This study examined health beliefs associated with novel influenza A (H1N1) immunization among US college undergraduates during the 2009-2010 pandemic. Undergraduates (ages 18–24 years) from a large Midwestern University were invited to complete an online survey during March, 2010, five months after H1N1 vaccines became available. Survey items measured H1N1 vaccine history and H1N1-related attitudes based on the health belief literature. Logistic regression was used to identify attitudes associated with having received an H1N1 vaccine, and thematic analysis of student comments was conducted to further understand influences on vaccine decisions. Among the 296 students who participated in the survey, 15.2% reported having received an H1N1 vaccine. In regression analysis, H1N1 immunization was associated with seasonal flu vaccine history, perceived vaccine effectiveness, perceived obstacles to vaccination, and vaccine safety concerns. Qualitative results illustrate the relationship of beliefs to vaccine decisions, particularly in demonstrating that students often held concerns that vaccine could cause H1N1 or side effects. Vaccine safety, efficacy, and obstacles to immunization were major considerations in deciding whether to accept the H1N1 pandemic vaccine. Therefore, focusing on those aspects might be especially useful in future vaccine efforts within the college population. 1. Introduction College students are at especially high risk of contracting and passing on infectious diseases, due in part to dormitory living [1] and large social gatherings [2], and influenza is a known health and academic concern for that population [3]. When novel influenza A (H1N1) pandemic vaccines were made available in 2009, young people up to 25 years of age were targeted for vaccination due to their high rate of H1N1 infection and complications [4]. For these reasons, the Centers for Disease Control and Prevention [5] and the American College Health Association [6] issued guidelines for colleges regarding the evolving H1N1 flu pandemic, recommending strategies for containing the epidemic on campuses including facilitating student vaccinations. However, by Fall, 2009, anecdotal reports indicated that students were choosing to forgo H1N1 vaccination even after concentrated campus vaccine promotion efforts [7]. Although no definitive data regarding college H1N1 vaccine acceptance rates are available, several published studies utilizing college samples suggest that protective behaviors, intentions to be vaccinated and actual H1N1 vaccine uptake among US and international
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