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David L. Wood, MD, MPH; Philip Rosenthal, MD; Debra Scarlata, MS

Arch Pediatr Adolesc Med. 1995;149(7):769-773.

Abstract
Objective
To assess California pediatricians' level of agreement with and implementation of universal infant hepatitis B immunization.

Research Design
Mailed questionnaire in the summer and fall of 1993 to a random sample of 1030 California pediatricians to determine whether they universally immunize infants with hepatitis B vaccine. The response rate was 71%.

Results
More than 81% said they universally immunize infants against hepatitis B infection; however, 18.3% stated that they do not. Pediatricians were more likely to immunize infants universally against hepatitis B if they (1) agreed with the recommendations (90% vs 54%, P<.01), (2) practiced in a health maintenance organization setting vs private group practice (92% vs 79%, P<.05), or (3) practiced in settings with predominantly low-income patients (89% vs 78%, P=.01). Pediatricians who universally immunize infants against hepatitis B virus were in practice an average of 1.7 years longer than those who do not (13.3 years vs 11.6 years, P=.01). In multivariate analyses, the most powerful predictor of universal immunization was agreement with the recommendations. Among those who disagreed with the recommendations, the most common reasons for disagreement included the following: (1) the long-term efficacy of hepatitis B vaccine is not proved—54%; (2) an additional immunization would make the visits too costly—53%; and (3) three shots would be too much at one visit—53%.

Conclusions
A majority (81.6%) of our sample of California pediatricians universally immunize infants against hepatitis B; however, a significant minority (18.4%) do not agree with the recommendations and do not plan to implement them. Many of their objections are being addressed through combination vaccine development and ongoing research; however, alternative policies and additional research should also be considered.

(Arch Pediatr Adolesc Med. 1995;149:769-773)

Author Affiliations
From the Ahmanson Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, Calif (Drs Wood and Rosenthal); RAND, Santa Monica, Calif (Dr Wood); and Amgen Corporation, Thousand Oaks, Calif (Ms Scarlata).

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