Parental Vaccination Decisions Research Articles

1140. Impact of an Implementation Science Initiative to Improve Vaccine Confidence for Invasive Meningococcal Disease (IMD) Prevention within American Indian (AI) Communities

Abstract Background Meningococcal vaccine uptake among adolescents remains suboptimal. This project aimed to identify barriers and motivators for vaccination in AI communities. Methods Between 12/2022 and 2/2023, 3 live family education sessions were held within AI communities in WI and ND. Healthcare provider (HCP) participants also attended a workshop to review current vaccine recommendations. Surveys were administered before/after the workshop and family education sessions. Results Surveys were completed by 56 family members. Baseline confidence in vaccine safety, efficacy and benefit was low, which increased after the sessions (Fig. 1). Parent understanding that the vaccine cannot cause disease improved from 51% to 82% (p =.001). Top reported barriers to vaccination were concern for immediate side effects and long-term side effects, and low perceived risk for IMD (34%, 26%, 25%, respectively). Parents identified learning more about IMD (40%), friends/family getting vaccinated (19%), and a local outbreak (12%) as top motivators to seek vaccination. When asked what they thought would motivate families to seek vaccination, HCPs leading the sessions (n=11) identified learning more about IMD (82%) and friends/family getting vaccinated (27%) only. HCP confidence in counseling families was low and improved after the sessions (Fig. 2). HCPs attending the workshop (n=28) reported discomfort contradicting patients/families as the top challenge in addressing vaccine hesitancy, and more HCPs felt confident having conversations to reduce vaccine hesitancy after the workshop (80%) than before (28%). HCP knowledge improved after the workshop, and more HCPs understood that MenACWY booster doses are not needed when initial vaccination occurs at age ≥16 (50%), and correctly identified “provider recommendation” as the top literature-reported factor influencing parental vaccine decisions (50%) compared to baseline (32% and 14%, respectively). HCP action plans for after the sessions prioritized routinely discussing vaccines at well visits (80%), providing written materials (50%) and staying current on new vaccines (50%). Conclusion Parent and provider knowledge and confidence improved after the program and offered insights into community-level motivators and barriers to vaccination. Disclosures All Authors: No reported disclosures

How a 'good parent' decides on childhood vaccination. Demonstrating independence and deliberation during Dutch healthcare visits.

Childhood vaccination consultations are considered an important phase in parents' decision-making process. To date, only a few empirical studies conducted in the United States have investigated real-life consultations. To address this gap, we recorded Dutch vaccination conversations between healthcare providers and parents during routine health consultations for their newborns. The data were analysed using Conversation Analysis and Discursive Psychology. We found that the topic of vaccination was often initiated with 'Have you already thought about vaccination?' (HYATAV), and that this formulation was consequential for parental identity work. Exploring the interactional trajectories engendered by this initiation format we show that: (1) interlocutors treat the question as consisting of two types of queries, (2) conversational trajectories differ according to which of the queries is attended to and that (3) parents work up a 'good parent' identity in response to HYATAV, by demonstrating that they think about their child's vaccination beforehand and make their decisions independently. Our findings shed new light on the interactional unfolding of parental vaccination decisions.

Predictors and impact of trust on vaccine decisions in parents of 2-year-old children in Canada: findings from the 2017 Childhood National Immunization Coverage Survey (cNICS)

