Introduction
Vaccine hesitancy, the “delay in acceptance or refusal of vaccines, despite their availability,”1 is a growing threat to public health.2,3 Researchers have spent significant time documenting and analyzing vaccine hesitancy in the human context.2,3 More recently, several analyses have started to shift the focus towards pet owners.4,5 While research has been limited in this era, there is evidence of declining pet vaccination rates over time.6,7 Growing vaccine hesitancy and corresponding declines in vaccination rates are not only a concern from a public health perspective but may also detrimentally affect veterinarians and other care providers5–7 as well as pet owners.8
There is evidence that the type and number of sources of vaccine information are contributing factors to vaccine hesitancy.3,9–12 Indeed, while medical providers serve as an important source of vaccine information, today parents and pet owners have easy access to a wide variety of information sources.13,14 However, the seeking out of vaccine information from nonmedical professionals raises concerns for a variety of reasons, including association with vaccine hesitancy in general, preference for “alternative” vaccination schedules,9 and lower factual knowledge about vaccines.3,9–12
At the same time, a number of studies15–17 have affirmed the crucial role that trust plays in provider-patient relationships in general, and these findings have also held for veterinarians.18–24 Higher rates of trust in providers are associated with lower rates of patient turnover, increases in the probability of recommending providers to others, and compliance with treatment regimens.15,22 Trust in medical providers also plays a crucial role in the decision-making process related to vaccinations, and parents who trust their medical providers are more likely to accept recommended vaccines.4,10,19,25–29 Veterinarians are in an excellent position to encourage appropriate vaccination behavior because they have been consistently identified as one of the most trusted professions.30,31 However, while there is evidence that trust in medical providers and use of nonprovider sources of vaccine information are connected for child vaccinations,32 the issue has yet to be explored in the veterinary context.
With a national survey of 2,853 dog and 1,977 cat owners, this study assessed the association between pet owners’ trust in veterinarians and the type and number of sources of information related to vaccines as well as the connection between trust and vaccine-related information seeking. Controlling for relevant variables, 3 preregistered hypotheses were evaluated:
Hypothesis 1: pet owners with lower levels of trust in their pet’s veterinarian will list more vaccine information sources compared with owners with higher levels of trust.
Hypothesis 2: owners’ level of trust in their pet’s veterinarian will be associated with the type of vaccine information sources, with higher levels of trust associated with listing veterinarians as primary information sources.
Hypothesis 3: lower levels of trust will be associated with making it a point to read or watch stories about vaccines.
In addition, the connection between vaccination status and trust in veterinarians as well as vaccine information sources was also explored.
Methods
Survey distribution
An online survey was programmed in Qualtrics and fielded by the survey firm Lucid from May 7 to May 15, 2024. Lucid utilizes quota sampling based on national benchmarks to generate the study sample.33 Lucid has been used extensively to assess attitudes about vaccines in general as well as for pet owners.28,34 Lucid’s data have been vetted and determined to be valid and reliable.33,35 A total of 5,784 respondents completed the survey (completion rate, 61.9%). In order to further improve the national representativeness of the data, survey weights based on gender, race, income, and education were developed and applied (Supplementary Table S1; Supplementary Figure S1). The weights ensured that the analyses better matched national data for these variables. Of the 5,784 respondents who completed the survey, 2,853 indicated that they owned at least 1 dog (49.3%) and 1,977 (34.2%) indicated that they owned at least 1 cat (Supplementary Table S2). Pet ownership rates matched recent research4,5 as well as other national surveys.36,37 The study received approval from the institutional review board at Texas A&M University.
Survey design and inclusion criteria
After entering the survey, respondents were asked whether they currently owned at least 1 cat or 1 dog. Respondents who answered in the affirmative were included in the study and then received a number of questions on pet ownership (Supplementary Table S2) as well as vaccines and trust in their veterinarians.
Dependent variables
To learn more about their sources of vaccine information, respondents were asked, “Which of the following are sources you get vaccine information from?” Respondents were then instructed to mark all sources that applied. The list was an adapted version from research32 on this topic in the human context and included the following (Supplementary Table S2):
My [dog’s/cat’s] veterinarian
Other veterinary professionals
Government agencies like the Department of Public Health or CDC
The internet
TV, radio, books, and magazines
Owners who believe their [dog/cat] was hurt by a vaccine
Other [dog/cat] owners
Other friends or family
Any other sources of information about vaccines
Affirmative responses were summed to establish a count of the number of sources used for each owner. Subsequently, respondents were asked which of these sources served as their primary source for vaccine information. Additionally, respondents were asked whether they agreed with the statement “I make a point to read or watch stories about vaccines” and offered a standard 5-point scale from “strongly disagree” to “strongly agree,” with a neutral midpoint. Lastly, pet owners were queried about the vaccination status of their pet for 3 core vaccines (dogs: rabies, canine parvovirus, canine distemper; cats: rabies, feline panleukopenia, feline herpesvirus-1) and 2 noncore vaccines (dogs: canine influenza and Lyme disease; cats: feline Chlamydia [chlamydophilosis] and feline Bordetella).
