Vaccine Hesitancy: Factors in the Pathways to Pediatric Immunization Decision Making among U.S. Parents of Children ages 0-6 Open Access

Benedict, Samantha C. (2015)

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Background: Parents who delay or refuse vaccines for their children create gaps in herd immunity that leave their children and others vulnerable to infection. School vaccination mandates that have enabled the current high levels of vaccine coverage are circumvented in many states through religious or personal belief exemptions. These often cluster, in schools, neighborhoods, and communities. Sociodemographic characteristics of parents and parent knowledge, attitudes, and beliefs about childhood vaccination play an interconnected role in vaccine decision outcomes. Understanding vaccine hesitant parents can facilitate new methods for improving vaccination coverage.

Objective: This research aims to examine the relationships between parent sociodemographic characteristics and parent knowledge, attitudes, and beliefs about pediatric immunization, with each other and with parental vaccine decision-making. Also, if and to what extent sociodemographic characteristics effect on parental vaccine decision-making is mediated by knowledge, attitudes, and beliefs. By elucidating these relationships we hope to develop a pathway framework.

Methods: Analysis was conducted on two pooled samples from nationally representative online poll of parent opinions about pediatric immunizations. The survey was completed by 2,603 parents ≥18 years with a child 0-6 years in 2012, and by 2,518 in 2014. This study modeled mediating and moderating sociodemographic factors, and persuasive influences on vaccine decisions.

Results: Those influenced by a doctor or nurse had lower odds of choosing to delay (OR=0.55; 95% CI: 0.40, 0.78) or refuse (OR=0.30; 95% CI: 0.16, 0.54), and also less likely to choose to refuse than delay (OR=0.53; 95% CI: 0.29, 0.98), adjusting for KABs. The odds of delaying for those aged 30-44 were higher compared to those 18-29 (OR=2.38; 95% CI: 1.57, 3.61). The West was more likely to delay, and the Midwest more likely to refuse than the South.

Conclusion: Several sociodemographic characteristics exhibited an indirect effect on vaccine decisions; parent knowledge, attitudes, and beliefs mediated the effect. Parent age has a relationship with vaccine decision independent of included KABs variables. Our findings indicate the effectiveness of doctors in promoting immunization uptake. This study also reveals that sociodemographic factors could be used to target practices in geographic areas where vaccine hesitant behavior is more common.

Table of Contents

Chapter I: Introduction. 1-3

Chapter II: Literature Review. 4-33

Chapter III: Methods. 34-42

Chapter IV: Results. 43-59

Chapter V: Discussion. 60-70

Works Cited. 71-77

Tables Sample Description1.1 Sociodemographics by survey year. 78-79

1.2 Descriptive statistics of parental knowledge, attitudes and beliefs. 80

1.3 Weighted descriptive parental knowledge, attitudes and beliefs. 81

1.4 Descriptive statistics for Vaccine Attitude Score. 82

1.5 Variable Descriptions. 83

Bivariate Analysis

2.1 Sociodemographics vs. vaccine decision outcome. 84-85

2.2 KABs vs. vaccine decision outcome. 86-87

2.3 SD vs. KABs: doctor choice. 88-89

2.4 SD vs. KABs: doctor/nurse influence on vaccine decision. 90-91

2.5 SD vs. KABs: How do you approach vaccines?. 92-93

2.6 SD vs. KABs: How do you think other parents approach vaccines?. 94-95

2.7 SD vs. KABs: Do you know someone with a vaccine-injured child?. 96-97

2.8 SD vs. KABs: Do you know someone who delayed a vaccine?. 98-99

2.9 SD vs. KABs: Do you know someone who refused a vaccine?. 100-101

Multivariable Models

3.1 Model 1: KABs vs. vaccine decision. 102-103

3.2 Model 2: SD vs. vaccine decision. 104

3.3 Models 3 & 4: Doctor decision and Dr. or RN influence. 105

3.4 Model 5: How do you approach vaccines?. 106

3.5 Model 6: How do you think other parents approach vaccines. 107

3.5 Model 7: Do you know anyone with a vaccine-injured child?. 108

3.6 Models 8 & 9: Do you know a delayer or refuser?. 109

3.7 Model 10: Vaccine Attitude Score (Linear Regression). 110

3.8 Full/Saturated Model. 111-113


1. Hypothesized Model. 114

2.Sample Population Vaccine Decision. 115

3. Comparing Vaccine Attitude Score to Vaccine Decision. 116

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