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Xie YJ, Liao X, Lin M, Yang L, Cheung K, Zhang Q, Li Y, Hao C, Wang HH, Gao Y, Zhang D, Molassiotis A, Siu GKH, Leung AYM. Community Engagement in Vaccination Promotion: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e49695. [PMID: 38478914 PMCID: PMC11127135 DOI: 10.2196/49695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/27/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. OBJECTIVE This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. METHODS This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. RESULTS A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children's immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P<.001) and between-group comparison (RD 0.18, 95% CI 0.07-0.29, I2=98.4%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95% CI 0.36-0.67, I2=99.9%, P<.001), followed by intervention development (RD 0.36, 95% CI 0.23-0.50, I2=100.0%, P<.001), intervention implementation (RD 0.35, 95% CI 0.22-0.47, I2=99.8%, P<.001), and data collection (RD 0.34, 95% CI 0.19-0.50, I2=99.8%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95% CI 0.17-0.82, I2=100.0%, P<.001), followed by moderate community engagement extent (RD 0.45, 95% CI 0.33-0.58, I2=99.6%, P<.001) and low community engagement extent (RD 0.15, 95% CI 0.05-0.25, I2=99.2%, P<.001). The meta-analysis revealed that "health service support" demonstrated the largest effect sizes (RD 0.45, 95% CI 0.25-0.65, I2=99.9%, P<.001), followed by "health education and discussion" (RD 0.39, 95% CI 0.20-0.58, I2=99.7%, P<.001), "follow-up and reminder" (RD 0.33, 95% CI 0.23-0.42, I2=99.3%, P<.001), and "social marketing campaigns and community mobilization" (RD 0.24, 95% CI 0.06-0.41, I2=99.9%, P<.001). CONCLUSIONS The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a "fit-for-purpose" approach rather than a "one-size-fits-all" approach to maximize the effectiveness of vaccine promotion. TRIAL REGISTRATION PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339081.
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Affiliation(s)
- Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Xiaoli Liao
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Meijuan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Harry Hx Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Alex Molassiotis
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Gilman Kit Hang Siu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Angela Yee Man Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Institute on Smart Aging (RISA), The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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McCann E, Ladzekpo D, Lendrum E, Burkhardt MC, Klein M. Understanding Immunization Hesitancy in Underserved Neighborhoods. Clin Pediatr (Phila) 2024; 63:461-465. [PMID: 37477186 DOI: 10.1177/00099228231186501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
- Erin McCann
- Department of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Deawodi Ladzekpo
- Department of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth Lendrum
- Department of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mary Carol Burkhardt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Melissa Klein
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Newcomer SR, Graham J, Irish K, Freeman RE, Leary CS, Wehner BK, Daley MF. Identification of Spatial Clusters of Undervaccination Patterns Among Children Aged <24 Months Using Immunization Information System Data, Montana, 2015-2019. Public Health Rep 2024; 139:360-368. [PMID: 37503702 PMCID: PMC11037227 DOI: 10.1177/00333549231186603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Spatial clustering of undervaccination leads to increased risk of vaccine-preventable diseases. We identified spatial clustering of undervaccination patterns among children aged <24 months in Montana. METHODS We used Montana's immunization information system data to analyze deidentified vaccination records of children aged <24 months born from January 2015 through November 2017. We measured 3 outcomes that were not mutually exclusive: not completing the combined 7-vaccine series by age 24 months, having an undervaccination pattern indicative of parental hesitancy, and having an undervaccination pattern indicative of structural barriers to timely vaccination. Using geomasked residential addresses, we conducted separate Bernoulli spatial scans with a randomization P < .01 to identify spatial clusters consisting of ≥100 children for each outcome and calculated the relative risk of having the undervaccination pattern inside versus outside the cluster. RESULTS Of 31 201 children aged <24 months included in our study, 11 712 (37.5%) had not completed the combined 7-vaccine series by age 24 months, and we identified 5 spatial clusters of this outcome across Montana. We identified 4 clusters of undervaccination patterns indicative of parental vaccine hesitancy, all in western Montana. The cluster with the largest relative risk (2.3) had a radius of 23.7 kilometers (n = 762 children, P < .001). We also identified 4 clusters of undervaccination patterns indicative of structural barriers, with 3 of the largest clusters in eastern Montana. CONCLUSION In Montana, different strategies to increase routine and timely childhood vaccination are needed in distinct areas of this large and predominantly rural state. Immunization information system data can pinpoint areas where interventions to increase vaccination uptake are needed.
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Affiliation(s)
- Sophia R. Newcomer
- School of Public and Community Health Sciences and Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Jon Graham
- Department of Mathematical Sciences and Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Kayla Irish
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Rain E. Freeman
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Cindy S. Leary
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Bekki K. Wehner
- Communicable Disease Bureau, Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Matthew F. Daley
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
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O'Leary ST, Opel DJ, Cataldi JR, Hackell JM. Strategies for Improving Vaccine Communication and Uptake. Pediatrics 2024; 153:e2023065483. [PMID: 38404211 DOI: 10.1542/peds.2023-065483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
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Daley MF, Clarke CL, Glanz JM, Albers AN, Michels SY, Freeman RE, Newcomer SR. National trends in patterns of under-vaccination in early childhood: National Immunization Survey-Child, United States, 2011-2021. Expert Rev Vaccines 2024; 23:740-749. [PMID: 39109453 DOI: 10.1080/14760584.2024.2389922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/24/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The study's objective was to examine national trends in patterns of under-vaccination in the United States. RESEARCH DESIGN AND METHODS The National Immunization Survey-Child (NIS-Child) is an annual cross-sectional survey that collects provider-verified vaccination records from a large national probability sample of children. Records from the 2011-2021 NIS-Child were used to assess receipt of the combined 7-vaccine series by age 24 months. Based on prior work, patterns indicative of hesitancy included zero vaccines, not starting ≥1 series, and consistent vaccine-limiting. Patterns indicative of practical issues included starting all series but missing doses. Up-to-date (UTD) was defined as receiving all doses in the combined 7-vaccine series. RESULTS The study population comprised 127,257 children. Over the observation period, patterns indicative of hesitancy significantly decreased (p-trend < 0.0001), patterns indicative of practical issues significantly decreased (p-trend < 0.0001), and UTD significantly increased (p-trend < 0.0001). In 2021, the weighted percentage in each category was as follows: probable hesitancy 6.3% (95% confidence interval [CI] 5.4%, 7.2%), probable practical issues 26.0% (95% CI 24.4%, 27.6%), and UTD 67.7% (95% CI 66.0%, 69.4%). CONCLUSION Over an 11-year period, vaccination coverage in the United States for the combined 7-vaccine series has improved, with patterns suggestive of practical issues or hesitancy declining.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christina L Clarke
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Alexandria N Albers
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Sarah Y Michels
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Rain E Freeman
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
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Campbell K, Severson R. Estimating Vaccine Hesitancy in Colorado by Using Immunization Information System Data. Public Health Rep 2023; 138:806-811. [PMID: 36346179 PMCID: PMC10467494 DOI: 10.1177/00333549221133072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Vaccine hesitancy is a complex issue that threatens global health. We used data from the Colorado Immunization Information System (CIIS) to quantify vaccine hesitancy. METHODS We examined immunization records from CIIS for patients age 2 up to 9 months to estimate vaccine hesitancy by tabulating the number of doses received per visit and comparing it with the number of expected doses based on recommendations of the Advisory Committee on Immunization Practices. We calculated the percentage of patients in each vaccine hesitancy group who were up to date on the 7-antigen series by age 35 months. We examined the distribution of vaccine-hesitant populations among vaccination providers who report to CIIS to estimate the difference in vaccine-hesitant patient populations among vaccination providers in Colorado. RESULTS Of 201 450 patients, 5147 (2.6%) consistently limited the number of shots received at each visit as compared with recommendations from the Advisory Committee on Immunization Practices; 166 927 (82.9%) patients did not limit the number of shots received; 5693 (2.8%) limited the number of shots received at >1 visit but not all visits; and 23 683 (11.8%) limited the number of shots received at only 1 visit. We found differences in vaccine hesitancy distributions among certain Colorado vaccination providers. CONCLUSIONS Immunization information system data, although sometimes incomplete, offer an opportunity to investigate state-level vaccine hesitancy. Areas of future research include performing similar analyses over time and determining geographic and socioeconomic factors that contribute to vaccine hesitancy.
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Affiliation(s)
- Kimberly Campbell
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Rachel Severson
- Colorado Department of Public Health and Environment, Denver, CO, USA
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Freeman RE, Leary CS, Graham JM, Albers AN, Wehner BK, Daley MF, Newcomer SR. Geographic proximity to immunization providers and vaccine series completion among children ages 0-24 months. Vaccine 2023; 41:2773-2780. [PMID: 36964002 PMCID: PMC10229224 DOI: 10.1016/j.vaccine.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES In the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations. METHODS We analyzed records from Montana's immunization information system for children born 2015-2017. Using geolocated address data, we calculated distance in road miles from children's residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24 months. RESULTS Among 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24 months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median = 1.7; IQR = 3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96-0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85-0.92). CONCLUSIONS Long travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.
