Methods: Nationally representative survey conducted 6/2012-10/2012. A multivariable analysis assessed association of often/always dismissing families with physician/practice characteristics, state philosophical exemption policy, and degree of difficulty obtaining exemptions.
Results: The response rate was 66% (534/815). Overall, 83% of physicians reported that in a typical month, ≥1% of parents refused one or more infant vaccines, and 20% reported that >5% of parents refused. Fifty-one percent reported always/often requiring parents to sign a form if they refused (Peds 64%, FP 29%, p<0.0001); 21% of Peds and 4% of FP reported always/often dismissing families if they refused ≥1 vaccine. Forty-three percent of Peds reported dismissing families at least some of the time. Peds only were further analyzed because few FP dismissed families. In bivariate analysis, in states where philosophical exemptions are allowed, only 9% of Peds report dismissing families for refusing vaccines in the infant series versus 34% in states that do not allow philosophical exemptions (p<0.0001). In multivariable analysis, Peds who dismissed families were more likely to be in private practice (Adjusted OR (AOR) 4.90, 95% CI 1.40-17.19), from the South (AOR 4.07, 95% CI 1.08-15.31), and reside in a state without a philosophical exemption law (AOR 3.70, 95% CI 1.74-7.85). There was no association with degree of difficulty in obtaining exemptions.
Conclusion: Almost all physicians encounter parents who refuse infant vaccines. One-fifth of Peds report dismissing families who refuse, but there is substantial variation in this practice. Given the frequency of dismissal, the impact of this practice on vaccine refusers and on pediatric practices should be studied.
L. Crane, None
B. Beaty, None
L. Hurley, None
M. Brtnikova, None
A. Jimenez-Zambrano, None
A. Kempe, None