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Despite vaccines benefits, parent's vaccine hesitancy is growing. Health locus of control (HLOC) may affect decision making regarding child vaccinations. The aim of this study was to investigate the relationship between parents' HLOC and compliance with routine childhood immunization programs. A cross-sectional survey was conducted among 731 parents of children aged 3-4 years. Internal HLOC, powerful others and chance HLOC (dimensions of external HLOC), reliability of information sources, and attitudes towards vaccines were measured. Path analysis was conducted to explore direct and indirect associations between HLOC and vaccination's compliance. The results show that High powerful others HLOC has a direct association with vaccination compliance (ß = 0.23, p< 0.001). High internal and chance HLOC have indirect associations through parents' attitudes regarding vaccines. Perceived reliability of information sources was associated with not complying with vaccines (ß = -0.07, p < 0.05). For conclusions, Interaction between internal and external HLOC may explain vaccination compliance. Decreasing levels of chance HLOC and increasing powerful others HLOC may increase levels of compliance with childhood vaccinations.

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WHAT'S KNOWN ON THIS SUBJECT:Behavioral insomnia and problematic feeding behaviors are 2 prevalent conditions in young children. Interaction between caregiver characteristics, child temperament, and parent-child interaction factors substantially contribute to both behavioral insomnia and problematic feeding behaviors.WHAT THIS STUDY ADDS: Problematic sleep and feeding behaviors tend to coexist in early childhood. Increased awareness of clinicians involved in the treatment of pediatric sleep or feeding disorders to this coexistence may allow early intervention and improve outcome. abstract OBJECTIVE: Behavioral insomnia and feeding difficulties are 2 prevalent conditions in healthy young children. Despite similarities in nature, etiology, prevalence, and age distribution, the association between these 2 common disorders in young children has not been examined thus far. PATIENTS AND METHODS: Children aged 6 to 36 months with either behavioral insomnia or feeding disorders were recruited. Children aged 6 to 36 months who attended the well-care clinics were recruited and served as controls. Sleep and feeding were evaluated by using a parental questionnaire. RESULTS: Six hundred eighty-one children were recruited. Fifty-eight had behavioral insomnia, 76 had feeding disorders, and 547 were controls. The mean age was 17.0 Ϯ 7.6 months. Parents of children with feeding disorders considered their child's sleep problematic significantly more frequently compared with controls (37% vs 16%, P ϭ .0001 [effect size (ES): 0.66]). They reported shorter nocturnal sleep duration and delayed sleep time compared with controls (536 Ϯ 87 vs 578 Ϯ 88 minutes, P ϭ .0001) and 9:13 Ϯ 0.55 PM vs 8:26 Ϯ 1.31 PM, P ϭ .003). Parents of children with behavioral insomnia described their child's feeding as "a problem" more frequently compared with controls (26% vs 9%, P ϭ .001 [ES: 0.69]). They reported being more concerned about their child's growth (2.85 Ϯ 1.1 vs 2.5 Ϯ 1.0, P ϭ .03) and reported higher scores of food refusal compared with controls (3.38 Ϯ 0.54 vs 3.23 Ϯ 0.44, P ϭ .04). CONCLUSIONS: Problematic sleep and feeding behaviors tend to coexist in early childhood. Increased awareness of clinicians to this coexistence may allow early intervention and improve outcome. Pediatrics 2011;127:e615-e621 AUTHORS: