Prevalence and Correlates of Vaccine Attitudes and Behaviors in a Cohort of Low-Income Mothers




Ross M. Gilbert, Joshua P. Mersky, and Chien-Ti Plummer Lee

Brief Type

Journal Publication


  • Early Head Start Home-Based Option (EHS)
  • Healthy Families America (HFA)
  • Nurse-Family Partnership (NFP)
  • Parents as Teachers (PAT)


The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%–21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization. (author abstract)

Data Collection Methods

  • Surveys or questionnaires



For More Information

Gilbert, R. M., Mersky, J. P., & Lee, C. T. P. (2021). Prevalence and correlates of vaccine attitudes and behaviors in a cohort of low-income mothers. Preventive Medicine Reports21, 101292. https://doi.org/10.1016/j.pmedr.2020.101292
Author Contact Information:
Joshua P. Mersky


  • Participant Characteristics