Trust is known to be an important factor in vaccine decisions for parents of young children, but there has been a lack of Canadian data measuring the determinants and impact of trust. Using data from the 2017 Canadian Childhood National Immunization Coverage Survey (cNICS), this study analyzed the relationships between sources that parents trust for vaccine information and demographics, parental knowledge, attitudes, and beliefs (KAB) and vaccine decisions (refusal, delay or reluctance) in parents of 2-year-old children who had accepted at least one vaccine for their child (n = 6125). The findings show that 83% of parents trust doctors for vaccine information; 70–80% trust pharmacists, PMH, nurses and HC/PHAC; 34% trust family and 23% trust friends and CAM HCPs. However, parents found to have poor or moderate KAB were less likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC. Parents were also less likely to trust the PMH or HC/PHAC if they had high school education or less or trade/college education, or were widowed, separated, or divorced. Parents who had never been reluctant to vaccinate their 2-year-old child were over 2 times more likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC while parents who trusted family and friends were less likely to delay or refuse vaccines. There was also significant regional variation within Canada, with parents from Quebec most likely to trust doctors, nurses, pharmacists, friends, PMH and HC/PHAC. Parents from the Territories were less likely to trust doctors, nurses and pharmacists, but more likely to trust family. Parents were less likely to trust doctors if they were from the Prairies, and pharmacists if they were from BC, and parents from the Prairies and BC were less likely to trust HC/PHAC. Parents from Ontario were less likely to trust family or friends, but more likely to trust the PMH. Tailored vaccine campaigns are needed to account for educational, marital, and regional differences across Canada to improve vaccine uptake.

What Causes the Discrepancy in SARS-CoV-2 Vaccine Between Parental Hesitancy for Themselves and for Their Children During Lockdown Period?

Parents are usually the decision-makers for vaccinations of children. Therefore, it is important to understand parental beliefs and attitudes toward severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine for themselves and their children when it was approved for children age 3-17. A cross-sectional survey based on an anonymous online questionnaire for parents was conducted in seven provinces of China, and demographic information, vaccination history, parental decision motives, and health belief model toward themselves and their children were collected, respectively. The overall parental hesitancy rate toward themselves was 20.30%, and that toward their children was 7.80%. More parental concerns on disease severity (odd ratio [OR] = 1.11, 95% confidence interval [CI]: 1.01-1.61) and susceptibility (OR = 1.29, 95% CI: 1.01-1.63) of children could be the causes of discrepancy in hesitancy for themselves and for their children. Parents who hesitated to vaccinate themselves might also be hesitated to vaccinate their children (β = 0.077, P < 0.001). Threat perception may lead to inconsistencies in parental vaccination decisions toward themselves and toward their children. Correcting misinformation and strengthening education about COVID-19 are of great significance in addressing vaccine hesitancy among parents and children.

Vaccination - yes or no? What reasons influence the vaccination decision of dog owners? - A survey of responses from private dog owners, breeders and veterinarians

Dogs are important companions in many people's lives. This high priority leads to differentiated considerations regarding the health care of the animal, also with regard to vaccinations. In this study, reasons for the vaccination decision of private dog owners and breeders as well as possible influencing factors were analyzed and compared with the information provided by the participating veterinarians. A total of 1480 private dog owners, 349 breeders, and 365 veterinarians participated in this survey, which was conducted exclusively online using the LimeSurvey software. Absolute and percentage frequencies, mean values and standard deviations were analyzed based on the information provided by dog owners and veterinarians. A Mann Whitney test was used to compare the change in vaccination behavior between private dog owners and breeders. A total of 98 % of participants in this study classified their dog as a family member. The evaluation of reasons that influence the vaccination decision of dog owners showed that anxieties and a sense of responsibility play a greater role for dog owners than external circumstances. However, from the point of view of the participating veterinarians, financial aspects and requirements of third parties such as dog schools or boarding houses possess a stronger influence on the vaccination decision than dog owners stated. The evaluation of the vaccination motives of dog owners revealed results similar to the information provided in parental vaccination decisions. The comparison between statements of the interviewed veterinarians and accounts by the dog owners shows a clear need for communication and education for vaccinations in veterinary practice. Already established strategies from human medicine may also be used for this purpose in veterinary practice and should be developed for veterinary medicine in the future.

