Childhood Seasonal Immunization Coverage Survey (CSICS), 2024: Methodological Report

Prepared for the Public Health Agency of Canada

Supplier name: Advanis Inc.
Contract number: 6D142-23-5582
Contract value: $292,727.40 (including HST)
Award date: February 13, 2024
Delivery date: October 24, 2024
Registration number: POR 131-23

For more information on this report, please contact Health Canada at:
por-rop@hc-sc.gc.ca

Ce rapport est aussi disponible en français.

This report presents the methodological details for the Childhood Seasonal Immunization Coverage Survey (CSICS), 2024 conducted by Advanis Inc. on behalf of the Public Health Agency of Canada (PHAC). The survey was administered among 11,258 members of the adult Canadian general public, between April 18 and July 15, 2024.

Ce rapport est aussi disponible en français sous le titre: Enquête sur la couverture vaccinale saisonnière des enfants (ECVSE), 2024

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from the Public Health Agency of Canada. For more information on this report, please contact:
por-rop@hc-sc.gc.ca

Health Canada, CPAB
200 Eglantine Driveway, Tunney's Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9

Catalogue Number: H14-643/2024E-PDF
International Standard Book Number (ISBN): 978-0-660-74286-1

Related publications (registration number: 131-23):
Catalogue number: (Methodological Report, French) H14-643/2024F-PDF
International Standard Book Number (ISBN): (French) 978-0-660-74287-8

• 1 Executive summary
  • 1.1 Background
  • 1.2 Objectives
  • 1.3 Methodology
  • 1.4 Contract value
  • 1.5 Political neutrality requirement
• 2 Methodology
  • 2.1 Survey design
  • 2.2 Sampling and administration
  • 2.3 Web methodology
  • 2.4 CATI methodology
  • 2.5 Weighting and data cleaning
  • 2.6 Quality control
• 3 Non-response bias and limitations
• 4 Guidelines for analysis and release
  • 4.1 Rounding guidelines
• Appendix A: Weights for the direct weighting method
• Appendix B: Response rate calculation
• Appendix C: Questionnaire

1. Executive Summary

1.1 Background

The Childhood Seasonal Immunization Coverage Survey (CSICS), previously the Childhood COVID-19 Immunization Coverage Survey (CCICS), was implemented in 2022 to collect information on COVID-19 and influenza (flu) vaccination coverage among children younger than 18 years of age living in Canada. Upcoming cycles of the questionnaire could be updated to accommodate future seasonal or annual vaccines recommended among children as/if they arise.

In December 2020, COVID-19 vaccines were authorized for use in individuals 16 years of age and older. In August 2021, Health Canada subsequently expanded the Interim Order authorization for adolescents 12 to 17 years of age. In March 2022, COVID-19 vaccine was authorized for use among children 5 to 11 years of age, in July 2022 the vaccine was authorized for children 6 months to 4 years. Furthermore, in December 2022, NACI recommended one bivalent booster dose for children 5 to 11 years of age, especially those considered high risk. This is consistent with recommendations for children 12 years and older that came out prior to this. Throughout this period of incremental vaccine rollout to children, PHAC has adapted existing surveillance tools and created new approaches to enable national and jurisdictional coverage assessment of COVID-19 vaccine uptake as more age groups become eligible.

NACI recommends continuous monitoring of COVID-19 vaccine uptake, particularly according to the socioeconomic status of families with children, and for decision makers to consider measures to reduce the risk of socioeconomic disparities in vaccine confidence and uptake. Coverage assessment for COVID-19 vaccination is measured for children through provincial and territorial immunization registries. However, immunization registries do not provide information on socioeconomic determinants of health, Sex and Gender based Analysis (SGBA)+ indicators, and parental knowledge, attitudes and beliefs (KAB). Another surveillance tool, the childhood National Immunization Coverage survey (cNICS) is a biennial survey that measures routine childhood immunization coverage among children aged 2-, 7-, 14- and 17-year-olds. The cNICS does not collect information on a representative sample of Canadian children aged 6 months to younger than 18 years old; therefore, its sampling frame is not suitable to collect information on COVID-19 and influenza (flu) vaccines.

There is also a continued need to collect information on influenza (flu) vaccine coverage among children. Influenza (Flu) is also a public health concern among children with immunocompromised status or children who have chronic medical conditions. CCICS (now CSICS) was implemented in 2022 to close knowledge gaps around annual influenza (flu) vaccination coverage among children. The only other source that collected some information on flu vaccination among children was the Canadian Health Survey on Children and Youth (CHSCY) 2019.

In addition, there are challenges with estimating influenza vaccination coverage among children living in Canada because influenza vaccines are not consistently recorded in parent-held records or captured in immunization registries and therefore results reported from parents are subject to recall bias. All efforts were made to minimize parental recall bias for the proposed survey.

Continued monitoring of parental knowledge and views around COVID-19 and influenza are important to adapt public communication and education accordingly.

Monitoring parental attitudes is essential to predict expected vaccine uptake and to guide education and awareness efforts to promote vaccination.

1.2 Objectives

The primary objective of this research is to continue a surveillance program established in 2022 that will provide both national and provincial/territorial level estimates on an annual basis.

Specifically, this research aims to:

• Provide data on:
  • COVID-19 and seasonal influenza (flu) immunization coverage among children in Canada younger than 18 years of age.
  • Parental intentions to vaccinate children who have not yet been vaccinated.
• Determine parental knowledge, attitudes and beliefs towards their child's COVID-19 and seasonal influenza (flu) vaccination.
• Determine barriers to COVID-19 and seasonal influenza (flu) immunization among children (e.g., vaccine hesitancy).
• Collect information on chronic medical conditions and socioeconomic indicators to examine vulnerable children or those at higher risk of COVID-19 and influenza complications by applying SGBA+ analysis (when possible).

Results will be used by PHAC to promote vaccine uptake, leverage public opinion research to address evolving issues relating to vaccine hesitancy.

1.3 Methodology

Data collection started April 18, 2024, and ended July 15, 2024, and was conducted by Advanis.

Advanis sought a probability-based sample of 11,200 Canadian parents/guardians aged 18 or older through the use of Advanis' General Population Representative Sample (GPRS) sample and through Random digit dialing (RDD).

Data was collected using a multimodal approach, collecting survey responses online and on the phone, to obtain a nationally representative sample. First, participants taken from our GPRS sample were recruited by phone and were invited to participate in a Web survey. Those who agreed to participate received an email or SMS inviting them to take part in the survey. In hard-to-reach populations, the survey was also offered by phone, using a Computer Assisted Telephone Interviewing (CATI) methodology.

Survey results were weighted by region, children's age group and children's sex at birth. The results for 2024 are based on responses from 11,258 parents/guardians (18 years of age or older) with children younger than 18 years of age across all provinces and territories. Recruitment ensured quotas were reached for key sub-populations to ensure statistical relevance and representativeness.

Weighted results can be extrapolated to the broader population. Cross tabulations must align with the weighted categories to be extrapolated to the broader population.

1.4 Contract Value

The contract value for this survey was $292,727.40 (including HST).

1.5 Political Neutrality Requirement

I hereby certify as a Senior Officer of Advanis that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research.

Specifically, the deliverables do not contain any reference to electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leader.

Nicolas Toutant

Vice President, Research and Evaluation

Advanis

nicolas.toutant@advanis.ca

2. Methodology

PHAC contracted Advanis to conduct the Childhood Seasonal Immunization Coverage Survey 2024 (CSICS), formerly known as the Childhood COVID-19 Immunization Coverage Survey. CSICS is a survey of Canadian parents/guardians of children and adolescents younger than 18 years of age. Data collection started April 18, 2024, and ended July 15, 2024, and was conducted by Advanis.

The project used Advanis' proprietary General Population Random Sample (GPRS), using an IVR-to-Web and CATI-to-Web methodology to contact potential respondents. This consists of using our proprietary interactive voice response (IVR) system and our in-house CATI call center to conduct random digit dialing (RDD) to recruit respondents to be part of the GPRS sample.

This method is probability-based; that is, every recruit has an equal and known chance of being invited to participate since Advanis uses a random sampling approach when selecting people to invite from its GPRS sample. Advanis then used a two-step approach where people who are part of our GPRS sample were recruited by telephone to participate in an online web survey.

The study used Advanis' proprietary, probability-based General Population Representative Sample (GPRS) to recruit respondents to participate in a web survey and random digit dialing (RDD) for harder to reach populations. The probability-based study was conducted using a two-step approach where respondents were recruited by phone to participate in an online web survey. Respondents were invited to participate in the online survey by either email or SMS (text message), based on their preference at the time of recruitment. After the initial invitation, if respondents had not yet completed the survey, they were sent up to two (2) reminder messages. Reminder messages were sent 3 and 6 days after the initial recruitment.

There can be an unknown bias since not everyone agrees to participate in studies. The inherent potential bias of our GPRS sample is similar to other random sampling approaches.

2.1 Survey Design

The questions for this survey were designed by the Public Health Agency of Canada and supplied to Advanis. Advanis was responsible for the French survey translation. The questionnaire contained questions for the parent and the child on demographics, immunization for influenza and COVID-19, and knowledge, attitudes and beliefs (KAB) questions on COVID-19 and influenza vaccines.

The Government of Canada's standards for pre-testing were adhered to. The pretest was conducted in both English and French. The pretest was conducted from April 18 to April 21, 2024. Advanis conducted surveys with 57 participants from across Canada (35 English and 22 French). During the pre-test phase the phone survey length averaged 23.5 minutes and the web survey averaged 13 minutes, the target was approximately 15 minutes.

