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The Impact of Education-level on Parents Willingness to Vaccinate their Children

Yassir Colindres

Brooks College of Health, University of North Florida

HSC4730: Public Health Research

Dr. Emily Moore

December 4, 2020
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Abstract

Vaccinations have been widely accepted throughout the world as a means of protecting one’s self

and others from various diseases. Although, vaccines are widely accepted; the knowledge most

people have on their effects and reliability is different based on their education-level. It has been

said that those with a four-year college degree in a health-related field may be more

knowledgeable on recommended vaccination practices than those who do not have a college

degree. Encouraging parents to pursue a college-education could result in the increase of

vaccination rates providing children more protection from diseases that take the lives of millions

of children on an annual basis. This literature review will examine recent studies that have

analyzed the impact of education-level on the vaccination practices of parents. Many of these

studies are supportive of the idea that parents who have a higher-education level have more

knowledge on vaccines, and therefore, follow the appropriate guidelines health professionals lay

out regarding the vaccination of children under six. One study pointed out how cultural norms

may have an underlying effect on vaccination practices of parents coming from various cultural

backgrounds. This study suggested that, along with a lower education-level, a conservative

religious background may also lead to lower rates in certain vaccines. From the studies analyzed

in this literature review, it can be determined that a college education has an immediate impact

on vaccination rates in children under the age of six, however, more studies must be conducted to

further encourage parents to pursue a college education.

Keywords: education-level, vaccine, vaccination rates

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Introduction

Vaccinations have been developing in the healthcare field around the globe for centuries;

being used to protect against deadly diseases such as smallpox and measles as early as the 18 th

century. This study analyzes how a college degree in a health-related field impacts the

vaccination practices of parents to children under the age of six in Duval County, Florida.

Although, there is much speculation on the reliability of vaccinations and the effect they can

have on people, the Centers for Disease Control and Prevention’s (CDC) recommendations are

tied to evidence-based research and testing done by professionals in their in the healthcare

industry.

Vaccine Recommendations

The CDC (Centers for Disease Control and Prevention) is the federal agency responsible

for our nation’s health which involves determining whether a certain vaccine is recommendable

for public use. According to the CDC website, “Vaccines are recommended throughout your

child’s life to protect against serious, sometimes deadly diseases.” (CDC, 2019). A variety of

vaccinations such as the hepatitis B vaccine after birth, flu vaccines every year protecting against

influenza types, and many others are recommended throughout life as a means of primary

protection. In the first two months of infancy, the CDC recommends that babies are given their

first dose of the DTaP (Diphtheria, tetanus, and pertussis), the first dose of the Haemophilus

influenzae type b disease (Hib) vaccination, their first polio (IPV) vaccination, and their first

PCV13 (Pneumococcal disease) vaccination. Although, there is risk of developing a reaction to

certain vaccines the importance of having these immunizations is paramount, especially for

children. As stated by the Association of American Family Physician (AAFP), “Common local
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reactions to vaccines include pain, swelling, and redness at the injection site. Systemic reactions,

including fever, irritability, drowsiness, and rash, may also occur” (Sanford, 2002, Volume 66,

Number 11). Reactions from vaccinations may be somewhat frustrating for children; however,

the positive effects of vaccines far outweigh the negative side effect. Children are not as aware as

adults when it comes to the process of how bacteria spreads and since a lot of diseases and

viruses spread through the air or by direct-contact, children are generally more susceptible to

becoming infected. Having parameters in place to safeguard our children is extremely important

to the health of the entire population.

Vaccine Misconceptions and the Impact of Education

The speculation that is associated with vaccines and the underlying effects they can have

has been increasingly popular in modern society. The misconceptions surrounding vaccinations

are difficult to validate and the reason for these misconceptions continues to concern healthcare

professionals who know the importance of vaccinations. The Journal of the American Academy

of PA’s states, “To maintain herd immunity and prevent disease outbreaks, an immunization rate

of 95% is required.” (Clift, 2014, p.21).

According to a study, which used data from the 1995-2001 National Immunization

Survey, “The most frequent reason for non-vaccination, stated by 69% of the parents, was

concern that the vaccine might cause harm.” (Omer S.B. et. Al, 2009, pg. 1985). These may be

legitimate concerns for parents to have, however, data shows that having a higher level of

education may result in parents making more educated decisions in whether they choose to

vaccinate their children. One study using data from the 2016 Behavioral Risk Factor Surveillance

System (BRFSS), supports the idea that higher education encourages people to stay up to date

with vaccinations. The BRFSS is a public record from self-reported by adults living in the United
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States. According to the Preventative Medicine journal, data from that system found that “65.1%

of individuals with above 4 years of college education were up to date, whereas 50.3% of those

with a grade 11 education or less were up to date…” (Rencken Preventive Medicine, 2020, pg.

