Skip to main content
NCBI home page
Preventive Medicine Reports logoLink to Preventive Medicine Reports
. 2026 Jul 27;69:103588. doi: 10.1016/j.pmedr.2026.103588

Parental vaccination intentions following Florida's announced elimination of school vaccine mandates: The role of vaccine hesitancy

Nolan Kline a,⁎, Sobur Ali a, Stacey B Griner b, Sarah B Maness c, Laura Merrell c, Erika L Thompson d, Christopher W Wheldon e, Connor Martz a
PMCID: PMC13474388  PMID: 42602619

Abstract

Objectives: In 2025, Florida officials announced plans to end vaccine mandates, including school-based vaccine requirements. This study assessed whether Florida parents/caregivers reported changes in pediatric vaccination intentions related to the state's announcement and identified correlates of reported changes.

Methods: We conducted an online survey with 519 Florida parents/caregivers of school-aged children in December 2025. Eligibility criteria included being aged 18 or older, having at least one school-aged child, residing in Florida, and speaking English. Measures included sociodemographic characteristics, political affiliation, vaccine hesitancy, and self-reported changes in vaccination intention following the policy announcement. Descriptive statistics and multivariate regression models examined correlates of vaccine hesitancy and vaccination intention change.

Results: Overall, 42% of participants reported being more likely to vaccinate children following the announcement, 38% reported no change, and 20% reported being less likely. Vaccine hesitancy was the only variable independently associated with reported intention change. Hesitant respondents were more likely than non-hesitant respondents to report decreased vaccination intentions (44% vs 13%) and less likely to report increased intentions (16% vs 50%).

Conclusions: Findings suggest vaccine hesitancy shapes responses to vaccine policy change. Such policies may reinforce existing vaccination attitudes, resulting in divergent vaccination intentions among caregivers with differing levels of hesitancy.

Keywords: Vaccine hesitancy, Vaccine refusal, Political determinants, Policy, Politics

Highlights

  • •

    Existing vaccine hesitancy predicted parental vaccination intention change.

  • •

    Policy announcements were associated with divergent intention changes among parents.

  • •

    Sociodemographic factors were not independently associated with intention change.

  • •

    Changing vaccine policy climates may result in differential vaccine uptake.

1. Introduction

Vaccination is among the top 10 public health achievements in the past century and has reduced vaccine-preventable disease incidence (Centers for Disease Control and Prevention [CDC], 1999). Yet, vaccine hesitancy is increasing in the United States, and coverage of some childhood vaccines recommended by the U.S. Advisory Committee on Immunization Practices has declined in recent years (Hill et al., 2026). Misinformation and politicization of vaccines are key contributors to increases in vaccine hesitancy (Bolsen and Palm, 2022; Zimmerman et al., 2023). These factors may be exacerbated by states such as Florida moving to end school-based vaccine requirements for children.

Florida's children receive most recommended vaccinations at rates near or above the national average (CDC, 2025; CDC, 2026). Announced changes to vaccine policies, however, may threaten this. On September 3, 2025, Florida Surgeon General Joseph Ladapo announced plans to eliminate all vaccine mandates, including school-entry requirements, claiming school-based vaccination mandates were “immoral” hindrances on parents' decision making.

Research has established that physicians and government officials can influence vaccination intentions (Ruiz and Bell, 2021). For example, healthcare provider recommendation is a key predictor of vaccination for non-school-entry-required vaccines like human papillomavirus (Sonawane et al., 2020), and political views have been shown to influence COVID-19 vaccination intentions (El-Mohandes et al., 2021). What is not known, however, is how government officials with health credentials and power to influence policy may impact vaccine intentions, including for those historically required for school entry. As the top physician and a political leader in Florida, Dr. Ladapo's announcement may influence vaccine decision making for parents with school-aged children.

This study assessed whether Florida parents reported changes in intention to vaccinate their school-aged children following the announced elimination of state vaccine mandates and identified correlates of reported changes. The study provides a unique opportunity to understand how rapid changes in public health requirements impact public perceptions of pediatric vaccinations. We identified vaccine hesitancy as the primary predictor of reporting vaccine intention changes using an online survey completed by 519 parents following the announcement. Findings from this study suggest that altering school-based vaccine requirements may reinforce some parents' existing hesitant beliefs.

