title: Evaluation of low immunization coverage among the Amish population in rural Ohio.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Review included childhood immunizations among the 10 great public health achievements in the United States in the 20th century. Despite this acknowledged success, childhood immunization rates continue to be much lower in select populations. Amish communities have persistently lower immunization rates. Recent outbreaks in Amish communities include a 2014 measles outbreak in Ohio, resulting in 368 cases reported. A recent outbreak of pertussis in an Amish community in Ohio resulted in the death of a 6-week-old Amish baby.
  
  
  METHODS
  A study was designed to determine the knowledge, beliefs, attitudes, and opinions of Amish parents relative to the immunization of Amish children. Data were collected through a questionnaire. Each potential participant was mailed a copy of a letter describing the proposed study. The questionnaire, a copy of the current immunization schedule, and a return stamped envelope were also included in the mailed packet. The study sample consisted of 84 Amish individuals who voluntarily filled out and returned questionnaires.
  
  
  RESULTS
  The findings from the data analysis demonstrated that fear, especially concern over too many recommended immunizations and immunizations overwhelming the child's system, was the most frequent reported reasons for not having children immunized according to recommendations.
  
  
  CONCLUSIONS
  Religious factors and access to care were not among reasons most reported. Designing an educational campaign for educating Amish parents on the risks and benefits of immunizations with focus on specific concerns may improve immunization rates.
authors.affiliation: Ashtabula County Health Department, Jefferson, OH; Indiana Wesleyan University, Marion, IN; Walden University, Minneapolis, MN. Electronic address: tredwaychris@yahoo.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Kettunen
authors.affiliation: Walden University, Minneapolis, MN.
authors.forename: John
authors.initials: J
authors.lastname: Nemecek
authors.affiliation: Akron Children's Hospital, Akron, OH.
authors.forename: Olivia
authors.initials: O
authors.lastname: Wenger
mesh_terms: D000293:Adolescent; D000328:Adult; D061365:Amish / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010290:Parents / Q000523:psychology; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology*; D000073887:Vaccination Coverage / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Amish parents; Child health promotion; Immunizations; Reason for refusal