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Brooks EM, Fugate-Laus K, Webel B, Naavaal S. Perceptions of a State-Level HPV Vaccine Mandate and Exemption Option in Rural Virginia: A Qualitative Study. Vaccines (Basel) 2024; 12:401. [PMID: 38675783 PMCID: PMC11054131 DOI: 10.3390/vaccines12040401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; yet, despite the availability of safe and effective HPV vaccines, only half of eligible adolescents have completed the vaccine series. School-entry requirements are one proven strategy to increase vaccination rates among children and youth and reduce the burden of HPV-related cancer. This study investigated community perceptions of an HPV vaccine school-entry mandate in Virginia and the consequences of a low threshold exemption option included in the legislation. We conducted 40 interviews with community members including 15 interviews with parents, 19 with healthcare providers, and 6 with community leaders. Interviews asked about knowledge, beliefs, and attitudes concerning the HPV vaccine and mandate. Interviews were recorded, transcribed, and thematically analyzed. Despite healthcare provider support for the mandate, there was widespread confusion over the school-entry policy and concern that the exemption option undermined vaccination efforts. Understanding variations in community-level perceptions and response to school-based vaccination mandates is crucial for designing effective public health strategies. Findings suggest statewide vaccination initiatives should preemptively identify low uptake areas and provide targeted information to communities. Future mandates should avoid the use of ambiguous and contradictory language in vaccine-related legislation.
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Affiliation(s)
- E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kendall Fugate-Laus
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Shillpa Naavaal
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
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Shah S, Brumberg HL. Advocate to vaccinate: moving away from the "politics" of vaccination. Pediatr Res 2024; 95:1168-1171. [PMID: 38337042 DOI: 10.1038/s41390-024-03043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Shetal Shah
- Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA.
| | - Heather L Brumberg
- Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
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Correira JW, Kamstra R, Zhu N, Doll MK. School Vaccine Coverage and Medical Exemption Uptake After the New York State Repeal of Nonmedical Vaccination Exemptions. JAMA Netw Open 2024; 7:e2354710. [PMID: 38306096 PMCID: PMC10837748 DOI: 10.1001/jamanetworkopen.2023.54710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
Importance Although New York State (NYS) recently adopted legislation eliminating nonmedical vaccination exemption options from school-entry requirements, the implications of the law for school vaccine coverage and medical vaccine exemption uptake have not been examined. Objective To evaluate the implications of the repeal of school-entry nonmedical vaccination exemptions for vaccine coverage and medical exemption uptake at NYS schools outside of New York City (NYC). Design, Setting, and Participants This cohort study had an interrupted time-series design and used generalized estimating equation models to examine longitudinal school immunization compliance data from the 2012 to 2013 through 2021 to 2022 school years. The cohort comprised NYS public and nonpublic schools, excluding NYC schools, with any students enrolled in kindergarten to 12th grade. Eligible schools had enrollment and immunization data before and after the implementation of the Senate Bill 2994A legislation. Data analyses were conducted in July 2023. Exposure Senate Bill 2994A was passed in June 2019, eliminating school-entry nonmedical vaccination exemptions. Since compliance with the law was evaluated for most students during the next school year, the 2019 to 2020 school year was considered to be the law's effective date. Main Outcomes and Measures The primary outcomes were school vaccine coverage (defined as the percentage of students at each school who completed grade-appropriate requirements for all required vaccines) and medical exemption uptake (defined as the percentage of students at each school who received a medical exemption). Results Among the 3821 eligible schools, 3632 (95.1%) were included in the analysis, representing 2794 (96.9% of eligible) public schools and 838 (89.2% of eligible) nonpublic schools. The implementation of Senate Bill 2994A was associated with absolute increases in mean vaccine coverage of 5.5% (95% CI, 4.5%-6.6%) among nonpublic schools and 0.9% (95% CI, 0.7%-1.1%) among public schools, with additional annual increases in vaccine coverage observed through the 2021 to 2022 school year. The law's implementation was also associated with a 0.1% (95% CI, 0.0%-0.1%) mean absolute decrease in medical vaccination exemption uptake at both public and nonpublic schools, and small but significant mean annual decreases in medical vaccination exemptions (0.02%; 95% CI, 0.01%-0.03%) through the end of the study period. Conclusions and Relevance Results of this cohort study suggested that repeal of school-entry nonmedical vaccination exemptions was associated with increased vaccine coverage at NYS schools outside of NYC. Coverage gains were not replaced by increases in medical vaccination exemptions.
