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Background: Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged ≥65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002–2003 influenza season examines factors that may be associated with low coverage. Methods: A national sample of 1839 community-dwelling adults aged ≥65 years was surveyed by telephone during January–May 2003. Outcomes analyzed in 2004–2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination. Results: Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was ≥15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and <10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%. Conclusions: Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified. [Copyright &y& Elsevier]

: ObjectivesTo determine which patient beliefs associated with influenza vaccination changed during a vaccine shortage year (2000–2001) from a nonshortage year (1999–2000).: MethodsElderly patients (n=319), who had been previously interviewed about the 1999–2000 influenza season, were interviewed regarding the 2000–2001 season. Participants were from inner-city and suburban medical practices receiving influenza vaccine supply on time or late in the season.: ResultsAlthough vaccination rates did not diminish due to the influenza vaccine shortage (73% in 1999–2000 vs 74% in 2000–2001), some patient attitudes changed. More respondents expressed concerns about the influenza vaccine (3% in 1999–2000 vs 12% in 2000–2001, p<0.0001), and fewer responded that friends thought that they should get the vaccine (75% 1999–2000 vs 66% 2000–2001, p=0.005); that if one person in the household “got the flu” others would also (71% 1999–2000 vs 67% 2000–2001, p<0.0001), and that “a person who does not get the flu shot will get influenza” (36% 1999–2000 vs 30% 2000–2001, p=0.02).: ConclusionsThe influenza vaccine shortage resulted in a small increase in concerns about influenza vaccine, even in a population with good access to vaccine and high vaccination rates. Vaccine availability updates should include reassurances of vaccine safety and efficacy. [Copyright &y& Elsevier]

: BackgroundInfluenza vaccination rates among adults, especially in minority populations, remain below national goals of 90%. This study investigated in diverse settings, facilitators of and barriers to patient influenza vaccination from the physician''s perspective.: MethodsTwo-stage, stratified, random-cluster sampling was employed to select 71 clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices, and a random sample of 925 of their patients aged ≥65 years. Questionnaires and interviews based on the PRECEDE–PROCEED framework assessed clinician factors. Associations among clinician beliefs, practice characteristics, patient beliefs, and self-reported influenza vaccination status were determined.: ResultsThe clinician response rate was 85% (60/71). Several factors of the PRECEDE–PROCEED framework were associated with higher influenza vaccination rates. For instance, patients at practices with express vaccination clinics had higher vaccination rates than at clinics without such immunization programs (87% v 76%, p =0.01). Using multivariate models, influenza vaccination status was related to several patient factors, including plans to receive influenza vaccination next year (p <0.001); belief that those who are not vaccinated will contract influenza (p =0.049); and history of being screened for colon cancer (p =0.023). Influenza vaccination status was also related to several physician factors, including awareness of recommendation to vaccinate asthmatics (p =0.024); agreement with these recommendations (p =0.004); and practice type and setting (“strata”), of which the VA was highest.: ConclusionsThrough proactive office systems and education, physicians may influence patients'' intentions to be vaccinated and thereby increase influenza vaccination rates. [Copyright &y& Elsevier]