Cases of measles and other highly contagious diseases are rising in the United States. Public health experts blame the rise partly on the spatial concentration of parents declining to vaccinate their children, but researchers have given little attention to theorizing why this clustering occurs in particular communities. We argue that residential and school selection processes create “pockets of homogeneity” attracting parents inclined to opt out of vaccines. Structural features of these enclaves reduce the likelihood of harsh criticism for vaccine refusal and foster a false sense of protection from disease, making the choice to opt out seem both safe and socially acceptable. Examination of quantitative data on personal belief exemptions (PBEs) from school-based vaccination requirements in California schools and districts, as well as findings from parent interviews, provide empirical support for the theory. We discuss substantive implications for lawmakers and public health officials, as well as broader sociological contributions concerning neighborhood effects and residential sorting.
AloeCarlinKulldorffMartinBloomBarry R.2017. “Geospatial Analysis of Nonmedical Vaccine Exemptions and Pertussis Outbreaks in the United States.” Proceedings of the National Academy of Sciences114(27):7101–05.
2.
AndrewsKenneth T.SeguinCharles. 2015. “Group Threat and Policy Change: The Spatial Dynamics of Prohibition Politics, 1890–1919.” American Journal of Sociology121(2):475–510.
3.
AttwellKatieMeyerSamantha B.WardPaul R.2018. “The Social Basis of Vaccine Questioning and Refusal: A Qualitative Study Employing Bourdieu’s Concepts of ‘Capitals’ and ‘Habitus.’” International Journal of Environmental Research and Public Health15(5):1044.
4.
AtwellJessica E.Van OtterlooJoshZipprichJenniferWinterKathleenHarrimanKathleenSalmonDaniel A.HalseyNeal A.OmerSaad B.2010. “Nonmedical Vaccine Exemptions and Pertussis in California, 2010.” Pediatrics132(4):624–30.
5.
BafumiJosephShapiroRobert Y.2009. “A New Partisan Voter.” The Journal of Politics71(1):1–24.
6.
BaldassareMark. 1992. “Suburban Communities.” Annual Review of Sociology18(1):475–94.
7.
BaldassarriDeliaGoldbergAmir. 2014. “Neither Ideologues nor Agnostics: Alternative Voters’ Belief System in an Age of Partisan Politics.” American Journal of Sociology120(1):45–95.
8.
BeanSandra J.2011.” Emerging and Continuing Trends in Vaccine Opposition Website Content.” Vaccine29(10):1874–80.
9.
BellahRobert N.MadsenRichardSullivanWilliam M.SwidlerAnnTiptonSteven M.1985. Habits of the Heart: Individualism and Commitment in American Life. Berkeley: University of California Press.
10.
BeninAndrea L.Wisler-ScherDaryl J.ColsonEveShapiroEugene D.HolmboeEric S.2006. “Qualitative Analysis of Mothers’ Decision-Making about Vaccines for Infants: The Importance of Trust.” Pediatrics117(5):1532–41.
11.
BergerPeter L.1967. The Sacred Canopy: Elements of a Sociological Theory of Religion. Norwell, MA: Anchor Press.
12.
BirnbaumMichael S.JacobsElizabeth T.Ralston-KingJenniferErnstKacey C.2013. “Correlates of High Vaccination Exemption Rates among Kindergartens.” Vaccine 31(5):750–56.
13.
BishopBill. 2008. The Big Sort: Why the Clustering of Like-Minded America Is Tearing Us Apart. New York: Houghton Mifflin.
14.
BlauPeter. 1977. Inequality and Heterogeneity. New York: Free Press.
15.
BlauPeter M.SchwartzJoseph E.1984. Crosscutting Social Circles: Testing a Macrostructural Theory of Intergroup Relations. Piscataway, NJ: Transaction Publishers.
16.
BrandtAlan. 1987. No Magic Bullet: A Social History of Venereal Disease in the United States since 1880. London, UK: Oxford University Press.
17.
