Associations Between Religion, Religiosity, and Parental Vaccine Hesitancy
Joshua Williams, MD, Denver Health
Introduction: Religious exemptions to vaccines required for daycare or school are widely available in the US and increasing, despite decreases in American religiosity. This is concerning, as clusters of children with non-medical vaccine exemptions have been linked to outbreaks of measles, pertussis, and other diseases in faith communities. Qualitative and epidemiological research suggests few parents have genuine religious objections to vaccines and that many claim religious exemptions if alternative non-medical exemption policies are unavailable. Yet, the literature lacks rigorous studies testing associations between parental religion or religiosity and parental vaccine hesitancy among parents of young children in clinical settings. Thus, we tested associations between religion, religiosity, and vaccine hesitancy in a sample of parents of 2-year-olds in Denver, CO. We hypothesized there would be no association between parental vaccine hesitancy and four variables assessing religious affiliation and religiosity.
Methods: We surveyed English- and Spanish-speaking parents of 2-year-olds attending well or sick visits in three clinics in 2020. We collected caregiver demographics, religious affiliation, self-reported religiosity across three domains - Religious Service Attendance, Private Religious Activities, Intrinsic Religiosity - with the Duke University Religiosity Index (DUREL), and vaccine hesitancy using a validated tool. We also asked, “Have you ever delayed or refused a shot for your child for religious reasons?” We compared hesitant and non-hesitant caregivers and estimated distinct multivariable logistic regression models to examine associations.
Results: Our sample included 255 predominantly poor, Latino, Christian, and English-speaking parents (response rate: 90%). Table 1 presents participant demographic information, stratified by religiosity domains. Of all caregivers, 68% identified with a major faith tradition, 20% attended religious services weekly, 11% prayed or mediated daily, and 26% were highly religious. Thirty-three (13%) of parents were vaccine hesitant. Table 2 summarizes multivariable regression analyses examining odds of parental vaccine hesitancy by religious affiliation and religiosity domains. Parents from major faith traditions were not significantly more likely to be vaccine hesitant than those identifying with no tradition (adjusted Odds Ratio 1.46; 95% CI 0.29, 7.26). However, parents who identified with “Other” or who preferred not to provide a religious affiliation were over five times more likely to be hesitant, referent to parents without a religious affiliation (adjusted Odds Ratio 5.10; 95% CI 1.06, 24.5). Associations for parental vaccine hesitancy and all three religiosity domains were not significant (Table 2).
Conclusions: This pilot study found no associations between parental vaccine hesitancy, religiosity, or adherence to a major faith tradition in a sample of mostly poor, Latino, Christian parents. Notably, parents who preferred not to provide an affiliation or identified as “Other” were five times more likely to be vaccine hesitant, referent to non-religious parents. Future work should clarify the nature of vaccination concerns – i.e. whether they are sacred or secular – among adherents who do not identify with major traditions, identify how best to reach individuals who do not attend religious services or belong to established organizations, and consider whether existing religious exemption policies can still serve their intended purposes.
Methods: We surveyed English- and Spanish-speaking parents of 2-year-olds attending well or sick visits in three clinics in 2020. We collected caregiver demographics, religious affiliation, self-reported religiosity across three domains - Religious Service Attendance, Private Religious Activities, Intrinsic Religiosity - with the Duke University Religiosity Index (DUREL), and vaccine hesitancy using a validated tool. We also asked, “Have you ever delayed or refused a shot for your child for religious reasons?” We compared hesitant and non-hesitant caregivers and estimated distinct multivariable logistic regression models to examine associations.
Results: Our sample included 255 predominantly poor, Latino, Christian, and English-speaking parents (response rate: 90%). Table 1 presents participant demographic information, stratified by religiosity domains. Of all caregivers, 68% identified with a major faith tradition, 20% attended religious services weekly, 11% prayed or mediated daily, and 26% were highly religious. Thirty-three (13%) of parents were vaccine hesitant. Table 2 summarizes multivariable regression analyses examining odds of parental vaccine hesitancy by religious affiliation and religiosity domains. Parents from major faith traditions were not significantly more likely to be vaccine hesitant than those identifying with no tradition (adjusted Odds Ratio 1.46; 95% CI 0.29, 7.26). However, parents who identified with “Other” or who preferred not to provide a religious affiliation were over five times more likely to be hesitant, referent to parents without a religious affiliation (adjusted Odds Ratio 5.10; 95% CI 1.06, 24.5). Associations for parental vaccine hesitancy and all three religiosity domains were not significant (Table 2).
Conclusions: This pilot study found no associations between parental vaccine hesitancy, religiosity, or adherence to a major faith tradition in a sample of mostly poor, Latino, Christian parents. Notably, parents who preferred not to provide an affiliation or identified as “Other” were five times more likely to be vaccine hesitant, referent to non-religious parents. Future work should clarify the nature of vaccination concerns – i.e. whether they are sacred or secular – among adherents who do not identify with major traditions, identify how best to reach individuals who do not attend religious services or belong to established organizations, and consider whether existing religious exemption policies can still serve their intended purposes.