Trust measures
Trust for veterinarians among pet owners related to vaccinations was measured with an approach developed in the human context.32 The overall measure was composed of 4 individual items. Three of these items are part of the Parent Attitudes About Childhood Vaccines survey, a measure developed to assess the vaccine hesitancy of parents as well as parental concerns about vaccinations.38,39 These items were adapted to the context of care for dogs and cats. The 3 items were as follows:
Overall, I trust the information I receive about shots.
I am able to openly discuss my concerns about shots with my [dog’s/cat’s] veterinarian.
All things considered, how much do you trust your [dog’s/cat’s] veterinarian?
The first 2 items were on a 5-point scale from “strongly disagree” to “strongly agree,” with a neutral midpoint, while the third item was on an 11-point scale from “strongly disagree” to “strongly agree.” The fourth item comes from the CDC’s National Immunization Survey and asked, “In general, medical professionals in charge of vaccinations have my [dog’s/cat’s] best interests at heart.” Respondents were again offered a 5-point scale from “strongly disagree” to “strongly agree,” with a neutral midpoint.
Following Eller et al,32 as well as the common procedure to score the Parent Attitudes About Childhood Vaccines survey,38,39 scores of 0, 1, or 2 were assigned, with “a score of 0 for responses suggestive of high trust, a score of 1 for responses suggestive of intermediate trust, and a score of 2 for responses suggestive of low trust.” Scores for each participant were then summed to create a scale from 0 to 8 (Supplementary Table S3). Again following Eller et al,32 the score was then dichotomized into trusting individuals (a score of 0) and less trusting individuals (scores from 1 to 8). This measure served as the primary measure of interest in the analyses that follow. As a robustness check, an alternative measure of trust that has been used extensively in survey research by highly reputable pollsters like the Pew Research Center and the American National Election Study, was also included. The survey item queried respondents about how confident they were that veterinarians acted in the best interest of the public. Respondents were offered 4 distinct choices from “no confidence at all” to “a great deal.” All findings presented here were confirmed with this alternate measure (omitted).
Additional explanatory measures
In addition to the measures of trust, respondents were also queried about their relationship with their veterinarian, as prior research32 indicates the importance of long-standing relationships between patients and their medical providers and there is some evidence to indicate that this might also be the case for pet owners.4 Specifically, respondents were asked how long they had been with their current veterinarian, with response options for < 1 year, 1 to 2 years, 2 to 5 years, and > 5 years.8 Subsequently, owners were asked about the number of pets at their residence, offering 5 options from 1 dog (or cat) to 5 or more dogs (or cats).8
Moreover, a number of variables that have been shown to serve as important correlates of vaccine-related behavior were established. The first such variable was respondent ideology as liberal, moderate, or conservative.5,40 Moreover, because human-focused research27,40,41 has established that vote choice in the 2020 presidential election can serve as an independent correlate for vaccine behavior irrespective of ideology, respondents were also asked about their vote choice in that election, a dichotomous indicator for respondents who voted for former President Trump. Owners were also asked about their levels of religiosity with the standard survey question, “How would you classify your level of involvement with your religion or spirituality?” Responses included very inactive, moderately inactive, neither active nor inactive, moderately active, and very active.28
All models also included common controls for pet owners’ gender, education (high school graduation or less, some college, or college graduation), income (up to $14,999; $15,000 to $24,999; $25,000 to $34,999; $35,000 to $49,999; $50,000 to $74,999; and $75,000 and more), age, and race and ethnicity (non-Hispanic White respondents, non-Hispanic Black respondents, non-Hispanic Asian respondents, Hispanic respondents, and a catchall for all other responses).4,27,28,41–44
Statistical analysis
Weighted tests of proportions and t tests were utilized for bivariate analyses. For multivariate analyses, 4 distinct types of models were estimated. First, to assess the number of vaccine-related information sources, weighted Poisson models were estimated. Poisson models are used to estimate the probability of counts (here, the number of information sources). Second, weighted logit models were used to assess correlates for whether veterinarians served as the primary source of vaccine information. Logit models are used for dichotomous outcomes. In this case, they were used to estimate the probability of respondents indicating that veterinarians served as their primary source of information. In both cases, coefficients are not directly interpretable, and average marginal effects (AMEs) were derived for cases where they were statistically significant at conventional levels (P < .05).45 Average marginal effects were particularly useful here because they offered a simple explanation of the findings that mirrored traditional ordinary least-squares models in terms of the direction and effect size of variables.46 For indicator variables, AMEs were calculated for changes from 0 to 1, and for ordinal variables, AMEs were calculated for discrete changes by 1 unit. Third, weighted least-squares models were estimated to assess correlates of whether respondents were actively seeking out information about vaccines. Weighted least-squares models were analogous to standard least-squares models, with the exception that the aforementioned weights were applied to make the data more representative of the national population. Weighted least-squares models were also used to assess the association between trust and vaccination sources and pet vaccination status to serve as linear probability models. Although this is a binary outcome, linear probability models are frequently used to facilitate interpretation because they are directly interpretable and facilitate display, particularly when the number of models displayed is large.
