An internet-based survey on parental attitudes towards immunization

Parental misperceptions have been identified as major barriers towards immunizations in children. By use of a German internet vaccine forum for lay persons, a survey was performed to assess current attitudes of parents regarding prevalent issues related to childhood vaccination. Of 6025 participants, 5722 (95.0%) regarded their paediatrician as the most important source of information regarding immunization, followed by leaflets (48.0%), health magazines (44.7%), and the internet (38.7%). Of currently generally recommended childhood immunizations, those against pertussis, Hib and especially measles-mumps-rubella were considered least important by parents. Furthermore, 22.6% of survey participants felt that immunizations are administered "too early" in life and 21.0 and 12.2% thought that overload of the child's immune system and induction of allergies, respectively, would be side effects of immunizations. This survey provided information on prevalent parental attitudes towards immunization, which should be used to plan information strategies to counteract existing misperceptions.     

Parental concerns and medical-seeking behavior after immunization

OBJECTIVE: To examine demographics and immunization attitudes, beliefs, and behaviors of parents who sought medical attention for a child due to an adverse event following immunization (AEFI). METHODS: A sample of households that participated in the National Immunization Survey was re-contacted during 2001. This analysis was conducted in 2004 and 2005. RESULTS: Of 2286 respondents, 223 (6.9%, weighted) sought medical attention for a child due to an AEFI. Compared with parents reporting no adverse event, parents who sought medical attention were less likely to be African American (adjusted odds ratio [AOR]=0.34, 95% confidence interval [CI]=0.16-0.75) or Hispanic (AOR=0.16, 95% CI=0.07-0.39) versus white, aged 35 years or older versus 25 to 34 (AOR=0.35, 95% CI=0.17-0.72), more likely to believe that immunizations cause minor side effects (AOR=5.74, 95% CI=2.99-11.00), report unwanted yet required childhood immunizations (AOR=3.54, 95% CI=1.45-8.66), not want a new baby to be fully immunized (AOR=3.48, 95% CI=1.25-9.67), report concern about immunization safety (AOR=2.08, 95% CI=1.07-4.05), believe that immunizations are dangerous (AOR=3.56, 95% CI=1.14-11.13), and have a child missing two or more doses of three immunizations (measles-containing vaccine, DTaP/DTP, or hepatitis B) (AOR=2.30, 95% CI=1.17-4.55). CONCLUSIONS: This study suggests that research is needed to determine whether negative parental attitudes associated with a child's AEFI might be lessened by improving vaccine safety communication between physician and parent.     

Attitudes and beliefs related to childhood vaccinations among parents of 6 years old children in Zagreb,Croatia

The Croatian Immunization Programme is a mandatory prevention programme in which vaccines are offered free of charge and little is known about parental vaccine-related beliefs and attitudes. We aimed to describe beliefs and attitudes towards childhood vaccination of parents in Zagreb, estimate the proportion of parents with positive attitudes towards vaccination, and to identify the possible predictors of positive attitudes. Using a self-administered questionnaire, we performed a cluster sampling survey among parents of 6-years-old children in Zagreb. In total 542 questionnaires were collected, 80% (n = 430/542) of respondents were mothers. Even though 72.6% (n = 385/531; 95%CI: 69–76) respondents feel that childhood vaccination should remain mandatory, 36.3% (n = 192/528; 95%CI: 58.3–65.3) considered that simultaneous administration of vaccines can have negative effect to their child’s health. In addition, 38% (n = 202/532; 95%CI: 33.2–43.1%) feared that vaccines may harm their child. Of total, parents mostly reported positive attitude towards vaccination (61.8%; 95% CI: 34.7–42). Parents with positive attitudes were more likely to state their child experienced mild or no adverse reaction after vaccination, report not delaying vaccination and provide additional non-mandatory vaccines to their child (p < 0.05). Gender, age, education and marital status of parent were not significantly associated with the positive attitude towards vaccination. Our results suggest the need for educational interventions and communication strategies that could foster better knowledge on immunization with a focus on parental misconceptions, perceived constraints and safety issues about vaccine.     

