Characterizing the vaccine knowledge, attitudes, beliefs, and intentions of pregnant women in Georgia and Colorado

Figures & data

Table 1. Frequency of pregnant women intending to receive maternal and infant vaccines, stratified by sociodemographic characteristics

Selected Characteristics	Total Sample, N (%)	Influenza Vaccine, N (%)	P^a	Tdap Vaccine, N (%)	P^a	All Infant Vaccines on Time, N (%)	P^a
All	2196	1,381 (63)		1,426 (65)		1,495 (68)
State
Colorado	1099 (50)	735 (67)	<0.01	737 (67)	0.04	746 (68)	0.75
Georgia	1097 (50)	646 (59)		689 (63)		749 (69)
Total	2196	1,381 (63)		1,426 (65)		1,495 (68)
Education^b
Graduate degree	482 (27)	375 (78)	<0.01	369 (77)	<0.01	386 (80)	<0.01
Undergraduate degree	812 (45)	519 (64)		550 (68)		566 (70)
No college degree	518 (29)	261 (50)		296 (57)		311 (60)
Total	1,812	1,155 (64)		1,215 (67)		1,263 (70)
Ethnicity
Black/African American	312 (17)	148 (47)	<0.01	153 (49)	<0.01	172 (55)	<0.01
Hispanic/Latino	209 (11)	117 (56)		109 (52)		138 (66)
White	1,175 (63)	819 (70)		879 (75)		863 (74)
Other	166 (9)	99 (60)		97 (58)		111 (67)
Total	1,862	1,183 (64)		1,238 (66)		1,284 (69)
Number of prior children
0	1015 (46)	603 (59)	<0.01	605 (60)	<0.01	633 (62)	<0.01
1	781 (36)	539 (69)		568 (73)		583 (75)
2	266 (12)	168 (63)		181 (68)		193 (73)
3	90 (4)	47 (52)		46 (51)		59 (66)
4+	43 (2)	24 (56)		26 (60)		27 (63)
Total	2195	1,381 (63)		1,426 (65)		1,495 (68)

^a P-value for the Pearson chi-squared proportion test at the significance level of (α) 5%; boldface indicates statistical significance (p < 0.05).

^b Graduate degree includes master’s, doctoral, and professional degrees; undergraduate degree includes bachelor’s and associate’s degrees.

Table 2. Frequency of agreement with maternal vaccine statements, and unadjusted odds ratios for maternal vaccine intentions

	Agree or Strongly Agree, N (%)	Influenza, OR (95% CI)^a	Tdap, OR (95% CI)^a
Total (N = 2210)
Number of Vaccine Safety Concerns Identified^b
Influenza vaccine concerns (0–6)
0 (reference)	1,630 (74)	1
1–2	134 (6)	0.08 (0.05–0.12)
3–4	197 (9)	0.02 (0.02–0.04)
5–6	235 (11)	0.01 (0.00–0.02)
Tdap vaccine concerns (0–6)
0 (reference)	1,739 (79)		1
1–2	106 (5)		0.08 (0.05–0.13)
3–4	206 (9)		0.04 (0.03–0.06)
5–6	145 (7)		0.02 (0.01–0.04)
Confidence in Vaccine Safety Statements
I am confident that getting the flu vaccine during my pregnancy is safe for me.	1662 (76)	37.50 (27.43–51.26)
I am confident that getting the flu vaccine during my pregnancy is safe for my unborn baby.	1676 (76)	26.49 (19.86–35.34)
I am confident that getting the whooping cough vaccine during my pregnancy is safe for me.	1754 (80)		28.80 (20.95–39.59)
I am confident that getting the whooping cough vaccine during my pregnancy is safe for my unborn baby.	1771 (81)		18.07 (13.57–24.06)
Risk Perception Statements
I worry that I could get the flu while I am pregnant.	998 (61)	4.76 (3.84–5.91)
The flu is dangerous for pregnant women.	1401 (85)	2.53 (1.92–3.33)
The flu is more dangerous for pregnant women than for women who are not pregnant.	1296 (79)	2.17 (1.70–2.75)
I worry that I could get whooping cough while I am pregnant.	649 (39)		3.57 (2.83–4.50)
I worry that I could give whooping cough to my baby after birth.	935 (57)		6.20 (4.96–7.76)
Whooping cough is dangerous for pregnant women.	1256 (76)		2.61 (2.07–3.29)
Confidence in Vaccine Efficacy Statements
Getting the flu vaccine will reduce my risk of getting the flu during my pregnancy.	1136 (69)	18.74 (14.39–24.41)
Getting the flu vaccine while I am pregnant will reduce my unborn baby’s risk of getting the flu.	774 (47)	6.12 (4.84–7.72)
Whooping cough vaccine will reduce my chances of getting whooping cough.	1238 (75)		10.92 (8.40–14.19)
Whooping cough vaccine will reduce the chance of me giving whooping cough to my unborn baby.	1146 (70)		7.55 (5.98–9.54)
Getting the whooping cough vaccine while I am pregnant will reduce my unborn baby’s risk of getting whooping cough.	1019 (62)		6.40 (5.12–8.00)
Self-Efficacy Statement
It is in my control whether or not I get vaccines during my pregnancy.	1601 (98)	1.54 (0.83–2.87)	1.67 (0.90–3.10)
Social Norms Statements
The majority of my friends and family would get the vaccines that are recommended during pregnancy.	1608 (73)	7.99 (6.45–9.90)	6.10 (4.97–7.50)
The majority of my friends and family would encourage me to get the vaccines that are recommended during pregnancy.	1579 (72)	9.92 (7.99–12.32)	7.26 (5.91–8.93)
Perceived Knowledge Statements
I have most of the important information I need to make a decision about vaccines given during pregnancy.	1806 (82)	4.13 (3.27–5.21)	3.88 (3.09–4.88)
I know enough about the safety of the flu vaccine to make a decision about getting the vaccine for myself while pregnant.	1343 (82)	4.60 (3.53–6.01)
I know enough about the safety of the whooping cough vaccine to make a decision about getting the vaccine for myself while pregnant.	1173 (71)		4.50 (3.59–5.65)
Trust in Vaccine Information Source Statements
I trust the information provided by my obstetrician or midwife about vaccines during pregnancy.	2032 (93)	8.62 (5.74–12.96)	6.70 (4.61–9.72)
I trust the information provided by my baby’s doctor about vaccines during pregnancy.^c	1871 (92)	8.28 (5.52–12.43)	6.82 (4.68–9.93)
I trust the information provided by naturopathic and/or chiropractic doctors about vaccines during pregnancy.^c	917 (64)	0.65 (0.52–0.81)	0.72 (0.57–0.90)
I trust the information provided by federal agencies such as the Centers for Disease Control and Prevention (CDC) about vaccines during pregnancy.	1768 (81)	6.38 (5.04–8.07)	5.62 (4.47–7.07)
I trust the information provided by scientists and doctors at universities and academic institutions about vaccines during pregnancy.	1799 (82)	3.85 (3.07–4.84)	3.55 (2.83–4.45)

