Flu Season Has Begun, but Most College Students Ignore the Vaccine

BUFFALO, N.Y. -- Influenza spreads like wildfire on college campuses because of high-density living conditions. Its symptoms -- weakness, muscle pain, vomiting and diarrhea are unpleasant but usually not serious, although many people get very sick and thousands die every year in the U.S. from complications of the flu.

Given all this, we might expect that when offered an effective, and often free, flu vaccine, college students would get one. But the vast majority of them do not and it poses a serious threat to their own health and that of those around them.

A study by University at Buffalo researcher Janet Yang, PhD, assistant professor of communication, published in the October issue of Risk Analysis: An International Journal (a publication of the nonprofit Society for Risk Analysis), considers why vaccination non-compliance is so common among college students and what can be done about it.

Yang's study "Too Scared or Too Capable? Why Do College Students Stay Away from the H1N1 Vaccine?" is based on surveys of college students in 2010, following the 2009 pandemic of Swine Flu (caused by the H1N1 virus), which killed an estimated 294,000 people worldwide. The study is online at http://onlinelibrary.wiley.com/doi/10.1111/j.1539-6924.2012.01799.x/full.

Yang says that during that pandemic, the Centers for Disease Control undertook a strong outreach program in an attempt to get college students and other initial target groups vaccinated. The subsequent vaccination rate for groups like pregnant women and health care workers was 34.2 percent, but the compliance rate among college students was only 10 percent. This concerned public health officials because as of November 2009, 80 percent of H1N1 flu cases were in people under the age of 30.

In 2010, Yang conducted a survey of 317 college students to ascertain their attitudes toward the flu and its vaccine and to find out why they did or did not get vaccinated.

She found that a complex set of factors affected student avoidance of the vaccine, but that public health officials could increase compliance rates if they better understood the reasons for non-compliance and then tailored their outreach communications to better accommodate this audience.

"Many students surveyed were confident that they had all the information they needed to make an informed decision about being vaccinated," Yang says.

"In fact, however, they often did not have even minimal baseline knowledge of the flu itself or of the vaccine that prevented it."

One reason for this, she says, is that although the students considered them credible, many of the sources they relied on for information about both flu and vaccine were questionable.

"For instance," Yang says, "during the pandemic, dubious information was circulated on YouTube about the risks associated with getting the vaccine -- but not about the risks of getting the flu itself." This contaminated the health information environment surrounding the flu and complicated efforts to prevent the disease from spreading, according to Yang.

"It was also the case," she says, "that many students did not see the relevance of the vaccine to their health or that of others, and so did not consider vaccination an act of social responsibility. This also promoted non-compliance.

"Overall," she says, "the study demonstrated how the perception of risk associated with vaccination could influence individuals' information-seeking behavior and intention to be vaccinated."

She says as well, however, that specific changes in health communication could promote vaccination and other healthy behaviors in this population.

"First," she says, "it is critical that public health communicators recognize students' existing perceptions and attitudes toward the vaccine, and understand their emotional reaction to potential risks such as post-vaccine fever or muscle pain.

"We want to avoid students' unwarranted confidence in their knowledge of the flu and their ability to adopt preventive behavior," she says.

"So accurate, credible, documented information about the virus and its consequences needs to be provided to students," Yang says, "along with facts about how infection spreads, how it can be prevented and the safety of the vaccine. All of this should be presented in a clear format that is easy to find and easy to read."

She points out that students surveyed who determined their flu vaccine information source to be credible sought more information, which in turn increased their intention to get the vaccine.

"It also is critical to present vaccination as an action that bears personal relevancy and immediacy to the students," Yang says, "and to this end, the use of emotional appeals and normative social influences could be quite effective in constructing messages."

Because she used a convenience sample, Yang says her results should not be over generalized or applied to all college students. With some caveats in mind, however, she says her findings confirm a strong role for risk communication in promoting a preventive health behavior among a unique population group.

Yang's research and publications center on the communication of risk information related to science, health and environmental issues, and, in particular, how cognitive and affective evaluations of risk influence individuals' decision making.

Much of her work focuses on social cognitive factors that influence information seeking and processing, health decision making and public perception of environmental and health risks. Her recent research projects have involved improving communication about climate change, renewable energy and cancer clinical trials.

Yang was the 2011-12 head of ComSHER: Communicating Science, Health, Environment and Risk, a division of the Association for Education in Journalism and Mass Communication.