Efficient burdens decrease nonmedical exemption rates: A cross-county comparison of Michigan's vaccination waiver education efforts
Efficient burdens decrease nonmedical exemption rates: A cross-county comparison of Michigan's vaccination waiver education efforts
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DOI：
10.1016/j.pmedr.2020.101049
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发表时间：
2020-03-01
影响因子：
2.8
通讯作者：
McCright, Aaron M.
中科院分区：
文献类型：
--
作者：
Navin, Mark C.;Largent, Mark A.;McCright, Aaron M.
密歇根州的非医疗豁免的强制性咨询的引入与非医疗豁免率下降。然而，虽然密歇根州的45个地方卫生部门各自决定如何进行免疫咨询，但咨询项目负担的差异与豁免率的变化无关。密歇根州地方卫生部门的调查数据（在线，2015年10月），密歇根州卫生和人类服务部的流行病学数据（在线，不同日期）以及美国社区调查的社会和经济数据（在线，不同日期）用于解释县级非医疗豁免率变化的模型。在2014年12月规则变更后首次需要教育课程的县，2015年的非医疗豁免率比已经需要教育课程的县降低了30%。密歇根州的疫苗接种豁免教育的经验表明，对非医疗豁免申请人施加负担会降低非医疗豁免率。它还表明，可能存在一个负担阈值，超过该阈值，不便的增量增加不会进一步降低豁免率。因此，在高度政治化和紧缩的背景下，卫生部门可能明智地避免实施额外的繁琐程序，因为这些程序在政治上或经济上都是昂贵的。
Michigan's introduction of mandatory counseling for nonmedical exemptions was associated with decreased nonmedical exemption rates. However, while each of Michigan's 45 local health departments made its own decisions about how to conduct immunization counseling, differences in the burdensomeness of counseling programs was not associated with greater or lesser changes in exemption rates. Data from a survey of Michigan local health departments (online, October 2015), epidemiological data from Michigan's Department of Health and Human Services (online, various dates), and social and economic data from the American Community Survey (online, various dates) were used in models explaining change in county-level nonmedical exemption rates. Counties that first required an education session after the December 2014 rule change had a 30% greater reduction in their nonmedical exemption rates for 2015 than did counties that already required education sessions. Michigan's experience with vaccination waiver education suggests that imposing burdens on nonmedical waiver applicants decreases nonmedical waiver rates. It also indicates there may be a burden threshold beyond which incremental increases in inconvenience do not further reduce exemption rates. Thus, in a context of hyper-politicization and austerity, health departments may be wise to avoid implementing additionally burdensome processes that are politically or economically expensive to administer.