Title

Identifying and Addressing Predictors for Nonmedical Exemptions from Mandated Vaccines in New Jersey Elementary Schools

Document Type

Presentation

Publication Date

7-23-2015

Comments

Advisor:

D Harris, Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA

Abstract

The public health achievement of elimination and near elimination of vaccine preventable diseases is currently threatened by state policies enabling children the ability to opt out of mandated vaccines. All 50 states require children to meet certain immunization requirements as a condition of school enrollment, and 18 currently have legislation that allow exemption for personal or philosophical reasons. Three states allow only medical exemptions. In New Jersey, the school vaccine mandate law allows exemptions when vaccines pose a medical concern or violation of an individual’s religious belief. The purpose of this study was to examine the impact of the December 2008 state interpretation of existing policy and subsequent regulation requiring school and public health officials to grant a religious exemption to any child with a parent’s note referencing religion. Evidence exists that some vaccine-hesitant parents share boilerplate language to exploit use of the unchallenged religious exemption (RE). Trend analysis using school-reported data on the New Jersey Annual Immunization Status Reports for school years 2005-2006 through 2013-2014 demonstrated an over five-fold increase in the number of religious exemptions granted by local public and private schools. Multiple regression analyses using six predictor variables were performed using the 2013-2014 county religious exemption rates for Kindergarten and First Grade to build a profile of high utilization areas. For Kindergarten, higher RE rates were associated with White and Asian race, high household income, and advanced education (p<.05). For first grade, living in rural areas was significantly associated with higher RE rates (p<.01). Recommendations to address vaccine hesitancy are delivered using levels of the ecological model, including the need for further research about parents who fit the predictor profile, tailoring education using social marketing principles and storytelling, policy change and enforcement, publication of school-level vaccine compliance rates, and improved provider support, with the aim to increase immunization coverage levels in the state.

Presentation: 33 minutes