{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:16:37Z","timestamp":1786115797530,"version":"build-2736575974"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-National Immunization Program vaccines (non-NIPV) are recommended but not publicly funded in China, complementing National Immunization Program vaccines (NIPV) by providing protection against additional vaccine-preventable diseases. Their uptake depends largely on parental decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Assess maternal willingness to use non-NIPV (WNV) for their children across single-child households (SCH) and multiple-children households (MCH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional questionnaire survey was conducted among biological mothers of children aged 42\u202fdays to 3\u202fyears. The primary endpoint was the proportion expressing WNV. The exploratory endpoint compared WNV between household types. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI). Propensity score overlap weighting was implemented as a sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 395 biological mothers of children aged 42\u202fdays to 3\u202fyears, mothers in SCH were younger than those in MCH (31.36\u202f\u00b1\u202f4.24 vs. 35.51\u202f\u00b1\u202f4.28\u202fyears). Compared with MCH, SCH had higher proportions of mothers with senior high school education or above (94.27% vs. 70.68%), employment (89.69% vs. 78.20%), and urban residence (83.97% vs. 72.93%). Overall WNV was 64.81%. WNV was higher in SCH than in MCH (67.94% vs. 58.65%). MCH was associated with lower odds of WNV (OR 0.34, 95% CI 0.18, 0.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001). Findings were consistent in overlap-weighted dataset analyses (OR 0.46, 95% CI 0.23, 0.90,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.022).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maternal WNV varied by household structure, with lower willingness among MCH. Family composition may represent an important contextual factor in discretionary vaccination decisions. These findings support the consideration of household context and parental perceptions when designing communication strategies for non-NIPV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1835253","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:33:13Z","timestamp":1785994393000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Differences in maternal acceptance of non-national immunization program vaccines between single-child and multiple-children households a hospital-based cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Rong","family":"Xing","sequence":"first","affiliation":[{"name":"Department of Preventive Healthcare, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanling","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanli","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Hao","sequence":"additional","affiliation":[{"name":"Early Childhood Education Center, Shanxi Provincial Children's Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Preventive Healthcare, Xiaodian Community Health Service Center","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manxia","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Preventive Healthcare, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Evidence-Based Medicine, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Preventive Healthcare, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2307","DOI":"10.1016\/S0140-6736(24)00850-X","article-title":"Contribution of vaccination to improved survival and health: modelling 50 years of the expanded programme on immunization","volume":"403","author":"Shattock","year":"2024","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/S0140-6736(20)32657-X","article-title":"Vaccine impact modelling C. Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study","volume":"397","author":"Li","year":"2021","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1542\/peds.2021-056013","article-title":"Impact of routine childhood immunization in reducing vaccine-preventable diseases in the United States","volume":"150","author":"Talbird","year":"2022","journal-title":"Pediatrics"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e1016","DOI":"10.1016\/S2468-2667(23)00248-7","article-title":"Adding new childhood vaccines to China's National Immunization Program: evidence, benefits, and priorities","volume":"8","author":"Zhang","year":"2023","journal-title":"Lancet Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-022-14670-z","article-title":"The potential public health impact of adolescent 4CMenB vaccination on Neisseria gonorrhoeae infection in England: a modelling study","volume":"23","author":"Looker","year":"2023","journal-title":"BMC Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"682","DOI":"10.15585\/mmwr.mm7331a2","article-title":"Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program\u2014United States, 1994-2023","volume":"73","author":"Zhou","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1007\/s10654-021-00728-6","article-title":"COVID-19 vaccine acceptance among pregnant women and mothers of young children: results of a survey in 16 countries","volume":"36","author":"Skjefte","year":"2021","journal-title":"Eur J Epidemiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1186\/s12905-024-03377-5","article-title":"Global parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations for their children: a systematic literature review and meta-analysis","volume":"24","author":"Heyde","year":"2024","journal-title":"BMC Womens Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.vaccine.2022.11.060","article-title":"Education level modifies parental hesitancy about COVID-19 vaccinations for their children","volume":"41","author":"Tang","year":"2023","journal-title":"Vaccine"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"276","DOI":"10.3390\/vaccines8020276","article-title":"Socioeconomic determinants in vaccine hesitancy and vaccine refusal in Italy","volume":"8","author":"Bertoncello","year":"2020","journal-title":"Vaccines (Basel)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2513708","DOI":"10.1080\/21645515.2025.2513708","article-title":"Barriers