Results
An overview of the overall sample as well as dog and cat owners is presented in Table 1 (also Supplementary Table S4). In terms of trust in veterinarians, the survey identified 62.9% of dog owners (95% CI, 60.7 to 65.1) and 61.2% of cat owners (95% CI, 58.5% to 63.9%) as having high levels of trust (Supplementary Table S5).
Select demographics of respondents.
| Variable | All respondents (weighted) | Dog owners (weighted) | Cat owners (weighted) |
|---|---|---|---|
| Female | 52% | 51% | 51% |
| Non-Hispanic White | 63% | 63% | 70% |
| Non-Hispanic Black | 13% | 10% | 8% |
| Non-Hispanic Asian | 3% | 2% | 2% |
| Hispanic | 17% | 20% | 16% |
| Age (mean) | 48 | 44 | 46 |
| Income (median) | $50,000 to $74,999 | $50,000 to $74,999 | $50,000 to $74,999 |
| Education (median) | Some college | Some college | Some college |
| Liberal | 25% | 25% | 29% |
| Conservative | 30% | 30% | 29% |
| Trump voter | 33% | 35% | 32% |
| Religious activity (median) | Neither active nor inactive | Neither active nor inactive | Neither active nor inactive |
| Trust in veterinarians | |||
| Trusting | |||
| 0 | 63% | 61% | |
| Less trusting | |||
| 1 | 16% | 14% | |
| 2 | 9% | 8% | |
| 3 | 5% | 5% | |
| 4 | 4% | 5% | |
| 5 | 2% | 4% | |
| 6 | 1% | 2% | |
| 7 | < 1% | 1% | |
| 8 | < 1% | < 1% | |
| Time with veterinarian (median) | 2–5 y | 2–5 y | |
| No. of dogs/cats in household (median) | 1 | 1 | |
| No. of sources (median) | 2 | 2.3 | |
| Veterinarian as primary source | 77% | 73% | |
| Making it a point to seek out vaccine information (median) | 3 | 3 | |
| Vaccination status | |||
| Canine: rabies | 96% | ||
| Canine: parvovirus | 90% | ||
| Canine: distemper | 89% | ||
| Feline: rabies | 88% | ||
| Feline: panleukopenia | 77% | ||
| Feline: herpes | 75% |
Weighted data are displayed. Analyses were based on data collected by the author from an online survey of 5,784 US residents (May 7 to May 15, 2024). Of these, 2,853 owned a dog (49%) and 1,977 owned a cat (34%). Additional information is displayed in Supplementary Table S4.
Number of sources of vaccine information
On average, dog owners indicated that they consulted 2.50 sources (95% CI, 2.42 to 2.58) about vaccine information (Supplementary Table S6). Veterinarians were the most commonly mentioned source for both trusting (93.9%) and less trusting owners (76.6%), and the difference was statistically significant (P < .001). For both, the internet was the second most common source, although less trusting owners cited it more frequently (36.3% vs 41.2%; P = .033). The groups also differed with regard to those who believed their dog was hurt by a vaccine (8.1% vs 11.0%; P = .036). No differences were identified between the groups for the remaining sources of information, including social media, other dog owners, other friends or family, government sources, other veterinary professionals, and TV, radio, books, and magazines (Supplementary Table S7).
Cat owners consulted, on average, 2.27 sources (95% CI, 2.17 to 2.37; Supplementary Table S8). Veterinarians again were the most commonly listed sources for both trusting (94.4%) and less trusting individuals (67.4%), and the difference was once again statistically significant (P < .001), followed by the internet (28.2% vs 35.3%; P = .009). However, there were also differences for social media (12.9% vs 17.9%; P = .021). All other sources were indistinguishable, including other veterinary professionals; government sources; TV, radio, books, and magazines; owners who believed their cat was hurt by a vaccine; other cat owners; other friends or family; and other sources (Supplementary Table S9).
