Purpose: Explore acceptability of vaccines in development: cancer, Type II diabetes, Alzheimer’s disease, Lyme disease, Ebola, and obesity. Research questions: To what extent does acceptability vary by vaccine type? To what extent does acceptability of vaccines in development vary by race and other key demographics? To what extent are general vaccine hesitancy and key demographics associated with acceptability of vaccines in development? Design: Cross-sectional online survey administered through GfK’s KnowledgePanel in 2015. Analysis completed in 2020. Subjects: Nationally representative sample of Black and White American adults (n = 1,643). Measures: Willingness to accept a novel vaccine was measured on a 4-point Likert scale. Independent variables included demographics (e.g. age, race, gender) and measures of vaccine hesitancy, trust, and the “Three C’s” of vaccine confidence, complacency, and convenience. Analysis: Exploratory analysis including descriptive statistics and regression modeling. Results: Acceptability varied from 77% for a cancer vaccine to 55% for an obesity vaccine. White race, male gender, older age, having a chronic health condition, and higher socioeconomic status were associated with higher acceptability. Higher vaccine confidence and lower vaccine hesitancy were predictors for acceptability. Conclusion: The success of a vaccine depends on widespread public acceptance. Vaccine hesitancy may hinder acceptance of future vaccines, with significant differences by demographics. Future social science research is necessary to better understand and address vaccine hesitancy.

Both studies found that greater trust in government action was associated with willingness to accept EUA products 9,10 In a qualitative study on public understanding of medical countermeasures, Liu etal 11 assessed willingness to comply with protective actions during a hypothetical novel respiratory virus scenario The White House's adoption of Operation Warp Speed and promises of a vaccine by fall 2020 have undermined trust in any vaccine, whether as an approved EUA or not 13 Graphic representations of the vaccine process, such as the New York Times Coronavirus Vaccine Tracker, may be helpful to demystify the complex process and reassure individuals about the multiple levels of quality control and the independence of various entities along the production chain 14 Greater transparency about the process may potentially address underlying fears about the pharmaceutical industry's motives or concerns about the politicization of the process Two vaccine candidates now in clinical trials are using technologies not previously approved for vaccines, and given the speed of the research process, it would not be surprising to learn more about potential side effects after any EUA 14 It would behoove the FDA to be forthright and clear in communicating with the public and to avoid overpromising on results, balancing optimism with realistic assessments of existing research Local, state, and federal public health agencies must form partnerships with community organizations, health care providers, faith communities, the media, the private sector, unions, and civic associations

Today, the United States and countries throughout the world are experiencing measles outbreaks that have sickened thousands of children. From the Disneyland outbreak in 2014 to today, some states have responded with changes in laws on vaccine requirements and exemptions. In this article, we examine the history of vaccine laws, and using our 2015 survey data, explore to what extent the news coverage of the Disneyland outbreak altered parents’ attitudes toward required vaccination and non-medical exemptions. We explore those results in the context of today’s increasing polarized and politicalized battle over vaccine laws, and consider how health care providers and policy makers can work to improve public attitudes about vaccines.

Introduction: Vaccine hesitancy (VH) has emerged as a factor in vaccine delay and refusal yet the measurement of the constructs within vaccine hesitancy remains a challenge. Outstanding questions include; should VH be measured as an attitude or a behavior? What is the role of key constructs including confidence, complacency, and convenience? What is the role of trust? Should measures be general or vaccine specific? Furthermore, much of the research has centered on parental acceptance of vaccines for their children. Methods: In March of 2015, we contracted with the GfK Group to conduct a nationally representative survey with 819 African American and 838 White, US born adults. Measures include general vaccine hesitancy and confidence, trust, and influenza vaccine specific measures of hesitancy, confidence and trust. Results: Factor analysis yielded a bi-factor structure for both general vaccine hesitancy and flu vaccine specific hesitancy. Greater hesitancy, both in general and specific to the flu vaccine, was associated with lower vaccine uptake. In the flu vaccine specific model, greater confidence was associated with higher vaccine uptake. Trust remained distinct from vaccine confidence in both the general and flu vaccine specific models. Conclusions: Clearly, there is value in the utilization of general vaccine hesitancy and confidence measures, as well as vaccine specific measures. Trust continues to provide additional insights apart of vaccine confidence and remains an important factor for inclusion in future research. Our set of measures can be tested and validated with other populations and applied to other vaccines for adults and children. (C) 2019 Published by Elsevier Ltd.