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Affiliation(s)
- Rain E Freeman
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States.
| | - Cindy S Leary
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
| | - Jonathan M Graham
- Center for Population Health Research, University of Montana, Missoula, MT, United States; Department of Mathematical Sciences, University of Montana, Missoula, MT, United States
| | - Alexandria N Albers
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
| | - Bekki K Wehner
- Montana Immunization Program, Department of Public Health and Human Services, Helena, MT, United States
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States; University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, United States
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
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Newcomer SR, Glanz JM, Daley MF. Beyond Vaccination Coverage: Population-Based Measurement of Early Childhood Immunization Schedule Adherence. Acad Pediatr 2023; 23:24-34. [PMID: 35995410 PMCID: PMC10253042 DOI: 10.1016/j.acap.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 01/19/2023]
Abstract
The immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) provides a structure for how 10 different vaccine series should be administered to children in the first 18 months of life. Progress toward US early childhood immunization goals has largely focused on measuring vaccination coverage at age 24 months. However, standard vaccination coverage measures do not reflect whether children received vaccine doses by recommended ages, or whether vaccines were given concomitantly, per the schedule. In this paper, we describe innovations in population-level measurement of immunization schedule adherence through quantifying vaccination timeliness and undervaccination patterns. Measuring vaccination timeliness involves comparing when children received vaccine doses relative to ACIP age recommendations. To assess undervaccination patterns, children's vaccination histories are analyzed to determine whether they were vaccinated consistent with the ACIP schedule. Some patterns, such as spreading out vaccines across visits, are indicative of parental hesitancy. Other patterns, such as starting all recommended series but missing doses, are largely indicative of other immunization services delivery challenges. Since 2003, at least 12 studies have used National Immunization Survey-Child, immunization information system, or integrated health plan data to measure vaccination timeliness or undervaccination patterns at national or state levels. Moving forward, these novel measures can be leveraged for population-based surveillance of vaccine confidence, and for distinguishing undervaccination due to parental vaccine hesitancy from undervaccination due to other causes. Broader adoption of these measures can facilitate identification of targeted strategies for improving timely and routine early childhood vaccination uptake across the United States.
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Affiliation(s)
- Sophia R Newcomer
- University of Montana School of Public and Community Health Sciences (SR Newcomer), Missoula, Mont; University of Montana Center for Population Health Research (SR Newcomer), Missoula, Mont.
| | - Jason M Glanz
- Kaiser Permanente Colorado, Institute for Health Research (JM Glanz, MF Daley), Aurora, Colo; University of Colorado, Colorado School of Public Health, Department of Epidemiology (JM Glanz), Aurora, Colo
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research (JM Glanz, MF Daley), Aurora, Colo; University of Colorado, School of Medicine, Department of Pediatrics (MF Daley), Aurora, Colo
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Nguyen CG, Pogemiller MI, Cooper MT, Garbe MC, Darden PM. Characteristics of Oklahoma Pediatricians Who Dismiss Families for Refusing Vaccines. Clin Pediatr (Phila) 2023; 62:24-32. [PMID: 35883261 DOI: 10.1177/00099228221108801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vaccine refusal is increasing. Objectives were to assess frequency of declining or dismissing patients who refuse vaccines, which vaccine(s) prompt pediatricians to decline/dismiss patients, and demographics of pediatricians who decline/dismiss patients. Active members of the Oklahoma American Academy of Pediatricians (AAP) were surveyed. Chi-square tests with non-overlapping 95% confidence intervals compared proportions of providers across various metrics. In all, 47% (48/103) versus 35% (34/98) reported declining versus dismissing patients for refusing vaccines, respectively. Pediatricians were unlikely to decline/dismiss patients if they refused influenza, human papilloma virus (HPV), or MenB vaccines. Pediatricians with more years in practice were less likely to decline 15% (9/62) versus 44% (16/36), P = 0.002 and dismiss 8% (5/62) versus 33% (12/36), P = 0.002 patients. Rural pediatricians were less likely than urban to decline 12% (2/17) versus 29% (26/89), P = NS and dismiss patients 0% (0/17) versus 21% (19/89), P = 0.04. Dismissing/declining patients for vaccine refusal is more common among Oklahoma pediatricians than nationally reported. Patterns differ by practice setting, years in practice, and specific vaccine refused.
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Affiliation(s)
| | - Mark I Pogemiller
- University of Oklahoma College of Medicine, Oklahoma City, OK, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael T Cooper
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Connor Garbe
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul M Darden
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Michels SY, Freeman RE, Williams E, Albers AN, Wehner BK, Rechlin A, Newcomer SR. Evaluating vaccination coverage and timeliness in American Indian/Alaska Native and non-Hispanic White children using state immunization information system data, 2015-2017. Prev Med Rep 2022; 27:101817. [PMID: 35656223 PMCID: PMC9152883 DOI: 10.1016/j.pmedr.2022.101817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022] Open
Abstract
Comprehensive estimates of vaccination coverage and timeliness of vaccine receipt among American Indian/Alaska Native (AI/AN) children in the United States are lacking. This study’s objectives were to quantify vaccination coverage and timeliness, as well as the proportion of children with specific undervaccination patterns, among AI/AN and non-Hispanic White (NHW) children ages 0–24 months in Montana, a large and primarily rural U.S. state. Data from Montana’s immunization information system (IIS) for children born 2015–2017 were used to calculate days undervaccinated for all doses of seven recommended vaccine series. After stratifying by race/ethnicity, up-to-date coverage at key milestone ages and the proportion of children demonstrating specific patterns of undervaccination were reported. Among n = 3,630 AI/AN children, only 23.1% received all recommended vaccine doses on-time (i.e., zero days undervaccinated), compared to 40.4% of n = 18,022 NHW children (chi-square p < 0.001). A greater proportion of AI/AN children were delayed at each milestone age, resulting in lower overall combined 7-vaccine series completion, by age 24 months (AI/AN: 56.6%, NHW: 64.3%, chi-square p < 0.001). As compared with NHW children, a higher proportion of AI/AN children had undervaccination patterns suggestive of structural barriers to accessing immunization services and delayed starts to vaccination. More than three out of four AI/AN children experienced delays in vaccination or were missing doses needed to complete recommended vaccine series. Interventions to ensure on-time initiation of vaccine series at age 2 months, as well initiatives to encourage completion of multi-dose vaccine series, are needed to reduce immunization disparities and increase vaccination coverage among AI/AN children in Montana.
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Affiliation(s)
- Sarah Y. Michels
- Yale School of Public Health, New Haven, CT, United States
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- Corresponding author at: University of Montana, Center for Population Health Research, 32 Campus Drive, Skaggs 173, Missoula, MT 59804, United States.
| | - Rain E. Freeman
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
| | - Elizabeth Williams
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
- All Nations Health Center, Missoula, MT, United States
| | - Alexandria N. Albers
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
| | - Bekki K. Wehner
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, United States
| | - Annie Rechlin
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, United States
| | - Sophia R. Newcomer
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
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11
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Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature. Prev Med Rep 2022; 27:101804. [PMID: 35656229 PMCID: PMC9152779 DOI: 10.1016/j.pmedr.2022.101804] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/23/2022] [Accepted: 04/18/2022] [Indexed: 12/22/2022] Open
Abstract
Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children <36 months old in rural areas. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we reported studies' methodologies and targeted populations, definitions of rurality, and common themes across studies that reflected barriers to or facilitators of vaccination. Ultimately, 17 papers met inclusion criteria for review. The majority of studies (10/17) were conducted within one U.S. state, and the same number (10/17) were conducted prior to 2005. Facilitators of vaccine uptake in rural communities identified across studies included reminder/recall systems and parents' relationships with providers. Parental hesitancy, negative clinic experiences, referrals outside of primary care settings, and distance to providers were identified as barriers to vaccination in rural settings. This review revealed a limited scope of evidence on barriers to and facilitators of early childhood immunization in rural communities. More investigations of the causes of low vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed in rural pediatric populations to address persistent rural-urban immunization disparities.
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Affiliation(s)
- Alexandria N. Albers
- University of Montana, School of Public and Community Health Sciences, 32 Campus Drive, Missoula, MT, USA
- University of Montana, Center for Population Health Research, 32 Campus Drive, Missoula, MT, USA
| | - Juthika Thaker
- University of Montana, School of Public and Community Health Sciences, 32 Campus Drive, Missoula, MT, USA
- University of Montana, Center for Population Health Research, 32 Campus Drive, Missoula, MT, USA
| | - Sophia R. Newcomer
- University of Montana, School of Public and Community Health Sciences, 32 Campus Drive, Missoula, MT, USA
- University of Montana, Center for Population Health Research, 32 Campus Drive, Missoula, MT, USA
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12
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Rughiniş C, Flaherty MG. The Social Bifurcation of Reality: Symmetrical Construction of Knowledge in Science-Trusting and Science-Distrusting Discourses. FRONTIERS IN SOCIOLOGY 2022; 7:782851. [PMID: 35224088 PMCID: PMC8864180 DOI: 10.3389/fsoc.2022.782851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
This article proposes a conceptual framework to study the social bifurcation of reality in polarized science-trusting and science-distrusting lay worldviews, by analyzing and integrating five concepts: science work, number work, emotion work, time work, and boundary work. Despite the epistemological asymmetry between accounts relying on mainstream science and science-distrusting or denialist ones, there are symmetrical social processes contributing to the construction of lay discourses. Through conceptual analysis, we synthesize an alternative to the deficit model of contrarian discourses, replacing the model of social actors as "defective scientists" with a focus on their culturally competent agency. The proposed framework is useful for observing the parallel construction of polarized realities in interaction and their ongoing articulation through hinge objects, such as vaccines, seatbelts, guns, or sanitary masks in the Covid-19 context. We illustrate the framework through a comparative approach, presenting arguments and memes from contemporary online media in two controversies: namely, vaccine-trusting versus vaccine-distrusting views and Covid-convinced versus Covid-suspicious discourses.
