Factors Associated with Parental Vaccine Hesitancy in Childhood Immunization: Insights from a Cross-Sectional Survey in Southern Italy

Introduction Parental vaccine hesitancy (VH) threatens childhood immunization and may improve vaccination coverage. Thisstudy aimed to investigate parental VH factors in childhood immunization in Southern Italy, focusing on sociodemographicfactors, adverse events following immunization (AEFIs), and participants perceptions of child vulnerability and health factors.Methods A cross-sectional electronic survey was conducted between September 2024 and January 2025 among parents/caregivers of children and adolescents in Sicily and Calabria. The survey included the Parent Attitudes about ChildhoodVaccines Questionnaire (PACV-5), the Child Vulnerability Scale (CVS), and the Parent Health Locus of Control Scales(PHLoC). Multivariable logistic regression models were used to identify independent factors associated with VH reportingadjusted Odds Ratio (aOR) with corresponding 95% confidence intervals (CIs).Results In this facility-based sample, 44.5% screened positive for VH in childhood immunization. Prior vaccine refusal (aOR3.56; 95% CI: 2.09–6.06), experiencing an AEFI after the last vaccination (aOR: 2.00; 95% CI: 1.09–3.67), including morethan one AEFI (aOR: 1.88; 95% CI: 1.14–3.11), or changes in hesitancy following an AEFI (aOR 5.31; 95% CI: 2.60–10.90)were associated with higher VH. PHLoC Destiny (aOR 1.43; 95% CI: 1.21–1.69) and Divine (aOR 1.14; 95% CI: 1.01–1.30)were associated with higher VH, whereas PHLoC Professionals with lower VH (aOR 0.72; 95% CI: 0.60–0.86).Conclusion Parental VH was associated with safety concerns and the influence of imponderable PHLoC factors, while trustin healthcare professionals was linked to lower VH, underscoring the need for targeted, empowerment-based communicationstrategies to improve vaccination confidence.