International Journal of Public Health

, Volume 57, Issue 2, pp 333–340 | Cite as

Similarity of parents and physicians in the decision to vaccinate children against measles, mumps and rubella

Original Article



This study investigates parental decisions to vaccinate their children against measles, mumps and rubella (MMR). Parent and provider survey data allow the analysis of interactions between these major players in decision making.


Three datasets are used for analysis: (a) the basic population of the school entry-level health checkup in Munich, Germany; (b) a face-to-face survey with parents of children taking the school entry-level health checkup; (c) a face-to-face survey of the physicians treating these children. Logistic, OLS and multilevel regressions were applied.


Homophily due to similar ages of parents and physicians boosts the decision to vaccinate children against MMR. Also in relation to parent–physician interaction, the fact that a physician may be homeopathic has no effect on a parents’ decision to immunize, although vaccination-skeptical parents choose physicians who are trained in homeopathy.


Efforts to improve the number of parental decisions for vaccination should focus on the educational level of the parents as well as homophily of parents and physicians. Notably, homogeneity of parents and providers concerning age changes decisions in favor of vaccinating.


MMR Vaccination behavior Parent–physician interaction Multilevel analysis 



The author is grateful to Monika Jungbauer-Gans and the German Research Foundation (DFG) for supporting the project. I thank Ralf Karhausen-Beermann and the Munich Ministry of Health and Environment for access to the school entry health checkup data, and Catherine Bennewitz, Kyle Hanniman and the two anonymous reviewers for helpful suggestions to improve the manuscript.

Conflict of interest

The author declares that he has no competing interests.


