Exploring the Choice to Refuse or Delay Vaccines: A National Survey of Parents of 6- Through 23-Month-Olds

doi:10.1016/j.acap.2012.06.007

Academic Pediatrics

Volume 12, Issue 5, September–October 2012, Pages 375-383

https://doi.org/10.1016/j.acap.2012.06.007 Get rights and content

Abstract

Objective

The purpose of this study was to assess respondents' self-reported choices for vaccinating their young children; knowledge, attitudes, and beliefs (KABs) about vaccination; and communication with their child's vaccination provider.

Methods

A national telephone survey of 1500 parents of children aged 6 to 23 months was conducted in 2010. We calculated proportions of parents who had chosen—or planned—to refuse or delay 1 or more recommended vaccines, and proportions for responses to KABs and communication questions, stratified by vaccination choice (ie, refuse or delay).

Results

The response rate was 46%. Among the 96.6% of respondents (95% confidence interval [CI], 95.5%–97.4%; weighted n = 1453) who had chosen for their child to receive at least 1 vaccine, 80.6% (95% CI, 78.8%–83.0%) reported that their child had received all vaccines when recommended and 86.5% (95% CI, 84.7%–88.2%) reported that their child would receive remaining vaccines when recommended. Respondents who considered not following recommendations, but ultimately did, cited the physician's recommendation as the reason for vaccinating. Most vaccinators who reported past or planned deviations from recommendations cited only 1 vaccine that they would refuse and/or delay; all vaccines were mentioned. These parents reported approaching vaccination with serious concerns, while believing other parents did not. All parents cited “vaccine side effects” as their top question or concern. Almost all parents talked to a doctor or nurse about vaccines and, overall, satisfaction with communication was high.

Conclusions

Communication about vaccines is important to most parents, but may be challenging for providers, because parental choices vary; thus, efforts to improve and support vaccine communication by providers should continue.

Section snippets

Study Sample and Response Rate

The sample was drawn from respondents to the Gallup Healthways Well-Being Index survey (well-beingindex.com) who: (1) participated in Healthways during August 2009 to March 2010, (2) agreed to be re-contacted for additional surveys, and (3) were identified as having a child younger than age 2 years in the household. Healthways is a national telephone survey of adults that includes equal probability samples of list-assisted landline and wireless telephone numbers. For respondents who had a child

Demographics

Overall, the mean age of respondents was 32 years (95% CI, 32.0–32.8) (Table 1). Most respondents were women, non-Hispanic white, had completed some college or more, and lived in households with incomes ranging from $35,000 to $150,000. Among the children about whom the respondent reported vaccination choices, 33.3% (95% CI, 30.1%–35.8%) were aged 6 to 11 months, 32.8% (95% CI, 30.5%–35.2%) were aged 12 to 17 months, and 33.9% (95% CI, 31.5%–36.3%) were aged 18 to 23 months.

Children Who Had Received No Vaccines

Overall, 3.4% of

Discussion

This survey of parents and caregivers who were in the process of making choices to vaccinate their infants and toddlers during the first 2 years of life reveals that parents view vaccine communication with their child's doctor as an integral part of the process. The survey also reveals potential complexities in vaccine communication among doctors and parents. Our findings should reassure providers that vaccine communication remains effective, and examining potential complexities offers insights

Conclusion

Overall we found that most parents ask questions about vaccines and have the same general questions and concerns. However, parents who deviate from vaccination recommendations may choose to delay or reject any recommended vaccine, and they are more likely to approach vaccination with serious concerns about a vaccine and whether the child needs it. Thus, a targeted, one-on-one approach to communication is likely needed for many of these parents, but the time required may pose substantial

Acknowledgments

The authors gratefully acknowledge the expertise provided by James Singleton, John Stevenson, and Pascale Wortley during the design of this study, and the expert guidance provided by Pascale Wortley during the preparation of the article. The authors also thank Michael Kelly for statistical support.