3). Rural areas all around the United States are known for having higher rates of school dropouts

and higher rates of teenage pregnancies. When students are dropping out of school before the end

of their senior year, they are missing the education that is needed to make it out of young

adulthood and succeed in later life, especially in those rural areas. It was found in a study in

South Florida, that rural communities generally do not have enough knowledge of specific

important vaccines and require support in making a change in those communities. According to

an article, “Community leaders, healthcare providers and researchers noted HPV vaccination has

been studied in rural Florida such as Hendry and Glades counties, also known as the ‘rural spine

of the state’ where the main industry is agriculture and historically there is a lack of resources

and integration of healthcare services.” (Tami L Thomas Human Vaccines &

Immunotherapeutics, 2019, pg. 1667). This statement reiterates the fact that these communities

may have a disadvantage due to social stigma, but still deserve equal access to healthcare and

education.

The reasoning behind the growing stigma surround vaccines is not supported by scientific

evidence. This is the main reason why the people who refuse to get vaccinated are in the

minority and statistics show that vaccinations do indeed work, and very well for that matter.

When looking back at measles outbreaks that used to ravage the United States with hundreds of

thousands of deaths annually and comparing those rates to today, a drastic difference can be

recognized. This drastic change was the before and after of not having a vaccine to developing a

vaccination in the late 80s. According to a study published in The New England Journal of
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Medicine, “In the United States, the reported number of cases dropped from an average of

500,000 annually in the era before vaccination (with reported cases considered to be a fraction of

the estimated total, which was more than 2 million) to a mean of 62 cases per year from 2000

through 2007.” (Omer S.B. et. Al, 2009, pg. 1984). When we look at measles cases today, they

are almost completely non-existent and in the cases that do arise most patients were either not

vaccinated or did not have a history of immunization. According to the same journal, “Outbreaks

of vaccine-preventable disease often start among persons who refused vaccination…” (pg.1984).

Parents must try to do their own research on the effect vaccines have had in our past in order to

protect their children. Without herd-immunity children could not live the care-free life every

child deserves, and the general public would live in constant fear of outbreaks. The numbers that

comprise the data make it very clear that vaccinations do a phenomenal job in preventing the

spread of disease and without vaccines the world today would be a different place.

Recommendations and Conclusion

When looking at how far our public health professionals have taken us in making the

United States a safer place for our children, we must appreciate the effort that is put into the

work they do. There is plenty of work to be done in improving the communities that are left in

the dark went it comes to community health and education. We must push community leaders to

improve the education systems that keep smaller, poorer communities on the back burner.

Encouraging our young adults to strive for a four-year college degree will not only increase the

rates of vaccinations but also start to break down the stigma around vaccinations that is ever-

growing. This study will reflect that education-level is associated with the vaccination habits of

parents, and whether they are able to make an informed decision regarding the vaccination of

their children.
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Research Question and Hypothesis

In this study, the proposed research question is: What impact does a college degree in a

health-related field have on parents’ willingness to vaccinate their children under six? The

hypothesis suggests that a higher-education level, and more specifically a degree in a health-

related field, will encourage parents to vaccinate their children.

Pilot Study

The preliminary survey, posted to a UNF parent blog on November 2, 2020, had a total of

53 participants who gave responses. The survey utilized included parents who attended or had

previously attended the University of North Florida within a four-year timeframe. The only

limiting factor of our participants, was that they must be parents living in Duval County with at

least one child under the age of six. Survey participants were asked to answer a series of

questions including their number of children, what area of residence in Duval County they live

in, the highest level of education achieved, which degree-major (if applicable), their familiarity

of vaccination recommendations from the CDC, their opinion on whether vaccines cause autism,

whether they vaccinate their child(ren), likelihood of their child receiving a variety of

recommended vaccines, and whether their child(s) school requires vaccinations.

