title: Washington State Licensed Child Care Facility Directors' Perspectives on Childhood Immunization.
abstract: BACKGROUND
  The study objective was to determine Washington State childcare facility directors' compliance with state immunization education and monitoring requirements and the role of directors' immunization attitudes and beliefs on compliance.
  
  
  METHODS
  We mailed a self-administered survey to 2000 randomly selected childcare facility directors in Washington State. The primary outcome measures were reported compliance with state requirements to educate parents about the importance of immunizations and monitor the immunization status of enrolled children.
  
  
  RESULTS
  Our response rate was 28%. The majority of respondents worked at facilities with a licensed capacity of <25 children, had ≥11 years of experience, and were parents themselves. Overall, 68% agreed that they educated enrolled parents about the importance of immunizations and 90% agreed that they monitored the immunization status of enrolled children. However, 60% were concerned that children might have a serious side effect from an immunization, 51% were concerned that any one of the childhood immunizations might not be safe, and 11% were distrustful of the immunization information they received. These beliefs were associated with a statistically significant decreased likelihood of educating parents about immunization (adjusted odds ratios [aORs]: 0.57, 0.46, 0.19, respectively) and monitoring immunization status of children (aORs: 0.32, 0.32, 0.19, respectively).
  
  
  CONCLUSIONS
  Most Washington State child care facility directors who responded to our survey are compliant with state requirements for immunization education and monitoring. A substantial number of directors are concerned about vaccine safety, however, and these concerns may decrease the likelihood of these requirements being followed.
authors.affiliation: Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Opel
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Ashmita
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Coalition for Safety and Health in Early Learning, Seattle, Washington.
authors.forename: Peggy
authors.initials: P
authors.lastname: King
authors.affiliation: Coalition for Safety and Health in Early Learning, Seattle, Washington.
authors.forename: Cathe
authors.initials: C
authors.lastname: Paul
authors.affiliation: Coalition for Safety and Health in Early Learning, Seattle, Washington.
authors.forename: Danette
authors.initials: D
authors.lastname: Glassy
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, and.
authors.forename: Kyle
authors.initials: K
authors.lastname: Yasuda
keywords: Daycare; Immunizations; Vaccines