2.2 Sampling and Administration

The target audience for this project was Canadian parents/guardians of children and adolescents younger than 18 years old living in the 10 provinces and three territories. The targeted number of completed surveys was 11,200 Canadian adults. Key sub-population that required quotas were :

• Parents/guardians with children in the following age groups: 0-4 years, 5-11 years, 12-17 years
• Parents/guardians in specific regions (individual provinces and territories)
• Children of both sexes (50% males, 50% females)

Respondents needed to be parents/legal guardians of children aged 18 or less and living in Canada in order to be eligible for the survey. Participants were taken from our GPRS sample and others were reached through Random digit dialing (RDD). If a participant expressed the desire to complete the survey online, they were sent an email or SMS invitation.

To target parents/guardians in Atlantic and Northern provinces/territories who are often more difficult to reach online, prospective participants were reached on the phone and were asked if they wanted to complete the survey with an interviewer. Those who agreed to participate in the survey were interviewed with the use of Computer Assisted Telephone Interviewing (CATI) methodology.

A total of 11,258 responses were obtained (9,372 in English and 1,886 in French) to reach quotas, where possible (Table 1). Overall, 51.3% of children were male and 48.7% were female (unweighted)

2.3 Web methodology

Invitations were sent by SMS/email and grouped by province, to ensure that they were sent out during appropriate hours within each time zone. Invitations were sent to a targeted sample that matched the target audience characteristics based on already compiled information in our GPRS sample.

Overall, 43,535 people were recruited to the web survey, with 12,268 participating, for a response rate of 28.2%. However, 2,223 were screened out either for refusing to provide the number of children, not being a parent or legal guardian, or for living outside Canada. Hence, 10,045 eligible participants completed the web survey.

After sending the initial invitation, a reminder message was sent three days later to applicants who did not complete a survey or who were not screened out of the survey. The majority of respondents were sent two reminder messages. Overall, 106,363 SMS and email messages were sent during data collection for this study.

Each survey had a unique number embedded in the hyperlink to eliminate the possibility of duplicate responses from any participant.

2.4 CATI methodology

Participants who completed the survey on the phone were reached between April 18, 2024, and July 15, 2024. Interviews were offered in French or English based on respondent preference. In total, 117,080 potential respondents were called and 14,262 agreed to participate in the survey. The response rate for the CATI portion of the study was 13.9%. Of those who agreed to participate, 13,137 were ineligible. In total, 1,125 respondents completed the survey on the phone.

Overall, 11,258 respondents completed the survey (web or CATI), with a response rate of 18.1%, and a margin of error of +/-0.9% (19 times out of 20 at a 95% confidence interval). More detailed data collection statistics can be found in Appendix B.

2.5 Weighting and Data Cleaning

A direct weighting approach was conducted using three variables: age, sex assigned at birth and province. The population sizes are based on the latest Statistics Canada census results published for the 2021 census. This weight and its corresponding weighting scheme identifier are provided in the final clean data. Detailed weight values can be found in Appendix A.

To account for the complexity of the sampling design and any issues arising from it (i.e., selecting non-working numbers, unreachable or out-of-scope respondents, etc.) five subsamples were drawn from the original sampling frame to create five different replicates of primary sampling units within each province.

The sampling method used to obtain the replicates followed closely the original sampling used to obtain the primary sampling units. This was done to account for the variation created while sampling and the fact that sampling was done without replacement.

Each replicate included a similar number of responses, and their sum added up to the total number of sampling units within each province. Bootstrap samples were created by randomly selecting 4 out of these 5 replicates. Weights were calculated for each bootstrap sample using the probability of selection within each province and then calibrated by age and sex assigned at birth.

Primary sampling units in non-selected replicates would have a weight of zero; to avoid any issues when calculating estimates and protect confidentiality of survey respondents, mean bootstrap weights were calculated, each mean bootstrap weight was generated from 12 regular bootstrap samples. A total of 500 mean bootstrap weight variables are provided in a separate file.

The database was cleaned to remove any errors at the end of the data-collection phase, and all unique identifiers in the client profiles were removed in the final data set provided to PHAC. The verbatim responses were reviewed, and no unique identifiers were found. For verbatim responses, if the verbatim response aligned with an existing question level the response was recoded to match the existing level. New levels were created when needed.

2.5.1 Detailed description of bootstrap weighting^{Footnote 1}

2.5.1.1 Background

Data obtained from complex large-scale surveys, cross-sectional as well as longitudinal studies, typically involve stratified, multi-stage cluster sampling, leading to dependencies among sample elements or unequal probabilities of selection, which frequently means unequal design weights^{Footnote 2}. Additionally, weights are often calibrated to known population totals of auxiliary variables as well as subjected to unit non-response adjustments.

Because of this, application of standard statistical methods to survey data could lead to incorrect inferences even for large samples: underestimation of standard errors of estimators, inflated type I error rates (probabilities of rejecting a true null hypothesis) and erroneous model diagnostics. This is what motivated the development of new methods such as bootstrapping. Different bootstrapping schemes have been used and developed since then and factors such as resampling replications, calibration, and balancing have to be considered.^{Footnote 2}

2.5.1.2 General methods

Bootstrap belongs to a family of variance estimation techniques known as replicate-based variance estimation. The steps for constructing replicate weights for a survey are:

1. Choose the method for replicate variance estimation. Bootstrap produces consistent variance estimators for smooth functions of means and quantiles and allows to view the sampling distribution for statistics calculated from the data. The main disadvantage of bootstrap is that it requires a large number of replicates to produce a reliable estimate (in this case, 500 replicates were created).
2. Construct the columns of sampling weights (w_i). The sampling weight for unit i is the reciprocal of the probability the unit was selected to be in the sample. The final weight for unit i (w^*_i) incorporates any weighting adjustments, post-stratification, raking or calibration.
3. Construct replicate sampling weight vectors w₁, w₂, …., w₅₀₀ using the method selected in step 1. For bootstrap, w₁ is the vector of weights created from the first bootstrap resample. This step applies the replicate weight method to the sampling weights from the full sample.
4. For each replicate weight vector w_r, for r=1,..., 500, apply the same adjustments that were used to arrive at the final weights w^*_i in step 2. The result is a set of replicate weights w^*₁, …, w^*₅₀₀.

All of the methods produce variance estimates of the form:

Where the coefficients c_r depend on the method used. For bootstraps c_r =(1/(R-1) for replicate r. The replicate variance estimator has the form for any statistic, whether that statistic is an estimated mean, population total, ratio, regression or correlation coefficient, or quantile.

Poststratification is often used when a sample does not reflect the distribution of some known variable in the population. When sampling quotas have been used to oversample units that belong to a small but important subgroup, then those sample units that had higher selection probabilities represent fewer population units. Therefore, in this situation, weights are not inverse selection probabilities, but ratios of population size to sample size within post-strata.

If this type of sampling has been used, post-stratification weights must be defined as the ratio of population size to design-weighted sample size. Note that post-stratification reduces the sampling error because the weighted average of the within post-strata variance is smaller than the overall variance. Variables that are associated with the post-stratification variables will also have reduced variance.

Please note: The bootstrap methods used in CSICS 2024 is an improvement to methods used in previous cycles of the survey. More specifically, additional corrections were made to the bootstrap algorithm to correct for a type of random sampling which accounts for aspects not previously accounted for. Although previous methods used are valid and not necessarily incorrect, the newer method serves as an improvement.

2.5.1.3 Analysis

In Stata, the svyset command can be used to calculate reliable estimates of the variance to account for the complex survey design. The svyset statement to be used in Stata for 500 mean bootstrap weights each composed of 12 bootstrap weights would have the following form: 

svyset [pweight=weightN], bsrweight(Wgt_1-Wgt_500) bsn(12) vce(bootstrap) dof(500)

Declaring pweight=weightN tells Stata that the survey weight is the variable weightN. The option vce(bootstrap) states that bootstrap variance estimation should be used. The option bsn(12) states that variance estimation should be done with a bootstrap mean-weight adjustment of 12. The option bsrweight (Wgt_1-Wgt_500) states that the bootstrap weight variables are Wgt_1, Wgt_2, …, Wgt_500.

Other software, like SAS, could calculate proper variances when mean bootstrap weights are provided by applying the BRR variances or using Fay coefficient^{Footnote 3}.

2.5.1.4 Limitations

The empirical properties of variance estimators depend on the size and composition of the estimation domain. Moreover, certain bootstrap schemes are appropriate only in certain circumstances and therefore non-response corrections and other weight adjustments have to be considered.

Bootstrapping may not always be the best method for variance estimation, but is applicable in a wider set of circumstances, such as when the sample size is insufficient for direct statistical inference (usually the case in general population samples), when the theoretical distribution of a statistic of interest is complicated or unknown, or when power calculations are needed from a small sample. This explains its popularity when estimating variance for complex studies.

The trade-off between bias and variance for complex survey data are well known. It is recommended to assess the efficiency when using different types of methods to determine if the trade-off is worthwhile.

The data presented in this report were analyzed using bootstrap weighting and balanced repeated replication (BRR) to obtain weighted population estimates representative of the adult population living in Canada, and to estimate variance. This allows for reporting national population-representative estimates of immunization coverage and, depending on the degree of variance, estimates for sub-populations. The bootstrap weights were calibrated using three criteria from population data obtained from the 2021 Census of Population: age groups, sex assigned at birth, and geographic location.

In general, there are several methods to developing bootstrap weights, each with their advantages and disadvantages. Bootstrapping schemes can take into account many factors, such as population size, available data about a population, and what sub-categories of the general population are being used to develop the bootstrap weights.

It is important to note that there are limitations to any method of design and estimation in survey sampling. The sample was obtained using random digit dialing (RDD) and this method, while strong and well-established, limits respondents to those who have access to a landline or cellphone, who speak English or French, and who are both literate and competent with electronic devices to be able to complete the self-administered survey online. The likelihood of them participating may be reduced considering their reading skills and thus their non-response bias for cannot be fully accounted for in the bootstrap weights. Even though all estimates should be treated as valid and sound, the limitations listed should be considered when deriving any conclusions from the data.

2.6 Quality Control

Advanis employs several quality control measures to ensure success across the entire life cycle of the project. These measures are detailed below.