The impact of negative emotional reactions on parental vaccine hesitancy after the 2018 vaccine event in China: A cross-sectional survey

ABSTRACT Vaccination programs are cost-effective for preventing communicable diseases, yet vaccine events caused vaccine crises among parents nationwide, which has created challenges for current and future vaccination programs. This study aimed to investigate parents’ emotional reactions (i.e., anger and anxiety) toward the 2018 vaccine event in China and explore the associations between parental emotional reactions and vaccine decision-making. A cross-sectional survey was conducted among 1,135 parents in 2018. Five-point Likert scales were provided for respondents to rank their anger and anxiety toward the event, and their vaccine-related trust and intentions before and after the event. Multiple logistic regression analyses were employed to explore the associations. Regarding the vaccine event, 576 (50.8%) and 402 (35.4%) respondents felt very angry and angry, and 310 (27.4%) and 516 (45.5%) respondents felt very anxious and anxious, respectively. Altogether, 797 (70.3%) respondents reported a lower trust in domestically produced vaccines after the event, and 704 (62.3%) respondents reported declines in intention to choose domestically produced vaccines for their children. Multiple logistic regression analyses revealed that anxiety was a predictor of lower trust and intention after the event (p < .001), anger was a predictor of lower trust (p = .005), and both were risk factors for declines in trust and intention (p < .01). This study confirmed that negative emotional reactions toward a vaccine event were important contributors for parental vaccine decisions. Health authorities and facilities are encouraged to act in a timely manner to reduce the public’s negative emotions by providing rapid crisis responses.

Expectant parents' vaccine decisions influenced by the 2018 Chinese vaccine crisis: A cross-sectional study

Immunization programs have been challenged by vaccine crises. Between 2013 and 2018, China has experienced three major vaccine scandals and crises, which has partly impaired Chinese public trust in domestically produced vaccines. This study aims to explore the associations between parental trust toward CDC-released crisis communication information, parents' critical understanding of crisis information, parental confidence in vaccine efficacy, and parental vaccine decisions. A cross-sectional survey was conducted among 1065 expectant parents two weeks after the 2018 vaccine crisis was revealed. The proportion of parental hesitancy toward domestically produced vaccines and overall vaccination increased from 30.6% to 82.7% and 8.3% to 52.1%, respectively, after the crisis. Parents with higher levels of trust toward crisis communication information were less likely to report vaccine hesitancy toward both domestically produced vaccines and vaccines overall after the crisis. Parents with better critical understanding of crisis information were less likely to report a vaccine hesitancy toward overall vaccine and more likely to maintain a vaccine intention. Additionally, parents with lower levels of confidence in vaccine efficacy were more likely to became vaccine hesitant but were also more likely to maintain their vaccine intentions after the crisis. It is crucial to guarantee the safety of vaccines, maintain parental confidence in vaccine efficacy, and eliminate the potential risks that result in parental vaccine hesitancy. Future crisis communication strategies are encouraged to ensure timely responses to sustain public confidence.

A qualitative study of parental views of HPV vaccination in Ireland

Background Despite significant evidence supporting the Human Papillomavirus (HPV) vaccine in the prevention of cervical cancer, uptake of this vaccine is below target in many countries. HPV uptake in Ireland has declined from 87% in 2014–15 to 51% in 2016–17 and currently remains suboptimal at 64.1% in 2017–18. Objectives This study aimed to explore parental views of the HPV vaccine; elucidate specific concerns relating to this vaccine and to identify relevant influences on the decision to vaccinate against HPV to inform strategies to optimise uptake. Methods An in-depth qualitative study, using semi-structured interviews was conducted among parents of 11–13-year-old girls (n = 18) who had not yet been offered the HPV vaccine. Convenience sampling was used. Interviews, conducted in the Republic of Ireland over six-months in 2018, were audio-recorded, transcribed, and analysed by thematic analysis. Results Eighteen interviews were conducted (14 female and 4 male participants). Parents favoured HPV vaccination to protect their daughters and prevent disease. Barriers to vaccination included; the fear of long-term side effects, lack of knowledge and the risk versus benefit ratio. General practitioners (GPs) were identified as having a strong influence over parental vaccination decisions, as did media reports and the recent cervical screening programme controversy in Ireland. Conclusion This study suggests that significant parental concerns remain to the HPV vaccine. More comprehensive information on the research surrounding this vaccine’s safety profile is required. GP’s may play a pivotal role in HPV vaccination going forward.

