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Influenza Vaccination Coverage Among English-Speaking Asian Americans

Published:September 24, 2018DOI:https://doi.org/10.1016/j.amepre.2018.06.018

      Introduction

      English-speaking non-Hispanic Asians (Asians) in the U.S. include populations with multiple geographic origins and ethnicities (e.g., Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese). Health behaviors and outcomes can differ widely among Asian ethnicities, and highlight the importance of subgroup analysis. Aggregating Asians may mask differences in influenza vaccination across various ethnicities.

      Methods

      Combined data from 2013 to 2015 Behavioral Risk Factor Surveillance System, a population-based, telephone survey of the non-institutionalized, U.S. population aged ≥18 years, were analyzed in 2017 to assess influenza vaccination among Asians. Weighted proportions were calculated. Multivariable logistic regression was used to determine independent associations between sociodemographic factors and receipt of influenza vaccination.

      Results

      Influenza vaccination varied widely among Asian ethnicities, both nationally and by state. Overall, 42.1% of Asians reported having received an influenza vaccine, similar to vaccination among whites (42.4%). Coverage ranged from 36.1% among Koreans to 50.9% among Japanese. Factors independently associated with influenza vaccination among some or all Asian ethnicities included age (≥50 years), female, never married, high school or higher education, annual household income ≥$75,000, possession of medical insurance and personal healthcare provider, routine checkup in the previous year, and presence of certain chronic conditions.

      Conclusions

      Though Asians and whites had similar overall influenza vaccination coverage, differences existed between Asian ethnicities, both nationally and by state. This information may help community-based, state-level, and national-level public health agencies to support targeted approaches for outreach to these populations, such as improving cultural and linguistic access to care, to improve influenza vaccination.
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      REFERENCES