Survey Programming: Advanis utilizes technology to maximize quality control in survey programming. Having developed a proprietary survey engine tool, Advanis professionals are able to design and program a survey in a browser-based environment, eliminating the need to involve a programmer who is less familiar with the survey subject matter. The survey was thoroughly pre-tested by Advanis' project team members, as well as by non-team members (non-team members provide "fresh eyes" for catching potential errors).

CATI Methodology: The CATI recruit script was programmed on Advanis' proprietary CATI platform with no unforeseen challenges. Advanis was able to leverage its experience for the survey programming and the reminder process to achieve high quality standards. Advanis implemented the following to ensure the highest quality data collection:

• Trained the interviewers to best understand the survey's objectives and to ensure that they were able to pronounce and understand the survey wording.
• Detailed call records were kept by the automated CATI system, and were monitored for productivity analysis (i.e., not subject to human error).
• The recruit scripts were pre-tested for best possible flow.
• Our average interviewer employment tenure is very high compared to industry standards, resulting in a team of interviewers who are more experienced and knowledgeable regarding the target audience.
• Advanis' Quality Assurance team listened to the actual recordings of ten percent of completed surveys and compared the responses to those entered by the interviewer, to ensure that responses were properly recorded. This is in addition to the live monitoring done by field supervisors.
• Team Supervisors conduct regular, more formal evaluations with each interviewer, in addition to nightly monitoring of each interviewer on their team.

To ensure high interview quality, our interviewers are trained to use various interviewing techniques. As well as maintaining a professional attitude, our interviewers must also be convincing, read word-for-word, take notes, systematically confirm the information given and listen to the respondent. Advanis has also created internal tools within the survey script for interviewers allowing them to use the phonetic alphabet to confirm email address spelling (e.g., a for alpha, b for bravo, etc.) to help reduce the amount of bounced email addresses. However, should bounced emails occur, Advanis has also developed additional tools that allow for someone to re-listen to the recording and easily adjust to correct the email address.

Web Methodology: All Advanis web surveys are hosted internally by Advanis, and employ a rigorous and stringent set of data collection control mechanisms to ensure the highest quality for the data collected, including:

• Respondents have a unique access code to ensure that only that respondent can complete the online survey.
• Extensive internal logic checks are programmed directly into the survey to ensure logical responses.
• Web surveys are implemented using Advanis' proprietary software (which is designed to handle complicated survey formats).
• Advanis administered a detailed internal test and an external pretest to ensure that the survey instrument was working as planned.
• Tested the questionnaire in multiple browsers and provided PHAC with a link so they could do internal testing.

Data Handling and Reporting: For the data collected, Advanis develops rules to check the validity of the data. These rules include items such as:

• Time taken to complete the survey.
• Checking for verbatims that are gibberish or don't make sense.
• Rigorous checks are completed to ensure the data is accurate and error-free according to the questionnaire logic (skip patterns).

All data cleaning performed on projects are outlined and tracked in an internal specification document so they can be quality assured and signed off on. The original raw data file is never overwritten, so that if an error is discovered in our code, we can quickly and easily rerun things to produce a new data file. Individuals developing code incorporate internal checks in their code (e.g., crosstabs) to ensure the adjustment had the desired effect. In addition, all recoding is reviewed by another team member or technical specialist for accuracy.

3. Non-response Bias and Limitations

Non-response bias occurs when non-responders differ in a meaningful way from respondents and this difference impacts the information gathered. It is difficult to assess the presence of non-response bias since information about why non-responders did not participate is usually unavailable. One way to gauge the potential impacts of non-response bias is to evaluate if the sample is representative by comparing the respondents' characteristics and gauge if they reflect known population characteristics. Where possible, we can check the distribution of respondents across various demographic (e.g., age and gender) and geographic categories and compare those distributions against known population characteristics. If the variation is fairly small and we have no reason to believe there are other factors impacting respondents' willingness to participate, we can conclude that the likelihood of non-response bias impacting the information gathered in the survey is minimal. This is the case with the current survey.

Several strategies were employed to increase response rates and reduce the effects of non-response bias. These include:

• Recruiting respondents by telephone (cellular).
• Outpulsing a local phone number (rather than a toll-free number) which increases pick-up rates (reducing call screening).
• Systematically setting the next call date and time based on the outcome of the current call, which ensures that each respondent is called methodically across days of the week and times of the day. Especially for respondents that are difficult to reach, this maximizes the likelihood of reaching them.
• Sending an SMS text message to recruits, which assures a seamless transition from the telephone survey to the online survey, as receipt can be confirmed in real time and encourages respondents to complete the survey as soon as the call ends.
• Collecting both email address and telephone number for recruitment so that if the email address does bounce, we can contact them via SMS message if they agree.
• Offering the survey in both official languages to maximize ease of completion.

4. Guidelines for Analysis and Release

When doing an analysis, it is important to align the analysis plan with the weighting scheme. The weights adjust the data to better reflect the population based on parameters that have been chosen to maximize the level of detail without creating distortions due to extreme weights (an extreme weight will occur when a population group is represented by a proportionally smaller subset of respondents compared to other population groups, thus introducing an important risk of bias due to their specific profile).

For this survey, the basic sociodemographic information that should be used in the analysis of results are:

• Provinces and Territories
• Age: 0 to 4, 5 to 11 and 12 to 17, or any unaltered grouping of theses ranges (i.e., 0 to 11 or 5 to 17)
• Sex: male or female

Using age groupings other than the ones described above could potentially produce distorted data. As these results would be inaccurate based on how the weights were calculated, we strongly advise not to report any results that are not aligned with these specified categories.

Any results with an unweighted base size (denominator) of less than 30 should not be reported, due to statistical robustness.5^-6 This is due to the increased coefficient of variation and, hence, there are larger confidence intervals around results with smaller bases. Furthermore, for confidentiality purposes, any estimates with an unweighted numerator of less than 5 (i.e., 1 to 4) should be suppressed.

For all estimates based on a denominator size of 30 or more, the following guidelines for data suppression related to coefficient of variations (CV) should be used when reporting estimates:^{Footnote 8}

Examining the confidence interval of the estimate will provide further indication of the quality of the estimate in terms of the variability. Long confidence intervals indicate less precision in the estimate while smaller confidence intervals indicate greater precision. When assessing the trustworthiness of sample proportions, the confidence intervals of estimates should be taken into account.^{Footnote 8}

4.1 Rounding Guidelines

Users are urged to adhere to the following rounding guidelines for estimates.

• Estimates in the main body of a statistical table are to be rounded to the nearest hundred units using the normal rounding technique. In normal rounding, if the first or only digit to be dropped is 0 to 4, the last digit to be retained is not changed. If the first or only digit to be dropped is 5 to 9, the last digit to be retained is raised by one. For example, in normal rounding to the nearest 100, if the last two digits are between 00 and 49, they are changed to 00 and the preceding digit (the hundreds digits) is left unchanged. If the last digits are between 50 and 99, they are changed to 00 and the preceding digit is increased by 1.
• Marginal sub-totals and totals in statistical tables are to be derived from their corresponding unrounded components and then are to be rounded themselves to the nearest 100 units using normal rounding.
• Averages, rates and percentages are to be computed from unrounded components (i.e., numerators and/or denominators) and then are to be rounded themselves to one decimal using normal rounding. In normal rounding to a single digit, if the final or only digit to be dropped is 0 to 4, the last digit to be retained is not changed. If the first or only digit to be dropped is 5 to 9, the last digit to be retained is increased by 1.
• Under no circumstances are unrounded estimates to be published or otherwise released by users. Unrounded estimates imply greater precision than actually exists.

Appendix A: Weights for the direct weighting method

Appendix B: Response rate calculation

Appendix C: Questionnaire

PHAC CSICS Parent Survey 2024 RDD
Government of Canada (Non-protected)
Generated on 2024-04-22 at 14:26:09 MT

Languages: English, French

Section Login page

wcag, LoginTCH

Page Consent

wcag Show if OfferWCAG (custom: <<current_mode_is("web")>> and <<offer_wcag()>>)

Si vous préférez répondre à l'étude en français, veuillez cliquer sur français

You have been invited to participate in the 2024 Childhood Seasonal Immunization Coverage Survey (CSICS). The Public Health Agency of Canada has contracted an independent public opinion research company, Advanis (opens in a new window) (http://advanis.net), to conduct this research on behalf of the Public Health Agency of Canada. TellCityHall is one of Advanis' data collection methods. The online survey is voluntary, and you may withdraw at any time. The survey will take approximately 10-15 minutes to complete.

The aim of the survey is to measure how many children and teens in Canada have received COVID-19 and influenza (flu) vaccines. The survey will also ask parents about their views on these vaccines. Even if you are not sure about the vaccines, or have family members that are not vaccinated, we would still like to understand all points of view from parents.

You may skip questions that you do not feel comfortable answering by clicking "Prefer not to answer" where applicable. Your answers will remain confidential and we will not ask you to provide us with any information that could directly identify you or your child, such as name(s), or full date of birth. The protection of your personal information is very important to us and we will make every effort to safeguard it.

Once data collection is complete, Advanis will provide the Public Health Agency of Canada (PHAC) with a dataset that researchers have no way of knowing which data belongs to which participant. The dataset will also be available to federal and provincial governments and researchers across Canada, if requested. Any reports or publications produced based on this research will use grouped data and will not identify you/your child or link you to these survey results.

This research has been approved by the Public Health Agency of Canada Research Ethics Board.

For more details about your personal information and the Privacy Act, please read below.

If you agree to participate in this survey, please click on the following button to continue:

For technical support with the survey, accessibility requirements, or to request to complete the survey over the phone you can contact TellCityHall and Advanis at sday+ccic@tellcityhall.ca (mailto:sday+ccic@tellcityhall.ca).

For more information about COVID-19 vaccination: https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines.html (opens in a new window) (https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines.html)

For more information about the influenza (flu) vaccine: https://www.canada.ca/en/public-health/services/diseases/flu-influenza/get-your-flu-shot.html (opens in a new window) (https://www.canada.ca/en/public-health/services/diseases/flu-influenza/get-your-flu-shot.html)

This survey is registered with the Canadian Research Insights Council's (CRIC) Research Verification Service. The project verification number is: 20240417-AD654. Click here (opens in a new window) (https://www.canadianresearchinsightscouncil.ca/rvs/home/) to verify the legitimacy of this survey.

Privacy Notice

Why are we collecting your information?

The aim of the Childhood Seasonal Immunization Coverage Survey is to measure how many children and teens in Canada have received COVID-19 and influenza (flu) vaccines. The survey will also ask parents about their views on these vaccines. Even if you are not sure about the vaccines, or have family members that are not vaccinated, we would still like to understand all points of view from parents.

Your answers will help develop vaccination programs in Canada. You will be asked questions, such as age, gender, and ethnicity. Your answers will remain confidential and we will not ask you to provide us with any information that could directly identify you or your child, such as name(s), or full date of birth. The protection of your personal information is very important to us and we will make every effort to safeguard it and reduce the risk that you are identified.

What is the Authority to Collect the Information?
The information you provide to the Public Health Agency of Canada is collected under the authority of section 4 of the Department of Health Act and section 3 of the Public Health Agency of Canada Act and handled in accordance with the Privacy Act.

Will we use or share your personal information for any other reason?
The survey firm, Advanis, will be responsible for collecting survey data from all participants. Once data collection is complete, Advanis will provide the Public Health Agency of Canada (PHAC) with a dataset that will not include any personal identifiers to ensure your and your child's confidentiality. The dataset will also be available to federal and provincial governments and researchers across Canada, if requested. Any reports or publications produced based on this research will use grouped data and will not identify you/your child or link you to these survey results.

What are your rights?

You have a right to complain to the Privacy Commissioner of Canada if you feel your personal information has not been handled properly.

If you have any questions or concerns about the survey or the information we are collecting, please e-mail: sday+ccic@tellcityhall.ca (mailto:sday+ccic@tellcityhall.ca)

What You Will Be Asked to Do
Y

ou will be asked to complete a 15-minute survey to answer questions related to the COVID-19 and influenza (flu) vaccines. Please note that certain questions will be asked at the start of the survey, to determine if you are eligible to participate. If you are not eligible to participate, your data will be removed and destroyed.

Benefits

By participating in this study you will help advance understanding of Canadian children's uptake of COVID-19 and influenza (flu) vaccines.

Confidentiality

The survey will not collect information that directly identifies you or your child and data will be stored on password-protected computers. Responses will be grouped for analysis and presented in grouped form. Your responses will remain anonymous.

• If you require a screen reader or assistive device to complete this survey, check this box to access a compatible version
• Start Survey

Section Screeners

S3, S3b, S3c, T4, record, RecordTerm, AgeChildren, B0, Q4, T6, A5, T7, B2ageunder6months, B2age6monthslessthan5, B2ageChild5to11, B2ageChild12to17

Page Your household

S3

(Show if CATI) Would you prefer to continue in English or French? (switch language based on the response and continue)

How many children under the age of 18 currently live in your household?

DO NOT READ LIST.

(Show if Web) How many children under the age of 18 currently live in your household?

<<SingleInstruction>>

• None
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 or more
• I prefer not to answer

S3b Show if Number of children Not provided (S3 = I prefer not to answer)

For our analysis of the data, we need to know for how many children under the age of 18 you are the parent/legal guardian.

Are you sure you don't want to give this information?

(Show if Web) <<SingleInstruction>>

• Yes, I'm sure
• No, I will answer

S3c Show if WillAnswer AND Number not provided ((S3b = 2) AND (S3 = I prefer not to answer))

T4 Show if NoChildren OR Confirmed Number not provided ((S3 = 0) OR (S3b = 1))

We're sorry but for this survey we need to speak with parents/legal guardians of children aged 18 or less that live in your household and the person most knowledgeable about the child's immunization. Thank you for your time.

Status Code: 503

record Show if isCATI (custom: <<current_mode_is("cati")>>)

Thank you, before we get started please note that this call may be recorded for quality assurance purposes. Participation in this study survey is voluntary and you can withdraw at any time. This research has been approved by the Public Health Agency of Canada Research Ethics Board. Your answers will remain confidential and we will not ask you to provide us with any information that could directly identify you or your child, such as name(s), or full date of birth. This project also has been registered with the Canadian Research Insights Council.

Can we begin?

(Show if CATI) IF MORE DETAIL REQUESTED: See help page

• Yes
• No, I do not wish to participate

RecordTerm Show if No consent (record = 2)

Thank you for your time. Good-bye.

Status Code: 551

Page Your household

AgeChildren

How old is each child living in your household, starting with the oldest child?

(Show if CATI) Wait for the respondent to say age and then select appropriate level. DO NOT READ AGE BUCKETS UNLESS NEEDED.

(Show if Web) <<TableInstruction>>

1. 1st child
2. 2nd child (Show if 2 or more children (S3 = 2,3,4,5,6,7,8,9,10))
3. 3rd child (Show if 3 or more children (S3 = 3,4,5,6,7,8,9,10))
4. 4th child (Show if 4 or more children (S3 = 4,5,6,7,8,9,10))
5. 5th child (Show if 5 or more children (S3 = 5,6,7,8,9,10))
6. 6th child (Show if 6 or more children (S3 = 6,7,8,9,10))
7. 7th child (Show if 7 or more children (S3 = 7,8,9,10))
8. 8th child (Show if 8 or more children (S3 = 8,9,10))
9. 9th child (Show if 9 or more children (S3 = 9,10))
10. 10th child (Show if 10 children (S3 = 10))

• under 6 months
• 6 months to less than 5 years
• 5 years to less than 12 years
• 12 years to less than 18 years

B0

(if Selected Child Under6months (SelectedChild = 1) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10)) During the survey we would like to ask you about your child who is under 6 months of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Selected Child Under6months (SelectedChild = 1) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10)) During the survey we would like to ask you about your child who is under 6 months of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is under 6 months of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is under 6 months of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if 6monthsless5 (SelectedChild = 2) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10) and Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is 6 months to less than 5 years of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if 6monthsless5 (SelectedChild = 2) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10)) During the survey we would like to ask you about your child who is 6 months to less than 5 years of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if 6monthsless5 (SelectedChild = 2) and Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is 6 months to less than 5 years of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if 6monthsless5 (SelectedChild = 2)) During the survey we would like to ask you about your child who is 6 months to less than 5 years of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child5to11 (SelectedChild = 4) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10) and Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is 5 years to less than 12 years of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child5to11 (SelectedChild = 4) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10)) During the survey we would like to ask you about your child who is 5 years to less than 12 years of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child5to11 (SelectedChild = 4) and Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is 5 years to less than 12 years of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child5to11 (SelectedChild = 4)) During the survey we would like to ask you about your child who is 5 years to less than 12 years of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child12to17 (SelectedChild = 5) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10) and Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is 12 years to less than 18 years of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child12to17 (SelectedChild = 5) and 2 or more children (S3 = 2,3,4,5,6,7,8,9,10)) During the survey we would like to ask you about your child who is 12 years to less than 18 years of age old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child12to17 (SelectedChild = 5) and Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is 12 years to less than 18 years of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Child12to17 (SelectedChild = 5)) During the survey we would like to ask you about your child who is 12 years to less than 18 years of age old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if 2 or more children (S3 = 2,3,4,5,6,7,8,9,10) and Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is <<ChildAgeInsert>> old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if 2 or more children (S3 = 2,3,4,5,6,7,8,9,10)) During the survey we would like to ask you about your child who is <<ChildAgeInsert>> old. If you have more than one child in this age group, please think of the <<YoungestOldest>>. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Selected Child Under6months (SelectedChild = 1)) During the survey we would like to ask you about your child who is <<ChildAgeInsert>> old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus, or questions about intentions to vaccinate your child.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.
(if Default) During the survey we would like to ask you about your child who is <<ChildAgeInsert>> old. You will be asked questions about this child's vaccination history for COVID-19 and the influenza virus.

In order to simplify your responses for the rest of the survey, please provide a nickname which will be used to refer to this child throughout the survey. This information will not be kept or associated with any of your responses. It will only be used for you as a reference as you are completing this survey.

(Show if CATI) IF NEEDED: Please do not use your child's full name.

(Show if Web) Please do not use your child's full name.

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Q4

What is your relationship to <<B0.text>>?

(Show if CATI) READ LIST IF NEEDED

(Show if Web) <<SingleInstruction>>

• Mother
• Father
• I am a legal guardian
• Relative (non-guardian)
• Unrelated

T6 Show if Unrelated or not legal guardian (Q4 = 4,5)

We're sorry but for this survey we need to speak with the parent/legal guardian/person most knowledgeable about the child's immunization. Thank you for your time.

Status Code: 507

A5

In which province or territory do you reside?

(Show if CATI) DO NOT READ LIST.

(Show if Web) <<SingleInstruction>>

1. Newfoundland and Labrador
2. Prince Edward Island
3. Nova Scotia
4. New Brunswick
5. Quebec
6. Ontario
7. Manitoba
8. Saskatchewan
9. Alberta
10. British Columbia
11. Nunavut
12. Northwest Territories
13. Yukon
14. I live outside of Canada

T7 Show if Live outside Canada (A5 = 14)

We're sorry but for this survey we need to speak with those that live in Canada. Thank you for your time.

Status Code: 505

Page Demographic information for your child

B2ageunder6months Show if Selected Child Under6months (SelectedChild = 1)

What is the exact age of <<B0.text>>?

(Show if Web) <<SingleInstruction>>

• 1 month
• 2 months
• 3 months
• 4 months
• 5 months
• I prefer not to answer

B2age6monthslessthan5 Show if 6monthsless5 (SelectedChild = 2)

What is the exact age of <<B0.text>>?

(Show if Web) <<SingleInstruction>>

• 6 months
• 7 months
• 8 months
• 9 months
• 10 months
• 11 months
• 1 year old
• 2 years old
• 3 years old
• 4 years old
• I prefer not to answer

B2ageChild5to11 Show if Child5to11 (SelectedChild = 4)

What is the exact age of <<B0.text>>?

(Show if Web) <<SingleInstruction>>

• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• I prefer not to answer

B2ageChild12to17 Show if Child12to17 (SelectedChild = 5)

What is the exact age of <<B0.text>>?

(Show if Web) <<SingleInstruction>>

• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• I prefer not to answer

Section COVID 19 and Influenza Immunization

D1, D2, DXa, D4, D5, D6, D7, D8, D11, D12, D13, D14, D15, D22, DX3, D19, D20, D21, D23, D24, D18b, Dx2, D16, D17, D18a

Page COVID-19 Immunization

Show if Child is 6 months and older (SelectedChild > 1)

D1

The next few questions are about your child's experience with COVID-19 and vaccination against COVID-19.

How many doses of a COVID-19 vaccine has <<B0.text>> received so far?

(Show if Web) <<SingleInstruction>>

• 1 dose
• 2 doses
• 3 doses
• 4 doses
• 5 or more doses
• Has not received a COVID-19 vaccine
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D2 Show if Child COVID19 vaccinated DK PNA (D1 = 1,2,3,4,5,<<catiDoNotRead>>Prefer not to answer,<<catiDoNotRead>>Don't know)

From September 1st, 2023 to now, has <<B0.text>> received a COVID-19 vaccine?

(Show if CATI) DO NOT READ LIST.

(Show if Web) <<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

DXa Show if Child Not COVID19 vaccinate DK PNA (D1 = 6,<<catiDoNotRead>>Prefer not to answer,<<catiDoNotRead>>Don't know)

Did you intentionally decide not to get a COVID-19 vaccine for <<B0.text>>?

Deciding not to receive a vaccine means you were not willing to get a vaccine or chose not to get a vaccine.

(Show if CATI) DO NOT READ LIST.

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D4 Show if Child Not COVID19 vaccinated (D1 = 6)

(Show if CATI) What were the reasons why <<B0.text>> did not receive a COVID-19 vaccine? Would you say it is because…?

For each option please answer yes or no.

READ LIST. Select all that apply.

(Show if Web) What were the reasons why <<B0.text>> did not receive a COVID-19 vaccine? Would you say it is because…?

Select all that apply

• Do not consider it necessary for my child *
• Do not think the vaccine is safe/concerned about side effects *
• Do not think the vaccines are effective in protecting against the virus *
• Religious, philosophical or cultural reasons *
• I do not trust the government and/or pharmaceutical companies *
• I am opposed to COVID-19 vaccines *
• My child already had COVID-19 and I believe they are adequately protected by natural immunity *
• My child is not at risk of getting COVID-19 *
• It was not advised for my child due to medical reasons *
• [READ IF NO RESPONSE SELECTED / ]Other reason, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

Page COVID-19 Immunization

D5

How likely are you to keep <<B0.text>>'s COVID-19 doses up to date (i.e., in the future, receiving them as they are recommended by public health)?

Even if you are opposed to COVID-19 vaccines, we would still like to know if, in the future, you would consider getting the vaccine for your child.

(Show if CATI) READ LIST.

• Definitely will
• Probably will
• Probably won't
• Definitely won't
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D6 Show if Child COVID19 vaccinated (D1 = 1,2,3,4,5)

(Show if CATI) Why did <<B0.text>> receive a COVID-19 vaccine?

For each option please answer yes or no.

READ LIST. Select all that apply.

(Show if Web) Why did <<B0.text>> receive a COVID-19 vaccine?

Select all that apply.

• To protect them and household members against COVID-19 infection and/or severe outcomes *
• To protect them against long COVID[ IF NEEDED / ](symptoms that last more than 12 weeks) *
• Based on public health recommendations *
• To prevent the spread of COVID-19 in my community *
• It was recommended by a health care professional *
• Because I know friends/family who have had their children vaccinated *
• In order to be able to travel or do other activities that required a COVID-19 vaccination *
• It was available and free *
• It was offered at the same time as the influenza (flu) vaccine *
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

D7

Has <<B0.text>> ever tested positive for COVID-19?

(Show if CATI) DO NOT READ LIST.

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D8 Show if Child diagnosed COVID19 (D7 = 1)

(Show if CATI) Has a health care provider ever diagnosed <<B0.text>> with any of the following conditions, after a COVID-19 infection?

For each option please answer yes or no.

READ LIST. Select all that apply.

(Show if Web) Has a health care provider ever diagnosed <<B0.text>> with any of the following conditions, after a COVID-19 infection?

Select all that apply.

• Multisystem inflammatory syndrome in children (MIS-C)[ IF NEEDED / ](high fever and inflammation in their body or organs) *
• Long COVID[ IF NEEDED / ](i.e., symptoms that lasted more than 12 weeks after COVID-19 infections) *
• None of the above conditions (Exclusive)
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

Page COVID-19 Immunization

Show if Child is 6 months and older (SelectedChild > 1)

D11 Show if NOT Opposed to covid vaccine (D4_6 != 1)

(Show if CATI) Did any obstacles make it difficult or prevent <<B0.text>> from getting the COVID-19 vaccine?

For each option please answer yes or no.

READ LIST. Select all that apply.

(Show if Web) Did any obstacles make it difficult or prevent <<B0.text>> from getting the COVID-19 vaccine?

Select all that apply.

• No obstacles (Exclusive)
• Difficulty getting an appointment (e.g., no appointments available, or scheduling conflicts)
• Live in a remote area/limited transportation
• My child fears needles
• I/my child had an adverse reaction to a previous vaccine
• At least one parent opposed it
• No vaccine available
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D12 Show if NOT Opposed to covid vaccine (D4_6 != 1)

(Show if CATI) Have you ever been hesitant to vaccinate <<B0.text>> against COVID-19?

IF NEEDED: Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

DO NOT READ LIST.

(Show if Web) Have you ever been hesitant to vaccinate <<B0.text>> against COVID-19?

Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

<<SingleInstruction>>

• Not at all hesitant
• Not very hesitant
• Somewhat hesitant
• Very hesitant
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D13 Show if Child hesitant COVID19 vaccine (D12 = 2,3,4)

(Show if CATI) Why were you hesitant to get a COVID-19 vaccine for <<B0.text>>?

For each option please answer yes or no.

READ LIST. Select all that apply.

(Show if Web) Why were you hesitant to get a COVID-19 vaccine for <<B0.text>>?

Select all that apply.

• My child fears needles *
• My child is not at risk of getting COVID-19 *
• Did not discuss COVID-19 vaccines with my child's health care practitioner *
• Concerns that not enough research on the vaccine has been done in children *
• Concerns about the effectiveness *
• Concerns about the safety *
• My child had a bad experience with previous vaccinations *
• Did not know where to get reliable information *
• Religious, philosophical or cultural reasons *
• Mistrust in COVID-19 vaccine related information *
• My child is not at risk of getting very sick from COVID-19 *
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

Page Influenza Immunization

Show if Child is 6 months and older (SelectedChild > 1)

D14

(Show if CATI) The next few questions are about <<B0.text>>'s experience with vaccination against the flu (influenza). Children 6 months of age and older are eligible for the influenza vaccine.

Prior to the 2023-2024 flu season, how often did <<B0.text>> receive their flu vaccine? Would you say...

READ LIST.

(Show if Web) The next few questions are about <<B0.text>>'s experience with vaccination against the flu (influenza). Children 6 months of age and older are eligible for the influenza vaccine.

Prior to the 2023-2024 flu season, how often did <<B0.text>> receive their flu vaccine?

<<SingleInstruction>>

• Every flu season
• Most flu seasons
• Some flu seasons (including once only)
• Never
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D15

(Show if CATI) Did <<B0.text>> receive a flu vaccine this flu season, between September 2023 and April 2024?

IF NEEDED: There are two general types of flu vaccinations. Most influenza vaccine is given with a needle and syringe but some children may receive a spray in their nose.

DO NOT READ LIST.

(Show if Web) Did <<B0.text>> receive a flu vaccine this flu season, between September 2023 and April 2024?
There are two general types of flu vaccinations. Most influenza vaccine is given with a needle and syringe but some children may receive a spray in their nose.

<<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D22 Show if child did NOT receive flu vaccine this season DK PNA (D15 = 0,<<catiDoNotRead>>Prefer not to answer,<<catiDoNotRead>>Don't know)

(Show if CATI) Did you intentionally decide not to get the flu vaccine for <<B0.text>>, during this flu season?

IF NEEDED: Flu season: between September 2023 and April 2024
Deciding not to receive a vaccine means you were not willing to get a vaccine or chose not to get a vaccine.

DO NOT READ LIST.

(Show if Web) Did you intentionally decide not to get the flu vaccine for <<B0.text>>, during this flu season?
Flu season: between September 2023 and April 2024.

Deciding not to receive a vaccine means you were not willing to get a vaccine or chose not to get a vaccine.

<<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

DX3 Show if child did NOT receive flu vaccine this season (D15 = 0)

(Show if CATI) What were the reasons why <<B0.text>> did not receive the flu vaccine ? Would you say it is because…?

For each option please answer yes or no.

IF NEEDED: Flu season: between September 2023 and April 2024.

READ LIST. Select all that apply.

(Show if Web) What were the reasons why <<B0.text>> did not receive the flu vaccine ? Would you say it is because…?
Flu season: between September 2023 and April 2024.

Select all that apply.

