BACKGROUND:
Recent attention has focused on the hypothesized but not established association of Hepatitis B vaccination (HBV) with some chronic diseases, but the impact of such putative associations on provider practices is unknown.

OBJECTIVE:
We explored knowledge, attitudes, and practices (KAP) of childhood providers and its relationship to their immunization practices.

METHOD:
The 2000 National Immunization Survey, a probability sample of US households with children 19-35 months old, was used to generate a sample of children, including some who had and had not HBV, defined as receiving >3 doses. KAP to HBV was assessed by mail survey among a non-probability sample of providers.

RESULT:
Of 5748 providers surveyed, 1979 (34%) responded; 63% were pediatricians, 10% were family practice physicians, and 28% were nurses or others. 75% of children sampled were fully immunized against HBV. 70% of providers thought that Hepatitis B was a serious health concern in their community. 98% reported offering strong recommendations for HBV to families. About half the providers did not know whether the hypothesized associations between HBV and the adverse occurrence of asthma, diabetes, autoimmune diseases, rheumatoid arthritis, multiple sclerosis, or autism were scientifically established. 46% of providers had received information concerning possible adverse effects of HBV from the medical literature, 45% from CDC, 36% from parents, and 22% from representatives of pharmaceutical firms, among other sources.

CONCLUSION:
Although nearly all providers strongly recommended HBV vaccine, many did not know whether putative adverse vaccine effects indeed had a scientific basis. The high proportion of providers who received vaccination information from their families suggests the need for practical strategies to educate providers with the most current information and assist them in translating these reassurances to their patients.

LEARNING OBJECTIVES:
To better understand provider KABs concerning putative risks of HBV and their impact on immunization practices.