PUBLIC HEALTH BRIEFS
Participation in Flu Immunization Projects: What Can We Expect in the Future? WILLIAM A. PEARMAN, PHD
The Problem Following completion of the 1976 swine flu immunization project public health authorities expressed fear that the many problems associated with the program would impact negatively on public participation in future immunization projects. They were concerned that the negativism associated with the swine flu campaign would be generalized by the public to affect willingness to take flu shots in the future, or even to immunization generally, such as immunization against childhood diseases. This research assesses the impact of the swine flu immunization program on citizen participation in future flu immunization campaigns.
Methodology The data reported here were collected in an interview survey of a Southeastern Pennsylvania borough having a population of approximately 6,000 residents. The interview took place in the late spring of 1977, about five months after the swine flu immunization project ceased. Block statistics from the 1970 U.S. Census were used to define a population which consisted of all blocks in the borough. A number was associated with each block, numbers were then randomly selected for the purpose of obtaining a sample. Approximately 38 per cent of the blocks in the borough were included in the final sample. Interviews were attempted with one adult in every house on the blocks selected. Interviews were attempted with 372 households; completed interviews and usable data were obtained from 342 households or 92 per cent of the sample. Call backs were attempted at least three times, and some interviews were scheduled at the convenience of the respondent. The survey instrument consisted of both open-ended and closed questions on health practices and health care utilization. The focus of the instrument, however, was on participation in immunization.
Reslults Interviewees were queried as to their attitudes toward immunization, their participation in the swine flu immunization program, and their feelings about participation in future flu immunization projects. The specific questions were: "Do you think people ought to take flu shots?"; "Did you yourAddress reprint requests to Dr. William A. Pearman, Dean, Social Sciences, Millersville State College, Millersville, PA 17551. This paper, submitted to the Journal October 11, 1977, was revised and accepted for publication December 17, 1977. 674
self take shots during the recent swine flu immunization?"; and "Do you think you will take flu shots in the future, if a nationwide flu outbreak seems possible?". Responses appear in Tables 1, 2, and 3 respectively, analyzed in terms of aggregate responses as well as according to the variables of sex, occupation, and education. Although the majority of interviewees (52.92 per cent) believed that flu immunization is a good idea, the support is not strong. One respondent in four did not think that people ought to take flu shots, and one in five stated that they didn't know whether people ought to do so or not. Women were less likely to participate in the swine flu campaign, to think that flu shots are a good idea, or to indicate intent to participate in future immunization. This is contrary to other studies and particularly to Rosenstock's model relative to participation in health services.' However, the availability of flu shots in work places may have contributed to the more positive feeling toward flu immunization among males. In response to the question of why they received swine flu shots, men, more often than women, stated that they participated because shots were available and free at their work place; they also were more likely to state that co-workers pressured them to take shots and thus conform, and that they perceived participation in immunization to be company policy. The established relationship of income to preventive health care behavior would lead to a prediction of a more positive attitude toward flu immunization on the part of nonmanual workers.2 In this study, little difference was found. Manual workers were, however, more likely than nonmanual workers to have received swine flu shots. The data support the generalization that education is positively associated with preventive health behavior. The least support for the idea of flu immunization was found among respondents with the least amount of formal education. The highest support existed not among those with the highest amount of education, but among persons who completed from 9-12 years of school. Also, when negative attitudes toward flu immunization are examined, the least educated are found to be most negative and the college educated are found to be the least negative. A difference of 24 per cent exists between these groups. As indicated in Table 1, the difference between these two groups is statistically significant at the .01 level. Similar findings are produced in both Tables 2 and 3. Education is an extremely important variable.
Discussion Table 3 documents that the problems of the swine flu campaign did not have the adverse effect on future immuniAJPH July, 1978, Vol. 68, No. 7
PUBLIC HEALTH BRIEFS TABLE 2-Participation of Respondents in Swine Flu Immunization.
TABLE 1-Responses to: "Do You Think People Should Take Flu Shots?" Variable
Aggregate Response Male* Female Manual Workers Non-Manual Workers 0-8 yrs. schooling" 9-122yrs. schooling 13-16 yrs. schooling 17+ yrs. schooling
Yes
No
52.9 60.5 49.1 50.3 50.7 34.3 57.4 53.5 48.6
24.0 20.2 25.9 27.0 22.9 42.9 23.9 19.0 22.9
Response Don't Know No Answer
19.6 16.7 21.1 20.8 21.5 22.7 17.4 20.7 22.9
3.5 2.6 4.0 1.9 4.9 0.0 1.3 6.9 5.7
Variable
N
Had
Did Not
No
Shots
Have Shots
Answer
N
51.8 59.7 47.8 51.6 48.6 45.7 51.6
47.7 39.5 51.8 47.2 51.4 54.3 48.4
342 114 228 159 144 35 155
50.9
48.3
0.6 0.9 0.5 1.3 0.0 0.0 0.0 0.9 0.0
Aggregate Response
342 114 228 159 144 35 155 116 35
Male*
Female Manual Workers Non-Manual Workers 0-8 yrs. schooling"* 9-12 yrs. schooling 13-16 yrs. schooling 17+ yrs. schooling
62.9
37.1
116
35
Chi square on "yes" versus "no" responses, on variables of sex, male versus female response, equals 4.46, sig. at .05. Chi square on "yes" versus "no" responses, between 0-8 and 17+ yrs. of of school, equals 7.76, sig. at .01.