The data collected from the survey showed most parents having one child. Most of the

survey respondents lived either in Southside, or at the Beaches. Many respondents had some

college education or a degree, mostly pursuing a major in public health. Surprisingly, when

asked about their familiarity with the CDC’s recommendations regarding vaccines, parents had a
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wide variety of responses. Almost all the parents who participated did not believe that vaccines

cause autism, although, three answered that they do believe vaccines cause autism and eight

respondents didn’t know. Oddly, when asked whether parents do vaccinate their children, there

were less parents who did not vaccinate their child than parents who thought that vaccines cause

autism.

Survey results were based off a total of 53 survey participants who fit the criteria for this

preliminary study. Out of all participants, 33 (63%) had one child, 12 (23%) had two children, 5

(9%) had three children, two (4%) had four children, and one (2%) parent had five children. Of

the survey participants, four (8%) lived in Arlington, 19 (36%) lived at the Beaches, three (6%)

lived on the Northside, seven (13%) lived on the Westside, 13 (25%) lived on the Southside, and

seven (13%) parents lived in another area in Duval County. Figure 1 shows the results of the

question asking parents to disclose their highest level of education. When questioned on their

highest level of education, only one (2%) parent completed graduate school, 29 (55%) completed

their undergraduate degree, 20 (38%) took some college classes without completing a degree,

and three (6%) completed high school. Of the survey participants who completed their college

degree, 45 (90%) had a public health concentration, two (4%) had a political science degree, and

three (6%) selected ‘other’. Figure 2 shows the results of the question asking parents about their

familiarity with vaccination recommendations from the CDC. When questioned on their

familiarity, 12 (23%) were very familiar, 16 (30%) were somewhat familiar, six (11%) were

neutral, 11 (21%) were somewhat unfamiliar, and eight (15%) were very unfamiliar. Of the

survey respondents, 42 (79%) did not believe that vaccines cause autism, three (6%) believed

that vaccines do cause autism, and eight (15%) did not know whether vaccines cause autism. Out

of all the survey respondents, 38 (72%) do vaccinate their child(ren), 12 (23%) do not, and three
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(6%) vaccinate sometimes. When questioned regarding the likelihood for parents to have their

child(ren) be vaccinated for specific diseases, a variety of responses were recorded. When

questioned regarding the Hepatitis B vaccine; 30 (73%) parents said they’re very likely, five

(12%) were somewhat likely, four (10%) were neither likely nor unlikely, one (2%) was

somewhat unlikely, and one (2%) more was very unlikely. When questioned regarding the

Rotavirus vaccine, 29 (71%) parents said they’re very likely, seven (17%) were somewhat likely,

four (10%) were neither likely nor unlikely, and one (2%) more was very unlikely. When

questioned regarding the DTaP vaccine, 32 (78%) parents said they’re very likely, 5 (12%) were

somewhat likely, three (7%) were neither likely nor unlikely, and one (2%) more was very

unlikely. When questioned regarding the haemophilus influenzae type B (Hib) vaccine, 30 (73%)

parents said they’re very likely, 6 (15%) were somewhat likely, three (7%) were neither likely

nor unlikely, one (2%) more was somewhat unlikely, and one (2%) more was very unlikely.

When questioned regarding the polio (IPV) vaccine, 31 (76%) parents said they’re very likely, 5

(12%) were somewhat likely, four (10%) were neither likely nor unlikely, and one (2%) more

was very unlikely. Of the survey respondents, 35 (66%) said their child’s school/care facility

does have vaccination requirements, four (8%) said they do not, and 14 (26%) said the do not

know whether their child’s school/care facility has vaccination requirements or not.

Pilot Study Visuals

Figure 1

Graph showing responses to highest-level of education.

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Figure 2
Graph showing responses to parents’ familiarity with vaccine recommendations from the CDC

Figure 3
Graph showing responses to whether parents vaccinate their child
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Research Methods

Throughout this study the Principal Investigator (PI) who will be responsible for doing

research is Yassir Colindres. The PI will be the individual preparing data, conducting research,

and analyzing results in this research study with the assistance of one research assistant. This

study will be ongoing for a duration of approximately six months, unless the PI believes further

research is needed. The proposed study is being conducted to further understand the link between

vaccination practices of parents and their education-level.

This study will require all participants to be a minimum of 18 years of age and a parent

and/or guardian of a child or children under the age of six. In order to safeguard the population

and the data collected, surveys will be conducted in a private setting, participants may start/stop

participation in the survey at any time, participants will not have to disclose any personal

information (names, DOB, address, phone number, etc.), and data collected will be stored on a

key-protected file which only the PI and research assistant will have access to.