BrennanJulia M.BednarczykRobert A.RichardsJennifer L.AllenKristen E.WarraichGohar J.OmerSaad B.2017. “Trends in Personal Belief Exemption Rates among Alternative Private Schools: Waldorf, Montessori, and Holistic Kindergartens in California, 2000–2014.” American Journal of Public Health107(1):108–12.
CarpianoRichard M.FitzNicholas S.2017. “Public Attitudes toward Child Undervaccination: A Randomized Experiment on Evaluations, Stigmatizing Orientations, and Support for Policies.” Social Science & Medicine185:127–36.
23.
CarrelMargaretBittermanPatrick. 2015. “Personal Belief Exemptions to Vaccination in California: A Spatial Analysis.” Pediatrics136(1):80–88.
CoserLewis. 1956. The Functions of Social Conflict. New York: Free Press.
26.
DelamaterPaul L.LeslieTimothy F.YangY. Tony. 2018. “Examining the Spatiotemporal Evolution of Vaccine Refusal: Nonmedical Exemptions from Vaccination in California, 2000–2013.” BMC Public Health18(458):1–13.
27.
DellaPostaDanielShiYongrenMacyMichael. 2015. “Why Do Liberals Drink Lattes?” American Journal of Sociology120(5):1473–511.
28.
DickensonDonna. 2013. Me Medicine vs. We Medicine: Reclaiming Biotechnology for the Common Good. New York: Columbia University Press.
29.
DuffellErika. 2001. “Attitudes of Parents towards Measles and Immunisation after a Measles Outbreak in an Anthroposophical Community.” Journal of Epidemiology and Community Health55(9):685–86.
30.
DurkheimEmile. [1915] 2008. The Elementary Forms of the Religious Life. Mineola, NY: Dover Publications.
31.
EpsteinSteven. 1996. Impure Science: AIDS, Activism, and the Politics of Knowledge. Berkeley: University of California Press.
32.
EstepKevin A.2018. “Neighborhood Political Composition and Personal Belief Exemptions from Immunization Requirements in California Kindergartens, 2000–2015.” Vaccine36(20):4298–303.
33.
FeikinDaniel R.LezotteDennis C.HammanRichard F.SalmonDaniel A.ChenRobert T.HoffmanRichard E.2000. “Individual and Community Risks of Measles and Pertussis Associated with Personal Exemptions to Immunization.” Journal of the American Medical Association284(24):3145–50.
34.
FielJeremy E.2013. “Decomposing School Resegregation: Social Closure, Racial Imbalance, and Racial Isolation.” American Sociological Review78(5):828–48.
35.
FischerClaude S.1975. “Toward a Subcultural Theory of Urbanism.” American Journal of Sociology80(6):1319–41.
36.
FischerClaude S.MattsonGreggor. 2009. “Is America Fragmenting?” Annual Review of Sociology35:435–55.
37.
FloridaRichard. 2002. The Rise of the Creative Class. New York: Basic Books.
38.
FrankenbergEricaSiegel-HawleyGenevieveDiemSarah. 2017. “Segregation by District Boundary Line: The Fragmentation of Memphis Area Schools.” Educational Researcher46(8):449–63.
GellinBruce G.MaibachEdward W.MarcuseEdgar K.2000. “Do Parents Understand Immunizations? A National Telephone Survey.” Pediatrics106(5):1097–1102.
41.
GierynThomas F.2000. “A Space for Place in Sociology.” Annual Review of Sociology26(1):463–96.
42.
GromisAshleyLiuKa-Yuet. 2020. “The Emergence of Spatial Clustering in Medical Vaccine Exemptions Following California Senate Bill 277, 2015–2018.” American Journal of Public Health110(7):1084–91.
43.
HaysSharon. 1998. The Cultural Contradictions of Motherhood. New Haven, CT: Yale University Press.
44.
HedgecoeAdam. 2004. The Politics of Personalised Medicine: Pharmacogenetics in the Clinic. Cambridge, UK: Cambridge University Press.
45.
HippJohn R.PerrinAndrew J.2009. “The Simultaneous Effect of Social Distance and Physical Distance on the Formation of Neighborhood Ties.” City & Community8(1):5–25.
46.