Homeschooling parents in California: Attitudes,beliefs and behaviors associated with child’s vaccination status

BackgroundSenate Bill 277 (SB277) banned nonmedical exemptions from school-entry vaccination requirements for children attending classroom-based schools in California, but excluded homeschooled children from vaccination requirements. Thus, it was hypothesized that more parents would choose to homeschool to avoid vaccination requirements in response to SB277. There is limited literature on the vaccine attitudes, beliefs, and behaviors among the homeschooling population in the US, despite an overall increase in homeschooling nationwide and documented vaccine-preventable disease outbreaks within the homeschooled child population.MethodsBetween November 2018 and January 2019, we conducted a cross-sectional online survey among homeschooling parents with at least one child in grades K-8 who is currently enrolled in one of the legally-acceptable mechanisms to homeschool in California: (1) home-based private school satellite program (PSP), or (2) public or charter independent study program (ISP) with no classroom-based instruction.ResultsAmong 140 homeschooling parents from 8 schools in California, 71% reported that their youngest child in grade K-8 was up-to-date on immunizations at kindergarten-entry and 56% reported that they made the decision to homeschool their child after the implementation of SB277. Compared to homeschooling parents whose child was up-to-date at kindergarten entry, homeschooling parents whose child was not up-to-date at kindergarten entry reported higher concerns over vaccine safety and effectiveness, more frequently cited immunization mandates as a reason to homeschool, and were more likely to report having considered moving out of California due to immunization mandates.ConclusionThere was variation in vaccine attitudes and beliefs within the homeschooling population in this sample. Immunization mandates were a factor in the decision to homeschool for some parents in this sample, supporting the hypothesis that vaccine-hesitant parents considered homeschooling as a way to avoid immunization mandates such as SB277. Future studies should explore the complexities around vaccine attitudes, beliefs and behaviors among homeschooling populations.     

Parents concerned about vaccine safety: Differences in race/ethnicity and attitudes

BACKGROUND: Parental concerns about immunization safety have been covered widely in the media and on the Internet and have been correlated in some studies with under-immunization and the late receipt of immunizations. OBJECTIVES: Phase 1: To (1) measure the prevalence of parents with immunization safety concern, specifically those with high-level concern, (2) determine demographic characteristics and attitudes typical for this subgroup of parents, and (3) determine factors that influence such parents, nevertheless, to have their children immunized. Phase 2: To further explore the racial/ethnic difference found in the first-phase results, specifically to compare the immunization attitudes of Hispanic (both black and white) and non-Hispanic black parents with those of non-Hispanic white parents. METHODS: ConsumerStyles (2004) survey data of a nationwide panel of U.S. adults were analyzed in January 2006. In Phase 1, bivariate and logistic regression analyses were used to identify factors associated with parental concerns about immunization safety. In Phase 2, logistic regression was used to compare immunization attitudes among non-Hispanic black; Hispanic (both black and white); and non-Hispanic white parents. RESULTS: The response rate was 62% (6207/10,000); analysis was restricted to the 2937 (47%) respondents who were parents with a child aged 18 years or younger; 634 (21%) responded with the highest level of concern, 5 on a 1-to-5-point scale. Demographics (Hispanic ethnicity/nonwhite race, low income, and less education) and negative attitudes toward immunization and the child's healthcare provider were significantly associated with high-level concern. Seventy-two percent of parents with high-level concern responded that the risk of a child getting a disease was their primary reason for having their child immunized, while 17% listed state laws requiring immunizations for school/daycare entry. Importantly, black parents were more likely than white parents to have negative attitudes toward immunizations and their child's healthcare provider. CONCLUSIONS: One fifth of parents reported high-level concern with the safety of childhood immunizations. To prevent the erosion of childhood immunization rates, healthcare providers need to learn how to recognize and address these concerns.     

