{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:10:53Z","timestamp":1789783853177,"version":"4.0.1"},"reference-count":27,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,11,1]]},"abstract":"<jats:p>OBJECTIVES. Parents who have concerns about vaccine safety may be reluctant to have their children vaccinated. The purpose of this study was to explore how vaccination coverage among children 19 to 35 months of age is associated with health care providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety.<\/jats:p>\n                  <jats:p>METHODS. Parents of 7695 children 19 to 35 months of age sampled by the National Immunization Survey were administered the National Immunization Survey Parental Knowledge Module between the third quarter of 2001 and the fourth quarter of 2002. Health care providers were defined as a physician, nurse, or any other type of health care professional. Parents provided responses that summarized the degree to which they believed vaccines were safe, and the influence providers had on their decisions to vaccinate their children. Children were determined to be up-to-date if their vaccination providers reported administering \u22654 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, \u22653 doses of polio vaccine, \u22651 dose of measles-mumps-rubella vaccine, \u22653 doses of Haemophilus influenzae type b vaccine, and \u22653 doses of hepatitis B vaccine.<\/jats:p>\n                  <jats:p>RESULTS. Of all of the parents, 5.7% thought that vaccines were not safe, and 21.5% said that their decision to vaccinate their children was not influenced by a health care provider. Compared with parents who responded that providers were not influential in their decision to vaccinate their children, parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a health care provider had an estimated vaccination coverage rate that was significantly higher than the estimated coverage rate among children whose parents' decision was not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%).<\/jats:p>\n                  <jats:p>CONCLUSIONS. Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe. Physicians, nurses, and other health care professionals should increase their efforts to build honest and respectful relationships with parents, especially when parents express concerns about vaccine safety or have misconceptions about the benefits and risks of vaccinations.<\/jats:p>","DOI":"10.1542\/peds.2006-0923","type":"journal-article","created":{"date-parts":[[2006,11,2]],"date-time":"2006-11-02T13:04:44Z","timestamp":1162472684000},"page":"e1287-e1292","source":"Crossref","is-referenced-by-count":295,"title":["Association Between Health Care Providers' Influence on Parents Who Have Concerns About Vaccine Safety and Vaccination Coverage"],"prefix":"10.1542","volume":"118","author":[{"given":"Philip J.","family":"Smith","sequence":"first","affiliation":[{"name":"National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison M.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Wooten","sequence":"additional","affiliation":[{"name":"National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah A.","family":"Gust","sequence":"additional","affiliation":[{"name":"National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry K.","family":"Pickering","sequence":"additional","affiliation":[{"name":"National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2006,11,1]]},"reference":[{"key":"2021120823175068800_R1","doi-asserted-by":"crossref","unstructured":"Orenstein WA, Douglas RG, Rodewald LE, Hinman AR. Immunizations in the United States: success, structure, and stress. Health Aff (Millwood).\u20082005;24:599\u2013610","DOI":"10.1377\/hlthaff.24.3.599"},{"key":"2021120823175068800_R2","doi-asserted-by":"crossref","unstructured":"Hinman A. Eradication of vaccine preventable diseases. Annu Rev Public Health.