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Affiliation(s)
- Cosima Rughiniş
- Faculty of Sociology and Social Work, University of Bucharest, Bucharest, Romania
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13
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Freeman RE, Thaker J, Daley MF, Glanz JM, Newcomer SR. Vaccine timeliness and prevalence of undervaccination patterns in children ages 0-19 months, U.S., National Immunization Survey-Child 2017. Vaccine 2022; 40:765-773. [PMID: 34961632 PMCID: PMC8856130 DOI: 10.1016/j.vaccine.2021.12.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Typically, early childhood vaccination coverage in the U.S. is measured as the proportion of children by age 24 months who completed recommended vaccine series. However, these measures do not reflect whether vaccine doses were received at the ages recommended by the U.S. Advisory Committee on Immunization Practices, or whether children received vaccines concomitantly, per the ACIP recommended schedule. This study's objective was to quantify vaccine timeliness and prevalence of specific patterns of undervaccination in U.S. children ages 0-19 months. METHODS Using 2017 National Immunization Survey-Child data, we calculated days undervaccinated for the combined 7-vaccine series and distinguished undervaccination patterns indicative of parental vaccine hesitancy, such as spreading out vaccines across visits ("shot-limiting") or starting some but not all recommended vaccine series ("selective vaccination"), from other non-hesitancy patterns, such as missing final vaccine doses or receiving all doses, with some or all late. We measured associations between demographic, socioeconomic and other characteristics with undervaccination patterns using multivariable log-linked binomial regression. Analyses accounted for the complex survey design. RESULTS Among n = 15,333 U.S. children, only 41.2% received all recommended vaccine doses on-time by age 19 months. Approximately 20.9% of children had an undervaccination pattern suggestive of parental vaccine hesitancy, and 36.2% had other undervaccination non-hesitancy patterns. Uninsured children and those with lower levels of maternal education were more likely to exhibit undervaccination patterns suggestive of parental hesitancy. Lower levels of maternal education were also associated with other non-hesitancy undervaccination patterns. CONCLUSIONS More than half of children in the U.S. are undervaccinated at some point by 19 months of age. Ongoing assessment of vaccine timeliness and immunization schedule adherence could facilitate timely and targeted public health interventions in populations with high levels of undervaccination.
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Affiliation(s)
- Rain E. Freeman
- School of Public and Community Health Sciences, University of Montana, Missoula, MT
| | - Juthika Thaker
- School of Public and Community Health Sciences, University of Montana, Missoula, MT
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO;,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO;,Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO
| | - Sophia R. Newcomer
- School of Public and Community Health Sciences, University of Montana, Missoula, MT
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14
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Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Prim Health Care Res Dev 2022; 23:e68. [PMID: 36330835 PMCID: PMC9641700 DOI: 10.1017/s1463423622000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim: This review aims are to (1) identify relevant quantitative research on parental childhood vaccine hesitancy with vaccine uptake and vaccination intention being relevant outcomes and (2) map the gaps in knowledge on vaccine hesitancy to develop suggestions for further research and to guide interventions in this field. Background: Vaccine hesitancy recognises a continuum between vaccine acceptance and vaccine refusal, de-polarising past anti-vaccine, and pro-vaccine categorisations of individuals and groups. Vaccine hesitancy poses a serious challenge to international efforts to lessen the burden of vaccine-preventable diseases. Potential vaccination barriers must be identified to inform initiatives aimed at increasing vaccine awareness, acceptance, and uptake. Methods: Five databases were searched for peer-reviewed articles published between 1998 and 2020 in the fields of medicine, nursing, public health, biological sciences, and social sciences. Across these datasets, a comprehensive search technique was used to identify multiple variables of public trust, confidence, and hesitancy about vaccines. Using PRISMA guidelines, 34 papers were included so long as they focused on childhood immunisations, employed multivariate analysis, and were published during the time frame. Significant challenges to vaccine uptake or intention were identified in these studies. Barriers to vaccination for the target populations were grouped using conceptual frameworks based on the Protection Motivation Theory and the World Health Organization’s Strategic Advisory Group of Experts on Immunization Working Group model and explored using the 5C psychological antecedents of vaccination. Findings: Although several characteristics were shown to relate to vaccine hesitancy, they do not allow for a thorough classification or proof of their individual and comparative level of influence. Understudied themes were also discovered during the review. Lack of confidence, complacency, constraints, calculation, and collective responsibility have all been highlighted as barriers to vaccination uptake among parents to different degrees.
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15
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Daley MF, Reifler LM, Shoup JA, Narwaney KJ, Kharbanda EO, Groom HC, Jackson ML, Jacobsen SJ, McLean HQ, Klein NP, Williams JTB, Weintraub ES, McNeil MM, Glanz JM. Temporal Trends in Undervaccination: A Population-Based Cohort Study. Am J Prev Med 2021; 61:64-72. [PMID: 34148627 PMCID: PMC8899861 DOI: 10.1016/j.amepre.2021.01.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Monitoring the trends in undervaccination, including that because of parental vaccine refusal or delay, can inform public health responses directed at improving vaccine confidence and vaccination coverage. METHODS A retrospective cohort study was conducted in the Vaccine Safety Datalink. The cohort included all children born in 2004-2017 with ≥3 well-child visits between ages 2 and 23 months. Using electronic health record-based vaccination data, the average days undervaccinated was calculated for each child. Undervaccination patterns were assessed through age 23 months. Temporal trends were inspected for inflection points and were analyzed using linear regression. Nested within the cohort study, a survey was conducted to compare parent reports of vaccine refusal or delay with observed vaccination patterns. Data were analyzed in 2020. RESULTS The study cohort consisted of 808,170 children. The percentage of children with average days undervaccinated=0 (fully vaccinated, no delays) rose from a nadir of 47.1% for the birth year 2008 to 68.4% for the birth year 2017 (ptrend<0.001). The percentage with no vaccines rose from 0.35% for the birth year 2004 to 1.28% for the birth year 2017 (ptrend<0.001). Consistent vaccine limiting was observed in 2.04% for the birth year 2017. Omission of measles, mumps, and rubella vaccine peaked at 4.76% in the birth year 2007 and declined thereafter (ptrend<0.001). On the parent survey (response rate 60.2%), a high proportion of parents of the most undervaccinated children reported refusing or delaying vaccines. CONCLUSIONS In a 14-year cohort study, vaccination timeliness has improved. However, the small but increasing number of children who received no vaccines by age 23 months warrants additional attention.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus Aurora, Colorado.
| | - Liza M Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | | | - Holly C Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Joshua T B Williams
- Department of General Pediatrics, Denver Health and Hospitals, Denver, Colorado
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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16
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Newcomer SR, Freeman RE, Wehner BK, Anderson SL, Daley MF. Timeliness of Early Childhood Vaccinations and Undervaccination Patterns in Montana. Am J Prev Med 2021; 61:e21-e29. [PMID: 33975767 PMCID: PMC8217328 DOI: 10.1016/j.amepre.2021.01.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Early childhood vaccination rates are lower in rural areas than those in urban areas of the U.S. This study's objective is to quantify vaccine timeliness and the prevalence of undervaccination patterns in Montana and to measure the associations between timeliness and series completion by age 24 months. METHODS Using records from January 2015 to November 2019 in Montana's centralized immunization information system, days undervaccinated were calculated for the combined 7-vaccine series. Undervaccination patterns indicative of certain barriers to vaccination, including parental vaccine hesitancy, were identified. Using multivariable log-linked binomial regression, the association between timing of vaccine delay and not completing the combined 7-vaccine series by age 24 months was assessed. Analyses were conducted in March 2020-August 2020. RESULTS Among 31,422 children, 38.0% received all vaccine doses on time; 24.3% received all doses, but some were received late; and 37.7% had not completed the combined 7-vaccine series. Approximately 18.7% had an undervaccination pattern suggestive of parental vaccine hesitancy, and 19.7% started all series but were missing doses needed for multidose series completion. Although falling behind on vaccinations at any age was associated with failing to complete the combined 7-vaccine series, being late at age 12-15 months had the strongest association (adjusted prevalence ratio=3.73, 95% CI=3.56, 3.91) compared with being on time at age 12-15 months. CONCLUSIONS Fewer than 2 in 5 Montana children were fully vaccinated on time for the combined 7-vaccine series. To increase vaccination rates, initiatives to increase vaccine confidence and remind parents to complete vaccine series are needed.
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Affiliation(s)
- Sophia R Newcomer
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana.
| | - Rain E Freeman
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - Bekki K Wehner
- Immunization Section, Montana Department of Public Health and Human Services, Helena, Montana
| | - Stacey L Anderson
- Communicable Disease Epidemiology Section, Montana Department of Public Health and Human Services, Helena, Montana
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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17
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Deerin JF, Clifton R, Elmi A, Lewis PE, Kuo I. Hepatitis B birth dose vaccination patterns in the military health System, 2014-2018. Vaccine 2021; 39:2094-2102. [PMID: 33741189 DOI: 10.1016/j.vaccine.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Since 2005, the universal hepatitis B (HepB) birth dose has been recommended for all medically stable infants weighing ≥2,000 g at birth. The timing of the birth dose provides a critical safeguard and prevents infection among infants born to HBsAg-positive mothers not identified prenatally. We assess infant HepB vaccination in the U.S. Department of Defense's Military Health System (MHS) to identify trends in vaccination coverage and sociodemographic factors associated with non-receipt of the birth dose, receiving the first HepB vaccine >3 days of life, and not receiving any HepB vaccine in the first 18 months of life utilizing parental refusal codes. To our knowledge, this is one of the first studies assessing trends in parental refusal of the HepB birth dose utilizing administrative claims parental refusal codes. METHODS We conducted a retrospective cohort analysis of MHS live births from January 1, 2014 through December 31, 2018 utilizing administrative claims data. Data were included from 44 hospitals in 24 unique states, territories, or countries. We analyzed diagnosis codes for vaccine refusal and vaccination and current procedural terminology (CPT) codes to identify vaccination patterns. Generalized linear mixed effects models with a logit link were used to assess factors associated with vaccination patterns. RESULTS HepB birth dose vaccination coverage increased from 79.6% in 2014 to 88.1% in 2018 (p < .0001). Refusal rates also increased from 3.7% in 2014 to 4.5% in 2018 (p < .0001). The percentage of patients with missing diagnosis codes for vaccine refusal or vaccination decreased from 16.7% in 2014 to 7.4% in 2018. Factors associated with non-receipt of the birth dose included earlier year of birth, white maternal race, higher maternal age, higher birth order, and longer infant length of stay in hospital. CONCLUSION Vaccination coverage for HepB birth dose is high in the MHS and increased over time; concurrently, refusal rates also increased over time. Utilizing administrative claims data has the benefit of differentiating reasons for non-receipt of the birth dose over time.