• My child is not at risk of getting the flu *
• Concerns about the safety/side effects of the flu vaccine *
• Concerns about receiving a COVID-19 and flu vaccine at the same time *
• Religious, philosophical or cultural reasons *
• The flu vaccine does not work *
• Did not consider it necessary for my child *
• I am opposed to flu vaccines *
• I did not get around to it (e.g. too busy, lack of time) *
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

Page Influenza Immunization Show if Child is 6 months and older (SelectedChild > 1)

D19 Show if child received flu vaccine this season (D15 = 1)

(Show if CATI) Why did <<B0.text>> receive a flu vaccine this flu season?

For each option please answer yes or no.
IF NEEDED: Flu season: between September 2023 and April 2024.

READ LIST. Select all that apply.

(Show if Web) Why did <<B0.text>> receive a flu vaccine this flu season?
Flu season: between September 2023 and April 2024.

Select all that apply.

• To protect themselves and/or household members *
• It was offered at the same time when my child was getting a COVID-19 vaccine *
• Based on public health recommendations *
• To prevent the spread of the flu in my community *
• It was recommended by a health care provider *
• It was available and free *
• Increased concerns about flu because of the COVID-19 pandemic *
• My child receives it every year *
• I know friends/family who have vaccinated their child *
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

D20 Show if NOT opposed to flu vaccine (DX3_7 != 1)

(Show if CATI) Did any obstacles make it difficult or prevent <<B0.text>> from getting the flu vaccine this flu season?

For each option please answer yes or no.
IF NEEDED: Flu season: between September 2023 and April 2024.

READ LIST. Select all that apply.

(Show if Web) Did any obstacles make it difficult or prevent <<B0.text>> from getting the flu vaccine this flu season?
Flu season: between September 2023 and April 2024.

Select all that apply.

• No obstacles (Exclusive)
• Difficulty getting an appointment (e.g., no appointments available, or scheduling conflicts)
• At least one parent opposed it
• Living in a remote area / limited transportation
• I/my child had an adverse reaction to a previous vaccine
• My child fears needles
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D21 Show if NOT opposed to flu vaccine (DX3_7 != 1)

(Show if CATI) Have you ever been hesitant to vaccinate <<B0.text>> against the flu during this flu season?

IF NEEDED : Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

IF NEEDED: Flu season: between September 2023 and April 2024.

DO NOT READ LIST.

(Show if Web) Have you ever been hesitant to vaccinate <<B0.text>> against the flu during this flu season?
Flu season: between September 2023 and April 2024.

Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

<<SingleInstruction>>

• Not at all hesitant
• Not very hesitant
• Somewhat hesitant
• Very hesitant
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D23 Show if child hesitant flu (D21 = 2,3,4)

(Show if CATI) Why were you hesitant to get the flu vaccine for <<B0.text>>?

For each option please answer yes or no.
IF NEEDED: Flu season: between September 2023 and April 2024.

READ LIST. Select all that apply.

(Show if Web) Why were you hesitant to get the flu vaccine for <<B0.text>>?
Flu season: between September 2023 and April 2024.

Select all that apply.

• My child fears needles *
• My child is not at risk of getting the flu *
• Did not discuss the flu vaccine with my child's health care practitioner *
• I was concerned about the effectiveness *
• I had concerns about the safety *
• My child had a bad experience with previous vaccines *
• I did not know where to get reliable information *
• Religious, philosophical or cultural reasons *
• I do not trust the government or pharmaceutical companies *
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

D24

(Show if CATI) Did the COVID-19 pandemic affect your decision to get <<B0.text>> vaccinated against the flu during this flu season?
IF NEEDED: Flu season: between September 2023 and April 2024.

IF YES: Prompt with first two response options.

(Show if Web) Did the COVID-19 pandemic affect your decision to get <<B0.text>> vaccinated against the flu during this flu season?
Flu season: between September 2023 and April 2024.

<<SingleInstruction>>

• Yes, it motivated me to get my child vaccinated
• Yes, it made me not want to get my child vaccinated
• No, it did not impact my decision
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Page Influenza Immunization

D18b

How likely are you to get <<B0.text>> vaccinated against the flu in the next flu season, as of September 1, 2024?

(Show if CATI) READ LIST.

(Show if Web) <<SingleInstruction>>

• Definitely will
• Probably will
• Probably won't
• Definitely won't
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Page Combined Immunization

Dx2 Show if Child is 6 months and older (SelectedChild > 1)

(Show if CATI) Did a health care provider recommend that <<B0.text>> receive...
IF NEEDED : Flu season: between September 2023 and April 2024.

(Show if Web) Did a health care provider recommend that <<B0.text>> receive...

1. the COVID-19 vaccine?
2. the influenza (flu) vaccine this flu season?
   Flu season: between September 2023 and April 2024.

• Yes
• A healthcare provider did not mention it
• No, a healthcare provider recommended against it
• I did not consult a healthcare provider
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D16 Show if Child received flu AND covid vaccines ((D1 = 1,2,3,4,5) AND (D15 = 1))

Did <<B0.text>> receive the flu and COVID-19 vaccines during the same visit?

(Show if Web) <<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D17 Show if Child received flu and covid same time (D16 = 1)

What is the main reason why <<B0.text>> received the flu and COVID-19 vaccines at the same visit? Would you say it is …?

(Show if Web) <<SingleInstruction>>

• To save time
• Easier to book an appointment
• To help reduce workload for health care system
• It was recommended by a health care professional
• The other vaccine was offered during my child's visit
• Other reasons, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

D18a Show if Child did not receive covid and flu same time (D16 = 0)

What is the main reason why <<B0.text>> did not receive the flu and COVID-19 vaccines at the same visit? Would you say it is because…?

(Show if Web) <<SingleInstruction>>

• Receiving both vaccines might cause a higher number of adverse reactions/side effects
• Vaccines could be less effective than getting them at different time points
• Two vaccines at the same time can overload my child's immune system
• My child only wanted or needed one of the two vaccines
• My child was not offered the option/not able to book an appointment to receive both at the same visit
• Other reasons, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Section Lifestyle/Risk of contracting infection

C1, C2

Page Demographic information of child

C1

(Show if CATI) Does <<B0.text>> have any of the following conditions?

For each option please answer yes or no.

Interviewer note: Migraines and mental health conditions, such as depression, anxiety, PTSD, etc., are not included.

READ LIST. Select all that apply.

(Show if Web) Does <<B0.text>> have any of the following conditions?

Select all that apply.

• Sickle cell anemia or thalassemia major *
• Chronic heart disease *
• Neurologic or neurodevelopmental disorders[ IF NEEDED / ](e.g., epilepsy, Down syndrome, etc.) *
• Autoimmune conditions [ IF NEEDED / ](e.g., systemic lupus erythematosus [SLE], rheumatoid arthritis, Crohn's disease, psoriasis, ulcerative colitis) *
• Asthma or other chronic lung disease[ IF NEEDED / ](e.g., cystic fibrosis, etc.) *
• Chronic liver disease or kidney disease [ IF NEEDED / ](e.g., impaired kidney functions, dialysis, hepatitis, cirrhosis, etc.) *
• Cochlear implant *
• Diabetes, obesity or other endocrine disorders [ IF NEEDED / ](e.g., hypothyroid, etc.) *
• Immune suppression[ IF NEEDED / ](e.g., chemotherapy, radiation, steroid use, an organ or stem cells transplant, HIV/AIDS, etc.) *
• Cancer [ IF NEEDED / ](any type, including leukemia and lymphoma) *
• Spleen problems or removal *
• [READ IF NO RESPONSE SELECTED / ]Other medical condition, please specify: __________________________________________________
• None of these conditions (Exclusive)
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

C2

(Show if CATI) Does <<B0.text>> identify as a person with a disability?

IF NEEDED : A person with a disability is a person who has a long-term or recurring impairment (such as vision, hearing, mobility, flexibility, dexterity, pain, learning, developmental, memory or mental health-related) which limits their daily activities inside or outside the home (such as at school, work, or in the community in general).

DO NOT READ LIST.

(Show if Web) Does <<B0.text>> identify as a person with a disability?

A person with a disability is a person who has a long-term or recurring impairment (such as vision, hearing, mobility, flexibility, dexterity, pain, learning, developmental, memory or mental health-related) which limits their daily activities inside or outside the home (such as at school, work, or in the community in general).

<<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Section COVID-19 and Influenza immunization history - PARENT

E1, E2, E3, E3a, E4, E6, E8, E9, E14, E11, E13, E15

Page COVID-19 immunization of parent/legal guardian

E1

The next few questions are about your experiences with vaccination against COVID-19 and the flu (influenza).

How many doses of a COVID-19 vaccine have you received?

(Show if CATI) READ LIST IF NEEDED.

(Show if Web) <<SingleInstruction>>

• 1 dose
• 2 doses
• 3 doses
• 4 doses
• 5 or more doses
• I have not received a COVID-19 vaccine
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E2 Show if Parent received covid vaccine (E1 = 1,2,3,4,5,<<catiDoNotRead>>Prefer not to answer,<<catiDoNotRead>>Don't know)

From September 1st, 2023 to now, have you received a COVID-19 vaccine?

(Show if Web) <<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E3 Show if Parent NOT received covid vaccine DK PNA (E1 = 6,<<catiDoNotRead>>Prefer not to answer,<<catiDoNotRead>>Don't know)

Did you intentionally decide not to get a COVID-19 vaccine for yourself?
Deciding not to receive a vaccine means you were not willing to get a vaccine or chose not to get a vaccine.

(Show if Web) <<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E3a Show if parent did NOT receive covid19 vaccine (E1 = 6)

(Show if CATI) What were the reasons why you did not receive a COVID-19 vaccines? Would you say it is because…?

For each option please answer yes or no.

READ LIST Select all that apply

(Show if Web) What were the reasons why you did not receive a COVID-19 vaccine? Would you say it is because…?