2. Methods

2.1. Study design and population

A sample of 519 Florida parents or caregivers of school-age children were recruited online via survey panel to complete an exploratory cross-sectional survey regarding parental vaccination attitudes. To be eligible, participants were required to speak English, be aged 18 or older, have at least one child aged 6 or older, and live in Florida. The study was conducted in December 2025, approximately three months after Florida's announced vaccine policy change. Surveys were administered in Qualtrics and the study was approved by the University of Central Florida Institutional Review Board.

2.2. Measures

The primary outcome of self-reported vaccination intention change was assessed by asking participants about their likelihood of vaccinating their child (or any future children) for routine school-entry vaccines (e.g., measles-mumps-rubella, diphtheria-tetanus-acellular pertussis, polio, varicella) following the Florida Surgeon General's policy announcement. Responses were measured on a 5-point Likert scale (“much less likely” to “much more likely”) and collapsed into three categories: “More Likely” (combining “more” and “much more likely”), “No Change”, and “Less Likely” (combining “less” and “much less likely”). “No Change” served as the referent category.

Survey measures also assessed sociodemographic correlates of vaccination intention change. Vaccine hesitancy was assessed using the Vaccine Hesitancy Scale: a validated 10-item scale developed by the World Health Organization Strategic Advisory Group of Experts on Immunization (Shapiro et al., 2018) with items assessing attitudes towards childhood vaccine safety, effectiveness, and necessity. Seven items were scored on a Likert scale from 1 (strongly agree) to 5 (strongly disagree), where higher scores indicated greater hesitancy; three negatively worded items were reverse coded prior to scoring so that higher values consistently reflected greater hesitancy across all items. A mean score was calculated across the 10 items, and respondents with a mean score greater than 3 were classified as vaccine hesitant (Ali et al., 2025). Consistent with applications of the Vaccine Hesitancy Scale, analyses in this study used a binary classification (Szilagyi et al., 2020).

Other self-reported sociodemographic characteristics included: parents' birth year (to derive age), gender identity, household income, educational attainment, race and ethnicity, and political affiliation. Age was categorized into three groups (18–29, 30–39, 40–49 years). Sex was categorized as Man or Woman; respondents who indicated non-binary, genderqueer, transgender, and prefer not to disclose were excluded from the final analytic sample due to low cell counts (n = 6). Educational attainment was classified as: high school or less, some college/associate degree, four-year college degree, or postgraduate degree. Household income was categorized as: <$50,000, $50,000–$100,000, or > $100,000. Race was grouped as White, Black or African American, or Multiracial/Other (including Asian, American Indian, Alaska Native, Pacific Islander, and multiracial). Ethnicity was recorded as Hispanic or non-Hispanic. Political affiliation was categorized as Democrat, Republican, Independent, or Other/No Preference.

2.3. Statistical analysis

Descriptive statistics were used to characterize the sociodemographic composition of the analytic sample and to summarize distributions of key study variables overall and by subgroup. Bivariate chi-square tests were used to examine unadjusted associations between sociodemographic characteristics and both vaccine hesitancy status and changes in vaccination intention.

Two sets of multivariable regression models were estimated using listwise deletion, resulting in an analytic sample of 491 participants. First, binary logistic regression was used to identify sociodemographic predictors of vaccine hesitancy status, with non-hesitant respondents as the reference group. Second, multinomial logistic regression was used to examine sociodemographic correlates of vaccination intention changes, with “No Change” as the referent category; this approach allows simultaneous estimation of the relative odds of reporting decreased versus increased vaccination intentions. Both models adjusted for the same set of covariates: age group (ref: 18–29 years), sex (ref: Man), race (ref: White), Hispanic ethnicity, educational attainment (ref: high school or less), household income (ref: < $50,000), and political identification (ref: Other/No Preference). The multinomial model additionally adjusted for vaccine hesitancy status (ref: non-hesitant).

A series of exploratory supplemental interaction models explored whether hesitancy status moderated associations between key sociodemographic characteristics and vaccination intention change. Results from regression models are presented as odds ratios (OR) with 95% confidence intervals (CI). Results from some of the supplemental models should be interpreted as exploratory given small cell sizes. Statistical analyses were performed using R (Version 4.4.3).

