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Kevin Estep, PhD, assistant professor in the Department of Cultural and Social Studies in Creighton’s College of Arts and Sciences, and Pierce Greenberg, PhD, also an assistant professor in the department, published “Opting Out: Individualism and Vaccine Refusal in Pockets of Socioeconomic Homogeneity” in the American Sociological Review this month. The article will appear in print in the journal’s December 2020 issue.
The study examines why certain California communities report higher numbers of “personal belief exemptions” (PBEs) to childhood vaccine requirements in local schools. Estep and Greenberg propose that families with similar values and views on parenting cluster in certain neighborhoods, creating “pockets of homogeneity.” Living around like-minded people, parents inclined to opt-out of vaccines are less likely to have their beliefs challenged and more likely to feel as though the choice to not vaccinate their children is socially acceptable and safe.
“When you think about it, certain kinds of places attract people that think a certain way,” Estep says. Affluent families have more freedom to be selective about where they live, and “as there’s more geographic mobility, they have the ability to insulate themselves residentially and around school districts. So, our argument is that people have more and more opportunities to sort along ideological lines.”
In California, where Estep and Greenberg focused their research, these pockets of homogeneity emerged in schools and school districts of high affluence surrounded by areas of low affluence. These types of communities, they write, often attract parents who are more likely to adopt “an individualist parenting ideology that emphasizes personalization of risks and benefits for children, rather than accepting generic recommendations of medical and public health officials.”
Moreover, the study reports, “the enclave-like features of these pockets could reinforce the tendency to opt out by reducing the social stigma of ‘free-riding’ and by giving a false sense of protection from disease. Consequently, vaccine refusal may be viewed as both a safe and socially acceptable decision in these unique settings.”
Public health experts warn that these areas of low vaccination “are like holes in the protective wall of community health, which weaken herd immunity to infectious diseases and put non-vaccinated individuals and entire communities at risk,” the study states. The rising trend has led to measurable consequences: In 2019, the U.S. experienced its highest number of measles cases in 25 years.
Greenberg and Estep write their research opens the door for a place-based approach to public health measures promoting the importance of childhood vaccinations. Targeting the “at risk” areas like those described in the study, public health officials can implement education strategies that “denormalize” vaccine refusal and associate timely vaccination with good parenting.
The research, Estep says, has implications beyond the issue of childhood vaccinations. The COVID-19 pandemic has highlighted disputes over the rights of the individual versus the public good, particularly in regard to mask mandates and social distancing requirements.
“Thus, our argument about pockets of homogeneity might help officials address other situations where noncompliance with public health recommendations or directives in certain spatial contexts could be problematic,” the study states. “Our theory suggests people in pockets of homogeneity may be more likely than others to resist those recommendations — their neighborhoods or surroundings might feel like a protected space, and neighbors may be more likely to excuse such resistance.”