HobbsFrankStoopsNicole. 2002. Demographic Trends in the 20th Century, Vol. 4. Washington, DC: U.S. Census Bureau.
47.
HolmeJennifer Jellison. 2002. “Buying Homes, Buying Schools: School Choice and the Social Construction of School Quality.” Harvard Educational Review72(2):177–206.
48.
HyraDerek S.2015. “The Back-to-the-City Movement: Neighbourhood Redevelopment and Processes of Political and Cultural Displacement.” Urban Studies52(10):1753–73.
49.
JordanMary. 1994. “College Dorms Reflect Trend of Self-Segregation: Many Universities Are Organizing Dormitories by Race, Ethnicity, Sexual Orientation on Student Demand.” The Washington Post, March6.
50.
KornrichSabinoFurstenbergFrank. 2013. “Investing in Children: Changes in Parental Spending on Children, 1972–2007.” Demography50(1):1–23.
51.
LamontMichèleMolnárVirág. 2002. “The Study of Boundaries in the Social Sciences.” Annual Review of Sociology28:167–95.
52.
LamontMichèleSchmalzbauerJohnWallerMaureenWeberDaniel. 1996. “Cultural and Moral Boundaries in the United States: Structural Position, Geographic Location, and Lifestyle Explanations.” Poetics24(1):31–56.
53.
LareauAnnette. 2003. Unequal Childhoods: Class, Race, and Family Life. Berkeley: University of California Press.
54.
LeachMelissaFairheadJames. 2012. Vaccine Anxieties: Global Science, Child Health and Society. Sterling, VA: Taylor & Francis.
55.
LeesLorettaSlaterTomWylyElvin. 2013. Gentrification. New York: Routledge.
56.
LeyDavid. 1996. The New Middle Class and the Remaking of the Central City. London, UK: Oxford University Press.
57.
LieuTracy A.RayG. ThomasKleinNicola P.ChungCindyKulldorffMartin. 2015. “Geographic Clusters in Underimmunization and Vaccine Refusal.” Pediatrics135(2):280–89.
58.
LoganJohn R.MolotchHarvey Luskin. 1987. Urban Fortunes: The Political Economy of Place. Berkeley: University of California Press.
59.
LubienskiChristopher. 2003. “Innovation in Education Markets: Theory and Evidence on the Impact of Competition and Choice in Charter Schools.” American Educational Research Journal40(2):395–443.
60.
McNuttLouise-AnneDesemoneCristinaDeNicolaEricaEl ChebibHassanNadeauJessica A.BednarczykRobert A.ShawJana. 2016. “Affluence as a Predictor of Vaccine Refusal and Underimmunization in California Private Kindergartens.” Vaccine34(14):1733–38.
61.
McVeighRory. 2009. The Rise of the Ku Klux Klan: Right-Wing Movements and National Politics. Minneapolis: University of Minnesota Press.
62.
McVeighRoryBeyerleinKraigVannBurrelJr.TrivediPriyamvada. 2014. “Educational Segregation, Tea Party Organizations, and Battles over Distributive Justice.” American Sociological Review79(4):630–52.
63.
McVeighRoryCrubaughBryantEstepKevin. 2017. “Plausibility Structures, Status Threats, and the Establishment of Anti-abortion Pregnancy Care Centers.” American Journal of Sociology122(5):1533–71.
64.
McVeighRorySikkinkDavid. 2005. “Organized Racism and the Stranger.” Sociological Forum20(4):497–522.
65.
MichmanRonald D.MazzeEdward M.GrecoAlan James. 2003. Lifestyle Marketing: Reaching the New American Consumer. Westport, CT: Greenwood Publishing Group.
66.
MottaMatthewCallaghanTimothySylvesterSteven. 2018. “Knowing Less but Presuming More: Dunning-Kruger Effects and the Endorsement of Anti-vaccine Policy Attitudes.” Social Science & Medicine211:274–81.
67.
NathanJoe. 1997. Charter Schools: Creating Hope and Opportunity for American Education. San Francisco, CA: Jossey-Bass.
68.
Nguyen-HoangPhuongYingerJohn. 2011. “The Capitalization of School Quality into House Values: A Review.” Journal of Housing Economics20(1):30–48.