* Chi square on "yes" versus all other responses, on variable of sex, male vs. female response, equals 3.95, sig. at .05. ** Chi square on "yes" versus "no" responses only between 0-8 and 17 + yrs. of school, equals 7.93, sig. at .01.
TABLE 3-Respondents' Anticipation of Participation in Future Flu Immunization. Variable
Aggregate Response Male Female Manual Non-Manual 0-8 yrs. schooling 9-12 yrs. schooling 13-16 yrs. schooling 17+ yrs. schooling
Will Participate
Will Not Participate
Don't Know
No Answer
N
58.8 69.3 53.5 59.8 57.6 54.3 57.4 58.6 74.3
24.9 18.4 28.1 25.2 23.6 34.3 24.5 25.9 11.4
16.1 12.3 18.0 14.5 18.8 11.4 18.1 14.7 14.3
0.3 0.0 0.4 0.6 0.0 0.0 0.0 0.9 0.0
342 114 228 159 144 35 155 116 35
zation that was predicted. Anticipated participation rates exceed the figures reported in the other tables. The "don't know" response in the table again points up the degree of uncertainty or ambivalence which exists in the mind of the public concerning flu immunization. Education is needed to explain exactly what flu vaccine is, and the risks and benefits involved in immunization. The data are also consistent with a belief that the swine flu campaign contained too many contradictory messages about whether or not an actual epidemic was impending. When solid proof of a possible nationwide flu outbreak is provided, the data suggest that people will be immunized. The variables examined here point up possible au-
AJPH July, 1978, Vol. 68, No. 7
diences to whom public education campaigns should be addressed. Women, in particular, since they are likely to be a key to the immunization of their children and families, should be addressed seriously by any campaign that is intended to reach the entire population.
REFERENCES 1. Rosenstock, 1. M. Why people use health services. Milbank Memorial Fund Quarterly 44:94-127, 1966. 2. Rosenstock, 1. M. Prevention of Illness and Maintenance of Health, in J. Kosa and 1. K. Zola, Poverty and Health. Cambridge, MA: Harvard University Press, 1976, P. 193-223.
675
Participation in Flu Immunization Projects: What Can We Expect in the Future? WILLIAM A. PEARMAN, PHD
The Problem Following completion of the 1976 swine flu immunization project public health authorities expressed fear that the many problems associated with the program would impact negatively on public participation in future immunization projects. They were concerned that the negativism associated with the swine flu campaign would be generalized by the public to affect willingness to take flu shots in the future, or even to immunization generally, such as immunization against childhood diseases. This research assesses the impact of the swine flu immunization program on citizen participation in future flu immunization campaigns.
Methodology The data reported here were collected in an interview survey of a Southeastern Pennsylvania borough having a population of approximately 6,000 residents. The interview took place in the late spring of 1977, about five months after the swine flu immunization project ceased. Block statistics from the 1970 U.S. Census were used to define a population which consisted of all blocks in the borough. A number was associated with each block, numbers were then randomly selected for the purpose of obtaining a sample. Approximately 38 per cent of the blocks in the borough were included in the final sample. Interviews were attempted with one adult in every house on the blocks selected. Interviews were attempted with 372 households; completed interviews and usable data were obtained from 342 households or 92 per cent of the sample. Call backs were attempted at least three times, and some interviews were scheduled at the convenience of the respondent. The survey instrument consisted of both open-ended and closed questions on health practices and health care utilization. The focus of the instrument, however, was on participation in immunization.
Reslults Interviewees were queried as to their attitudes toward immunization, their participation in the swine flu immunization program, and their feelings about participation in future flu immunization projects. The specific questions were: "Do you think people ought to take flu shots?"; "Did you yourAddress reprint requests to Dr. William A. Pearman, Dean, Social Sciences, Millersville State College, Millersville, PA 17551. This paper, submitted to the Journal October 11, 1977, was revised and accepted for publication December 17, 1977. 674
self take shots during the recent swine flu immunization?"; and "Do you think you will take flu shots in the future, if a nationwide flu outbreak seems possible?". Responses appear in Tables 1, 2, and 3 respectively, analyzed in terms of aggregate responses as well as according to the variables of sex, occupation, and education. Although the majority of interviewees (52.92 per cent) believed that flu immunization is a good idea, the support is not strong. One respondent in four did not think that people ought to take flu shots, and one in five stated that they didn't know whether people ought to do so or not. Women were less likely to participate in the swine flu campaign, to think that flu shots are a good idea, or to indicate intent to participate in future immunization. This is contrary to other studies and particularly to Rosenstock's model relative to participation in health services.' However, the availability of flu shots in work places may have contributed to the more positive feeling toward flu immunization among males. In response to the question of why they received swine flu shots, men, more often than women, stated that they participated because shots were available and free at their work place; they also were more likely to state that co-workers pressured them to take shots and thus conform, and that they perceived participation in immunization to be company policy. The established relationship of income to preventive health care behavior would lead to a prediction of a more positive attitude toward flu immunization on the part of nonmanual workers.2 In this study, little difference was found. Manual workers were, however, more likely than nonmanual workers to have received swine flu shots. The data support the generalization that education is positively associated with preventive health behavior. The least support for the idea of flu immunization was found among respondents with the least amount of formal education. The highest support existed not among those with the highest amount of education, but among persons who completed from 9-12 years of school. Also, when negative attitudes toward flu immunization are examined, the least educated are found to be most negative and the college educated are found to be the least negative. A difference of 24 per cent exists between these groups. As indicated in Table 1, the difference between these two groups is statistically significant at the .01 level. Similar findings are produced in both Tables 2 and 3. Education is an extremely important variable.