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Affiliation(s)
- John W. Correira
- Department of Allied Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York
| | | | - Nanqing Zhu
- Precision Analytics, Montreal, Quebec, Canada
| | - Margaret K. Doll
- Department of Allied Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York
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4
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Greyson D, Goh G. Education components of school vaccine mandates: An environmental scan. Vaccine 2023; 41:7089-7095. [PMID: 37923695 DOI: 10.1016/j.vaccine.2023.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND School vaccine mandates (SVMs) are population health interventions that require monitoring and communicating about vaccination of school-aged children, with an aim of controlling infectious disease outbreaks. While 43 % of World Health Organization member states report having some sort of SVM, their details vary. A newer element of some SVMs is an "education component" requiring compulsory information, education, or counseling of parents/guardians who decline to vaccinate their children for non-medical reasons. METHODS This environmental scan sought, mapped, and synthesized evidence on the existence, format, and impacts of education components of SVMs in 18 affluent Organization for Economic Co-operation and Development comparator countries. FINDINGS We found current SVMs in nine of the 18 comparator countries, but education components to those SVMs only in Canada (n = 2) and the U.S. (n = 9), where such policies were made at the provincial/state level. The earliest was implemented in 2011 and most recent has not yet been implemented. Education components were used as requirements for obtaining non-medical exemptions from SVMs, and involved either an informational paper to be read and signed, a counseling or information session from a health professional (public health worker or licensed provider such as family doctor), or an online module to be completed. Peer-reviewed research on in-person sessions suggests association with at least short-term increased vaccine uptake and reduction of non-medical exemptions. Available data on online module education components suggests similar impacts, but research to date is limited. CONCLUSION SVMs with educational components are uncommon but have been increasing since 2011. The details of these education components vary, although topics covered in online modules are relatively consistent. Evidence to date suggests at least short-term reduction in non-medical exemptions associated with implementation of SVM education components, but additional research is required to follow-up and confirm, especially as regards online education modules.
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Affiliation(s)
- Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, Canada.
| | - Gerry Goh
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; School of Information, University of British Columbia, Vancouver, Canada
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5
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Adegboyega A, Adeyimika D, Omoadoni O, Mark D. HPV vaccination and cervical cancer screening promotion among Black individuals: social ecological perspectives from key informants interviews. ETHNICITY & HEALTH 2023; 28:1026-1040. [PMID: 36973897 PMCID: PMC10522792 DOI: 10.1080/13557858.2023.2193360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/10/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Rates of HPV infection and HPV-related cancers are elevated in the Black population of the US. Efforts to promote HPV vaccination and cervical cancer screening are important to reducing the cancer burden among Black populations. The purpose of this qualitative descriptive study guided by social ecological model (SEM) was to describe from the perspective of key informants, the challenges and opportunities for HPV vaccination and cervical cancer screening promotion among Black adults. DESIGN Twenty-three key informants participated in individual interviews over zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy prior to data analysis. Two qualitatively trained researchers analyzed the data using content analysis. RESULTS Participants were aged 50 ± 4.1 years, 12 were females, and 18 identified as Black. Participants included health care providers, teachers, church and community leaders. Themes included HPV and cancer literacy, influence of religion, health care provider recommendations, social and cultural influences, accessibility and availability of services, economic constraints, limited community resources, and HPV vaccine mandates. CONCLUSIONS SEM factors contribute to low HPV vaccine uptake and cervical cancer screening and these factors need to be addressed. Interventions addressing SEM factors peculiar to Black populations may promote HPV vaccination and cancer screening in this population.