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Affiliation(s)
- Jessica Fung Deerin
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology, United States.
| | - Rebecca Clifton
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology, United States
| | - Angelo Elmi
- The George Washington University, Milken Institute School of Public Health, Department of Biostatistics and Bioinformatics, United States
| | - Paul E Lewis
- Defense Health Agency, Armed Forces Health Surveillance Branch, United States
| | - Irene Kuo
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology, United States
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18
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Gilbert RM, Mersky JP, Lee CTP. Prevalence and correlates of vaccine attitudes and behaviors in a cohort of low-income mothers. Prev Med Rep 2021; 21:101292. [PMID: 33489723 PMCID: PMC7804978 DOI: 10.1016/j.pmedr.2020.101292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/22/2020] [Accepted: 12/13/2020] [Indexed: 12/02/2022] Open
Abstract
The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%–21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization.
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Affiliation(s)
- Ross M Gilbert
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Joshua P Mersky
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Chien-Ti Plummer Lee
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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19
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Atamian EK, Steele RW. Lessons From the Past and Present. Clin Pediatr (Phila) 2020; 59:205-207. [PMID: 31244339 DOI: 10.1177/0009922819859433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Russell W Steele
- Tulane University, New Orleans, LA, USA.,University of Queensland, Ochsner Clinical School, New Orleans, LA, USA
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20
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Huang Z, Wagner AL, Lin M, Sun X, Zikmund-Fisher BJ, Boulton ML, Ren J, Prosser LA. Preferences for vaccination program attributes among parents of young infants in Shanghai, China. Hum Vaccin Immunother 2020; 16:1905-1910. [PMID: 31977272 DOI: 10.1080/21645515.2020.1712937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Compared to many other countries, China offers fewer pediatric vaccines. Future attempts to add mandatory vaccines may run counter to parents' preferences for shot-limiting. The aim of this study was to assess Chinese parents' preferences and willingness-to-pay (WTP) for programmatic attributes of vaccination services. Parents of young infants ≤3 months of age presenting at immunization clinics in Shanghai, China, in 2017 completed a discrete choice experiment (DCE) on vaccination program attributes: waiting time at the clinic, number of shots before 7 months, number of injections per visit, cost per visit, and location of the shot. We estimated preference utilities and WTP using logistic regression. In total, 590 completed the DCE. Caregivers expressed greater utility for less waiting time, fewer office visits, lower cost of vaccines, and fewer injections co-administered. Over the course of their child's first 6 months, parents were willing to pay 113 RMB ($17) to avoid an additional 10 minutes of waiting at each appointment (95% confidence interval [CI]: 213, 929), 474 RMB ($70) to avoid an additional office visit (95% CI: 241, 707), and 703 RMB ($104) to avoid an additional injection at each appointment (95% CI: 337, 1068). As China expands its list of publicly funded vaccines, public health officials will have to counter Chinese parents' strong preferences for limiting the total number of office visits and the number of injections administered at each visit, potentially through the use of combination vaccines.
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Affiliation(s)
- Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention , Shanghai, China
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, MI, USA
| | - Muzi Lin
- Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, MI, USA
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention , Shanghai, China
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan , Ann Arbor, MI, USA.,Department of Internal Medicine, Division of General Medicine, Michigan Medicine , Ann Arbor, MI, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Infectious Disease, Michigan Medicine , Ann Arbor, MI, USA
| | - Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention , Shanghai, China
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Communicable Diseases, Michigan Medicine , Ann Arbor, MI, USA
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21
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Rosso A, Massimi A, Pitini E, Nardi A, Baccolini V, Marzuillo C, De Vito C, Villari P. Factors affecting the vaccination choices of pregnant women for their children: a systematic review of the literature. Hum Vaccin Immunother 2020; 16:1969-1980. [PMID: 31916903 PMCID: PMC7482832 DOI: 10.1080/21645515.2019.1698901] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In recent years, an increase in vaccine hesitancy has led to a decrease in vaccination coverage in several countries. We conducted a systematic review of studies that assessed knowledge of and attitudes toward pediatric vaccinations, and the vaccination choices and their determinants among pregnant women. A total of 6,277 records were retrieved, and 16 full texts were included in the narrative synthesis. The published literature on the topic shows that, overall, pregnant women believe that vaccines are important for the protection of their children and the community, but various concerns and misunderstandings persist around vaccine safety and efficacy, which reduce the trust of expectant mothers in immunization. Nevertheless, such attitudes and choices vary depending on the vaccine being considered and the corresponding determinants should therefore be studied in the context of each specific vaccination. Further research on this topic is needed, particularly in non-western countries.
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Affiliation(s)
- Annalisa Rosso
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy.,Local Health Unit-Azienda Sanitaria Locale Roma 2 , Rome, Italy
| | - Azzurra Massimi
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Erica Pitini
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Angelo Nardi
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Valentina Baccolini
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Carolina Marzuillo
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Corrado De Vito
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
| | - Paolo Villari
- Deparment of Public Health and Infectious Diseases, Sapienza University of Rome , Rome, Italy
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22
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Robison SG. The Impact of the Number of Injections per Visit on the Likelihood of Human Papillomavirus Immunization. THE JOURNAL OF PEDIATRICS: X 2020. [DOI: 10.1016/j.ympdx.2020.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Gianfredi V, Moretti M, Lopalco PL. Countering vaccine hesitancy through immunization information systems, a narrative review. Hum Vaccin Immunother 2019; 15:2508-2526. [PMID: 30932725 PMCID: PMC6930057 DOI: 10.1080/21645515.2019.1599675] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/06/2019] [Accepted: 03/15/2019] [Indexed: 01/02/2023] Open
Abstract
Immunization is one of the most important public health interventions to contrast infectious disease; however, many people nowadays refuse vaccination. Vaccine hesitancy (VH) is due to several factors that influence the complex decision-making process. Information technology tools might play an important role in vaccination programs. In particular, immunization information systems (IISs) have the potential to improve performance of vaccination programs and to increase vaccine uptake. This review aimed to present IIS functionalities in order to counter VH. In detail, we analyzed the automatic reminder/recall system, the interoperability of the system, the decision support system, the web page interface and the possibility to record adverse events following immunization. IIS could concretely represent a valid instrument to increase vaccine confidence, especially trust in both health-care workers and decision makers. There are not enough trials aimed to evaluate the efficacy of IIS to counter VH. Further researches might focalize on this aspect.
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Affiliation(s)
- Vincenza Gianfredi
- Post-Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Massimo Moretti
- Department of Pharmaceutical Science, Unit of Public Health, University of Perugia, Perugia, Italy
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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24
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Frew PM, Murden R, Mehta CC, Chamberlain AT, Hinman AR, Nowak G, Mendel J, Aikin A, Randall LA, Hargreaves AL, Omer SB, Orenstein WA, Bednarczyk RA. Development of a US trust measure to assess and monitor parental confidence in the vaccine system. Vaccine 2018; 37:325-332. [PMID: 30503657 DOI: 10.1016/j.vaccine.2018.09.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop a Vaccine Confidence Index (VCI) that is capable of detecting variations in parental confidence towards childhood immunizations centered on trust and concern issues that impact vaccine confidence. METHODS We used a web-based national poll of 893 parents of children <7 years in 2016 to assess the measures created for the Emory VCI (EVCI). EVCI measures were developed using constructs related to vaccine confidence identified by the U.S. National Vaccine Advisory Committee (i.e., "Information Environment", "Trust", "Healthcare Provider", "Attitudes and Beliefs", and "Social Norms"). Reliability for EVCI was assessed using Cronbach's alpha. Using the variables related to each of the constructs, we calculated an overall EVCI score that was then assessed against self-reported childhood vaccine receipt using chi-square and the Cochrane-Armitage trend tests. RESULTS Respondents' EVCI scores could range from 0 to 24, and the full range of values was observed in this sample (Mean = 17.5 (SD 4.8)). EVCI scores were significantly different (p ≤ 0.006 for all comparisons) between parents who indicated their child(ren) received routinely recommended vaccines compared with parents who indicated they had delayed or declined recommended immunizations. There was also a significant, consistent association between higher EVCI scores and greater reported vaccine receipt. CONCLUSIONS We developed EVCI to reliably measure parental vaccine confidence, with individuals' scores linked to parental vaccine-related attitudes, intentions, and behaviors. As such, EVCI may be a useful tool for future monitoring of both population and individual confidence in childhood immunization.
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Affiliation(s)
- Paula M Frew
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Raphiel Murden
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - C Christina Mehta
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison T Chamberlain
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Alan R Hinman
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, United States
| | - Glen Nowak
- University of Georgia Grady College of Journalism and Mass Communication, 120 Hooper St, Athens, GA 30602, United States
| | - Judith Mendel
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Ann Aikin
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Laura A Randall
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison L Hargreaves
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Saad B Omer
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Walter A Orenstein
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States
| | - Robert A Bednarczyk
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
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Mohanty S, Carroll-Scott A, Wheeler M, Davis-Hayes C, Turchi R, Feemster K, Yudell M, Buttenheim AM. Vaccine Hesitancy in Pediatric Primary Care Practices. QUALITATIVE HEALTH RESEARCH 2018; 28:2071-2080. [PMID: 29947574 DOI: 10.1177/1049732318782164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges and strained patient-provider relationships. Strategies to minimize the burden of vaccine hesitancy included training for vaccine counseling, screening for vaccine hesitancy prior to immunization visits, tailored vaccine counseling, and primary care provider visits for follow-up immunization. Pediatric practices reported many challenges when caring for vaccine-hesitant families. Multiple strategies were identified to reduce the burden of vaccine hesitancy, which future studies should explore to determine how effective they are in increasing vaccine acceptance in pediatric practices.
