title: Is the cultural context of MMR rejection a key to an effective public health discourse?
abstract: OBJECTIVE
  (1) To explore the social and cultural influences, and health beliefs associated with low uptake of MMR (measles, mumps and rubella vaccine). (2) To describe and explore the prevalence of health beliefs associated with non-compliance with MMR, with a view to improving the personal relevance and impact of information for parents, in the context of persisting low uptake following public controversy.
  
  
  METHODS
  We undertook a survey of mothers' experiences of and attitudes to the MMR, developed through ethnographic study, which was linked to maternal and child information on the Child Health Database in Brighton, England.
  
  
  RESULTS
  Mothers interpret MMR risk through concepts of child health embedded in family health history, with a majority both of compliers and non-compliers holding that each child's immune system is unique. Cultural 'risk factors' for non-compliance relate strongly to the use of complementary healthcare, such as homeopathy, with evidence that rejection of vitamin K is associated with MMR non-compliance. Forty per cent, both of compliers and non-compliers, did not consider the possible benefits to other children of MMR.
  
  
  CONCLUSIONS
  These findings have paradoxical and challenging consequences for the promotion of immunization in the policy context of increasing emphasis on healthy choices. They demonstrate the need for immunization information that acknowledges and addresses lay concepts of immunity.
authors.affiliation: Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill Street, London NW2 2PF, UK. j.cassell@pcps.ucl.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Cassell
authors.forename: M
authors.initials: M
authors.lastname: Leach
authors.forename: M S
authors.initials: MS
authors.lastname: Poltorak
authors.forename: C H
authors.initials: CH
authors.lastname: Mercer
authors.forename: A
authors.initials: A
authors.lastname: Iversen
authors.forename: J R
authors.initials: JR
authors.lastname: Fairhead
mesh_terms: D000293:Adolescent; D000328:Adult; D000884:Anthropology, Cultural; D001294:Attitude to Health / Q000208:ethnology*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003469:Culture; D003657:Decision Making; D004739:England; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007223:Infant; D022542:Measles-Mumps-Rubella Vaccine / Q000009:adverse effects; D009035:Mothers / Q000523:psychology*; D010817:Physician-Patient Relations; D011634:Public Health; D011795:Surveys and Questionnaires
chemical_list: D022542:Measles-Mumps-Rubella Vaccine