Association of vaccine-related attitudes and beliefs between parents and health care providers

Objectives

Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child's health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child's primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents.

Methods

We surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002–2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression.

Results

Surveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief.

Conclusions

The beliefs of children's health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.     

Confidence in vaccination: a parent model

Although vaccination has been heralded as one of the 10 greatest public health achievements, how parents differ in their views about vaccination is not well understood. A deeper understanding of these attitudes and beliefs may improve the effectiveness of vaccine communications. In this mailed survey of U.S. parents in January 2001 (return response rate 49%), parental confidence in vaccination was very high, although there was significant variation among parents. Using multivariate analyses to group and profile parents, 90% of parents (n=1820) were classified into one of four distinct parent groups: (1) "Vaccine Believer" parents who were convinced of the benefit of vaccination; (2) "Cautious" parents noteworthy for a high emotional investment in their child; (3) "Relaxed" parents characterized by a less involved parenting style and some skepticism about vaccines; and (4) "Unconvinced" parents distinguished by their distrust of vaccinations and vaccination policy. These findings suggest that messages that are customized to parents' attitudes and beliefs may improve their understanding and acceptance of vaccination.     

Attitudes and Beliefs About Adolescent Work and Workplace Safety Among Parents of Working Adolescents

PurposeThis study was designed to examine the attitudes and beliefs of the parents of working adolescents related to the safety of the employment of their children.MethodsA cross-sectional telephone survey was conducted in 2003 among English-speaking parents of working adolescents aged 14–18 years in the continental United States. Questions addressed parental concerns about adolescents' employment and potential safety issues at work.ResultsMost parents expressed favorable attitudes about adolescent employment, although many expressed concerns about fatigue (48%), problems completing schoolwork (33%), or spending time with families (35%). Half of all parents indicated concerns about adolescents being present during a robbery, and 40–50% were concerned about adolescents working alone or not having adequate safety training. Parents were favorable to laws that regulate the teen work environment, although most (69%) also indicated that parents, not laws, should determine the work that teens do.ConclusionsParents of working teens are favorable to their teens working, but they do have varied concerns about safety. Although many parents believe they should set the rules about teen work, they are also generally supportive of governmental regulation of hours and tasks. Helping parents understand child labor policies and consider evidence about work hazards may facilitate their ability to provide appropriate advice to their children.     

Parent attitudes toward immunizations and healthcare providers the role of information

BACKGROUND: Lack of information has been associated with patient anxiety or concern in a number of healthcare areas. OBJECTIVES: (1) Identify the proportion of parents who agreed, were neutral, and disagreed that they had access to enough information to make a decision about immunizing their child; (2) examine how parents who agreed and disagreed differed with respect to sociodemographic characteristics, and their attitudes about immunizations, their child's healthcare provider, immunization requirements/exemptions, and immunization policymakers; and (3) identify if differences exist in specific immunization concerns. METHODS: A sample of parents with at least one child aged < or =6 years (n=642) was analyzed using data from the HealthStyles survey conducted during July and August 2003. Odds ratios and the Mantel-Haenszel chi-square test were used for analysis. RESULTS: Response rate for HealthStyles was 69% (4035/5845). The largest proportion of parents agreed they had access to enough information (67%) compared to parents who were neutral (20%) or who disagreed (13%). Compared to parents who agreed, parents who disagreed were more likely to be less confident in the safety of childhood vaccines (odds ratio [OR]=5.4, 95% confidence interval [CI]=3.3-8.9), and to disagree that their child's main healthcare provider is easy to talk to (OR=10.3, 95% CI=3.7-28.1). There was a significant linear trend in the percentage of parents expressing immunization concerns among those who agreed, were neutral, and who disagreed they had access to enough information (p<0.05; df=1). CONCLUSIONS: While most parents agreed that they had access to enough immunization information, approximately a third did not. Perceived lack of information was associated with negative attitudes about immunizations and toward healthcare providers. Basic information about the benefits and risks of vaccines presented by a trusted provider could go a long way toward maintaining and/or improving confidence in the immunization process.     