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Affiliation(s)
| | | | | | - Dignan Mark
- College of Medicine, Prevention Research Center, University of Kentucky, Lexington, KY, USA
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6
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Correira JW, Pettigrew SM, Kamstra R, Megyeri PR, Silverstein GJ, Kambrich S, Ma J, Doll MK. Exploring the impact of the New York State repeal of nonmedical vaccination exemptions on student enrollment, absenteeism, and school workload: Perspectives from a survey of school administrators. Hum Vaccin Immunother 2023; 19:2261176. [PMID: 37750393 PMCID: PMC10524776 DOI: 10.1080/21645515.2023.2261176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
In June 2019, New York State (NYS) adopted Senate Bill 2994A eliminating nonmedical vaccine exemptions from school entry laws. Since student noncompliance with the law required school exclusion, we sought to evaluate the law's effects on student enrollment and absenteeism, and school workloads related to its implementation. In November 2019, we sent an electronic survey to NYS (excluding New York City) schools. Due to the COVID-19 pandemic, outreach was curtailed in March 2020 with 525 (14%) of 3,759 eligible schools responding. To account for non-response, results were analyzed using inverse probability weighting. After weighting, 39% (95% CI: 34%, 44%) of schools reported enrollment changes and 31% (95% CI: 26%, 36%) of schools reported absenteeism related to the law. In addition, 95% (95% CI: 93%, 98%) of schools reported holding meetings and/or preparing correspondence about the law, spending a mean of 14 (95% CI: 11, 18) hours on these communication efforts. Schools in the highest pre-mandate nonmedical exemption tertile (vs. lowest) were more likely to report enrollment and absenteeism changes, and higher workloads. While our results should be interpreted with caution, changes in student enrollment, absenteeism, and school workloads may represent important considerations for policymakers planning similar legislation.
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Affiliation(s)
- John W. Correira
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | - Stacy M. Pettigrew
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | | | - Perrie Rose Megyeri
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | - Gabriel J. Silverstein
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | | | - Julia Ma
- Precision Analytics, Montreal, Quebec, Canada
| | - Margaret K. Doll
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
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Kahn BZ, Huang Q, Thompson P, Gilkey MB, Alton Dailey S, Brewer NT. Getting Human Papillomavirus Vaccination Back on Track: A National Survey. J Adolesc Health 2023; 72:950-957. [PMID: 36922312 PMCID: PMC10010471 DOI: 10.1016/j.jadohealth.2023.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Adolescent human papillomavirus (HPV) vaccine uptake in the United States dropped during the COVID-19 pandemic due to a decrease in well visits. This study sought to identify opportunities for primary care professionals (PCPs) to get adolescent vaccination back on track. METHODS In early 2021, we recruited 1,047 PCPs (71% physicians) who provided adolescent vaccines in the United States from an existing panel. Participants completed an online survey about changes in adolescent HPV vaccine uptake and actions taken to promote vaccination during the pandemic, as well as intentions to engage in activities to increase adolescent vaccination in the next 3 months. RESULTS A substantial proportion of PCPs (43%) reported that HPV vaccine uptake decreased in the first year of the pandemic; few (7%) PCPs reported an increase in uptake. PCPs reporting increased uptake were more likely to have used nurse-only vaccination visits, held drop-in and drive-through vaccination clinics, and used telehealth visits to recommend vaccination (all p < .05). Nearly two-thirds (62%) of all PCPs planned to promote adolescent vaccine uptake in the next 3 months. Planning was more common among PCPs who believed HPV vaccine uptake at their clinics increased during the pandemic, who saw more than 10 adolescent patients per week, who had ever reviewed their clinic's vaccination rates, and were nurses (all p < .05). DISCUSSION Many PCPs saw HPV vaccination drop during the pandemic. Several interventions could help clinics get HPV vaccination back on track, including increasing the availability of nurse-only vaccination visits and vaccination-only clinics.
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Affiliation(s)
- Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
| | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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Mahameed H, Al-Mahzoum K, AlRaie LA, Aburumman R, Al-Naimat H, Alhiary S, Barakat M, Al-Tammemi AB, Salim NA, Sallam M. Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination. Vaccines (Basel) 2023; 11:vaccines11050897. [PMID: 37243001 DOI: 10.3390/vaccines11050897] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics.