Using classification and regression tree analysis to explore parental influenza vaccine decisions

Background and objectivesInfluenza poses a public health threat for children and adults. The CDC recommends annual influenza vaccination for children <18 years, yet vaccine uptake remains low for children (57.9%) and adults (37.1%). Given that parental decision-making is key in childhood vaccine uptake, there is a critical need to understand vaccine hesitancy among parents who decide not to vaccinate their children. This study aims to explore predictors of children’s influenza vaccine status given parental vaccination status and examine the factors that contribute to concordance or discordance between parental and children’s vaccine uptake. MethodsClassification and regression tree (CART) analyses were used to identify drivers of parental decisions to vaccinate their children against influenza. Hierarchy and interactions of these variables in predicting children’s vaccination status were explored. ResultsFrom a nationally representative sample of non-Hispanic Black and White parents who completed an online survey (n = 328), the main factors influencing parents’ decisions to vaccinate their children were vaccine behavior following physician recommendation, knowledge of influenza recommendations for children, influenza vaccine confidence and disease risk. Among unvaccinated parents, the greatest concordance was observed among parents who usually do not get vaccinated following physician recommendation and had lower knowledge of recommendations for influenza vaccination for children. The greatest discordance was observed among unvaccinated parents who had lower hesitancy about recommended vaccines. ConclusionsUnderstanding drivers of parental decisions to vaccinate themselves and their children can provide insights on health communication and provider approaches to increase influenza vaccine coverage and prevent influenza related mortality.

Childhood vaccinations: knowledge, attitudes and practices of paediatricians and factors associated with their confidence in addressing parental concerns, Italy, 2016.

BackgroundPaediatrician recommendations are known to influence parental vaccine decisions.AimOur aim was to examine vaccination knowledge, attitudes and practices among paediatricians in Italy and identify factors associated with their confidence in addressing parental questions.MethodsAn electronic questionnaire survey was conducted from February to March 2016, among a sample of Italian paediatricians.ResultsThe survey was completed by 903 paediatricians (mean age: 56 years). Of 885 who responded to the specific question, 843 (95.3%) were completely favourable to vaccinations. Sixty-six per cent (570/862) felt sufficiently knowledgeable about vaccinations and vaccine-preventable diseases to confidently discuss them with parents. Paediatricians who were male, who were 55 years or older, who had participated in training courses in the last 5 years, who reported that taking courses and reading the scientific literature had contributed to their knowledge, or who had implemented vaccination promotion activities, felt more knowledgeable than other paediatricians. When asked to rate their level of agreement with statements about vaccine safety and effectiveness, only 8.9% (80/903) responded fully as expected. One third (294/878) did not systematically verify that their patients are up to date with the immunisation schedule. Only 5.4% (48/892) correctly identified all true and false contraindications.ConclusionsThe majority of paediatricians in Italy are favourable to vaccination but gaps were identified between their overall positive attitudes and their knowledge, beliefs and practices. Targeted interventions are needed aimed at increasing paediatricians’ confidence in addressing parents’ concerns, strengthening trust towards health authorities and improving systems barriers.

Parental Decision-Making on Childhood Vaccination.