69.
O’BrienRobert M.2007. “A Caution Regarding Rules of Thumb for Variance Inflation Factors.” Quality & Quantity41(5):673–90.
70.
OlzakSusan. 1992. The Dynamics of Ethnic Competition and Conflict. Stanford, CA: Stanford University Press.
71.
OmerSaad B.EngerKyle S.MoultonLawrence H.HalseyNeal A.StokleyShannonSalmonDaniel A.2008. “Geographic Clustering of Nonmedical Exemptions to School Immunization: Requirements and Associations with Geographic Clustering of Pertussis.” American Journal of Epidemiology168(12):1389–96.
72.
OmerSaad B.SalmonDaniel A.OrensteinWalter A.deHartM. PatriciaHalseyNeal. 2009. “Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases.” The New England Journal of Medicine360(19):1981–88.
73.
OwensAnn. 2016. “Inequality in Children’s Contexts: Income Segregation of Households with and without Children.” American Sociological Review81(3):549–574.
74.
OwensAnnReardonSean F.JencksChristopher. 2014. “Trends in School Economic Segregation, 1970 to 2010.” CEPA Working Paper. Stanford, CA: Center for Education Policy Analysis.
75.
OwensAnnReardonSean F.JencksChristopher. 2016. “Income Segregation between Schools and School Districts.” American Educational Research Journal53(4):1159–97.
76.
ParkLisa Sun-HeePellowDavid N.2011. The Slums of Aspen: Immigrants vs. the Environment in America’s Eden. New York: New York University Press.
77.
ParkRobert E.1915. “The City: Suggestions for the Investigation of Human Behavior in the City Environment.” American Journal of Sociology20(5):577–612.
78.
PutnamRobert. 2015. Our Kids: The American Dream in Crisis. New York: Simon and Schuster.
RameyGareyRameyValerie A.2010. “The Rug Rat Race.” Pp. 129–76 in Brookings Papers on Economic Activity, edited by RomerD. H.WolfersJ.Washington, DC: The Brookings Institution.
81.
ReaganLeslie. 2010. Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America. Berkeley: University of California Press.
82.
ReardonSean F.BischoffKendra. 2011. “Income Inequality and Income Segregation.” American Journal of Sociology116(4):1092–153.
83.
ReardonSean F.MatthewsStephen A.O’SullivanDavidLeeBarrett A.FirebaughGlennFarrellChad R.BischoffKendra. 2008. “The Geographic Scale of Metropolitan Racial Segregation.” Demography45(3):489–514.
84.
ReichJennifer A.2014. “Neoliberal Mothering and Vaccine Refusal: Imagined Gated Communities and the Privilege of Choice.” Gender & Society28(5):679–704.
85.
ReichJennifer A.2016. Calling the Shots: Why Parents Reject Vaccines. New York: New York University Press.
86.
ReichJennifer A.2020. “Vaccine Refusal and Pharmaceutical Acquiescence: Parental Control and Ambivalence in Managing Children’s Health.” American Sociological Review85(1):106–27.
87.
RenzulliLindaEvansLorraine. 2005. “School Choice, Charter Schools, and White Flight.” Social Problems52(3):398–418.
88.
RichardsJennifer L.WagenaarBradley H.Van OtterlooJoshuaGondaliaRahulAtwellJessica E.KleinbaumDavid G.SalmonDaniel A.OmerSaad B.2013. “Nonmedical Exemptions to Immunization Requirements in California: A 16-Year Longitudinal Analysis of Trends and Associated Community Factors.” Vaccine31(29):3009–13.
89.
SalmonDaniel A.MoultonLawrence H.OmerSaad B.deHartM. PatriciaStokleyShannonHalseyNeal A.2005. “Factors Associated with Refusal of Childhood Vaccines among Parents of School-Aged Children: A Case-Control Study.” Archives of Pediatrics & Adolescent Medicine 159(5):470–76.
90.
SampsonRobert J.2012. Great American City: Chicago and the Enduring Neighborhood Effect. Chicago: University of Chicago Press.