Socioeconomic factors play a more important role in childhood vaccination coverage than parental perceptions: a cross-sectional study in Greece

To identify predictive factors of complete and age-appropriate vaccination status in Greece, we conducted a cross-sectional study, using stratified cluster sampling, among children attending the first year of the Greek Grammar school (about 6 years of age) and their parents/guardians. Almost 88% (N = 3878) of pupils in the selected clusters (school classrooms) provided their vaccination booklet and their parents/guardians completed a questionnaire regarding beliefs and attitudes towards immunization. Belonging to a minority group, having other siblings and perceiving long distance to immunization site as a barrier were independent predictors of both incomplete and delayed vaccination status in the final logistic regression model. Maternal age ≥ 30 years and the perception that natural disease is preferable to vaccination were associated with complete vaccination, whereas paternal education of high school or higher was the other independent determinant of age-appropriate immunization. Socioeconomic factors rather than parental beliefs and attitudes towards immunization explained underimmunization. Further interventions are warranted to enhance vaccine coverage in high-risk groups identified in this study.     

Parental perceptions,attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study

ObjectivesThe widespread availability and use of vaccines have tremendously reduced morbidity, mortality and health care costs associated with infectious diseases. However, parental beliefs about vaccination are one of the major factors in achieving high vaccination rates. Thus, this study aims to assess the perceptions and attitudes regarding routine childhood immunization among Saudi parents.MethodsA cross sectional study with a pre-tested 18-item questionnaire was conducted using 467 randomly selected parents from the Hail region of Saudi Arabia in the period between February 1st, 2016, and February 1st, 2017. The validated questionnaire consisted of three sections that collected information on participants’ demographics, parents’ awareness of vaccine benefits, and parents’ practices regarding the immunization of their children.ResultsFemale and male parents comprised 54.5% (255) and 45.5% (212) of the sample, respectively, and the response and completion rates were 97%. The majority of the respondents had received a formal education (94.1%, 439), were gainfully employed (62.9%, 294) and had a regular monthly income (73.3%). The majority of the respondents were aware of childhood vaccinations (78.9%), completed vaccinations mandated for children up to 5 years (86.2%), encouraged other parents to do so (89.9%), and had easy access to vaccines (90.5%). Sixty to ninety percent of the respondents were knowledgeable regarding the health benefits of vaccinations in children, even though 18.4% of their children had experienced vaccination-related minor adverse effects during or after vaccination of which 23.2% required doctor's visits. Health care professionals were the most frequent source of parents’ vaccine-related information (65.2%), and vaccination reminder services provided by the Ministry of Health (MOH) via mobile phones were cited by 57.5% of respondents.ConclusionsConfidence in and acceptance of childhood vaccinations, perceptions of vaccine-related health benefits and ease of access to immunizations appeared to be quite good among Saudi parents.     

Predictors of childhood immunization completion in a rural population.

Despite the availability of effective vaccines, immunization rates among two-year old children continue to be low in many areas of the United States including rural West Virginia. The goal of this study was to identify barriers to childhood immunization in rural West Virginia and determine factors that were important in the completion of the childhood immunization schedule. A telephone survey was used to collect data from a randomly selected sample of 316 mothers, of two-year olds, from 18 rural counties of West Virginia. Results indicated that two-thirds or 65% of the children in the study sample had completed their recommended immunizations by two years of age. Immunization barriers identified in this study include: living in health professional shortage areas, lack of health insurance, negative beliefs and attitudes regarding childhood immunizations, problems accessing the immunization clinic, and a perception of inadequate support from the immunization clinic. Results of the structural equation modeling, using LISREL-8, indicated that 20% of the variation in immunization completion (R2 = 0.197) was explained by attitude towards immunization and perceived support received from the immunization clinic. Furthermore, 42% of the variation in attitude towards immunization (R2 = 0.419) was explained by immunization-related beliefs, and 28% of the variation in immunization-related beliefs (the R2 = 0.277) was explained by general problems faced during immunization and perceived clinic support. The study concluded that positive immunization-related beliefs and attitudes, support from the immunization clinic, and ease of the immunization seeking process are important factors in the timely completion of the childhood immunization schedule.     

Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network

Parental decision making about childhood vaccinations is complex and multidimensional. There is a perception that the number of parents having concerns regarding childhood vaccinations has been increasing in Canada. The aim of this study was to explore vaccine hesitancy among Canadian parents and to examine factors associated with a parent’s intention to vaccinate his/her child. Informed by the Theory of Planned Behaviour (TPB) this study assesses potential associations between parents’ knowledge, attitudes and beliefs toward vaccination and their intention to vaccinate their child in the future. A national sample of Canadian parents of children aged 24–59 months (N = 2013) was surveyed using an online survey methodology. Half of the surveyed parents strongly intended to have their child vaccinated in the future. Parents’ information needs and searches as well as parents’ trust in different institutions were associated with intention to vaccinate. Parents who reported having frequently looked for vaccine information, who considered that it was their role as parents to question vaccines, or who had previously experienced difficulty accessing vaccination services were less likely to strongly intend to vaccinate their child in the future. Parents who had a high level of trust in doctors and public health were most likely to strongly intend to vaccinate their child. Results of the multivariate analysis showed that positive attitudes (aOR = 8.0; 95% CI: 6.0, 10.4), higher perceived social support (aOR = 3.0; 95% CI: 2.3, 3.93), and higher perceived behavioural control (aOR = 1.8; 95% CI: 1.4, 2.43) were associated with parents’ intention to vaccinate their child. Findings of this study suggest that trust-building interventions that promote pro-vaccine social norms and that address negative attitudes toward vaccination could enhance vaccine acceptance among Canadian parents.     

Impact of an immunization education program on middle school adolescents

OBJECTIVES: To raise middle school student awareness, attitudes, and proactive behaviors about immunization, and to increase immunization rates among middle school students through implementation of a comprehensive integrated immunization promotion curriculum (Immunization Plus!) METHODS: Evaluation used a quasi-experimental non-equivalent comparison-groups design conducted in a sample of 40 classrooms in 22 schools in California. RESULTS: Sixth-grade students exposed to the curriculum developed more positive knowledge and attitudes, and were more likely to be immunized, to intend to obtain newly required immunizations, and to tell parents about immunizations. CONCLUSION: Infectious disease control and immunizations are under-developed subject areas within school-based health promotion in the United States that can be effectively taught to middle school students.     

Parental beliefs and child-rearing attitudes and mental health problems among schoolchildren

OBJECTIVE: To verify the prevalence and identify the risk factors related to mental health problems among schoolchildren and its possible association with the beliefs and educational attitudes of parents/caretakers. METHODS: Cross-sectional study with a stratified probabilistic sample (n=454) of first to third-graders from public and private schools in Southeastern Brazil. Standardized instruments were administered to parents/caretakers by trained interviewers, including screening questionnaires for mental health problems among children and parents/caretakers; a questionnaire on beliefs and attitudes; and a questionnaire for socio-economic status. Chi-square tests and logistic regression models were used for statistical analysis. RESULTS: We found 35.2% prevalence of clinical/borderline cases among students. Parents/caretakers that believed in corporal punishment as a child-rearing method used physical aggression towards their children more frequently (64.8%). Logistic regression models showed that the act of hitting the child with a belt was associated to conduct problems and to overall mental health problems among schoolchildren in the presence of other risk factors: child gender (male), parents/caretakers with mental health problems, and adverse socioeconomic conditions. CONCLUSIONS: The high prevalence of mental health problems among schoolchildren and its association with child-rearing methods and mental health problems among parents/caretakers indicate the need for psycho-educational interventions aimed to reduce physical abuse and mental health problems in childhood.     

