Sustainable Public Health Policies: Understanding Influenza Vaccination Uptake Among College Students in a Changing Society

Influenza poses a significant public health threat, causing millions of severe cases and hundreds of thousands of deaths annually. Vaccination remains the most effective measure to reduce transmission, complications, and the strain on healthcare systems. Despite its importance, vaccination uptake remains suboptimal among college students, a key population for infectious disease transmission and a target group for public health interventions. The primary objective of this study was to examine the psychological and contextual determinants of influenza vaccination among college students in Israel, utilizing the Theory of Planned Behavior (TPB) as the guiding framework. A cross-sectional online survey was conducted among 591 students at Ashkelon Academic College between April and May 2023. The questionnaire included validated items assessing attitudes toward vaccination, subjective norms, perceived behavioral control, and vaccination history. Hierarchical logistic regression was used to assess the predictive power of these variables in explaining actual vaccination behavior. The results indicated that prior vaccination was the strongest predictor of current influenza vaccine uptake (OR = 38.7, p < 0.001). Positive attitudes (e.g., belief in vaccine protection), strong social influences (e.g., parental vaccination behavior and trust in healthcare professionals), and high perceived behavioral control (e.g., accessibility and convenience) were all significantly associated with increased vaccination likelihood. The final model explained 68% of the variance in vaccination behavior (Nagelkerke R 2 = 0.68, p < 0.001). These findings affirm the TPB as a robust framework for understanding vaccination behavior and underscore the importance of habitual vaccination, public trust, and systemic accessibility. The study contributes to the field by illustrating how national healthcare infrastructure interacts with individual-level beliefs to shape preventive health actions. Practical applications include the development of targeted interventions to promote first-time vaccination, address vaccine safety concerns, and leverage trusted social networks. Future research should investigate how digital communication, policy variation, and sociocultural context influence the components of the TPB across diverse populations.