Adolescent Attitudes Toward Influenza Vaccination and Vaccine Uptake in a School-Based Influenza Vaccination Intervention: A Mediation Analysis

Background: In February 2008, the CDC's Advisory Committee on Immunization Practices expanded the recommended ages for annual influenza vaccination to include all children and adolescents 6 months - 18 years of age. School-based vaccination programs may provide an effective strategy to immunize adolescents against influenza.

Objectives: This study examined whether adolescent attitudes toward influenza vaccination mediated the effect of a school-based influenza vaccination intervention on vaccine uptake.

Methods: Participants were recruited from two counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N=337). Data were collected from surveys distributed to adolescents at pre- and post-intervention time points and vaccine vouchers documenting influenza vaccination. Surveys assessed demographic, behavioral, and psychosocial variables, guided by the Health Belief Model and the Integrated Behavioral Model. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow-up mediated the relationship between intervention condition and influenza vaccine uptake.

Results: Controlling for background variables, Step 1 of the mediation analysis revealed a significant relationship between intervention condition and vaccine uptake (OR=1.77, p=.038). Step 2 of the mediation analysis revealed a significant relationship between intervention condition and changes in three psychosocial variables from baseline to follow-up: perceived benefits of influenza vaccination (p=.037), perceived barriers to influenza vaccination (p=.016), and intention to receive an influenza vaccine (p=.018). Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between the intervention and receipt of an influenza vaccination by intention to receive an influenza vaccination.

Conclusions:Findings suggest that the success of our school-based influenza vaccination intervention in increasing vaccine uptake may have been mediated by adolescent’s intention to receive an influenza vaccination. Future influenza vaccination efforts geared towards rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine.