OBJECTIVE: To determine knowledge and attitudes of elementary school parents regarding the hepatitis B immunization including site of vaccination and consent preferences.

METHODS: A survey was distributed to 1,011 parents of 4^th grade students at schools of all strata of socioeconomic status throughout a large urban school district. 563 parents responded (55.7%). Parents were asked what shots they were sure their children had received, knowledge questions about transmission of hepatitis B, the likelihood that their child could contract the disease of hepatitis B, where they preferred that their children be immunized, how they wanted to consent for the vaccination, zip code (to determine the median household income variable), race, ethnicity, and primary language spoken at home. Responses were examined using frequencies, chi squares, ANOVA, and t-tests.

RESULTS: Of the respondents, 62% were black, 27% white, 1% Asian, and 10% other. 77.5% self-identified as Hispanic, 62% speak English and 37% speak Spanish at home. 60%, 55%, and 39% responded that one can not get the disease from unprotected sex, IV drugs or exposure to infected blood, respectively. 7% reported that the virus can be transmitted via vaccination. 20% of parents report that their children do not have the vaccine. Overall preference for site of vaccination was: private doctor 31%, neighborhood clinic 27%, mobile clinic 1%, and school 40%. 47% noted that parents should have to sign consent 3 times and be present for the shots, 27% felt parents should have to sign consent for each shot, 24% felt parents should have to sign one consent for all three shots, and 2% did not feel parents should have to sign consent. Median income was not associated with whether the child had the hepatitis B vaccination or perceived likelihood of disease acquisition but was associated with site preference: those preferring neighborhood clinics had a significantly lower income level than those preferring school or private doctors' offices (P=0.001). Hispanics were also more likely to prefer school for vaccination (P=0.001). Race and primary language spoken at home were not associated with site preference, but blacks were more likely to report higher risk of disease acquisition. Income, ethnicity, primary language spoken at home, and race were not associated with consent preferences.

CONCLUSIONS: An alarming number of parents do not have correct knowledge regarding the risk factors for acquiring hepatitis B. A significant number of 4^th graders are still not immunized. Although many parents prefer school as the site of immunization, they still prefer the maximum amount of involvement for consent.