There are a lot of assumptions about the reasons, and not enough qualitative studies in this area. More qualitative research need to be conducted in order to uncover some possible reasons behind the low rates of flu vaccination among older African Americans (65 years or older).

I don't have any hard data, but I would agree with those who say that a general distrust of the medical care system based on events long past but still remembered is part of it.

For example, the family of Charles Drew, the physician who discovered how to bank blood plasma, for years did not contradict the myth that he died because he had been refused a transfusion when taken to an all-white hospital. (You may recall hearing Hawkeye tell that story on ""M*A*S*H.") They thought that, while false, the story helped white people grasp the evils of segregated medicine. Several years ago, however, they decided to begin actively setting the record straight, because they had come to believe that the myth had contributed to a misplaced distrust of the medical system among African Americans, and that that had led to the lower participation of African Americans in things like organ donation.

I will leave it to social scientists to verify this perception. Let me stress that I am not suggesting that we forget the many ways in which medical institutions participated in the oppression of American blacks: the Tuskegee experiments, the active opposition to black physicians by the AMA, and all the rest. For most people of all races, however, the message has to be that mistrust of the medical system—if not of the insurance companies control the payments—is misplaced.

I recently published an integrative review on influenza vaccination practices of registered nurses and there was one qualitative study of predominately African American nurses who refused the vaccination based on mistrust of the medical system and they cited the Tuskegee experiment to support this belief.

I can't help but wonder about the context of your question. Is it that African Americans over 65 years of age are refusing influenza vaccination or is simply a report of prevalence rates? Socioeconomic factors, such as transportation problems, costs, health providers failure to offer vaccinations, and other external factors may contribute to low prevalence rates. Tuskegee may indeed be an influence if the issue is refusal but I think it is wise to clarify the issue prior to attributing the cause to cultural or historical factors.

It is not clear whether why the rates of flu vaccine among older African Americans remains the lowest among all other racial/ethnic groups, hence the need for the study. This is a qualitative inquiry. Additionally, the rates remain low when barriers such as access, education, and lack of insurance, are removed. As noted by several of the comments above, there are many beliefs as to the reasons for the low rates. The intent of my inquiry is to gain the perspective from the target population themselves. I have also found as well that several people do not specifically mention Tuskegee as a reason. From personal experience I also know that there are other racial and ethnic groups outside of African Americans who do not trust the medical system.