Nonmedical exemptions to immunization requirements in California: A 16-year longitudinal analysis of trends and associated community factors

Jennifer L. Richards, Bradley H. Wagenaar, Joshua Van Otterloo, Rahul Gondalia, Jessica Erin Atwell, David G. Kleinbaum, Daniel Salmon, Saad B. Omer

Research output: Contribution to journalArticle

Abstract

Background: Rates of nonmedical exemptions to kindergarten-entry immunization requirements have increased over the past 2 decades, especially in states that permit philosophical exemptions and/or have easier administrative policies for obtaining nonmedical exemptions. We evaluated trends in school personal belief exemption rates over the period 1994-2009 in California, and associated school and community characteristics. Methods: We used data on personal belief exemptions from 6392 public and private elementary schools from the California Department of Public Health, as well as census tract and school demographic data. Generalized estimating equations were used to model annual mean increases in personal belief exemption rates, and to identify school and community characteristics associated with personal belief exemption rates. Results: Over the study period, the average school personal belief exemption rate increased from 0.6% in 1994 to 2.3% in 2009, an average of 9.2% (95% CI: 8.8-9.6%) per year. The average personal belief exemption rate among private schools over the entire study period was 1.77 (95% CI: 1.55-2.01) times that among public schools. The annual rate of increase was slightly higher among private schools (10.1%, 95% CI: 9.1-11.1%) than among public schools (8.8%, 95% CI: 8.4-9.2%). Schools located within census tracts classified as rural had 1.66 (95% CI: 1.26-2.08) times higher personal belief exemption rates than schools located within urban census tracts. Exemption rates were also associated with race, population density, education, and income. Conclusions: This study confirms concerns about increasing rates of nonmedical exemptions to kindergarten vaccine requirements within the state of California, using data collected over a 16-year period.

Original languageEnglish (US)
Pages (from-to)3009-3013
Number of pages5
JournalVaccine
Volume31
Issue number29
DOIs
StatePublished - Jun 24 2013

Fingerprint

Immunization
immunization
private schools
kindergarten
public schools
Censuses
high schools
elementary schools
education
public health
income
population density
demographic statistics
vaccines
Population Density
Vaccines
Public Health
Demography
Education

Keywords

  • Exemption
  • Immunization
  • School mandate
  • Vaccines

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • veterinary(all)
  • Molecular Medicine

Cite this

Nonmedical exemptions to immunization requirements in California : A 16-year longitudinal analysis of trends and associated community factors. / Richards, Jennifer L.; Wagenaar, Bradley H.; Van Otterloo, Joshua; Gondalia, Rahul; Atwell, Jessica Erin; Kleinbaum, David G.; Salmon, Daniel; Omer, Saad B.

In: Vaccine, Vol. 31, No. 29, 24.06.2013, p. 3009-3013.

Research output: Contribution to journalArticle

Richards, Jennifer L. ; Wagenaar, Bradley H. ; Van Otterloo, Joshua ; Gondalia, Rahul ; Atwell, Jessica Erin ; Kleinbaum, David G. ; Salmon, Daniel ; Omer, Saad B. / Nonmedical exemptions to immunization requirements in California : A 16-year longitudinal analysis of trends and associated community factors. In: Vaccine. 2013 ; Vol. 31, No. 29. pp. 3009-3013.
@article{c253237109f847c993c7ce080a553425,
title = "Nonmedical exemptions to immunization requirements in California: A 16-year longitudinal analysis of trends and associated community factors",
abstract = "Background: Rates of nonmedical exemptions to kindergarten-entry immunization requirements have increased over the past 2 decades, especially in states that permit philosophical exemptions and/or have easier administrative policies for obtaining nonmedical exemptions. We evaluated trends in school personal belief exemption rates over the period 1994-2009 in California, and associated school and community characteristics. Methods: We used data on personal belief exemptions from 6392 public and private elementary schools from the California Department of Public Health, as well as census tract and school demographic data. Generalized estimating equations were used to model annual mean increases in personal belief exemption rates, and to identify school and community characteristics associated with personal belief exemption rates. Results: Over the study period, the average school personal belief exemption rate increased from 0.6{\%} in 1994 to 2.3{\%} in 2009, an average of 9.2{\%} (95{\%} CI: 8.8-9.6{\%}) per year. The average personal belief exemption rate among private schools over the entire study period was 1.77 (95{\%} CI: 1.55-2.01) times that among public schools. The annual rate of increase was slightly higher among private schools (10.1{\%}, 95{\%} CI: 9.1-11.1{\%}) than among public schools (8.8{\%}, 95{\%} CI: 8.4-9.2{\%}). Schools located within census tracts classified as rural had 1.66 (95{\%} CI: 1.26-2.08) times higher personal belief exemption rates than schools located within urban census tracts. Exemption rates were also associated with race, population density, education, and income. Conclusions: This study confirms concerns about increasing rates of nonmedical exemptions to kindergarten vaccine requirements within the state of California, using data collected over a 16-year period.",
keywords = "Exemption, Immunization, School mandate, Vaccines",
author = "Richards, {Jennifer L.} and Wagenaar, {Bradley H.} and {Van Otterloo}, Joshua and Rahul Gondalia and Atwell, {Jessica Erin} and Kleinbaum, {David G.} and Daniel Salmon and Omer, {Saad B.}",
year = "2013",
month = "6",
day = "24",
doi = "10.1016/j.vaccine.2013.04.053",
language = "English (US)",
volume = "31",
pages = "3009--3013",
journal = "Vaccine",
issn = "0264-410X",
publisher = "Elsevier BV",
number = "29",

