title: Perceptions of personal belief vaccine exemption policy: a survey of Arizona vaccine providers.
abstract: BACKGROUND
  As exemptions to school-entry requirements rise, vaccination rates in Arizona school children are approaching levels that may threaten public health. Understanding the interactions physicians have with vaccine-hesitant parents, as well as the opinions physicians hold regarding vaccination, exemption, and exemption policies, are critical to our understanding of, and ability to affect, vaccination exemption rates among children.
  
  
  METHODS
  Survey responses were elicited from practitioners listed in The Arizona Partnership for Immunization and the Arizona Medical Association databases using a multi-pronged recruitment approach. Respondents provided data regarding their practice, comfort with parental refusal of individual vaccines, opinions about the beliefs held by parents that seek exemptions, parent education strategies, issues regarding providing care to unvaccinated children, and potential changes to Arizona policy.
  
  
  RESULTS
  A total of 152 practitioners providing care to a wide geographic and economic population of Arizona responded to the survey. Respondents were generally strong advocates of all immunizations but were more accepting of parents' desires to refuse hepatitis B and rotavirus vaccines. Almost all providers indicated that they see patients whose parents request to refuse or delay from vaccinations at least occasionally (88% and 97%, respectively). Only 37% of respondents indicated that they would be supportive of a policy requiring them to sign off on a parent's decision to refuse vaccination.
  
  
  CONCLUSIONS
  Vaccination providers in Arizona are generally very supportive of childhood immunizations but have varying comfort with exemption from individual vaccines. Responding providers tended to not support a requirement for a physician's signature for vaccine exemptions due to varying concerns regarding the implementation of such a practice.
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States. Electronic address: shaenchen@arizona.edu.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Haenchen
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States; University of Arizona Cancer Center, University of Arizona, 1515N. Campbell Avenue, Tucson, AZ 85724, United States.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Jacobs
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States.
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Bratton
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States.
authors.forename: Aubri S
authors.initials: AS
authors.lastname: Carman
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States.
authors.forename: Eyal
authors.initials: E
authors.lastname: Oren
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States.
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Pottinger
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Regan
authors.affiliation: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Avenue, Tucson, AZ 85724, United States.
authors.forename: Kacey C
authors.initials: KC
authors.lastname: Ernst
mesh_terms: D001130:Arizona; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs; D008297:Male; D010290:Parents; D011369:Professional-Patient Relations; D016312:Treatment Refusal; D014611:Vaccination / Q000523:psychology*
keywords: Family practice; Immunization; Pediatrics; Policy; Vaccine exemption