Select all that apply

• Do not consider it necessary for myself *
• Do not think the vaccine is safe/concerned about side effects *
• Do not think the vaccines are effective in protecting against the virus *
• Religious, philosophical or cultural reasons *
• I do not trust the government and/or pharmaceutical companies *
• I am opposed to COVID-19 vaccines *
• I have already had COVID-19 and I believe I am adequately protected by natural immunity *
• I am not at risk of getting COVID-19 *
• It was not advised due to medical reasons *
• [READ IF NO RESPONSE SELECTED / ]Other reason, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

E4

How likely are you to keep your COVID-19 doses up to date (i.e., in the future, receiving them as they are recommended by public health)?

(Show if CATI) READ LIST.

(Show if Web) <<SingleInstruction>>

• Definitely will
• Probably will
• Probably won't
• Definitely won't
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E6 Show if NOT Opposed to vaccines covid for parent (E3a_6 != 1)

(Show if CATI) Have you ever been hesitant to get a COVID-19 vaccine for yourself?
IF NEEDED: Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

DO NOT READ LIST.

(Show if Web) Have you ever been hesitant to get a COVID-19 vaccine for yourself?

Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

<<SingleInstruction>>

• Not at all hesitant
• Not very hesitant
• Somewhat hesitant
• Very hesitant
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Page Influenza Immunization of parent/legal guardian

E8

Prior to the 2023-2024 flu season, how often did you receive the flu vaccine?

(Show if CATI) READ LIST.

(Show if Web) <<SingleInstruction>>

• Every flu season
• Most flu seasons
• Some flu seasons (including once only)
• Never
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E9

(Show if CATI) Did you get the flu vaccine during this flu season?

IF NEEDED : Flu season: between September 2023 and April 2024.

DO NOT READ LIST.

(Show if Web) Did you get the flu vaccine during this flu season?
Flu season: between September 2023 and April 2024.

<<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E14 Show if Parent not received flu vaccine DK PNA (E9 = 0,<<catiDoNotRead>>Prefer not to answer,<<catiDoNotRead>>Don't know)

Did you intentionally decide not to get the flu vaccine, during this flu season?

(Show if CATI) DO NOT READ LIST.

(Show if Web) <<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E11 Show if Parent not received flu vaccine1 (E9 = 0)

(Show if CATI) What were the reasons why you did not receive the flu vaccine? Would you say it is because…?

For each option, please answer yes or no.

IF NEEDED: Flu season: between September 2023 and April 2024.

Select all that apply

(Show if Web) What were the reasons why you did not receive the flu vaccine? Would you say it is because…?

Flu season: between September 2023 and April 2024.

Select all that apply

• I am not at risk of getting the flu *
• Concerns about the safety/side effects of the flu vaccine *
• Concerns about receiving a COVID-19 and flu vaccine at the same time *
• Religious, philosophical or cultural reasons *
• The flu vaccine does not work *
• Did not consider it necessary for myself *
• I am opposed to flu vaccines *
• I did not get around to it (e.g. too busy, lack of time) *
• [READ IF NO RESPONSE SELECTED / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Levels marked with * are randomized

E13 Show if NOT Opposed to vaccines flu for parent (E11_7 != 1)

(Show if CATI) Were you hesitant about getting the flu vaccine during this flu season?

IF NEEDED: Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

Flu season: between September 2023 and April 2024.

DO NOT READ LIST.

(Show if Web) Were you hesitant about getting the flu vaccine during this flu season?

Flu season: between September 2023 and April 2024.

Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite availability.

<<SingleInstruction>>

• Not at all hesitant
• Not very hesitant
• Somewhat hesitant
• Very hesitant
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

E15

How likely are you to get vaccinated against the flu in the next flu season, as of September 1, 2024?

(Show if CATI) READ LIST.

(Show if Web) <<SingleInstruction>>

• Definitely will
• Probably will
• Probably won't
• Definitely won't
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Section Knowledge, Attitudes and Behaviours

F2, F3

Page Knowledge, Attitudes and Behaviours

F2

What is your most trusted source of information about COVID-19 vaccines?

(Show if CATI) SINGLE RESPONSE READ LIST.

(Show if Web) <<SingleInstruction>>

• Health care providers
• Family/Friends
• Social media (e.g., X (formerly called Twitter), Facebook)
• Scientific publications/journals
• My local public health unit/provincial health authority/immunization clinic
• Public Health Agency of Canada/Health Canada
• Community nursing stations or clinics
• News/media (e.g., TV, radio, newspapers)
• National Advisory Committee on Immunization (NACI)
• International sources (e.g., World Health Organization (WHO), Center for Disease Control and Prevention (CDC))
• Other
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

F3

(Show if CATI) To what extent do you agree with the following statements?

Read statement, then probe:

Would you say you strongly agree, somewhat agree, somewhat disagree or strongly disagree?

(Show if Web) To what extent do you agree with the following statements?

<<TableInstruction>>

• 1. In general, vaccines are safe *
• 2. In general, vaccines are effective *
• 3. In general, COVID-19 vaccines are safe *
• 4. In general, COVID-19 vaccines are effective *
• 6. Close family and friends want me to get my child vaccinated against COVID-19 *
• 9. My child needs to be vaccinated against COVID-19 even if they've had a COVID-19 infection before *
• 13.I have access to enough trustworthy information about COVID-19 vaccines to make an informed decision *
• 14. In general, the flu vaccine is safe *
• 15. In general, the flu vaccine is effective *

Levels marked with * are randomized

• Strongly agree
• Somewhat agree
• Somewhat disagree
• Strongly disagree
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Section Demographic information of child

B2, B4, B5, G5, G6, F1

Page Demographic information of your child

B2

The next few questions will help us understand background characteristics of children in this survey. Remember that all the information you provide is completely anonymous and will be kept confidential.

What was <<B0.text>>'s assigned sex at birth?

(Show if CATI) DO NOT READ LIST.

(Show if Web) <<SingleInstruction>>

• Male
• Female
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

B4

(Show if CATI) What is <<B0.text>>'s racial or ethnic background?
IF NEEDED: We recognize this list of racial or ethnic identifiers may not exactly match how you would describe your child.
Select all that apply.

READ LIST UNTIL INTERUPTED, AFTER, PROMPT FOR 'ANY OTHERS?'

(Show if Web) What is <<B0.text>>'s racial or ethnic background?
We recognize this list of racial or ethnic identifiers may not exactly match how you would describe your child.

Select all that apply.

• Black (African, Afro-Caribbean, African descent)
• East/Southeast Asian (e.g., Chinese, Korean, Japanese, Taiwanese, Filipino, Vietnamese, Cambodian, Thai, Indonesian, other Southeast Asian descent)
• Indigenous (First Nations, Métis, Inuit)
• Latin American
• Middle Eastern and North African (Arab, Algerian, Egyptian, West Asian descent (e.g., Iranian, Israeli, Lebanese, Turkish, Kurdish, etc.))
• South Asian descent (e.g., Afghan, Indian, Pakistani, Bangladeshi, Sri Lankan, etc.)
• White European descent
• Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

B5 Show if Child identifies as indigenous (B4_3 = 1)

Does <<B0.text>> identify as First Nations, Métis and/or Inuit?

(Show if CATI) DO NOT READ LIST. Select all that apply.

(Show if Web) Select all that apply.

• First Nations (includes status and non status individuals)
• Métis
• Inuit
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G5 Show if Identifies as First Nation (B5_1 = 1)

Is <<B0.text>>'s primary residence on a reserve?

(Show if CATI) DO NOT READ LIST.

(Show if Web) <<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G6 Show if Identifies as Inuit (B5_3 = 1)

Is <<B0.text>>'s primary residence in Inuit Nunangat (Inuvialuit, Nunavik, Nunatsiavut, or Nunavut)?

(Show if CATI) DO NOT READ LIST.

(Show if Web) <<SingleInstruction>>

• Yes
• No
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

F1

(Show if CATI) Has <<B0.text>> received all recommended routine vaccinations for their age?

Do not include COVID-19 and flu vaccines.

IF NEEDED: Routine childhood vaccinations for children 0-17 years of age include vaccines against infections such as measles, mumps, rubella, chickenpox, hepatitis B, tetanus, diphtheria, human papillomavirus, etc. More information can be found here: https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/provincial-territorial-routine-vaccination-programs-infants-children.html.

READ LIST IF NEEDED.

(Show if Web) Has <<B0.text>> received all recommended routine vaccinations for their age?

Do not include COVID-19 and flu vaccines.

Routine childhood vaccinations for children 0-17 years of age include vaccines against infections such as measles, mumps, rubella, chickenpox, hepatitis B, tetanus, diphtheria, human papillomavirus, etc. More information can be found here (opens in a new window) (https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/provincial-territorial-routine-vaccination-programs-infants-children.html).

<<SingleInstruction>>

• Yes
• No, only some were received
• No, none
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Section Demographic Information of parent/legal guardian

G1, G2, A3, G3, G7, G8, G9, G10, G11, G12

Page Demographic Information of parent/legal guardian

G1

These last few questions are about you and will be used to help us better understand the background of parents in this survey.

What was your assigned sex at birth?

(Show if CATI) DO NOT READ.

(Show if Web) <<SingleInstruction>>

• Male
• Female
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G2

(Show if CATI) Do you live in an urban or rural area?

IF NEEDED: An urban area is a city, town or village with a population of 1000 people or more, while a rural area is any other area of lower population.

DO NOT READ.

(Show if Web) Do you live in an urban or rural area?
An urban area is a city, town or village with a population of 1000 people or more, while a rural area is any other area of lower population.

<<SingleInstruction>>

• Urban
• Rural
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

A3

How old are you?

Minimum: 18, Maximum: 120

__________ years old

• [DO NOT READ / ]Prefer not to answer

G3

(Show if CATI) What is your racial or ethnic background?
IF NEEDED: We recognize this list of racial or ethnic identifiers may not exactly match how you would describe yourself.
Select all that apply.

READ LIST UNTIL INTERRUPTED, AFTER, PROMPT FOR 'ANY OTHERS?'

(Show if Web) What is your racial or ethnic background?
We recognize this list of racial or ethnic identifiers may not exactly match how you would describe yourself.