The multivariate Poisson models found no statistically significant differences between trusting and less trusting dog owners or cat owners, respectively, going against the first hypothesis (Table 2; Supplementary Table S10). However, liberal dog owners, on average, relied on 0.213 additional sources (P = .028), while female dog owners relied on 0.304 fewer sources (P < .001). Moreover, both religiosity (0.096; P = .001) and educational attainment (0.128; P = .009) were associated with more sources, while age (–0.007; P = .003) was associated with fewer sources. Cat owners who voted for former President Trump relied on fewer sources (–0.188; P = .045), while Hispanic cat owners relied on more sources compared to White cat owners (0.342; P = .025). Findings related to religion (0.120; P < .001), gender (–0.347; P < .001), education (0.170; P = .003), and age (–0.011; P < .001) were similar to dog owners.
Results for analyses of number of sources, veterinarians as primary source of vaccine information, and information seeking.
| Variable | No. of sources | Veterinarian as primary source | Information seeking | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Dog owners (1) Poisson coefficient | AME | Cat owners (2) Poisson coefficient | AME | Dog owners (3) Logit coefficient | AME | Cat owners (4) Logit coefficient | AME | Dog owners (5) WLS coefficient | Cat owners (6) WLS coefficient | |
| Trust in veterinarians (binary) | 0.008 (0.793) | –0.021 (0.601) | 1.204*** (0.000) | 0.201 0.000 | 1.354*** (0.000) | 0.252 0.000 | 0.231*** (0.000) | 0.362*** (0.000) | ||
| Time with veterinarian (reference, < 1 y) | ||||||||||
| 1–2 y | 0.085# | 0.019 | 0.198 | 0.060 | 0.173* | 0.424*** | ||||
| (0.070) | (0.766) | (0.253) | (0.760) | (0.029) | (0.000) | |||||
| 2–5 y | –0.009 | –0.046 | 0.462** | 0.077 | 0.200 | 0.082 | 0.182# | |||
| (0.839) | (0.414) | (0.010) | 0.011 | (0.312) | (0.318) | (0.081) | ||||
| > 5 y | –0.049 | –0.109# | 0.787*** | 0.122 | 0.568** | 0.095 | –0.033 | 0.045 | ||
| (0.300) | (0.057) | (0.000) | 0.000 | (0.005) | 0.005 | (0.683) | (0.648) | |||
| (0.261) | (0.421) | (0.198) | (0.349) | (0.754) | (0.744) | |||||
| Liberal (binary) | 0.084* | 0.213 | 0.051 | –0.419** | –0.067 | –0.158 | 0.272*** | 0.171* | ||
| (0.025) | 0.028 | (0.279) | (0.004) | 0.005 | (0.358) | (0.000) | (0.040) | |||
| Conservative (binary) | –0.074# | –0.000 | –0.149 | –0.057 | –0.113# | –0.070 | ||||
| (0.057) | (0.998) | (0.340) | (0.768) | (0.097) | (0.404) | |||||
| Trump voter (binary) | –0.012 | –0.086* | –0.188 | –0.137 | 0.184 | 0.019 | 0.011 | |||
| (0.745) | (0.046) | 0.045 | (0.318) | (0.298) | (0.756) | (0.893) | ||||
| Religious activity (5 points) | 0.038*** | 0.096 | 0.052*** | 0.120 | –0.095* | –0.064 | 0.151*** | 0.165*** | ||
| (0.001) | 0.001 | (0.000) | 0.000 | (0.042) | (0.194) | (0.000) | (0.000) | |||
| Female (binary) | –0.123*** | –0.304 | –0.154*** | –0.347 | 0.526*** | 0.080 | 0.213 | –0.242*** | –0.234*** | |
| (0.000) | 0.000 | (0.000) | 0.000 | (0.000) | 0.000 | (0.139) | (0.000) | (0.000) | ||
| Average prediction | 2.478 | 2.238 | 0.770 | 0.735 | ||||||
| Observations | 2,803 | 1,908 | 2,777 | 1,892 | 2,799 | 1,905 | ||||
Analyses 1 and 2 presented are weighted Poisson models. Average marginal effects are interpreted as the change in the number of sources listed. Analyses 3 and 4 presented are weighted logit models. Average marginal effects are interpreted as the change in the probability that veterinarians were identified as the primary sources of information. Analyses 5 and 6 presented are weighted linear squares models. Analyses were based on data collected by the author from the survey described in Table 1. P values are in parentheses.
***P < .001.
**P < .01.
*P < .05.
#P < .10.
AME = Average marginal effect. WLS = Weighted least-squares.
