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Assessing Child Vaccine Hesitancy using Mobile Panels

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Presented at AAPOR 2017 by John M Boyle, Lew Berman, Jamie Dayton, Ronaldo Iachan and Deirdre Middleton of ICF

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Assessing Child Vaccine Hesitancy using Mobile Panels

  1. 1. AAPOR 2017 John M Boyle Lew Berman Jamie Dayton Ronaldo Iachan Deirdre Middleton ICF Alex Coheo mFour Assessing Child Vaccine Hesitancy using Mobile Panels 1
  2. 2. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. 2016 Childhood Immunization Attitudes and Behavior Survey: Background  Childhood Immunization rates are a priority public health issue  National Immunization Survey (NIS) is primary tool for monitoring these rates  Dual frame RDD sampling methodology to screen for children aged 19-35 months of age  Household eligibility rate: 1.5% for landline, 3.3% for cell phone  NIS Challenges  Low incidence population+ lack of targeted frame → Large sample needs to be screened  Estimates needed for more than 50 geographic areas → Larger sample needed  Immunization estimates based on provider records for children → Larger sample needed  Declining response rates → Larger sample needed  The current methodology requires 7.5 million telephone numbers dialed to obtain 24,000 completed interviews with parents of age-eligible children, to get 15,000 cases with adequate provider data  Vaccine hesitancy, particularly among minorities, has gotten increased attention in the past year  Since NIS cannot cover all public health issues associated with childhood immunization, such as vaccine hesitancy, and resources are limited, alternative methods are needed to supplement it in a timely and cost-efficient manner
  3. 3. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. What Are the Alternatives for Large Samples of Low Incidence Populations?  Web  The fastest and least expensive mode of data collection  Email addresses  No national population based frame exists  Non-probability Web Panels  Large enough (<1,000,000) to generate national samples of low incidence populations  Have member profiles with characteristics (e.g., children in HH) that can reduce screening costs and time  Mobile panels  Particularly appropriate in terms of coverage and use for web surveys of young adults --- 85% smart phone ownership among 18-29 year olds, 79% among 30-49 year olds (PEW 2014)  App based surveys are much more “mobile optimized” for use on mobile devices than more traditional web based survey designs
  4. 4. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. What Should I Know about Non-Probability Samples? • Non-probability samples are not based on statistical models that allow us to estimate sampling variability and calculate confidence limits about sample estimates • However, they are not necessarily subject to other sources of total survey error to a greater degree than probability samples (i.e., point estimate may be accurate even if confidence interval cannot be calculated) • AAPOR acknowledges that non-probability samples may be “fit for purpose” for certain populations or study objectives • CDC already uses non-probability samples to track immunization rates among key populations at the beginning and end of flu season • This study explores using a national mobile web panel as a particularly appropriate method for exploring factors affecting childhood immunization in the population
  5. 5. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Methodology for 2016 ChIMPS  National sample drawn from national mobile panel with one million + members  Invitations were sent to adults with children in household from panel profile  Interviews conducted in English only  Interview length: 10.1 minutes (average)  10,000 invitations sent to households with children  1029 completed interviews with adults with children aged 19-35 months  All 50 states and District of Columbia represented in completed sample  Field period 12/16/16 to 12/21/16
  6. 6. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Geographic Distribution: Census Regions 15.4% 21.8% 36.4% 26.4% 16.1% 20.9% 38.4% 24.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Northeast Midwest South West CHIMPS NIS Weighted N=1029 households with age-eligible children
  7. 7. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Number of Eligible Children (19-35 months) Based on Date of Birth 1.1 1.0 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 Children 19-35 months CHIMPS NIS S3. Please tell me the month, day, and year of birth for the FIRST/SECOND/THIRD/FOURTH child in your household who is between 19-35 months old. N=1020 households (1072 eligible children)
  8. 8. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Relationship of Respondent to Target Child: 1st Child 19 – 35 Months (Base: All respondents) What is your relationship to {S5}? Code Option CHIMPS % NIS % 1 Mother (step, foster, adoptive) or female guardian 63.1% 69.0% 2 Father (step, foster, adoptive) or male guardian 29.4% 23.4% 3 Grandparent 2.5% 5.9% 7 Other family member or friend 4.9% 1.7% C5X. What is your relationship to (S5)? n=1020
  9. 9. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Respondent Age 2.9% 37.1% 60.0% 0.5% 34.8% 64.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Under 20 20-29 years 30 + Years CHIMPS NIS Respondent Age from Sample Profile n=1020
  10. 10. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Age Group of Eligible Child 30.0% 43.2% 26.8% 29.5% 30.0% 40.5% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 19-23 months 24-29 months 30-35 months CHIMPS NIS S3: Please tell me the month, day, and year of birth of the (FIRST/NEXT) child in your household who is between 19-35 months old. (Converted to months of age.) N=1072 age-eligible children
