Associations of Elements of Parental Social Integration with Migrant Children’s Vaccination: An Epidemiological Analysis of National Survey Data in China

Round 1

Reviewer 1 Report

The authors have selected an important topic for research, given the often controversial reasons for not receiving the COVID or other recommended vaccines, and as especially related to migrant children. Their results show that the overwhelming number of migrant children ie 94.7% did receive the recommended vaccines, thus making the study of the remaining 5.3% of less significance, also given the complex nature of the individual parameters and interrelationships. These issues could be better addressed in the Discussion.

Author Response

Reviewer 1
Point 1: Their results show that the overwhelming number of migrant children ie 94.7% 
did receive the recommended vaccines, thus making the study of the remaining 5.3% 
of less significance, also given the complex nature of the individual parameters and 
interrelationships. These issues could be better addressed in the Discussion.
Response: Thank you for your kind words and your suggestions. We have 
provided more information and revised the discussion. The added content now 
reads as follows:
The current study found 94.6 percent of migrant children were completely 
vaccinated, and only 5.4 percent of migrant children were incompletely 
vaccinated for their age. This incomplete vaccination rate of remaining 5.4 
percent seems like to be somewhat less significant. However, given there were 
35.81 million migrant children in China according to the 2010 census, there 
are still nearly two million migrant children are not completely vaccinated. To 
address this issue is of high significance to achieve the goal of 100 percent 
vaccination rate among the children in China.
Our research shows that economic integration, social and cultural
integration and internal identity of social integration are related to the 
complete vaccination of migrant children in China. In the aspect of economic 
integration, employment identity and medical insurance status are positively 
associated with migrant children's complete vaccination. Some previous 
studies also found that the children whose parents have higher-status 
occupations had a higher likelihood of being completely vaccinate [14,16,24]. 
It may be explained that migrants can get more formal and better health 
services if they have a better job, so they would be better educated on 
immunization and have a good sense of complete vaccination of their children. 
As for the association between medical insurance and complete vaccination of 
migrant children, evidence has shown that migrant children are less likely to 
see a doctor than their local counterparts, even when they are insured. 
Regarding social cultural integration, major neighborhood composition and 
language communication with the locals significantly affect the migrant 
children’s complete vaccination. Migrants living with the locals have higher 
likelihood of being completely vaccinated compared to those living with 
foreigners. Many studies had explored the effect of neighborhood composition 
on health status or health behavior [25,26]. Migrants who use their native 
language to communicate with the locals are more likely to have their children 
get complete vaccination. The association between language and complete 
vaccination after stratification by flow range (interprovincial, intra-province) 
proves our speculation that migrants who speak home language with the locals 
may come from places where aren’t very far and the difference between home 
and local language is within acceptable limits for fluent communication. Good 
connection with local neighbors may promote migrants to learn local lifestyle, 
to adopt local life and even to use local health services. Many studies found 
that language barrier could significantly affect the migrant vaccination 
because of their unawareness of vaccination services or unawareness of their 
access for vaccines free of charge due to linguistic difficulties[27,28].
When comes to internal identity, we found that migrants’ discrimination 
perception was significantly related with complete vaccination of their 
children. Few previous studies explore the association between discrimination 
and immunization, but a study from Europe also indicated that perceived 
discrimination is related with poor health outcomes in migrants[29]. We 
speculate that perceived discrimination may do harm to migrants’ mental 
health, make them integrate into local life more difficultly, and then hinder 
their utilization of health and immunization services. 
This study is subjected to several limitations. Firstly, when we selected 
complete vaccination as dependent variable by questionnaires, recall bias and 
selection bias may occurred due to self-reported measures; on the other hand, 
it may not be as accurate as coverage rates for specific vaccines. Secondly, we 
only selected some indicators of economic integration, social cultural 
integration and internal identity, which may not comprehensively reflect social 
integration. Thirdly, as the lack of qualitative data, we didn’t explore how 
social integration factors been as the barrier and facilitators for the parents’
behavior of vaccinating their child which would be remedied in the follow-up 
studies. (Discussion section, lines 197-244, p7-8)

Reviewer 2 Report

This paper reports the findings of a study of the effects of parental social integration on migrant children’s vaccination status in China using sample survey data obtained from 4,915 participants from the 2014 China Migrants Dynamic Survey. For the most part, the analyses of the data appear reasonably well done. Here are a couple of items to attend to in a revision.

On p. 7 of the text, it is stated "Table 4 presents Univariate Logistic regression analysis of associations between language when communicate with locals and complete vaccination." But the title of Table 4 states that the contents of the table are from a multivariate regression. This needs to be clarified. And you need to indicate that the entries of Table 4 are from the multivariate regression results in Table 3 (I presume) but are reported in Table 4 for emphasis. And the text of the paper needs to clearly explain the meaning of the entry "It depends".