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Affiliation(s)
- Salini Mohanty
- 1 University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- 2 Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Marissa Wheeler
- 1 University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Cecilia Davis-Hayes
- 3 Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Renee Turchi
- 2 Drexel University, Philadelphia, Pennsylvania, USA
- 4 St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Kristen Feemster
- 5 Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Alison M Buttenheim
- 1 University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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26
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Daley MF, Shoup JA, Newcomer SR, Jackson ML, Groom HC, Jacobsen SJ, McLean HQ, Klein NP, Weintraub ES, McNeil MM, Glanz JM. Assessing Potential Confounding and Misclassification Bias When Studying the Safety of the Childhood Immunization Schedule. Acad Pediatr 2018; 18:754-762. [PMID: 29604461 PMCID: PMC6445249 DOI: 10.1016/j.acap.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/13/2018] [Accepted: 03/17/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Some parents are concerned the childhood immunization schedule could increase risk for allergic disorders, including asthma. To inform future safety studies of this speculated association, a parent survey was conducted to examine the risk of misclassification of vaccination status in electronic health record data, and to assess the potential for confounding if asthma risk factors varied by vaccination status. METHODS A survey was conducted among parents of children 19 to 35 months old at 6 medical organizations within the Vaccine Safety Datalink. Parents of children in 4 vaccination groups were surveyed: 1) no vaccines by 12 months of age and a diagnosis of parental vaccine refusal; 2) consistent vaccine limiting (≤2 vaccines per visit); 3) not consistently vaccine limiting but otherwise undervaccinated with a vaccine refusal diagnosis; and 4) fully vaccinated with no delays and no vaccine refusal. Parents were surveyed about their child's vaccination status and whether asthma risk factors existed. RESULTS Among a survey sample of 2043 parents, 1209 responded (59.2%). For receiving no vaccines, the observed agreement between parent report and electronic health record data was 94.0% (κ = 0.79); for receiving all vaccines with no delays, the observed agreement was 87.3% (κ = 0.73). Although most asthma risk factors (allergic rhinitis, eczema, food allergies, family asthma history) reported by parents did not differ significantly between children in the vaccination groups studied, several factors (aeroallergen sensitivity, breastfeeding) differed significantly between groups. CONCLUSIONS Measurement and control of disease risk factors should be carefully considered in observational studies of the safety of the immunization schedule.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo
| | - Sophia R Newcomer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Wash
| | | | | | | | | | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo
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27
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Corben P, Leask J. Vaccination hesitancy in the antenatal period: a cross-sectional survey. BMC Public Health 2018; 18:566. [PMID: 29716556 PMCID: PMC5930425 DOI: 10.1186/s12889-018-5389-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/28/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent reports of childhood vaccination coverage in Australia have shown steadily improving vaccination coverage and narrowing differences between highest and lowest coverage regions, yet the NSW North Coast consistently has the lowest coverage rates nationally. Better understanding of parents' vaccination attitudes and actions within this region may guide strategies to improve uptake. The antenatal period is when many parents explore and consolidate vaccination attitudes and so is pivotal for study. METHODS Women attending public antenatal clinics at six NSW North Coast hospitals completed a 10-min cross-sectional survey capturing stage of decision-making and decisional-conflict as well as vaccination hesitancy, attitudes, intentions and actions. Unscored responses were analysed for individual items. Decisional conflict subscales were scored using published algorithms. For consented children, immunisation status was assessed at 8 months using the Australian Immunisation Register. For Likert scale items, odds ratios and Fisher's exact, chi-squared and Chasson's tests assessed differences between subgroups. Wilcoxon rank-sum tests assessed differences between subgroups for items on scales of 0-to-10 and decisional conflict sub-scale scores. RESULTS First-time mothers were 3 times more likely than others (OR = 3.40, 95% CI 1.34-8.60) to identify as unsure, somewhat or very hesitant. Most respondents (92.2%) wanted their new baby to receive all recommended vaccinations. Many had high or moderate levels of concern about vaccine side effects (25.4%), safety (23.6%) and effectiveness (23.1%). Increased hesitancy was associated with decreased confidence in the schedule (p < 0.001), decreased trust in child's doctor (p < 0.0001), decreased perceived protection from disease (p < 0.05) and increased decisional conflict on all measured subscales (p < 0.0001). First-time mothers had higher decisional conflict on values clarity, support and uncertainty sub-scales. By 8 months of age, 83.2% of infants were fully vaccinated. Those with none or a few minor concerns were over 8 times more likely than others to vaccinate on schedule (OR = 8.7, 1.3-56.7). CONCLUSIONS Importantly this study provides further strong justification to talk with women about vaccination during pregnancy and particularly to ensure that first-time mothers are offered assistance in making these important decisions, where indicated. Further research should focus on optimising the timing, content and delivery style of perinatal interventions.
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Affiliation(s)
- Paul Corben
- Director, North Coast Public Health, Mid North Coast Local Health District, PO Box 126, Port Macquarie, NSW 2444 Australia
| | - Julie Leask
- Associate Professor, Sydney Nursing School and, Principal Research Fellow, School of Public Health, University of Sydney, 88 Mallett Street (MO2), Sydney, NSW 2050 Australia
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Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
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29
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Glanz JM, Newcomer SR, Daley MF, DeStefano F, Groom HC, Jackson ML, Lewin BJ, McCarthy NL, McClure DL, Narwaney KJ, Nordin JD, Zerbo O. Association Between Estimated Cumulative Vaccine Antigen Exposure Through the First 23 Months of Life and Non-Vaccine-Targeted Infections From 24 Through 47 Months of Age. JAMA 2018; 319:906-913. [PMID: 29509866 PMCID: PMC5885913 DOI: 10.1001/jama.2018.0708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Some parents are concerned that multiple vaccines in early childhood could weaken their child's immune system. Biological data suggest that increased vaccine antigen exposure could increase the risk for infections not targeted by vaccines. OBJECTIVE To examine estimated cumulative vaccine antigen exposure through the first 23 months of life in children with and without non-vaccine-targeted infections from 24 through 47 months of age. DESIGN, SETTING, AND PARTICIPANTS A nested case-control study was conducted in 6 US health care organizations participating in the Vaccine Safety Datalink. Cases were identified by International Classification of Diseases codes for infectious diseases in the emergency department and inpatient medical settings and then validated by medical record review. Cases of non-vaccine-targeted infection were matched to controls by age, sex, health care organization site, and chronic disease status. Participants were children ages 24 through 47 months, born between January 1, 2003, and September 31, 2013, followed up until December 31, 2015. EXPOSURES Cumulative vaccine antigen exposure, estimated by summing the number of antigens in each vaccine dose received from birth through age 23 months. MAIN OUTCOMES AND MEASURES Non-vaccine-targeted infections, including upper and lower respiratory infections and gastrointestinal infections, from 24 through 47 months of age, and the association between these infections and estimated cumulative vaccine exposure from birth through 23 months. Conditional logistic regression was used to estimate matched odds ratios representing the odds of non-vaccine-targeted infections for every 30-unit increase in estimated cumulative number of antigens received. RESULTS Among the 944 patients (193 cases and 751 controls), the mean (SD) age was 32.5 (6.3) months, 422 (45%) were female, and 61 (7%) had a complex chronic condition. Through the first 23 months, the estimated mean (SD) cumulative vaccine antigen exposure was 240.6 (48.3) for cases and 242.9 (51.1) for controls. The between-group difference for estimated cumulative antigen exposure was -2.3 (95% CI, -10.1 to 5.4; P = .55). Among children with vs without non-vaccine-targeted infections from 24 through 47 months of age, the matched odds ratio for estimated cumulative antigen exposure through age 23 months was not significant (matched odds ratio, 0.94; 95% CI, 0.84 to 1.07). CONCLUSIONS AND RELEVANCE Among children from 24 through 47 months of age with emergency department and inpatient visits for infectious diseases not targeted by vaccines, compared with children without such visits, there was no significant difference in estimated cumulative vaccine antigen exposure through the first 23 months of life.
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Affiliation(s)
- Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver
| | - Frank DeStefano
- Immunization Safety Office (Vaccine Safety Datalink), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Holly C Groom
- Kaiser Permanente Center for Health Research, Northwest Kaiser Permanente, Portland, Oregon
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Bruno J Lewin
- Kaiser Permanente Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena
| | - Natalie L McCarthy
- Immunization Safety Office (Vaccine Safety Datalink), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L McClure
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver
| | | | - Ousseny Zerbo
- Kaiser Permanente Division of Research, Kaiser Permanente of Northern California, Oakland
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30
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Wang SV, Abdurrob A, Spoendlin J, Lewis E, Newcomer SR, Fireman B, Daley MF, Glanz JM, Duffy J, Weintraub ES, Kulldorff M. Methods for addressing "innocent bystanders" when evaluating safety of concomitant vaccines. Pharmacoepidemiol Drug Saf 2018; 27:405-412. [PMID: 29441647 DOI: 10.1002/pds.4399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/04/2017] [Accepted: 01/03/2018] [Indexed: 11/07/2022]
Abstract
PURPOSE The need to develop methods for studying the safety of childhood immunization schedules has been recognized by the Institute of Medicine and Department of Health and Human Services. The recommended childhood immunization schedule includes multiple vaccines in a visit. A key concern is safety of concomitant (same day) versus separate day vaccination. This paper addresses a methodological challenge for observational studies using a self-controlled design to investigate the safety of concomitant vaccination. METHODS We propose a process for distinguishing which of several concomitantly administered vaccines is responsible for increased risk of an adverse event while adjusting for confounding due to relationships between effect modifying risk factors and concomitant vaccine combinations. We illustrate the approach by re-examining the known increase in risk of seizure 7 to 10 days after measles-mumps-rubella (MMR) vaccination and evaluating potential independent or modifying effects of other vaccines. RESULTS Initial analyses suggested that DTaP had both an independent and potentiating effect on seizure. After accounting for the relationship between age at vaccination and vaccine combination, there was little evidence for increased risk of seizure with same day administration of DTaP and MMR; incidence rate ratio, 95% confidence interval 1.2 (0.9-1.6), P value = θ.226. CONCLUSION We have shown that when using a self-controlled design to investigate safety of concomitant vaccination, it can be critically important to adjust for time-invariant effect modifying risk factors, such as age at time of vaccination, which are structurally related to vaccination patterns due to recommended immunization schedules.
