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Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006.
Vaccine. 2012 Feb 01; 30(6):1132-42.V

Abstract

BACKGROUND AND OBJECTIVES

With vaccine-preventable diseases at record lows, few studies investigate rising parent-claimed exemptions to school immunization requirements. After finding exemption clusters in Oregon, we hypothesized that exemption risk factors may vary among communities. We surveyed parents to identify risk factors for exemptions and evaluated risk factor differences among communities with differing exemption rates.

DESIGN

Retrospective cohort study, multi-staged, population-proportionate sampling.

SETTING AND PARTICIPANTS

Parents of 2004-05 Oregon elementary school children (N=2900).

MAIN OUTCOME MEASURE

Parent-reported exemption status.

RESULTS

The response rate was 55%. Compared to vaccinators, exemptors were significantly more likely to have: strong vaccine concerns (weighted adjusted odds ratio (aOR)=15.3, 95% CI 6.4-36.7); "vaccine-hesitant" concerns (aOR=2.3; 95% CI 1.0-5.0); >1 childbirth(s) at a non-hospital, alternative setting (aOR=3.6; 95% CI 1.6-8.0); distrust of local doctors (aOR=2.7; 95% CI 1.0-7.5); reported chiropractic healthcare for their youngest school-age child (aOR=3.9; 95% CI 1.8-8.5); and reported knowledge of someone with a vaccine-hurt child (aOR=1.8; 95% CI 0.9-3.4). Exemptors were less likely to have "pro-vaccine" beliefs (aOR=0.2; 95% CI 0.0-0.6) and less likely to report relying on print materials (aOR=0.4; 95% CI 0.2-0.8). The strengths of association differed significantly for those with strong vaccine concerns and those reporting knowledge of someone with a vaccine-hurt child, depending on residence in exemption-rate areas, e.g., exemptors in medium-rate areas were more likely to have strong vaccine concerns (aOR=13.5; 95% CI 5.4-34.0) than those in high-rate areas (aOR=9.7; 95% CI 3.7-25.4).

CONCLUSIONS

Vaccine beliefs were important risk factors. That differing community-level exemption use modified the effects of several individual-level factors suggests that communities also influence parent decisions. Therefore, understanding community contexts and norms may be important when designing interventions.

Authors+Show Affiliations

Immunization Program, Office of Family Health, Public Health Division, State of Oregon Department of Human Services, Portland, OR 97232, USA. jag8nw@comcast.netNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22178105

Citation

Gaudino, James A., and Steve Robison. "Risk Factors Associated With Parents Claiming Personal-belief Exemptions to School Immunization Requirements: Community and Other Influences On More Skeptical Parents in Oregon, 2006." Vaccine, vol. 30, no. 6, 2012, pp. 1132-42.
Gaudino JA, Robison S. Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006. Vaccine. 2012;30(6):1132-42.
Gaudino, J. A., & Robison, S. (2012). Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006. Vaccine, 30(6), 1132-42. https://doi.org/10.1016/j.vaccine.2011.12.006
Gaudino JA, Robison S. Risk Factors Associated With Parents Claiming Personal-belief Exemptions to School Immunization Requirements: Community and Other Influences On More Skeptical Parents in Oregon, 2006. Vaccine. 2012 Feb 1;30(6):1132-42. PubMed PMID: 22178105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006. AU - Gaudino,James A, AU - Robison,Steve, Y1 - 2011/12/14/ PY - 2011/01/31/received PY - 2011/09/30/revised PY - 2011/12/03/accepted PY - 2011/12/20/entrez PY - 2011/12/20/pubmed PY - 2012/5/17/medline SP - 1132 EP - 42 JF - Vaccine JO - Vaccine VL - 30 IS - 6 N2 - BACKGROUND AND OBJECTIVES: With vaccine-preventable diseases at record lows, few studies investigate rising parent-claimed exemptions to school immunization requirements. After finding exemption clusters in Oregon, we hypothesized that exemption risk factors may vary among communities. We surveyed parents to identify risk factors for exemptions and evaluated risk factor differences among communities with differing exemption rates. DESIGN: Retrospective cohort study, multi-staged, population-proportionate sampling. SETTING AND PARTICIPANTS: Parents of 2004-05 Oregon elementary school children (N=2900). MAIN OUTCOME MEASURE: Parent-reported exemption status. RESULTS: The response rate was 55%. Compared to vaccinators, exemptors were significantly more likely to have: strong vaccine concerns (weighted adjusted odds ratio (aOR)=15.3, 95% CI 6.4-36.7); "vaccine-hesitant" concerns (aOR=2.3; 95% CI 1.0-5.0); >1 childbirth(s) at a non-hospital, alternative setting (aOR=3.6; 95% CI 1.6-8.0); distrust of local doctors (aOR=2.7; 95% CI 1.0-7.5); reported chiropractic healthcare for their youngest school-age child (aOR=3.9; 95% CI 1.8-8.5); and reported knowledge of someone with a vaccine-hurt child (aOR=1.8; 95% CI 0.9-3.4). Exemptors were less likely to have "pro-vaccine" beliefs (aOR=0.2; 95% CI 0.0-0.6) and less likely to report relying on print materials (aOR=0.4; 95% CI 0.2-0.8). The strengths of association differed significantly for those with strong vaccine concerns and those reporting knowledge of someone with a vaccine-hurt child, depending on residence in exemption-rate areas, e.g., exemptors in medium-rate areas were more likely to have strong vaccine concerns (aOR=13.5; 95% CI 5.4-34.0) than those in high-rate areas (aOR=9.7; 95% CI 3.7-25.4). CONCLUSIONS: Vaccine beliefs were important risk factors. That differing community-level exemption use modified the effects of several individual-level factors suggests that communities also influence parent decisions. Therefore, understanding community contexts and norms may be important when designing interventions. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/22178105/Risk_factors_associated_with_parents_claiming_personal_belief_exemptions_to_school_immunization_requirements:_community_and_other_influences_on_more_skeptical_parents_in_Oregon_2006_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(11)01929-3 DB - PRIME DP - Unbound Medicine ER -