Data will be collected from voluntary participants from three colleges in the study area,

Duval County, Florida. The cooperation of these universities will be necessary as surveys will be

conducted both on campus and through student email addresses obtained through each school.

The three colleges are The University of North Florida, Florida State College of Jacksonville,

and The Jacksonville University. The focus group of this study will include parents that are

incoming freshman, sophomores, juniors, seniors, and alumni from the three universities. The

information coming from incoming freshman will be regarded as the population who has

completed high-school as their highest level of education, sophomores and juniors will be
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represent those with some college education, and alumni will represent those participants who

have graduated and may have a graduate degree from the universities.

Surveys will be conducted/stored via laptop on campus or voluntary participants will

return the survey either through email. Data will be collected and analyzed through a Qualtrics

database which will group data between participants in four groups: those who have completed

high school, some college but no degree, college/university degree, and/or graduate degree. This

data will then be compared to the data collected regarding vaccination practices of the same

parent participants. The design of this study will be involving two or more variables from the

data collected through a population in Duval County, making it a correlational study. Data

collected will examine the relationship between education-level and vaccination practices of

parents to children under six.

Data Analysis

The proposed method for data analysis in this study will be a using multivariate analysis

of data and an independent t-test comparing multiple groups varying in education-level. The

multivariate analysis used in the study will guarantee that multiple data variables can be

considered at the same time. These purposed methods of data analysis will be utilized to

determine whether education-level has an impact on parents’ vaccination practices and beliefs.

Dissemination of Findings

As the data collected and analyzed in this study will pertain to the interests of parents to

young children. The findings in the study will be paramount in protecting the health of children

and the overall public which emphasizes the need for findings to be published in a peer-reviewed
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journal. The data will also be released to the Florida Department of Health in hopes to tackle the

problem of an increase in skepticism in vaccinations. With recent outbreaks throughout the

globe, the need for higher-education and focus on public health is crucial in protecting the

public’s health.

References

Holroyd, T. A., Sauer, M. A., & Limaye, R. J. (2020). Vaccine decision-making among parents
of children on Medicaid with and without autism spectrum disorder. Vaccine, 38(43), 6777-
6784. https://10.1016/j.vaccine.2020.08.041
Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine

Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases. The New

England Journal of Medicine, 360(19), 1981-1988. https://doi.org/10.1056/NEJMsa0806477

Rencken, C. A., Dunsiger, S., Gjelsvik, A., & Amanullah, S. (2020). Higher education associated

with better national tetanus vaccination coverage: A population-based assessment. Preventive

Medicine, 134, 106063. https://doi.org/10.1016/j.ypmed.2020.106063

Sanford, K. R. (2002, December 1). Vaccine Adverse Events: Separating Myth from Reality.

Retrieved December 5, 2020, from https://www.aafp.org/afp/2002/1201/afp20021201p2113.pdf

Stein-Zamir, C., Shoob, H., Abramson, N., & Zentner, G. (2012). Who are the children at risk?

Lessons learned from measles outbreaks. Epidemiology and Infection, 140(9), 1578.

https://10.1017/S095026881100238X

Thomas, T. L., Caldera, M., & Maurer, J. (2019). A short report: parents HPV vaccine

knowledge in rural South Florida. Human Vaccines & Immunotherapeutics: HPV Vaccination:
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From Seroprevalence to Public Health Policy and Everything in Between, 15(7-8), 1666-1671.

https://doi.org/10.1080/21645515.2019.1600986
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Appendix A
Pilot Study Survey on Education-level and Impact on Parents’ Vaccination practices
Criteria: Individual must be a parent or guardian to a child, or children, under the age of six, that
lives in Duval County.
  
Purpose: The purpose of this study is to identify how a college degree in a health-related field
may influence the decision for parents to vaccinate children under the age of six.

You may start and/or stop taking this survey at any time in the survey and participation is
completely voluntary.

This survey should take you approximately 5-15 minutes to complete.

  
Completion of this survey indicates your consent to participating in this study.  
If you would like to participate in this survey, you may click begin below.