^aOdds ratio (95% Confidence interval) for intention to receive influenza or Tdap vaccine by agreement with survey statement; boldface indicates statistical significance (p < 0.05).

^bSpecific safety concerns were only obtained from those who did not agree that the vaccine in question was safe.

^cRemoved those who stated they had not yet seen this type of provider from this analysis.

OR, Odds ratio

Table 3. Frequency of agreement with infant vaccine statements, and unadjusted odds ratios for infant vaccine intentions

	Agree or Strongly Agree, N (%)^a	All Infant Vaccines on Time, OR (95% CI)^a
Total (N = 2203)
Number of Infant Vaccine Safety Concerns Identified (0–4)^b
0 (reference)	1,904 (87)	1
1–2	93 (4)	0.11 (0.07–0.18)
3–4	199 (9)	0.02 (0.01–0.04)
Confidence in Vaccine Safety Statements
I am confident that vaccines are safe for my baby after birth.	1886 (86)	16.66 (12.08–22.98)
Risk Perception Statements
I worry that my baby could get whooping cough after birth.	1010 (61)	2.53 (2.05–3.13)
Whooping cough is dangerous for babies.	1519 (92)	2.39 (1.66–3.44)
Whooping cough is more dangerous for babies than older children or adults.	1417 (86)	2.46 (1.86–3.26)
Confidence in Vaccine Efficacy Statements
Getting the whooping cough vaccine for my baby after birth will reduce my baby’s chances of getting whooping cough.	1198 (73)	4.41 (3.50–5.55)
I believe it is better for my baby to develop their own immunity by getting sick rather than by getting a vaccine.	473 (29)	0.26 (0.21–0.32)
Self-Efficacy Statement
It is in my control whether or not my baby gets his/her vaccines.	1581 (96)	1.52 (0.90–2.55)
Social Norms Statements
The majority of my friends and family would get all of the vaccines recommended for their babies after birth.	1789 (82)	4.75 (3.78–5.97)
The majority of my friends and family would encourage me to get all of the vaccines recommended for my baby after birth.	1769 (81)	5.81 (4.63–7.30)
Perceived Knowledge Statements
I have most of the important information I need to make a decision about vaccines for my baby after birth.	1843 (84)	4.40 (3.46–5.58)
I know enough about the safety of the whooping cough vaccine to make a decision about getting the vaccine for my baby after birth.	1682 (77)	3.13 (2.55–3.84)
Trust in Vaccine Information Source Statements
I trust the information provided by my obstetrician or midwife about vaccines for babies after birth.	2034 (93)	15.22 (9.68–23.94)
I trust the information provided by my baby’s doctor about vaccines for babies after birth.^c	1868 (94)	26.84 (14.67–49.11)
I trust the information provided by naturopathic and/or chiropractic doctors about vaccines for babies after birth.^c	863 (63)	0.87 (0.69–1.09)
I trust the information provided by federal agencies such as the Centers for Disease Control and Prevention (CDC) about vaccines for babies after birth.	1775 (81)	7.30 (5.77–9.23)
I trust the information provided by scientists and doctors at universities and academic institutions about vaccines for babies after birth.	1806 (82)	4.68 (3.72–5.90)

