Rates of influenza vaccination among US Hispanics are lower than for non-Hispanic whites, yet little is known about factors affecting vaccination in this population. Additionally, although Hispanics are a diverse population with culturally distinct subgroups, they are often treated as a homogenous population. This study (1) examines how confidence in vaccine safety and influenza vaccine use vary by Hispanic subgroup and (2) identifies individual, cultural and structural correlates of these outcomes. This study analyzed survey data from 1565 Hispanic women who were recruited at clinic- and community-based sites in Los Angeles. Education, healthcare coverage, acculturation, fatalism, and religiosity were predictors of influenza vaccination behavior and predictors varied by subgroup. These findings provide guidance for how influenza vaccine promotion efforts can be developed for Hispanic subgroups. Confidence in the safety of a vaccine is a major predictor of flu vaccination and an important modifiable target for intervention.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
U.S. Department of Health and Human Services: Healthy people 2020: immunization and infectious diseases. 2014. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases.
Grohskoph LA, Olsen SJ, Sokolow LZ, et al. Prevention and control of seasonal Influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 influenza season. MMWR Morb Mortal Wkly Rep. 2014;63(23):691–7.
Centers for Disease Control & Prevention: Flu vaccination coverage, United States, 2013–14 influenza season. 2014. http://www.cdc.gov/flu/fluvaxview/coverage-1314estimates.htm.
Lu PJ, Singleton JA, Euler GL, et al. Seasonal influenza vaccination coverage among adult populations in the United States, 2005–2011. Am J Epidemiol. 2013;178(9):1478–87.
Haviland AM, Elliott MN, Hambarsoomian K, et al. Immunization disparities by Hispanic ethnicity and language preference. Arch Intern Med. 2011;171(2):158–65.
Phippart AE, Kimura AC, Lopez K, et al. Understanding knowledge, attitudes, and behaviors related to influenza and the influenza vaccine in US–Mexico border communities. J Immigr Minor Health. 2013;15(4):741–6.
Elder JP, Ayala GX, Parra-Medina D, et al. Health communication in the Latino community: issues and approaches. Annu Rev Public Health. 2009;30:227–51.
Lopez MH, Gonzalez-Barrera A, Cuddington D.Diverse origins: The nation’s 14 largest Hispanic-origin groups. Washington DC: Pew Research Center. 2013. http://www.pewhispanic.org/2013/06/19/diverse-origins-the-nations-14-largest-hispanic-origin-groups/.
Motel S, Patten E. Statistical portrait of the foreign-born population in the United States, 2011. Washington DC: Pew Research Center. 2013. http://www.pewhispanic.org/2013/01/29/statistical-portrait-of-the-foreign-born-population-in-the-united-states-2011/.
Cokkinides VE, Bandi P, Siegel RL, et al. Cancer-related risk factors and preventive measures in US Hispanics/Latinos. CA Cancer J Clin. 2012;62(6):353–63.
Siegel R, Ahmedin Jemal D. Cancer facts and figures. Atlanta, GA: American Cancer Society. 2012. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf.
Daviglus ML, Talavera GA, Avilés-Santa ML, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308(17):1775–84.
Fang J, Madhavan S, Alderman MH. The influence of birthplace on mortality among Hispanic residents of New York City. Ethn Dis. 1996;7(1):55–64.
Howe HL, Wu X, Ries LA, et al. Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among US Hispanic/Latino populations. Cancer. 2006;107(8):1711–42.
Iribarren C, Darbinian JA, Fireman BH, et al. Birthplace and mortality among insured Latinos: the paradox revisited. Ethn Dis. 2009;19(2):185–91.
Pinheiro PS, Williams M, Miller EA, et al. Cancer survival among Latinos and the Hispanic Paradox. Cancer Causes Control. 2011;22(4):553–61.
Singh GK, Rodriguez-Lainz A, Kogan MD. Immigrant health inequalities in the United States: use of eight major national data systems. Sci World J. 2013;2013:512313. doi:10.1155/2013/512313.
Corace K, Prematunge C, McCarthy A, et al. Predicting influenza vaccination uptake among health care workers: what are the key motivators? Am J Infect Control. 2013;41(8):679–84.
Gust DA, Strine TW, Maurice E, et al. Underimmunization among children: effects of vaccine safety concerns on immunization status. Pediatrics. 2004;114(1):e1–22.
Hakim H, Gaur AH, McCullers JA. Motivating factors for high rates of influenza vaccination among healthcare workers. Vaccine. 2011;29(35):5963–9.
Salmon DA, Moulton LH, Omer SB, et al. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Arch Pediatr Adolesc Med. 2005;159(5):470–6.
Dutta M. Communicating health: a culture-centered approach. London: Polity Press; 2008.
Airhihenbuwa CO. Health and culture: beyond the western paradigm. Thousand Oaks: SAGE; 1995.
Egede LE, Zheng D. Racial/ethnic differences in influenza vaccination coverage in high-risk adults. Am J Public Health. 2003;93(12):2074–8.
