School of Public Policy, University of California, Riverside, Riverside, CA, USA; Department of Sociology, University of California, Riverside, USA; Center for Healthy Communities, School of Medicine, University of California, Riverside, USA.
School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
Prev Med. 2019 Jun;123:278-287. doi: 10.1016/j.ypmed.2019.03.033. Epub 2019 Mar 20.
Childhood vaccination efforts in Canada have been negatively impacted by parents' vaccine hesitancy based on their knowledge, attitudes, and beliefs (KAB) about vaccinations. Less understood is the extent to which child vaccination receipt and KAB vary by parents' socioeconomic status (SES). Analyzing different age groups of children and vaccinations, we examine the extent to which (a) family SES (parent education, household income) is a determinant of Canadian parents' vaccination KAB and child vaccination receipt, and (b) whether SES was indirectly associated with receipt via KAB. In 2017, we analyzed 2013 Childhood National Immunization Coverage Survey (CNICS) data. We estimated models for parental KAB and child vaccination receipt for measles, mumps, and rubella (MMR) at age 2 (n = 3620); diphtheria, pertussis, and tetanus (DPT) at age 7 (n = 3465); and human papillomavirus (HPV) at ages 12-14 (n = 5213 females). SES is inconsistently associated with KAB and vaccine receipt across the three age groups. SES differences in KAB mostly center on vaccine-specific side effect and safety concerns, with lower education and income levels associated with higher odds of being concerned. Non-receipt of minimum age-specific vaccination dosages was associated with concerns about vaccine effectiveness (DPT, HPV) and side effects (MMR, HPV) and lower perceived importance of immunizing a child (MMR, HPV). KAB mediation was mostly limited to SES patterns in MMR. We discuss the implications of these findings for designing general and population-specific vaccination education strategies and future studies of KAB and undervaccination.
加拿大的儿童疫苗接种工作受到了父母对疫苗接种的知识、态度和信念（KAB）的影响，这些父母对接种疫苗犹豫不决。人们对父母的社会经济地位（SES）对儿童疫苗接种的接受程度和 KAB 的影响程度了解甚少。通过分析不同年龄组的儿童和疫苗接种情况，我们研究了（a）家庭 SES（父母教育程度、家庭收入）是否是加拿大父母 KAB 和儿童疫苗接种接受程度的决定因素，以及（b）SES 是否通过 KAB 与接受程度间接相关。2017 年，我们分析了 2013 年儿童国家免疫覆盖调查（CNICS）的数据。我们为麻疹、腮腺炎和风疹（MMR）年龄 2 岁（n=3620）、白喉、百日咳和破伤风（DPT）年龄 7 岁（n=3465）以及人乳头瘤病毒（HPV）年龄 12-14 岁（n=5213 名女性）的父母 KAB 和儿童疫苗接种接受情况估计了模型。SES 在三个年龄组中与 KAB 和疫苗接种接受情况的关系不一致。KAB 中的 SES 差异主要集中在疫苗的特定副作用和安全性问题上，教育程度和收入水平较低与更高的担忧几率相关。未接种最低年龄特定疫苗剂量与对疫苗有效性（DPT、HPV）和副作用（MMR、HPV）的担忧以及对儿童免疫接种重要性的认知较低（MMR、HPV）相关。KAB 中介主要限于 MMR 中的 SES 模式。我们讨论了这些发现对设计一般和特定人群的疫苗接种教育策略以及未来的 KAB 和疫苗接种不足研究的意义。
