Table 3.

Weighted prevalence (%) of children 6 months–17 years for whom their parent received a provider recommendation for them to receive an influenza vaccination,^* and who received influenza vaccination stratified by parental receipt of provider recommendation, by selected sociodemographic characteristics, United States, National Immunization Survey-Influenza (NIS-Flu), 2013–14 through 2015–16 influenza seasons

Characteristics	2013–14 influenza season				2014–15 influenza season				2015–16 influenza season

	Prevalence of provider recommendati on	Influenza vaccination coverage^† by parental receipt of provider recommendation		PAR^‡	Prevalence of provider recommendati on	Influenza vaccination coverage by parental receipt of provider recommendation		PAR	Prevalence of provider recommendati on	Influenza vaccination coverage by parental receipt of provider recommendation		PAR
	Prevalence of provider recommendati on	Recommendati on	No recommendati on	PAR^‡	Prevalence of provider recommendati on	Recommendati on	No recommendat ion	PAR	Prevalence of provider recommendati on	Recommendati on	No recommendati on	PAR

	% (± 95% CI^§)	% (± 95% CI)	% (± 95% CI)	%	% (± 95% CI)	% (± 95% CI)	% (± 95% CI)	%	% (± 95% CI)	% (± 95% CI)	% (± 95% CI)	%