Racial disparities in influenza vaccination persist between African American and White adults. It is critical to explore the reasons behind this disparity, which may be linked to the use of "folk" or home remedies for illness prevention and treatment. For this study, The GfK Group was contracted to conduct a nationally-representative survey (n = 819 African American and 838 White respondents). Respondents were asked about behaviors, attitudes, and risk perception related to the influenza vaccine, as well as frequency of home remedy use. Results were analyzed using adjusted logistic regression with 95% confidence intervals. In comparison to those who never use home remedies, those who use home remedies often or almost always were less likely to get vaccinated for influenza (respectively, OR = 0.70, CI 0.49, 0.99; OR = 0.27, CI 0.15, 0.49), less likely to be in favor of the vaccine (OR=0.47, CI 0.33, 0.67; OR = 0.19, CI 0.10, 0.34), less likely to trust the vaccine (OR = 0.42, CI 0.29, 0.61; OR = 0.34, CI 0.20, 0.61), and more likely to perceive higher risk of vaccine side effects (OR = 1.79, CI 1.19, 2.68; OR = 4.00, CI 2.38, 6.73). These associations did not vary by race. Home remedy users may hold negative views toward the influenza vaccine, such that a combination of little trust in the vaccine process, and overestimation of risk associated with the vaccine itself, may contribute to vaccine refusal. Health care professionals can use these findings to tailor advice toward individuals with a preference for home remedy use to allay fears and correct misconceptions surrounding influenza and its vaccine.

Background and objectives: Influenza poses a public health threat for children and adults. The CDC recommends annual influenza vaccination for children <18 years, yet vaccine uptake remains low for children (57.9%) and adults (37.1%). Given that parental decision-making is key in childhood vaccine uptake, there is a critical need to understand vaccine hesitancy among parents who decide not to vaccinate their children. This study aims to explore predictors of children's influenza vaccine status given parental vaccination status and examine the factors that contribute to concordance or discordance between parental and children's vaccine uptake. Methods: Classification and regression tree (CART) analyses were used to identify drivers of parental decisions to vaccinate their children against influenza. Hierarchy and interactions of these variables in predicting children's vaccination status were explored. Results: From a nationally representative sample of non-Hispanic Black and White parents who completed an online survey (n = 328), the main factors influencing parents' decisions to vaccinate their children were vaccine behavior following physician recommendation, knowledge of influenza recommendations for children, influenza vaccine confidence and disease risk. Among unvaccinated parents, the greatest concordance was observed among parents who usually do not get vaccinated following physician recommendation and had lower knowledge of recommendations for influenza vaccination for children. The greatest discordance was observed among unvaccinated parents who had lower hesitancy about recommended vaccines. Conclusions: Understanding drivers of parental decisions to vaccinate themselves and their children can provide insights on health communication and provider approaches to increase influenza vaccine coverage and prevent influenza related mortality. (C) 2019 Elsevier Ltd. All rights reserved.

