influenza Coverage Recommended Groups 1998 – 2005 San Diego Telephone Surveys = CDC survey, 6 -23 month olds, 1 dose of influenza vaccine

Questions on Adults’ Reasons for Not Receiving a Flu Vaccination • Adults who had never received a flu vaccine were asked: “If you have never received a flu vaccination, can you tell me the main reason why? ” • Adults who had received a flu vaccine in the past, but not in the past 12 months were asked: “If you did not receive a flu vaccination this past year, can you tell me the main reason why? ”

Questions on Reasons Infants Did Not Receive a Flu Vaccination • Parents who had not gotten their 6 -23 month old infant vaccinated against the flu were asked: “If your child did not receive the flu shot, can you tell me the main reason why? ”

Methods of Coding Respondents’ Reasons for Not Receiving a Flu Vaccination • Open-ended questions. • Pre-printed answers often heard in past years’ surveys. • Categorized according to issues Immunization Branch staff wanted to study. • Coded by trained interviewers. • Interviewers wrote new answers almost word-for-word on blank lines. • Survey managers post-coded these into new categories, after conferring with each other.

• Common Reasons for NEVER Getting a Flu Vaccination 2005 (age ≥ 65, 18 -49 with health conditions, health care workers) • I don’t get sick, I don’t need it. • I don’t believe the vaccination protects. • Flu vaccination makes me sick or has side effects.

• Common Reasons for Not Getting a Flu Vaccination LAST SEASON, 2005 • • (age ≥ 65, 18 -49 with health conditions, health care workers) Provider did not have vaccine; vaccine shortage. Saving the vaccine for those who need it more. I don’t get sick, I don’t need it. Flu vaccination makes me sick or has side effects.

Percentage of Frequency Parents’ Main Reason for Infant Not Getting a Flu Shot Age 6 -23 Months Reasons

Disparities in 6 – 23 Month old Infants’ Flu Vaccinations 2004 - 05 • English language interview (43% flu vaccination) > Spanish interview (31%) • College educated mothers (40% - 50%) > elementary or high school (30% - 33%) • Children with health insurance (42%) > without insurance (18%) • Parents used internet for health info (45%) > not used internet (36%)

Percentage of Frequency Main Reason for Not Getting a Flu Shot* Age 65+ Reasons * In 2005, 79 Respondents (11%) had never received a flu shot

Main Reason for Not Getting a Flu Shot* 18 -49 Years with Health Conditions, 2005 Reasons • In 2005, of 335 people with health conditions surveyed, 122 (36%) had never received a flu shot, and 109 (32%) had ever received one but not in the past 12 months

Main Reason for Not Getting a Flu Shot* Healthcare Workers, 2005 Reasons • In 2005, of 105 healthcare workers surveyed, 24 (23%) had never received a flu shot, and 31 (30%) had ever received one but not in the past 12 months

Disparities Among Adults Who Never Received Flu Vaccination • All high risk groups aged 18 -49: less educated people more often said they did not know they needed a flu vaccination elementary or high school (17% - 24%) > college educated (6% - 11%)

Disparities Among Adults Who Received Flu Vaccination, But Not in 2004 - 2005 • HCW, household contacts & age 50 -64 more than others often said: saving vaccine for others, I am healthy • 18 -49 years with high risk condition more than others often said: saving vaccine for others • 65+ years more than others often said: vaccine makes me sick

Conclusions • Adults in different age and risk factor categories gave similar patterns and percentages of answers. • Half of healthcare workers had not received flu vaccinations. – Many thought the flu vaccination does not protect against the flu – Many thought they did not need it, or did not know they were recommended to receive it. • Among infants unvaccinated against flu: – In 2004, almost half did not know they should get it. – By 2005, this reduced to 26%. – Factors: lack of health insurance, parents interviewed in Spanish, less educated, not use internet