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Am J Public Health. 2016 Jan;106(1):172-7. doi: 10.2105/AJPH.2015.302926. Epub 2015 Nov 12.

Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California.

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Y. Tony Yang is with the Department of Health Administration and Policy, George Mason University, Fairfax, VA. Paul L. Delamater and Timothy F. Leslie are with the Department of Geography and Geoinformation Science, George Mason University. Michelle M. Mello is with the Stanford Law School, and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.



We examined the variability in the percentage of students with personal belief exemptions (PBEs) from mandatory vaccinations in California schools and communities according to income, education, race, and school characteristics.


We used spatial lag models to analyze 2007-2013 PBE data from the California Department of Public Health. The analyses included school- and regional-level models, and separately examined the percentage of students with exemptions in 2013 and the change in percentages over time.


The percentage of students with PBEs doubled from 2007 to 2013, from 1.54% to 3.06%. Across all models, higher median household income and higher percentage of White race in the population, but not educational attainment, significantly predicted higher percentages of students with PBEs in 2013. Higher income, White population, and private school type significantly predicted greater increases in exemptions from 2007 to 2013, whereas higher educational attainment was associated with smaller increases.


Personal belief exemptions are more common in areas with a higher percentage of White race and higher income.

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