3. Results

Among the sample of 519 Florida parents or caregivers of school-age children, respondents were predominantly female (67.4%) and aged 30 to 39 (48.6%), with smaller proportions aged 18 to 29 (30.7%) and 40 to 49 (20.7%). The racial and ethnic composition of the sample was 62.2% White, 29.2% Black or African American, and 6.4% Multiracial or some other race, with approximately one quarter (23.4%) identifying as Hispanic. Regarding socioeconomic position, 39.0% of respondents had a high school education or less, and 44.6% reported household incomes below $50,000. Politically, the sample was relatively evenly distributed across Democrat (26.3%), Republican (30.5%), and Independent (25.1%), with the remainder reporting other or no political preference (18.1%). Descriptive characteristics of the overall sample stratified by hesitancy status are presented in Table 1. The sample differed from 2024 American Community Survey estimates for Florida adults across several characteristics. Women and Black or African American respondents were overrepresented (67% vs. 51% and 31% vs. 15%, respectively), while Hispanic respondents were underrepresented (22% vs. 29%). The sample also skewed lower income, with fewer households earning above $100,000 (19% vs. 39%) and more earning below $50,000 (45% vs. 32%); educational attainment was comparable to state estimates.

Table 1.

Sociodemographic characteristics, political identification, change in vaccination intention, and vaccine hesitancy score among Florida parents or caregivers of school-age children (N = 519), overall and by vaccine hesitancy status, surveyed in December 2025, approximately three months after Florida's vaccine mandate rollback.

Overall (N = 519) Hesitant (n = 121) Not Hesitant (n = 398)
Age group, n (%)
18–29 159 (30.70) 42 (34.70) 117 (29.50)
30–39 252 (48.60) 59 (48.80) 193 (48.60)
40–49 107 (20.70) 20 (16.50) 87 (21.90)
Sex, n (%)
Man 164 (31.70) 42 (34.70) 122 (30.70)
Woman 349 (67.40) 79 (65.30) 270 (68.00)
Other 5 (1.00) 0 (0.00) 5 (1.30)
Race, n (%)
Black or African American 151 (29.20) 37 (30.60) 114 (28.70)
White 322 (62.20) 74 (61.20) 248 (62.50)
Multiracial or Other 33 (6.40) 6 (5.00) 27 (6.80)
Ethnicity, n (%)
Hispanic 121 (23.40) 30 (24.80) 91 (22.90)
Non-Hispanic 396 (76.40) 91 (75.20) 305 (76.80)
Education, n (%)
High school or less 202 (39.00) 63 (52.10) 139 (35.00)
Some college 154 (29.70) 38 (31.40) 116 (29.20)
College 108 (20.80) 14 (11.60) 94 (23.70)
Postgraduate 54 (10.40) 6 (5.00) 48 (12.10)
Household income, n (%)
< $50,000 231 (44.60) 67 (55.40) 164 (41.30)
$50,000–$100,000 179 (34.60) 41 (33.90) 138 (34.80)
> $100,000 96 (18.50) 9 (7.40) 87 (21.90)
Political identification, n (%)
Democrat 136 (26.30) 21 (17.40) 115 (29.00)
Republican 158 (30.50) 34 (28.10) 124 (31.20)
Independent 130 (25.10) 43 (35.50) 87 (21.90)
Other/No Preference 94 (18.10) 23 (19.00) 71 (17.90)
Change in vaccination intention, n (%)
More likely 219 (42.30) 19 (15.70) 200 (50.40)
Less likely 103 (19.90) 53 (43.80) 50 (12.60)
No change 196 (37.80) 49 (40.50) 147 (37.00)
Vaccine hesitancy score, Mean (SD) 2.60 (0.78) 3.66 (0.54) 2.28 (0.51)
Open in a new tab

Note: Values may not sum to the total sample size due to missing data on individual items. Hesitancy status defined as 10-item mean > 3.

Approximately 23% of respondents met criteria for vaccine hesitancy based on the 10-item scale (mean hesitancy score: 2.60 [SD = 0.78]). Overall, 42% of respondents reported being more likely to vaccinate their children following the announced policy change, 20% reported being less likely, and 38% reported no change in vaccination intentions.

