Date of Completion


Embargo Period



Mary Fischer, Mary Bernstein

Field of Study



Master of Arts

Open Access

Open Access


Much of the current research that exists on vaccine refusal focuses on point-in-time examinations of who is refusing and how exemptions impact disease outbreaks. In the present study I address the question of who is refusing vaccines over the course of the last two decades. I specifically examine how social class influences the propensity to refuse vaccines over time. Using pooled cross-sectional National Immunization Survey data from 1995 to 2012, I estimate binary logistic regressions on the probability of being unvaccinated. The results indicate that social class does impact the propensity to refuse vaccines, but in dynamic ways. Two components of social class––education and household income––operate in opposite directions. Initially, higher levels of income decrease the odds of being unvaccinated, while higher levels of education increase the odds of being unvaccinated. However, over time income replaces education as a predictor of vaccine refusal. The changing relevance of education and income are made clearer in the key finding of this study, which is that families with status offsets––high income/low education and low income/high education––have had the greatest growth in vaccine refusal since 1995. These results suggest that class status, as it relates to vaccine refusal, influences people in dynamic ways.

Major Advisor

Jeremy Pais