Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study

Figures & data

Table 1. Participant demographic characteristics

	% ^a (N = 257)
Caregiver English Proficiency
Excellent English	91.8 (236)
Less Than Excellent	8.2 (21)
Caregiver Education
High School or Less	23.7 (61)
Some College or Above	76.3 (196)
Caregiver Age
<30 years old	32.3 (83)
30-39	59.9 (154)
40+	7.8 (20)
Relationship to the Child
Mother	84.1 (216)
Other	16.0 (41)
Child Age
6–23 months	91.8 (236)
2–8 years	8.2 (21)
Child Gender
Male	52.1 (134)
Female	47.9 (123)
Child Insurance Type
Public Insurance/No Insurance ^b	30.4 (78)
Commercial ^c	69.7 (179)
Child Race
White	70.0 (180)
Black	18.3 (47)
Asian	7.0 (18)
Other	4.7 (12)
Child Ethnicity
Hispanic/Latino/Spanish	16.0 (41)
Non- Hispanic/Latino/Spanish	84.1 (216)
Child Health
Excellent	79.8 (205)
Less Than Excellent	20.2 (52)

^aAll percentages were rounded up. Due to rounding, the total percentages may not equal 100%.

^b3 participants had no insurance and were categorized into Public Insurance/No Insurance.

^c3 participants had Tricare insurance and were categorized into Commercial.

Table 2. Response distribution and score assignment (0–2) to a measure of caregiver vaccine hesitancy: PACV-5 survey tool

PACV-5 Survey Items	PACV-5 Responses % (n) ^a (total N=256)
	Strongly Agree (Score 0)	Somewhat Agree (Score 0)	Not Sure/I don’t Know (Score 1)	Somewhat Disagree (Score 2)	Strongly Disagree (Score 2)
1. I trust the information I receive about shots	70.7% (181)	23.8% (61)	4.7% (12)	0.39% (1)	0.39% (1)
	Strongly Agree (Score 2)	Somewhat Agree (Score 2)	Not Sure/I don’t Know (Score 1)	Somewhat Disagree (Score 0)	Strongly Disagree (Score 0)
2. It is better for my child to develop immunity by getting sick than to get a shot	3.1% (8)	5.5% (14)	14.1% (36)	33.2% (85)	44.1% (113)
3. It is better for children to get fewer shots at the same time	10.2% (26)	25.4% (65)	27.7% (71)	25.4 (65)	11.3% (29)
4. Children get more shots than are good for them	9.4% (24)	17.6% (45)	11.3% (29)	34.8% (89)	27% (69)
	Not at All Hesitant (Score 0)	Not Too Hesitant (Score 0)	Not Sure/I don’t Know (Score 1)	Somewhat Hesitant (Score 2)	Very Hesitant (Score 2)
5. Overall, how hesitant about childhood shots would you consider yourself to be?	58.6% (150)	27.3% (70)	4.7% (12)	7.4% (19)	2% (5)

^aDue to rounding, the total percentages may not equal 100%.

Table 3. Caregiver knowledge, attitudes, and beliefs about influenza disease and vaccine

Survey Items	Knowledge, Attitudes and Beliefs Responses % (n) ^a (total N=256)
	Inaccurate			Accurate
	Very Protected	Don’t Know	Total (all 2 categories combined)	Somewhat Protected	Somewhat Unprotected	Very Unprotected
How well do you think your child will be protected if he/she only gets one flu shot this season?	12.1% (31)	3.1% (8)	15.2% (39)	48.8% (125)	29.7% (76)	6.3% (16)
	Inaccurate					Accurate
	Strongly Agree	Somewhat Agree	Somewhat Disagree	Don’t Know	Total (all 4 categories combined)	Strongly Disagree
The flu shot can cause the flu	4.3% (11)	24.6% (63)	26.6% (68)	1.6% (4)	57.0% (146)	43% (110)
The flu is just a bad cold.	7% (18)	12.1% (31)	20.3% (52)	0.8% (2)	40.2% (103)	59.8% (153)
Children cannot die from the flu ^b	5.5% (14)	5.5% (14)	19.9% (51)	1.2% (3)	32.0% (82)	68% (174)

^aAll percentages were rounded up. Due to rounding, the total percentages may not equal 100%.

^bThe original statement was “Children can die from the flu.” It was reversely coded to “children cannot die from the flu” to match other inaccurate beliefs. After re-coding, the only response considered accurate was “strongly disagree”. All other responses (strongly agree, somewhat agree, somewhat disagree, & don’t know) were summarized under inaccurate beliefs.

Table 4. Caregiver vaccine hesitancy: PACV-5 score distribution and categorization

PACV-5Score	Responses % (n)^a(total N=256)	PACV-5 VaccineHesitancy Category	PACV-5 Vaccine Hesitancy Category Combined
0	22.7% (58)	Low: 88.3% (226)	Low: 88.3% (226)
1	16.8% (43)
2	22.7% (58)
3	14.5% (37)
4	11.7% (30)
5	3.5% (9)	Moderate: 8.2% (21)	Moderate/High: 11.7% (30)
6	4.7% (12)
7	1.6% (4)	High: 3.5% (9)
8	1.6% (4)
9	0.4% (1)
10	0

^aDue to rounding, the total percentages may not equal 100%.

