{
  "abstract": "Background: Childhood vaccination is a cost-effective intervention for preventing vaccine-preventable diseases. However, the specific mechanisms by which parental education level influences willingness to vaccinate (WTV) for self-paid child vaccines remain unexplored.\n\nObjectives: This study investigates the mediating roles of family income, vaccine awareness, and trust in self-paid child vaccines in the relationship between parental education and WTV for self-paid child vaccines, including pentavalent, EV71, varicella, and flu vaccines in China.\n\nMethods: A survey of 2,212 households with children under five in Hangzhou, Zhejiang Province, was conducted. Mediation analysis was used to assess the effects of family income, vaccine awareness, and trust on WTV.\n\nResults: Our findings indicate that family income was an important pathway linking parental education to WTV, particularly for flu and varicella vaccines. After family income was introduced, the association between parental education and WTV was attenuated, suggesting that income may play an important mediating role. For the pentavalent vaccine, vaccine awareness and trust in self-paid vaccines also attenuated this association. These findings suggest that, although economic factors are important, non-economic factors such as vaccine awareness and trust in self-paid vaccines should also be considered.\n\nConclusion: Addressing financial barriers is crucial for increasing vaccine uptake for self-paid child vaccines in developing countries. Public health strategies should prioritize financial assistance programs and targeted communication efforts to build trust and ensure equitable access to essential vaccinations.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences",
    "Vanke School of Public Health, Tsinghua University",
    "Institute for Healthy China, Tsinghua University",
    "School of Public Health, Capital Medical University",
    "Department of Medicine, Rutgers University",
    "Nanyang Technological University",
    "School of Pharmaceutical Sciences, Tsinghua University",
    "Department of Economic Management, Huazhong Agricultural University",
    "School of Public Health, Zhejiang University School of Medicine",
    "Department of Health Data Science, Anhui Medical University",
    "MOE Key Laboratory of Population Health Across Life Cycle",
    "China Medical Board, Beijing Office"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Linbo Xie"
    },
    {
      "affs": [
        3
      ],
      "name": "Zhihan Wu"
    },
    {
      "affs": [
        4
      ],
      "name": "Qiao Zhang"
    },
    {
      "affs": [
        5
      ],
      "name": "Kehan Wang"
    },
    {
      "affs": [
        6
      ],
      "name": "Ziyan Zhu"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Zihan Wang"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Peiyao Li"
    },
    {
      "affs": [
        7
      ],
      "name": "Siyu Chen"
    },
    {
      "affs": [
        8
      ],
      "name": "Junfang Xu"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Min Yuan"
    },
    {
      "affs": [
        11
      ],
      "name": "Jiming Zhu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1gsk0ccm2x815.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1804018",
  "fulltext_url": "https://europepmc.org/articles/PMC13713807",
  "id": "1gsk0ccm2x815",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1804018/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "3306|Vaccine Coverage and Hesitancy"
    ]
  ],
  "openalex": "W7221830606",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1804018/pdf",
  "pmcid": "PMC13713807",
  "pmid": "42952823",
  "published": "2026-10-14",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/1gsk0ccm2x815.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:22Z",
      "native_id": "10.3389/fpubh.2026.1804018",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1804018/full"
    },
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42952823",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42952823"
    },
    {
      "first_seen": "2026-11-01T12:21:25Z",
      "native_id": "PMC13713807",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fpubh.2026.1804018"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2296-2565",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Parental education and willingness to vaccinate children with self-paid vaccines in Hangzhou, China: a cross-sectional study",
  "title_text": "Parental education and willingness to vaccinate children with self-paid vaccines in Hangzhou, China: a cross-sectional study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:25Z",
  "url": "https://research.draconitic.com/paper/1gsk0ccm2x815",
  "venue": "Frontiers in Public Health",
  "versions": []
}