Objective: Influenza is one of the major causes of morbidity. This study summarized major components that influence college/university students´ use of the vaccination using Ecological System Theory; and evaluated racial differences in key predictors of influenza vaccination/intention.

Data source: Sixteen engines (e.g., PsycINFO, Academic Search Premier, Science Citation Index) were used to search for cross-sectional studies (2009-2019).

Study inclusion/exclusion criteria: PI/CO criteria were applied (U.S. students, multidimensional ecological system, influenza vaccination/intention).

Data extraction: 25 cross-sectional studies were included from the initial 810 citations. Four reviewers performed the cross-checking.

Data synthesis and results: Higher SES (e.g., education, vaccine affordability, healthcare resource) were positively associated with vaccination/intention. Under micro levels, both internal factors (e.g., positive beliefs, perceptions, attitudes) and external factors (e.g., supports/recommendations from physicians, families or peers, information, engagement in campus activities) enhanced influenza vaccination/intention of students. Meso level factors (private university, dorm-residence, or student housing) also influenced influenza vaccination/intention. Despite limited information on the effects of race on influenza vaccination, the current study synthesized the racial variances in vaccination behaviors of students.

Conclusions: Enhancing positive beliefs, perceptions, or attitudes toward influenza vaccination with students is critical. Information about the safety and effectiveness of vaccination could be provided for students through official media, medical sources/physicians, campaigns, or internet websites. Family-to-student or peer-to-peer awareness campaigns could facilitate the vaccination of students.