1. Are you a parent or guardian?  

a. Yes 
b. No 
 
2. How many children do you provide care for under the age of six?  
a. 1-2 
b. 3-4 
c. 5-6 
d. Other:                                       
 
3. What part of Duval do you reside?  
a. Arlington 
b. Beaches 
c. Northside 
d. Westside 
e. Southside  
f. Other: 
 
4. What is the highest level of education do you have completed?   
a. Less than high school 
b. High school 
c. Some college but no degree 
d. College/university degree 
e. Graduate degree  
f. Other:  
 
5. If you have attended college, what was your specified major?  
a. Public Health   
b. Political Science  
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c. Theology  
d. Other: 
 
 
6. How familiar are you with the recommend vaccinations from the CDC for children under
6?  
a. Very unfamiliar 
b. Somewhat unfamiliar 
c. Neutral 
d. Somewhat familiar 
e. Very familiar 
 
7. Do you believe that vaccinations cause autism?  
a. Yes 
b. No  
 
8. Do you prefer to vaccinate your child?  
a. I prefer to vaccinate my child 
b. I prefer not to vaccinate my child 
c. I prefer to give some/certain vaccinations to my child 
 
****if ‘A’ or ‘B’, skip to question 19, if ‘C’ answer the following questions****  
 
9. How likely are you to give your child the Hepatitis B (HepB) vaccine? 
a. Very likely 
b. Somewhat likely 
c. Neutral 
d. Somewhat unlikely 
e. Very unlikely 
 
10. How likely are you to give your child the Rotavirus (RV) vaccine? 
a. Very likely 
b. Somewhat likely 
c. Neutral 
d. Somewhat unlikely 
e. Very unlikely 
 
11. How likely are you to give your child the Diphtheria, tetanus, & acellular pertussis
(DTaP) vaccine? 
a. Very likely 
b. Somewhat likely 
c. Neutral 
d. Somewhat unlikely 
e. Very unlikely 
 
12. How likely are you to give your child the Haemophilus influenzae type B (Hib) vaccine? 
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a. Very likely 
b. Somewhat likely 
c. Neutral 
d. Somewhat unlikely 
e. Very unlikely 
 
13. How likely are you to give your child the Polio (IPV) vaccine? 
a. Very likely 
b. Somewhat likely 
c. Neutral 
d. Somewhat unlikely 
e. Very unlikely 

21. Are there vaccine requirements in your child’s daycare/school?  

a. Yes 
b. No  
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Appendix B
Pilot Study Codebook
# Survey Question Names Label Code Label
1 How many children 1 1 child
do you provide care 2 2 children
for under the age of 3 3 children
six? Children 4 4 children
under 5 5 children
Children under six 6 6 children
six number 7 More than 6 children
2 In what area of Duval 1 Arlington
do you reside? 2 Beaches
3 Northside
4 Westside
Reside 5 Southside
Duval_area Duval 6 Other
3 What is the highest Less than highschool
level of education do Highschool
you have completed? 1 Some college but no
2 degree
Highest 3 College/university
Highest_educat educatio 4 degree
ion n name 5 Graduate degree
4 What was your 1 Public Health
major? 2 Political Science
3 Social Sciences
Major 4 Theology
Major name 5 Other
5 How familiar are you
with the Very likely
recommended 1 Somewhat likely
vaccinations from the 2 Neither likely nor
CDC for children 3 unlikely
under 6? Recommended Familiar 4 Somewhat unlikely
vaccines vaccines 5 Very unlikely
6 Do you believe that
vaccinations cause Vaccine 1 Yes
autism? Vaccines_autis s cause 2 No
m autism 3 I don't know
7 Do you vaccinate 1 Yes
your child? Vaccinat 2 No
Vaccinate e child 3 Sometimes
8 Select likelihood your
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child will receive the

following
vaccinations:

8a HepB_vaccine HepB_vaccine Very likely

1 Somewhat likely
2 Neither likely nor
3 unlikely
Hepatiti 4 Somewhat unlikely
sB 5 Very unlikely
8b Very likely
1 Somewhat likely
2 Neither likely nor
3 unlikely
ROTA_vaccin Rotaviru 4 Somewhat unlikely
ROTA_vaccine e s 5 Very unlikely
8c Diphther
ia, Very likely
Tetanus, 1 Somewhat likely
2 Neither likely nor
Acellula 3 unlikely
r 4 Somewhat unlikely
DTaP_vaccine DTaP_vaccine Pertussis 5 Very unlikely
8d Very likely
1 Somewhat likely
Haemop 2 Neither likely nor
hilus 3 unlikely
influenz 4 Somewhat unlikely
HbOC_vaccine HbOC_vaccine a type B 5 Very unlikely
9 Very likely
1 Somewhat likely
2 Neither likely nor
3 unlikely
4 Somewhat unlikely
IPV_vaccine IPV_vaccine Polio 5 Very unlikely
10 Does your Requirements School_ 1 Yes
child(ren)'s require 2 No
school/care facility ments 3 I don't know
have requirements on
vaccinations?

