BACKGROUND:
Lack of trust in health care providers is associated with under-immunization. There is a need to broaden our knowledge of how trust affects parental immunization attitudes regardless of immunization status.

OBJECTIVE:
To determine the differences in provider-patient relationship and vaccine attitudes in parents who distrust the vaccine advice given by their child˘s provider compared with those who trust the advice.

METHOD:
We analyzed a sample of parents with children aged ≤18 years(n=1760) from a national panel survey(HealthStyles) conducted during 2003.

RESULT:
12.7% of parents did not agree or strongly agree that they trusted the vaccine advice given by their child˘s provider. Comparing distrustful parents with trusting parents, the final multivariate model revealed differences in provider-patient relationship and vaccine attitudes. Relationship predictors of distrust included having a provider who was not easy to talk with(OR: 7.2, 95% CI: 4.6-11.5), a provider who did not strongly recommend immunizations(OR: 4.0, 95% CI: 2.4-6.7), and not having enough information to make a good decision(OR: 1.9, 95% CI: 1.2-2.9). Vaccine attitude predictors of distrust included low of confidence in vaccine safety(OR: 27.5, 95% CI: 8.5-89.1), concern that immunizations weaken children¢s immune systems(OR: 1.9, 95% CI: 1.2-3.1), and asking a provider not to give their child a vaccine for reasons other than illness(OR: 2.7, 95% CI: 1.4-5.2).

CONCLUSION:
Parents who distrust the vaccine advice given by their child˘s provider have high concerns regarding the safety of immunizations. These concerns and distrust may partially be explained by poor provider-patient relationship. Findings illustrate the need to improve vaccine risk communication and foster increased trust to stimulate discussion regarding vaccine concerns.

LEARNING OBJECTIVES:
•Identify differences in vaccine attitudes by parents who distrust the vaccine advice given by their child˘s provider compared with those who trust the advice.
•Recognize the need to improve provider-patient relationship and vaccine risk communication in order to address parental vaccine concerns.