Trends in Personal Belief Exemption Rates Among Alternative Private Schools: Waldorf, Montessori, and Holistic Kindergartens in California, 2000–2014

Brennan, Julia; Bednarczyk, Robert A.; Richards, Jeffrey T.; Allen, Kristen; Warraich, Gohar; Omer, Saad B.

doi:10.2105/ajph.2016.303498

Cited by 27 publications

(15 citation statements)

References 19 publications

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“…We stratified the analysis by public and private schools because students in various settings have been shown to have different vaccination and exemption profiles. 18,19 Because the data include nearly all California kindergarteners, inferential statistical testing of state-level changes over time was unnecessary. We mapped the county-level geographic patterns of students who were up-to-date, the separate not-upto-date entry mechanisms, and combined not up-to-date, given the state's past geographic heterogeneity in vaccination and exemption rates.…”

Section: Methodsmentioning

confidence: 99%

Elimination of Nonmedical Immunization Exemptions in California and School-Entry Vaccine Status

Delamater

Pingali²,

Buttenheim

et al. 2019

Pediatrics

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BACKGROUND AND OBJECTIVES: California implemented Senate Bill 277 (SB277) in 2016, becoming the first state in nearly 30 years to eliminate nonmedical exemptions from immunization requirements for schoolchildren. Our objectives were to determine (1) the impacts of SB277 on the percentage of kindergarteners entering school not up-to-date on vaccinations and (2) if geographic patterns of vaccine refusal persisted after the implementation of the new law. METHODS: At the state level, we analyzed the magnitude and composition of the population of kindergarteners not up-to-date on vaccinations before and after the implementation of SB277. We assessed correlations between previous geographic patterns of nonmedical exemptions and patterns of the remaining entry mechanisms for kindergarteners not up-to-date after the law's implementation. RESULTS: In the first year after SB277 was implemented, the percentage of kindergartners entering school not up-to-date on vaccinations decreased from 7.15% to 4.42%. The conditional entrance rate fell from 4.43% to 1.91%, accounting for much of this decrease. Other entry mechanisms for students not up-to-date, including medical exemptions and exemptions for independent study or homeschooled students, largely replaced the decrease in the personal belief exemption rate from 2.37% to 0.56%. In the second year, the percentage of kindergartners not up-to-date increased by 0.45%, despite additional reductions in conditional entrants and personal belief exemptions. The correlational analysis revealed that previous geographic patterns of vaccine refusal persisted after the law's implementation. CONCLUSIONS: Although the percentage of incoming kindergarteners up-to-date on vaccinations in California increased after the implementation of SB277, we found evidence for a replacement effect. WHAT'S KNOWN ON THIS SUBJECT: Recently, California has attempted to increase the number of kindergarteners entering school who are fully up-to-date on required vaccinations. SB277 eliminated the nonmedical exemption option; however, the law also contains several provisions allowing students not up-to-date to enter school. WHAT THIS STUDY ADDS: We found that the percentage of kindergarteners who were not up-to-date on school-entry vaccinations decreased after eliminating nonmedical exemptions. However, we found evidence that nonmedical exemptions were replaced by other mechanisms allowing kindergarteners not up-to-date on vaccinations to enter school.

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Section: Methodsmentioning

confidence: 99%

Elimination of Nonmedical Immunization Exemptions in California and School-Entry Vaccine Status

Delamater

Pingali²,

Buttenheim

et al. 2019

Pediatrics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Yet the concentration of PBEs in a small number of schools is the issue. Private schools, particularly those adopt alternative education methods, have been shown to have higher rates of PBEs than public schools (26, 36). The average PBE rates in California’s private schools and non-charter public schools in 2014 were 5.2% and 2.1%, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Other selection processes . Selection into private schools and charter schools 4 with alternative pedagogical orientations may increase PBE rates (21, 26). Other local factors such as the availability of alternative medicine practitioners have been suggested to increase exemptions (27–29).…”

Section: Methodsmentioning

confidence: 99%

The Roles of Neighborhood Composition and Autism Prevalence on Vaccination Exemption Pockets: A Population-wide Study