Vaccine confidence depends on trust in vaccines as products and trust in the system that produces them. In the US, this system consists of a complex network connecting pharmaceutical companies, government agencies, and the healthcare system. We explore narratives from White and African American adults describing their trust in these institutions, with a focus on influenza vaccine. Our data were collected between 2012 and 2014 as part of a mixed-methods investigation of racial disparities in influenza immunization. We interviewed 119 adults, primarily in Maryland and Washington, DC, in three stages utilizing semi-structured interviews (12), focus groups (9, n = 91), and in-depth interviews (16). Analysis was guided by grounded theory. Trust in institutions emerged as a significant theme, with marked differences by race. In 2018, we contextualized these findings within the growing scholarship on trust and vaccines. Most participants distrusted pharmaceutical companies, which were viewed to be motivated by profit. Trust in government varied. Whites described implicit trust of federal institutions but questioned their competency. African Americans were less trusting of the government and were more likely to doubt its motives. Trust in institutions may be fragile, and once damaged, may take considerable time and effort to repair.

Influenza vaccination rates in the U.S. remain low at 41% among adults over 18 years according to the Centers for Disease Control and Prevention's 2016 data. Reasons for the low rate vary and include factors such as risk perception, vaccine hesitancy, and access to health care. This cross-sectional study sought to examine the relationship between social media use and influenza vaccine uptake among a sample of White and African Americans over 18 years of age. Using bivariate, and unadjusted and adjusted logistic regression tests, this study examined the relationship among social media use, social media as a source of health information, and influenza vaccination status in 2015. Our results indicate that users of Twitter (OR4.41, 95%CI: 1.43-13.60) and Facebook (OR 1.66, 95%CI: 1.01-2.72) as sources of health information were more likely to be vaccinated in comparison to users who do not use Twitter or Facebook as a source of health information. These findings have implications for the potential of using social media platforms to disseminate influenza vaccine information and encourage users to get vaccinated annually. (C) 2018 Elsevier Ltd. All rights reserved.

Introduction: Racial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors.Methods: We contracted with GM to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior.Results: There were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge.Conclusions: Racial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications. (C) 2016 Published by Elsevier Ltd.

Trust is thought to be a major factor in vaccine decisions, but few studies have empirically tested the role of trust in adult immunization. Utilizing a 2015 national survey of African American and White adults (n = 1630), we explore multiple dimensions of trust related to influenza immunization, including generalized trust, trust in the flu vaccine, and trust in the vaccine production process. We find African Americans report lower trust than Whites across all trust measures. When considering demographic, racial, and ideological predictors, generalized trust shows statistically significant effects on both trust in the flu vaccine and trust in the vaccine process. When controlling for demographic, racial, and ideological variables, higher generalized trust was significantly associated with higher trust in the flu vaccine and the vaccine process. When controlling for generalized trust, in addition to the baseline covariates, psychosocial predictors (i.e. risk perception, social norms, knowledge) are significant predictors of trust in flu vaccine and trust in the vaccine process, with significant differences by race. These findings suggest that trust in vaccination is complex, and that significant differences in trust between White and African American adults may be contributing to disparities in influenza immunization.

Background: Adults with chronic conditions are at much greater risk of influenza-related morbidity and mortality, yet flu vaccine uptake remains suboptimal. Research focused on the high-risk population has been limited, particularly related to racial disparities in vaccination. We explore a broad range of demographic, racial, and psychosocial factors to identify predictors of vaccination among high-risk adults, with a focus on identify differences between Black and White adults. Methods: We conducted an online survey in March 2015, utilizing international research firm GfK's KnowledgePanel, for a nationally representative sample of Black and White adults (>= 18, USA) and limited analysis adults with high-risk of influenza-related complications. Using two-way ANOVA, we assessed demographic, racial, and psychosocial predictors across vaccine uptake in the past five years and across racial group. Results: 424 (52.2%) Black and 388 (47.8%) White respondents with high-risk complications completed the survey. 383 (47.3%) reported vaccination annually, 99 (12.2%) most years, 104 (12.9%) once/twice, and 223 (27.6%) never. ANOVA confirmed significant differences in vaccine behavior for most demographic predictors (except education), all racial factors (including racial fairness, experiences of discrimination, etc.), and most psychosocial factors (including vaccine attitudes, trust in the vaccine, etc.). ANOVA confirmed significant differences for most factors by race. We observed significant interaction effects between race and vaccine behavior for subjective social status, access to medical care, knowledge of vaccine recommendations, vaccine attitudes, perceived side effect risks, descriptive norms, subjective norms, flu vaccine hesitancy, and flu vaccine confidence, thus implying racial differences in the connection between vaccine uptake and key demographic, racial, and psychosocial factors. Conclusions: This study provides a novel examination of flu vaccine behavior among high-risk Blacks and Whites that identified factors influencing vaccine uptake. We found significant differences by race. Health care professionals can use this information to more effectively target high-risk adults during flu season. (C) 2017 Elsevier Ltd. All rights reserved.

