{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T14:22:25Z","timestamp":1794406945637,"version":"4.9.0"},"reference-count":54,"publisher":"SAGE Publications","issue":"2_suppl","license":[{"start":{"date-parts":[[2011,7,1]],"date-time":"2011-07-01T00:00:00Z","timestamp":1309478400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective.<\/jats:title>\n                    <jats:p>We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods.<\/jats:title>\n                    <jats:p>We used data from 11,206 parents of children aged 24\u201335 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and\/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>In 2009, approximately 60.2% of parents with children aged 24\u201335 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.<\/jats:title>\n                    <jats:p>Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549111260s215","type":"journal-article","created":{"date-parts":[[2017,1,25]],"date-time":"2017-01-25T11:22:07Z","timestamp":1485343327000},"page":"135-146","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":358,"title":["Parental Delay or Refusal of Vaccine Doses, Childhood Vaccination Coverage at 24 Months of Age, and the Health Belief Model"],"prefix":"10.1177","volume":"126","author":[{"given":"Philip J.","family":"Smith","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon G.","family":"Humiston","sequence":"additional","affiliation":[{"name":"Children's Mercy Hospitals & Clinics, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar K.","family":"Marcuse","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine, Department of Pediatrics, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Zhao","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina G.","family":"Dorell","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Howes","sequence":"additional","affiliation":[{"name":"National Opinion Research Center, University of Chicago, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Hibbs","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Immunization Safety Office, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,7,1]]},"reference":[{"key":"bibr1-00333549111260S215","first-page":"1011","volume":"77","author":"Communicable Disease Center, Public Health Service (US)","year":"1962","journal-title":"Public Health Rep"},{"key":"bibr2-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1126\/science.125.3257.1067"},{"key":"bibr3-00333549111260S215","volume-title":"American high: The years of confidence","author":"O'Neill WL","year":"1945"},{"key":"bibr4-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-195506000-00001"},{"key":"bibr5-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.46.1.75"},{"key":"bibr6-00333549111260S215","first-page":"158","volume":"23","author":"Belcher JC","year":"1958","journal-title":"Rural Sociol"},{"key":"bibr7-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.44.12.1526"},{"key":"bibr8-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.2307\/2088520"},{"key":"bibr9-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.48.2.141"},{"key":"bibr10-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.48.2.146"},{"key":"bibr11-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.2307\/4590386"},{"key":"bibr12-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.2307\/3348967"},{"key":"bibr13-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1177\/109019817400200407"},{"key":"bibr14-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1177\/109019817700500303"},{"key":"bibr15-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1177\/109019818401100101"},{"key":"bibr16-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(87)90291-7"},{"key":"bibr17-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1093\/her\/7.1.107"},{"key":"bibr18-00333549111260S215","volume-title":"Health behavior and health education: Theory, research, and practice","author":"Glanz K","year":"1997"},{"key":"bibr19-00333549111260S215","volume-title":"Health behavior and health education: Theory, research, and practice","author":"Strecher VJ","year":"1997"},{"key":"bibr20-00333549111260S215","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.18.2155"},{"key":"bibr21-00333549111260S215","unstructured":"Kennedy RF, Deadly immunity. 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