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Affiliation(s)
- Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Abdurrahman Abdurrob
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Julia Spoendlin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edwin Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Sophia R Newcomer
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.,Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Jonathan Duffy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Martin Kulldorff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, MA, USA
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31
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Newcomer SR, Kulldorff M, Xu S, Daley MF, Fireman B, Lewis E, Glanz JM. Bias from outcome misclassification in immunization schedule safety research. Pharmacoepidemiol Drug Saf 2018; 27:221-228. [PMID: 29292551 DOI: 10.1002/pds.4374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 11/11/2022]
Abstract
PURPOSE The Institute of Medicine recommended conducting observational studies of childhood immunization schedule safety. Such studies could be biased by outcome misclassification, leading to incorrect inferences. Using simulations, we evaluated (1) outcome positive predictive values (PPVs) as indicators of bias of an exposure-outcome association, and (2) quantitative bias analyses (QBA) for bias correction. METHODS Simulations were conducted based on proposed or ongoing Vaccine Safety Datalink studies. We simulated 4 studies of 2 exposure groups (children with no vaccines or on alternative schedules) and 2 baseline outcome levels (100 and 1000/100 000 person-years), with 3 relative risk (RR) levels (RR = 0.50, 1.00, and 2.00), across 1000 replications using probabilistic modeling. We quantified bias from non-differential and differential outcome misclassification, based on levels previously measured in database research (sensitivity > 95%; specificity > 99%). We calculated median outcome PPVs, median observed RRs, Type 1 error, and bias-corrected RRs following QBA. RESULTS We observed PPVs from 34% to 98%. With non-differential misclassification and true RR = 2.00, median bias was toward the null, with severe bias (median observed RR = 1.33) with PPV = 34% and modest bias (median observed RR = 1.83) with PPV = 83%. With differential misclassification, PPVs did not reflect median bias, and there was Type 1 error of 100% with PPV = 90%. QBA was generally effective in correcting misclassification bias. CONCLUSIONS In immunization schedule studies, outcome misclassification may be non-differential or differential to exposure. Overall outcome PPVs do not reflect the distribution of false positives by exposure and are poor indicators of bias in individual studies. Our results support QBA for immunization schedule safety research.
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Affiliation(s)
- Sophia R Newcomer
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,Colorado School of Public Health, Anschutz Medical Campus, Department of Epidemiology, Denver, CO, USA
| | - Martin Kulldorff
- Brigham and Women's Hospital and Harvard Medical School, Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, MA, USA
| | - Stan Xu
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,University of Colorado Denver, School of Medicine, Department of Pediatrics, Denver, CO, USA
| | - Bruce Fireman
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, CA, USA
| | - Edwin Lewis
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, CA, USA
| | - Jason M Glanz
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,Colorado School of Public Health, Anschutz Medical Campus, Department of Epidemiology, Denver, CO, USA
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32
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Parker TC, Mohammed A, Leong T, Mays S, Jain S, Churchill V, Ali F, Immergluck LC. Rotavirus vaccination rate disparities seen among infants with acute gastroenteritis in Georgia. ETHNICITY & HEALTH 2017; 22:585-595. [PMID: 27741577 PMCID: PMC6314174 DOI: 10.1080/13557858.2016.1244744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Rotavirus (RV) is one of the most common diarrheal diseases affecting children less than 5 years of age. RV vaccines have greatly reduced this burden in the United States. The purpose of this study was to determine possible disparities and socio-economic differences in RV vaccination rates. DESIGN Children with acute gastroenteritis were enrolled. Stool was tested for presence of rotavirus using an enzyme immunoassay kit. Vaccination records were abstracted from the state immunization registry and healthcare providers to examine complete and incomplete vaccination status. Cases were identified as children receiving a complete RV dose series and controls were identified as children with incomplete RV doses. A logistic regression model was used to determine disparities seen amongst children with incomplete vaccination status. RESULTS Racial differences between Black and white infants for RV vaccination rates were not significant when controlling for covariates (OR 1.15, 95% CI 0.74-1.78); however ethnicity (p-value .0230), age at onset of illness (p-value .0004), birth year (p-value < .0001), and DTaP vaccination status (p-value < .0001) were all significant in determining vaccination status for children. CONCLUSIONS Racial disparities and socio-economic differences are not determinants in rotavirus vaccination rates; however, age and ethnicity have an effect on RV vaccine status.
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Affiliation(s)
- Trisha C Parker
- a Departments of Pediatrics and Microbiology/Biochemistry/Immunology , Morehouse School of Medicine , Atlanta , GA , USA
- f Postgraduate Medical Institute Clinical Trials Unit , Anglia Ruskin University , Chelmsford , UK
| | - Anaam Mohammed
- b Pediatric Emergency Medicine Associates , Atlanta , GA , USA
| | - Traci Leong
- c Department of Biostatistics and Bioinformatics , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Shelley Mays
- e Children's Healthcare of Atlanta , Atlanta , GA , USA
| | - Shabnam Jain
- d Departments of Pediatrics and Medicine , Emory University , Atlanta , GA , USA
- e Children's Healthcare of Atlanta , Atlanta , GA , USA
| | - Victoria Churchill
- a Departments of Pediatrics and Microbiology/Biochemistry/Immunology , Morehouse School of Medicine , Atlanta , GA , USA
| | - Fatima Ali
- a Departments of Pediatrics and Microbiology/Biochemistry/Immunology , Morehouse School of Medicine , Atlanta , GA , USA
| | - Lilly C Immergluck
- a Departments of Pediatrics and Microbiology/Biochemistry/Immunology , Morehouse School of Medicine , Atlanta , GA , USA
- d Departments of Pediatrics and Medicine , Emory University , Atlanta , GA , USA
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33
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Vaccine Hesitancy: Where We Are and Where We Are Going. Clin Ther 2017; 39:1550-1562. [DOI: 10.1016/j.clinthera.2017.07.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022]
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Landowska K, Waller J, Bedford H, Rockliffe L, Forster AS. Influences on university students' intention to receive recommended vaccines: a cross-sectional survey. BMJ Open 2017; 7:e016544. [PMID: 28733302 PMCID: PMC5642662 DOI: 10.1136/bmjopen-2017-016544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To explore predictors of university students' intention to receive a recommended vaccine and the main sources of vaccine-related information accessed by university students. SETTING Participants were recruited from University College London (UK) in summer 2015. PARTICIPANTS 177 university students participated. The majority of participants were female (58%), White (68%) and had no religion (58%). Participants were aged 18 to 42 (mean age=23.6). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures included vaccine attitude, perceived subjective norm, perceived behavioural control, perceived self-efficacy, past receipt of recommended childhood vaccines, perceived adverse reaction to past vaccination and needle fear. As a secondary outcome sources of vaccine-related information were assessed. RESULTS Students classified as high intenders were more likely to have received all recommended childhood vaccines (OR 3.57; 95% CI 1.21 to 10.59; p=0.022), be less afraid of needles (OR 2.44; 95% CI 1.12 to 5.36; p=0.026) and to have lived in the UK until at least the age of 4 compared with those not living in the UK until at least the age of 4 (OR 0.39; 95% CI 0.18 to 0.83; p=0.015) and those who lived both in the UK and elsewhere (OR 0.42; 95% CI 0.04 to 4.06; p=0.424). The multivariable model explained 25.5% of variance in intention to receive a recommended vaccine. The internet was the most commonly reported source of vaccination information. CONCLUSIONS Findings provide an indication of the factors that may need to be addressed by interventions aiming to increase uptake of recommended vaccines in a university population. Future research is recommended using a prospective cohort design.
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Affiliation(s)
- Kate Landowska
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Helen Bedford
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Lauren Rockliffe
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Alice S Forster
- Research Department of Behavioural Science and Health, University College London, London, UK
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Daley MF, Glanz JM, Newcomer SR, Jackson ML, Groom HC, Lugg MM, McLean HQ, Klein NP, Weintraub ES, McNeil MM. Assessing misclassification of vaccination status: Implications for studies of the safety of the childhood immunization schedule. Vaccine 2017; 35:1873-1878. [PMID: 28285983 PMCID: PMC6445250 DOI: 10.1016/j.vaccine.2017.02.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/03/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND To address public concern about the safety of the childhood immunization schedule, the Institute of Medicine recommended observational studies comparing adverse health outcomes of fully vaccinated children to children under-vaccinated due to parental choice. Misclassification of vaccination status could bias such studies. OBJECTIVE To assess risk of misclassification of vaccination status within the Vaccine Safety Datalink (VSD). DESIGN/METHODS A retrospective cohort study was conducted in three phases. In phase 1, electronic health record (EHR) data were used to identify patterns of under-vaccination during the first 24months of life potentially due to parental choice. In phase 2, a random sample of records of under-vaccinated children was manually reviewed. In phase 3, a separate sample of parents were surveyed to assess whether EHR data accurately reflected their child's vaccination status. Phases 1 and 2 were conducted at 6 VSD sites, phase 3 at 1 site. RESULTS The study cohort included 361,901 children born 2004 through 2012. By 24months of age, 198,249 (54.8%) were fully vaccinated with no delays, 84,698 (23.4%) experienced delays but were fully vaccinated by 24months of age, 4865 (1.3%) received no vaccines, 3789 (1.0%) delayed starting vaccination until ≥4months of age, 4781 (1.3%) had consistent vaccine-limiting (≤2 vaccines per visit), and the remaining 65,519 (18.1%) were missing vaccine series or doses. When a diagnosis code for vaccine refusal was present in EHR data, encounter notes confirmed vaccine refusal as the reason for under-vaccination for nearly 100% of sampled records. Parent surveys confirmed these findings. Parents of under-vaccinated children were more likely to report visiting an alternative medical provider than parents of fully vaccinated children. CONCLUSIONS Specific groups of children, under-vaccinated due to parental choice, can be identified with relatively low likelihood of misclassification of vaccination status using EHR-based vaccine data and diagnosis codes.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States.
| | - Sophia R Newcomer
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States.
| | | | - Holly C Groom
- Kaiser Permanente Northwest, Portland, OR, United States.
| | - Marlene M Lugg
- Kaiser Permanente Southern California, Pasadena, CA, United States.
| | - Huong Q McLean
- Marshfield Clinic Research Foundation, Marshfield, WI, United States.
| | - Nicola P Klein
- Kaiser Permanente Northern California, Oakland, CA, United States.