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Affiliation(s)
- Haneen Mahameed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | | | | | - Hala Al-Naimat
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Sakher Alhiary
- Nursing Department, Jordan University Hospital, Amman 11942, Jordan
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Ala'a B Al-Tammemi
- Migration Health Division, International Organization for Migration (IOM), The UN Migration Agency, Amman 11953, Jordan
| | - Nesreen A Salim
- Prosthodontic Department, School of Dentistry, The University of Jordan, Amman 11942, Jordan
- Prosthodontic Department, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
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9
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Slotte P, Karlsson LC, Soveri A. Attitudes towards mandatory vaccination and sanctions for vaccination refusal. Vaccine 2022; 40:7378-7388. [PMID: 35688728 DOI: 10.1016/j.vaccine.2022.05.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 01/28/2023]
Abstract
AIMS Investigating attitudes towards mandatory vaccination and sanctions for vaccination refusal in an area with insufficient vaccination coverage may help health authorities to assess which strategies for increasing vaccination coverage are appropriate. This study examines attitudes to vaccine mandates and asks questions regarding what kinds of sanctions could legitimately result from vaccination refusal. It seeks to find out if people's attitudes towards mandates and towards sanctions for vaccination refusal are related to their attitudes to vaccines and the degree of trust they feel towards health care professionals and health care authorities. The study also discusses how the observed attitudes towards mandates may be related to perceptions of autonomy, responsibility, and equitability. METHODS Data collection was carried out in Finland through an online survey in a region with suboptimal vaccine uptake. Statistical analysis was conducted on a sample of 1101 respondents, using confirmatory factor analysis and structural regression analysis. RESULTS Persons hold different views on mandates and sanctions. Importantly, the persons who support vaccination mandates and sanctions for vaccination refusal are to a great degree the same people who have positive attitudes to vaccines and high trust in health care professionals and health authorities. CONCLUSION Trust is a key factor which has a bearing on people's attitudes towards mandates and sanctions for noncompliance. A focus on the reasons for lack of trust, and on how to enhance trust, is a more feasible long-term way (than mandates) to promote large- scale compliance with childhood vaccine programmes in the studied country context.
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Affiliation(s)
- Pamela Slotte
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Tehtaankatu 2, FI-20500 Turku, Finland; Centre of Excellence in Law, Identity and the European Narratives, Siltavuorenpenger 1A, FI-00014 University of Helsinki, Finland.
| | - Linda C Karlsson
- Department of Clinical Medicine, FI-20014 University of Turku, Turku, Finland.
| | - Anna Soveri
- Department of Clinical Medicine, FI-20014 University of Turku, Turku, Finland.
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10
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Greyson D, Carpiano RM, Bettinger JA. Support for a vaccination documentation mandate in British Columbia, Canada. Vaccine 2022; 40:7415-7425. [PMID: 35501180 DOI: 10.1016/j.vaccine.2022.02.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/16/2021] [Accepted: 02/24/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In recent years, Canadian provinces have been discussing, implementing, and tightening vaccination "mandate" policies for school enrolment. British Columbia (BC), Canada's westernmost province, implemented a Vaccination Status Reporting Regulation (VSRR) in September 2019, which requires the vaccination status of children in public, private, and home schooling be reported to a provincial vaccination registry and education for parents who refuse to vaccinate. Legal vaccination mandates can carry the risk of backlash, thereby making it important to monitor public attitudes across policy implementation windows. The present study aimed to evaluate public support for this new provincial mandate following implementation. METHODS An online panel of BC adults (n = 1301) was surveyed about 15 vaccine-promotion policy options in April 2020 following mandate implementation. Respondents were representative of the provincial population by gender, age, geographic residence, and percentage of households with children younger than 19 years of age. Poisson regression was used to estimate predictors of policy endorsement, and support for the VSRR. RESULTS Strong support existed for the VSRR with 88.2% of respondents agreeing or strongly agreeing that parents should be required to provide their children's immunization records at school entry, and 74.6% supporting required education sessions for parents who refuse to vaccinate their children. Overall, the sample was supportive of vaccination, and pro-vaccine attitudes were associated with strong agreement for nearly all vaccine policy options. Policies to impose rewards (e.g., tax credits) and penalties (e.g., fines) were the least likely to receive strong agreement from respondents. CONCLUSIONS Near the end of the first school year in British Columbia subject to the Vaccination Status Reporting Regulation, support for both the mandated documentation and mandated education elements of the policy are high, and associated with pro-vaccine attitudes. There are not marked differences in strong support based on gender, age, parenting, education level, or income.