Across the 10-item hesitancy scale, most respondents expressed broadly pro-vaccine attitudes (see supplemental Fig. 1). Majorities agreed or strongly agreed that vaccines are important for their child's health (70%), that vaccines are effective (70%), and that vaccination protects the health of others in the community (67%). However, meaningful proportions of respondents endorsed hesitancy-related beliefs: 52% agreed or strongly agreed that they were concerned about serious adverse side effects of vaccines, and 52% agreed or strongly agreed that new vaccines carry greater risks than older vaccines – the two items with the highest rates of hesitancy-consistent responses. Patterns of item endorsement were broadly similar across groups defined by reported changes in vaccination intention (see supplemental Fig. 2), though differences were substantially more pronounced when comparing hesitant and non-hesitant respondents (Fig. 1). Among hesitant respondents, disagreement with pro-vaccine items and agreement with hesitancy items was pervasive across nearly all scale domains.

Fig. 1.

Fig. 1

Open in a new tab

Distribution of vaccine hesitancy responses by hesitant versus non-hesitant Florida parents/caregivers of school-age children (n = 519) in December 2025, approximately three months after Florida's announced vaccine policy change. Note: Disagreement indicates greater hesitancy; items marked * were modified for visualization only. Hesitant status defined as 10-item mean > 3.

Bivariate chi-square tests revealed no statistically significant associations between sociodemographic characteristics and vaccination intention change following the announced policy change (all p > 0.20). In contrast, vaccine hesitancy status was strongly associated with intention change (χ2 = 65.60, p < 0.001). Hesitant respondents were substantially more likely to report decreased vaccination intentions (44% vs 13% among non-hesitant respondents) and substantially less likely to report increased intentions (16% vs 50%) (Fig. 2).

Fig. 2.

Fig. 2

Open in a new tab

Change in vaccination intention following Florida's vaccine policy change among hesitant versus non-hesitant Florida parents or caregivers of school-age children (n = 519) in December 2025, approximately three months after the policy change. Hesitant status defined as 10-item mean > 3.

These patterns were confirmed in multivariable multinomial logistic regression adjusting for sociodemographic characteristics. Vaccine hesitancy was the only covariate independently associated with vaccination intention change (Fig. 3). Hesitant respondents had significantly greater odds of reporting decreased vaccination intentions following the announced policy change, relative to reporting no change (OR = 3.51, 95% CI = 2.01, 6.13). Conversely, hesitant respondents had significantly lower odds of reporting increased vaccination intentions (OR = 0.32, 95% CI = 0.17, 0.58). No sociodemographic characteristics – including age, sex, race, ethnicity, education, income, or political identification – were independently associated with changes in vaccination intentions after adjustment for vaccine hesitancy. Estimates using the dichotomized hesitancy measure were consistent with models examining continuous mean scores.

Fig. 3.

Fig. 3

Open in a new tab

Adjusted odds ratios for sociodemographic correlates of change in vaccination intention (less likely versus more likely to vaccinate, relative to no change) following Florida's vaccine mandate rollback announcement, among Florida parents/caregivers of school-age children (n = 491) surveyed in December 2025.

Bivariate analyses indicated that vaccine hesitancy status varied significantly by educational attainment, household income, and political identification (all p < 0.01), but not by age, sex, race, or ethnicity. Descriptively, the prevalence of hesitancy declined monotonically with increasing education, ranging from 32% among those with a high school education or less to 1% among those with a graduate degree (see supplemental Fig. 3). Pairwise comparisons confirmed that hesitancy was significantly less prevalent among respondents with a college or graduate degree relative to those with high school education or less (Holm-adjusted p < 0.05). Similarly, hesitancy was significantly less common among respondents with household incomes above $100,000 compared with those earning less than $50,000 or between $50,000 and $100,000. Political identification was also associated with hesitancy status, with Independent respondents significantly more likely to be classified as hesitant relative to Democrats.

In multivariable logistic regression adjusting for all sociodemographic covariates, college educated respondents had significantly lower odds of vaccine hesitancy relative to those with a high school education or less (OR = 0.45, 95% CI = 0.21, 0.93). Similarly, individuals with household incomes above $100,000 had significantly lower odds of vaccine hesitancy compared with those earning less than $50,000 (OR = 0.37, 95% CI = 0.14, 0.86). No statistically significant associations were observed for age, sex, race, ethnicity, or political identification (Fig. 4).

Fig. 4.

Fig. 4

Open in a new tab

Adjusted odds ratios for sociodemographic correlates of vaccine hesitancy status among Florida parents or caregivers of school-age children (n = 491) surveyed in December 2025, approximately three months after Florida's vaccine mandate rollback announcement.

