Learning Objectives for this Presentation:
By the end of this presentation participants will be able to describe decision-making influences between parents claiming exemptions (“exemptors”) and parents considering exemptions (“considerers”).

Background:
As Oregon's rate of school exemptions rises, the traditional analysis comparing exemptors to fully vaccinated children may miss a growing population of parents who are increasingly uneasy with vaccination. In a previous smaller study, the majority of children were vaccinated, however the number of parents considering exemptions was significantly greater than the number claiming exemptions. Those considering may foreshadow future exemption trends.

Objectives:
Identify differences in beliefs and practices between exemptors and considerers to inform education efforts.

Methods:
Oregon, with funding from CDC, completed a statewide, case-control, multi-stage cluster survey of parents of school-age children in Spring 2006. Families were surveyed via mail, web and phone, resulting in a 55% adjusted response rate. A series of questions addressed parents' decisions to get or consider an exemption and who or what influenced that decision. Multiple logistic regression analysis of weighted response data was performed in StataV9.

Results:
Twice as many parents self-reported considering compared to exempting (14.1% vs 6.3%). Exemptors were: more likely to report their child saw an alternative care provider [adjusted odds ration=3.1; 95% CI 1.5-6.3]; more likely to be influenced by a provider's recommendation to get an exemption [7.7; 3.5-17.2]; more likely to be influenced by the ease of school enrollment or school suggestion to exempt [7.2; 2.1-24.4]; less likely to have a provider recommend all vaccinations [0.4; 0.2-0.7]; and less likely to follow provider advice [0.05; 0.02-0.12]. Anti-vaccine beliefs did not influence movement from considered to exemptor independently from the provider influence.

Conclusions:
Parents on the fence are at-risk for being influenced against immunizations. Provider recommendations are a strong force in both groups' decisions, making it imperative to continue to work with providers on immunization promotion.