Appendix C
Human Subject Plan
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The study that we are conducting is referred to as “Education Levels of Parents with

Children their Stance of Vaccinating Children Under the Age of Six.” The research question is

“How is education level associated with the vaccination practices by parents for children under

the age of six in Duval County?” The method that we used was a via telephone survey asking a

variety of questions such as how many children under the age of six they have, their furthest

education level, if they're familiar with CDC vaccination recommendations, if they vaccinate

their children, etc. We choose from a pool of telephone numbers with their identities being

hidden, so the study responses will still be anonymous. This method would be more time and

cost-efficient. We collected data through a software that broke down the responses by each

question. Our group will be seeking full board Institutional Review Board (IRB) approval due to

collecting vaccination data from individuals.

Individuals that will be included in our study are parents/guardians that have at least one

child under the age of six. Although our study doesn’t focus on one’s race/ethnicity, they must

reside in Duval County, Florida to be eligible to participate in this survey. Another demographic

characteristic that we are taking into consideration is what the parent/guardian's furthest

education level is.

Individuals that will not be included in our study are individuals without children under

the age of 6. Individuals without children under 6 will not be able to express if they allow those

children to receive vaccinations according to CDC recommendations. Individuals who do not

reside in Duval county will also be excluded because access to this study is limited to residential

areas in Duval county. Without these criteria, the results of the study would become inaccurate in

relation to the research question. There will be no incentives given in this study.
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For this study, the major health outcome will be CDC vaccine recommendations for

children under 6. These subjects are considered children because they are under the age of 18.

We decided to use children under 6 because between the ages of a newborn and 6 years old most

children are usually required to receive their shots. This can be due to school, childcare facilities,

or disease prevention. Our group also decided to exclude age groups that include pre-

adolescents, adolescents, young adults, and older adults. This is because at these ages’

vaccinations become a choice rather than a requirement. For example, vaccines such as HPV

help protect the body from sexually transmitted diseases so recommendations for it are usually

introduced around early teenage years.

As the focus of the study is centered around the education levels of parents and its effects

on parents’ vaccination practices, the impact of sex/gender does not compromise the goals of the

study. Therefore, gender representation is not necessary for the planned distribution of subjects

in the study and the survey instrument used does not ask participants to disclose their biological

sex whether male, female, or other. As the ethnic and racial origins of survey participants

(parents of children under the age of six) are not requested in the survey instrument for this

study, the racial and ethnic origin of study participants cannot be accurately determined.

However, race and ethnicity have historically played a role in the inequality of access to higher

education and could be a factor in studying the impact of education-level on parents’ vaccination

practices. To conduct a valid and inclusive analysis in studying how education-level influences

parents’ willingness to vaccinate their children, the involvement of different racial and ethnic

groups is necessary for this study. A proposed outreach program to recruit minorities could be

focused on local human service organizations that reach underprivileged minorities living in

communities that are seeking social welfare assistance. Another proposal that target’s a wide
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range of ethnic groups could be starting a social media campaign on the importance of

vaccinating children.

The two largest risks involved in this study is the protection of privacy and medical

records. The survey is anonymous, however, due to the participants being asked to complete a

follow-up survey, this is harder. To protect the participant's identification, there will be no

questions pertaining to age, gender, social security, or any other identification documents.

Telephone numbers will be deleted after the follow-up call to add an additional level of

protection. The survey also deals with medical records being discussed verbally, so there will be

an option to not answer any question the participant may not want to answer. The participants

being anonymous and being asked for verbal consent before the survey begins helps ensure that

the survey complies with the Health Insurance Portability and Accountability Act (HIPAA)

Privacy Rule. There are no physical, financial, psychological, or social risks involved in this

survey. This survey is a way of getting information on individuals' stances on vaccinations, and

every participant is asked to verbally give consent to begin the survey and they all have the

option to not answer a question if they would like.