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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Lieu TA, Zikmund-Fisher BJ, Chou C, Ray GT, Wittenberg E. Parents' Perspectives on How to Improve the Childhood Vaccination Process. Clin Pediatr (Phila) 2017; 56:238-246. [PMID: 27162178 DOI: 10.1177/0009922816649001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few national studies have asked parents how to improve the childhood vaccination process. We surveyed a nationally representative online panel of parents on how to improve this process, rationales for nonstandard approaches, and alternatives to the standard schedule. Twelve percent of the 1222 respondents reported using nonstandard approaches: 3.2% used a specific schedule, 6.0% had no specific schedule, and 2.5% declined all vaccinations. The most common rationales were that too many vaccines are given at once, and discomfort with vaccine ingredients. Regarding how to improve the process, parents using the standard schedule most often said nothing could be improved (51%), or better vaccine information (22%). Those using nonstandard approaches most often would have liked more choice (40%) or better vaccine information (26%). Parents' experiences with the vaccination process could be improved by offering information prior to visits, giving more information about side effects, and allowing more flexibility about vaccine scheduling.
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Affiliation(s)
- Tracy A Lieu
- 1 Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Brian J Zikmund-Fisher
- 2 Deaprtment of Health Behavior and Health Education, Department of Medicine, and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Cathy Chou
- 1 Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - G Thomas Ray
- 1 Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Eve Wittenberg
- 3 Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA
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Weinberg M, Dietz S, Potter R, Swanson R, Miller C, McFadden J. Vaccine shot-limiting: Estimating the prevalence, indicators, and impact on vaccination status - Michigan, 2012. Vaccine 2017; 35:1018-1023. [PMID: 28108229 DOI: 10.1016/j.vaccine.2017.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Concerns regarding vaccine safety and pain have prompted certain parents to limit the number of shots their child receives per visit. We estimated the prevalence of shot-limited children in Michigan, described their characteristics, assessed whether shot-limited children were up-to-date on recommended vaccinations, and investigated possible intervention points for vaccination education. METHODS We analyzed vaccination registry and birth record data of children born in Michigan during 2012 who had ⩾2 vaccination visits, with ⩾1 visits after age 5months. Shot-limited was defined as receiving ⩽2 shots at all visits through age 24months. Nonlimited children received >2 shots at ⩾1 visits. Up-to-date vaccination was based on receipt of a seven-vaccine series and was determined at ages 24months and 35months. Risk ratios (RR) were calculated using risk regression. RESULTS Of 101,443 children, a total of 2,967 (3%) children were shot-limited. Mothers of shot-limited children were more likely to be white (RR: 1.2; 95% confidence interval [CI]: 1.2-1.2), college graduate (RR: 1.9; 95% CI: 1.9-2.0), and married (RR: 1.5; 95% CI: 1.5-1.5). Compared with nonlimited children, shot-limited children were more likely to be born in a nonhospital setting (RR: 11.7; 95% CI: 9.4-14.6) and have a midwife attendant (RR: 1.9; 95% CI: 1.7-2.1). Shot-limited children were less likely to be up-to-date on recommended vaccinations (RR: 0.2; 95% CI: 0.2-0.3); this association was stronger for those with a midwife birth attendant (RR: 0.1; 95% CI: 0.1-0.2) rather than a medical doctor (RR: 0.3; 95% CI: 0.2-0.3). CONCLUSIONS Shot-limited children are less likely to be up-to-date on vaccinations, possibly leading to increased risk for vaccine-preventable diseases. This association was stronger for those with a midwife birth attendant. This analysis should prompt targeted education, such as to midwives, concerning risks associated with shot-limiting behavior.
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Affiliation(s)
- Meghan Weinberg
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA; Michigan Department of Health and Human Services, 333 S. Grand Avenue, Lansing, MI 48909, USA.
| | - Stephanie Dietz
- Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Rachel Potter
- Michigan Department of Health and Human Services, 333 S. Grand Avenue, Lansing, MI 48909, USA
| | - Robert Swanson
- Michigan Department of Health and Human Services, 333 S. Grand Avenue, Lansing, MI 48909, USA
| | - Corinne Miller
- Michigan Department of Health and Human Services, 333 S. Grand Avenue, Lansing, MI 48909, USA
| | - Jevon McFadden
- Michigan Department of Health and Human Services, 333 S. Grand Avenue, Lansing, MI 48909, USA; Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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Forster AS, Rockliffe L, Chorley AJ, Marlow LA, Bedford H, Smith SG, Waller J. A qualitative systematic review of factors influencing parents' vaccination decision-making in the United Kingdom. SSM Popul Health 2016; 2:603-612. [PMID: 28018959 PMCID: PMC5165048 DOI: 10.1016/j.ssmph.2016.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/20/2016] [Accepted: 07/22/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High uptake of vaccinations is crucial for disease prevention. Although overall uptake of childhood immunisations is high in the United Kingdom (UK), pockets of lower uptake remain. Novel systematic methods have not been employed when reviewing the qualitative literature examining parents' vaccination decisions. AIMS We aimed to conduct a qualitative systematic review of studies in the UK to understand factors influencing parental decisions to vaccinate a child. METHODS On 12/2/14 we searched PsycINFO, MEDLINE, CINAHL plus, Embase, Social Policy and Practice and Web of Science for studies using qualitative methods and reporting reasons why parents in the UK had or had not immunised their child. Participant quotes and authors' interpretations of qualitative data were extracted from the results of articles. Thematic synthesis was used to develop higher-order themes (conducted in 2015). RESULTS 34 papers were included. Two types of decision-making had been adopted: non-deliberative and deliberative. With non-deliberative decisions parents felt they had no choice, were happy to comply and/or relied on social norms. Deliberative decisions involved weighing up the risks and benefits, considering others' advice/experiences and social judgement. Emotions affected deliberative decision-making. Trust in information and vaccine stakeholders was integral to all decision-making. Practical issues affected those who intended to vaccinate. CONCLUSIONS Parents adopted two different approaches to decision-making about childhood vaccinations. By understanding more about the mechanisms underpinning parents' vaccination behaviour, in collaboration with vaccine stakeholders, we can better design interventions to enhance informed uptake.
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Affiliation(s)
- Alice S. Forster
- Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom
| | - Lauren Rockliffe
- Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom
| | - Amanda J. Chorley
- Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom
| | - Laura A.V. Marlow
- Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom
| | - Helen Bedford
- Institute of Child Health, UCL, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Samuel G. Smith
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom
| | - Jo Waller
- Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom
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Huang WT, Lin HC, Yang CH. Undervaccination with diphtheria, tetanus, and pertussis vaccine: National trends and association with pertussis risk in young children. Hum Vaccin Immunother 2016; 13:757-761. [PMID: 27858500 DOI: 10.1080/21645515.2016.1249552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The high coverage for ≥3 pertussis vaccine doses among Taiwanese children might not imply timely vaccination. Recently, resurgence of pertussis and challenges with availability of DTaP-IPV-Hib prompted this study. METHODS In the 1996-2012 national birth cohort, we calculated the prevalence and days of undervaccination against pertussis by age 36 months. We also compared the odds of undervaccination in each laboratory-confirmed pertussis patient at ages 3-35 months with sex-, residence-, and age-matched controls from the general population, using conditional logistic regression. RESULTS The prevalence of undervaccination was 60.6% (median 16 days) and decreasing (p < 0.0001). Among 145 cases and 2,900 controls, 58 (40.0%) and 721 (24.9%) were undervaccinated (OR 2.28, 95% CI 1.57-3.31). The attributable risk percent was 22.5% (95% CI 14.5-27.9). CONCLUSIONS Undervaccination was decreasing. Approximately up to one-fifth pertussis cases in children aged 3-35 months could have been prevented with on-time vaccination.
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Affiliation(s)
| | - Hui-Chen Lin
- a Taiwan Centers for Disease Control , Taipei , Taiwan
| | - Chin-Hui Yang
- a Taiwan Centers for Disease Control , Taipei , Taiwan
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40
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Frew PM, Chung Y, Fisher AK, Schamel J, Basket MM. Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication. Vaccine 2016; 34:5840-5844. [PMID: 27789148 DOI: 10.1016/j.vaccine.2016.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions. METHODS We conducted a national online panel survey of 2603 US parents of children aged <7. Primary outcomes included reported VIS receipt, delivery timing, reading experiences, and perceived utility. RESULTS Most parents received a VIS (77.2%; [95% CI: 74.5-79.7%]), 59.7% [56.6-62.7%] before vaccination but 14.5% [12.5-16.8%] reported receiving it after their child's immunization; 15.1% [13.0-17.6%] were unsure of receipt status or timing; another 10.7% [9.0-12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8-97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions. CONCLUSIONS Most parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication.
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Affiliation(s)
- Paula M Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States; Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, United States; Emory University, Rollins School of Public Health, Hubert Department of Global Health, United States; U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States.
| | - Yunmi Chung
- Oak Ridge Institute for Science and Education (ORISE), United States
| | - Allison Kennedy Fisher
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States
| | - Jay Schamel
- Oak Ridge Institute for Science and Education (ORISE), United States
| | - Michelle M Basket
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States
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Nowak GJ, Cacciatore MA. Parents' confidence in recommended childhood vaccinations: Extending the assessment, expanding the context. Hum Vaccin Immunother 2016; 13:687-700. [PMID: 27682979 DOI: 10.1080/21645515.2016.1236881] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
There has been significant and growing interest in vaccine hesitancy and confidence in the United States as well as across the globe. While studies have used confidence measures, few studies have provided in-depth assessments and no studies have assessed parents' confidence in vaccines in relationship to other frequently recommended health-related products for young children. This study used a nationally representative sample of 1000 US parents to identify confidence levels for recommended vaccinations, antibiotics, over-the-counter (OTC) medicines, and vitamins for children. The analyses examined associations between confidence ratings, vaccination behaviors and intentions, and trust in healthcare provider, along with associations between confidence ratings and use of the other health-related products. Parents' confidence in vaccines was relatively high and high relative to antibiotics, OTC medicines and vitamins. For all 4 health-related products examined, past product experience and knowledge of bad or adverse outcomes negatively impacted parents' confidence levels. Confidence levels were associated with both trust in advice from their child's healthcare provider and acceptance of healthcare provider recommendations. Parents in some groups, such as those with lower income and education levels, were more likely to have less confidence not just in vaccines, but also in antibiotics and OTC medicines for children. Overall, the findings extend understanding of vaccine confidence, including by placing it into a broader context.