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Affiliation(s)
- Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Department of Communication, University of Massachusetts Amherst, USA.
| | | | - Julie A Bettinger
- Vaccine Evaluation Center, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
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Attwell K, Rizzi M, Paul KT. Consolidating a research agenda for vaccine mandates. Vaccine 2022; 40:7353-7359. [PMID: 36396514 PMCID: PMC9662755 DOI: 10.1016/j.vaccine.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A workshop on mandatory vaccination was pitched to the World Public Health Congress in 2019 and the resultant special issue was pitched to Vaccine in 2020. During this project, the COVID-19 pandemic pushed vaccine policy to the forefront of global public health policy, and the imposition of vaccine mandates prompted a new wave of scholarship in the field. This introductory article employs the heuristic of Lasswell's (1956) policy cycle to synthesise the findings of the articles in the special issue. It considers the temporal lifetime of mandates and highlights findings regarding: the emergence of mandates as a policy option, public support and policy instrument design, what matters in the implementation of mandates, and what we can learn from evaluating them. The second half of the paper categorizes the included papers in terms of what aspects of mandates they study and the methods they employ to do so, in order to formulate a guide for future researchers of vaccine mandates. Scholars study either speculative or existing mandates - research can address several stages of the policy cycle or just one of them, ranging from attitudinal research to implementation studies and impact studies. Historical and contextual studies that take deep dives into a particular mandate are a much needed resource for studying emerging mandates, too, and scoping and framework- building work will undoubtedly be valuable in understanding and appreciating the wealth of knowledge production in this growing field. This special issue can serve as a roadmap for a consolidation of this interdisciplinary research agenda, and provide a helpful resource for decisionmakers at this historical juncture.
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Affiliation(s)
- Katie Attwell
- School of Social Science, The University of Western Australia, Perth, Australia.
| | - Marco Rizzi
- UWA Law School, The University of Western Australia, Perth, Australia
| | - Katharina T Paul
- Department of Political Science, Faculty of Social Sciences, The University of Vienna, Vienna, Austria
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12
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Cohn E, Chimowitz M, Long T, Varma JK, Chokshi DA. The effect of a proof-of-vaccination requirement, incentive payments, and employer-based mandates on COVID-19 vaccination rates in New York City: a synthetic-control analysis. Lancet Public Health 2022; 7:e754-e762. [PMID: 36057274 PMCID: PMC9433052 DOI: 10.1016/s2468-2667(22)00196-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND COVID-19 vaccines have been available to all adults in the USA since April, 2021, but many adults remain unvaccinated. We aimed to assess the joint effect of a proof-of-vaccination requirement, incentive payments, and employer-based mandates on rates of adult vaccination in New York City (NYC). METHODS We constructed a synthetic control group for NYC composed of other counties in the core of large, metropolitan areas in the USA. The vaccination outcomes for NYC were compared against those of the synthetic control group from July 26, 2021, to Nov 1, 2021, to determine the differential effects of the policies. Analyses were conducted on county-level vaccination data reported by the Centers for Disease Control and Prevention. The synthetic control group was constructed by matching on county-level preintervention vaccination outcomes, partisanship, economic attributes, demographics, and metropolitan area population. Statistical inference was conducted using placebo tests for non-treated counties. FINDINGS The synthetic control group resembled NYC across attributes used in the matching process. The cumulative adult vaccination rate for NYC (in adults aged 18 years or older who received at least one dose of an authorised COVID-19 vaccine) increased from 72·5% to 89·4% (+16·9 percentage points [pp]) during the intervention period, compared with an increase from 72·5% to 83·2% (+10·7 pp) for the synthetic control group, a difference of 6·2 pp (95% CI 1·4-10·7), or 410 201 people (90 966-706 532). Daily vaccinations for NYC were consistently higher than those in the synthetic control group, a pattern that started shortly after the start of the intervention period. INTERPRETATION The combination of a proof-of-vaccination requirement, incentive payments, and vaccine mandates increased vaccination rates among adults in NYC compared with jurisdictions that did not use the same measures. Whether the impact of these measures occurred by inducing more people to get vaccinated, or by accelerating vaccinations that would have occurred later, the increase in vaccination rates likely averted illness and death. FUNDING None.
