Public health authorities regularly recommend that health care workers receive influenza vaccine annually to protect themselves, coworkers, patients, and others from the potentially serious health consequences of influenza. Despite this recommendation, a minority (about 40%) of health care workers in the United States and abroad routinely comply. Formative research developed using a social marketing approach indicates a complex structure of perceptions, information, attitudes, and intentions underlying this behavior among health care workers in Rhode Island. As a result, a revised policy (take the vaccine or wear a mask) effective upon designation of widespread influenza in the state produced a substantial increase in vaccination rates among this group. This example indicates the use of social marketing to inform the development of �upstream� policy interventions in public health and discusses the ethical context of this approach.
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