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Affiliation(s)
- Glen J Nowak
- a Grady College Center for Health & Risk Communication, Grady College of Journalism and Mass Communication, University of Georgia , Athens , GA , USA
| | - Michael A Cacciatore
- b Grady College of Journalism and Mass Communication, University of Georgia , Athens , GA , USA
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Hough-Telford C, Kimberlin DW, Aban I, Hitchcock WP, Almquist J, Kratz R, O'Connor KG. Vaccine Delays, Refusals, and Patient Dismissals: A Survey of Pediatricians. Pediatrics 2016; 138:peds.2016-2127. [PMID: 27573091 DOI: 10.1542/peds.2016-2127] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Parental noncompliance with the American Academy of Pediatrics and Centers for Disease Control and Prevention immunization schedule is an increasing public health concern. We examined the frequency of requests for vaccine delays and refusals and the impact on US pediatricians' behavior. METHODS Using national American Academy of Pediatrics Periodic Surveys from 2006 and 2013, we describe pediatrician perceptions of prevalence of (1) vaccine refusals and delays, (2) parental reasons for refusals and/or delays, and (3) physician dismissals. Questions about vaccine delays were asked only in 2013. We examined the frequency, reasons for, and management of both vaccine refusals and delays by using bivariate and multivariable analyses, which were controlled for practice characteristics, demographics, and survey year. RESULTS The proportion of pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 (P < .001). Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported "always" dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004). CONCLUSIONS Pediatricians reported increased vaccine refusal between 2006 and 2013. They perceive that vaccine-refusing parents increasingly believe that immunizations are unnecessary. Pediatricians continue to provide vaccine education but are also dismissing patients at higher rates.
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Affiliation(s)
| | | | | | | | | | - Richard Kratz
- Pennridge Pediatric Associates, Sellersville, Pennsylvania; and
| | - Karen G O'Connor
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
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Abstract
Immunizations have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about addressing parental concerns about vaccination.
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Vaccination Confidence and Parental Refusal/Delay of Early Childhood Vaccines. PLoS One 2016; 11:e0159087. [PMID: 27391098 PMCID: PMC4938536 DOI: 10.1371/journal.pone.0159087] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To support efforts to address parental hesitancy towards early childhood vaccination, we sought to validate the Vaccination Confidence Scale using data from a large, population-based sample of U.S. parents. METHODS We used weighted data from 9,354 parents who completed the 2011 National Immunization Survey. Parents reported on the immunization history of a 19- to 35-month-old child in their households. Healthcare providers then verified children's vaccination status for vaccines including measles, mumps, and rubella (MMR), varicella, and seasonal flu. We used separate multivariable logistic regression models to assess associations between parents' mean scores on the 8-item Vaccination Confidence Scale and vaccine refusal, vaccine delay, and vaccination status. RESULTS A substantial minority of parents reported a history of vaccine refusal (15%) or delay (27%). Vaccination confidence was negatively associated with refusal of any vaccine (odds ratio [OR] = 0.58, 95% confidence interval [CI], 0.54-0.63) as well as refusal of MMR, varicella, and flu vaccines specifically. Negative associations between vaccination confidence and measures of vaccine delay were more moderate, including delay of any vaccine (OR = 0.81, 95% CI, 0.76-0.86). Vaccination confidence was positively associated with having received vaccines, including MMR (OR = 1.53, 95% CI, 1.40-1.68), varicella (OR = 1.54, 95% CI, 1.42-1.66), and flu vaccines (OR = 1.32, 95% CI, 1.23-1.42). CONCLUSIONS Vaccination confidence was consistently associated with early childhood vaccination behavior across multiple vaccine types. Our findings support expanding the application of the Vaccination Confidence Scale to measure vaccination beliefs among parents of young children.
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Williams SE, Morgan A, Opel D, Edwards K, Weinberg S, Rothman R. Screening Tool Predicts Future Underimmunization Among a Pediatric Practice in Tennessee. Clin Pediatr (Phila) 2016; 55:537-42. [PMID: 26581360 PMCID: PMC7864550 DOI: 10.1177/0009922815615823] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Parent Attitudes about Childhood Vaccines (PACV) survey for identifying vaccine-hesitant parents was recently validated in Washington State but did not include all recommended childhood vaccines. The current study compares vaccination rates for all recommended childhood vaccines and PACV scores at one pediatric practice in Tennessee. Children were enrolled at the 2-week well visit, and vaccination rates were assessed at 19 months of age. Outcomes at 19 months of age included mean percentage of days underimmunized and up-to-date status (yes/no) compared with PACV scores. The impact of provider on immunization status was assessed. Complete vaccination data were available for 158 children of 183 enrolled (86%). Higher PACV scores were associated with more days underimmunized (P < .001) and being overdue for vaccine doses at 19 months of age (P < .001). No difference was seen between providers and up-to-date status. Our study supports the predictive validity of the PACV for underimmunization.
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Affiliation(s)
| | - Ashley Morgan
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Douglas Opel
- University of Washington School of Medicine, Seattle, WA, USA
| | - Kathryn Edwards
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Stuart Weinberg
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Russell Rothman
- Vanderbilt University School of Medicine, Nashville, TN, USA
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Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015 [corrected]. Public Health Rep 2016; 130:573-95. [PMID: 26556929 DOI: 10.1177/003335491513000606] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Glanz JM, Newcomer SR, Jackson ML, Omer SB, Bednarczyk RA, Shoup JA, DeStefano F, Daley MF, Goddard K, Panneton M, Groom H, Plotkin SA, Orenstein WA, Marcuse EK, Brookhart MA, Kulldorff M, Shimabukuro T, McNeil M, Gee J, Weintraub E, Sukumaran L. White Paper on studying the safety of the childhood immunization schedule in the Vaccine Safety Datalink. Vaccine 2016; 34 Suppl 1:A1-A29. [DOI: 10.1016/j.vaccine.2015.10.082] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Cacciatore MA, Nowak G, Evans NJ. Exploring The Impact Of The US Measles Outbreak On Parental Awareness Of And Support For Vaccination. Health Aff (Millwood) 2016; 35:334-40. [DOI: 10.1377/hlthaff.2015.1093] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michael A. Cacciatore
- Michael A. Cacciatore ( ) is an assistant professor in the Department of Advertising and Public Relations at Grady College, University of Georgia, in Athens
| | - Glen Nowak
- Glen Nowak is a professor in the Department of Advertising and Public Relations and director of the Center for Health and Risk Communication, both at Grady College, University of Georgia
| | - Nathaniel J. Evans
- Nathaniel J. Evans is an assistant professor in the Department of Advertising and Public Relations at Grady College, University of Georgia
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O’Leary ST, Allison MA, Fisher A, Crane L, Beaty B, Hurley L, Brtnikova M, Jimenez-Zambrano A, Stokley S, Kempe A. Characteristics of Physicians Who Dismiss Families for Refusing Vaccines. Pediatrics 2015; 136:1103-11. [PMID: 26527552 PMCID: PMC6802277 DOI: 10.1542/peds.2015-2086] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Physicians dismissing families who refuse vaccines from their practices is controversial. We assessed the following among pediatricians (Peds) and family physicians (FPs): (1) reported prevalence of parental refusal of 1 or more vaccines in the infant series; (2) physician response to refusal; and (3) the association between often/always dismissing families and provider/practice characteristics and state exemption laws. METHODS Nationally representative survey conducted June to October 2012. A multivariable analysis assessed association of often/always dismissing families with physician/practice characteristics, state philosophical exemption policy, and degree of difficulty obtaining nonmedical exemptions. RESULTS The response rate was 66% (534/815). Overall, 83% of physicians reported that in a typical month, ≥1% of parents refused 1 or more infant vaccines, and 20% reported that >5% of parents refused. Fifty-one percent reported always/often requiring parents to sign a form if they refused (Peds 64%, FP 29%, P < .0001); 21% of Peds and 4% of FPs reported always/often dismissing families if they refused ≥1 vaccine. Peds only were further analyzed because few FPs dismissed families. Peds who dismissed families were more likely to be in private practice (adjusted odds ratio [aOR] 4.90, 95% confidence interval [CI] 1.40-17.19), from the South (aOR 4.07, 95% CI 1.08-15.31), and reside in a state without a philosophical exemption law (aOR 3.70, 95% CI 1.74-7.85). CONCLUSIONS Almost all physicians encounter parents who refuse infant vaccines. One-fifth of Peds report dismissing families who refuse, but there is substantial variation in this practice. Given the frequency of dismissal, the impact of this practice on vaccine refusers and on pediatric practices should be studied.
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Affiliation(s)
- Sean T. O’Leary
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Mandy A. Allison
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Allison Fisher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lori Crane
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Community and Behavioral Health, Colorado School of Public Health, Denver, Colorado
| | - Brenda Beaty
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Laura Hurley
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Division of General Internal Medicine, Denver Health, Denver, Colorado
| | - Michaela Brtnikova
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Andrea Jimenez-Zambrano
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Kempe
- The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
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Glanz JM, Newcomer SR, Daley MF, McClure DL, Baxter RP, Jackson ML, Naleway AL, Lugg MM, DeStefano F. Cumulative and episodic vaccine aluminum exposure in a population-based cohort of young children. Vaccine 2015; 33:6736-44. [DOI: 10.1016/j.vaccine.2015.10.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
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