OBJECTIVE: Vaccine safety concerns can diminish parents' willingness to vaccinate their children. The objective of this study was to characterize the current prevalence of parental vaccine refusal and specific vaccine safety concerns and to determine whether such concerns were more common in specific population groups. METHODS: In January 2009, as part of a larger study of parents and nonparents, 2521 online surveys were sent to a nationally representative sample of parents of children who were aged ≤17 years. The main outcome measures were parental opinions on vaccine safety and whether the parent had ever refused a vaccine that a doctor recommended for his or her child. RESULTS: The response rate was 62%. Most parents agreed that vaccines protect their child(ren) from diseases; however, more than half of the respondents also expressed concerns regarding serious adverse effects. Overall, 11.5% of the parents had refused at least 1 recommended vaccine. Women were more likely to be concerned about serious adverse effects, to believe that some vaccines cause autism, and to have ever refused a vaccine for their child(ren). Hispanic parents were more likely than white or black parents to report that they generally follow their doctor's recommendations about vaccines for their children and less likely to have ever refused a vaccine. Hispanic parents were also more likely to be concerned about serious adverse effects of vaccines and to believe that some vaccines cause autism. CONCLUSIONS: Although parents overwhelmingly share the belief that vaccines are a good way to protect their children from disease, these same parents express concerns regarding the potential adverse effects and especially seem to question the safety of newer vaccines. Although information is available to address many vaccine safety concerns, such information is not reaching many parents in an effective or convincing manner.

CONTEXT: The source of health information can have an impact on the manner and frequency of its use. In the arena of vaccine safety, a variety of sources promulgate information from very different perspectives. The spectrum runs from traditional sources such as public health officials and physicians to nontraditional sources, such as celebrities. OBJECTIVE:To assess what proportion of parents trust vaccine information from different sources and whether different groups of parents vary in their trust of such information. METHODS:In January 2009, as part of a larger study of parents and nonparents, 2521 online surveys were fielded to a nationally representative sample of parents of children aged Յ17 years. The main outcome measure was the source credibility of vaccine-safety information used by parents. RESULTS:The response rate was 62%. Parents reported trusting their children's doctor for vaccine-safety information most often (76% endorsed a lot of trust), followed by other health care providers (26%), government vaccine experts/officials (23%), and family and friends (15%). In contrast, celebrities were trusted a lot by 2% of the respondents and not at all by 76% of the respondents. Levels of trust in specific sources of vaccine-safety information varied significantly by gender (women Ͼ men) and race/ethnicity (Hispanics Ͼ other groups). CONCLUSIONS:Although most parents place a lot of trust in their child(ren)'s physician, parents' trust in non-health professional sources for such information should not be discounted. Those who design public health efforts to provide evidence-based information must recognize that different strategies may be required to reach some groups of parents who use other information sources. Pediatrics 2011;127:S107-S112

More than 1 of 10 parents of young children currently use an alternative vaccination schedule. In addition, a large proportion of parents currently following the recommended schedule seem to be "at risk" for switching to an alternative schedule.

Objective-Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF).Methods-We surveyed 624 U.S. Department of Veterans Affairs primary care patients in three study groups: 184 with HF, 221 with diabetes and 219 general primary care users. We compared health status and function between those with and without chronic pain within the three study groups. Among those with chronic pain, we compared pain location, severity and treatment across groups.Results-More than 60% in each group reported chronic pain, with the majority reporting pain in the back, hip or knee. In all groups, patients with chronic pain were more likely to report fair or poor health than those without pain (P < .05). In the HF and diabetes groups, a higher percentage of patients with pain were not working because of health reasons. Of those with pain, more than 70% in each group took medications for pain; more than one-half managed pain with rest or sedentary activities; and less than 50% used exercise for managing their pain.Discussion-Chronic pain is a prevalent problem that is associated with poor functioning among multimorbid patients. Better management of chronic pain among complex patients could lead to significant improvements in health status, functioning and quality of life and possibly also improve the management of their other major chronic health conditions. KeywordsChronic Pain; Multi-morbidity; Pain Management Chronic pain is a prevalent condition that has significant negative effects on individuals and the healthcare system. Approximately one-third of adults have chronic or persistent pain and the prevalence of chronic pain increases with age. 1-3 Chronic pain has been linked to limitations in activities of daily living and loss of employment, as well as to increased medical expenditures and poor self-rated health. 4, 5Although the negative effects of chronic pain have been well described, an increasing number of adults suffer from multiple chronic conditions 6 and the experience of chronic pain among these patients is not well understood. In particular, we know little about the type and severity Managing the competing demands of multiple chronic health conditions is a significant challenge for many patients and their primary care providers. 7 Chronic pain is of particular concern as a comorbid condition considering its prevalence among older persons, who also tend to have other chronic conditions, and its association with increased disability, poorer health status and decreased quality of life in general. 3, 8, 9 Prior work also suggests that among patients with other chronic illnesses chronic pain is associated with greater reported difficulty performing certain essential self-management activities. 10, 11 Consequently, better understanding how different conditions interact is essential for improving both quality of care...