Parental barriers to childhood immunizations vary among countries, states and communities. There is a plethora of studies that exist to examine barriers to immunizations including many intervention studies designed to improve immunization rates in children. Often, intervention studies designed to minimize barriers and increase immunization uptake among children lack the inclusion of a standardized instrument to measure accurately parental barriers to childhood immunizations before and after interventions. The Searching for Hardships and Obstacles To Shots (SHOTS) survey is a standardized survey instrument to measure parental barriers to childhood immunizations. In several studies, the SHOTS survey has demonstrated consistent reliability and has been validated in diverse populations. The inclusion of the SHOTS survey instrument in studies to examine barriers to childhood immunization will provide researchers and clinicians with a better understanding of parents' individualized barriers to immunizations. Furthermore, use of the SHOTS survey instrument to collect information about parental barriers to immunizations can lead to targeted interventions to minimize these obstacles at the individual and community level and to help us to achieve our national, state and community childhood immunization goals.
Objectives. Examination of immunization coverage and personal beliefs exemptions (PBEs) to mandated vaccines in child care facilities prior to changes made in schoolentry vaccine laws to identify San Diego County regions with a potential gap in herd immunity related to PBEs that may remain in effect until a child enters a new grade span. Methods. A secondary data analysis was completed on a subset of publicly available data in the 2013-2014 California Child Care Facility (CCF) Assessment. Examination of data by type of CCF and stratified by Health and Human Services Agency Regions. Descriptive findings included measures of central tendency and bivariate analyses were completed using chi-square tests. Results. Among 790 CCFs, children enrolled in private CCFs in the North Coastal HHSA region were least likely to have had all required immunizations (ARI; 82.9%; 95% confidence interval [CI] = 79.6, 86.1). Conversely, children enrolled in Head Start CCFs in the South Region were most likely to have received all immunizations (98.8%; 95% CI = 97.8, 99.7). The private CCFs of the North Coastal region showed the highest mean percentage of children with PBEs, over 29.4 times higher than the South region. Conclusion. Immunization coverage and PBE rates varied significantly throughout San Diego County Regions. Parents of children in CCFs and kindergarten through 6 th grade schools in the North Coastal region should be assessed for barriers to immunization and targeted for community outreach in efforts to increase childhood vaccine uptake.
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