Document Type

Honors Project On-Campus Access Only


Vaccine refusal in the United States has reached unprecedented levels. Rates of non-immunization have reached high enough levels to produce sporadic outbreaks of infectious diseases such as measles and whooping cough. This research follows a long line of geographic studies on vaccination refusal. While many researchers have addressed social factors that lead to vaccine refusal, these variables are usually compositional in nature, thus ignoring place-based contextual factors, such as risk perception.

This paper integrates research on environmental risk and place effects on health in order to develop a theoretical framework for understanding why vaccine refusal patterns differ between neighborhoods. This project utilizes CalEnviroScreen, an area level composite measure of environmental risk and social vulnerability in California, to address the questions: Which variables of CalEnviroScreen are associated with vaccination refusal, and How are risk and vulnerability at the area level linked to vaccination decision outcomes? Previous research indicated a clear association between lower levels of CalEnviroScreen. This means that low environmental and social risk are associated with high rates of vaccine refusal. However, explanations for the association are unclear and intriguing conceptually. This research project seeks to describe this ambiguous relationship though risk and vulnerability literature to vaccination behavior work. This research makes significant theoretical contributions to these fields.

In this paper, I use personal belief exemption (PBE) data from immunization for schools (kindergarten level) in California from 2012-2015. Using simple linear regression, cluster analysis using Kulldorff’s spatial scan statistic, and logistic regression, I test the association between risk and high and low rates of PBE incidence. I find that we must consider multiple variables when addressing risk and vulnerability. These findings not only contribute data and empirical evidence on how risk relates to vaccine refusal, but also further the discussion on how exposure to environmental risk influences vaccination refusal.



© Copyright is owned by author of this document