Background
Approximately 36,000 individuals die each year of influenza in the United States. Elderly people are at greatest risk, with more than 90% of mortality in individuals older than 65 years of age. Despite the existence of an effective vaccine, often available for free from worksite, private, and public health clinics, vaccine use rates remain low, at 65% on average. Only two thirds of Medicare recipients received the vaccination in 1996, and vaccine use is even lower among the young and minority groups. Prominent among the explanations for not getting vaccinated are concerns about safety and adverse events.

Mission
This study seeks to further our understanding of these safety concerns and their sources through qualitative research, and through the development and audience assessment of message materials and dissemination strategies.

Current Activities
A series of in-depth interviews and focus groups with medical providers and non-provider African Americans 50 and over were carried out in the St. Louis area. Interviews and focus groups gathered information from providers about their experience providing the influenza vaccination as well as strategies they and their organizations have used to promote vaccination. General public focus groups and in-depth interviews were used to explore safety and adverse event concerns about influenza vaccines and their sources among older African Americans. Information from the general public and providers was used to develop messages to encourage vaccination in older African Americans. Messages are now being pre-tested and revised for submission to the National Immunization Program.

Innovations and Uses of Findings
This project allows for the development of theoretically-sound and empirically-based message strategies that allay safety concerns and contribute to the likelihood of vaccine acceptance by individuals exposed to the messages. Ideas for message distribution strategies were gained from providers working with the general public to provide influenza vaccinations and other preventive health care. Existing vaccination promotion messages broadly encourage influenza prevention. This project allows for messages focused on the specific barrier of safety concerns in African American 50 and older. Safety concerns are a major barrier, and addressing them directly is an evidence-based strategic approach to influenza vaccination health promotion messages.