Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: Community and other influences on more skeptical parents in Oregon, 2006
Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: Community and other influences on more skeptical parents in Oregon, 2006
复制标题
DOI：
10.1016/j.vaccine.2011.12.006
复制
发表时间：
2012-02-01
期刊：
影响因子：
5.5
通讯作者：
Robison, Steve
中科院分区：
文献类型：
--
作者：
Gaudino, James A.;Robison, Steve
背景和目标：随着疫苗可预防的疾病处于历史最低水平，很少有研究调查父母声称的学校免疫要求豁免的增加。在俄勒冈州发现豁免集群后，我们假设豁免风险因素可能因社区而异。我们调查了父母，以确定风险因素的豁免和评估社区之间的风险因素差异，不同的豁免rate.Design：回顾性队列研究，多阶段，人口比例抽样。背景和参与者：2004-05年俄勒冈州小学儿童的父母（N= 2900）。主要结果测量：家长报告的豁免状态。结果：应答率为55%。与疫苗接种者相比，豁免者更有可能有：强烈的疫苗担忧（加权调整比值比（aOR）= 15.3，95% CI 6.4-36.7）;“疫苗犹豫”问题（aOR = 2.3; 95% CI 1.0-5.0）;在非医院替代环境中分娩>1次（aOR= 3.6; 95% CI 1.6-8.0）;不信任当地医生（aOR= 2.7; 95% CI 1.0-7.5）;报告最小学龄儿童接受脊椎按摩治疗（aOR = 3.9; 95% CI 1.8-8.5）;和报告的知识，有人与疫苗伤害的孩子（aOR= 1.8; 95% CI 0.9-3.4）。豁免者不太可能有“预防接种”的信念（aOR = 0.2; 95% CI 0.0-0.6），不太可能报告依赖印刷材料（aOR = 0.4; 95%CI 0.2-0.8）。对于那些强烈关注疫苗的人和那些报告知道有人有疫苗伤害的孩子的人来说，关联的强度存在显著差异，这取决于居住在豁免率地区，例如，在一个实施例中，中等接种率地区的豁免者比高接种率地区的豁免者更可能有强烈的疫苗担忧（aOR = 13.5; 95%CI 5.4-34.0）（aOR = 9.7; 95%CI 3.7-25.4）。结论：疫苗信念是重要的危险因素。不同的社区层面的豁免使用修改了几个个人层面的因素的影响表明，社区也影响父母的决定。因此，在设计干预措施时，了解社区背景和规范可能很重要。(C)2011爱思唯尔有限公司保留所有权利。
Background and objectives: With vaccine-preventable diseases at record lows, few studies investigate rising parent-claimed exemptions to school immunization requirements. After finding exemption clusters in Oregon, we hypothesized that exemption risk factors may vary among communities. We surveyed parents to identify risk factors for exemptions and evaluated risk factor differences among communities with differing exemption rates.Design: Retrospective cohort study, multi-staged, population-proportionate sampling. Setting and participants: Parents of 2004-05 Oregon elementary school children (N= 2900). Main outcome measure: Parent-reported exemption status.Results: The response rate was 55%. Compared to vaccinators, exemptors were significantly more likely to have: strong vaccine concerns (weighted adjusted odds ratio (aOR)= 15.3,95% Cl 6.4-36.7); "vaccine-hesitant" concerns (aOR = 2.3; 95% Cl 1.0-5.0); >1 childbirth(s) at a non-hospital, alternative setting (aOR= 3.6; 95% Cl 1.6-8.0); distrust of local doctors (aOR= 2.7; 95% Cl 1.0-7.5); reported chiropractic healthcare for their youngest school-age child (aOR = 3.9; 95% Cl 1.8-8.5); and reported knowledge of someone with a vaccine-hurt child (aOR= 1.8; 95% Cl 0.9-3.4). Exemptors were less likely to have "provaccine" beliefs (aOR = 0.2; 95% Cl 0.0-0.6) and less likely to report relying on print materials (aOR = 0.4; 95% CI 0.2-0.8).The strengths of association differed significantly for those with strong vaccine concerns and those reporting knowledge of someone with a vaccine-hurt child, depending on residence in exemption-rate areas, e.g., exemptors in medium-rate areas were more likely to have strong vaccine concerns (aOR = 13.5; 95% Cl 5.4-34.0) than those in high-rate areas (aOR = 9.7; 95% Cl 3.7-25.4). Conclusions: Vaccine beliefs were important risk factors. That differing community-level exemption use modified the effects of several individual-level factors suggests that communities also influence parent decisions. Therefore, understanding community contexts and norms may be important when designing interventions. (C) 2011 Elsevier Ltd. All rights reserved.