BUFFALO, N.Y. -- Influenza spreads like wildfire on college
campuses because of high-density living conditions. Its symptoms --
weakness, muscle pain, vomiting and diarrhea are unpleasant but
usually not serious, although many people get very sick and
thousands die every year in the U.S. from complications of the
Given all this, we might expect that when offered an effective,
and often free, flu vaccine, college students would get one. But
the vast majority of them do not and it poses a serious threat to
their own health and that of those around them.
A study by University at Buffalo researcher Janet Yang, PhD,
assistant professor of communication, published in the October
issue of Risk Analysis: An International Journal (a publication of
the nonprofit Society for Risk Analysis), considers why vaccination
non-compliance is so common among college students and what can be
done about it.
Yang's study "Too Scared or Too Capable? Why Do College Students
Stay Away from the H1N1 Vaccine?" is based on surveys of college
students in 2010, following the 2009 pandemic of Swine Flu (caused
by the H1N1 virus), which killed an estimated 294,000 people
worldwide. The study is online at
Yang says that during that pandemic, the Centers for Disease
Control undertook a strong outreach program in an attempt to get
college students and other initial target groups vaccinated. The
subsequent vaccination rate for groups like pregnant women and
health care workers was 34.2 percent, but the compliance rate among
college students was only 10 percent. This concerned public health
officials because as of November 2009, 80 percent of H1N1 flu cases
were in people under the age of 30.
In 2010, Yang conducted a survey of 317 college students to
ascertain their attitudes toward the flu and its vaccine and to
find out why they did or did not get vaccinated.
She found that a complex set of factors affected student
avoidance of the vaccine, but that public health officials could
increase compliance rates if they better understood the reasons for
non-compliance and then tailored their outreach communications to
better accommodate this audience.
"Many students surveyed were confident that they had all the
information they needed to make an informed decision about being
vaccinated," Yang says.
"In fact, however, they often did not have even minimal baseline
knowledge of the flu itself or of the vaccine that prevented
One reason for this, she says, is that although the students
considered them credible, many of the sources they relied on for
information about both flu and vaccine were questionable.
"For instance," Yang says, "during the pandemic, dubious
information was circulated on YouTube about the risks associated
with getting the vaccine -- but not about the risks of getting the
flu itself." This contaminated the health information environment
surrounding the flu and complicated efforts to prevent the disease
from spreading, according to Yang.
"It was also the case," she says, "that many students did not
see the relevance of the vaccine to their health or that of others,
and so did not consider vaccination an act of social
responsibility. This also promoted non-compliance.
"Overall," she says, "the study demonstrated how the perception
of risk associated with vaccination could influence individuals'
information-seeking behavior and intention to be vaccinated."
She says as well, however, that specific changes in health
communication could promote vaccination and other healthy behaviors
in this population.
"First," she says, "it is critical that public health
communicators recognize students' existing perceptions and
attitudes toward the vaccine, and understand their emotional
reaction to potential risks such as post-vaccine fever or muscle
"We want to avoid students' unwarranted confidence in their
knowledge of the flu and their ability to adopt preventive
behavior," she says.
"So accurate, credible, documented information about the virus
and its consequences needs to be provided to students," Yang says,
"along with facts about how infection spreads, how it can be
prevented and the safety of the vaccine. All of this should be
presented in a clear format that is easy to find and easy to
She points out that students surveyed who determined their flu
vaccine information source to be credible sought more information,
which in turn increased their intention to get the vaccine.
"It also is critical to present vaccination as an action that
bears personal relevancy and immediacy to the students," Yang says,
"and to this end, the use of emotional appeals and normative social
influences could be quite effective in constructing messages."
Because she used a convenience sample, Yang says her results
should not be over generalized or applied to all college students.
With some caveats in mind, however, she says her findings confirm a
strong role for risk communication in promoting a preventive health
behavior among a unique population group.
Yang's research and publications center on the communication of
risk information related to science, health and environmental
issues, and, in particular, how cognitive and affective evaluations
of risk influence individuals' decision making.
Much of her work focuses on social cognitive factors that
influence information seeking and processing, health decision
making and public perception of environmental and health risks. Her
recent research projects have involved improving communication
about climate change, renewable energy and cancer clinical
Yang was the 2011-12 head of ComSHER: Communicating Science,
Health, Environment and Risk, a division of the Association for
Education in Journalism and Mass Communication.