The following variables were omitted from the table for space: number of pets, income, education, age, non-Hispanic Black, non-Hispanic Asian, Hispanic, other races/ethnicities, and constant. The full table is presented as Supplementary Table S10.
Primary source for vaccine information
Overall, 76.9% of dog owners (95% CI, 75.0% to 78.8%) indicated that their veterinarian served as their primary source of vaccine information (Figure 2; Supplementary Table S11). When the findings were dichotomized by level of trust, this was the case for 85.4% of dog owners with high levels of trust (95% CI, 83.2% to 87.3%) but only 62.6% of dog owners with lower levels of trust (95% CI, 59.0% to 66.1%) in their veterinarian (P < .001). Among all cat owners, 72.8% (95% CI, 70.3% to 75.2%) listed veterinarians as their primary source of vaccine information. This was the case for 83.8% (95% CI, 81.1% to 86.2%) of those with high levels of trust and 56.3% (95% CI, 51.7% to 60.7%) of those with lower levels of trust (Supplementary Table S12).
Sources of vaccine information for pet owners. Confidence bounds were omitted for clarity. Refer to Supplementary Tables S7 and S8 for further details. Analyses were based on data collected by the author from an online survey of 5,784 US residents (May 7 to May 15, 2024). Of these, 1,977 owned a cat (34%).
Citation: Journal of the American Veterinary Medical Association 2025; 10.2460/javma.24.08.0551
Primary sources of vaccine information for dog and cat owners. Confidence bounds were omitted for clarity. Further details are presented in Supplementary Tables S11 and S12. Analyses were based on data collected by the author from the survey described in Figure 1.
Citation: Journal of the American Veterinary Medical Association 2025; 10.2460/javma.24.08.0551
Differences based on the level of trust were again confirmed in the multivariate setting with weighted logit models (Table 2; Supplementary Table S10). Confirming the second hypothesis, the probability of listing veterinarians as their primary source of vaccine information increased by 0.201 (P < .001) on a scale from 0 to 1 for dog owners categorized as trusting as compared to less trusting (0.847 [0.830 to 0.864] vs 0.646 [0.617 to 0.675]). Moreover, individuals who had been with their veterinarian longer were also more likely to list them as their primary source. The increase in probability was 0.077 (P = .011) for those who had been with their veterinarian for 2 to 5 years and 0.122 (P < .001) for those who had been with their veterinarian for more than 5 years. Female owners were also more likely (0.080; P < .001) to list veterinarians as their primary source, as were older individuals (0.003; P < .001). Liberal (–0.067; P = .005) and Black respondents (–0.091; P = .012) were less likely to do so.
For cat owners, trusting owners had an increased probability of 0.252 (P < .001) for listing their veterinarian as their primary source. The probability also increased for those who had been with their veterinarian for more than 5 years (0.095; P = .005) as well as older individuals (0.002; P = .012) and those with higher income (0.015; P = .031). Probabilities were reduced for Black respondents (–0.118; P = .018).
Seeking out vaccine information
Among trusting dog owners, 8.9% (95% CI, 7.4% to 10.6%) strongly disagreed and 15.2% (95% CI, 13.3% to 17.4%) disagreed with the statement that they made “it a point to read or watch stories about vaccines” (Figure 3; Supplementary Table S13). This compared to 31.2% (95% CI, 28.6% to 33.9%) who agreed and 20.5% (95% CI, 18.3% to 22.9%) who strongly agreed. Among less trusting dog owners, the numbers were 10.6% (95% CI, 8.6% to 13.0%) and 16.0% (95% CI, 13.6% to 18.8%) in the disagreement categories and 30.6% (95% CI, 27.3% to 34.1%) and 11.8% (95% CI, 9.6% to 14.5%) in the agreement categories. Overall, trusting owners scored slightly higher than their less trusting counterparts (3.31; 95% CI, 3.24 to 3.87) versus 2.95 (95% CI, 2.85 to 3.04; P < .001) on the 5-point scale.
Pet owners making it a point to seek out vaccine information. Confidence bounds were omitted for clarity. Further details are presented in Supplementary Table S14. Analyses were based on data collected by the author from the survey described in Figure 1.
Citation: Journal of the American Veterinary Medical Association 2025; 10.2460/javma.24.08.0551
Among trusting cat owners, 11.4% (95% CI, 9.4% to 13.8%) strongly disagreed, 14.3% (95% CI, 12.1% to 16.8%) disagreed, 30.4% (95% CI, 27.3% to 33.7%) agreed, and 19.1% (95% CI, 16.4% to 22.0%) strongly agreed with the statement (Figure 3; Supplementary Table S14). For less trusting owners, the numbers were 16.6% (95% CI, 13.4% to 20.2%), 18.7% (95% CI, 15.4% to 22.6%), 28.1% (95% CI, 24.2% to 32.3%), and 9.2% (95% CI, 6.9% to 12.3%). Comparing the mean scores on the 5-point scale, trusting cat owners scored slightly higher than their less trusting counterparts (3.39 [95% CI, 3.33 to 3.45] vs 3.17 [95% CI, 3.10 to 3.24]; P < .001).
