Assessing Child Vaccine Hesitancy using Mobile Panels

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

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

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

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

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

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

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)

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

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

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

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

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

Vaccine Attitudes and Behaviors

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

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)

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%
(n=100)
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)

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%
(n=100)
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)

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)

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%
(n=100)
Y…
B3: Do you plan or intend to have your child or children get all the remaining recommended
vaccines? (Base: All respondents: n=1029)

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%
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)

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%
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)

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%
Strongly
Somewhat
Children get too many vaccines during the first three years of life. (Base: All respondents: n=1029)

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%
Strongly
Somewhat
Vaccines may cause learning disabilities, such as autism. (Base: All respondents: n=1029)

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%
Strongly
Somewhat
Some vaccines have ingredients that are unsafe. (Base: All respondents: n=1029)

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
Strongly
Somewhat
Some vaccines are given to children to prevent diseases they are not likely to get. (Base: All respondents: n=1029)
.

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
Strongly
Somewhat
Some vaccines are given to children to prevent diseases that are not serious. (Base: All respondents: n=1029)
.

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%
Strongly
Somewhat
Childhood vaccines are important for my child's health. (Base: All respondents: n=1029).

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%
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)

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%
Strongly
Somewhat
Having my child vaccinated is important for the health of others in my community.
(Base: All respondents: n=1029)

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%
Strongly
Somewhat
The information I receive about vaccines from the government is reliable and trustworthy.
(Base: All respondents: n=1029)

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)

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.

Assessing Child Vaccine Hesitancy using Mobile Panels

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