Date of Defense


Date of Graduation




First Advisor

Sally Vliem

Second Advisor

Dawn Smith


nonmedical exemptions, vaccine coverage, vaccine preventable diseases


Vaccinations are a safe and effective way to prevent the spread of disease. In recent years, vaccine coverage rates have declined while nonmedical exemption rates have increased. These changes have contributed to increased prevalence of vaccine preventable diseases. Declining vaccine coverage and increasing nonmedical exemptions are a threat to public health and the relationship between these factors needs to be understood. Clusters and outbreaks of vaccine preventable diseases have occurred as a result of more people declining vaccination. Factors that may incline someone to refuse vaccination include safety concerns, lack of trust, freedom of choice, decreased understanding for the need, technology, and accessibility. The ease of obtaining a nonmedical exemption is associated with the increase in nonmedical exemptions and decrease in coverage. States with more stringent exemptions policies have lower rates of exemptions and states that do not accept nonmedical exemptions have increased vaccine uptake. Recommendations to improve vaccine coverage include changes to areas such as education, accessibility, finances, and laws and policies.

Access Setting

Honors Thesis-Open Access

Included in

Nursing Commons