Vaccinating children under the age of six has many benefits. Diseases associated with

vaccines include mumps, measles, chickenpox, hepatitis B, etc. These diseases have symptoms

associated with them that could potentially be deadly for children. Especially since children have

very fragile immune systems due to them not being exposed to many things because they are so

young. Vaccines do have cons associated with them, but the pros out way them especially when

it comes down to keeping children disease-free. Vaccinating children can not only keep one child

safe but many other children too. If one child gets vaccinated, they can prevent a mass spread of
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a disease saving the world from another pandemic. Vaccines were made for a reason to fight the

spread of diseases not to make a child worse.

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Appendix D

INFORMED CONSENT FORM

to Participate in Research, and

AUTHORIZATION
to Collect, Use, and Disclose Protected Health Information (PHI)

Title of this study: Education Levels of Parents and their stance on Vaccinating Children
under the Age of six.

Researchers: Yassir Colindres

You are being asked to participate in a research study.

Before you agree to take part in this study, Yassir Colindres

or his/her representative will tell you:

 Why the study is being done and what will happen to you if you take part in the
study:
This study is being conducted in order to analyze the impact that education level has on parents and
their stance on vaccinating children under the age of six. Researchers assume that having a college
education related to health care provides individuals with the education necessary to make an
informed decision regarding the vaccination of children by following the guidance of health
professionals and scientific evidence. In order to support the protocol of the study, participants will
be asked to complete a digital questionnaire on a laptop consisting of nine multiple choice
questions. The survey questionnaire given will ask participants to disclose information such as
number of children, highest level of education, area of residence, likelihood of vaccinating their
child, etc. The information given will be used in our research and will remain anonymous.

 How long you will be in the study:

Participants involved in the study will be asked to complete a questionnaire consisting of 9
multiple choice questions. Before the questionnaire participants will be informed of the study
which will take approximately 5 minutes to cover in full. The questionnaire given to participants
will take approximately 5-15 minutes to complete.

 How many people will be in the study:

Researchers plan to have a minimum of 50 participants in the study and no maximum. Study
participants will be restricted to the residential areas of Duval County including Northside,
 25

Southside, Westside, Arlington, and the Beaches. Participants will also be limited to parents that
have a child(s) under the age of six.

 The possible foreseeable risks, discomforts, and benefits of this research:

There are no foreseeable risks that will be involved in participating in this study. Participants will
be asked to dedicate less than 30 minutes of their time which will primarily be in an office
setting working on a laptop. Discomforts involved in the study may include disclosing
information that participants may not feel comfortable disclosing at any given time. The benefits
of this study are developing more data on the relationship between having a college education
and making the best decision when deciding whether to vaccinate a child.

 Alternatives to being in the study:

There are no other alternatives to being in the study. All information in the study is dedicated to
the research regarding education level and the impact it has on vaccination practices in parents.

 How your study records will be maintained and who will have access:
Study records that are disclosed in this study will be maintained on a secure laptop that will
have program software installed to safely collect all data from participants. The data collected
throughout the study will be maintained by the research lead and kept on a secure Excel
document.

 If it will cost you anything to take part in this study:

In order to take part in this study, participants will need to have transportation methods in place
to travel to the given survey site. There will be no costs associated with the study and any
parking fees will be reimbursed.

 When or if you may be told about new findings which may affect your willingness
to keep taking part in this study:
If at any given time throughout the study, new studies or findings are released that may affect
participants willingness to continue participation in the study, participants will be notified
immediately.

If you agree to participate in this study, you will be given a signed copy of this
document.

You may contact Yassir Colindres at (888) 888-8888 at any time if you have questions
about the research or if you think that you have been hurt by the research.
 26

You may contact the Institutional Review Board at the University of Mid-Florida Health
Science Center at (999) 999-9999 if you have questions about your rights as a research
subject or what to do if you are injured.

You may choose not to be in this study, or you may quit being in the study at any time
and there will be no penalty and no loss of any benefits you are entitled to.
If you agree to participate in this study, Yassir Colindres will create, collect, and use private
information about you and your health. This information is called protected health
information or PHI. In order to do this, the Principal Investigator needs your authorization.

