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Aim: To examine the parent-dependent barriers to varicella immunization in Israel. Methods: Data were collected by questionnaire from parents of children aged 1 to 18 years who attended an outpatient paediatric centre in five cities in Israel from March to May 2003. Results: A total of 1474 parents completed the questionnaire. A history of chicken pox was reported in 850 children (57.8%), mostly (83%) between ages 1–6 years. Of the 624 children without a history of chicken pox, 213 (34.1%) were immunized against varicella. Immunization rates were significantly lower in families with lower parental education and in patients from cities with a lower socioeconomic ranking (p < 0.05). The main reasons for not being vaccinated (49%) were related to insufficient information about the vaccine itself and the vaccination process. These reasons were more common in families with lower parental education and from cities with lower socioeconomic ranking (p < 0.01). Other reasons included fear of adverse effects (12%) and waning immunity (6%), preference of natural illness over immunization (12%), and financial limitations (5%). Conclusions: Promoting parental knowledge about the varicella vaccine appears to be a key factor in improving the immunization rate, especially in families of lower education, and from cities with low socioeconomic ranking. [ABSTRACT FROM AUTHOR]