\u20081999;20:211\u2013229","DOI":"10.1146\/annurev.publhealth.20.1.211"},{"key":"2021120823175068800_R3","unstructured":"Centers for Disease Control and Prevention. Achievements in public health, 1900\u20131999 impact of vaccines universally recommended for children \u2013United States, 1990\u20131998. MMWR Morb Mortal Wkly Rep.\u20081999;48:243\u2013248"},{"key":"2021120823175068800_R4","unstructured":"Smith PJ, Hoaglin DC, Battaglia MP, Khare M, Barker LE; Centers for Disease Control and Prevention. Statistical methodology of the National Immunization Survey: 1994\u20132002. National Center for Health Statistics. Vital Health Stat. Series.\u20082005;138:1\u201355. Available at: www.cdc.gov\/nchs\/data\/series\/sr_02\/sr02_138.pdf. Accessed: February 14, 2006"},{"key":"2021120823175068800_R5","unstructured":"Centers for Disease Control and Prevention. Recommended childhood immunization schedule \u2013United States, 1999. MMWR Morb Mortal Wkly Rep.\u20081999;48:12\u201316"},{"key":"2021120823175068800_R6","unstructured":"Research Triangle Institute. SUDAAN User's Manual, Release 8.0. Research Triangle Park, NC: Research Triangle Institute; 2002"},{"key":"2021120823175068800_R7","doi-asserted-by":"crossref","unstructured":"Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to forgo pertussis vaccination for their children. J Clin Epidemiol.\u20081996;49:697\u2013703","DOI":"10.1016\/0895-4356(96)00007-8"},{"key":"2021120823175068800_R8","doi-asserted-by":"crossref","unstructured":"Gust DA, Strine TA, Maurice E, et al. Underimmunization among children: effects of vaccine safety concerns on immunization status. Pediatrics.\u20082004;114(1). Available at: www.pediatrics.org\/cgi\/content\/full\/114\/1\/e16","DOI":"10.1542\/peds.114.1.e16"},{"key":"2021120823175068800_R9","doi-asserted-by":"crossref","unstructured":"Gellin BG, Maibach EW, Marcuse EK. Do parents understand immunizations? A national telephone survey. Pediatrics.\u20082000;106:1097\u20131102","DOI":"10.1542\/peds.106.5.1097"},{"key":"2021120823175068800_R10","doi-asserted-by":"crossref","unstructured":"Freed GL, Clark SJ, Hibbs BF, Santoli JM. Parental vaccine safety concerns: the experiences of pediatricians and family physicians. Am J Prev Med.\u20082004;26:11\u201314","DOI":"10.1016\/j.amepre.2003.09.004"},{"key":"2021120823175068800_R11","doi-asserted-by":"crossref","unstructured":"Flanagan-Klygis EA, Sharp L, Fader JE. Dismissing the family who refuses vaccines. Arch Pediatr Adolesc Med.\u20082005;159:929\u2013943","DOI":"10.1001\/archpedi.159.10.929"},{"key":"2021120823175068800_R12","doi-asserted-by":"crossref","unstructured":"May T, Silverman RD. Cluster of exemptions' as a collective action threat to heard immunity. Vaccine.\u20082003;21:1048\u20131051","DOI":"10.1016\/S0264-410X(02)00627-8"},{"key":"2021120823175068800_R13","doi-asserted-by":"crossref","unstructured":"Smith, PJ, Chu SY, Barker LE. Children who have received no vaccines: Who are they and where do they live?Pediatrics.\u20082004;114:187\u2013195","DOI":"10.1542\/peds.114.1.187"},{"key":"2021120823175068800_R14","unstructured":"Jackson County Online. What Ashland parents told us about vaccines and religious exemptions. Report complied by Jackson County Department of Health and Human Services and the Immunization Program of the Oregon Department of Human Services. Available at: www.co.jackson.or.us\/files\/ashland%20cvs%20final%20report.pdf. Accessed 2003"},{"key":"2021120823175068800_R15","unstructured":"Jackson County Online. School exemptions and disease risk in Ashland, Oregon. Report complied by Jackson County Department of Health and Human Services and the Immunization Program of the Oregon Department of Human Services. Available at: www.co.jackson.or.us\/files\/school%20exemptions%20and%20disease%20risk%20-%20final.pdf. Accessed 2003"},{"key":"2021120823175068800_R16","doi-asserted-by":"crossref","unstructured":"Feikin DR, Lezotte DC, Hamman RF. Individual and community risks of measles and pertussis associated with personal exemptions to immunization. JAMA.