Analysis of Parental Vaccine Beliefs by Child’s School Type Allison Kennedy, MPH National Immunization Conference May 12, 2004

Background Schools have traditionally played a role in childhood immunization Direct provision of services Maintenance of records Enforcement of school entry laws Control of disease outbreaks Direct provision of services, for instance, Hepatitis B vaccination clinics Maintenance of vaccination records and the associated enforcement of up-to-date vaccination requirements for school entry Control of disease outbreaks through notification of parents and exclusion of ill or unimmunized children to prevent the spread of disease

Background Schools could be a useful channel for parental vaccine education Traditional involvement in health education and services Role in maintaining high immunization coverage Schools have a history of involvement in health services, such as school nursing and school-based health centers, as well as general health education efforts directed at both parents and children. In addition to their current role in educating parents about local immunization policies, schools may also play a larger role in vaccine education and service provision in the future.

Objective To determine if parental vaccination beliefs differ by the type of school attended by their youngest child Given the role of the school as a potential channel for parental vaccine education, the objective of our analysis was to determine if the existing vaccine-related beliefs of parents differ by the type of school their child attends. This information could then be used to determine if future educational efforts that use the school as a channel need to tailor their message depending on school type.

Methods: Survey 2003 HealthStyles Survey Administered every year since 1995 as the second wave of a series of consumer mail panel surveys Questions about health beliefs, attitudes, social norms, and behaviors First wave: 10,000 adult panel respondents selected through stratified random sampling to receive the ConsumerStyles survey in May-June 2003 Second wave: 5,873 HealthStyles surveys sent to those households that responded to the ConsumerStyles survey

Methods: Survey 2003 HealthStyles Survey Data weighted to the 2002 U.S. Current Population Survey Responses favorably compare to similar questions from the Behavioral Risk Factor Surveillance System (BRFSS) survey Data weighted on: age, sex, race, hh size, and income. Pollard W, 2002.

Methods: Analysis Dependent variable: type of school attended by respondent’s youngest child Independent variables: Demographics, safety concerns, importance beliefs, trust in government and healthcare systems, sources of information, laws and exemptions Responses to the dependent variable included: Public Private, non-religious Private, religious Charter Homeschool Other My youngest child is not yet in school For the analysis, parents whose youngest child was not yet in school were excluded. The two private school categories were collapsed, as were the categories “charter” and “other”.

Methods: Analysis Descriptive frequencies calculated and stratified by school type Chi square tests used to determine statistical association between demographic, belief, and behavior variables and child’s school type

Results HealthStyles response rate=69% A weighted sample of 980 respondents reported having at least one child in school

School Type of Youngest Child Public 752 (77) Private 144 (15) Charter/other 57 (6) Homeschool 27 (3) Note that the numbers were included on this slide to highlight small numbers of parents in non-public schools. Keep this in mind as results are presented. *Results are weighted to the 2002 Census Current Population Survey. Percentages are rounded and may not add up to 100.

Demographics: Education* Public Private Charter/other Home Total <12 years 27 1 5 7 12 years 39 11 28 25 Some college 33 47 59 College grad 19 31 12 20 Grad school 10 24 4 *Percentages shown are weighted to the 2002 Census Current Population Survey. **Statistically significant (p<0.05).

Demographics: Income* Public Private Charter/other Home Total $0-29,999 23 15 33 25 22 $30-49,999 21 14 24 32 $50-74,999 13 17 29 $75-99,999 12 7 $100,000+ 36 19 *Percentages shown are weighted to the 2002 Census Current Population Survey. **Statistically significant (p<0.05).

Demographics: Age* Age** Public Private Charter/other Home Total 18-29 6 10 33 19 8 30-44 60 51 32 63 57 45 + 34 39 35 *Percentages shown are weighted to the 2002 Census Current Population Survey. **Statistically significant (p<0.05).

Demographics: Race* Race Public Private Charter/other Home Total White 70 78 69 68 71 Hispanic 14 5 9 11 12 African American 10 21 Asian/Pacific Islander 4 6 2 Other 1 Note that race was similar across school types. *Percentages shown are weighted to the 2002 Census Current Population Survey.

Safety of vaccines* In general, how safe do you think vaccines are for children? (dichotomized 10 pt.) Not/somewhat safe (1-7) Safe/very safe (8-10) Total Public Private Charter/other Home Results are weighted to the 2002 Census Current Population Survey. Percentages are rounded and may not add up to 100. *Statistically significant (p<0.05).

Importance of vaccines* In general, how important do you think immunizations are for keeping children healthy? (dichotomized 10 pt.) Not/somewhat imp (1-7) Imp/very imp (8-10) Total Public Private Charter/other Home Results are weighted to the 2002 Census Current Population Survey. Percentages are rounded and may not add up to 100. *Statistically significant (p<0.05).

Trust in government to set vaccine policy* Do you trust the government to set policy for childhood vaccines? yes no dk Total Public Private Charter/other Home Results are weighted to the 2002 Census Current Population Survey. Percentages are rounded and may not add up to 100. *Statistically significant (p<0.05).

Trust in the vaccine advice of child’s main healthcare provider* I trust the vaccine advice my child’s main healthcare provider gives me. (5pt. Likert) Sd/D/N A/SA Total Public Private Charter/other Home Results are weighted to the 2002 Census Current Population Survey. Percentages are rounded and may not add up to 100. *Statistically significant (p<0.05).

Access to vaccine information I have access to all the information I need to make good decisions about immunizing my children. (5 pt Likert). Sd/D/N A/SA Total Public Private Charter/other Home Note that this question was not statistically different across groups. Results are weighted to the 2002 Census Current Population Survey. Percentages are rounded and may not add up to 100.

Would child be immunized if not required?* Would you have your child fully immunized if it were not required in order to enter daycare or school? yes no dk Total Public Private Charter/other Home Results are weighted to the 2002 Census Current Population Survey. Percentages are rounded and may not add up to 100. *Statistically significant (p<0.05).

Summary Parent demographic characteristics-- including age, education, and household income--differed by child’s school type

Summary Homeschooling parents had the lowest proportion of respondents who believed that vaccines were safe (52%) or important (54%) Overall trust in the government to set vaccine policy was low (56%); trust was lowest among homeschoolers (19%) Trust in the vaccine advice of a child’s physician was high (88%), but was lowest among homeschoolers (68%) Although the small number of homeschooling parents in our study limits our ability to generalize these conclusions, it is important to note that this was the group that appeared least supportive of vaccination. Further study is needed to confirm these results and explore possible reasons behind them, as well as ways in which the vaccine concerns of homeschooling parents can be addressed.

Study Limitations Small sample size of non-public school parents may fail to detect differences Cross-sectional, self-report data Non-probability sampling method Cross-sectional data does not allow us to determine causality, and self report data is subject to recall and social desirability biases.

Conclusions Although most parents in this survey believed that vaccines are safe and important, a sizeable minority of parents reported concerns Level of concern differed depending on the type of school attended by the respondent’s youngest child An opportunity exists for public health professionals to work through various educational settings to provide information tailored to reflect differences in parental beliefs and concerns.

Future Studies Planned Study of vaccine knowledge, attitudes, and beliefs of parents who homeschool Development of information for different “audience segments” of parents, including parents who homeschool Partnering with school health professionals and homeschooling groups to evaluate the effectiveness of these interventions We have planned the following studies in order to address the findings of this preliminary study.

Acknowledgements Deb Gust Porter Novelli