Select all that apply.

• Black (African, Afro-Caribbean, African descent)
• East/Southeast Asian (e.g., Chinese, Korean, Japanese, Taiwanese, Filipino, Vietnamese, Cambodian, Thai, Indonesian, other Southeast Asian descent)
• Indigenous (First Nations, Métis, Inuit)
• Latin American
• Middle Eastern and North African (Arab, Algerian, Egyptian, West Asian descent (e.g., Iranian, Israeli, Lebanese, Turkish, Kurdish, etc.))
• South Asian descent (e.g., Afghan, Indian, Pakistani, Bangladeshi, Sri Lankan, etc.)
• White European descent
• Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G7

Which group best defines your citizenship status in Canada?

(Show if CATI) READ LIST AS NEEDED.

(Show if Web) <<SingleInstruction>>

• Canadian citizen by birth[ IF NEEDED / ](i.e., born in Canada or born outside Canada with at least one of the parents being Canadian.)
• Canadian citizen by naturalization[ IF NEEDED / ](i.e., a person who was not born as a Canadian citizen who was granted citizenship of Canada under the Citizenship Act.)
• Permanent resident/landed immigrant
• Other (e.g., refugee, holds work or study permit)
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G8 Show if Parent citizenship not by birth (G7 = 2,3,4)

How many years have you been living in Canada?

(Show if CATI) Enter 0 if less than a year.

(Show if Web) If less than a year please enter 0.

Minimum: 0, Maximum: 9999999

__________ years

• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G9

What is the highest level of formal education you have completed?

(Show if CATI) READ LIST AS NEEDED.

(Show if Web) <<SingleInstruction>>

• Less than a high school diploma or equivalent
• High school / Secondary school / École secondaire diploma or equivalent
• Registered apprenticeship or other trade certificate or diploma
• College / CEGEP or other non-university certificate or diploma
• University certificate or diploma below bachelor's level
• University – bachelor's degree
• University – post-graduate degree above bachelor's level
• [DO NOT READ / ]Other, please specify: __________________________________________________
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]I don't know

G10

Which best describes your current employment status? Are you…

(Show if CATI) READ LIST UNTIL INTERUPTED.

(Show if Web) <<SingleInstruction>>

• Working full-time, 35 or more hours per week
• Working part-time, less than 35 hours per week
• Self-employed
• Unemployed, but looking for work
• A student attending school full-time or part-time
• Retired
• Not in the workforce (full-time homemaker, unemployed, not looking for work)
• [DO NOT READ / ]Other
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G11

(Show if CATI) Are you currently working or volunteering in any of the following sectors?

We are interested in jobs that put employees at high-risk of vaccine preventable diseases. For each option please answer yes or no.

READ LIST. Select all that apply.

(Show if Web) Are you currently working or volunteering in any of the following sectors?

We are interested in jobs that put employees at high-risk of vaccine preventable diseases.

Select all that apply.

• Health care or laboratory worker[ IF NEEDED / ](e.g., physician, nurse, occupational/physical therapist, etc., those who work, study, or volunteer in hospitals, long-term care, nursing home, and community settings)
• Child care or schools[ IF NEEDED / ](e.g., teacher, daycare worker)
• Exposed to animals or their materials[ IF NEEDED / ](e.g., veterinarian)
• Emergency services worker[ IF NEEDED / ](e.g., police, fire fighter, EMT)
• Other[ IF NEEDED / ](e.g., worker in a correction facility, on a crew ship or aircraft, military personnel, humanitarian relief or essential community service)
• I don't work in any of the above sectors (Exclusive)
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

G12

(Show if CATI) What was your total household income, before taxes and deductions, for the year ending December 31, 2023.

READ LIST UNTIL INTERRUPTED.

(Show if Web) Please indicate your total household income, before taxes and deductions, for the year ending December 31, 2023.

<<SingleInstruction>>

• Under $20,000
• $20,000 to $39,999
• $40,000 to $59,999
• $60,000 to $79,999
• $80,000 to $99,999
• $100,000 to $149,999
• $150,000 and above
• [DO NOT READ / ]Prefer not to answer
• [DO NOT READ / ]Don't know

Section TCH Sample - Gather Email

Show if TCHSample (phone_source = 3,4)

RTCHcanemail, RTCHcollectemail

Page Email_Confirmation

Show if DoesNotHaveEmail (panel_have_email = 0)

RTCHcanemail

(Show if CATI) TellCityHall makes the results to many of our studies available to the public free of charge.

Would you be willing to provide your email address to receive any of the following?

<<catiReadList>>

(Show if Web) TellCityHall makes the results to many of our studies available to the public free of charge.

Would you be willing to provide your email address to receive any of the following?

Select all that apply

• Information on research we have published (Up to 4 times a year)
• Invitations to future surveys
• Neither of the above

RTCHcollectemail

Show if CanEmailFuture AND Email not provided in current recruit ((RTCHcanemail_1 = 1 OR RTCHcanemail_2 = 1) AND (confirmemail = Not Answered))

What email address should we use?

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Section Survey End

WebEndTCH, CATIEnd

Page Survey End

WebEndTCH

Show if isWeb (custom: <<current_mode_is("web")>>)

(if is WCAG (wcag = 1))

This survey was conducted on behalf of the Public Health Agency of Canada. We hope you've found it interesting, and we sincerely thank you for your time.

(if is not WCAG (wcag != 1))

This survey was conducted on behalf of the Public Health Agency of Canada. We hope you've found it interesting, and we sincerely thank you for your time.
^©2024 Advanis and TellCityHall Privacy Policy (opens in a new window) (http://www.tellcityhall.ca/privacy.html) CRIC Pledge (opens in a new window) (https://www.canadianresearchinsightscouncil.ca/wp-content/uploads/2020/09/CRIC-Pledge-to-Canadians.pdf)

(if Default)

This survey was conducted on behalf of the Public Health Agency of Canada. We hope you've found it interesting, and we sincerely thank you for your time.
^©2024 Advanis and TellCityHall Privacy Policy (opens in a new window) (http://www.tellcityhall.ca/privacy.html) CRIC Pledge (opens in a new window) (https://www.canadianresearchinsightscouncil.ca/wp-content/uploads/2020/09/CRIC-Pledge-to-Canadians.pdf)

Status Code: -1

CATIEnd Show if isCATI (custom: <<current_mode_is("cati")>>)

We hope you've found it interesting, and we sincerely thank you for your time.

The Public Health Agency of Canada has contracted an independent public opinion research company Advanis to conduct this research.

Status Code: -1

Help Page

For technical support with the survey, accessibility requirements, or to request to complete the survey using another method you can contact TellCityHall and Advanis at sday+ccic@tellcityhall.ca (mailto:sday+ccic@tellcityhall.ca).

The CCICS will not collect information that directly identifies you or your child and data will be stored on password-protected computers. Responses will be grouped for analysis and presented in grouped form. Your responses will remain anonymous.

The Public Health Agency of Canada (part of the Government of Canada) has contracted an independent public opinion research company, Advanis, to conduct the research on PHAC's behalf. This survey uses Advanis' TellCityHall data collection methodology (for TCH sample). This project has been registered with CRIC under number 20240417-AD654. https://www.canadianresearchinsightscouncil.ca/rvs/home/?lang=en

The aim of the Childhood COVID-19 Immunization Coverage Survey (CCICS) is to measure how many children and teens in Canada have received COVID-19 and flu vaccines. The survey will also ask parents about their views on these vaccines. Your answers will help develop vaccination programs in Canada. You will be asked questions, such as age, gender, and ethnicity. Your answers will remain confidential and we will not ask you to provide us with any information that could directly identify you or your child, such as name(s), or full date of birth. The protection of your personal information is very important to us and we will make every effort to safeguard it and reduce the risk that you are identified.

Participation in this study is voluntary and you can withdraw at any time, and there will be no consequences if you decide not to participate. Your decision to participate does not waive your right to legal recourse in the event of research-related harm. You may skip any questions that you do not feel comfortable answering. You may also complete the survey in several sessions and from different devices. If you get interrupted while doing the survey, you can click on the same link to pick up right where you left off. Once data has been collected, please note that researchers have no way of knowing which data belongs to which participant.

What is the Authority to Collect the Information?
The information you provide to the Public Health Agency of Canada is collected under the authority of section 4 of the Department of Health Act and section 3 of the Public Health Agency of Canada Act and handled in accordance with the Privacy Act.

Will we use or share your personal information for any other reason?

The survey firm, Advanis, will be responsible for collecting survey data from all participants. Once data collection is complete, Advanis will provide the Public Health Agency of Canada (PHAC) with a dataset that will not include any personal identifiers to ensure your and your child's confidentiality. The dataset will also be available to federal and provincial governments and researchers across Canada, if requested. Any reports or publications produced based on this research will use grouped data and will not identify you/your child or link you to these survey results.

What are your rights?

You have a right to complain to the Privacy Commissioner of Canada if you feel your personal information has not been handled properly.
If you have any questions or concerns about the survey or the information we are collecting, please e-mail: sday+ccic@tellcityhall.ca (mailto:sday+ccic@tellcityhall.ca)

What You Will Be Asked to Do

You will be asked to complete a 15-minute survey to answer questions related to the COVID-19 and flu vaccines. Please note that certain questions will be asked at the start of the survey, to determine if you are eligible to participate. If you are not eligible to participate, your data will be removed and destroyed.

Benefits

By participating in this study you will help advance understanding of Canadian children's uptake of COVID-19 and flu vaccines.

Confidentiality

The CCICS will not collect information that directly identifies you or your child and data will be stored on password-protected computers. Responses will be grouped for analysis and presented in grouped form. Your responses will remain anonymous.

For technical support with the survey, you can contact TellCityHall and Advanis at sday+ccic@tellcityhall.ca (mailto:sday+ccic@tellcityhall.ca).
For more information about COVID-19 vaccination: https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines.html (https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines.html)