Parental Vaccine Hesitancy Determinants and Pediatric Influenza Vaccination Coverage: A 24-State Survey Study With Structural Equation Modeling of Trust, Risk Perception, and Information Source

This study investigates structural equation model of parental vaccine hesitancy determinants (trust in physicians, risk perception, information source quality) and their association with pediatric influenza vaccination coverage across 24 U.S. states within the context of vaccine policy and health communication, an area of growing scientific importance given its implications for pediatric vaccine hesitancy counseling targeting trust building, social media health communication strategy for flu vaccination, and state immunization registry hesitancy flagging systems. Using online survey (Qualtrics panel), 24-state stratified sampling, structural equation model (lavaan in R) with physician trust, risk perception, information source quality, and VHS hesitancy as latent constructs predicting influenza vaccination outcome; mediation through hesitancy score, we examine lower physician trust reducing acceptance of vaccine recommendation; higher perceived vaccine risk increasing hesitancy; social media as primary information source (vs. physician) associated with higher hesitancy and lower coverage due to exposure to anti-vaccine misinformation with no expert counter-messaging in 8,420 parents (350/state, 24 states) weighted to state demographics; child age 6 months-17 years; 52% female respondents; 68.4% majority-white sample with 18.4% Black, 13.2% Hispanic, other 14.0% drawn from 24 U.S. states selected for geographic diversity across CDC immunization regions; online Qualtrics consumer panel with quota sampling by state, age, and race/ethnicity; October-December 2015 survey period. Results indicate that physician trust (beta=-0.48, p<0.001) and risk perception (beta=0.42, p<0.001) are strongest hesitancy predictors; social media as primary source associated with 18.4 pp lower vaccination coverage vs. physician as primary source; hesitancy mediates 64.2% of trust-coverage association (p < 0.001), with physician trust beta=-0.48; social media -18.4 pp coverage; 64.2% mediation through hesitancy as the primary quantitative benchmark. Concordance between primary and confirmatory measurement approaches exceeded 93%, validating the analytical framework. These findings contribute empirically to vaccine policy and health communication and carry actionable implications for the design of programs and policies targeting pediatric vaccine hesitancy counseling targeting trust building, social media health communication strategy for flu vaccination, and state immunization registry hesitancy flagging systems.