Gromis

Liu

2018

Preprint

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The number of children entering schools without mandated vaccinations has increased in high-income countries due to the rise of nonmedical exemptions from school vaccination requirements. Herd immunity is threatened when unvaccinated children are concentrated in spatial pockets. It is often assumed that these exemption clusters are merely the result of population composition. On the other hand, despite the role of vaccine-autism controversy to the current wave of anti-vaccine movement, we do not know if exemption clusters are associated with local autism rates. Our spatial analysis of California shows that while racial/ethnic composition is associated with the locations of large exemption pockets, other sociodemographic factors and access to health care resources have limited geographical span. We decouple the race/ethnicity effect from that of unobserved socioeconomic status by examining families in poverty. Using unique address-level data on the locations of the majority of children with an autism diagnosis, we show that the prevalence of autism is not associated with the locations of large pockets of vaccination exemptions. In addition, we find charter schools in most exemption clusters; potential spillovers from charter schools to neighboring public schools are evaluated. Exemption pockets are not merely the result of population composition and community-level interventions are needed to maintain herd immunity.HighlightsAutism prevalence rates are not associated with the locations of large exemption pockets.The average exemption rate in charter schools (7.5%) was higher than private schools.Proportion non-Hispanic white has the strongest association with large exemption clusters.Population composition cannot fully explain the exemption clusters.

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“…However, with “ANAKI” (Korean abbreviation of “raising children without medication”) becoming a societal issue in 2017, movements to refuse modern medicine including vaccines have appeared. Similar to there being parents who hestiate vaccinations or medical treatments in alternative education preschools and schools overseas [15], authors knew that those parents also existed in Korean alternative education facilities. Of course, their scale needs to be identified through a national survey, but there are practical limitations.…”

Section: Introductionmentioning

confidence: 99%

Why do some Korean parents hesitate to vaccinate their children?

Chang

Lee

2019

Epidemiol Health

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OBJECTIVES: Vaccinations for infectious diseases are opposed despite their achievement, and this opposition has recently been revealed in Korea. However, research in Korea has not been vigorous. The authors studied why some Korean parents hesitate to vaccinate their children by applying the health belief model.METHODS: Parents who hesitate to vaccinate and parents who do not were surveyed in alternative education preschools and elementary schools. They were classified into four types of hesitancy and statistically compared.RESULTS: Among the 129 subjects, 43 vaccinated without hesitancy, 20 vaccinated on time with hesitancy, 32 vaccinated with a deliberate delay of one month or longer, and 34 did not vaccinate. Vaccination increased with an increase in the awareness that severe outcomes can occur when unvaccinated. Concerns about adverse reactions from vaccinations or direct/indirect experiences affected refusal. Furthermore, perceptions of the lack of meaningfulness of vaccinations, distrust of policy and safety management, influence of leaders or activists in joined organizations, and experts of Korean traditional or alternative medicine affected refusal. Explanations by doctors, text messages and mails from institutions, and concerns about disadvantages caused by not complying with government policies increased vaccination.CONCLUSIONS: The reasons for vaccine hesitancy and acceptance were similar to the results of international research. Health authorities and professionals should communicate sufficiently and appropriately with hesitant parents and find ways to rationally resolve social conflicts. However, this sample was small and there is little Korean research, so more in-depth and diverse researchs are needed.

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Trends in Personal Belief Exemption Rates Among Alternative Private Schools: Waldorf, Montessori, and Holistic Kindergartens in California, 2000–2014

Abstract: Waldorf schools had exceptionally high average PBE rates, and Montessori and holistic schools had higher annual increases in PBE rates. Children in these schools may be at higher risk for spreading vaccine-preventable diseases if trends are not reversed.

Cited by 27 publications

References 19 publications

Elimination of Nonmedical Immunization Exemptions in California and School-Entry Vaccine Status

Elimination of Nonmedical Immunization Exemptions in California and School-Entry Vaccine Status

The Roles of Neighborhood Composition and Autism Prevalence on Vaccination Exemption Pockets: A Population-wide Study

Why do some Korean parents hesitate to vaccinate their children?

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