{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:55:23Z","timestamp":1762876523294,"version":"3.40.5"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of School Health"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>We aimed to better understand the impact of statewide legislation removing personal belief exemptions (PBEs) for the measles, mumps, and rubella (MMR) school immunization requirement and factors associated with resulting health\u2010seeking behaviors.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We used chi\u2010squared tests and logistic regression models to determine individual\u2010 and school\u2010level characteristics associated with holding a MMR PBE and with post\u2010law MMR immunization status among students linked to the Washington State Immunization Information System.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of students with a MMR PBE pre\u2010law change, 43.0% completed the MMR vaccine series and 40.4% sought another exemption type. Religious exemptions made up most new MMR exemptions signed (71.8%), followed by medical exemptions (18.5%), and religious membership exemptions (9.7%). Students were more likely to complete the vaccine series post\u2010law change if they attended a school with a low school\u2010level MMR exemption rate, a public school, or held a lower number of school\u2010required immunization exemptions.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>This study confirms previous concerns that parents might replace their PBE with another exemption type; however, nearly half the students in the cohort completed the MMR vaccine series. Our findings suggest that targeted immunization policies can increase MMR coverage 1\u2010year post\u2010law change but must account for a replacement effect when exemption categories are eliminated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/josh.13504","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T03:44:01Z","timestamp":1729568641000},"page":"1031-1039","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Characteristics Associated With Measles, Mumps, and Rubella Coverage and Exemptions After a School Immunization Law Change in Washington, 2019\u20102020"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2685-7272","authenticated-orcid":false,"given":"Tyler","family":"Moore","sequence":"first","affiliation":[{"name":"Washington State Department of Health Office of Immunization  Tumwater 98501 WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Graff","sequence":"additional","affiliation":[{"name":"Washington State Department of Health Office of Immunization  Tumwater 98501 WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teal R.","family":"Bell","sequence":"additional","affiliation":[{"name":"Washington State Department of Health Office of Immunization  Tumwater 98501 WA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.1695"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.1506"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/phr\/116.4.289"},{"key":"e_1_2_5_5_1","unstructured":"Washington State Department of Health.Measles in Washington;2019. Vol. 24. 2019. Available at:https:\/\/doh.wa.gov\/sites\/default\/files\/legacy\/Documents\/5000\/\/420\u2010002\u2010epitrends2019\u201009.pdf."},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/14760584.2019.1562344"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.24.3145"},{"key":"e_1_2_5_8_1","unstructured":"Vaccine\u2010preventable diseases children must be protected against for full immunization. In: Washington State Legislature editor.2014."},{"key":"e_1_2_5_9_1","unstructured":"Immunization Program\u2014Exemptions Washington State Legislature;2019. Available at:https:\/\/apps.leg.wa.gov\/rcw\/default.aspx?cite=28A.210.090."},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002578"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010018\u20105368\u2010y"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2013.04.053"},{"key":"e_1_2_5_13_1","unstructured":"Centers for Disease Control and Prevention.Vaccination Coverage and Exemptions among Kindergartners;2022. Available at:https:\/\/www.cdc.gov\/vaccines\/imz\u2010managers\/coverage\/schoolvaxview\/data\u2010reports\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fimz\u2010managers%2Fcoverage%2Fschoolvaxview%2Fdata\u2010reports%2Fexemptions\u2010reports%2F2016\u201017.html. 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