BACKGROUND:
Studies of adult vaccination suggest racial and ethnic disparities in coverage. Neither the cause nor the solution is known.

OBJECTIVE:
To assess the influenza (IV), pneumococcal (PPV), and hepatitis B (HBV) vaccine needs of adults in an urban emergency department (ED) and to analyze the factors related to the hypothetical acceptance of vaccination following a brief self-assessment and education intervention.

METHOD:
A convenience sample was taken of 104 uninsured or Medicaid enrolled patients between the ages of 18 and 64 years, seeking care for non-life threatening health problems in a public ED. Paramedical staff asked patients to respond to statements using our assessment/reminder (A/R) form. Each statement corresponded to factors listed in ACIP recommendations. If vaccine was indicated, educational material was offered. Then the patient was asked if they would like to get the vaccine (acceptance). A logistic regression analysis was used to determine factors influencing vaccine acceptance.

RESULT:
IV was recommended for 71 (68%) of the 104 patients. Of those 65 patients were unvaccinated and needed flu vaccine; 52 (80%) agreed to be vaccinated. Vaccine acceptance was related to baseline belief that vaccination was needed (P=0.02) and increased with age (P=0.02); but was unrelated to race, monthly income, Medicaid status, or gender. For PPV and HBV, acceptance of vaccine in the ED was unrelated to baseline belief about the need for the vaccine, age, race, monthly income, Medicaid status, or gender.

CONCLUSION:
Following a uniform assessment and education protocol, acceptance of the vaccines was not related to demographic variables, and did not differ among the races. That is, these results suggest that acceptance, and presumably coverage rates could be increased for African-Americans in this setting with similar procedures.

LEARNING OBJECTIVES:
Examine whether the effect of an assessment reminder instrument on vaccine acceptance differs for different ethnicities.