Abstract: Annual influenza vaccination has been recommended for all adults in the United States since 2010, but coverage estimates indicate that less than half of American adults complied during the 2018-19 flu season. A number of studies have assessed the correlates of adult influenza vaccination attitudes and behaviors, but stagnating flu vaccination rates suggest new approaches are needed to better understand influenza vaccination beliefs, behaviors, and intentions. This work introduces a new concept to the vaccination attitude and behavior literature. This new measure of health decision-making preferences is not only correlated with vaccine confidence and hesitancy, but it is positively related to prior flu vaccination behaviors and future flu vaccination intentions, even after controlling for a host of factors known to influence vaccine attitudes and behaviors. The implications of the new measure for communication and targeted (flu) vaccination messaging are discussed.