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Affiliation(s)
- Ezra Cohn
- New York City Mayor's Office of Management and Budget, New York, NY, USA.
| | - Michael Chimowitz
- New York City Mayor's Office of Management and Budget, New York, NY, USA
| | - Theodore Long
- New York City Health and Hospitals, New York, NY, USA
| | | | - Dave A Chokshi
- New York University, Grossman School of Medicine, New York, NY, USA
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Hammershaimb EA, Cole LD, Liang Y, Hendrich MA, Das D, Petrin R, Cataldi JR, O'Leary ST, Campbell JD. COVID-19 Vaccine Acceptance Among US Parents: A Nationally Representative Survey. J Pediatric Infect Dis Soc 2022; 11:361-370. [PMID: 35748047 PMCID: PMC9278238 DOI: 10.1093/jpids/piac049] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/31/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little was known about US parental attitudes, beliefs, and intentions surrounding coronavirus disease 2019 (COVID-19) vaccines for children before their introduction. METHODS An online cross-sectional nationally representative survey of US parents/guardians of children < 18 years old via Ipsos KnowledgePanel, fielded from October 26, 2021 to November 30, 2021. RESULTS Response rate was 64.2% (3230/5034). For children ages 0-4 years, 51.5% of parents were likely to have their children vaccinated, and for ages 5-11 and 12-17, 54.0% and 69.7% of parents, respectively, reported they were likely to vaccinate or had already vaccinated their children. Among respondents with unvaccinated children, 25.2% (ages 0-4) and 22.0% (ages 5-11) reported they would seek COVID-19 vaccination for their children as soon as authorization occurred. Factors associated with willingness to have children receive a COVID-19 vaccine were: belief in benefits of COVID-19 vaccination (odds ratio [OR] = 6.44, 5.68, 4.57 in ages 0-4, 5-11, and 12-17 respectively), acceptance of routine childhood vaccines (OR = 6.42, 5.48, 1.76), parental COVID-19 vaccination (OR = 1.85, 3.70, 6.16), perceptions that pediatric COVID-19 is severe (OR = 1.89, 1.72, 1.35), Hispanic ethnicity (OR = 2.07, 2.29, 2.60), influenza vaccine acceptance (OR = 1.07, 0.88, 1.62), presence of children of another age group in the household (OR = 0.71, 0.71, 0.65), and attitudinal barriers to COVID-19 vaccination (OR = 0.30, 0.26, 0.49). CONCLUSIONS Belief in the benefits of COVID-19 vaccination and acceptance of routine childhood vaccines are the strongest predictors of intention to vaccinate children. Further research is needed to track how parental attitudes change as more data about pediatric COVID-19 vaccines become available and how intentions translate into pediatric vaccine uptake.
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Affiliation(s)
- E Adrianne Hammershaimb
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lyndsey D Cole
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yuanyuan Liang
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Dhiman Das
- Ipsos Public Affairs, Washington DC, USA
| | | | - Jessica R Cataldi
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - James D Campbell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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14
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Dudley MZ, Schwartz B, Brewer J, Kan L, Bernier R, Gerber JE, Ni HB, Proveaux TM, Rimal RN, Salmon DA. COVID-19 Vaccination Status, Attitudes, and Values among US Adults in September 2021. J Clin Med 2022; 11:3734. [PMID: 35807016 PMCID: PMC9267733 DOI: 10.3390/jcm11133734] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The Delta COVID-19 variant caused a resurgence in cases and deaths during the summer of 2021, particularly among the unvaccinated, highlighting the need to increase vaccine coverage. We describe a survey conducted in September 2021, in the midst of the Delta variant surge, after the FDA fully approved Pfizer-BioNTech’s vaccine for ages 16+ and issued an emergency use authorization for ages 12−15. Methods and Findings: US adults were surveyed to measure COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities. More than three-quarters (77%) reported receiving at least one dose of COVID-19 vaccination. Of the unvaccinated, 6% intended to vaccinate, 40% were unlikely to ever vaccinate, and 55% remained uncertain. Most of the unvaccinated were <45 years old (62%), without a bachelor’s degree (83%), earning less than $85,000 annually (74%), and Republican/Independent (66%). Concerns among the unvaccinated-yet-still-uncertain included the vaccines’ safety (86%), speed of development (86%), and suspicion of government (79%) and pharmaceutical companies (69%). Most (86%) of the unvaccinated reported they would not vaccinate if mandated by their employer. About one third (34%) of the unvaccinated reported facing at least one barrier to vaccination. Conclusion: More than half of unvaccinated adults remained uncertain about COVID-19 vaccination, indicating an opportunity to support their decision making. Public health must increase easy and equitable access to vaccination and renew efforts to provide unvaccinated populations access to information from trusted sources.