^a Odds ratio (95% Confidence interval) for intention to get their baby all vaccines on time by agreement with survey statement; boldface indicates statistical significance (p < 0.05).

^b Specific safety concerns were only obtained from those who did not agree that the vaccine in question was safe.

^c Removed those who stated they had not yet seen this type of provider from this analysis.

OR, Odds ratio

Table 4. Adjusted odds ratios of pregnant women intending to receive vaccines by significantly associated attitudinal constructs

Attitudinal Constructs and Sociodemographic Characteristics Associated with Intention to Vaccinate^a	aOR (95% CI)^b
Intention to Receive Influenza Vaccine^c
Sociodemographic Characteristics
Having at least a college degree	1.98 (1.37–2.85)
Prior children	1.24 (0.88–1.74)
State (Colorado vs Georgia)	1.44 (1.01–2.05)
Ethnicity
White (reference)
Black	0.89 (0.55–1.44)
Hispanic	0.75 (0.43–1.30)
Other	0.97 (0.52–1.79)
Attitudinal Constructs
Number of specific vaccine safety concerns (influenza vaccine)	0.56 (0.46–0.68)
Confidence in vaccine safety (for the mother)	1.30 (1.12–1.52)
Confidence in vaccine efficacy (influenza)	1.60 (1.42–1.81)
Perceived risk (maternal influenza)	1.22 (1.12–1.33)
Pro-vaccine social norms	1.11 (1.04–1.18)
Intention to Receive Tdap Vaccine^d
Sociodemographic Characteristics
Having at least a college degree	1.17 (0.83–1.64)
Prior children	1.44 (1.06–1.97)
State (Colorado vs Georgia)	0.94 (0.68–1.31)
Ethnicity
White (reference)
Black	0.60 (0.40–0.92)
Hispanic	0.59 (0.35–0.99)
Other	0.73 (0.43–1.24)
Attitudinal Constructs
Number of specific vaccine safety concerns (Tdap vaccine)	0.70 (0.60–0.83)
Confidence in vaccine safety (for the mother)	1.31 (1.15–1.48)
Confidence in vaccine efficacy (whooping cough)	1.14 (1.06–1.24)
Perceived risk (maternal whooping cough)	1.24 (1.16–1.32)
Pro-vaccine social norms	1.08 (1.02–1.15)
Intention to Get All Infant Vaccines on Time^e
Sociodemographic Characteristics
Having at least a college degree	1.13 (0.81–1.58)
Prior children	1.50 (1.10–2.05)
State (Colorado vs Georgia)	0.82 (0.60–1.14)
Ethnicity
White (reference)
Black	0.82 (0.54–1.26)
Hispanic	1.41 (0.86–2.31)
Other	1.53 (0.88–2.68)
Attitudinal Constructs
Number of specific vaccine safety concerns (infant DTaP vaccine)	0.64 (0.51–0.81)
Confidence in vaccine safety (for the infant)	1.28 (1.18–1.40)
Trust in vaccine information (from obstetricians and pediatricians ^f)	1.19 (1.11–1.28)
Trust in vaccine information (from naturopaths and chiropractors ^f)	0.88 (0.81–0.95)
Trust in vaccine information (from federal agencies and academic institutions)	1.11 (1.03–1.19)

^aVariables representing attitudinal construct summary scores chosen for best-fit multiple logistic regression (MLR) model using backward stepwise selection at the significance level of p < 0.05; sociodemographic characteristics included in all models regardless of significance.

^bAdjusted odds ratio (95% Confidence interval) for intention to vaccinate by attitudinal construct summary score or sociodemographic characteristic; boldface indicates statistical significance (p < 0.05).

^cModel fit information: Akaike information criterion (AIC) = 914; Bayesian information criterion (BIC) = 977.

^dModel fit information: AIC = 1063; BIC = 1125.

^eModel fit information: AIC = 1049; BIC = 1110.

^fRemoved those who stated they had not yet seen this type of provider from this analysis.

aOR, Adjusted odds ratio

CI, Confidence interval

DTaP, Diphtheria, tetanus, and pertussis

MLR, Multiple logistic regression

Tdap, Tetanus, diphtheria, and pertussis

AIC, Akaike information criterion

BIC, Bayesian information criterion