A growing number of parents delay vaccinations or are deciding not to vaccinate their children altogether. This increases the risk of contracting vaccine-preventable diseases and disrupting herd immunity, and also impairs the trust in the capacities of health care systems to protect people. Vaccine hesitancy is related to a range of both psychological and demographic determinants, such as attitudes toward vaccinations, social norms, and trust in science. Our aim is to understand those determinants in parents, because they are a special group in this issue—they act as proxy decision makers for their children, who are unable to decide for themselves. The fact that deciding to vaccinate is a socially forced choice that concerns a child's health makes vaccine-related decisions highly important and involving for parents. This high involvement might lead to parents overemphasizing the potential side effects that they know to be vaccine-related, and by amplifying those, parents are more focused on the potential outcomes of vaccine-related decisions, which can yield specific pattern of the outcome bias. We propose two related studies to investigate factors which promote vaccine hesitancy, protective factors that determine parental vaccination decisions, and outcome bias in parental vaccination intentions. We will explore demographic and psychological factors, and test parental involvement related to vaccine hesitancy using an online battery in a correlation panel design study. The second study is an experimental study, in which we will investigate the moderating role of parents' high involvement in the specific domain of vaccination decision making. We expect that higher involvement among parents, compared to non-parents, will shape the pattern of the proneness to outcome bias. The studies will be conducted across eight countries in Europe and Asia (Finland, Germany, Hong Kong, the Netherlands, Serbia, Slovenia, Spain, and the United Kingdom), rendering findings that will aid with understanding the underlying mechanisms of vaccine hesitancy and paving the way for developing interventions custom-made for parents.

Immunology beliefs as a factor in vaccine opposition among complementary and alternative medical providers.

Objectives:Parental pediatric vaccine decisions are influenced by parents’ health provider networks. Complementary and alternative medical providers may be key influences in the networks of those parents who do not vaccinate their children.Methods:From March to July 2013, we conducted semi-structured interviews of Oregon complementary and alternative medical providers (N = 36) in five disciplines likely to treat parents or children, or both, and whose practitioners are known to express opinions about vaccines and vaccination. We interviewed them concerning their immunology beliefs, vaccine positions, and what these providers recommend to their patients concerning vaccines. We conducted face-to-face interviews and analyzed the interview data using thematic analysis methodology.Results:This article identifies the range and type of immunological beliefs of complementary and alternative medical providers concerning pediatric vaccine recommendations. From repeated readings of the data, we identified three areas of alternative immunological beliefs among complementary and alternative medical providers (i.e. “natural is best,” “innate intelligence,” and “the fragile immune system”). In addition, complementary and alternative medical providers who embraced mainstream medicine were likely to be vaccine accepters and to mention vaccines as a positive health measure to their patients—these themes were “vaccines prevent illness” and “herd immunity.”Conclusion:Complementary and alternative medical providers influence their patients’ vaccination decisions, particularly urging caution or complete vaccine avoidance, and may be a major influence in states like Oregon with high non-medical exemption rates. Complementary and alternative medical providers come to their anti-vaccine positions largely through post-graduation continuing education courses and seminars. In Oregon, such courses are unregulated and not vetted.

Predictors of self and parental vaccination decisions in England during the 2009 H1N1 pandemic: Analysis of the Flu Watch pandemic cohort data

During the 2009 H1N1 pandemic, UK uptake of the pandemic influenza vaccine was very low. Furthermore, attitudes governing UK vaccination uptake during a pandemic are poorly characterised. To the best of our knowledge, there is no published research explicitly considering predictors of both adult self-vaccination and decisions regarding whether or not to vaccinate one’s children among the UK population during the H1N1 pandemic. We therefore aimed to identify predictors of both self-vaccination decisions and parental vaccination decisions using data collected during the H1N1 pandemic as part of the Flu Watch cohort study.Data were analysed separately for 798 adults and 85 children: exploratory factor analysis facilitated reduction of 16 items on attitudes to pandemic vaccine into a smaller number of factors. Single variable analyses with vaccine uptake as the outcome were used to identify variables that were predictive of vaccination in children and adults. Potential predictors were: attitudinal factors created by data reduction, age group, sex, region, deprivation, ethnicity, chronic condition, vocation, healthcare-related occupation and previous influenza vaccination.Consistent with previous literature concerning adult self-vaccination decisions, we found that vaccine efficacy/safety and perceived risk of pandemic influenza were significant predictors of both self-vaccination decisions and parental vaccination decisions. This study provides the first systematic attempt to understand both the predictors of self and parental vaccination uptake among the UK general population during the H1N1 pandemic. Our findings indicate that concerns about vaccine safety, and vaccine effectiveness may be a barrier to increased uptake for both self and parental vaccination.

