Flu Vaccination Among Children of Immigrants: Implication for Children's Immunity during the Pandemic

Background and Purpose:

Influenza (flu), a contagious respiratory disease caused by virus, 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. However, limited knowledge prevents an in-depth understanding of flu vaccination prevalence among children of immigrants, the fastest-growing population in the US. Few studies examined flu vaccination rates associated with immigrant generation, which is an important health determinant. 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 a multivariate logistic regression model, this study estimates the rates of flu vaccination among children in different immigrant generations and compare vaccination rates. As an additional analysis, 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. We report unadjusted and adjusted results for all analyses described above.

Results:

We find that second-generation children had a lower chance to get flu vaccines than children of US-born parents (OR=0.873, CI=0.784-09.71, p<0.01). The post hoc test shows that first-generation children have lower odds of receiving vaccination compared to second-generation children (OR=1.160, CI=1.100-1.224, p<0.0001). Although first-generation children appear to have higher 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. Second-generation children had lower odds of having flu vaccine than children of US-born parents, and first- generation children had higher odds of getting flu vaccines compared to second-generation children, regardless of family poverty status. The results from the unadjusted model are consistent with those from the adjusted model in most analyses.

Conclusions and Implications:

This study identifies that second-generation children group is at risk for low rates of flu vaccination among all children in different generations, irrespective of family poverty status. Consistent with assimilation theory, second-generation families might adopt low levels of vaccination practice prevalent in the US culture. Vaccination hesitancy among second-generation families may be compounded by limited access to health care, prevalent among immigrant families, which do not affect children of US-born parents. At the same time, first-generation children might be less exposed to politically and culturally driven vaccination hesitancy in the US because of low levels of acculturation. Also, recent immigrant families may have already built routine vaccination practice in their home country. Immigration policy that acquires up-to-date vaccine documentation and verification may influence the higher rates of flu vaccination as well. The findings inform that social work should focus on promoting flu vaccine administration among second-generation families. Also, studying protective factors among first-generation families may inform culturally appropriate policy making to boost the children’s immunity.