In sensitivity analyses adjusting for child's vaccination history, provider trust, and trust in health authorities (n = 464), vaccine hesitancy remained independently associated with vaccination intention change, with a slightly stronger association for decreased intent (OR = 4.31, 95% CI = 2.17, 8.56) and a modestly attenuated but directionally consistent association for increased intent (OR = 0.49, 95% CI = 0.24, 1.01) relative to the primary model. Child's vaccination history and trust in health authorities were each independently associated with increased vaccination intent OR = 2.68 and OR = 2.84, respectively; both p < 0.05).

Exploratory supplemental analyses tested whether the association between vaccine hesitancy and vaccination intention change differed across sociodemographic subgroups. Among models examining education-by-hesitancy interactions, hesitant respondents with some college education (relative to high school or less) had significantly greater odds of reporting decreased vaccination intentions following the announced policy change; a similar pattern was observed among hesitant respondents with a graduate degree, though this estimate should be interpreted cautiously given sparse cell counts (n = 6). No significant income-by-hesitancy interaction terms were identified, with the exception of a hesitancy-by-income-above-$100,000 term that was likely underpowered (n = 9). Significant political-identification-by-hesitancy interactions indicated that hesitant Democrats (relative to Other/No Preference) had significantly greater odds of reporting decreased vaccination intentions; a similar trend was observed for hesitant Independents (p = 0.07). Hesitant Hispanic respondents (relative to non-Hispanic) had lower odds of reporting decreased vaccination intentions.

4. Discussion

As a cross-sectional study relying on retrospective self-reporting, findings should be interpreted as association rather than evidence that the policy announcement caused changes in vaccination intentions; pre-existing parental attitudes may have shaped both vaccine hesitancy and reported intention changes. Accordingly, findings from this study should be understood as reflecting patterns within a non-probability sample of Florida parents rather than population-representative estimates. These findings should also be interpreted as reflecting changes in intention rather than confirmed changes in vaccination behavior.

Vaccine hesitancy emerged as the dominant predictor of changes in parental vaccination intentions following the policy announcement. This finding is consistent with existing literature demonstrating that hesitancy is one of the most proximal and powerful determinants of vaccination behavior. Hesitancy is often rooted in parental concerns around vaccine safety and side-effects, particularly for new vaccines (Nowak and Cacciatore, 2023). In our sample, though many parents endorsed generally pro-vaccine beliefs, substantial proportions expressed concerns about adverse effects and newer vaccines, which aligns with prior work showing that ambivalence, not outright opposition, often drives hesitancy and subsequent behavioral decisions (Dubé et al., 2015).

These results suggest that policy changes are interpreted through pre-existing attitudes that shape whether individuals become more or less inclined to vaccinate their children. Prior research has similarly demonstrated that vaccine-related beliefs act as a lens through which individuals process health information and policy signals, often reinforcing rather than shifting underlying intentions (Jamison et al., 2019; Opel et al., 2020). Thus, hesitancy may function as a critical mechanism through which policy may influence behavior.

Although descriptive differences in vaccination intentions were observed across political affiliations, these differences were not statistically significant after adjustment, indicating that political identity did not independently predict intention change once hesitancy was accounted for. This pattern aligns with emerging evidence suggesting that the relationship between political affiliation and vaccination behavior is largely mediated by underlying attitudes, trust, and risk perceptions rather than political identity itself (Fridman et al., 2021; Kreps et al., 2020). In other words, while political contexts may shape the development or expression of hesitancy, it is the attitudinal construct of hesitancy that more directly drives behavioral intentions.

Findings from this study can be connected to a wider theoretical base around social norms. For example, Tankard and Paluck (2016) argue that policy decisions from authority figures carry particular normative weight because they are simultaneously visible to many group members and interpreted as reflecting or directing collectively acceptable behavior (Tankard and Paluck, 2016). When a government or public official takes a position on a health behavior, people use that signal to update their sense of what others around them think and do. Florida's announced elimination of school entry vaccine requirements is an example of such a signal, one that in this case challenged rather than aligned with the existing expectation that vaccination is a normative part of school entry. Existing research suggests that when policy decisions contradict prevailing public opinion in this way, people do not respond uniformly. Instead, responses tend to polarize along pre-existing attitudinal lines (Clark et al., 2024). For already hesitant parents, the announced policy change may have validated pre-existing resistance and lowered the social cost of acting on it, effectively giving them permission to follow through on doubts they already held (Tankard and Paluck, 2016).