Multivariate analyses confirmed these findings (Table 2; Supplementary Table S10). Out of line with hypothesis 3, dog owners with more trust scored 0.231 (P < .001) higher and cat owners scored 0.362 (P < .001) higher on the 5-point scale than those who were classified as less trusting. Moreover, liberal respondents (dog owners, 0.272 [P < .001]; cat owners, 0.171 [P = .040]) scored higher than moderate respondents, while female owners scored lower (–0.242 [P < .001]; –0.234 [P < .001]) than male owners. Individuals who were more religiously active (0.151 [P < .001]; 0.165 [P < .001]) and Hispanic respondents (0.241 [P = .001]; 0.381 [P < .001]) also scored higher, while this only applied to Black dog owners as compared to White dog owners (0.440; P < .001). Trust in veterinarians also increased the score for cat owners (0.362; P < .001). The same held for liberal respondents (0.171; P = .040), the religiously active (0.165; P < .001), those who had been with their veterinarian for 1 to 2 years (0.424; P < .001), and Hispanic respondents (0.381; P < .001). Lower scores were associated with being female (–0.234; P < .001) and age (–0.008; P < .001).
Association between trust, vaccination sources, and vaccination status
Lastly, exploratory analyses were conducted to assess whether trust in veterinarians as well as sources of vaccine information were associated with the vaccination status of pets (Table 3; Supplementary Table S15). Trust in veterinarians increased the probability of having one’s pet vaccinated for both dogs (0.017 to 0.074; P < .065) and cats (0.096 to 0.137; P < .001). For dogs, the findings were largest for Lyme disease (0.074; P < .001), and for cats, they were largest for feline herpes (0.137; P < .001). The number of sources was not associated with vaccination status, while the seeking of vaccine information was consistently associated with higher level of vaccine take-up for cat owners (0.037 to 0.055; P < .001) and in 3 cases for dog owners (0.014 to 0.023; P < .026). Listing the internet as a primary source of vaccine information was negatively associated with vaccination take-up (–0.070 to –0.166; P < .010). At the same time, long-standing relationships with veterinarians were also correlates of vaccination status. This held for 1 to 2 years (0.048 to 0.130; P < .038), 2 to 5 years (0.042 to 0.140; P < .018), and more than 5 years (0.035 to 0.142; P < .033).
Association between trust in veterinarians, vaccine sources, and vaccination status.
| Variable | Canine | Feline | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| (1) Rabies | (2) Parvovirus | (3) Distemper | (4) Lyme | (5) Influenza | (6) Rabies | (7) Panleukopenia | (8) Herpes | (9) Chlamydia | (10) Bordetella | |
| Trust in veterinarians | 0.017# | 0.034* | 0.048** | 0.074*** | 0.064*** | 0.096*** | 0.103*** | 0.137*** | 0.114*** | 0.098*** |
| (0.064) | (0.023) | (0.003) | (0.000) | (0.001) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | |
| Time with veterinarian | ||||||||||
| 1–2 y | 0.057*** | 0.048* | 0.066** | 0.119*** | 0.113*** | 0.111*** | 0.130*** | 0.119*** | 0.129*** | 0.110** |
| (0.000) | (0.037) | (0.009) | (0.000) | (0.000) | (0.000) | (0.000) | (0.001) | (0.000) | (0.003) | |
| 2–5 y | 0.042** | 0.054* | 0.065* | 0.089** | 0.076** | 0.101*** | 0.139*** | 0.140*** | 0.124*** | 0.127*** |
| (0.008) | (0.017) | (0.011) | (0.002) | (0.010) | (0.000) | (0.000) | (0.000) | (0.001) | (0.001) | |
| > 5 y | 0.035* | 0.066** | 0.064* | 0.087** | 0.108*** | 0.084** | 0.142*** | 0.108** | 0.088* | 0.103** |