Overall	69.1 (± 2.2)	71.1 (±2.4)	37.0 (±4.6)	38.9	71.0 (± 1.2)	72.4 (±1.4)	34.4 (±2.1)	44.0	70.3 (± 1.2)	72.2 (±1.5)	32.1 (±2.3)	46.8
Child’s age
a. 6–23 months	77.3 (± 4.9)^\|\|,d	79.2 (±5.7)^c,d	34.8 (±10.5)^¶	49.7	80.7 (± 2.5)^c,d	80.8 (±2.6)^c,d	42.5 (±7.2)^d	42.1	80.0 (± 2.5)^b,c,d	80.7 (±3.2)^c,d	37.3 (±6.6)^d	48.2
b. 2–4 years	78.9 (± 4.3)^c,d	79.8 (±4.9)^c,d	43.1 (±8.7)^d	40.2	77.5 (± 2.5)^c,d	77.9 (±2.6)^c,d	43.1 (±6.1)^d	38.5	75.8 (± 2.9)^a,c,d	76.5 (±3.2)^d	40.0 (±6.7)^d	40.9
c. 5–12 years	71.6 (± 3.1)^b,d	71.7 (±3.2)^a,b,d	43.0 (±7.4)^d	32.3	72.3 (± 1.7)^a,b,d	73.6 (±2.1)^a,b,d	37.4 (±3.4)^d	41.2	72.2 (± 1.8)^a,b,d	73.5 (±2.3)^a,d	33.5 (±3.5)^d	46.3
d. 13–17 years	58.2 (± 4.4)^a,b,c	60.6 (±5.2)^a,b,c	30.3 (±7.5)^b,c	36.8	62.5 (± 2.4)^a,b,c	63.2 (±3.2)^a,b,c	27.0 (±3.3)^a,b,c	45.6	61.6 (± 2.3)^a,b,c	63.6 (±3.2)^a,b,c	27.3 (±3.7)^a,b,c	45.0
Child’s sex
a. Male	69.4 (± 3.2)	74.0 (±3.2)^b	38.4 (±6.2)	39.2	71.1 (± 1.6)	74.2 (±1.8)^b	35.4 (±2.9)	43.8	69.2 (± 1.7)	72.2 (±1.9)	33.4 (±3.3)	44.6
b. Female	68.9 (± 3.1)	68.1 (±3.5)^a	35.5 (±6.9)	38.8	70.9 (± 1.7)	70.4 (±2.1)^a	33.3 (±3.1)	44.1	71.5 (± 1.7)	72.2 (±2.3)	30.7 (±3.0)	49.1
Child’s race/ethnicity^**
a. White, non-Hispanic	68.7 (± 2.4)	68.6 (±3.0)^c,d	33.5 (±5.1)	41.9	70.2 (± 1.5)	71.2 (±1.8)^d	31.6 (±2.8)^c,d	46.8	69.2 (± 1.5)	71.4 (±1.9)^d	27.9 (±2.4)^c,d	51.9
b. Black, non-Hispanic	69.0 (± 5.3)	65.0 (±7.4)^c,d	33.6 (±10.0)	39.2	71.0 (± 3.1)	70.0 (±4.1)^d	33.4 (±5.6)^d	43.8	70.5 (± 3.0)	69.8 (±3.8)^d	32.3 (±5.4)^d	45.0
c. Hispanic	70.9 (± 6.3)	76.8 (±4.9)^a,b	45.9 (±13.2)^¶	32.3	72.5 (± 2.7)	74.1 (±3.5)	38.5 (±5.1)^a	40.1	72.9 (± 3.0)	73.6 (±4.1)	38.0 (±5.9)^a	40.6
d. Other, non-Hispanic	67.7 (± 8.7)	81.1 (±5.1)^a,b	42.5 (±16.7)^¶	38.1	72.3 (± 3.4)	78.7 (±3.7)^a,b	43.6 (±7.0)^a,b	36.8	70.6 (± 4.4)	76.6 (±4.4)^a,b	43.7 (±10.0)^a,b	34.7
Language survey completed
a. English	68.4 (± 2.4)^b	70.0 (±2.7)^b,c	36.7 (±4.9)	38.3	70.3 (± 1.2)^b	71.5 (±1.4)^b	32.6 (±2.2)^b,c	45.6	70.0 (± 1.3)	71.2 (±1.6)^b,c	29.8 (±2.3)^b,c	49.3
b. Spanish	77.2 (± 7.5)^a,c	79.0 (±5.7)^a	38.2 (±15.7)^¶	45.2	77.4 (± 3.8)^a,c	79.5 (±5.4)^a	49.7 (±8.5)^a	31.7	75.1 (± 4.6)	80.7 (±5.0)^a	57.1 (±10.2)^¶,a	23.7
c. Other language	63.3 (±11.2)^b	84.5 (±10.4)^¶,a	52.4 (±17.4)^¶	27.9	67.6 (± 8.9)^b	72.5 (±14.6)^¶	60.4 (±14.1)^¶,a	11.9	64.2 (±10.0)	87.4 (±9.5)^a	53.2 (±14.7^)¶,a	29.2
Mother’s education
a. <High school	68.2 (± 7.3)	75.5 (±6.5)^b,c	49.2 (±15.0)^¶,c	26.7	71.2 (± 3.8)^d	75.1 (±4.9)^b,c	41.8 (±7.6)^c	36.2	71.0 (± 4.2)	78.0 (±4.3)^b,c	45.1 (±8.2)^b,c,d	34.1
b. High school or equivalent	63.7 (± 5.9)	63.3 (±6.2)^a,d	33.1 (±12.8)^¶	36.8	67.6 (± 3.1)^d	68.1 (±4.2)^a,d	35.2 (±5.0)	38.7	66.9 (± 3.0)^d	71.3 (±4.0)^a,c	30.7 (±4.7)^a	46.9
c. Some college	68.7 (± 3.5)	66.2 (±4.6)^a,d	28.5 (±4.9)^a,d	47.6	67.7 (± 2.4)^d	66.4 (±2.9)^a,d	30.8 (±4.0)^a	43.9	66.3 (± 2.6)^d	65.7 (±3.4)^a,b,d	27.2 (±3.8)^a	48.4
d. ≥College degree	72.3 (± 3.4)	76.3 (±3.0)^b,c	40.4 (±7.4)^c	39.1	75.7 (± 1.6)^a,b,c	76.4 (±1.8)^b,c	35.2 (±3.4)	47.0	73.9 (± 1.7)^b,c	74.5 (±2.2)^c	31.6 (±3.8)^a	50.1
Poverty/annual household income^††
a. Above poverty (>$75,000)	73.7 (± 3.2)^b,c,d	77.2 (±3.2)^b	38.8 (±6.7)	42.2	76.0 (± 1.7)^b,c,d	75.4 (±2.0)^b	34.4 (±3.7)	47.5	72.5 (± 1.9)^‡‡	74.3 (±2.1)^b	31.8 (±4.1)	49.2
b. Above poverty (≤$75,000)	68.2 (± 3.6)^a	64.1 (±4.5)^a,c	31.2 (±6.9)	41.8	68.5 (± 2.1)^a	68.4 (±2.6)^a,d	32.7 (±3.5)^c	42.8	69.3 (± 2.2)	67.2 (±3.2)^a,c	28.3 (±3.3)^c,d	48.8
c. Below poverty	65.4 (± 5.9)^a	71.3 (±5.4)^b	45.3 (±12.3)^¶	27.3	69.6 (± 2.8)^a,d	71.4 (±3.6)	40.0 (±5.3)^b,d	35.3	68.4 (± 3.0)	76.6 (±3.2)^b	37.1 (±5.7)^b	42.1
d. Unknown	64.5 (± 6.2)^a	70.5 (±5.9)	31.8 (±8.9)	44.0	64.7 (± 3.7)^a,c	74.4 (±4.5)^b	29.4 (±5.3)^c	49.8	69.2 (± 3.4)	71.4 (±4.4)	34.9 (±5.6)^b	42.0
Number of children in household
a. 1	62.2 (± 3.9)^b,c	71.4 (±4.2)	32.2 (±6.5)	43.1	67.9 (± 1.9)^b,§§	72.0 (±2.4)	35.1 (±3.1)	41.7	66.2 (± 2.2)^b,c	72.8 (±3.0)	31.0 (±3.9)^c	47.2
b. 2–3	71.5 (± 3.0)^a	71.7 (±3.2)	39.1 (±6.8)	37.3	73.0 (± 1.6)^a,c	72.2 (±1.9)	34.2 (±3.0)	44.8	71.5 (± 1.6)^a	72.9 (±1.8)	34.7 (±3.1)^c	44.0
c. ≥4	71.4 (± 5.5)^a	67.4 (±7.0)	39.5 (±10.2)^¶	33.5	67.4 (± 4.0)^b	73.7 (±4.4)	33.4 (±7.2)	44.9	73.7 (± 3.6)^a,‡‡	67.6 (±5.5)	21.6 (±5.2)^a,b	61.1
Urban-rural residence
a. Urban (MSA,^\|\|\|\| principal city)	68.4 (± 4.0)	73.3 (±4.0)	34.3 (±7.4)	43.7	73.1 (± 2.3)^c,§§	75.6 (±2.7)^b,c	35.4 (±4.2)	45.4	73.9 (± 2.2)^b,c,§§	77.5 (±2.5)^b,c	38.0 (±4.7)^b,c	43.4
b. Suburban (MSA, not principal city)	70.7 (± 3.1)	70.1 (±3.5)	41.4 (±6.6)^c	32.9	72.0 (± 1.5)^c	71.9 (±1.9)^a,c	35.3 (±2.8)	42.7	70.4 (± 1.7)^a,c	70.4 (±2.1)^a	30.9 (±3.1)^a	47.4
c. Rural (non-MSA)	63.8 (± 4.9)	71.8 (±4.3)	25.7 (±5.9)^b	53.4	62.3 (± 3.3)^a,b	67.8 (±3.3)^a,b	30.0 (±5.2)	44.0	63.7 (± 2.9)^a,b	69.8 (±3.8)^a	28.7 (±4.2)^a	47.7
Region of residence
a. Northeast	73.3 (± 4.2)^b,c	75.9 (±3.8)^b	41.8 (±10.7)^¶,b	37.4	76.6 (± 2.5)^b,c,d	75.1 (±2.9)^b	36.3 (±5.4)	45.0	76.0 (± 2.2)^b,c,d	76.5 (±2.7)^b,c,d	35.3 (±4.6)^b	47.0
b. Midwest	67.3 (± 4.3)^a	65.4 (±5.4)^a	28.4 (±6.1)^a,c	46.7	69.8 (± 2.1)^a	69.4 (±2.5)^a,c	30.6 (±3.8)^c	47.0	70.7 (± 2.0)^a	72.1 (±2.4)^a	29.0 (±3.6)^a,c	51.2
c. South	65.6 (± 3.8)^a,d	71.3 (±3.7)	41.8 (±8.3)^b	31.6	69.2 (± 1.7)^a	73.6 (±2.0)^b	36.0 (±3.1)^b	42.0	68.4 (± 1.7)^a	71.0 (±2.3)^a	34.2 (±3.0)^b	42.4
d. West	73.5 (± 4.8)^c	72.0 (±6.0)	32.9 (±7.3)	46.6	70.9 (± 3.2)^a	71.0 (±3.9)	34.1 (±5.7)	43.4	69.0 (± 3.7)^a	70.8 (±4.8)^a	29.6 (±6.8)	49.0

