Introduction: The COVID-19 pandemic disrupted routine childhood vaccinations schedules, posing significant challenges among underserved communities. Understanding how different sociodemographic groups in Tennessee perceive and navigate childhood vaccination barriers is critical for developing strategies to improve vaccination rates and reduce vulnerability to vaccine-preventable diseases. Methods: A cross-sectional survey was conducted to explore barriers to vaccination across diverse sociodemographic groups in Tennessee. Data were collected from caregivers/parents of children aged 18 years and younger across all 95 counties in Tennessee at community events and through partnerships with schools and other local organizations. Parental responses were analyzed to identify barriers in access, concern, and importance domains. The distribution of barriers across different sociodemographic groups such as race, income, education level, and insurance status was identified. Descriptive statistics, non-parametric tests, and log-binomial regressions were used to address the research objectives. Results: This study found that the most prominent barriers to childhood vaccination were concerns regarding vaccine safety and side effects. Significant differences in vaccine barriers were observed across racial and ethnic groups for access barriers (p < 0.001), concern barriers (p = 0.006), and importance barriers (p < 0.001). Parents with lower education levels, children without health insurance, and lower-income families faced disproportionate challenges across two of the three barrier domains studied (access and perceived importance of vaccines). Additionally, concern barriers (aPR = 0.998, p < 0.001) and importance barriers (aPR = 0.997, p < 0.001) were strongly associated with the parent-reported prevalence of up-to-date vaccination status. Conclusions: Addressing parental vaccination barriers related to concern, access, and perceived importance is crucial, particularly for underserved populations including low-income families, uninsured parents, racial/ethnic minorities, and those with limited education. A sustained, equity-focused approach integrating scientific communication, community engagement, and policy interventions is essential for increasing vaccine uptake and ensuring equitable vaccination access.

Purpose: To examine the association between sociodemographic determinants and parent-reported up-to-date childhood vaccination status in Tennessee. Design: Cross-sectional statewide survey. Setting: All 95 Tennessee counties, July 2022 to May 2024. Surveys were distributed at community outreach events (health fairs, Head Start programs, community baby showers), and community organizations (schools, daycares, and preschools). Sample: Parents or caregivers of children aged 18 years and younger (N = 8954). Measures: The primary outcome was parent-reported up-to-date childhood vaccination status. Covariates included child’s age, health insurance status, parental race/ethnicity and education, household income, and rural/urban residency. Analysis: Descriptive statistics and log-binomial regression models were used to assess associations between sociodemographic factors and vaccination status. Stratified analyses were conducted by rural and urban status. Adjusted prevalence (aP) and 95% confidence intervals (CIs) with robust estimates were reported. Results: Overall, 96.5% reported that their children were up-to-date on vaccinations. The lowest vaccination rates were observed among children of multiracial (86.4%), and Asian/Native Hawaiian/Pacific Islander (90.3%) parents. Children without health insurance had a significantly higher prevalence of under-vaccination (aP = 0.104; 95% CI, 0.079-0.137) compared to insured children (aP = 0.029; 95% CI, 0.025-0.033). Across both rural and urban areas, under-vaccination was significantly associated with insurance, race, and child age, while parental education was significant only in urban areas and household income only in rural areas. Conclusions: Findings highlight critical gaps in vaccine coverage tied to insurance, race, and age. Targeted outreach to underserved and low-education communities is needed to promote equity in childhood vaccination.