        • Williams WW
        • Lu PJ
        • O'Halloran A
        • et al.
        Surveillance of vaccination coverage among adult populations–United States, 2014.
        MMWR Surveill Summ. 2016; 65: 1-36
        • Lu PJ
        • O'Halloran A
        • Williams WW
        • et al.
        Racial and ethnic disparities in vaccination coverage among adult populations in the U.S.
        Am J Prev Med. 2015; 49: S412-S425
        • Lu PJ
        • O'Halloran A
        • Bryan L
        • et al.
        Trends in racial/ethnic disparities in influenza vaccination coverage among adults during the 2007–08 through 2011–12 seasons.
        Am J Infect Control. 2014; 42: 763-769
        • Williams WW
        • Lu PJ
        • O'Halloran A
        • et al.
        Noninfluenza vaccination coverage among adults–United States, 2012.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 95-102
        • Lu PJ
        • Singleton JA
        • Euler GL
        • Williams WW
        • Bridges CB
        Seasonal influenza vaccination coverage among adult populations in the United States, 2005–2011.
        Am J Epidemiol. 2013; 178: 1478-1487
        • CDC
        Influenza vaccination coverage—FluVaxView.
        (Updated October 6, 2016. Accessed October 26)
        • Healthy People 2020
        Topics & Objectives–Immunization and infectious diseases.
        (Updated October 25, 2016. Accessed October 26)
        • Singleton JA
        • Santibanez TA
        • Wortley PM
        Influenza and pneumococcal vaccination of adults aged >65: racial/ethnic differences.
        Am J Prev Med. 2005; 29: 412-420
        • Lindley MC
        • Wortley PM
        • Winston CA
        • Bardenheier BH
        The role of attitudes in understanding disparities in adult influenza vaccination.
        Am J Prev Med. 2006; 31: 281-285
        • Link MW
        • Ahluwalia IB
        • Euler GL
        • et al.
        Racial and ethnic disparities in influenza vaccination coverage among adults during the 2004–2005 season.
        Am J Epidemiol. 2006; 163: 571-578
        • Lu PJ
        • Santibanez TA
        • Williams WW
        • et al.
        Surveillance of influenza vaccination coverage–United States, 2007–08 through 2011–12 influenza seasons.
        MMWR Surveill Summ. 2013; 62: 1-28
        • Daniels NA
        • Gildengorin G
        • Nguyen TT
        • et al.
        Influenza and pneumococcal vaccination rates among Vietnamese, Asian, and non-Hispanic white Americans.
        J Immigr Minor Health. 2010; 12: 370-376
        • Quach S
        • Hamid JS
        • Pereira JA
        • et al.
        Influenza vaccination coverage across ethnic groups in Canada.
        CMAJ. 2012; 184: 1673-1681
        • Barnes PM
        • Adams PF
        • Powell-Griner E
        Health characteristics of the Asian adult population: United States, 2004–2006.
        Adv Data. 2008; : 1-22
        • Budhwani H
        • De P
        Disparities in influenza vaccination across the United States: variability by minority group, Asian sub-populations, socio-economic status, and health insurance coverage.
        Public Health. 2016; 138: 146-153
        • Damiani G
        • Federico B
        • Visca M
        • Agostini F
        • Ricciardi W
        The impact of socioeconomic level on influenza vaccination among Italian adults and elderly: a cross-sectional study.
        Prev Med. 2007; 45: 373-379
        • Takayama M
        • Wetmore CM
        • Mokdad AH
        Characteristics associated with the uptake of influenza vaccination among adults in the United States.
        Prev Med. 2012; 54: 358-362
        • Frew PM
        • Alhanti B
        • Vo-Green L
        • et al.
        Multilevel factors influencing hepatitis B screening and vaccination among Vietnamese Americans in Atlanta, Georgia.
        Yale J Biol Med. 2014; 87: 455-471
        • Lu PJ
        • Rodriguez-Lainz A
        • O'Halloran A
        • Greby S
        • Williams WW
        Adult vaccination disparities among foreign-born populations in the U.S., 2012.
        Am J Prev Med. 2014; 47: 722-733
        • Lee S
        • Chae DH
        • Jung MY
        • Chen L
        • Juon HS
        Health examination is not a priority for less acculturated Asian Americans.
        J Racial Ethn Health Disparities. 2017; 4: 1022-1031
        • CDC
        Behavioral Risk Factor Surveillance System.
        (Updated August 26, 2016. Accessed January 26)
        • American Association for Public Opinion Research
        Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys.
        9th edition. American Association for Public Opinion Research, Oakbrook Terrace, IL2016
        • CDC
        Behavioral Risk Factor Surveillance System. 2013 Summary data quality report with response rate.
        (Updated June 23, 2014. Accessed December 26)
        • CDC
        Behavioral Risk Factor Surveillance System. 2014 Summary data quality report with response rates.
        (Updated September 11, 2015. Accessed December 26)
        • CDC
        Behavioral Risk Factor Surveillance System. 2015 Summary data quality report with response rates.
        (Updated August 11, 2017. Accessed December 26)
        • CDC
        Behavioral Risk Factor Surveillance System. 2015 Weighting formula.
        (Updated September 11, 2015. Accessed December 26)
        • Linn ST
        • Guralnik JM
        • Patel KV
        Disparities in influenza vaccination coverage in the United States, 2008.
        J Am Geriatr Soc. 2010; 58: 1333-1340
        • Almario CV
        • May FP
        • Maxwell AE
        • Ren W
        • Ponce NA
        • Spiegel BM
        Persistent racial and ethnic disparities in flu vaccination coverage: results from a population-based study.
        Am J Infect Control. 2016; 44: 1004-1009
        • Jenkins CN
        • McPhee SJ
        • Wong C
        • Nguyen T
        • Euler GL
        Hepatitis B immunization coverage among Vietnamese-American children 3 to 18 years old.
        Pediatrics. 2000; 106: E78
        • Lin SY
        • Chang ET
        • So SK
        Stopping a silent killer in the underserved Asian and Pacific Islander community: a chronic hepatitis B and liver cancer prevention clinic by medical students.
        Asian Pac J Cancer Prev. 2009; 10: 383-386
        • Levy JD
        • Nguyen GT
        • Nguyen ET
        Factors influencing the receipt of hepatitis B vaccination and screenings in Vietnamese Americans.
        J Health Care Poor Underserved. 2010; 21: 851-861
        • Nguyen TT
        • Taylor V
        • Chen Jr., MS
        • et al.
        Hepatitis B awareness, knowledge, and screening among Asian Americans.
        J Cancer Educ. 2007; 22: 266-272
        • Grytdal SP
        • Liao Y
        • Chen R
        • et al.
        Hepatitis B testing and vaccination among Vietnamese- and Cambodian-Americans.
        J Community Health. 2009; 34: 173-180
        • Upadhyaya N
        • Chang R
        • Davis C
        • et al.
        Chronic hepatitis B: perceptions in Asian American communities and diagnosis and management practices among primary care physicians.
        Postgrad Med. 2010; 122: 165-175
        • Ma GX
        • Fang CY
        • Shive SE
        • et al.
        Risk perceptions and barriers to hepatitis B screening and vaccination among Vietnamese immigrants.
        J Immigr Minor Health. 2007; 9: 213-220
        • Strong C
        • Lee S
        • Tanaka M
        • Juon HS
        Ethnic differences in prevalence and barriers of HBV screening and vaccination among Asian Americans.
        J Community Health. 2012; 37: 1071-1080
        • Santibanez TA
        • Mootrey GT
        • Euler GL
        • Janssen AP
        Behavior and beliefs about influenza vaccine among adults aged 50–64 years.
        Am J Health Behav. 2010; 34: 77-89
      1. Bridges CB,Coyne-Beasley T. Advisory Committee on Immunization Practices(ACIP), ACIP Adult Immunization Work Group, Centers for Disease Control and Prevention. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older: United States, 2014. MMWR Morb Mortal Wkly Rep. 2014;63(5):110--112. https://doi.org/10.7326/M13-2826.