  11. 11. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Gender of Eligible Child 51.9% 48.1% 51.4% 48.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Male Female CHIMPS NIS S4. Is the child born on (date) male or female? N=1072 age-eligible children
  12. 12. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Household Income 25.2% 18.0% 30.3% 26.5% 20.4% 18.0% 22.0% 39.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% $0-20,000 $20,000-$40,000 $40,000-$75,000 Greater than $75,000 CHIMPS NIS N=1029 households with age-eligible children
  13. 13. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Vaccine Attitudes and Behaviors
  14. 14. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Race/Ethnicity of Respondent 65.1% 9.7% 15.6% 5.2% 4.4% 0% 10% 20% 30% 40% 50% 60% 70% Caucasian African-American Hispanic Asian Other Base: All respondents: n=1029 14
  15. 15. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Child Received All Recommended Vaccines 95.7% 96.0% 96.3% 96.2% 97.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian (n=670) African-American (n=100) Hispanic (n=161) Asian (n=53) Other (n=45) Yes CBF01 - (Has your child / have all of your children) received all of the vaccines that are recommended for children up to his / her age? (Base: All respondents: n=1029)
  16. 16. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Child had Flu Vaccine Since July 1, 2016 61.8% 67.0% 67.1% 81.1% 75.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian (n=670) African-American (n=100) Hispanic (n=161) Asian (n=53) Other (n=45) Y… BBX. Since July 1, 2016 has (S5) had a flu vaccination? There are two types of flu vaccinations. One is a shot and the other is a spray, mist, or drop in the nose. (Base: All respondents: n=1029)
  17. 17. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Ever Delayed Recommended Vaccine for Child 20.3% 25.0% 24.2% 22.6% 37.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian (n=670) African-American (n=100) Hispanic (n=161) Asian (n=53) Other (n=45) Y… A1: Have you ever delayed having your child or children get a recommended vaccine for reasons other than illness or allergy? By delayed we mean put off, but ultimately ended up having it done. (Base: All respondents: n=1029)
  18. 18. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Ever Decided Not to Give Vaccine to Child 3.6% 8.0% 4.9% 4.9% 14.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian (n=524) African-American (n=75) Hispanic (n=122) Asian (n=41) Other (n=28) Yes B2: Have you ever decided not to have your child or children get a recommended vaccine for reasons other than illness or allergy? (Base: Never delayed a recommended vaccine: n=800)
  19. 19. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Plan for Child to Get All Remaining Vaccines 97.2% 94.0% 96.9% 100.0% 91.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian (n=670) African-American (n=100) Hispanic (n=161) Asian (n=53) Other (n=45) Y… B3: Do you plan or intend to have your child or children get all the remaining recommended vaccines? (Base: All respondents: n=1029)
  20. 20. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Painful for Children to Get So Many Shots: Agree 26% 39% 38% 34% 32% 48% 44% 47% 47% 41% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att1: Please indicate how much you would agree or disagree with the following statement. It is painful for children to receive so many shots during one doctor visit. (Base: All respondents: n=1029)
  21. 21. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Children Receive too Many Vaccines in one Doctor’s Visit: Agree 20% 25% 25% 19% 16% 31% 35% 39% 45% 42% 0% 10% 20% 30% 40% 50% 60% 70% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att2: Please indicate how much you would agree or disagree with the following statement. Children receive too many vaccines in one doctor's visit. (Base: All respondents: n=1029)
  22. 22. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Too Many Vaccines in the First 3-years of life: Agree 17% 29% 29% 29% 16% 22% 25% 30% 37% 36% 0% 10% 20% 30% 40% 50% 60% 70% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att3: Please indicate how much you would agree or disagree with the following statement. Children get too many vaccines during the first three years of life. (Base: All respondents: n=1029)
  23. 23. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Vaccines May Cause Learning Disabilities, Such as Autism: Agree 8% 21% 12% 5% 10% 12% 18% 15% 14% 21% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att4: Please indicate how much you would agree or disagree with the following statement. Vaccines may cause learning disabilities, such as autism. (Base: All respondents: n=1029)
  24. 24. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Some Vaccines Have Unsafe Ingredients: Agree 13% 27% 14% 8% 13% 27% 41% 30% 35% 37% 0% 10% 20% 30% 40% 50% 60% 70% 80% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att5: Please indicate how much you would agree or disagree with the following statement. Some vaccines have ingredients that are unsafe. (Base: All respondents: n=1029)
  25. 25. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Some Vaccines Prevent Unlikely Diseases: Agree 15% 30% 20% 16% 22% 31% 36% 29% 27% 42% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Caucasian African-American Hispanic Asian Other Strongly Somewhat Att6: Please indicate how much you would agree or disagree with the following statement. Some vaccines are given to children to prevent diseases they are not likely to get. (Base: All respondents: n=1029) .
