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

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. 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”.

8. 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

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

10. 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.

11. 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).

12. 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).

13. Demographics: Age* Age** Public Private Charter/other Home Total 18-296 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).

14. Demographics: Race* Race Public Private Charter/other Home Total White70 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.

15. 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).

16. 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).

17. 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).

18. 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).

19. 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.

20. 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).

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

22. 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.

23. 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.

24. 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.

25. 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.

26. Acknowledgements
Deb Gust
Porter Novelli