Health Disparities And Prevention: Racial/ethnic Barriers To Flu Vaccinations

Judy Y. Chen; Sarah A. Fox; Clairessa H. Cantrell; Susan E. Stockdale; Marjorie Kagawa-Singer


J Community Health. 2007;32(1):5-20. 

In This Article


African Americans and Latinos were significantly less likely to be vaccinated for influenza than Whites, a result supported by earlier studies.[8,9,16] While most studies showed no difference in influenza vaccination rates between Whites and aggregated Asian Americans, we found that Filipino Americans were significantly less likely to be vaccinated than Whites.

Concern about getting influenza had the strongest and most significant association with receipt of influenza vaccine among Whites, African Americans, Japanese Americans, and Filipino Americans. When unvaccinated individuals were asked for the main reason why they did not get influenza vaccination in the past 12 months, the most common answer given was that they did not need the vaccine. Respondents felt that they did not need the vaccine because they believed they were not at risk of getting influenza or they relied on other preventive measures. These findings correspond with results from the 2001-2002 Medicare Current Beneficiary Survey which reported that not knowing who should be vaccinated was the leading reason for nonvaccination.[17]

We found notable variation in determinants of nonvaccination among different racial/ethnic groups. Household income and perceived severity of getting the flu were significant determinants of receipt of influenza vaccine among African Americans only and not of other racial/ethnic groups. This suggests that very low-income African Americans are particularly at risk of nonvaccination and that a strategy emphasizing the possible severe consequence of having the flu may be useful to increase vaccination rates in the African American community.

On closer inspection, the vaccination rate disparity between Whites and African Americans is not explained solely by demographic/socioeconomic factors or perceived susceptibility and severity of getting the flu. When respondents were asked for the main reason for nonvaccination, African Americans were more likely than any other group to cite concern over the influenza vaccine causing influenza or serious side effects. This finding is supported by Hebert et al examined the 1995-1996 Medicare Current Beneficiary Survey and found that among unvaccinated individuals, African Americans age 65 years and older were more likely to be concerned over the possible negative outcomes of vaccination than Whites.[18] Previous studies have revealed that African Americans place little trust in government agencies, medical researchers, or health care providers stemming from discrimination in the US health care system, and this lack of trust may significantly hinder delivery of preventive care.[19,20,21] Further research will be needed to explore strategies to address African Americans' concerns over the influenza vaccine.

Latinos mentioned structural barriers as the major factors keeping vaccination rates low. In stratified multivariate analysis, health insurance status was a significant determinant of influenza vaccination only among Latinos. When asked for the main reason for nonvaccination, Latinos cited access (i.e. do not know where to go, no transportation, no health care provider) and cost barriers more than any other racial/ethnic group did. Bautista et al found that compared to Whites, Latinos were more likely to report lack of transportation to vaccination sites and inability to afford vaccination thus supporting our findings.[22]

Filipino Americans seemed to share many of the same barriers to influenza vaccination as Whites and Japanese Americans. Originally the difference in influenza vaccination rates between Whites and Filipino Americans was only marginally significant, but the difference increased to statistical significance when we controlled for covariates. In particular, perceived susceptibility to the flu was the main covariate that generated an increase to statistical significance. Although Filipino Americans were more likely to be very concerned about contracting influenza than Whites, paradoxically they were less likely to be vaccinated. More research will be needed to elucidate why flu vaccination rates among Filipino Americans is disproportionate to their concern of getting influenza.

Our study was not population-based; we studied faith-based parishioners aged 50 to 75 years in two cities, which limits our ability to generalize our findings. However the 2002 General Social Survey found that 60% of adults aged 50 to 75 years attended faith-based congregations at least monthly, indicating that a sizable proportion of the adult population can be reached through faith-based organizations. Many of the findings of this study are consistent with the results of other large population-based surveys, and we have no reason to suspect that the health beliefs of parishioners regarding flu vaccination are any different from the rest of the population.

In conclusion, our study offers four main policy implications for increasing influenza vaccination rates in the United States. First, interventions to increase influenza vaccination rates should increase the general effort to increase the public's awareness of the seriousness of contracting influenza. Second, we need ethnic specific strategies to address the issues of mistrust by African Americans expressed in sentiments such as their concern that the influenza vaccine causes influenza, and linguistically appropriate community outreach to Latinos to provide information on ways to obtain free or low-cost flu vaccination. Finally, our study emphasizes the importance of disaggregating Asian American and Pacific Islander subgroups to examine health and receipt of health care; notably the low vaccination rates among Filipino Americans were masked by the high rates among Japanese Americans. Future interventions for influenza prevention will need to be specifically designed to meet the unique barriers to vaccination found in different racial/ethnic populations.


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