title: Association between health care providers' influence on parents who have concerns about vaccine safety and vaccination coverage.
abstract: OBJECTIVE
  Parents who have concerns about vaccine safety may be reluctant to have their children vaccinated. The purpose of this study was to explore how vaccination coverage among children 19 to 35 months of age is associated with health care providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety.
  
  
  METHODS
  Parents of 7695 children 19 to 35 months of age sampled by the National Immunization Survey were administered the National Immunization Survey Parental Knowledge Module between the third quarter of 2001 and the fourth quarter of 2002. Health care providers were defined as a physician, nurse, or any other type of health care professional. Parents provided responses that summarized the degree to which they believed vaccines were safe, and the influence providers had on their decisions to vaccinate their children. Children were determined to be up-to-date if their vaccination providers reported administering > or = 4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, > or = 3 doses of polio vaccine, > or = 1 dose of measles-mumps-rubella vaccine, > or = 3 doses of Haemophilus influenzae type b vaccine, and > or = 3 doses of hepatitis B vaccine.
  
  
  RESULTS
  Of all of the parents, 5.7% thought that vaccines were not safe, and 21.5% said that their decision to vaccinate their children was not influenced by a health care provider. Compared with parents who responded that providers were not influential in their decision to vaccinate their children, parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a health care provider had an estimated vaccination coverage rate that was significantly higher than the estimated coverage rate among children whose parents' decision was not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%).
  
  
  CONCLUSIONS
  Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe. Physicians, nurses, and other health care professionals should increase their efforts to build honest and respectful relationships with parents, especially when parents express concerns about vaccine safety or have misconceptions about the benefits and risks of vaccinations.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, National Immunization Program, MS E-32, 1600 Clifton Rd, NE, Atlanta, GA 30333, USA. pzs6@cdc.gov
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Allison M
authors.initials: AM
authors.lastname: Kennedy
authors.forename: Karen
authors.initials: K
authors.lastname: Wooten
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Gust
authors.forename: Larry K
authors.initials: LK
authors.lastname: Pickering
mesh_terms: D002675:Child, Preschool; D006282:Health Personnel; D006801:Humans; D007223:Infant; D010290:Parents; D012449:Safety; D014611:Vaccination / Q000592:standards* / Q000706:statistics & numerical data*; D014612:Vaccines / Q000009:adverse effects
chemical_list: D014612:Vaccines