Factors Associated With Refusal of Childhood Vaccines Among Parents of School-aged Children

Salmon, Daniel A.; Moulton, Lawrence H.; Omer, Saad B.; deHart, M. Patricia; Stokley, Shannon; Halsey, Neal A.

doi:10.1001/archpedi.159.5.470

Cited by 475 publications

(399 citation statements)

References 21 publications

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“…However, other researchers have shown that even in states allowing religious exemptions only, an increasing number of parents who refuse to have their children vaccinated have secular reasons for their refusal, such as safety concerns about vaccines. 20,21 Our data showed that among states that did not grant exemptions for philosophical reasons, states with procedures that were "easy" had the highest exemption rates. 15 Complex procedures for applying for an exemption may discourage less steadfast religious objectors from acquiring exemptions in "medium" and "difficult" states.…”

Section: Discussionmentioning

confidence: 76%

Exempting Schoolchildren From Immunizations: States With Few Barriers Had Highest Rates Of Nonmedical Exemptions

2013

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Rates of nonmedical exemptions from school immunizations are increasing and have been associated with resurfacing clusters of vaccine-preventable diseases, such as measles. Historically, state-level school immunization policies successfully suppressed such diseases. We examined state immunization exemption regulations across the United States. We assessed procedures for exempting schoolchildren and whether exemption rates were associated with the complexity of the procedures. We also analyzed legal definitions of religious objections and state legislatures' recent modifications to exemption policies. We found that states with simpler immunization exemption procedures had nonmedical exemption rates that were more than twice as high as those in states with more-complex procedures. We also found that the stringency of legal definitions of religious exemptions was not associated with exemption procedure complexity. Finally, we found that although there were more attempts by state legislatures to broaden exemptions than to tighten them in 2011-13, only bills tightening exemptions passed. Policy makers seeking to control exemption rates to achieve public health goals should consider tightening nonmedical exemption procedures and should add vaccine education components to the procedures by either mandating or encouraging yearly educational sessions in schools for parents reluctant to have their children vaccinated.

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Section: Discussionmentioning

confidence: 76%

Exempting Schoolchildren From Immunizations: States With Few Barriers Had Highest Rates Of Nonmedical Exemptions

2013

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“…1,2 Underimmunization has been associated with elevated risk of vaccine-preventable disease in individual patients. [3][4][5][6][7][8][9] Beyond individual risk, nonmedical immunization exemptions have been associated with increased community risk of measles and pertussis outbreaks. 4,6,10 For optimal public health and patient care, clinicians and health care systems ideally should tailor care to their communities.…”

Section: What This Study Addsmentioning

confidence: 99%

Geographic Clusters in Underimmunization and Vaccine Refusal

et al. 2015

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BACKGROUND AND OBJECTIVE: Parental refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in some communities. Such clusters could pose public health risks and barriers to achieving immunization quality benchmarks. Our aims were to (1) describe geographic clusters of underimmunization and vaccine refusal, (2) compare clusters of underimmunization with different vaccines, and (3) evaluate whether vaccine refusal clusters may pose barriers to achieving high immunization rates. METHODS: We analyzed electronic health records among children born between 2000 and 2011 with membership in Kaiser Permanente Northern California. The study population included 154 424 children in 13 counties with continuous membership from birth to 36 months of age. We used spatial scan statistics to identify clusters of underimmunization (having missed 1 or more vaccines by 36 months of age) and vaccine refusal (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes). RESULTS: We identified 5 statistically significant clusters of underimmunization among children who turned 36 months old during 2010–2012. The underimmunization rate within clusters ranged from 18% to 23%, and the rate outside them was 11%. Children in the most statistically significant cluster had 1.58 (P < .001) times the rate of underimmunization as others. Underimmunization with measles, mumps, rubella vaccine and varicella vaccines clustered in similar geographic areas. Vaccine refusal also clustered, with rates of 5.5% to 13.5% within clusters, compared with 2.6% outside them. CONCLUSIONS: Underimmunization and vaccine refusal cluster geographically. Spatial scan statistics may be a useful tool to identify locations with challenges to achieving high immunization rates, which deserve focused intervention.

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“…Several studies have shown that a medical professional's recommendation to vaccinate is positively correlated with vaccination. [13][14][15][16] In our study, parents voiced high confidence in their doctor's recommendations. One parent said: " Doctor' s advice; it' s the best advice.…”

Section: Confidence In Health Care Providersmentioning

confidence: 61%

“…21 Compared with parents of vaccinated children, those of unvaccinated children are less likely to perceive vaccine-preventable diseases to be severe or believe that their own children are susceptible to these diseases. 13 Parents of unvaccinated American children also reported less trust in the government, the vaccine industry, and vaccine researchers. 13 Because of this distrust, some parents continue to voice concerns about vaccine safety even after these concerns have been scientifically refuted in large studies.…”

Section: Applying These Motivators To the United Statesmentioning

confidence: 99%

“…13 Parents of unvaccinated American children also reported less trust in the government, the vaccine industry, and vaccine researchers. 13 Because of this distrust, some parents continue to voice concerns about vaccine safety even after these concerns have been scientifically refuted in large studies. 22 In Pallavapuram, we saw that strong messages about the severity of vaccine-preventable diseases from health professionals and public health campaigns were ingrained in parents' minds, particularly about polio, even in those not personally familiar with the diseases.…”

Section: Applying These Motivators To the United Statesmentioning

confidence: 99%

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Sustaining motivation to immunize

Manthiram

Edwards

Hassan

2014

Human Vaccines & Immunotherapeutics

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Factors Associated With Refusal of Childhood Vaccines Among Parents of School-aged Children

Abstract: Continued efforts must be made to educate parents about the utility and safety of vaccines, especially parents requesting nonmedical exemptions to school immunization requirements.

Cited by 475 publications

References 21 publications

Exempting Schoolchildren From Immunizations: States With Few Barriers Had Highest Rates Of Nonmedical Exemptions

Exempting Schoolchildren From Immunizations: States With Few Barriers Had Highest Rates Of Nonmedical Exemptions

Geographic Clusters in Underimmunization and Vaccine Refusal

Sustaining motivation to immunize

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