Social differentiation of vaccine hesitancy among French parents and the mediating role of trust and commitment to health: A nationwide cross-sectional study

Background: The relations between vaccine hesitancy (VH) and individual socioeconomic status (SES) vary with context and remain poorly understood. We examined associations between parental SES and VH levels and their potential mediation by two attitudinal factors: commitment to making good health-related decisions and trust in mainstream medicine. Methods: Data come from the 2016 Barometre sante, a random cross-sectional telephone survey of the French general population. We analyzed a sample comprising 3927 parents of children aged 1-15 years, dividing them into 4 categories according to their VH level. We performed bivariate and then multiple multinomial logistic regression analyses to study associations between parental educational level, income, and VH. We then reassessed the logistic model with a causal steps approach, adding the commitment and trust scores. Results: Vaccine refusers accounted for 26% of parents (95% CI = 25%, 28%), delayers 7% (95% CI = 6%, 8%), and acceptors with doubts 13% (95% CI = 12%, 14%). In bivariate analyses, educational level was associated with VH but income was not, while commitment and trust scores varied significantly with both VH and educational level (p < 0.001). In multivariate analyses, highly educated parents were more prone to be delayers (AOR (>= Bac + 4 versus < Bac) = 1.73, 95% CI = 1.12, 2.69) or refusers (AOR (>= Bac + 4 versus < Bac) = 1.56, 95% CI = 1.19, 2.04) than nonhesitant. These associations did not remain significant after inclusion of the commitment and trust scores in the model. Conclusions: Vaccine refusal and delay are frequent among French parents, especially the more educated. Our results suggest that levels of commitment and trust play a key role in shaping VH. Suitable educational interventions are needed to restore trust in authorities and vaccines. Helping healthcare professionals to communicate better with vaccine-hesitant parents is also essential. (C) 2018 Elsevier Ltd. All rights reserved.