title: Parental vaccine concerns, information source, and choice of alternative immunization schedules.
abstract: Alternative immunization schedules increase the time a child is unvaccinated and require greater resources from providers. Understanding what drives interest in alternative immunization schedules can potentially inform the design of effective, targeted messages that help to reduce time spent counseling and decrease requests for alternative immunization schedules. This study used the Theory of Planned Behavior to explore associations between sources of vaccine information, parental vaccine concerns, peer norms for vaccine behavior and intentions to follow an alternative immunization schedule. We performed logistic regression using medical record data from a private pediatric practice in a large northeastern city. Routine data were recorded in the EMR by the pediatrician during an initial vaccine counseling conversation with the parent(s). Parents who received vaccine information from doctors were less likely to have immunization concerns while parents who got vaccine information from friends and family or from books were more likely to report specific vaccine concerns. Our multivariate analysis shows that number of reported vaccine concerns and concerns about the utility or necessity of vaccines are strongly associated with alternative immunization intentions. We also find a direct relationship between sources of information about vaccines and alternative immunization intentions. Our results suggest that vaccine concerns and non-physician information sources play an important role in alternative immunization intentions while communication from physicians may play an important role in addressing vaccine concerns and promoting adherence to the ACIP immunization schedule.
authors.affiliation: University of Pennsylvania School of Nursing; Philadelphia, PA USA.
authors.forename: Marissa
authors.initials: M
authors.lastname: Wheeler
authors.forename: Alison M
authors.initials: AM
authors.lastname: Buttenheim
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D006266:Health Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007115:Immunization Schedule; D010290:Parents; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines
keywords: childhood immunization schedule; information source; parents; vaccination intention; vaccine hesitancy
references.citation: Pediatrics. 2006 May;117(5):1532-41
references.pmid: 16651306
references.citation: Arch Pediatr Adolesc Med. 2004 Jun;158(6):569-75
references.pmid: 15184221
references.citation: Semin Pediatr Infect Dis. 2003 Jul;14(3):207-12
references.pmid: 12913833
references.citation: Pediatrics. 2009 Jun;123(6):1446-51
references.pmid: 19482753
references.citation: Pediatrics. 2010 Apr;125(4):747-55
references.pmid: 20308208
references.citation: Pediatrics. 2010 Apr;125(4):654-9
references.pmid: 20194286
references.citation: Pediatrics. 2005 May;115(5):1428-31
references.pmid: 15867060
references.citation: Am J Prev Med. 2005 Feb;28(2):221-4
references.pmid: 15710279
references.citation: Public Health Rep. 2010 Jul-Aug;125(4):534-41
references.pmid: 20597453
references.citation: Paediatr Drugs. 2007;9(3):143-8
references.pmid: 17523694
references.citation: Public Health Rep. 2011 Jul-Aug;126 Suppl 2:13-23
references.pmid: 21812165
references.citation: Pediatrics. 2008 Oct;122(4):718-25
references.pmid: 18829793
references.citation: Emerg Themes Epidemiol. 2006 Sep 27;3:13
references.pmid: 17005041
references.citation: Pediatrics. 1997 Feb;99(2):209-15
references.pmid: 9024448
references.citation: Pediatr Ann. 2010 Aug;39(8):476-82
references.pmid: 20704143
references.citation: Pediatrics. 2011 Dec;128(6):1094-9
references.pmid: 22123877
references.citation: Pediatrics. 2011 May;127 Suppl 1:S107-12
references.pmid: 21502236
references.citation: Pediatrics. 2004 Jul;114(1):e16-22
references.pmid: 15231968
references.citation: Pediatrics. 2009 Jan;123(1):e164-9
references.pmid: 19117838
references.citation: Vaccine. 2010 Jun 11;28(26):4235-48
references.pmid: 20438879
references.citation: Fam Med. 2004 Jun;36(6):431-9
references.pmid: 15181556
references.citation: MMWR Morb Mortal Wkly Rep. 1999 Apr 2;48(12):241-3
references.pmid: 10220250
references.citation: Arch Pediatr Adolesc Med. 2010 Jan;164(1):66-70
references.pmid: 20048244
references.citation: Pediatrics. 2011 Nov;128(5):848-56
references.pmid: 21969290
references.citation: Arch Pediatr Adolesc Med. 2005 Oct;159(10):929-34
references.pmid: 16203937
references.citation: Am J Epidemiol. 2008 Dec 15;168(12):1389-96
references.pmid: 18922998