  26. 26. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Some Vaccines Prevent Non-Serious Diseases: Agree 10% 19% 13% 16% 23% 21% 23% 23% 30% 23% 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 Caucasian African-American Hispanic Asian Other Strongly Somewhat Att7: Please indicate how much you would agree or disagree with the following statement. Some vaccines are given to children to prevent diseases that are not serious. (Base: All respondents: n=1029) .
  27. 27. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Vaccines are Important to My Child’s Health: Agree 75% 63% 67% 68% 69% 20% 32% 27% 30% 31% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att8: Please indicate how much you would agree or disagree with the following statement. Childhood vaccines are important for my child's health. (Base: All respondents: n=1029).
  28. 28. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Childhood Vaccines are Effective: Agree 70% 46% 58% 62% 61% 25% 42% 37% 37% 37% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att9: Please indicate how much you would agree or disagree with the following statement: Childhood vaccines are effective. (Base: All respondents: n=1029)
  29. 29. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Vaccination is Important to Community Health: Agree 77% 63% 70% 65% 62% 17% 27% 24% 33% 33% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att10: Please indicate how much you would agree or disagree with the following statement: Having my child vaccinated is important for the health of others in my community. (Base: All respondents: n=1029)
  30. 30. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Vaccine Information from the Government is Reliable and Trustworthy: Agree 37% 29% 35% 46% 49% 46% 44% 44% 50% 39% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Caucasian African-American Hispanic Asian Other Strongly Somewhat Att11: Please indicate how much you would agree or disagree with the following statement: The information I receive about vaccines from the government is reliable and trustworthy. (Base: All respondents: n=1029)
  31. 31. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Correlations between Vaccine Attitudes and Behavior Had Flu Vaccination Plan to Have Remaining Vaccines Ever Delayed Vaccination Ever Decided Not to Vaccinate Too Painful -.082** -.111** .278** .120** Too many in one visit -.139** -.171** .344** .182** Too many in first 3 years -.113** -.199** .334** .211** May cause learning disabilities -.074 -.250** .338** .289** Have unsafe ingredients -.103** -.239** .361** .241** Prevent unlikely diseases -.063 -.181** .250** .155** Prevent diseases not serious -.079 -.203** .251** .202** Important for my child’s health .185** .404** -.167** -.350** Are effective .151** .375** -.177** -.312** Important to health of others .203** .402** -.156** -.351** Government information on vaccines is reliable/trustworthy .270** .315** -.140** -.235** Pearson correlation. **Significant at .01 (two-tailed)
  32. 32. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Discussion  Mobile panel is an efficient and low cost approach for vaccination estimates in NIS age eligible children  Characteristics (gender, age, household income) are generally comparable although not identical between non-probability panel and NIS.  96% of parents report their children received their recommended vaccinations. While some children have had delays in getting vaccinations, few decided not to immunize their children and most expect to get the remaining shots.  Nonetheless, there is concern among parents about the age children receive shots, number of shots, and associated perceived pain. And, there remains concern about autism. Most of these concerns are substantially higher among minorities than among white parents.  At the same time, a majority of parents agree that vaccinations are effective and important to children and communities. And, the government can be trusted regarding vaccine information. However, these positive attitudes are held by somewhat fewer minority parents than white parents.  There is a positive correlation between beliefs in the effectiveness and importance of vaccination and trust in government information, and immunization behavior among parents of young children. Conversely, there is a positive correlation between concerns about pain and vaccine safety, and immunization delay and avoidance among parents. For those planning to have the remaining vaccinations there is a strong correlation with the belief that vaccinations are important to a child’s health or that vaccinations are effective.  The public health education model posits a causal relationship between knowledge, attitudes, beliefs and behavior, which would make attitudes and beliefs precursors of public health related behaviors.  At the present time, there is no ongoing surveillance system for immunization knowledge, attitudes and beliefs that might predict challenges and changes to immunization behavior. A properly designed non-probability panel might represent an alternative to measuring such trends in the target population.

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