An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling

The study examined factors that affect parental intention-to-vaccinate adolescent daughters with HPV vaccine in Mysore district, India. A cross-sectional study was conducted among 1609 parents of adolescent girls attending schools in Mysore District between February 2010 and October 2011. A validated questionnaire was used to assess parental attitudes, beliefs related with HPV infection, cervical cancer, HPV vaccine and vaccination in general. Structural equation modeling was used to estimate parameters and assess whether a model based on the integrative behavior theory would fit the current data. More than two-thirds (78.0%) of parents would accept vaccinating their daughters with HPV vaccine. Intention to HPV vaccination significantly increased with increase in the perception of parents about the benefits (standardized regression coefficient (β)?=?0.39) or sources of information about HPV vaccine (β?=?0.24), but intention decreased significantly with an increase in the perception about barriers to HPV vaccination β?=??0.44). The effect of beliefs about severity of HPV infection or cervical cancer (β?=?0.20), and beliefs about benefits (β?=?0.20) or barriers (β?=??0.25) to vaccination in general on intention to HPV vaccination were significantly mediated by parental attitudes and source of information about the vaccine. Geographical location significantly moderated the awareness about HPV on beliefs about severity of HPV infection or cervical cancer (β?=?0.33), and the effect of religion on norms related to HPV vaccination (β?=?0.19). Fit of the model to the data was acceptable. This study identified modifiable parental attitudes about HPV vaccine and beliefs related with HPV infection, cervical cancer and vaccination, which predicted parental intention-to-vaccinate their daughters with HPV vaccine in India. Health education interventions tailored to counter parental negative attitudes and beliefs about HPV vaccine and vaccination in general would be important for the community to promote HPV vaccination.     

Treatment choices and experiences in attention deficit and hyperactivity disorder: relations to parents' beliefs and attributions

BACKGROUND: Despite their potential to influence treatment decisions, parents' beliefs and attitudes regarding attention deficit hyperactivity disorder (ADHD) have not been widely studied. This research examined relations between parents' beliefs and attitudes and their experiences with different treatments for their children's ADHD. METHODS: Canadian parents of 73, 5- to 13-year-old, boys with ADHD completed questionnaires measuring beliefs about ADHD, attributions for ADHD behaviours, and treatment experiences. RESULTS: Parents reported using primarily behaviour management and stimulant medications in treating ADHD. Approximately half of the families also used diet/vitamin therapies. Parents were knowledgeable about ADHD and held generally accurate beliefs. They saw ADHD symptoms as predominantly internal to the child and as relatively enduring and pervasive. Parents' beliefs were related to their use of different treatments and parents who used less empirically supported treatments were more likely to see ADHD behaviours as internal to the child, enduring and pervasive. CONCLUSIONS: The findings highlight the importance of assessing parents' use of alternate treatments for ADHD and the potential role of parents' beliefs and attributions in shaping treatment choices.     

