Neighborhood Influences on Seasonal Influenza Vaccination among Older African Americans in Atlanta, Georgia.

Abstract

Influenza vaccination coverage in the US is lower than the recommended Healthy People 2020 threshold, especially among older African Americans. This analysis explores the complex relationship among neighborhood-level factors, socio behavioral influences, and influenza vaccination outcomes among older African Americans. We analyzed data from 221 Black/African American participants' age ≥50 years living in Atlanta, Georgia. Generalized Estimating Equations for linear and logistic models assessed associations among socio demographic factors, census-tract neighborhood characteristics, and reported 2012-2013 seasonal influenza vaccination receipt, controlling for correlations among individuals within the same census tracts. Evaluated environmental factors included neighborhood deprivation indicators such as vacant housing percentage, vehicle availability, area violent crimes, and racial/ethnic composition. Reported greater influenza immunization uptake was significantly associated with older age ≥65 years [OR=1.05, p=0.04], positive vaccination attitudes [OR=5.30, p<0.01], having health insurance [OR=14.37, p=0.03], lower perceived neighborhood security [OR=0.51, p=0.02], and lower neighborhood vehicle ownership [OR=1.07, p=0.04], a proxy for neighborhood affluence and transportation ease. Having a post-secondary education was significantly associated with both positive perceived neighborhood security [β=0.28, p=0.02] and positive vaccination attitudes [β=0.27, p=0.02]. The findings provide evidence for distal neighborhood-level influences on influenza vaccination uptake among older African Americans. Lower vehicle ownership and lower perceived neighborhood security influenced seasonal influenza immunizations. Those who perceived personal risk, based on reported neighborhood security, displayed intent to obtain the seasonal influenza vaccine. Further investigation of multilevel, socio geographic factors is therefore warranted to more effectively address suboptimal influenza vaccine coverage among this population.