- Surveys mailed to 1375 women in each of two groups: vaccinated and unvaccinated.
- Survey assessed factors such as attitudes toward vaccines, comfort with sexual health, and physician recommendation 
- 98% of vaccinated women had both discussed the vaccine with their doctor and received a recommendation for vaccination
- Majority of unvaccinated had either not discussed the vaccine with their doctor or discussed it but not received a recommendation 

California Polytechnic State University, San Luis Obispo

- Physician Recommendation
- Socioeconomic Status
- Occupation and Income
- Health care insurance and accessibility
- Education


Social Factors that Affect Adult Vaccination Uptake

Rosenthal, S. L., Weiss, T. W., Zimet, G. D., Ma, L., Good, M. B., & Vichnin, M. D. (2011). 
Predictors of HPV vaccine uptake among women aged 19-26: importance of a physician's recommendation. Vaccine, 29(5), 890–895. https://doi.org/10.1016/j.vaccine.2009.12.063


Predictors of HPV vaccine uptake among women aged 19-26: importance of a physician's recommendation

Lack of access to healthcare is a significant barrier to vaccination uptake because being uninsured, not having a usual source of healthcare, and not seeing a medical practitioner in the past year were associated with lower vaccine uptake. Furthermore, studies conducted during the 2009-2010 influenza season among adults show that having health insurance was associated with vaccine uptake. Addressing access to care is important because without access to care, other approaches to increasing vaccine uptake may not be possible. 

Health care insurance/accessibility and its relation to adult vaccination uptake 

- Education level is a socio demographic characteristic and is often associated with lack of access to sufficient and adequate healthcare. Generally, those reporting higher education in the US are more likely to report having received the influenza vaccine. 
- Lower vaccination coverage was detected among those with less education in the age group 65 or older.
- Education level was found to have an effect on knowledge. Patients with a middle school education or lower and high school education were less knowledgeable about influenza and its vaccination compared to those who have a college degree or higher. 

Education level and its relation to adult vaccination uptake 

Physician Recommendation and Adult Vaccination Uptake 

- Surveillance data in the US has revealed higher rates of influenza hospitalizations in areas with high levels of poverty, population density, and crowded housing conditions.
- In a systematic review of 42 articles, 52.4% (n = 22) found that higher levels of SES resulted in higher levels of influenza vaccination.
- 4.5% (n = 2) reported a negative association; and 14.3% (n = 6) found no association. 26.2%, n = 12) of articles reported mixed results.
- The searches examined SES (occupation, income, education, employment, class, or social and material deprivation) and influenza immunization


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