Reasons for refusing free hepatitis B vaccine in a community-based sample of drug users

Drug use and risky sexual behavior are important risk factors for hepatitis B virus (HBV) transmission. The New York Academy of Medicine currently provides free onsite HBV vaccine for research participants with a drug use history. Study participants are offered HBV vaccine prior to confirming HBV serostatus and complete a questionnaire about knowledge, attitudes, and beliefs regarding HBV and HBV vaccine. The sample was 69.4% male, 48.2% Black and 35.3% Hispanic; 42.5% have less than a 12th grade education and 73.3% reported low legal income levels. Of the 151 (54.9%) individuals that expressed interest in receiving the vaccine, 86.8% indicated that protection against HBV was their primary reason for getting the vaccine. Of the 109 that refused the vaccine, prior vaccination was the main reason for refusal (52.3%), followed by previous HBV infection (21.5%), religious reasons (10.3%), not wanting it (7.5%), dislike of needles (4.7%), waiting for HBV antibody/antigen results (4.7%), not comfortable with the vaccine (3.7%), and time constraints (2.8%). There were no statistically significant differences with respect to demographic, drug use, or sex risk behaviors among those that refused or accepted. Self-reported HBV vaccination was the main reason for refusal, however 50% of those who reported previous vaccination were found to be susceptible by serology (Kappa statistic for comparison between self-reported and serologic evidence of vaccination was 0.19). Thus, vaccination programs for high risk groups should take this into consideration and offer vaccination prior to HBV seroscreening and/or a booster dose in cases where previous vaccination is reported.