Differential effects of honor ideology on flu vaccine uptake in the United States and Turkey

• Honor endorsement is linked with perceived invulnerability to the flu. • The honor-invulnerability link is found in both the U.S. and Turkey. • Honor predicts lower flu vaccine uptake in the U.S., but higher uptake in Turkey. • Collectivist/individualist themes may explain differences between U.S. and Turkey. Flu vaccine uptake is an important public health behavior which contributes to decreased flu mortality and less severe flu symptoms. Despite its proven potential for protecting vulnerable populations, many individuals do not get the flu vaccine due to beliefs or perception that they are invulnerable to the flu. The current research explored whether this perception and its subsequent impact on decreased flu vaccine uptake, may be more prevalent in cultures of honor, where maintaining a reputation of strength and resilience is encouraged. The study also explored if these effects replicate across two different honor cultures (southern United States and Turkey). Results showed that individual-level honor endorsement was linked with perceived invulnerability to the flu in both the U.S. and Turkey but while this was linked to decreased vaccine uptake in the U.S., it was linked with increased uptake in Turkey (Studies 1 and 2). Finally, a regional comparison in the U.S. showed that higher flu mortality in a U.S. honor region was explained by lower rates of flu vaccine uptake in the region (Study 3). Findings suggest that while honor facilitates decreased vaccine uptake among Americans because they perceive themselves strong and invulnerable to flu, it could actually increase uptake in cultures where honor is expressed as protecting one's family.