For non-hesitant parents, the same announcement may have made their commitment to vaccination feel more important to affirm, reinforcing rather than undermining their intentions (Tankard and Paluck, 2017). Our data are consistent with this account. Hesitant parents were substantially more likely to report decreased vaccination intentions following the policy change (43.8% vs. 12.6% among non-hesitant respondents), while non-hesitant parents were substantially more likely to report increased intentions (50.4% vs. 15.7%). The net effect is not a uniform shift in either direction but suggests a polarization of attitudes between hesitant and non-hesitant parents. These findings suggest that differences in vaccination intentions between hesitant and non-hesitant parents could contribute to future disparities in vaccination uptake, but longitudinal studies are needed to determine if such patterns emerge.

The differences in vaccination intention between hesitant and non-hesitant participants indicate that vaccine disparities may widen. Recent declines in childhood vaccinations in the US are already leading to outbreaks (e.g., measles, pertussis) and threatening decades of pediatric immunization progress (Brumbaugh et al., 2025). Amid declining vaccination rates and policy debates surrounding childhood vaccination, one study modeled long-term effects of decreased childhood vaccinations, finding that a 50% decline in childhood vaccines over 25 years could result in 10.3 million hospitalizations and over 150,000 deaths (Kiang et al., 2025). Our findings that vaccine hesitancy status is strongly associated with lower vaccination intentions are consistent with other US studies indicating that vaccine hesitancy is a barrier to pediatric vaccine uptake (Nowak and Cacciatore, 2023). Our study contributes to the literature on the scope of pediatric vaccine hesitancy and associated factors, which can strengthen public health programming and direct resources to primary causes of low uptake.

While policy is often the strongest lever for change in public health, including for vaccination, (The Community Guide, n.d.) vaccine hesitancy must be addressed through multiple levels of influence, especially when policy does not align with evidence-based and science-based recommendations. Thus, healthcare providers and leaders in health organizations and local public health programs will need to continue addressing vaccine hesitancy. To increase community demand for vaccinations in contexts where state immunization policies are misaligned with best public health practices, evidence-based interventions might include client/family incentive rewards, client reminder/recall systems, and standing orders. Moreover, multi-component community-based interventions and healthcare system-based interventions leverage multiple intervention points to achieve greater impact (The Community Guide, 2026). These interventions may need to be tailored to different segments of the population based on their baseline vaccine hesitancy levels.

Several methodological limitations warrant consideration. First, the sample size (N = 491) constrained statistical power – particularly for subgroup and interaction analyses (e.g., hesitant respondents with graduate degrees or incomes above $100,000). Findings from these analyses should be interpreted cautiously. Second, the sample does not fully represent the sociodemographic diversity of the state of Florida. Relative to 2024 American Community Survey estimates, the sample underrepresented Hispanic respondents and higher-income households, and overrepresented Black or African American respondents, which may limit the precision of observed estimates and restrict the generalizability of findings. The study also excluded non-English speaking participants. There were few sexual minority respondents, limiting analysis with this group. Similarly, survey panels are useful for rapid data collection in evolving sociopolitical contexts but are self-selected and limited to people with internet connections (Scherpenzeel, 2018). Additionally, findings may not be generalizable to states with demographic compositions, political environments, vaccination policies, or public health infrastructures dissimilar from Florida.

Third, the cross-sectional design and reliance on self-reported intention data preclude causal inference; it is not possible to determine whether observed associations reflect enduring attitudes or responses shaped by survey context. Fourth, self-reported change in vaccination intention may not correspond to actual vaccination behavior and is subject to social desirability and recall biases. While intention measures are commonly used as proxies for behavior, they do not provide direct evidence of vaccine uptake. Further, because the survey was conducted at a single time point after the policy announcement, responses reflect retrospective self-reported changes in intention and cannot establish temporal ordering or causality.