Medical countermeasures, including new drugs and vaccines, are necessary to protect the public's health from novel diseases and terrorist threats.Experience with the 2001 anthrax attack and the 2009 H1N1 pandemic suggest that there is limited willingness to accept such drugs and that minority groups may respond differently from others.We conducted 148 intercept interviews in the metropolitan Washington, DC, area, examining 2 hypothetical scenarios: a new respiratory virus and public exposure to high levels of radiation.Findings provide insights into key factors that affect whether diverse members of the public comply with recommended protective actions like taking emergency authorized vaccines.These insights can help improve how public health practitioners communicate during uncertain times.

Seasonal flu vaccination rates are low for U.S. adults, with significant disparities between African and white Americans. Risk perception is a significant predictor of vaccine behavior but the research on this construct has been flawed. This study addressed critical research questions to understand the differences between African and white Americans in the role of risk perception in flu vaccine behavior: (1) What is the dimensionality of risk perception and does it differ between the two races? (2) Were risk perceptions of white and African‐American populations different and how were sociodemographic characteristics related to risk for each group? (3) What is the relation between risk perception and flu vaccine behaviors for African Americans and whites? The sample, drawn from GfK's Knowledge Panel, consisted of 838 whites and 819 African Americans. The survey instrument was developed from qualitative research. Measures of risk perception included cognitive and emotional measures of disease risk and risk of side effects from the vaccine. The online survey was conducted in March 2015. Results showed the importance of risk perception in the vaccine decision‐making process for both racial groups. As expected, those who got the vaccine reported higher disease risk than those who did not. Separate cognitive and emotional factors did not materialize in this study but strong evidence was found to support the importance of considering disease risk as well as risk of the vaccine. There were significant racial differences in the way risk perception predicted behavior.

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.

Adult influenza vaccination rates remain suboptimal, particularly among African Americans. Social norms may influence vaccination behavior, but little research has focused on influenza vaccine and almost no research has focused on racially-specific norms. This mixed methods investigation utilizes qualitative interviews and focus groups (n = 118) and national survey results (n = 1643) to assess both descriptive and subjective norms surrounding influenza vaccination. Qualitative results suggest a perceived descriptive norm that 'about half' of the population gets vaccinated. Participants describe differing norms by race and vaccine behavior. Quantitative results confirm a perceived descriptive norm that 40-60% of the population gets vaccinated. Both African Americans and Whites accurately identified race-specific vaccination rates relative to the general population. Individuals who report that a majority of people around them want them to be vaccinated were significantly more likely to be vaccinated, suggesting subjective norms are influential for both White and African American adults. While perceived descriptive norms are somewhat accurate (mirroring the actual influenza vaccination rate), emphasizing a suboptimal vaccination rate may not be beneficial. Health promotion efforts, particularly those targeting African Americans, may benefit from focusing on subjective norms and encouraging friends and family members to talk about the benefits of influenza vaccination.

