Social Ecological Factors Associated with Parental Vaccination Decisions and Perceptions of Barriers to Childhood Immunizations

Abstract

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.