The Influence of Religiosity and Spirituality on Rural Parents' Health Decision Making and Human Papillomavirus Vaccine Choices.

General health implications of religiosity and spirituality on health have been associated with health promotion, so the purpose of this study was to examine the influence of religiosity and spirituality on rural parents' decision making to vaccinate their children against human papillomavirus (HPV). The associations of religiosity and spirituality with parental HPV vaccine decisions were examined in a sample of parents residing in small rural communities (N = 37). Parents of children aged 9 to 13 years participated in focus groups held in rural community contexts. Religiosity (i.e., participation in religious social structures) was a recurring and important theme when discussing HPV vaccination. Spirituality (i.e., subjective commitment to spiritual or religious beliefs) was found to influence the ways in which parents perceived their control over and coping with health issues potentially related to HPV vaccination. Together, religiosity and spirituality were found to play integral roles in these parents' lives and influenced their attitudes toward HPV vaccination uptake for their children.

Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial.

Physicians have a major influence on parental vaccine decisions. We tested a physician-targeted communication intervention designed to (1) reduce vaccine hesitancy in mothers of infants seen by trained physicians and (2) increase physician confidence in communicating about vaccines. We conducted a community-based, clinic-level, 2-arm cluster randomized trial in Washington State. Intervention clinics received physician-targeted communications training. We enrolled mothers of healthy newborns from these clinics at the hospital of birth. Mothers and physicians were surveyed at baseline and 6 months. The primary outcome was maternal vaccine hesitancy measured by Parental Attitudes on Childhood Vaccines score; secondary outcome was physician self-efficacy in communicating with parents by using 3 vaccine communication domains. We enrolled 56 clinics and 347 mothers. We conducted intervention trainings at 30 clinics, reaching 67% of eligible physicians; 26 clinics were randomized to the control group. Maternal vaccine hesitancy at baseline and follow-up changed from 9.8% to 7.5% in the intervention group and 12.6% to 8.0% in the control group. At baseline, groups were similar on all variables except maternal race and ethnicity. The intervention had no detectable effect on maternal vaccine hesitancy (adjusted odds ratio 1.22, 95% confidence interval 0.47-2.68). At follow-up, physician self-efficacy in communicating with parents was not significantly different between intervention and control groups. This physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy. Research is needed to identify physician communication strategies effective at reducing parental vaccine hesitancy in the primary care setting.

Parent and provider perspectives on immunization: Are providers overestimating parental concerns?

ObjectivesData are limited on whether providers understand parental attitudes to recommended childhood immunizations. We determined parental attitudes and assessed how accurately providers estimated parental opinions. MethodsSurvey of parents and providers (pediatricians, nurses, medical assistants) in randomly selected practices in Houston, Texas. Surveys assessed demographics, perceptions of immunization importance, safety and efficacy, and acceptability of vaccine delivery. Providers estimated parental responses. Results401 parents (82% mothers, 12% fathers, 6% other) and 105 providers participated. Parents thought vaccines were important for health (median score 9.5; 0=not important, 10=extremely important) but also were concerned regarding vaccine safety and side effects (8.9 on 0–10 scale). 309 (77%) agreed that vaccines effectively prevent disease. Route of administration mattered to 147 (37%), who preferred injection (9.0) over oral (7.3) or intranasal (4.8) routes. Although parents would prefer three or fewer injections per visit, preventing more diseases (189 [47.6%]) was more important than number of injections (167 [42.3%]) when deciding the number of vaccines allowed per visit. White parents rated vaccines less important in preventing some illnesses than did non-white (P≤0.006 for meningitis, hepatitis, HPV, influenza and rotavirus) and rated number of injections per visit more important than number of diseases prevented (51.6% white versus 34.2% non-white; P 0.002). Providers underestimated parental attitudes toward vaccine importance (particularly influenza and HPV), and overestimated the proportion of parents who thought route of administration mattered (63%) and that number of injections per visit was the most important factor (76%) around parental vaccine decisions (P<0.001 for parent–provider mismatch). ConclusionsMost surveyed parents believe vaccines are important for child health and rate disease prevention higher than number of injections entailed. Providers underestimate the importance of some vaccines to parents and overestimate parental concerns regarding route of administration. Future research should focus on how this mismatch impacts parental vaccine decisions.