  1. Becker GS (1965) A theory of the allocation of time. Econ J 75(299):493–517CrossRefGoogle Scholar
  2. Becker GS (1995) Human capital. A theoretical and empirical analysis, with special reference to education, 3 ed. The University of Chicago Press, ChicagoGoogle Scholar
  3. Borràs E, Domínguez À, Fuentes M, Batalla J, Cardeñosa N, Plasencia A (2009) Parental knowledge of paediatric vaccination. BMC Public Health 9(154):1–7Google Scholar
  4. Casiday RE (2007) Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med 65:1059–1070PubMedCrossRefGoogle Scholar
  5. English JM (1995) The rights and wrongs of measles vaccination. Br Homoeopath J 84:156–163CrossRefGoogle Scholar
  6. Farrington CP, Kanaan MN, Gay NJ (2001) Estimation of the basic reproduction number for infectious diseases from age-stratified serological survey data. J R Stat Soc Ser C (Appl Stat) 50(3):251–292CrossRefGoogle Scholar
  7. Grossman M (2000) The human capital model. In: Culyer AJ, Newhouse JP (eds) Handbook of health economics. Elsevier, Amsterdam, pp 347–408Google Scholar
  8. Gust DA, Strine TW, Maurice E, Smith PJ, Yusuf H, Wilkinson M, Battaglia MP, Wright R, Schwartz B (2004) Underimmunization among children: effects of vaccine safety concerns on immunization status. Pediatrics 114(1):16–22CrossRefGoogle Scholar
  9. Gust DA, Kennedy AM, Shui I, Smith PJ, Nowak G, Pickering LK (2005) Parent attitudes toward immunizations and healthcare providers. The role of information. Am J Prev Med 29(2):105–112PubMedCrossRefGoogle Scholar
  10. Hahné S, Te Wierik MJ, Mollema L, Velzen E, Coster E, Swaan C, Melker H, de Binnendijk R (2010) Measles outbreak, the Netherlands, 2008. Emerg Infect Dis J 16(3):567–569Google Scholar
  11. Hethcote HW (2000) The mathematics of infectious diseases. SIAM Rev 42(4):599–653CrossRefGoogle Scholar
  12. Jansen VAA, Stollenwerk N, Jensen HJ, Ramsay ME, Edmunds WJ, Rhodes CJ (2003) Measles outbreaks in a population with declining vaccine uptake. Science 301(5634):804PubMedCrossRefGoogle Scholar
  13. Jones L, Sciamanna C, Lehman E (2010) Are those who use specific complementary and alternative medicine therapies less likely to be immunized? Prev Med 50:148–154PubMedCrossRefGoogle Scholar
  14. Keeling MJ, Grenfell BT (1997) Disease extinction and community size: modeling the persistence of measles. Science 275(5296):65–67PubMedCrossRefGoogle Scholar
  15. Kennedy AM, Gust DA (2008) Measles outbreak associated with a church congregation: a study of immunization attitudes of congregation members. Public Health Rep 123:126–134PubMedGoogle Scholar
  16. Kennedy AM, Brown CJ, Gust DA (2005) Vaccine beliefs of parents who oppose compulsory vaccination. Public Health Rep 120:252–258PubMedGoogle Scholar
  17. Lehrke P, Nuebling M, Hofmann F, Stoessel U (2001) Attitudes of homoeopathic physicians towards vaccination. Vaccine 19(32):4859–4864PubMedCrossRefGoogle Scholar
  18. Lieu TA, Black SB, Ray P, Schwalbe JA, Lewis EM, Lavetter A, Morozumi PA, Shinefield HR (1997) Computer-generated recall letters for underimmunized children: how cost-effective? Pediatr Infect Dis J 16(1):28–33PubMedCrossRefGoogle Scholar
  19. McPherson M, Smith-Lovin L, Cook JM (2001) Birds of a feather: homophily in social networks. Annu Rev Sociol 27:415–444CrossRefGoogle Scholar
  20. Meissner CH, Strebel PM, Orenstein WA (2004) Measles vaccines and the potential for worldwide eradication of measles. Pediatrics 114(4):1065–1069PubMedCrossRefGoogle Scholar
  21. Mikolajczyk RT, Akmatov MK, Stich H, Krämer A, Kretzschmar M (2008) Association between acculturation and childhood vaccination coverage in migrant populations: a population based study from a rural region in Bavaria, Germany. Int J Public Health 53(4):180–187PubMedCrossRefGoogle Scholar
  22. Neuhaus JM, Kalbfleisch JD, Hauck WW (1991) A comparison of cluster-specific and population-averaged approaches for analyzing correlated binary data. Int Stat Rev 59(1):25–35CrossRefGoogle Scholar
  23. Newswire (2011) Cardiff TELEform in strong demand by top European hospitals. Accessed 27 Apr 2011
  24. Reiter S, Rasch G (2004) Schutzimpfungen, Heft 1, Gesundheitsberichterstattung des Bundes. RKI, BerlinGoogle Scholar
  25. Richard JL, Masserey Spicher V (2009) Large measles epidemic in Switzerland from 2006 to 2009: consequences for the elimination of measles in Europe. Eurosurveill 14(50):19443Google Scholar
  26. Robert Koch Institute (1999) Interventionsprogramm “Masern, mumps, Röteln (MMR)”. RKI, BerlinGoogle Scholar
  27. Robert Koch Institute (2010) Impfquoten bei den Schuleingangsuntersuchungen in Deutschland 2008. Epidem Bull 16:137–140Google Scholar
  28. Skea ZC, Entwistle VA, Watt I, Russell E (2008) Avoiding harm to others’ considerations in relation to parental measles, mumps and rubella (MMR) vaccination discussions—an analysis of an online chat forum. Soc Sci Med 67:1382–1390PubMedCrossRefGoogle Scholar
  29. Spence M (1973) Job market signaling. Q J Econ 87(3):355–374CrossRefGoogle Scholar
  30. Sporton RK, Francis SA (2001) Choosing not to immunize: are parents making informed choices? Fam Pract 18:181–188PubMedCrossRefGoogle Scholar
  31. Vandermeulen C, Roelants M, Theeten H, van Damme P, Hoppenbrouwers K (2008) Vaccination coverage and sociodemographic determinants of measles–mumps–rubella vaccination in three different age groups. Eur J Pediatr 167(10):1161–1168PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2011

Authors and Affiliations

  1. 1.Economic SociologyUniversity of Erlangen-NurembergNurembergGermany

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