Children who did not have a provider visit between July 1and the date of the interview during an influenza season were excluded.

^†

Influenza vaccination coverage was calculated by the Kaplan Meier method.

^‡

PAR = population attributable risk. Population attributable risk is a measure to assess the potential contribution of provider recommendation to the observed vaccination level and was calculated using the formula: P (PR-1) / [P (PR-1)+1], where P was the prevalence of receiving a provider recommendation for influenza vaccination and PR was the prevalence ratio of vaccination by provider recommendation.

^§

CI = confidence interval half-width.

^||

The presence or absence of superscripted letters denotes whether that estimate was statistically significantly different at P < 0.05 from another row, and denotes which row it differed from (a, b, c, or d), based on pair-wise comparison t-test. For example, in 2013–14, the percentage of children 6–23 months (a) who received a provider recommendation (77.3%) was statistically significantly different from the percentage of children 13–17 years (d) who received a provider recommendation (58.2%).

^¶

Estimates might not be reliable because confidence interval half-width is >10.

^**

Race/ethnicity is based on parental report. Children of Hispanic ethnicity may be of any race. Children categorized as white, black, or other were identified as non-Hispanic. The other race category included children of reported Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, other, or multiple (i.e. selected more than one race category) races.

^††

Poverty level was defined based on the reported number of people living in the household and annual household income, according to the U.S. Census poverty thresholds (https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html).

^‡‡

Statistically significant difference compared with the estimate for prevalence of provider recommendation from the 2014–15 influenza season.

^§§

Statistically significant difference compared with the estimate for prevalence of provider recommendation from the 2013–14 influenza season.

^||||

MSA = metropolitan statistical area. MSA was based on parent/guardian respondent-reported city, state, county, and zip code of residence using the (https://www.census.gov/programs-surveys/metro-micro.html) MSA definitions file.