Vaccine Perceptions Among Oregon Health Care Providers

Health care providers exert a significant influence on parental pediatric vaccination decisions. We conducted hour-long interviews with traditional and alternative health care providers in which we explored a range of associations between vaccination perceptions and practice. A key finding was that the Health Belief Model constructs of perceived susceptibility to and severity of either an illness or an adverse vaccine event partially explained health care provider (HCP) beliefs about the risks or benefits of vaccination, especially among alternative care providers. Low or high perceived susceptibility to a vaccine-preventable disease (VPD) or of the severity of a given VPD affects whether an HCP will promote or oppose pediatric vaccination recommendations. Beyond these perceptions, health and vaccination beliefs are affected by the contextual factors of personal experience, group norms, immunology beliefs, and beliefs about industry and government. Building powerful affective heuristics might be critical to balancing the forces that defeat good public health practices.

Association of vaccine-related attitudes and beliefs between parents and health care providers

ObjectivesHealth care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child's health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child's primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents. MethodsWe surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002–2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression. ResultsSurveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief. ConclusionsThe beliefs of children's health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.

Factors That Influence Parental Vaccination Decisions for Adolescents, 13 to 17 Years Old

We aim to describe factors that influence parental decisions to vaccinate their adolescents. Data from the July to December 2010 National Immunization Survey-Teen Parental Concerns Module were analyzed to determine factors that influence parental decisions to vaccinate their adolescents. Parents reported that their adolescent's health care provider recommended tetanus toxoid/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Td/Tdap; 74.4%), meningococcal conjugate (MenACWY; 60.3%), and human papillomavirus (HPV; 71.3%). Vaccination coverage estimates were significantly higher among parents who reported receiving a provider recommendation: 85.2% versus 76.7% (Td/Tdap), 77.3% versus 49.7% (MenACWY), and 62.2% versus 21.5% (HPV). Compared with Td/Tdap and MenACWY, fewer HPV vaccination conversations included recommendations for vaccination. Other than health care providers, school requirements (46.1%), news coverage (31.2%), and family (31.0%) were most frequently reported influences on parental vaccination decisions. Many factors influence parental decisions to vaccinate their adolescents; one of the most important factors is the provider recommendation. Missed opportunities for vaccination persist when strong vaccination recommendations are not given or are delayed.

Parental decline of pneumococcal vaccination and risk of pneumococcal related disease in children

BackgroundAn increasing number of parents are choosing to decline immunizations for their children. This study examined the association between the parental decision to decline pneumococcal conjugate (PCV7) vaccinations and the risk of hospitalization due to pneumococcal disease or lobar pneumonia in children. MethodsWe conducted a case–control study nested within a cohort of children enrolled in the Kaiser Permanente Colorado (KPCO) health plan between 2004 and 2009. Each child hospitalized with pneumococcal disease or lobar pneumonia (n=106) was matched to 4 randomly selected controls (n=401). Cases were matched to controls by age, sex, high-risk status, calendar time, and length of enrollment in KPCO. Disease status and parental vaccination decisions were validated with medical record review. Cases and controls were classified as vaccine decliners or vaccine acceptors. ResultsAmong 106 cases, there were 6 (6%) PCV7 vaccine decliners; among 401 controls, there were 4 (1%) vaccine decliners. Children of parents who declined PCV7 immunization were 6.5 times (OR=6.5; 95% CI=1.7, 24.5) more likely to be hospitalized for invasive pneumococcal disease or lobar pneumonia than vaccinated children. ConclusionsParental decline of pneumococcal vaccination apparently increases the risk for hospitalization due to pneumococcal disease or lobar pneumonia in children. Providers can use this information when helping parents weigh the benefits and risks of immunizing their children.