Kimberly N. Alleyne
Instances of U.S. influenza (flu) activity have reached the epidemic threshold for the 2014-15 flu season according to the Centers for Disease Control and Prevention (2015). Annually there are 15 to 61 million cases of influenza are in the United States; each year 36,000 U.S. deaths are caused by flu. The CDC stresses the importance of vaccination, especially among African-Americans who are less likely to get vaccinated (National Center for Health Statistics, 2011).
Several states (44 states and Puerto Rico for the week ending Jan. 24, 2015) have reported high flu activity. Epidemic levels are indicative of a higher-than-normal number of flu cases. The CDC determined the 2014-15 flu season would be challenging after finding the H3N2 strain in several samples from ill individuals; the H3N2 strain is particularly dangerous and, the CDC says, causes more hospital visits and hospitalizations. Further compounding the ramifications of increased flu activity — more hospitalizations and deaths — is that some pharmacies are finding it difficult to keep flu medicine on the shelves.
Listen to our podcast with Chandra Story, PhD., MCHES
Despite there being an epidemic, as in past flu seasons, African-Americans tend to resist vaccination more so than other groups. Chandra Story, Ph.D., assistant professor at Oklahoma State University College of Education, discovered several reasons for this behavior as part of her dissertation research. In “Influenza Immunization Status Among African Americans: Factors Influencing Vaccination Decisions,” Story found there are three primary factors that inform whether an African-American opts for the flu vaccine:
Says Story, “My study did indicate that social influence is a tremendous factor in whether Blacks receive the flu vaccine. They are more likely to get it if their family and friends and those in their community get the vaccine.:
”Beulah Teachey, Ph.D., R.N. validates Story’s findings: “African-Americans are sometimes less likely to get the flu vaccine because, Teachey says, “Bad information is communicated through word-of-mouth. Someone might tell a friend or a family member that they had a bad experience with vaccination, but they fail to relay all of the facts. A person should not allow one experience, or someone else’s experience to dictate whether or not they get it.”
Perceptions of vaccine safety
Common hindrances also involve a fear that the vaccine itself will cause illness. Older African-Americans in particular are suspicious of the healthcare system, and as Story notes, a reference to the Tuskegee Experiment (Tuskegee Study of Untreated Syphilis in the Negro Male) or other documented medical discrimination is common.
Culturally-appropriate sources of knowledge
Story notes that public home places, such as beauty salons, barber shops, community settings and the Black Church are examples of culturally-appropriate knowledge sources. Interactions in public home places have a significant impact on medical decisions, Story explains.
Story’s findings were based on the survey of 230 African-American adults who reside in Blount County, Tennessee.
According to American Lung Association, in 2008, 25.8 percent of African-Americans reported they received the flu vaccine. This rate was much lower than the nationwide average of 30.5 percent. Additionally, it is estimated that, annually, at least 1,000 flu deaths among African-Americans could be averted with flu vaccination (Fiscella, K, Dresseler, R., Meldrum S., et al. (2007).
Dr. Story writes that other causes for disparities in vaccination rates are “provider-related barriers such as a lack of recommendations from providers, substandard quality of care and missed opportunities for vaccination.”
Hindrances to Trust, Health
There are also patient-related barriers, as Story noted in her research, that contribute to vaccination disparities. They include lack of awareness of the flu vaccination, access, and a misunderstanding of flu susceptibility.
Common hindrances also involve a fear that the vaccine itself will cause illness. Older African-Americans in particular are suspicious of the healthcare system, and as Story notes, a reference to the Tuskegee Experiment (Tuskegee Study of Untreated Syphilis in the Negro Male) or other documented medical discrimination is common among the elderly.
Another reason is mistrust of the healthcare system or healthcare providers. Exacerbating suspicions of the healthcare system are continued occurrences of disparities. For example, African-American nursing home residents are less likely to get flu shots than whites, even within the same facility, according to a 2011 Brown University study. Blacks were also less likely to be offered vaccines; this includes Black nursing home residents.
The Role of Faith Communities in Flu Prevention
Because the Black Church is a public home place, faith communities can play a major part in prevention education among African-Americans, especially since religious leaders and faith tend to be influential cornerstones in the Black community.
The CDC’s faith-based flu toolkit provides tactics for disseminating messages among members of the faith community. Some of the tactics are sharing the message that every person six months and older should get the flu vaccine each year, and communicating with vulnerable and hard-to-reach populations such as homeless, non-English speaking, immigrants and persons who are disconnected from mainstream media.
“We [the Church] will have to combine education with efforts such as health clinics. We also need to include a peer-education component. A nurse at your church, for example, can provide background education before the clinic,” Story says.
People are more likely to believe and trust their peers, people like them. The peer-education component piece is important, Story says, because the vaccine is safe and continues to be the most effective flu prevention method.
Story believes the Black Church is in a position to make a significant impression on flu vaccination rates in the African-American community:
“One thing you have to consider is the influence of the Black Church despite the many denominations. Dr. Martin Luther King, Jr. spoke often about health though it is not often highlighted.”
Click here to read this Tennessee Department of Health resource for starting a health ministry.
The website for AARTH—African Americans Reach and Teach Health says it provides culturally-appropriate education for individuals who care for African-Americans, health education and training for African-American churches and health ministry development for churches among its priorities.