Parental vaccine hesitancy in Italy – Results from a national survey

In Italy, in 2016, we conducted a cross-sectional survey to estimate vaccine hesitancy and investigate its determinants among parents of children aged 16–36 months.Data on parental attitudes and beliefs about vaccinations were collected through a questionnaire administered online or self-administered at pediatricians’ offices and nurseries. Parents were classified as pro-vaccine, vaccine-hesitant or anti-vaccine, according to self-reported tetanus and measles vaccination status of their child. Multivariable logistic regression was used to investigate factors associated with hesitancy.A total of 3130 questionnaires were analysed: 83.7% of parents were pro-vaccine, 15.6% vaccine-hesitant and 0.7% anti-vaccine. Safety concerns are the main reported reason for refusing (38.1%) or interrupting (42.4%) vaccination. Anti-vaccine and hesitant parents are significantly more afraid than pro-vaccine parents of short-term (85.7 and 79.7% vs 60.4%) and long-term (95.2 and 72.3% vs 43.7%) vaccine adverse reactions. Most pro-vaccine and hesitant parents agree about the benefits of vaccinations. Family pediatricians are considered a reliable source of information by most pro-vaccine and hesitant parents (96.9 and 83.3% respectively), against 45% of anti-vaccine parents. The main factors associated with hesitancy were found to be: not having received from a paediatrician a recommendation to fully vaccinate their child [adjusted odds ratio (AOR): 3.21, 95% CI: 2.14–4.79], having received discordant opinions on vaccinations (AOR: 1.64, 95% CI: 1.11–2.43), having met parents of children who experienced serious adverse reactions (AOR: 1.49, 95% CI: 1.03–2.15), and mainly using non-traditional medical treatments (AOR: 2.05, 95% CI: 1.31–3.19).Vaccine safety is perceived as a concern by all parents, although more so by hesitant and anti-vaccine parents. Similarly to pro-vaccine parents, hesitant parents consider vaccination an important prevention tool and trust their family pediatricians, suggesting that they could benefit from appropriate communication interventions. Training health professionals and providing homogenous information about vaccinations, in line with national recommendations, are crucial for responding to their concerns.     

Swiss adolescents' and adults' perceptions of cannabis use: a qualitative study

Few studies have attempted to investigate the nature of adolescents' and adults' conceptions and perceptions of cannabis use. Our objectives were to explore adolescent and adult perception of use and misuse of cannabis, and their opinions and beliefs about the current legal context and preventive strategies. We used focus group discussions with four categories of stakeholders: younger (12-15 year old) adolescents, older (16-19 year old) adolescents, parents of teenagers and professionals working with young people. In some areas (legal framework, role of the media, importance of early preventive interventions), we found consensual attitudes and beliefs across the four groups of participants. In all four groups, participants did not have any consensual vision of the risks of cannabis use or the definition of misuse. In the area of the prevention of cannabis use/misuse, while parents focused on the potential role of professionals and the media, thus minimizing their own educational and preventive role, professionals stressed the importance of parental control and education. Within the Swiss context, we conclude there exists an urgent need for information and clarification of the issues linked with cannabis use and misuse directed at parents and professionals.     

Persuading the “Movable Middle”: Characteristics of effective messages to promote routine and COVID-19 vaccinations for adults and children – The impact of COVID-19 on beliefs and attitudes

PurposeWe sought to 1) explore trusted sources for vaccine information, 2) describe persuasive characteristics of trusted messages promoting routine and COVID-19 vaccines for children and adults and 3) explore how the pandemic has impacted attitudes and beliefs about routine vaccinations.We conducted a mixed method cross-sectional study between May 3-June 14, 2021 including a survey and six focus groups among a sub-set of survey respondents. A total of 1,553 survey respondents (from which n = 33 participated in the focus groups) including adults without children under age nineteen years (n = 582) and parents with children under age nineteen years (n = 971).ResultsPrimary care providers, family, and credible sources, characterized as known and well-established entities, were top sources of vaccine information.Neutrality, honesty, and having a trusted source to rely on in sorting through volumes of sometimes conflicting information were highly valued. Trustworthy qualities about sources included: 1) expertise, 2) fact-based, 3) unbiased, and 4) having an established process for sharing information. Because of the evolving nature of the pandemic, attitudes and beliefs about COVID-19 vaccine and sources of COVID-19 information differed from typical views about routine vaccines.Of 1,327 (85.4 %) survey respondents, 12.7 % and 9.4 % of adults and parents cited that the pandemic impacted their attitudes and beliefs. Among these respondents, 8 % of adults and 3 % of parents cited more favorable attitudes and beliefs about getting vaccinated with routine vaccines because of the pandemic.ConclusionVaccine attitudes and beliefs which inform intent to vaccinate can change and differ among different vaccines. Messaging should be tailored to resonate with parents and adults to improve vaccine uptake.