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Delay or refusal of childhood vaccines is common and may be increasing. Pediatricians are parents’ most trusted source for vaccine information, yet many struggle with how to communicate with parents who resist recommended vaccines. Evidence-based communication strategies for vaccine conversations are lacking. In this manuscript, we describe the development and perceived usefulness of a curriculum to train clinicians on a specific vaccine communication strategy as part of the PIVOT with MI study, a cluster randomized trial testing the effectiveness of this communication strategy on increasing childhood vaccination uptake among 24 pediatric practices in Colorado and Washington. The communication strategy is based on the existing evidence-based communication strategies of a presumptive format for initiating vaccine conversations and use of motivational interviewing if hesitancy persists. Focus groups and semi-structured interviews with pediatric clinicians helped inform the development of the training curriculum, which consisted of an introductory video module followed by 3 training sessions. Between September 2019 and January 2021, 134 pediatric clinicians (92 pediatricians, 42 advanced practice providers) participated in the training as part of the PIVOT with MI study. Of these, 92 % viewed an introductory video module, 93 % attended or viewed a baseline synchronous training, 82 % attended or viewed a 1st refresher training, and 77 % attended or viewed a 2nd refresher training. A follow-up survey was administered August 2020 through March 2021; among respondents (n = 100), >95 % of participants reported that each component of the training program was very or somewhat useful. These data suggest that the PIVOT with MI training intervention is a useful vaccine communication resource with the potential for high engagement among pediatric clinicians.
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Vaccine hesitancy, defined as a delay in acceptance or refusal of vaccination despite availability of vaccination services, was named by the World Health Organization as one of the top ten threats to public health in 2019 prior to the COVID-19 pandemic. [6] Concerns about vaccine side effects and safety are the most common reasons for delay or non-acceptance of routine childhood vaccinations. [7] In reference to COVID-19 vaccines, the unprecedented speed of vaccine production, adverse side effects, long-term safety, novel mRNA technology, and uncertainty about durability of immunity of the COVID-19 vaccine are often cited as reasons for hesitancy. [4,8–12]
The United States has the highest number of total cases and deaths due to coronavirus disease 2019 (COVID-19) worldwide (Johns Hopkins COVID Dashboard, 2021). Despite COVID-19 vaccine availability, uptake in the United States has been slow and vaccine hesitancy has been a significant barrier to achieving widespread vaccine uptake. Understanding determinants of vaccine acceptance is essential to implement successful population health interventions to increase COVID-19 vaccination.
We developed an anonymous cross-sectional parent survey to assess factors associated with parent and child COVID-19 vaccine acceptance and hesitancy during the initial pediatric vaccine rollout amongst adolescents 16 years +. The survey was sent via email to 25,308 parents registered to the Alachua County Public School System in May 2021 and remained active until July 2021.
There were a total of 2,620 survey responses. Overall, 31.5 % of parents with children ages 16 years + reported their child had received the COVID-19 vaccine, 65.2 % reported their (eligible) child had not received the vaccine, and 3.3 % reported their child was scheduled for the vaccine. A majority of parents (60.9 %) reported they planned to vaccinate all of their children once the COVID-19 vaccine was available for their children’s age. COVID-19 vaccine uptake in adolescents ages 16 + reported by Hispanic and White parents was two times higher than that reported by Black parents. Parent COVID-19 and influenza vaccine uptake were associated with increased child COVID-19 vaccination. The most commonly reported reasons why parents chose not to have their child vaccinated against COVID-19 were concerns about long–term negative side effects (75.7 %) and a negative reaction (56.5 %). Medical providers were reported as the most trusted source of information.
Our study provides insight into determinants of vaccine acceptance, vaccine hesitancy, and trusted sources of information that may be helpful to develop targeted interventions to increase youth COVID-19 vaccination.
Parental vaccine hesitancy and concerns regarding the COVID-19 virus
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Citation Excerpt :
Recently, a large internet-based survey in the United States found that approximately 40% of parents had concerns regarding childhood vaccine safety and only 70% were confident regarding vaccine efficacy (Kempe et al., 2020). In addition, a large national telephone survey of parents found that only 80% had accepted all vaccines as scheduled for their children, indicating that as many as 20% had some degree of hesitancy toward vaccinating (McCauley et al., 2012). Low rates of vaccination have contributed to the resurgence of many vaccine preventable diseases.
This study assessed parental vaccine hesitancy in a metropolitan area of the United States. The study aimed to determine what characteristics and contributing factors influenced parental vaccine hesitancy and concerns regarding COVID-19.
An online survey was used to recruit 93 parents to answer demographic and vaccine hesitancy information. Vaccine hesitancy was measured using the Parent Attitudes about Childhood Vaccines survey. The study was conducted between June 2020 and September 2020 during the COVID-19 pandemic.
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Our findings indicate that older mothers with two or more children are more likely to be vaccine hesitant and this hesitancy extends to the current COVID-19 pandemic.
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The aim of this paper is to review the current situation of vaccine hesitancy, with emphasis on children with neurological disorders, and to present the role social media plays in this situation.
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An increasing number of parents are becoming vaccine hesitant. Their motives are complex and nuanced and involve factors related to vaccine safety and efficiency, perceived personal risks and benefits, socio-demographic and psychological characteristics. Attitudes toward vaccination differ in adolescents from their parents. In children with neurological disorders, factors involved in vaccination decision included physicians' knowledge of neurological diseases and parents’ concerns that vaccination would exacerbate the chronic disorder. Unfortunately, the current pandemic is associated with an increase in vaccine hesitancy and brought forward unique determinants. The social media platforms can be a tool for the anti-vaccine movement to spread misinformation, but it can also be valued as a way for promoting health and pro-vaccine information.
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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.
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.
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 (p_trend<0.001). The percentage with no vaccines rose from 0.35% for the birth year 2004 to 1.28% for the birth year 2017 (p_trend<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 (p_trend<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.
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: The authors have no conflicts of interest to disclose.

: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Primary Care and Medical HomeExploring the Choice to Refuse or Delay Vaccines: A National Survey of Parents of 6- Through 23-Month-Olds

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Study Sample and Response Rate

Demographics

Children Who Had Received No Vaccines

Discussion

Conclusion

Acknowledgments

Am J Prev Med

Am J Prev Med

Am J Prev Med

Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles survey

Pediatrics

Confidence about vaccines in the United States: understanding parents' perceptions

Health Aff (Millwood)

Parental vaccine safety concerns in 2009

Pediatrics

Do parents understand immunizations? A national telephone survey

Pediatrics

Parents with doubts about vaccines: which vaccines and reasons why

Pediatrics

Underimmunization among children: effects of vaccine safety concerns on immunization status

Pediatrics

Are parental vaccine safety concerns associated with receipt of measles-mumps-rubella, diphtheria and tetanus toxoids with acellular pertussis, or hepatitis B vaccines by children?

Arch Pediatr Adolesc Med

Primary Care and Medical Home
Exploring the Choice to Refuse or Delay Vaccines: A National Survey of Parents of 6- Through 23-Month-Olds