# Attitudes and behaviors of adolescents with asthma and their parents toward influenza and COVID-19 vaccination: barriers and facilitators of uptake

## TL;DR

This study explores why adolescents with asthma and their parents are hesitant about getting flu and COVID-19 vaccines, and what can encourage better vaccination rates.

## Contribution

The study identifies parental vaccination behavior as a key predictor of adolescent vaccination uptake for both influenza and COVID-19.

## Key findings

- Only 23.6% of asthmatic adolescents had ever received influenza vaccination.
- Parental vaccination status strongly predicted adolescent vaccination behavior for both influenza and COVID-19.
- Safety concerns and lack of physician recommendations were major barriers to vaccine uptake.

## Abstract

Asthma is one of the most common chronic diseases of adolescence and significantly increases the risk of complications from respiratory viral infections such as influenza and COVID-19. Vaccination is the most effective preventive strategy, yet uptake among adolescents with asthma remains suboptimal. Parental beliefs and vaccine hesitancy are crucial determinants of immunization.

This study aimed to evaluate the attitudes and behaviors of asthmatic adolescents and their parents toward influenza and COVID-19 vaccination, with a focus on barriers and facilitators of uptake.

This study was conducted as a descriptive, cross-sectional study at the Pediatric Allergy and Immunology outpatient clinic between May and September 2022. Children aged 12–18 years with a physician-confirmed asthma diagnosis and their parents were consecutively recruited during follow-up visits. A structured questionnaire addressing demographic characteristics, vaccination history, knowledge, attitudes, and concerns was administered face-to-face by physicians working in the Pediatric Allergy and Immunology Department. Data were analyzed using descriptive and comparative statistics, with p<0.05 considered significant.

A total of 212 adolescents with asthma (median age 14 years; 52.8% male) and their parents were included. Only 23.6% had ever received influenza vaccination and 6.6% were vaccinated regularly. Overall, 87.7% and 81.6% of adolescents expressed willingness to receive influenza and COVID-19 vaccines, respectively. Parental vaccination status was the strongest determinant of adolescent vaccination behaviors. Parental influenza vaccination independently predicted adolescent influenza vaccination (OR 7.26, 95% CI 3.29–16.0), and parental COVID-19 vaccination predicted adolescent willingness to receive the COVID-19 vaccine (OR 48.53, 95% CI 12.26–192.18).

Despite high willingness, influenza vaccination rates among asthmatic adolescents remain low, contrasting with high COVID-19 uptake. Parental influence and safety concerns, particularly about long-term effects, were decisive factors. Targeted education, stronger physician recommendations, and clear communication on vaccine safety are essential to improve coverage in this vulnerable group.