91.
SampsonRobert J.MorenoffJeffrey D.Gannon-RowleyThomas. 2002. “Assessing ‘Neighborhood Effects’: Social Processes and New Directions in Research.” Annual Review of Sociology28(1):443–78.
92.
ScrimshawSusan. 1990. “Combining Qualitative and Quantitative Methods in the Study of Intra-Household Resource Allocation.” Pp. 86–98 in Intra-Household Resource Allocation: Issues and Methods for Policy Development and Planning, edited by RogersB. L.SchollsmanN. P.Tokyo: United Nations University Press.
93.
SilvermanRoss D.WileyLindsay F.2017. “Shaming Vaccine Refusal.” The Journal of Law, Medicine & Ethics 45(4):569–581.
94.
SimmelGeorg. 1955. Conflict and the Web of Group Affiliations. Glencoe, IL: Free Press.
95.
SmallMario Luis. 2011. “How to Conduct a Mixed Methods Study: Recent Trends in a Rapidly Growing Literature.” Annual Review of Sociology37:57–86.
96.
SmithNeil. 1996. The New Urban Frontier: Gentrification and the Revanchist City. New York: Routledge.
97.
SmithPhilip J.ChuSusan Y.BarkerLawrence E.2004. “Children Who Have Received No Vaccines: Who Are They and Where Do They Live?” Pediatrics114(1):187–95.
98.
SoboElisa J.2015. “Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School Parents.” Medical Anthropology Quarterly29(3):381–99.
StevensMitchell L.2001. Kingdom of Children: Culture and Controversy in the Homeschooling Movement. Princeton, NJ: Princeton University Press.
101.
StroubKori J.RichardsMeredith P.2013. “From Resegregation to Reintegration: Trends in the Racial/Ethnic Segregation of Metropolitan Public Schools, 1993–2009.” American Educational Research Journal50(3):497–531.
102.
SugermanDavid E.BarskeyAlbert E.DeleaMaryann G.Ortega-SanchezIsmael R.BiDaolingRalstonKimberly J.RotaPaul A.Waters-MontijoKarenLeBaronCharles W.2010. “Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated.” Pediatrics125(4):747–55.
TuttonRichard. 2012. “Personalizing Medicine: Futures Present and Past.” Social Science & Medicine75(10):1721–28.
105.
U.S. Census Bureau. 2014. “Selected Housing Characteristics, 2009–13; American Community Survey 5-Year Estimates” (https://www.nhgis.org/).
106.
U.S. Department of Education. 2016. National Center for Education Statistics, Common Core of Data (CCD). “Public Elementary/Secondary School Universe Survey, 2011-12 v.1a, 2012-13 v.2a, 2013-14 v.2a, 2016-17 v.1a” (https://nces.ed.gov/ccd/elsi/tableGenerator.aspx).
107.
WalkerEdward T.ReaChristopher M.2016. “Pediatric Care Provider Density and Personal Belief Exemptions from Vaccine Requirements in California Kindergartens.” American Journal of Public Health106(7):1336–41.
108.
WeissMichael. 2000. The Clustered World: How We Live, What We Buy, and What It All Means About Who We Are. New York: Little, Brown and Company.
109.
WilsonKenneth L.PortesAlejandro. 1980. “Immigrant Enclaves: An Analysis of the Labor Market Experiences of Cubans in Miami.” American Journal of Sociology86(2):295–319.
110.
WilsonWilliam Julius. 1987. The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy. Chicago: University of Chicago Press.
111.
YangY. TonyDelamaterPaul L.LeslieTimothy F.MelloMichelle M.2016. “Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California.” American Journal of Public Health106(1):172–77.
112.
YanniCarla. 2019. Living on Campus: An Architectural History of the American Dormitory. Minneapolis: University of Minnesota Press.
113.
ZukinSharon. 1987. “Gentrification: Culture and Capital in the Urban Core.” Annual Review of Sociology 13(1):129–47.
114.
ZorbaughHarvey Warren. 1929. The Gold Coast and the Slum: A Sociological Study of Chicago’s Near North Side. Chicago: University of Chicago Press.
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