Table 5. No one variable was consistently associated with vaccine hesitancy and inaccurate influenza disease and vaccine knowledge, attitudes and beliefs.^a

	PACV-5 Score (N=256)		Inaccurate Beliefs About Influenza Disease & Vaccine (N=256)
	Moderate or High VaccineHesitancy (5-10)		Your Child is Protected with“Only 1 Flu Shot”			“Flu Shot Can Cause theFlu”		“Flu is Just a Bad Cold”		Children Cannot “Die from theFlu”
Caregiver and Child Characteristics	%	Risk Difference (95% CI)	%		Risk Difference (95% CI)	%	Risk Difference (95% CI)	%	Risk Difference (95% CI)	%	Risk Difference (95% CI)
Caregiver English Proficiency
Excellent English	9.6	Ref	12.2		Ref	56.8	Ref	36.7	Ref	30.5	Ref
Less Than Excellent	28.5	19.0% (5.5, 48.3) ^b	43.2		31.0% (9.5, 66.2) ^b	61.4	4.7% (-24.1, 28.2)	92.2	55.5% (18.5, 62.7) ^b	50.9	20.4% (-7.2, 37.5)
Caregiver Education
Some College or Above	9.7	Ref	12.5		Ref	54.4	Ref	35.7	Ref	27.7	Ref
High School or Less	15.9	6.2% (-2.6, 18.8)	20.9		8.4% (-2.6, 24.7)	67.7	13.3% (-2.9, 31.0)	56.7	21.0% (0.9, 38.5) ^b	45.5	17.8% (1.5, 38.3) ^b
Relationship to a Child
Mother	11.4	Ref	14.3		Ref	58.2	Ref	42.9	Ref	31.7	Ref
Other	13.2	1.8% (-12.8, 13.3)	20.8		6.5% (-9.5, 20.4)	51.1	-7.1% (-31.4, 12.7)	26.6	-16.3% (-28.1, -4.4) ^b	33.6	1.9% (-13.5, 15.9)
Caregiver Age
<30 years old	12.5	Ref	18.3		Ref	58.1	Ref	41.9	Ref	33.0	Ref
30-39	9.6	-2.9% (-9.8, 6.1)	12.1		-6.1% (-14.4, 0.8)	57.0	-1.1% (-10.0, 9.7)	37.0	-4.9% (-18.3, 10.2)	28.7	-4.4% (-18.6, 15.5)
40+	21.5	8.9% (-6.3, 30.6)	20.1		1.8% (-11.0, 16.8)	53.4	-4.7% (-28.6, 20.8)	59.8	17.9% (0.3, 38.9) ^b	54.6	21.5% (7.9, 46.9) ^b
Child Insurance Type
Commercial	11.0	Ref	12.9		Ref	51.8	Ref	40.6	Ref	32.5	Ref
Public Insurance/No Insurance	12.6	1.6% (-10.2, 17.0)	18.2		5.3% (-7.6, 18.1)	70.7	18.9% (3.3, 33.3) ^b	39.4	-1.2% (-13.0, 12.2)	31.2	-1.3% (-17.1, 11.9)
Child Race
White	10.5	Ref	13.1		Ref	56.7	Ref	40.2	Ref	29.6	Ref
Black	13.1	2.6% (-3.4, 16.3)	20.5		7.4% (-4.8, 20.8)	54.2	-2.5% (-19.4, 13.1)	44.3	4.1% (-11.6, 17.7)	39.2	9.5% (-7.4, 24.4)
Asian	14.8	4.3% (-3.9, 32.8)	14.5		1.4% (-10.7, 33.6)	76.9	20.2% (-10.5, 37.1)	35.3	-4.9% (-28.0, 30.8)	58.2	28.6% (4.1, 44.0) ^b
Other	15.0	4.5% (-5.7, 39.9)	19.3		6.2% (-5.0, 42.2)	35.2	-21.5% (-41.3, -0.9) ^b	27.0	-13.3% (-29.2, 17.6)	12.6	-17.0% (-25.1, -1.2) ^b
Child Gender
Female	12.3	Ref	19.1		Ref	59.1	Ref	46.2	Ref	31.8	Ref
Male	11.2	-1.2% (-10.2, 8.9)	11.6		-7.5% (-16.0, -0.7) ^b	55.0	-4.1% (-16.3, 8.6)	34.7	-11.5% (-21.7, -1.5) ^b	32.2	0.4% (-10.7, 11.9)
Child Ethnicity
Non-Hispanic/Latino/Spanish	10.3	Ref	13.9		Ref	53.8	Ref	38.5	Ref	30.2	Ref
Hispanic/Latino/Spanish	16.3	6.0% (-9.3, 31.9)	19.8		5.9% (-9.2, 23.9)	76.3	22.5% (0.8, 42.5) ^b	51.0	12.5% (-6.4, 36.2)	41.3	11.1% (-5.5, 30.9)

^aStandardized proportions of demographic characteristics that showed associations in at least one study outcome model are shown. All models were adjusted for child age and child health.

^b95% confidence intervals do not cross zero.