Record: Pamela McDonald, Rupali J. Limaye, Saad B. Omer, Alison M. Buttenheim, Salini Mohanty, Nicola P. Klein, and Daniel A. Salmon, “Exploring California’s New Law Eliminating Personal Belief Exemptions to Childhood Vaccines and Vaccine Decision-Making among Homeschooling Mothers in California” in Vaccine 37 (2019), 742-750 [abstract here]
Summary: The authors, associated with schools of public health, nursing, or vaccine study at Johns Hopkins, Emory, the University of Pennsylvania, and The Kaiser Center, here present the results of interviews with 24 homeschooling mothers in California regarding their attitudes both to childhood vaccinations generally and to California’s Senate Bill 277, which eliminated the personal belief exemption to school immunization requirements for children attending schools.
As of July of 2016 the state of California stopped allowing parents who send their children to daycare or kindergarten to claim religious exemptions to vaccination requirements. The law very clearly stated that it did not apply to homeschoolers. The authors estimate that California currently has about 200,000 students enrolled in some form of homeschooling.
The authors wanted to discover two things. First, did SB 277 have a measurable impact on homeschooling in California? Is there evidence that some Californians decided they would rather opt out of schooling altogether than have their children immunized? Second, they wanted to get a sense of what homeschoolers actually believe about vaccination. There is a popular stereotype that homeschoolers are rabid anti-vaxxers. Is it true?
To find out the authors interviewed 24 California homeschoolers. They recruited their subjects at first through Facebook homeschooling groups in California regions they knew to have significant anti-vaccination populations (greater San Francisco and San Diego). Fifteen parents, all mothers, responded to their Facebook messages, and through these mothers the researchers were able to obtain access to others (so-called “snowball” sampling). A total of 24 mothers were interviewed between August and September of 2017. The interviews were recorded, transcribed, and coded in a standard fashion, with multiple researchers working independently and with help from the Dedoose software program to ensure inter-rater reliability.
The only demographic variable provided by the researchers was mother education background. 71% of the mothers in the sample had obtained at least a bachelor’s degree, far above the national average. Race and income profiles were not provided.
All 24 of the parents were familiar with SB 277 and agreed that it infringed on the rights of parents, but none said that it in any way affected their decisions about homeschooling or about immunizations.
Regarding feelings about vaccines, 10 of the mothers accepted them with little or no reservation, 1 had previously been opposed but was now a supporter of vaccination, 5 accepted them in principle but tended to want to delay administration of some and refuse others, 6 had accepted them for their older children but grew more critical over their maternal lifespan and were now the most outspoken anti-vaccination advocates in the sample, and 2 mothers had always rejected all vaccinations for their children.
Mothers’ position on the vaccination issue was informed by many factors. Mothers who accepted vaccinations tended to trust medical professionals and distrust alarmist anti-vaccination rhetoric appearing on the internet or coming from peers. Mothers who distrusted vaccinations tended to distrust medical professionals and put more stock in the results of their internet-based independent research into potential harms. Parents in the middle felt ambiguity on both sides. A similar spread concerning beliefs about vaccination’s effectiveness was observed, with accepting mothers believing them to be effective, rejecting mothers believing them ineffective, and mothers in the middle not sure what to think.
In their discussion the authors note that homeschooler attitudes, at least for this sample, represent a spread of beliefs also found among parents whose children school conventionally, suggesting that “home-schooling parents may make vaccination decisions in similar ways as parents who do not home school.” (p. 747) They acknowledge, however, that their sample can in no way be generalized to the broader California homeschooling population.
The authors conclude that their results are consistent with previous research finding that vaccine hesitancy “is not the result of one factor, but a complex fusion of multiple factors and is largely dependent upon the context of the individual’s experiences.” (p. 748) They speculate that though they were unable to document a causal relationship between passage of SB-277 and the choice to homeschool, the law’s recent passage could lead over time to an increase in parents choosing homeschooling over forced vaccination.
Appraisal: As with so much homeschooling research, we are presented here with a well-written, well-designed qualitative study that contains much rich information about parent (mother) attitudes. But none of it is generalizable. This excellent paper is a synthesis based upon 24 anecdotal accounts, all from a slice of the homeschooling population–well-educated homeschoolers–that researchers tend to over-study because these homeschoolers are most likely to have a robust internet presence and to be willing to respond to a request from a university researcher. The deliberate choice to look for homeschoolers in places known to be hotbeds of anti-vax sentiment, while understandable, is another factor limiting generalizability. That the researchers were unable to find any evidence that vaccination law affected homeschooling decisions for any of their subjects even in these regions suggests to me that, so far at least, the vaccination issue is not a major player in parental motivation to homeschool.
Milton Gaither
Messiah College