Date of Award


Degree Type


Degree Name

Doctor of Public Health

Field of Study



School of Public Health

First Advisor

Kathryn Cardarelli


Influenza illness is a vaccine-preventable disease, yet seasonal outbreaks occur yearly and vaccination coverage rates remain suboptimal. Given that childhood vaccination is dependent on parental decision-making processes, parental beliefs about influenza vaccination are important for elucidating the underlying factors contributing to suboptimal influenza vaccination coverage rates of young children. Furthermore, the 2009 H1N1 influenza pandemic was well-publicized in the media, yet the lack of increased vaccination coverage among pediatric populations during the pandemic may reflect insufficient concern regarding the threat of influenza. Our study aimed to evaluate the effect of social and behavioral factors that may influence parental decision making and subsequently influenza vaccination of children attending daycare during the 2010 – 2011 influenza season in Tarrant County, Texas. Our study involved the administration of a one-time self-administered paper survey to parents of children aged 6 months to 59 months attending home- or center-based daycare. One hundred sixty six parents from twenty-three daycares completed the survey. Logistic regression was used to estimate odds ratios for total associations and corresponding 95% confidence limits (CL) of each factor on influenza vaccine uptake. Our results suggest that physician recommendation (OR=16.4, 95% CL: 5.5, 48.6) and parents with high levels of preventive behaviors (High: OR=7.1, 95% CL: 1.9, 26.4; Moderate: OR=1.4, 95% CL: 0.4, 5.3) influence influenza vaccination of children in daycare. Parents with a high perceived threat of the 2009 H1N1 pandemic influenza strain had greater odds of vaccinating their children than parents with high perceived threat of influenza illness compared to parents with a low perceived threat of influenza illness (High: OR=3.3, 95% CL: 2.1, 5.1; Moderate: OR=1.2, 95% CL: 0.8, 1.8) and this association varied by race/ethnicity. Although preliminary, our findings suggest the potential relation of physician recommendation and parental preventive behaviors, with limited effect of the 2009 H1N1 influenza pandemic, as influential factors in the relation between health beliefs and behaviors and vaccination decision-making for children attending daycare. Future research may benefit from continued exploration of social and behavioral factors that influence influenza vaccination of children in pediatric populations with consideration of the measurement of social and health behavior constructs.


Offutt-Powell, Tabatha N. Individual child and parental factors that influence influenza vaccination in children 6 months to 59 months of age. Doctor of Public Health (Epidemiology), December 2011, 117 pp., 12 tables, 3 illustrations, references, 74 titles.