\u20082000;284:3145\u20133150","DOI":"10.1001\/jama.284.24.3145"},{"key":"2021120823175068800_R17","doi-asserted-by":"crossref","unstructured":"Davis TC, Fredrickson DD, Arnold CL, et al. Childhood vaccine risk\/benefit communication in private practice office settings: A national survey. Pediatrics.\u20082001;107(2). Available at: www.pediatrics.org\/cgi\/content\/full\/107\/2\/e17","DOI":"10.1542\/peds.107.2.e17"},{"key":"2021120823175068800_R18","doi-asserted-by":"crossref","unstructured":"Gust DA, Kennedy A, Shui I, Smith PJ, Nowak G, Pickering LK. Parent attitudes toward immunizations and healthcare providers: the role of information. Am J Prev Med.\u20082005;29:105\u2013112","DOI":"10.1016\/j.amepre.2005.04.010"},{"key":"2021120823175068800_R19","doi-asserted-by":"crossref","unstructured":"Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mother's decision-making about vaccines for infants: The importance of trust. Pediatrics.\u20082006;117:1532\u20131541","DOI":"10.1542\/peds.2005-1728"},{"key":"2021120823175068800_R20","doi-asserted-by":"crossref","unstructured":"O'Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med.\u20082004;38:777\u2013785","DOI":"10.1016\/j.ypmed.2004.01.018"},{"key":"2021120823175068800_R21","unstructured":"Parchman ML, Burge SK. The patient-physician relationship, primary care attributes, and preventive services. Fam Med.\u20082004;36:22\u201327"},{"key":"2021120823175068800_R22","doi-asserted-by":"crossref","unstructured":"Prislin R, Dyer JA, Blakely CH, Johnson CD. Immunization status and sociodemographic characteristics: The mediating role of beliefs, attitudes, and perceived control. Am J Public Health.\u20081998;88:1821\u20131826","DOI":"10.2105\/AJPH.88.12.1821"},{"key":"2021120823175068800_R23","doi-asserted-by":"crossref","unstructured":"Salmon DA, Moulton LH, Omer SB, DeHart MP, Stokley S, Halsey NA. Factors associated with refusal of childhood vaccines among parents of school-aged children. Arch Pediatr Adolesc Med.\u20082005;159:470\u2013476","DOI":"10.1001\/archpedi.159.5.470"},{"key":"2021120823175068800_R24","doi-asserted-by":"crossref","unstructured":"Gust D, Brown C, Sheedy K, Hibbs B, Weaver D, Nowak G. Immunization attitudes and believes among parents: Beyond a dichotomous perspective. Am J Health Behav.\u20082005;29:81\u201392","DOI":"10.5993\/AJHB.29.1.7"},{"key":"2021120823175068800_R25","doi-asserted-by":"crossref","unstructured":"Axelrod DA, Goold SD. Maintaining trust in the surgeon-patient relationship: challenges for the new millennium. Arch Surg.\u20082000;135:55\u201361","DOI":"10.1001\/archsurg.135.1.55"},{"key":"2021120823175068800_R26","doi-asserted-by":"crossref","unstructured":"Goold SD, Klipp G. Managed care members talk about trust. Soc Sci Med.\u20082002;45:897\u2013888","DOI":"10.1016\/S0277-9536(01)00070-3"},{"key":"2021120823175068800_R27","doi-asserted-by":"crossref","unstructured":"Diekema DS and the Committee on Bioethics. Responding to parental refusals of immunization of children. Pediatrics.\u20082005;115:1428\u20131431","DOI":"10.1542\/peds.2005-0316"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/5\/e1287\/1116648\/zpe011060e1287.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/5\/e1287\/1116648\/zpe011060e1287.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T22:30:44Z","timestamp":1639002644000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/118\/5\/e1287\/69855\/Association-Between-Health-Care-Providers"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,11,1]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2006,11,1]]},"published-print":{"date-parts":[[2006,11,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2006-0923","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,11,1]]}}}