OBJECTIVES: Misbeliefs regarding vaccine safety and strict immunization exemption policy have led to anti-vaccination sentiments in West Virginia which might affect the vaccination of children. This study assessed the levels of worry and hassles towards vaccination and their association with up-to-date vaccination status and future intentions to follow recommended vaccinations. METHODS: A cross-sectional online survey was conducted among 176 mothers of children under 3 years old in West Virginia who could read and understand English. Worry and hassles scales were developed, and mean scale scores were used to measure worry and hassles to vaccination. Chi-square, t-tests and logistic regression analyses were conducted. RESULTS: Participants were predominantly white (94.3%), non-Hispanic Appalachians (98.3%), with annual household income >$50,000 (72.6%) and health insurance (92.0%). Approximately 3.8% of participants’ children had not received any vaccination. Further, many participants’ children (14.2%) were not up to date with recommended vaccinations, and 13.6% of mothers reported no future intention to follow recommended vaccination. Chi-square analyses indicated that being a full time worker and self or family as child caretaker were associated with being up-to-date with recommended vaccination and future intention to follow recommended vaccinations (p’s<0.05). After adjusting for demographic variables, hassle scale was a significant predictor of up-to-date vaccination status (AOR = 0.12) and future intention to follow recommended vaccinations (AOR = 0.17). Similarly, worry scale was a significant predictor of up-to-date vaccination status (AOR = 0.24) and future intention to follow recommended vaccinations (AOR = 0.27). CONCLUSIONS: Despite having higher socio-economic status, many study participants’ children exhibited low immunization coverage, and had no future intention to follow recommended vaccination. The study highlights the need to increase awareness about safety of vaccine contents and its efficacy in preventing still endemic diseases like measles.