Vaccine delay and refusal present very real threats to public health. Since even a slight reduction in vaccination rates could produce major consequences as herd immunity is eroded, it is imperative to understand the factors that contribute to decision-making about vaccines. Recent scholarship on the concept of "vaccine hesitancy" emphasizes that vaccine behaviors and beliefs tend to fall along a continuum from refusal to acceptance. Most research on hesitancy has focused on parental decision-making about childhood vaccines, but could be extended to explore decision-making related to adult immunization against seasonal influenza. In particular, vaccine hesitancy could be a useful approach to understand the persistence of racial/ethnic disparities between African American and White adults. This study relied on a thematic content analysis of qualitative data, including 12 semi-structured interviews, 9 focus groups (N=90), and 16 in-depth interviews, for a total sample of 118 (N=118) African American and White adults. All data were transcribed and analyzed with Atlas.ti. A coding scheme combining both inductive and deductive codes was utilized to identify themes related to vaccine hesitancy. The study found a continuum of vaccine behavior from never-takers, sometimes-takers, and always-takers, with significant differences between African Americans and Whites.  We compared our findings to the Three Cs: Complacency, Convenience, and Confidence framework. Complacency contributed to low vaccine acceptance with both races.  Among sometimes-takers and always-takers, convenience was often cited as a reason for their behavior, while never-takers of both races were more likely to describe other reasons for non-vaccination, with convenience only a secondary explanation.  However, for African Americans, cost was a barrier.  There were racial differences in trust and confidence that impacted the decision-making process. The framework, though not a natural fit for the data, does provide some insight into the differential sources of hesitancy between these two populations. Complacency and confidence clearly impact vaccine behavior, often more profoundly than convenience, which can contribute either negatively or positively to vaccine acceptance. The Three Cs framework is a useful, but limited tool to understanding racial disparities. Understanding the distinctions in those cultural factors that drive lower vaccine confidence and greater hesitancy among African Americans could lead to more effective communication strategies as well as changes in the delivery of vaccines to increase convenience and passive acceptance.

ABSTRACTObjectiveThe Centers for Disease Control and Prevention estimated that up to 88 million H1N1 influenza cases, 398,000 hospitalizations, and up to 18,050 related deaths, including significant racial and ethnic disparities, occurred between April 2009 and March 13, 2010. The Food and Drug Administration (FDA) approved emergency use authorizations (EUAs), which allowed the distribution of unapproved drugs or the off-label use of approved drugs. In late 2009, peramivir was granted an EUA for patients with severe disease. This study examined factors associated with willingness to take peramivir.MethodsIn 2010 we conducted a nationally representative survey with 2079 respondents randomly drawn from the Knowledge Networks research panel. Our completion rate was 56%. Respondents received information about peramivir from a fact sheet and then answered questions about their willingness to take the drug.ResultsOverall, 48% of participants indicated that they would probably or definitely take peramivir. Seventy-nine percent definitely would take the drug if their doctor recommended it and there were no alternative treatments. There were significant racial differences in willingness. The termexperimentalto refer to the drug decreased willingness to accept peramivir among both whites and blacks.ConclusionsTrust in the FDA was important for peramivir acceptance. Particular care must be taken to ensure that patients and their families understand the complex nature of EUA drugs. Lessons learned can inform communication about future EUAs. (Disaster Med Public Health Preparedness. 2015;9:166-174)

BACKGROUND:Meals on Wheels (MOW) organizations are ideal community partners for delivering social support relating to health information exchange for vulnerable and home-bound older adults. OBJECTIVES:This article illustrates how formative organizational evaluation can be used to adapt health literacy interventions delivered by community partners. METHODS:Key informant interviews and ethnographic observations were conducted as part of a formative organizational evaluation of potential community partners. LESSONS LEARNED:The observed brevity of volunteer-client interaction led program planners to incorporate substantial emphasis on communicating with older adults into the health literacy coach training curriculum. Ethnographic observations made clear that program materials had to be portable and fit it in with the mobile nature of MOW delivery. CONCLUSIONS:Formative organizational research can greatly increase the chance of successful implementation of public health interventions when those interventions will be implemented in partnerships with community-based organizations in diverse settings and with varying practices.