| (0.032) | (0.005) | (0.015) | (0.003) | (0.000) | (0.004) | (0.000) | (0.003) | (0.017) | (0.006) | |
| No. of dogs/cats in household | ||||||||||
| 2 | –0.013 | –0.033# | –0.002 | –0.030 | –0.003 | –0.023 | –0.018 | –0.020 | –0.038 | –0.040 |
| (0.177) | (0.051) | (0.914) | (0.157) | (0.880) | (0.249) | (0.487) | (0.446) | (0.171) | (0.158) | |
| 3 | –0.019 | –0.023 | 0.015 | 0.052# | 0.009 | 0.005 | 0.006 | –0.020 | –0.010 | –0.009 |
| (0.368) | (0.424) | (0.593) | (0.095) | (0.783) | (0.836) | (0.871) | (0.635) | (0.821) | (0.834) | |
| 4 | 0.004 | 0.010 | 0.020 | 0.054 | 0.036 | 0.039 | 0.045 | 0.064 | 0.041 | 0.033 |
| (0.853) | (0.745) | (0.578) | (0.265) | (0.440) | (0.210) | (0.323) | (0.170) | (0.411) | (0.553) | |
| ≥ 5 | 0.020 | 0.045# | 0.031 | 0.060 | 0.059 | –0.026 | –0.019 | 0.011 | –0.037 | –0.008 |
| (0.283) | (0.099) | (0.443) | (0.231) | (0.186) | (0.469) | (0.687) | (0.817) | (0.507) | (0.881) | |
| Primary source of vaccine information (veterinarians served as reference) | ||||||||||
| Government agencies | –0.009 | 0.002 | –0.005 | 0.054# | 0.063* | –0.057 | –0.023 | –0.047 | –0.070 | –0.088 |
| (0.666) | (0.954) | (0.888) | (0.078) | (0.018) | (0.140) | (0.601) | (0.315) | (0.174) | (0.118) | |
| The internet | –0.070** | –0.107** | –0.117** | –0.114** | –0.074* | –0.141** | –0.159*** | –0.147** | –0.125** | –0.166*** |
| (0.009) | (0.002) | (0.001) | (0.003) | (0.046) | (0.001) | (0.001) | (0.002) | (0.008) | (0.001) | |
| Owners: pet was hurt by a vaccine | –0.005 | –0.026 | –0.062 | –0.047 | –0.002 | –0.207* | –0.179* | –0.179# | –0.173# | –0.141 |
| (0.855) | (0.669) | (0.417) | (0.530) | (0.973) | (0.016) | (0.049) | (0.070) | (0.074) | (0.108) | |
| Other friends or family | –0.058 | –0.132# | –0.132# | –0.087 | –0.084 | –0.175* | –0.158* | –0.197* | –0.191* | –0.152# |
| (0.239) | (0.064) | (0.072) | (0.209) | (0.224) | (0.021) | (0.038) | (0.013) | (0.015) | (0.075) | |
| Other veterinary professional | 0.011 | 0.002 | 0.004 | –0.036 | 0.096** | 0.011 | –0.194# | –0.168 | –0.166 | –0.165 |
| (0.624) | (0.957) | (0.937) | (0.577) | (0.005) | (0.803) | (0.079) | (0.138) | (0.141) | (0.131) | |
| No. of sources | 0.004 | 0.006 | 0.006 | 0.007 | 0.001 | –0.003 | –0.003 | –0.001 | –0.000 | –0.005 |
| (0.317) | (0.368) | (0.394) | (0.158) | (0.828) | (0.512) | (0.625) | (0.860) | (0.982) | (0.481) | |
| Seeking vaccine information | –0.000 | 0.014* | 0.009 | 0.023** | 0.025** | 0.037*** | 0.051*** | 0.049*** | 0.055*** | 0.046*** |
| (0.917) | (0.025) | (0.192) | 0.007 | 0.001 | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | |
| Observations | 2,773 | 2,773 | 2,773 | 2,773 | 2,773 | 1,890 | 1,890 | 1,890 | 1,890 | 1,890 |
| R2 | 0.038 | 0.045 | 0.040 | 0.070 | 0.063 | 0.131 | 0.125 | 0.136 | 0.126 | 0.110 |
Analyses presented are weighted linear probability models. Coefficients indicate changes in the probability of vaccination. P values are in parentheses. Analyses were based on data collected by the author from the survey described in Table 1.
***P < .001.
**P < .01.
*P < .05.
#P < .10.
The following variables were omitted from the table for space: liberal, conservative, religious activity, female, income, education, age, non-Hispanic Black, non-Hispanic Asian, Hispanic, other races/ethnicities, and constant. The following sources of information were also omitted: any other sources of information about vaccines; social media; other dog/cat owners; and TV, radio, books, and magazines. The full table is presented as Supplementary Table S15.