        • Feldstein LR
        • Mariat S
        • Gacic-Dobo M
        • Diallo MS
        • Conklin LM
        • Wallace AS
        Global routine vaccination coverage, 2016.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 1252-1255
        • Walker PF
        • Barnett ED
        An introduction to the field of refugee and immigrant healthcare.
        in: Walker PF Barnett ED Immigrant Medicine. Elsevier, Philadelphia, PA2007
        • Pallegadda RR
        • Wang EJ
        • Palaniappan LP
        • Gupta PK
        • Koenig CJ
        How does culture influence preventive service utilization among Asian Indians living in the USA? A qualitative study.
        Int J Qual Res Serv. 2014; 1: 232-247
        • Zanchetta MS
        • Poureslami IM
        Health literacy within the reality of immigrants’ culture and language.
        Can J Public Health. 2006; 97: S26-S30
        • Srivastav A
        • Zhai Y
        • Santibanez TA
        • et al.
        Influenza vaccination coverage of Vaccine for Children(VFC)-entitled versus privately insured children, United States, 2011–2013.
        Vaccine. 2015; 33: 3114-3121
        • Klaiman T
        • Ibrahim JK
        State health department structure and pandemic planning.
        J Public Health Manag Pract. 2010; 16: E1-E7
        • Nelson DE
        • Bland S
        • Powell-Griner E
        • et al.
        State trends in health risk factors and receipt of clinical preventive services among U.S. adults during the 1990s.
        JAMA. 2002; 287: 2659-2667
        • Holtzman D
        • Powell-Griner E
        • Bolen JC
        • Rhodes L
        State- and sex-specific prevalence of selected characteristics—Behavioral Risk Factor Surveillance System, 1996 and 1997.
        MMWR CDC Surveill Summ. 2000; 49: 1-39
      2. CDC. Surveillance for certain health behaviors among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2011. MMWR Surveill Summ . 2014;63(9):1--149.

        • Buelow VH
        • Van Hook J
        Timely immunization series completion among children of immigrants.
        J Immigr Minor Health. 2008; 10: 37-44
        • Rolnick SJ
        • Parker ED
        • Nordin JD
        • et al.
        Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors?.
        Vaccine. 2013; 31: 3928-3935
        • Mac Donald R
        • Baken L
        • Nelson A
        • Nichol KL
        Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients.
        Am J Prev Med. 1999; 16: 173-177
        • Mangtani P
        • Shah A
        • Roberts JA
        Validation of influenza and pneumococcal vaccine status in adults based on self-report.
        Epidemiol Infect. 2007; 135: 139-143
        • Zimmerman RK
        • Raymund M
        • Janosky JE
        • Nowalk MP
        • Fine MJ
        Sensitivity and specificity of patient self-report of influenza and pneumococcal polysaccharide vaccinations among elderly outpatients in diverse patient care strata.
        Vaccine. 2003; 21: 1486-1491
        • Stein AD
        • Courval JM
        • Lederman RI
        • Shea S
        Reproducibility of responses to telephone interviews: demographic predictors of discordance in risk factor status.
        Am J Epidemiol. 1995; 141: 1097-1105
        • Haviland AM
        • Elliott MN
        • Hambarsoomian K
        • Lurie N
        Immunization disparities by Hispanic ethnicity and language preference.
        Arch Intern Med. 2011; 171: 158-165