title: Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model.
abstract: OBJECTIVE
  We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months.
  
  
  METHODS
  We used data from 11,206 parents of children aged 24-35 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status.
  
  
  RESULTS
  In 2009, approximately 60.2% of parents with children aged 24-35 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines.
  
  
  CONCLUSIONS
  Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA 30333, USA. pzs6@cdc.gov
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Edgar K
authors.initials: EK
authors.lastname: Marcuse
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhao
authors.forename: Christina G
authors.initials: CG
authors.lastname: Dorell
authors.forename: Cynthia
authors.initials: C
authors.lastname: Howes
authors.forename: Beth
authors.initials: B
authors.lastname: Hibbs
mesh_terms: D002675:Child, Preschool; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D010290:Parents / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology*; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines