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Expert Rev Vaccines . Birth order and influenza vaccination: a comparative study of behaviors and intentions between first-time and second-time Chin

tetano

Editor, Senior Moderator
Expert Rev Vaccines


. 2025 Oct 16.
doi: 10.1080/14760584.2025.2576235. Online ahead of print. Birth order and influenza vaccination: a comparative study of behaviors and intentions between first-time and second-time Chinese parents

Kan Chen[SUP] 1 [/SUP], Zhexin Xu[SUP] 1 [/SUP], Yi Zhou[SUP] 1 2 [/SUP], Linchen Chu[SUP] 3 [/SUP], Hongni Wang[SUP] 1 2 [/SUP], Chuanxi Fu[SUP] 1 2 [/SUP]



Affiliations
Abstract

Background: This study investigates the impact of birth order on influenza vaccination behaviors and intentions among parents of children under 6 years of age, and identifies factors contributing to vaccination disparities to inform targeted strategies for reducing health inequities.
Research design and methods: A national cross-sectional survey in China (July - August 2024) using stratified sampling, with 3,569 parents of children aged 0-6 completing a WHO-DVH Matrix-based questionnaire. Logarithmic regression examined the relationship between age and vaccine hesitancy/vaccination rates. Random forest analysis identified key predictors, while one-way ANOVA examined influencing factors.
Results: Among respondents, 66.9% were first-time parents and 33.1% second-time parents. Vaccination rates for first-born children were lower than those for second-born children before 40 months (64.9% vs. 71.7%, p = 0.022), while vaccine hesitancy was higher among first-time parents before 49 months (58.6% vs. 49.9%, p < 0.001). These differences diminished after age three. Key predictors of vaccination intention included 'Immunization as a social norm' and perceptions of the 'Pharmaceutical industry.'
Conclusions: First-time parents demonstrate lower vaccination rates and higher hesitancy to children, particularly before age three, influenced by social norms and vaccine confidence. These findings provide empirical evidence for birth order-based strategies to improve vaccine equity.

Keywords: Birth order; First-time parents; Influenza vaccination; Random Forest; Second-time parents; Vaccine hesitancy.

 
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