Fifth, binary classification of vaccine hesitancy, while consistent with prior research, obscures meaningful variation by the nature and intensity of hesitant beliefs. However, our main findings were consistent with estimates from sensitivity analyses that examined vaccine hesitancy as a continuous variable. Sixth, political orientation was measured using self-identified party affiliation only. This measure does not capture strength of political beliefs, or attitudes about public health policies, which may inform vaccination decisions. Seventh, we were unable to assess participants' prior exposure to vaccine misinformation. Finally, the complexity of the relationships observed – including the patterning of hesitancy by socioeconomic and political factors and its moderating role in policy responses – suggests that more sophisticated modeling strategies (e.g., mediation analysis, latent class approaches) and more comprehensive measures of political beliefs would be valuable in future investigations with larger, more representative samples.

5. Conclusions

This study examined whether parents reported changes in intentions to vaccinate children following Florida's announced vaccine mandate changes. Overall, vaccine hesitancy was the strongest predictor of changes in intention to vaccinate. Additionally, parents who are already vaccine hesitant may become more so without state-level vaccine requirements. Within this sample, parents with higher levels of vaccine hesitancy were more likely to report decreased vaccination intentions in relation to the policy announcement, while non-hesitant parents were more likely to report increased intentions. Additional research is needed to assess whether similar patterns emerge in other states following comparable policy changes.

While the findings from this study cannot be generalized beyond Florida, public health practitioners and researchers should continue to assess the relationship between state policy and vaccination intention. Such attention is needed because state policies that revise pediatric vaccine requirements may undermine protections conferred through pediatric vaccination and potentially deepen vaccine disparities, particularly when combined with vaccine hesitancy. Future research examining vaccination coverage post-announcement and ongoing vaccination monitoring may provide additional insight about how changing vaccination policies informs parental decision-making and can inform needed responses from local public health leaders.

CRediT authorship contribution statement

Nolan Kline: Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation, Conceptualization. Sobur Ali: Writing – review & editing, Formal analysis. Stacey B. Griner: Writing – original draft, Conceptualization. Sarah B. Maness: Writing – original draft, Conceptualization. Laura Merrell: Writing – original draft, Conceptualization. Erika L. Thompson: Writing – original draft, Conceptualization. Christopher W. Wheldon: Writing – original draft, Conceptualization. Connor Martz: Writing – original draft, Formal analysis.

Declaration of competing interest

ELT is a speaker and consultant with Merck. She has received Merck Investigator Studies Program funding for HPV vaccination research through her university unrelated to this work. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data availability

Data will be made available on request.

