Graduation Year

2025

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Epidemiology and Biostatistics

Major Professor

Roneé Wilson, Ph.D.

Co-Major Professor

Janice Zgibor, Ph.D.

Committee Member

Eunsook Kim, Ph.D.

Committee Member

Dinorah Martinez Tyson, Ph.D.

Committee Member

Matthew Valente, Ph.D.

Keywords

health disparities, maternal health, maternal influenza vaccination, vaccine decision making

Abstract

Influenza remains a leading cause of morbidity and mortality in the United States, with Black individuals disproportionately affected. Pregnant women are particularly vulnerable due to their modulated immune state, placing them at increased risk of complications, hospitalization, and intensive care admission. Despite strong evidence supporting the safety and efficacy of maternal seasonal influenza vaccination (SIV), uptake remains suboptimal. This study employed a multi-method design to identify barriers and facilitators of maternal SIV uptake, with a particular focus on racial disparities.

Quantitative analyses utilized the Florida Pregnancy Risk Assessment Monitoring System (FL PRAMS) dataset from the years 2018–2022. In the fully adjusted logistic regression model, maternal race, diabetes, smoking status and insurance type were significantly associated with SIV uptake. Black women had lower odds of vaccination compared with White women (OR =.75, 95% CI: .62-.91), whereas women identifying as “Other” race had greater odds of vaccination (OR = 1.4, 95% CI: 1.05-1.8). Interaction analyses did not identify significant effect modification by race.

The qualitative component, consisting of in-depth interviews, highlighted the central role of provider recommendations, provider trust and perceptions of care quality. Strong provider recommendations encouraged uptake, while medical mistrust, skepticism about the vaccine’s necessity or safety, shaped hesitancy. Emergent themes included maternal motivations to protect the fetus, variable understandings of influenza severity and vaccine function. Although expected, social networks and perceived discrimination were not prominent influences.

These findings underscore the disparities in maternal SIV uptake that persist among Black women may be shaped by both individual and interpersonal factors. The strength and clarity of provider recommendations emerged as a facilitator of vaccine acceptance. Future work should incorporate neighborhood and policy level variables to further unpack mechanisms of vaccine decision-making. Culturally tailored interventions that strengthen provider communication, address medical mistrust and center the experiences of Black women are essential to improving maternal SIV and reducing maternal and child health disparities.

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