{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:39:07Z","timestamp":1790620747586,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,5,2]],"date-time":"2018-05-02T00:00:00Z","timestamp":1525219200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of Cincinnati Taft Research Center"},{"name":"Carl H. Lindner College of Business Summer Research stipend"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Economics"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In the wake of strong, although later refuted, claims of a link between autism and the measles\u2010mumps\u2010rubella (MMR) vaccine, I examine whether fewer parents immunized or delayed vaccinations for their children and if there was a differential response by mother's education level. Using various controls and a differencing strategy that compares in MMR take\u2010up with other vaccines, I find that the MMR\u2013autism controversy led to a decline in the immediate years and that there were negative spillovers onto other vaccines. I also find evidence that more highly educated mothers responded more strongly to the controversy either by not immunizing their children altogether or, to a lesser degree, delaying vaccination. Moreover, the educational gap was greater in states where there was greater media attention devoted to the controversy. This is consistent with the health allocative efficiency hypothesis whereby part of the education gradient in health outcomes is due to more\u2010educated individuals absorbing and responding to health information more quickly. However, unlike in the United Kingdom, where previous studies find that the gap was eliminated after the link was refuted, the evidence for the United States suggests that the educational gap persisted.<\/jats:p>","DOI":"10.1002\/hec.3645","type":"journal-article","created":{"date-parts":[[2018,5,2]],"date-time":"2018-05-02T12:29:28Z","timestamp":1525264168000},"page":"1043-1062","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Information, education, and health behaviors: Evidence from the MMR vaccine autism controversy"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6752-9361","authenticated-orcid":false,"given":"Lenisa V.","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Economics University of Cincinnati  Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,5,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2011.06.003"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2011.01.009"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2012.05.002"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3153"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","unstructured":"Chevalier A.andV.O'Sullivan(2007). \u201cMother's education and birth weight.\u201d IZA Discussion Paper #2640.","DOI":"10.2139\/ssrn.970232"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1257\/app.2.1.33"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2012.07.005"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.100.2.234"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1257\/jel.47.1.87"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1162\/003355303322552856"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2009.10.003"},{"key":"e_1_2_10_13_1","first-page":"CD004407","article-title":"Vaccines for measles, mumps and rubella in children","volume":"4","author":"Demicheli V.","year":"2005","journal-title":"Cochrane Database System Review"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-1962"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.106.5.1097"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3982\/ECTA7195"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/1362361398024007"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1257\/000282805774669907"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.1518"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1086\/259880"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0538"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.5.e84"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.2307\/1924567"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1086\/420748"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2005.01425.x"},{"key":"e_1_2_10_26_1","volume-title":"Immunization safety review: Measles\u2010mumps\u2010rubella vaccine and autism","author":"IOM","year":"2001"},{"key":"e_1_2_10_27_1","volume-title":"Immunization safety review: Thimerosal\u2010containing vaccines and neurodevelopmental disorders","author":"IOM","year":"2001"},{"key":"e_1_2_10_28_1","volume-title":"Financing vaccines in the 21st century: Assuring access and availability","author":"IOM","year":"2004"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2010.11.005"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1533"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.20140012"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1086\/261751"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2010.08.008"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1108\/S0731-219920170000025006"},{"key":"e_1_2_10_35_1","doi-asserted-by":"crossref","unstructured":"Lleras\u2010Muney A.andF.R.Lichtenberg(2005). \u201cThe effect of education on medical technology adoption: are the more educated more likely to use new drugs?\u201d Special issue of theAnnales d'Economie et Statistiquein memory of Zvi Griliches 79\/80.","DOI":"10.2307\/20777592"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2004.03.006"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021134"},{"issue":"1","key":"e_1_2_10_38_1","first-page":"158","article-title":"The effect of female education on fertility and infant health: Evidence from school entry laws using exact date of birth","volume":"101","author":"McCrary J.","year":"2011","journal-title":"American Economic Review, 2011"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11109-010-9112-2"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-2365"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2017.10.003"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.2307\/146268"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2009.08.005"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2005.078451"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2005.tb01779.x"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02256592"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-1760"},{"issue":"4","key":"e_1_2_10_48_1","first-page":"7","article-title":"Overview of the sampling design and statistical methods used in the National Immunization Survey","volume":"20","author":"Smith P. J.","year":"2001","journal-title":"American Journal of Preventive Medicine"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.114.1.187"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-2414"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)01239-8"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.2307\/145920"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1136\/mp.55.2.84"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0297.1997.tb00073.x"},{"key":"e_1_2_10_55_1","first-page":"265","article-title":"Measles, mumps, rubella vaccine: Through a glass, darkly","volume":"19","author":"Wakefield A. J.","year":"2001","journal-title":"Adverse Drug Reactions and Toxicological Reviews"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)11096-0"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1019"}],"container-title":["Health Economics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhec.3645","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hec.3645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T08:35:59Z","timestamp":1693643759000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hec.3645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,2]]},"references-count":56,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1002\/hec.3645"],"URL":"https:\/\/doi.org\/10.1002\/hec.3645","archive":["Portico"],"relation":{},"ISSN":["1057-9230","1099-1050"],"issn-type":[{"value":"1057-9230","type":"print"},{"value":"1099-1050","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,2]]},"assertion":[{"value":"2017-05-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-01-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}