Attitudes, beliefs, and characteristics mediating acceptance of childhood non-influenza live attenuated and conjugate vaccines in a 2016 national survey of parents Open Access

Abstract

Background: Understanding the factors related to vaccine acceptance and refusal has been of specific interest in efforts to maintain sufficient vaccine coverage in the United States, but most studies to this point have focused on a wide overview of vaccine acceptance or on a single vaccine or population.

Methods: In November 2016, a cross-sectional survey of parents with a child <7 years of age was conducted to study vaccine-related and non-vaccine-related factors associated with vaccine acceptance (n=886). The survey obtained information on receipt and perceived importance of all vaccines in the childhood schedule, as well as attitudes, beliefs, and information sources. These variables were included in multivariate logistic regression for five routine non-influenza live attenuated and conjugate vaccines to determine mediating factors of receipt.

Results: Reporting social media as a top vaccine information source was associated with highly decreased likelihood of parental reported receipt for MMR (OR: 0.12, 95% CI: 0.021, 0.632), varicella (OR: 0.2, 95% CI: 0.06, 0.86), and RV (OR: 0.1, 95% CI: 0.02, 0.40). Children with no insurance were much less likely to receive Hib vaccine than children with public (OR: 13.5, 95% CI: 2.43, 75.27) or private insurance coverage (OR: 19.0, 95% CI: 3.26, 110.65) and less likely to receive RV than children with public insurance coverage (OR: 4.0, 0.98, 15.95).

Conclusions: The role of information sources, such as social media, family, friends, and religious leaders, as positive or negative mediators of vaccine behavior reinforces the likely influence of social networks in parents' vaccine decision-making. Sociodemographic differences in insurance coverage, household income, education, and marital status highlight both potential barriers to access and populations choosing not to vaccinate. These varying factors suggest that diverse approaches should be taken when targeting specific vaccines for studies or interventions.

Table of Contents

Chapter I: Background/Literature Review...................................................................................................1

Childhood vaccine development and utilization in the United States..............................................................1

Vaccines and childhood vaccine mandates..............................................................................................13

Origins and evolution of vaccine hesitancy, delay and refusal.....................................................................18

Barriers to immunization and sociodemographic disparities..........................................................................23

Chapter II: Manuscript.............................................................................................................................25

Abstract...........................................................................................................................................25

Introduction......................................................................................................................................26

Methods...........................................................................................................................................28

Results.............................................................................................................................................31

Discussion.........................................................................................................................................40

References........................................................................................................................................49

Tables............................................................................................................................................58

Table 1. Selected study participant characteristics..........................................................................58

Table 2. Self-reported recommended childhood vaccine series initiation in age-eligible children.................60

Table 3. Proportion of recommended childhood vaccine series initiated for model-eligible responses...........61

Table 4. Vaccine uptake by statistically significant bivariate and multivariate predictors..........................62

Table 5. Odds of vaccine receipt in bivariate and multivariate logistic regression models by vaccine..........68

Figures ..........................................................................................................................................70

Figure 1. Study participation and exclusion criteria..........................................................................70

Chapter III: Public Health Implications and Future Directions......................................................................72

Appendices.............................................................................................................................................74

Appendix 1. Factors considered in vaccine acceptance model selection by topic...........................................75

Appendix 2. Survey Instrument...........................................................................................................76

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	epidemiology vaccine refusal vaccine hesitancy immunization pediatric vaccines
Committee Chair / Thesis Advisor	Orenstein, Walter, Emory University
Committee Members	Frew, Paula, Emory University
Partnering Agencies	US (Federal) agency other than CDC

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