Rates of delay and refusal of recommended childhood vaccines are increasing in many U.S. communities. Children’s health care providers have a strong influence on parents’ knowledge, attitudes, and beliefs about vaccines. Provider attitudes towards immunizations vary and affect their immunization advocacy. One factor that may contribute to this variability is their familiarity with vaccine-preventable diseases and their sequelae. The purpose of this study was to investigate the association of health care provider year of graduation with vaccines and vaccine-preventable disease beliefs. We conducted a cross sectional survey in 2005 of primary care providers identified by parents of children whose children were fully vaccinated or exempt from one or more school immunization requirements. We examined the association of provider graduation cohort (5 years) with beliefs on immunization, disease susceptibility, disease severity, vaccine safety, and vaccine efficacy. Surveys were completed by 551 providers (84.3% response rate). More recent health care provider graduates had 15% decreased odds of believing vaccines are efficacious compared to graduates from a previous 5 year period; had lower odds of believing that many commonly used childhood vaccines were safe; and 3.7% of recent graduates believed that immunizations do more harm than good. Recent health care provider graduates have a perception of the risk-benefit balance of immunization, which differs from that of their older counterparts. This change has the potential to be reflected in their immunization advocacy and affect parental attitudes.
References
[1]
Centers for Disease Control and Prevention (CDC). Impact of vaccines universally recommended for children—United States, 1990–1998. MMWR Morb. Mortal. Wkly. Rep. 1999, 48, 243–248.
Freed, G.L.; Clark, S.J.; Hibbs, B.F.; Santoli, J.M. Parental vaccine safety concerns: The experiences of pediatricians and family physicians. Am. J. Prev. Med. 2004, 26, 11–14, doi:10.1016/j.amepre.2003.09.004.
[4]
Bardenheier, B.; Yusuf, H.; Schwartz, B.; Gust, D.; Barker, L.; Rodewald, L. Are parental vaccine safety concerns associated with receipt of measles-mumps-rubella, diphtheria and tetanus toxoids with acellular pertussis, or hepatitis B vaccines by children? Arc. Pediatr. Adolesc. Med. 2004, 158, 569–575, doi:10.1001/archpedi.158.6.569.
[5]
Gust, D.A.; Strine, T.W.; Maurice, E.; Smith, P.; Yusuf, H.; Wilkinson, M.; Battaglia, M.; Wright, R.; Schwartz, R. Underimmunization among children: Effects of vaccine safety concerns on immunization status. Pediatrics 2004, 114, e16–e22, doi:10.1542/peds.114.1.e16.
[6]
Association of State and Territorial Health Offices. Communicating Effectively About Vaccines: Summary of a Survey of U.S. Parents and Guardians, ASTHO. Available online: http://www.astho.org/Communicating_Effectively_About_Vaccines/ (accessed on 12 December 2010).
[7]
Chen, R.T.; Hibbs, B. Vaccine safety: Current and future challenges. Pediatr. Ann. 1998, 27, 445–455.
Mnookin, S. The Panic Virus: A True Story of Medicine, Science, and Fear; Simon & Schuster: New York, NY, USA, 2011.
[10]
Salmon, D.A.; Moulton, L.H.; Omer, S.B.; deHart, M.P.; Stokley, S.; Halsey, N.A. Factors associated with refusal of childhood vaccines among parents of school-aged children: A case-control study. Arch. Pediatr. Adolesc. Med. 2005, 159, 470–476, doi:10.1001/archpedi.159.5.470.
[11]
Orenstein, W.A.; Bernier, R.H. Crossing the divide from vaccine technology to vaccine delivery: The critical role of providers. JAMA 1994, 272, 1138–1139, doi:10.1001/jama.1994.03520140068040.
[12]
Gust, D.A.; Kennedy, A.; Shui, I.; Smith, P.J.; Nowak, G.; Pickering, L.K. Parent attitudes toward immunizations and healthcare providers the role of information. Am. J. Prev. Med. 2005, 29, 105–112, doi:10.1016/j.amepre.2005.04.010.
[13]
Grabowsky, M.; Orenstein, W.A.; Marcuse, E.K. The critical role of provider practices in undervaccination. Pediatrics 1996, 97, 735–737.
Taylor, J.A.; Darden, P.M.; Slora, E.; Hasemeier, C.M.; Asmussen, L.; Wasserman, R. The influence of provider behavior, parental characteristics, and a public policy initiative on the immunization status of children followed by private pediatricians: A study from pediatric research in office settings. Pediatrics 1997, 99, 209–215.
[16]
Salmon, D.A.; Pan, W.K.Y.; Omer, S.B.; Navar, A.M.; Orenstein, W.; Marcuse, E.K.; Taylor, J.A.; deHart, M.P.; Stokley, S.; Carter, T.; et al. Vaccine knowledge and practices of primary care providers of exempt vs. vaccinated children. Hum. Vaccines 2008, 4, 286–291, doi:10.4161/hv.4.4.5752.
[17]
Zimmerman, R.K.; Bradford, B.J.; Janosky, J.E.; Mieczkowski, T.A.; DeSensi, E.; Grufferman, S. Barriers to measles and pertussis immunization: The knowledge and attitudes of Pennsylvania primary care physicians. Am. J. Prev. Med. 1997, 13, 89–97.
[18]
Ehresmann, K.R.; Mills, W.A.; Loewenson, P.R.; Moore, K.A. Attitudes and practices regarding varicella vaccination among physicians in Minnesota: Implications for public health and provider education. Am. J. Public Health 2000, 90, 1917–1920, doi:10.2105/AJPH.90.12.1917.
[19]
Zimmerman, R.K.; Giebink, G.S.; Street, H.B.; Janosky, J.E. Knowledge and attitudes of Minnesota primary care physicians about barriers to measles and pertussis immunization. J. Am. Board Fam. Pract. 1995, 8, 270–277.
[20]
Smith, P.J.; Humiston, S.G.; Parnell, T.; Vannice, K.S.; Salmon, D.A. The association between intentional delay of vaccine administration and timely childhood vaccination coverage. Public Health Rep. 2010, 125, 534–541.
[21]
Chatterjee, A.; O’Keefe, C. Current controversies in the USA regarding vaccine safety. Expert Rev. Vaccines 2010, 9, 497–502, doi:10.1586/erv.10.36.
[22]
Gust, D.; Weber, D.; Weintraub, E.; Kennedy, A.; Soud, F.; Burns, A. Physicians who do and do not recommend children get all vaccinations. J. Health Commun. 2008, 13, 573–582, doi:10.1080/10810730802281726.
[23]
Taylor, J.A.; Darden, P.M.; Brooks, D.A.; Hendricks, J.W.; Baker, A.E.; Wasserman, R.C. Practitioner policies and beliefs and practice immunization rates: A study from pediatric research in office settings and the national medical association. Pediatrics 2002, 109, 294–300, doi:10.1542/peds.109.2.294.
[24]
Koepke, C.P.; Vogel, C.A.; Kohrt, A.E. Provider characteristics and behaviors as predictors of immunization coverage. Am. J. Prev. Med. 2001, 21, 250–255, doi:10.1016/S0749-3797(01)00373-7.
