Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 22;191(9):1626-1635.
doi: 10.1093/aje/kwac049.

Population Attributable Fraction of Nonvaccination of Child and Adolescent Vaccines Attributed to Parental Vaccine Hesitancy, 2018-2019

Kimberly H Nguyen, Anup Srivastav, Akhil Vaish, James A Singleton

Population Attributable Fraction of Nonvaccination of Child and Adolescent Vaccines Attributed to Parental Vaccine Hesitancy, 2018-2019

Kimberly H Nguyen et al. Am J Epidemiol. .

Abstract

Understanding the role of vaccine hesitancy in undervaccination or nonvaccination of childhood vaccines is important for increasing vaccine confidence and uptake. We used data from April to June interviews in the 2018 and 2019 National Immunization Survey-Flu (n = 78,725, United States), a nationally representative cross-sectional household cellular telephone survey. We determined the adjusted population attributable fraction (PAF) for each recommended childhood vaccine to assess the contribution of vaccine hesitancy to the observed nonvaccination level. Hesitancy is defined as being somewhat or very hesitant toward childhood vaccines. Furthermore, we assessed the PAF of nonvaccination for influenza according to sociodemographic characteristics, Department of Health and Human Services region, and state. The proportion of nonvaccination attributed to parental vaccine hesitancy was lowest for hepatitis B birth dose vaccine (6.5%) and highest for ≥3-dose diphtheria and tetanus toxoids and acellular pertussis vaccine (31.3%). The PAF of influenza nonvaccination was highest for non-Hispanic Black populations (15.4%), households with high educational (17.7%) and income (16.5%) levels, and urban areas (16.1%). Among states, PAF ranged from 25.4% (New Hampshire) to 7.5% (Louisiana). Implementing strategies to increase vaccination confidence and uptake are important, particularly during the coronavirus disease 2019 pandemic.

Keywords: childhood vaccines; population attributable fraction; vaccine confidence; vaccine hesitancy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures (includes financial disclosures): The authors have no conflicts of interest relevant to this article to disclose. None of the authors have financial relationships relevant to this article to disclose.

Figures

Figure.
Figure.. Population attributable fraction (PAF)* of influenza non-vaccination among children 6 months – 17 years attributed to parental vaccine hesitancy by state, National Immunization Survey-Flu, April-June interviews, 2018–2019
* PAF = p (rr-1)/rr, where p is the proportion of hesitant individuals among the not vaccinated group of individuals and rr denotes the relative risk comparing the proportion of those who are not vaccinated among the hesitant group with the proportion of those who are not vaccinated among the non-hesitant group.
See this image and copyright information in PMC

Comment in

References

    1. Santibanez TA, Nguyen KH, Greby SM, Fisher A, Scanlon P, Bhatt A, Srivastav A, Singleton JA. Parental vaccine hesitancy and childhood influenza vaccination. Pediatrics. 2020. Nov 1. - PMC - PubMed
    1. Nguyen KH, Santibanez TA, Stokley S, Lindley MC, Fisher A, Kim D, Greby S, Srivastav A and Singleton J, 2021. Parental vaccine hesitancy and its association with adolescent HPV vaccination. Vaccine, pp.S0264–410X. - PMC - PubMed
    1. Smith PJ, Humiston SG, Marcuse EK, Zhao Z, Dorell CG, Howes C, Hibbs B. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model. Public health reports. 2011. Jul;126(2_suppl):135–46. - PMC - PubMed
    1. Mbaeyi S, Cohn A, Messonnier N. A call to action: strengthening vaccine confidence in the United States. Pediatrics. 2020;145(6):e20200390. doi:10.1542/peds.2020-0390 - DOI - PubMed
    1. Bedford H, Attwell K, Danchin M, Marshall H, Corben P, Leask J. Vaccine hesitancy, refusal and access barriers: the need for clarity in terminology. Vaccine. 2018;36(44):6556–6558. doi:10.1016/j.vaccine.2017.08.004 - DOI - PubMed

Publication types

Substances