Marin MG, Johanson WG Jr, Salas-Lopez D. Influenza vaccination among minority populations in the United States. Prev Med. 2002;34(2):235–41.
Williams WW, Lu PJ, Lindley MC, et al. Influenza vaccination coverage among adults: National Health Interview Survey, United States, 2008–09 influenza season. MMWR Morb Mortal Wkly Rep. 2012;61:65–72.
Kline MV, Huff RM. Health promotion in multicultural populations: a handbook for practitioners and students. Thousand Oaks: SAGE; 2007.
Barnack JL, Reddy DM, Swain C. Predictors of parents’ willingness to vaccinate for human papillomavirus and physicians’ intentions to recommend the vaccine. Womens Health Issues. 2010;20(1):28–34.
Lara M, Gamboa C, Kahramanian MI. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–97.
Niederdeppe J, Levy AG. Fatalistic beliefs about cancer prevention and three prevention behaviors. Cancer Epidemiol Biomarkers Prev. 2007;16(5):998–1003.
Institute of Medicine. Health literacy: a prescription to end confusion. Washington: National Academies Press; 2004.
Berk ML, Albers LA, Schur CL. The growth in the US uninsured population: trends in Hispanic subgroups, 1977 to 1992. Am J Public Health. 1996;86(4):572–6.
Bustamante AV, Fang H, Rizzo JA, et al. Heterogeneity in health insurance coverage among US Latino adults. J Gen Intern Med. 2009;24(3):561–6.
Frank LB, Murphy ST, Ball-Rokeach S. Personal network analysis and health among Latinas. Int Rev Soc Res. (in press).
DeSalvo KB, Fan VS, McDonell MB, et al. Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005;40(4):1234–46.
Marin G, Gamba RJ. A new measurement of acculturation for Hispanics: the bidimensional acculturation scale for hispanics (BAS). Hisp J Behav Sci. 1996;18(3):297–316.
Kim YC, Ball-Rokeach SJ. Community storytelling network, neighborhood context, and civic engagement: a multilevel approach. Hum Commun Res. 2006;32(4):411–39.
Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–94.
Chew LD, Griffin JM, Partin MR, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23(5):561–6.
SPSS Inc. SPSS statistics for windows, version 17.0. Chicago: SPSS Inc; 2008.
Messias DKH, Rubio M. Immigration and health. Annu Rev Nurs Res. 2004;23:101–34.
Ramirez AG, Thompson IM. Hispanic/Latino health, cancer, and disease: an overview. In: Huff RM, Kline MV, Peterson DV, editors. Health promotion in multicultural populations: a handbook for practitioners and students. 3rd ed. Thousand Oaks: SAGE; 2015.
Balcazar H, Alvarado M, Hollen ML, Gonzalez-Cruz Y, Hughes O, Vazquez E, Lykens K. Salud Para Su Corazon-NCLR: a comprehensive Promotora outreach program to promote heart-healthy behaviors among Hispanics. Health Promot Pract. 2006;7(1):68–77.
Swider SM. Outcome effectiveness of community health workers: an integrative literature review. Public Health Nurs. 2002;19(1):11–20.
Powe BD, Weinrich S. An intervention to decrease cancer fatalism among rural elders. Oncol Nurs Forum. 1999;26(3):583–8.
Schwingel A, Gálvez P. Divine interventions: faith-based approaches to health promotion programs for Latinos. J Relig Health. 2015. doi:10.1007/s10943-015-0156-9.
MacDonald R, Baken L, Nelson A, et al. Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients. Am J Prev Med. 1999;16(3):173–7.
El Omeiri N, Azziz-Baumgartner E, Clará W, et al. Pilot to evaluate the feasibility of measuring seasonal influenza vaccine effectiveness using surveillance platforms in Central-America, 2012. BMC Public Health. 2015;15:673. doi:10.1186/s12889-015-2001-1.
Ennis SR, Ríos-Vargas M, Albert NG. The hispanic population: 2010. US Department of Commerce, Economics and Statistics Administration, US Census Bureau. 2011.
Siatkowski AA. Hispanic acculturation: a concept analysis. J Transcult Nurs. 2007;18(4):316–23.
Opel DJ, Taylor JA, Mangione-Smith R, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine. 2011;29:6598–605.
Smith PJ, Chu SY, Barker LE. Children who have received no vaccines: who are they and where do they live? Pediatrics. 2004;114:187–95.
Conflict of interest
None of the authors of this manuscript have any conflicts of interest to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and Animal Rights Statement
The research reported in this manuscript involved human participants and all study procedures were approved by the university Institutional Review Board.
All participants in this study provided informed consent.
Rights and permissions
About this article
Cite this article
Moran, M.B., Chatterjee, J.S., Frank, L.B. et al. Individual, Cultural and Structural Predictors of Vaccine Safety Confidence and Influenza Vaccination Among Hispanic Female Subgroups. J Immigrant Minority Health 19, 790–800 (2017). https://doi.org/10.1007/s10903-016-0428-9
- Vaccine hesitancy