estimates of disease risks that families can compare with the quantified risks associated with the vaccines that are described in the VIPs. 1
The committee agreed that families' fears and the small but real risks of adverse reactions to vaccines must be acknowledged, but that more needs to be done to communicate the benefits of immunization. James Feist suggested that providers such as himself who must use the VIPs should have a greater role in developing them. Providers also may benefit from a better understanding of the formal principles and techniques developed by risk communication specialists.
Importance of immunization by 2 years of age. Providers, public health officials, and the many others who have a role in immunization education need to deliver a clear message that children must have most of their immunizations before they are 2 years old. They need to counter the impression that requirements for full immunization for school entry mean that children do not need to be immunized until then.
Education by providers and office staff. All members of the health care system need to be able to educate families about their children's immunization requirements. Physicians and nurses are important sources of information and should be able to provide detailed guidance about vaccines and immunization schedules. Other office and clinic staff also provide important information to families and need to be informed contributors to immunization education efforts. They can help keep parents aware of their children 's immunization schedules and endorse the value of immunization for keeping children healthy. Understanding the values and culture of the families being served contributes to successful communication and education. Development of a lay version of CDC's
Providers' perceptions of how families view the VIPs need to be validated. A study published after the workshop was held found that 76 percent of the parents who received the pamphlets said that the information encouraged them to have their children immunized (Clayton et al., 1994). By comparison, only 38 percent of the parents whose children were immunized before the VIPs were introduced gave a similar response regarding the information they received. The study does not provide a complete picture, however. Because it included only parents whose children received immunizations, it does not reflect the views of any parents who may have chosen not to have their children immunized.