More specifically, the following information may be collected, used, and shared with
others:

 How many children do you provide care for under the age of six?
 In what area of Duval do you reside?
 What is the highest level of education do you have completed?
 What was your major?
 How familiar are you with the recommended vaccinations from the CDC for
children under 6?
 Do you believe that vaccinations cause autism?
 Do you vaccinate your child?
 Vaccinations your child has received in the past. -- (HepB, RV, DTaP, Hib, IPV)
This information will be stored in locked filing cabinets or in secure computer servers with
security passwords.
Your PHI may be collected, used, and shared with others for the following study-related
purpose(s):
 To determine what vaccines children should be receiving according to Centers for
Disease Control and Prevention (CDC) recommendations  
 To determine if parents’ previous vaccination history determines their practices for
vaccinating their child(ren)
 To determine if there is a correlation between education level and parents’
willingness to vaccinate their children under the age of six
Once this information is collected, it becomes part of the research record for this study.
Only certain people have the legal right to collect, use and share your research records,
and they will protect the privacy and security of these records to the extent the law allows.
These people include:
 27

 the study Principal Investigator, and research staff associated with this project.
 other professionals at the University that provide study-related treatment or
procedures
 University of Mid-Florida Institutional Review Board (IRB; an IRB is a group of
people who are responsible for looking after the rights and welfare of people
taking part in research).

Your PHI may be shared with:

 Sponsor
 United States and foreign governmental agencies who are responsible for
overseeing research, such as the Food and Drug Administration, the Department
of Health and Human Services, and the Office of Human Research Protections

 Government agencies who are responsible for overseeing public health concerns
such as the Centers for Disease Control and federal, state and local health
departments

Otherwise, your research records will not be released without your permission unless
required by law or a court order. It is possible that once this information is shared with
authorized persons, it could be shared by the persons or agencies who receive it and it
would no longer be protected by the federal medical privacy law.

Your PHI will be used and shared with others until the end of the study (or alternative).

Once this research study is completed, any information that could identify you might be
removed from any identifiable private information or identifiable biospecimens collected
and that, after such removal, the information or biospecimens could be used for future
research studies or distributed to another investigator for future research studies without
additional informed consent from you or your legally authorized representative.

You are not required to sign this consent and authorization to allow researchers to collect,
use and share your PHI. Your refusal to sign will not affect your treatment, payment,
enrollment, or eligibility for any benefits outside this research study. However, you cannot
participate in this research unless you sign this consent and authorization.
You have the right to review and copy your protected health information. However, we
can make this available only after the study is finished.
You can revoke your authorization at any time before, during, or after your participation in
this study. If you revoke it, no new information will be collected about you, but information
 28

that was already collected may still be used and shared with others if the researchers
have relied on it to complete the research. You can revoke your authorization by giving a
written request with your signature on it to the Principal Investigator.

Signing this document means that the research study, including the above information,
has been described to you orally and/or that you have read this document, and you
voluntarily agree to take part.

________________________________ ______________
Signature of Person Obtaining Consent Date

________________________________ ______________
Consent and Authorization of Patient Date
 29

Appendix E

Budget-

Personnel Salary Benefits % time Total

Myself (Principal $50,000.00 Labor, Travel 100% $50,000.00 (Direct Cost)
Investigato Reimbursement
Research Assistant $40,000.00 Labor, Travel 75% $30,000.00 (Direct Cost)
Reimbursement
Food Caterer $30,000.00 Food Service, Travel 10% $3,000.00 (Direct Cost)
Other Expenses
Meeting Room Rented $65.00/hour Internet Access ~10 Hours $650.00 (Indirect Cost)
Equipment and Supplies
Laptops $750.00/each Supports study research Qty. (2) = $1,500.00
(Indirect Cost)
Paper $250.00 N/A $250.00 (Direct Cost)
Software Program $150.00/each Data collection/analysis Qty (2) = 300.00
(Indirect Cost)
Travel
Parking Fees ~$250.00 Annually N/A $250.00 (Direct Cost)
Other costs
Journal Publication Fees ~$2,000.00/each article N/A $2,000.00 (Direct Cost)
Total Direct Costs $85,500.00
Total Indirect Costs $2,450.00

Total Requested $87,950.00

 30

Research Timeline-

2021

Activity Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Research Question 8/31- 9/6

developed
Reviewed Supporting 9/7-
Studies & Public 913
Records
Literature Review 9/21-
9/27
Review Application 9/28- 10/4
Submitted
Recruit Participants 10/5-
10/11
Develop protocol & 10/12-
Survey instrument 10/18
Design Study & Acquire 10/26- 11/1
Data
Clean & Analyze Data 11/2-
11/8
Abstract Submission 11/9-
11/15
Developed introduction 11/16-
and Discussion chapter 11/22
Revision of Manuscript 11/23-
11/26
Submission to a Journal 12/1

Appendix F
 31

Map of study area-