}

TY - JOUR

T1 - Nonmedical exemptions to immunization requirements in California

T2 - A 16-year longitudinal analysis of trends and associated community factors

AU - Richards, Jennifer L.

AU - Wagenaar, Bradley H.

AU - Van Otterloo, Joshua

AU - Gondalia, Rahul

AU - Atwell, Jessica Erin

AU - Kleinbaum, David G.

AU - Salmon, Daniel

AU - Omer, Saad B.

PY - 2013/6/24

Y1 - 2013/6/24

N2 - Background: Rates of nonmedical exemptions to kindergarten-entry immunization requirements have increased over the past 2 decades, especially in states that permit philosophical exemptions and/or have easier administrative policies for obtaining nonmedical exemptions. We evaluated trends in school personal belief exemption rates over the period 1994-2009 in California, and associated school and community characteristics. Methods: We used data on personal belief exemptions from 6392 public and private elementary schools from the California Department of Public Health, as well as census tract and school demographic data. Generalized estimating equations were used to model annual mean increases in personal belief exemption rates, and to identify school and community characteristics associated with personal belief exemption rates. Results: Over the study period, the average school personal belief exemption rate increased from 0.6% in 1994 to 2.3% in 2009, an average of 9.2% (95% CI: 8.8-9.6%) per year. The average personal belief exemption rate among private schools over the entire study period was 1.77 (95% CI: 1.55-2.01) times that among public schools. The annual rate of increase was slightly higher among private schools (10.1%, 95% CI: 9.1-11.1%) than among public schools (8.8%, 95% CI: 8.4-9.2%). Schools located within census tracts classified as rural had 1.66 (95% CI: 1.26-2.08) times higher personal belief exemption rates than schools located within urban census tracts. Exemption rates were also associated with race, population density, education, and income. Conclusions: This study confirms concerns about increasing rates of nonmedical exemptions to kindergarten vaccine requirements within the state of California, using data collected over a 16-year period.

AB - Background: Rates of nonmedical exemptions to kindergarten-entry immunization requirements have increased over the past 2 decades, especially in states that permit philosophical exemptions and/or have easier administrative policies for obtaining nonmedical exemptions. We evaluated trends in school personal belief exemption rates over the period 1994-2009 in California, and associated school and community characteristics. Methods: We used data on personal belief exemptions from 6392 public and private elementary schools from the California Department of Public Health, as well as census tract and school demographic data. Generalized estimating equations were used to model annual mean increases in personal belief exemption rates, and to identify school and community characteristics associated with personal belief exemption rates. Results: Over the study period, the average school personal belief exemption rate increased from 0.6% in 1994 to 2.3% in 2009, an average of 9.2% (95% CI: 8.8-9.6%) per year. The average personal belief exemption rate among private schools over the entire study period was 1.77 (95% CI: 1.55-2.01) times that among public schools. The annual rate of increase was slightly higher among private schools (10.1%, 95% CI: 9.1-11.1%) than among public schools (8.8%, 95% CI: 8.4-9.2%). Schools located within census tracts classified as rural had 1.66 (95% CI: 1.26-2.08) times higher personal belief exemption rates than schools located within urban census tracts. Exemption rates were also associated with race, population density, education, and income. Conclusions: This study confirms concerns about increasing rates of nonmedical exemptions to kindergarten vaccine requirements within the state of California, using data collected over a 16-year period.

KW - Exemption

KW - Immunization

KW - School mandate

KW - Vaccines

UR - http://www.scopus.com/inward/record.url?scp=84879018578&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879018578&partnerID=8YFLogxK

U2 - 10.1016/j.vaccine.2013.04.053

DO - 10.1016/j.vaccine.2013.04.053

M3 - Article

C2 - 23664998

AN - SCOPUS:84879018578

VL - 31

SP - 3009

EP - 3013

JO - Vaccine

JF - Vaccine

SN - 0264-410X

IS - 29

ER -