Objective: The objective was to determine the awareness, attitudes, and behavior of college students regarding influenza vaccination. Acute respiratory illness, mainly influenza and pneumonia, is the eighth leading cause of death in the United States. Colleges and universities are places where influenza may spread easily due to large numbers of people living, working and learning in a confined area. On the other hand, there may be easy access to immunization services and a possible mandate for student immunization, especially within health professions programs. Associations are explored between influenza immunization behavior of students and university environment characteristics, as well as individual awareness and attitudes.;Methods: This online survey was conducted at a private, comprehensive university, and included full and part-time campus and online students in undergraduate, professional and graduate programs. Academic disciplines were in arts and science, health sciences, business, and law. A structured 24 item Qualtrics survey was created after performing a thorough literature review through PubMed, CINAHL and Cochrane. Surveys on influenza vaccination published by the Centers for Disease Control and Prevention, the World Health Organization, and various health organizations of the United Kingdom and Australia were referenced. Input from a faculty expert on immunizations and in student influenza vaccination, as well as from student health nurses was also used to inform survey design. The survey was pilot tested in nine of 8,992 students for item and response clarity and to determine the survey administration time. For some question sections, the survey had branching to follow-up questions based on previous responses. After approval by the University's Institutional Review Board, the survey was distributed electronically using student email addresses. In an attempt to increase the response rate, students were offered the opportunity to participate in a lottery for two $50 gift cards. Distribution of the survey took place in October 2017 using a modified Dillman's technique in which an invitation e-mail was sent. Two follow-up emails spaced seven days apart were sent to non respondents.;Results: Overall, 3,578 of 8,992 total university students responded, for a response rate of 39.8%. Excluding the incomplete responses, data from a total of 3,277 students (36.4%) was analyzed on SPSS 25.0. Of these respondents, 75% reported receiving vaccination in 2016-17. Reasons given for vaccination were the requirement of their academic program, reducing the risk of influenza and availability of free vaccines. Not getting vaccinated was linked with 'forgetting' to receive the vaccine and not considering themselves at a 'risk to contract influenza.' Students believed that promotion by the university with posters and e-mails positively influenced their vaccination decisions.;Implications: This research seeks to examine responses and associations for those in arts and sciences, health sciences, business, and law; campus versus off-site living; online versus campus students; full and part-time students and variations based on various demographic characteristics. Students' reporting incidents of a "flu-like illness" during the 2016-17 period were further assessed for any associations with vaccine behavior in the 2016-17 season. Health Sciences students were asked about their attitude toward influenza immunization based on presence of a current mandate, as well as their likely behavior in the future if absent of mandates, and how likely they thought they would be to recommend immunization for their future patients.
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