References

  1. Ali S., Griner S.B., Neelamegam M., Fogle S., Kline N. COVID-19 vaccine hesitancy among Latinx individuals in North Texas: understandings from a community study. Hum. Vaccin. Immunother. 2025;21(1) doi: 10.1080/21645515.2025.2597107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bolsen T., Palm R. Politicization and COVID-19 vaccine resistance in the US. Prog. Mol. Biol. Transl. Sci. 2022;188(1):81–100. doi: 10.1016/bs.pmbts.2021.10.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brumbaugh K., Gellert F., Mokdad A.H. Understanding vaccine hesitancy: insights and improvement strategies drawn from a multi-study review. Vaccines. 2025;13(10):1003. doi: 10.3390/vaccines13101003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CDC Vaccination Coverage among Adolescents (13–17 Years) TeenVaxView. 2025 https://www.cdc.gov/teenvaxview/interactive/index.html Accessed April 18, 2026. [Google Scholar]
  5. CDC Vaccination Coverage among Young Children (0–35 Months) ChildVaxView. 2026 https://www.cdc.gov/childvaxview/about/interactive-reports.html Accessed April 18, 2026. [Google Scholar]
  6. CDC C for DC and P Ten great public health achievements--United States, 1900–1999. MMWR Morb. Mortal Wkly. Rep. 1999;48(12):241–243. [PubMed] [Google Scholar]
  7. Clark C.S., Paluck E.L., Westwood S.J., Sen M., Malhotra N., Jessee S. Effects of a US supreme court ruling to restrict abortion rights. Nat. Hum. Behav. 2024;8(1):63–71. doi: 10.1038/s41562-023-01708-4. [DOI] [PubMed] [Google Scholar]
  8. Community Guide. CPSTF Findings for INcreasing Vaccination The Community Guide. 2026. https://www.thecommunityguide.org/pages/task-force-findings-increasing-vaccination.html
  9. Dubé E., Vivion M., MacDonald N.E. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev. Vaccines. 2015;14(1):99–117. doi: 10.1586/14760584.2015.964212. [DOI] [PubMed] [Google Scholar]
  10. El-Mohandes A., White T.M., Wyka K., et al. COVID-19 vaccine acceptance among adults in four major US metropolitan areas and nationwide. Sci. Rep. 2021;11(1):21844. doi: 10.1038/s41598-021-00794-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fridman A., Gershon R., Gneezy A. COVID-19 and vaccine hesitancy: a longitudinal study. PLoS One. 2021;16(4) doi: 10.1371/journal.pone.0250123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hill H.A., Yankey D., Elam-Evans L.D., et al. Vaccination coverage by age 24 months among children born in 2021 and 2022—National Immunization Survey-Child, United States, 2022–2024. MMWR Morb. Mortal Wkly. Rep. 2026;75 doi: 10.15585/mmwr.mm7511a2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jamison A.M., Quinn S.C., Freimuth V.S. “You don’t trust a government vaccine”: narratives of institutional trust and influenza vaccination among African American and white adults. Soc. Sci. Med. 2019;221:87–94. doi: 10.1016/j.socscimed.2018.12.020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kiang M.V., Bubar K.M., Maldonado Y., Hotez P.J., Lo N.C. Modeling reemergence of vaccine-eliminated infectious diseases under declining vaccination in the US. Jama. 2025;333(24):2176–2187. doi: 10.1001/jama.2025.6495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kreps S., Prasad S., Brownstein J.S., et al. Factors associated with US adults’ likelihood of accepting COVID-19 vaccination. JAMA Netw. Open. 2020;3(10) doi: 10.1001/jamanetworkopen.2020.25594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nowak G.J., Cacciatore M.A. State of vaccine hesitancy in the United States. Pediatr. Clin. 2023;70(2):197–210. doi: 10.1016/j.pcl.2022.11.001. [DOI] [PubMed] [Google Scholar]
  17. Opel D.J., Salmon D.A., Marcuse E.K. Building trust to achieve confidence in COVID-19 vaccines. JAMA Netw. Open. 2020;3(10) doi: 10.1001/jamanetworkopen.2020.25672. [DOI] [PubMed] [Google Scholar]
  18. Ruiz J.B., Bell R.A. Predictors of intention to vaccinate against COVID-19: results of a nationwide survey. Vaccine. 2021;39(7):1080–1086. doi: 10.1016/j.vaccine.2021.01.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Scherpenzeel A.C. Social and Behavioral Research and the Internet. Routledge; 2018. How representative are online panels? Problems of coverage and selection and possible solutions; pp. 105–132. [Google Scholar]
  20. Shapiro G.K., Tatar O., Dube E., et al. The vaccine hesitancy scale: psychometric properties and validation. Vaccine. 2018;36(5):660–667. doi: 10.1016/j.vaccine.2017.12.043. [DOI] [PubMed] [Google Scholar]
  21. Sonawane K., Zhu Y., Montealegre J.R., et al. Parental intent to initiate and complete the human papillomavirus vaccine series in the USA: a nationwide, cross-sectional survey. Lancet Public Health. 2020;5(9):e484–e492. doi: 10.1016/S2468-2667(20)30139-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Szilagyi P.G., Albertin C.S., Gurfinkel D., et al. Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine. 2020;38(38):6027–6037. doi: 10.1016/j.vaccine.2020.06.074. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tankard M.E., Paluck E.L. Norm perception as a vehicle for social change. Soc. Issues Policy Rev. 2016;10(1):181–211. [Google Scholar]
  24. Tankard M.E., Paluck E.L. The effect of a supreme court decision regarding gay marriage on social norms and personal attitudes. Psychol. Sci. 2017;28(9):1334–1344. doi: 10.1177/0956797617709594. [DOI] [PubMed] [Google Scholar]
  25. Vaccination Programs: Requirements for child care, school, and college attendance. The Community Guide. Accessed April 18, 2026. https://www.thecommunityguide.org/findings/vaccination-programs-requirements-child-care-school-and-college-attendance.html.
  26. Zimmerman T., Shiroma K., Fleischmann K.R., et al. Misinformation and COVID-19 vaccine hesitancy. Vaccine. 2023;41(1):136–144. doi: 10.1016/j.vaccine.2022.11.014. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data will be made available on request.

Articles from Preventive Medicine Reports are provided here courtesy of Elsevier

RESOURCES