 

 

Author Response

Reviewer 2
Point 1: On p. 7 of the text, it is stated "Table 4 presents Univariate Logistic 
regression analysis of associations between language when communicate with locals 
and complete vaccination" But the title of Table 4 states that the contents of the table 
are from a multivariate regression. This needs to be clarified.
Response: Thank you for this helpful comment, and we are happy to follow. 
In response, we have changed our title of table 4 into "Univariate Logistic 
regression of the relationship between social integration and complete 
vaccination"
Point 2: And you need to indicate that the entries of Table 4 are from the multivariate 
regression results in Table 3 (I presume) but are reported in Table 4 for emphasis.
Response: Many thanks to the reviewer for your careful read. In response, we 
have added the explanation of the association between Table 3 and Table 4.
The added content now reads as follows:
"Considering that the flow status is related to the complete vaccination, 
especially the geographic distance of flow is worthy of attention, we 
present the further analysis. Table 4 presents Univariate Logistic 
regression analysis of associations between language when 
communicating with locals and complete vaccination. The result showed 
that migrant parents who flew to the inside province and spoke their 
mother tongue (OR 1.90; 95%CI 1.04-3.47; p=0.037) or local language 
(OR 1.20;95%CI 0.71-2.04), migrant parents who flew to the outside 
province and spoke their mother tongue (OR 3.81; 95%CI 0.53-27.66; 
p=0.186) with locals had greater odds of their children being completely 
vaccinated." (Results section, line184-191, p7)
Point 3: And the text of the paper needs to clearly explain the meaning of the entry "It 
depends".
Response: Thank you very much for your valuable comments. We have 
added the annotation below table 3 to explain "It depends". According to 
the supplementary instruction of questionnaire, "It depends" means that if 
the respondent speaks different languages when communicating on 
different occasions. The adjusted content now reads as follows: (Results 
section, line181-183, p7)
Table 3. Multivariate Logistic regression of the relationship between social
integration and complete vaccination
Variables
Unadjusted Adjusted
OR 95%CI P OR 95%CI P
Economic integration 
Employment identity
Employees 1.0 1.0
Employers 2.32 1.27-4.24 0.006 2.27 1.24-4.16 0.008
Self-employed laborer/ 
Else
0.91 0.69-1.20 0.515 0.90 0.68-1.19 0.440
Total monthly income
Q1 1.0 1.0
Q2 1.08 0.75-1.55 0.680 1.05 0.73-1.51 0.794
Q3 1.02 0.74-1.42 0.888 0.97 0.70-1.35 0.857
Q4 1.08 0.76-1.54 0.674 1.00 0.69-1.44 0.997
Medical insurance
Yes 1.0 1.0
No 0.60 0.43-0.85 0.004 0.61 0.43-0.86 0.005
Social cultural 
interaction
Language when communicate with locals
Mandarin Chinese 1.0 1.0
Home language 1.76 1.02-3.04 0.042 1.75 1.01-3.02 0.045
Local language 0.76 0.51-1.13 0.179 0.74 0.49-1.10 0.132
It depends* 0.59 0.41-0.86 0.006 0.61 0.42-0.89 0.010
Participate activities
Yes 1.0 1.0
No 0.83 0.63-1.10 0.201 0.86 0.65-1.13 0.277
Major neighborhood 
composition
Outsiders 1.0 1.0
Native 1.88 1.25-2.82 0.002 1.78 1.18-2.68 0.006
Half outsiders and 
half native
1.27 0.94-1.70 0.117 1.26 0.94-1.70 0.122
Unclear 0.99 0.57-1.72 0.965 1.01 0.57-1.76 0.984
Internal identity
Discrimination 
perception
Completely disagree 1.0 1.0
Generally disagree 0.63 0.45-0.88 0.008 0.64 0.45-0.90 0.010
Generally agree 0.78 0.48-1.26 0.308 0.80 0.49-1.29 0.352
Completely agree 0.46 0.24-0.88 0.020 0.47 0.24-0.90 0.023
Feel local member or 
not
Yes 1.0 1.0
No 0.73 0.51-1.04 0.080 0.75 0.52-1.07 0.117
Willing to settle in
Yes 1.0 1.0
No 0.85 0.65-1.09 0.202 0.87 0.67-1.12 0.275
* If the respondent speaks different languages when communicating on different occasions

Round 2

Reviewer 1 Report

The authors have responded to the suggestions to include a response in the Discussion section. However, it seems unrealistic to expect that vaccination rates can be improved from 94.7% to 100%, even though the remaining unvaccinated numbers of almost 2 million seems worthy of further pursuit. Also not included that would have been of interest and importance are issues of concerns regarding vaccine safety or other reasons for those individuals not receiving or wanting the vaccine. It would be helpful to include this lack of information in the Discussion section.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The revisions to this manuscript have been responsive to the previous review, and I have no further comments for revision. 

Author Response

Thanks for your patient read and check!