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Affiliation(s)
- Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (J.B.); (T.M.P.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Benjamin Schwartz
- Fairfax County Health Department, 10777 Main St., Fairfax, VA 22030, USA;
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (J.B.); (T.M.P.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Lilly Kan
- National Association of County and City Health Officials, 1201 Eye Street, NW, 4th Floor, Washington, DC 20005, USA;
| | | | - Jennifer E. Gerber
- RTI International, 701 13th Street NW, Suite 750, Washington, DC 20005, USA;
| | - Haley Budigan Ni
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Tina M. Proveaux
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (J.B.); (T.M.P.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Rajiv N. Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (J.B.); (T.M.P.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;
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15
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Hong K, Lindley MC, Tsai Y, Zhou F. School Mandate and Influenza Vaccine Uptake Among Prekindergartners in New York City, 2012-2019. Am J Public Health 2022; 112:719-723. [PMID: 35324263 PMCID: PMC9010927 DOI: 10.2105/ajph.2022.306765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/04/2022]
Abstract
New York City (NYC) introduced a universal prekindergarten program in 2014 that mandated influenza vaccination for enrollment. We conducted a difference-in-difference-in-differences study to evaluate the program using 2012 to 2019 MarketScan claims data. After the introduction of the program, influenza vaccine uptake among four-year-old children in NYC during the subsequent seasons increased by 6.3 to 9.8 percentage points compared with the rest of New York State. (Am J Public Health. 2022;112(5):719-723. https://doi.org/10.2105/AJPH.2022.306765).
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Affiliation(s)
- Kai Hong
- Kai Hong, Megan C. Lindley, Yuping Tsai, and Fangjun Zhou are with the Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention
| | - Megan C Lindley
- Kai Hong, Megan C. Lindley, Yuping Tsai, and Fangjun Zhou are with the Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention
| | - Yuping Tsai
- Kai Hong, Megan C. Lindley, Yuping Tsai, and Fangjun Zhou are with the Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention
| | - Fangjun Zhou
- Kai Hong, Megan C. Lindley, Yuping Tsai, and Fangjun Zhou are with the Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention
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16
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Choi Y, Bhatti A, Liu Z, Ruch A, Skolnik A, Carias C, Goveia MG, Simon JK. Association Between State Hepatitis A Vaccination Requirements and Hepatitis A Vaccination Rates. J Pediatric Infect Dis Soc 2022; 11:295-299. [PMID: 35385115 PMCID: PMC9214775 DOI: 10.1093/jpids/piac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
Using National Immunization Survey Child and Teen (2008-2017), we associated state vaccination requirements with hepatitis A (Hep A) vaccination rates in children and adolescents. States with school entry or both childcare and school entry requirements were associated with 35%-40% higher Hep A vaccination rates, compared with states without such requirements.
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Affiliation(s)
- Yoonyoung Choi
- Corresponding Author: Yoonyoung Choi, PhD, MS, 1100 Ludlow Street, 8th floor, Philadelphia, PA 19107, USA. E-mail:
| | - Alexandra Bhatti
- Global Vaccine Public Policy and Partnerships, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Zhiwen Liu
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Alex Ruch
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Ava Skolnik
- Global Vaccine Public Policy and Partnerships, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Cristina Carias
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Michelle G Goveia
- Global Medical & Scientific Affairs, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Jakub K Simon
- Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, USA
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17
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Wilkenfeld DA, Johnson CM. In Defense of Vaccine Mandates: An Argument from Consent Rights. Public Health Ethics 2022; 15:27-40. [PMID: 35996430 PMCID: PMC9383732 DOI: 10.1093/phe/phac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article will focus on the ethical issues of vaccine mandates and stake claim to the relatively extreme position that outright requirements for people to receive the vaccine are ethically correct at both the governmental and institutional levels. One novel strategy employed here will be to argue that deontological considerations pertaining to consent rights cut as much in favor of mandating vaccines as against them. The presumption seems to be that arguments from consent speak semi-definitively against forcing people to inject something into their bodies, and so any argument in favor of mandates must produce different and overriding logical and ethical considerations. Our central claim will be that the same logic that might seem to prohibit vaccine mandates as violations of consent actually supports such mandates when viewed from the perspective of the potential bystander who might otherwise be exposed to COVID-19.