associated with the parental acceptance of human papillomavirus (HPV) vaccination of minors in Asir, Saudi Arabia: a cross-sectional study","volume":"21","author":"Alshahrani","year":"2025","journal-title":"Hum Vaccin Immunother"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2238513","DOI":"10.1080\/21645515.2023.2238513","article-title":"Parental intention to vaccinate children against seasonal influenza in the eastern Mediterranean region: a cross-sectional study using the health belief model","volume":"19","author":"Fadl","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"280","DOI":"10.3390\/healthcare13182280","article-title":"Parental self-efficacy in managing Pediatrics' medications and treatments in Jordan: a cross-sectional study","volume":"13","author":"Naser","year":"2025","journal-title":"Healthcare (Basel)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1186\/s12889-025-21848-8","article-title":"Stranger danger or good Samaritan? A cross-sectional study examining correlates of tolerance of risk in outdoor play among Canadian parents","volume":"25","author":"Faulkner","year":"2025","journal-title":"BMC Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s40249-023-01145-5","article-title":"Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces","volume":"12","author":"Zhou","year":"2023","journal-title":"Infect Dis Poverty"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.3390\/vaccines12121333","article-title":"Vaccination communication strategies and uptake in Africa: a systematic review","volume":"12","author":"Ekezie","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Bursac","year":"2008","journal-title":"Source Code Biol Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"342","DOI":"10.3390\/vaccines9040342.","article-title":"Vaccine hesitancy: COVID-19 and influenza vaccine willingness among parents in Wuxi, China-a cross-sectional study","volume":"9","author":"Wang","year":"2021","journal-title":"Vaccines (Basel)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2069427","DOI":"10.1080\/21645515.2022.2069427","article-title":"Measuring parents' acceptance of non-national immunization program vaccines for children and its influencing factors during the COVID-19 pandemic in Shanghai, China","volume":"18","author":"Wu","year":"2022","journal-title":"Hum Vaccin Immunother"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e0257590","DOI":"10.1371\/journal.pone.0257590","article-title":"Knowledge of mothers regarding children's vaccinations in Cyprus: a cross-sectional study","volume":"16","author":"Kyprianidou","year":"2021","journal-title":"PLoS One"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12939-022-01678-5","article-title":"Vaccine equity in low and middle income countries: a systematic review and meta-analysis","volume":"21","author":"Ali","year":"2022","journal-title":"Int J Equity Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1186\/s12889-023-17079-4","article-title":"Determinants of parental vaccine hesitancy in Canada: results from the 2017 childhood National Immunization Coverage Survey","volume":"23","author":"Chen","year":"2023","journal-title":"BMC Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"926","DOI":"10.3390\/vaccines11050926","article-title":"Why parents say no to having their children vaccinated against measles: a systematic review of the social determinants of parental perceptions on MMR vaccine hesitancy","volume":"11","author":"MLB","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s40249-023-01150-8","article-title":"The coverage and challenges of increasing uptake of non-National Immunization Program vaccines in China: a scoping review","volume":"12","author":"Jiang","year":"2023","journal-title":"Infect Dis Poverty"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"127","DOI":"10.3390\/vaccines12020127","article-title":"Vaccine hesitancy among European parents-psychological and social factors influencing the decision to vaccinate against HPV: a systematic review and Meta-analysis","volume":"12","author":"Achimas-Cadariu","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s11150-020-09538-3","article-title":"Working parents, financial insecurity, and childcare: mental health in the time of COVID-19 in the UK","volume":"19","author":"Cheng","year":"2021","journal-title":"Rev Econ Househ"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1136\/bmjgh-2021-006860","article-title":"Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews","volume":"6","author":"Kaufman","year":"2021","journal-title":"BMJ Glob Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e0265496","DOI":"10.1371\/journal.pone.0265496","article-title":"Potential factors influencing COVID-19 vaccine acceptance and hesitancy: a systematic review","volume":"17","author":"Roy","year":"2022","journal-title":"PLoS one"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1093\/tbm\/ibab048","article-title":"Acceptability of digital health interventions: embracing the complexity","volume":"11","author":"Perski","year":"2021","journal-title":"Transl Behav Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1146\/annurev-publhealth-090419-102240","article-title":"Vaccine hesitancy, acceptance, and anti-vaccination: trends and future prospects for public health","volume":"42","author":"Dube","year":"2021","journal-title":"Annu Rev Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"100091","DOI":"10.1016\/j.jvacx.2021.100091","article-title":"Demographic, psychological, and experiential correlates of SARS-CoV-2 vaccination intentions in a sample of Canadian families","volume":"8","author":"Lackner","year":"2021","journal-title":"Vaccine X"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1835253\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:33:14Z","timestamp":1785994394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1835253\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":31,"alternative-id":["10.3389\/fpubh.2026.1835253"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1835253","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"1835253"}}