Patient Characteristics and System-level Factors Associated with Prenatal Influenza Vaccination Counseling: Findings from the Los Angeles Mommy and Baby (LAMB) Survey

Background: Pregnant women are at high-risk for poor outcomes with influenza. Provider counseling has been shown to be an important mediator of women's receipt of flu vaccination. Objective: To investigate both patient characteristics and system level factors associated with provider counseling for flu vaccination in the prenatal setting. Methods: We used data from the 2007 LAMB survey, a population-based survey with multistage clustered sampling of women with live births (N=6264). Prenatal vaccination counseling was assessed by an item asking if providers discussed ‘getting a flu vaccine during pregnancy.' Weighted Pearson's chi-square examined associations between provider counseling and race/ethnicity, language barriers, education, insurance type and site of prenatal care. Results: Only 41% of women reported having discussed flu vaccination with their prenatal care provider. Forty-five percent of white women, 38% of Latinas, 43% of African Americans and 40% of Asians received vaccine counseling (p<0.0004). Among women who reported a language barrier with their provider, 58% did not receive counseling about flu vaccine (p=0.027). College educated women were more often counseled (48%) than women who only completed high school (34%, p<0.0001). Insurance type was not significantly associated with counseling rates. At the system-level, 62% percent of women seen in private physician's offices did not receive counseling, compared with only 51% of women in HMOs (p<0.0002). Discussion: The overall rate of counseling about flu vaccination for pregnant women is unacceptably low and ethnic disparities exist. Providers and public health practitioners should improve counseling for all women and develop strategies to overcome language barriers.