Flu Vaccination among Children of Immigrants: Immigrant Generation and Family Poverty

Overview: The study investigates the flu vaccination among children of immigrants by immigrant generation. Based on the nationally representative sample, the findings indicate that the probability of getting the flu vaccine is significantly higher among children of immigrants, particularly among second-generation children, irrespective of family poverty status.Proposal text: Background/Rationale:
Influenza (flu), a contagious respiratory disease caused by virus (CDC, 2022a), remains a prevalent health issue among children. In light of COVID-19, flu vaccination is recommended to be administered along with COVID-19 vaccination among children by CDC (2022b). However, limited knowledge prevents an in-depth understanding of flu vaccination prevalence among children of immigrants, the fastest-growing population in the US. Furthermore, few studies examined flu vaccination rates associated with immigrant generation, which is an important health determinant (Chang, 2018). To this end, this study examines flu vaccination prevalence among children of immigrants in different immigrant generations compared to children of US-born parents. This study also investigates flu vaccination rates by family poverty status, which may have a profound implication for policy development.

Methods:
The study uses the National Health Interview Survey (NHIS) 2010-2018 data with 81,183 sample children aged 0-17. Using multivariate logistic regression model, this study estimates the rates of flu vaccination among children of immigrants compared to children of US-born parents. We then separate the children sample into different immigrant generations and compare vaccination rates. As additional analyses, we assess whether the flu vaccination rates differ by poverty status. Post hoc test examines whether there are differences in vaccination rates between first- and second-generation children.

Results:
We find that children of immigrants have higher odds of getting flu vaccines compared to children of US-born parents (OR=1.145, CL =1.086 -1.207, p < 0.0001). When the sample was grouped by immigrant generations, second-generation children had a 30% higher chance to get flu vaccines than children of US-born parents (OR=1.304, CL=1.100-1.224, p < 0.0001). The post hoc test shows that first-generation children have lower odds of receiving vaccination compared to second-generation children (OR=0.873, CL=0.784-0.971, p < 0.018). Although first-generation children appear to have lower vaccination rates than children of US-born parents, the results were not statistically significant. Additional analyses grouped by family poverty status corroborate our results from the pooled sample. The results from the unadjusted model are consistent with those from the adjusted model.

Conclusions:
Based on the nationally representative children sample, we find that compared to children of US-born parents, the likelihood of getting flu vaccines is significantly higher among children of immigrants, irrespective of family poverty status. Among children of immigrants, second-generation children reported higher odds of getting flu vaccines than first-generation children. While children of immigrants are protected with higher vaccination rates in general, vaccine hesitancy and alternative treatment influenced by cultural health practices might have caused lower vaccination rates among first-generation families. It is also possible that first-generation immigrant families may still face health care barriers in getting access to flu vaccination as it is closely associated with the advice of physicians (Ozer et al., 2022). The findings indicate that active promotion of free-clinic and public resources for flu vaccination and maximizing the potential of the ACA and CHIPRA may increase flu vaccine uptake for first-generation children and keep them safe during the pandemic. The findings of this study may inform the development of culturally sensitive vaccination approaches during the current pandemic.