Breaking down the monolith: Understanding flu vaccine uptake among African Americans

Abstract

Black adults are significantly less likely to be immunized for seasonal influenza when compared to Whites. This persistent disparity contributes to increased influenza-related morbidity and mortality in the African American population. Most scholarship on vaccine disparities has compared Whites and Blacks. Employing Public Health Critical Race Praxis, this study seeks to shift the focus to explore differences within the Black population. Utilizing a nationally-representative 2015 survey of US Black adults (n = 806), we explore differences by gender, age, income, and education across vaccine-related measures (e.g., perceived risk, knowledge, attitudes) and racial factors (e.g. racial salience, racial fairness, perceived discrimination). We also explore differences by vaccine behavior in the past five years among those who vaccinate every year, most years but not all, once or twice, and never. Greater frequency of flu vaccine uptake was associated with better self-reported vaccine knowledge, more positive vaccine attitudes, more trust in the flu vaccine and the vaccine process, higher perceived disease risk, lower perceived risk of vaccine side effects, stronger subjective and moral norms, lower general vaccine hesitancy, higher confidence in the flu vaccine, and lower perceived barriers. Logistic regression results highlighted other significant differences among the groups, emphasizing areas to target for improved vaccination rates. We find great diversity within the Black community related to influenza immunization decisions, highlighting the need to “break down the monolith” in future research.

Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020

“…However, despite approximately 70% of Black and White women receiving a provider offer or referral for influenza vaccination, Black women were still less likely to be vaccinated than White women. Factors including negative attitudes and beliefs about vaccines, less knowledge about and access to vaccines, and a lack of trust in health care providers and vaccines has been shown to contribute to lower vaccination rates in Black adults ( 6 , 7 ). Provider offers or referrals for vaccination, in combination with culturally competent conversations with patients, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities ( 8 ).…”

The intersection of sex and gender in the treatment of influenza

“…When considering vaccination acceptance and its role in the control and prevention of influenza, it is also important to consider how sex and gender intersect with other social stratifiers, such as race, socio-economic status, education, and disability. Evidence shows that in the United States, for example, race plays a role in influenza vaccine attitudes and uptake [67,68], with African Americans having greater vaccine hesitancy and lower uptake of vaccination. Factors that contribute to lower rates of immunizations among different races include: personal beliefs, trust in health providers, limited access to health care, and anticipated negative side effects [61].…”

Using social media influencers to increase knowledge and positive attitudes toward the flu vaccine

“…Conversely, individuals who report that a majority of people around them receive the flu vaccine are in turn more likely to intend on becoming vaccinated themselves [14]. All of these factors potentially lead to differential vaccination coverage among races and ethnicities within the U.S., and ultimately, a higher morbidity and mortality for African Americans and Hispanics from flu and flu-related illness [7,15].…”

“…Despite the implementation of large-scale flu vaccination campaigns across the U.S., vaccination coverage among African Americans and Hispanics has remained low, with recent flu vaccination coverage for African Americans at 32.3% and for Hispanics at 28.4%, compared to over 40% vaccination coverage for their White and Asian counterparts [ 3 – 5 ]. Negative perceptions toward the flu vaccine may at least partially explain the low flu vaccination coverage, which may lead to social norms that discourage vaccination [ 6 , 7 ]. Studies have shown that African Americans are more likely than other groups to have higher risk perceptions of the flu vaccine and its potential side effects, to mistrust the medical community and government involvement in ensuring safety of the vaccine, and to be uninformed regarding the benefits of flu vaccination [ 8 – 10 ].…”