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Using classification and regression tree analysis to explore parental influenza vaccine decisions
Institution:1. Department of Family Science, University of Maryland, College Park, MD, United States;2. Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States;3. Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, United States;4. Center for Health Equity, University of Maryland, College Park, MD, United States;1. Charité University Medicine Berlin, Berlin, Germany;2. Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany;3. Media and Communication Science, University of Erfurt, Erfurt, Germany;4. World Health Organization Regional Office for Europe, Copenhagen, Denmark;5. Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany;6. Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Berlin, Germany;1. Center for Health Equity, 3302 School of Public Health Building, 4200 Valley Drive, University of Maryland, College Park, MD, USA;2. Department of Engineering Management & Systems Engineering, School of Engineering & Applied Sciences, George Washington University, Washington DC, USA;3. Computer Science Department, Johns Hopkins University, Baltimore, MD, USA;4. Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA;1. Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA;2. Maryland Center for Health Equity, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA;3. Center for Health and Risk Communication, University of Georgia, 120 Hooper Street, Athens, GA 30602, USA;4. Department of Human Development and Quantitative Methodology, University of Maryland, 1230 Benjamin Building, 3942 Campus Drive, College Park, MD 20742, USA;5. University Center for Social and Urban Research, University of Pittsburgh, 3343 Forbes Avenue, Pittsburgh, PA 15260, USA;1. Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742-2611, United States;2. Maryland Center for Health Equity, University of Maryland, College Park, MD, United States;3. Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, United States;4. Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States;1. State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiamen, Fujian, China;2. Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China;3. Department of Public Health, Tzu-Chi University, Taiwan
Abstract:Background and objectivesInfluenza poses a public health threat for children and adults. The CDC recommends annual influenza vaccination for children <18 years, yet vaccine uptake remains low for children (57.9%) and adults (37.1%). Given that parental decision-making is key in childhood vaccine uptake, there is a critical need to understand vaccine hesitancy among parents who decide not to vaccinate their children. This study aims to explore predictors of children’s influenza vaccine status given parental vaccination status and examine the factors that contribute to concordance or discordance between parental and children’s vaccine uptake.MethodsClassification and regression tree (CART) analyses were used to identify drivers of parental decisions to vaccinate their children against influenza. Hierarchy and interactions of these variables in predicting children’s vaccination status were explored.ResultsFrom a nationally representative sample of non-Hispanic Black and White parents who completed an online survey (n = 328), the main factors influencing parents’ decisions to vaccinate their children were vaccine behavior following physician recommendation, knowledge of influenza recommendations for children, influenza vaccine confidence and disease risk. Among unvaccinated parents, the greatest concordance was observed among parents who usually do not get vaccinated following physician recommendation and had lower knowledge of recommendations for influenza vaccination for children. The greatest discordance was observed among unvaccinated parents who had lower hesitancy about recommended vaccines.ConclusionsUnderstanding drivers of parental decisions to vaccinate themselves and their children can provide insights on health communication and provider approaches to increase influenza vaccine coverage and prevent influenza related mortality.
Keywords:Influenza vaccination  Influenza  Child health  Vaccine decision-making  CART"}  {"#name":"keyword"  "$":{"id":"k0030"}  "$$":[{"#name":"text"  "_":"Classification and regression tree analysis  CAM"}  {"#name":"keyword"  "$":{"id":"k0040"}  "$$":[{"#name":"text"  "_":"Complementary and alternative medicine  CDC"}  {"#name":"keyword"  "$":{"id":"k0050"}  "$$":[{"#name":"text"  "_":"Centers for Disease Control and Prevention  HCP"}  {"#name":"keyword"  "$":{"id":"k0060"}  "$$":[{"#name":"text"  "_":"Health care providers
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