Discussion Table 3 documents that the problems of the swine flu campaign did not have the adverse effect on future immuniAJPH July, 1978, Vol. 68, No. 7
PUBLIC HEALTH BRIEFS TABLE 2-Participation of Respondents in Swine Flu Immunization.
TABLE 1-Responses to: "Do You Think People Should Take Flu Shots?" Variable
Aggregate Response Male* Female Manual Workers Non-Manual Workers 0-8 yrs. schooling" 9-122yrs. schooling 13-16 yrs. schooling 17+ yrs. schooling
Yes
No
52.9 60.5 49.1 50.3 50.7 34.3 57.4 53.5 48.6
24.0 20.2 25.9 27.0 22.9 42.9 23.9 19.0 22.9
Response Don't Know No Answer
19.6 16.7 21.1 20.8 21.5 22.7 17.4 20.7 22.9
3.5 2.6 4.0 1.9 4.9 0.0 1.3 6.9 5.7
Variable
N
Had
Did Not
No
Shots
Have Shots
Answer
N
51.8 59.7 47.8 51.6 48.6 45.7 51.6
47.7 39.5 51.8 47.2 51.4 54.3 48.4
342 114 228 159 144 35 155
50.9
48.3
0.6 0.9 0.5 1.3 0.0 0.0 0.0 0.9 0.0
Aggregate Response
342 114 228 159 144 35 155 116 35
Male*
Female Manual Workers Non-Manual Workers 0-8 yrs. schooling"* 9-12 yrs. schooling 13-16 yrs. schooling 17+ yrs. schooling
62.9
37.1
116
35
Chi square on "yes" versus "no" responses, on variables of sex, male versus female response, equals 4.46, sig. at .05. Chi square on "yes" versus "no" responses, between 0-8 and 17+ yrs. of of school, equals 7.76, sig. at .01.
* Chi square on "yes" versus all other responses, on variable of sex, male vs. female response, equals 3.95, sig. at .05. ** Chi square on "yes" versus "no" responses only between 0-8 and 17 + yrs. of school, equals 7.93, sig. at .01.
TABLE 3-Respondents' Anticipation of Participation in Future Flu Immunization. Variable
Aggregate Response Male Female Manual Non-Manual 0-8 yrs. schooling 9-12 yrs. schooling 13-16 yrs. schooling 17+ yrs. schooling
Will Participate
Will Not Participate
Don't Know
No Answer
N
58.8 69.3 53.5 59.8 57.6 54.3 57.4 58.6 74.3
24.9 18.4 28.1 25.2 23.6 34.3 24.5 25.9 11.4
16.1 12.3 18.0 14.5 18.8 11.4 18.1 14.7 14.3
0.3 0.0 0.4 0.6 0.0 0.0 0.0 0.9 0.0
342 114 228 159 144 35 155 116 35
zation that was predicted. Anticipated participation rates exceed the figures reported in the other tables. The "don't know" response in the table again points up the degree of uncertainty or ambivalence which exists in the mind of the public concerning flu immunization. Education is needed to explain exactly what flu vaccine is, and the risks and benefits involved in immunization. The data are also consistent with a belief that the swine flu campaign contained too many contradictory messages about whether or not an actual epidemic was impending. When solid proof of a possible nationwide flu outbreak is provided, the data suggest that people will be immunized. The variables examined here point up possible au-
AJPH July, 1978, Vol. 68, No. 7
diences to whom public education campaigns should be addressed. Women, in particular, since they are likely to be a key to the immunization of their children and families, should be addressed seriously by any campaign that is intended to reach the entire population.
REFERENCES 1. Rosenstock, 1. M. Why people use health services. Milbank Memorial Fund Quarterly 44:94-127, 1966. 2. Rosenstock, 1. M. Prevention of Illness and Maintenance of Health, in J. Kosa and 1. K. Zola, Poverty and Health. Cambridge, MA: Harvard University Press, 1976, P. 193-223.
675