Discussion
Vaccine hesitancy is growing worldwide and poses a number of public health challenges.2,3 Emergent literature4,5 has begun to document that vaccine hesitancy is not confined to humans but also may affect animals via decisions of their owners and thus have a direct impact on veterinarians and their practice. In the human context, trust in medical providers has been established as playing an important role in a variety of ways and trust serves as an important resource in the provider-patient relationship, particularly when it comes to vaccinations.4,10,19,25–29,47 Trust also has been shown to play an important role in the veterinary setting, yet important research gaps have been left unaddressed.18–24 The analyses here fill some of these gaps related to vaccination-related behavior.
Overall, the analyses indicated that most owners of dogs and cats (about 2 in 3) trust their veterinarians. At the same time, this also means that a nonsubstantial number of owners (about 1 in 3) do not have high levels of trust, with particularly low levels for 5% to 10% of the pet owner population. These findings were reassuring because veterinarians continue to serve as one of the most trusted professions in US society. However, they were also cause for concern because of the number of individuals lacking complete trust in their pet’s medical provider. This was particularly concerning because the analyses here confirmed that trust may play an important role with regard to pet vaccinations. While there was no evidence that trust in veterinarians was associated with the number of sources for vaccine information, the analyses revealed important differences between those pet owners with high levels of trust in their veterinarian and those with lower levels of trust. Substantial differences were also identified between trusting and less trusting individuals with regard to listing veterinarians as a source of information as well as whether they serve as a primary source of vaccination information for both dog and cat owners. Differences between the 2 groups were also present for utilizing the internet as a source of information for both cat and dog owners, as well as for dog owners who believed their dog was hurt by a vaccine and also social media for cat owners. At the same time, trusting pet owners were slightly more likely to seek out additional vaccination information.
As apparent from the exploratory analyses, differential levels of trust also had direct effects on vaccination behavior, as trust in veterinarians was also correlated with vaccination uptake. At the same time, long-term relationships with veterinarians also were associated with higher rates of vaccinations. Notably, the influence of both measures appeared particularly pronounced for core vaccines besides rabies as well as noncore vaccines. These findings highlighted the substantial role that provider-owner relationships hold with regard to vaccinations, particularly with regard to those that may not be required by law. At the same time, vaccinations appear to not be affected by the number of sources of vaccine information. However, listing the internet as a primary source of information served as an important negative correlate, highlighting the powerful role that the medium holds for perpetuating and increasing vaccine-related concerns. Indeed, besides veterinarians, the internet stood out among all potential sources of information as uniquely influential and, at times, may have had a more substantial effect than veterinary-related measures. Lastly, cat owners seeking out information on vaccines were more likely to keep their pets up to date on vaccinations.
This study had several limitations. First, the data were derived from an internet-based, nonprobability sample, as is common in survey research.33 Importantly, Lucid’s data have been deemed reliable and valid. Moreover, Lucid has consistently worked to ensure data quality reduces fraud. Also, the data are cross-sectional and only representative at the national level. Answers also relied on the recall of respondents to confirm their pet’s vaccination status and could not be confirmed independently. It is plausible that not all owners were fully aware of their pet’s vaccination status, particularly for noncore vaccines. However, these concerns might be mitigated, as the analyses here were focused on deliberate choices to avoid vaccinations. Owners indicating that their pets are vaccinated may be less likely to be vaccine hesitant. Lastly, several of the vaccines analyzed here are often, but not always, given as combination vaccines. However, the analytical focus here was on pet owners and many pet owners might be unaware of this fact. As a result, owners were queried about individual vaccine choices. However, findings for the individual vaccines contained in the combination vaccine were essentially identical.
Overall, the analyses here are contributing to a budding enterprise that seeks to better understand pet owners and their behavior related to vaccines. Given the finding that veterinarians hold an important role in vaccine-related behavior, future research should explore the underlying factors that shape trust in veterinarians as well as how veterinarians can be more successful in establishing and maintaining long-lasting relationships with pet owners. Future research should also seek to develop evidence-based tools to increase trust in veterinarians because they are the most appropriate source of such information for each individual pet owner. More generally, the veterinary community should consider what role it can and should play in the much-needed conversation about the future of vaccines as well as maintaining appropriate rates of vaccinations. Importantly, the question emerges of what veterinarians can do to counter the detrimental influence of internet-based sources of vaccine information, which likely contain substantial amounts of misinformation. Moreover, more research is needed to better understand why and how pet owners seek out nonveterinary sources of vaccine information as well as how sources of vaccine information shape pet owners’ vaccine behavior. Lastly, more work is needed in parsing out differences among pet owners of different types of animals and how vaccine-related behavior may differ based on the type of pet individuals own.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org.
Acknowledgments
None reported.
Disclosures
The author has nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.
Funding
The author has nothing to disclose.
ORCID
S. Haeder https://orcid.org/0000-0003-0077-6047
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