title: Ready or not? School preparedness for California's new personal beliefs exemption law.
abstract: OBJECTIVE
  This paper describes elementary school officials' awareness of and preparedness for the implementation of California's new exemption law that went into effect on January 1, 2014. The new law prescribes stricter requirements for claiming a personal beliefs exemption from mandated school-entry immunizations.
  
  
  METHODS
  We used cross-sectional data collected from a stratified random sample of 315 schools with low, middle, and high rates of personal beliefs exemptions. We described schools' awareness and specific knowledge of the new legislation and tested for differences across school types. We additionally tested for associations between outcome variables and school and respondent characteristics using ordered logit and negative binomial regression. Finally, we described schools' plans and needs for implementing the new legislation.
  
  
  RESULTS
  Elementary school staff reported an overall low level of awareness and knowledge about the new legislation and could identify few of its features. We observed, however, that across the exemption-level strata, respondents from high-PBE schools reported significantly higher awareness, knowledge and feature identification compared to respondents from low-PBE schools. Multivariate analyses revealed only one significant association with awareness, knowledge and identification: respondent role. Support staff roles were associated with lower odds of having high self-rated awareness or knowledge compared to health workers, as well as with a reduced log count of features identified. Though most school officials were able to identify a communication plan, schools were still in need of resources and support for successful implementation, in particular, the need for information on the new law.
  
  
  CONCLUSIONS
  Schools need additional information and support from state and local agencies in order to successfully implement and enforce California's new school immunization law. In particular, our results suggest the need to ensure information on the new law reaches all levels of school staff.
authors.affiliation: Department of Family and Community Health, University of Pennsylvania School of Nursing, 235L Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Marissa
authors.initials: M
authors.lastname: Wheeler
authors.affiliation: Department of Family and Community Health, University of Pennsylvania School of Nursing, 235L Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, United States. Electronic address: abutt@nursing.upenn.edu.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Buttenheim
mesh_terms: D002140:California; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D033181:Information Dissemination; D045808:Refusal to Participate / Q000331:legislation & jurisprudence*; D012572:School Health Services; D012574:Schools; D014611:Vaccination / Q000331:legislation & jurisprudence*
keywords: California; Exemption; Implementation; Legislation; Preparedness; School immunization requirement