“We should continue to use our public home places such as the Church, barber shops, and community settings. The Bible says the body is a temple so as people of faith we must take care of ourselves and those with chronic diseases. We like to take care of our loved ones as people of color and we can’t do that when we are sick.” And Story says, “we have to proper education about the vaccine and we also must honor people’s experiences. We still have people [in the African-American community] who remember Tuskegee — although it is not a primary reason for their resistance to vaccination– especially in the mind of older African- Americans. We have to do a better job about the education piece and that comes with being a health resource person.”
The disparities in flu vaccination rates, Story offers, is a great opportunity to provide “our expertise and information that is culturally- and spiritually-appropriate.”
The importance of vaccination
Flu.gov warns that most healthy adults can infect others one day before symptoms even manifest and five to seven days after symptoms appear. Individuals with compromised immune systems may be contagious for a longer period.
Flu season typically occurs in the fall and winter, with flu activity peaking in January or February, but it can occur as early as October and as late as May. Symptoms include fever, aches, chills, cough and sore throat.
“Vaccination is very important because it protects the individual and gives him or her a greater sense of well-being,” says Beulah Teachey, Ph.D., R.N. “You also protect those around you, and your children, if you have them.” Teachey, a member of the U.S. Army Nurse Corps, is also a member of the Black Nurses Association.
Each year, five-20 percent of U.S. residents contract the flu and approximately 200,000 people are hospitalized for flu-related complications. Those with chronic diseases such as such as asthma, arthritis or diabetes, for example, have a heightened risk for serious complications are even more susceptible to these complications.
Other groups at risk for developing complications are seniors and children. That’s why Grace Cooper, an Atlanta-area certified nursing assistant, decided to have her children vaccinated. Jasmine, her 16-year-old daughter was the first.
“Jasmine was getting a physical, and her doctor recommended that I get her vaccinated,” Cooper says. “I’m glad I did.”
Several studies on influenza vaccination among African-Americans actually show that Cooper isn’t unique. The patients studied were more likely to get the flu vaccination when their doctor recommended one.
Story’s research affirms this point; a doctor’s recommendation is considered the number one factors that influence Blacks to get vaccinated.
“I work in healthcare and in my past experience I don’t know of anyone who got the vaccination and then got sick. So it is a precautionary measure. I even got my one-year-old grandson vaccinated, and I am going to get vaccinated, too,” Cooper continues.
Cooper’s doctor, Dr. Winston Price, says that yearly vaccination has multiple benefits.
“[It] provides the best protection to children, families, and communities to keep them healthy and lower their risks of hospitalization,” Price explains.
Despite the benefits of vaccination, and efforts by the CDC to educate minority and vulnerable populations about the importance, and safety, of vaccination, hesitation still lingers among many blacks.
For an example, John Eric Rembert, a retired Army veteran, says he was and remains leery of the flu vaccine, but was required to get it while he was active duty.
“The Army made vaccination a requirement, especially when H1N1 [swine flu] broke out,” the Beacon, N.Y. resident says. “I always had minor side effects after I got the shot. Nothing big, just cold symptoms and a headache, but I never got the flu.”
But, Price cautions those who wait to get vaccinated.
“Not getting vaccinated is like crossing a street without looking both ways for traffic. You might get lucky, but you risk getting hit — by the flu — and some people get killed. The shot is easy, safe and in most cases it is free,” he says.
Once an individual receives the flu vaccine, the immune system will create flu-fighting antibodies in approximately 14 days.
Story, who is also a Master Certified Health Education Specialist (MCHES), explains that “The vaccine has a dead virus but it is still designed to trigger your immune system so that your body builds up antibodies. The vaccine may trigger your immune system but it will not make you sick.”
- The flu shot will make me sick. The flu shot (influenza vaccine) is comprised of inactivated viruses so one cannot contract flu from the shot. (American Lung Association State of Lung Disease in Diverse Communities 2010) Dr. Story’s dissertation notes primary research (Kroger et all, 2011) that there are no contraindications to the flu vaccines with the exception of an “allergy to eggs, or a previous allergic reaction.
- ” I’m healthy, I don’t need the vaccine. Anyone can contract influenza, and the CDC recommends that all persons six months and older get the flu shot each year. It is especially important that vulnerable populations — pregnant women, individuals 65 and older, morbidly obese and persons with diabetes and high blood pressure — get vaccinated.
- I cannot afford the flu shot. The flu vaccine is free in some case; it is also covered by Medicare and many health coverage plans. (Dr. Winston Price; American Lung Association State of Lung Disease in Diverse Communities 2010)
Although flu activity is highest between December and February, the season can stretch as late as May. It is not too late to get vaccinated as long as the virus is circulating, according to the CDC. Even an unvaccinated person who has already been affected with a flu virus can still benefit from vaccination since the flu vaccine protects against three-four unique flu viruses that are estimated to spread each flu season.
The CDC recommends that persons six months and older get a flu vaccination annually, especially because the virus strains change every year. Flu vaccines protect against three to four unique flu viruses that are estimated to circulate each flu season trivalent vaccines provide protection against three different vaccines, and quadrivalent vaccines protect against four different vaccines.
One study notes that as many as 1,800 minority deaths can be prevented annually if immunization disparities are eradicated. And Healthy People 2010 projected that 33,000 years of minority life could be gained if immunization gaps are removed.
The CDC also has a list of five ways to fight the flu.
Visit flu.gov for the most recent information on the 2014-15 flu season. Click here more CDC resources for faith-based and community organizations.