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Affiliation(s)
- Daniel A Wilkenfeld
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, USA
| | - Christa M Johnson
- Department of Philosophy, University of Dayton, United States of America
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18
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DeSilva MB, Haapala J, Vazquez-Benitez G, Daley MF, Nordin JD, Klein NP, Henninger ML, Williams JTB, Hambidge SJ, Jackson ML, Donahue JG, Qian L, Lindley MC, Gee J, Weintraub ES, Kharbanda EO. Association of the COVID-19 Pandemic With Routine Childhood Vaccination Rates and Proportion Up to Date With Vaccinations Across 8 US Health Systems in the Vaccine Safety Datalink. JAMA Pediatr 2022; 176:68-77. [PMID: 34617975 PMCID: PMC8498937 DOI: 10.1001/jamapediatrics.2021.4251] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The COVID-19 pandemic has affected routine vaccine delivery in the US and globally. The magnitude of these disruptions and their association with childhood vaccination coverage are unclear. OBJECTIVES To compare trends in pediatric vaccination before and during the pandemic and to evaluate the proportion of children up to date (UTD) with vaccinations by age, race, and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This surveillance study used a prepandemic-postpandemic control design with data from 8 health systems in California, Oregon, Washington, Colorado, Minnesota, and Wisconsin in the Vaccine Safety Datalink. Children from age groups younger than 24 months and 4 to 6, 11 to 13, and 16 to 18 years were included if they had at least 1 week of health system enrollment from January 5, 2020, through October 3, 2020, over periods before the US COVID-19 pandemic (January 5, 2020, through March 14, 2020), during age-limited preventive care (March 15, 2020, through May 16, 2020), and during expanded primary care (May 17, 2020, through October 3, 2020). These individuals were compared with those enrolled during analogous weeks in 2019. EXPOSURES This study evaluated UTD status among children reaching specific ages in February, May, and September 2020, compared with those reaching these ages in 2019. MAIN OUTCOMES AND MEASURES Weekly vaccination rates for routine age-specific vaccines and the proportion of children UTD for all age-specific recommended vaccines. RESULTS Of 1 399 708 children in 2019 and 1 402 227 in 2020, 1 371 718 were female (49.0%) and 1 429 979 were male (51.0%); 334 216 Asian individuals (11.9%), 900 226 were Hispanic individuals (32.1%), and 201 619 non-Hispanic Black individuals (7.2%). Compared with the prepandemic period and 2019, the age-limited preventive care period was associated with lower weekly vaccination rates, with ratios of rate ratios of 0.82 (95% CI, 0.80-0.85) among those younger than 24 months, 0.18 (95% CI, 0.16-0.20) among those aged 4 to 6 years, 0.16 (95% CI, 0.14-0.17) among those aged 11 to 13 years, and 0.10 (95% CI, 0.08-0.13) among those aged 16 to 18 years. Vaccination rates during expanded primary care remained lower for most ages (ratios of rate ratios: <24 months, 0.96 [95% CI, 0.93-0.98]; 11-13 years, 0.81 [95% CI, 0.76-0.86]; 16-18 years, 0.57 [95% CI, 0.51-0.63]). In September 2020, 74% (95% CI, 73%-76%) of infants aged 7 months and 57% (95% CI, 56%-58%) of infants aged 18 months were UTD vs 81% (95% CI, 80%-82%) and 61% (95% CI, 60%-62%), respectively, in September 2019. The proportion UTD was lowest in non-Hispanic Black children across most age groups, both during and prior to the COVID-19 pandemic (eg, in May 2019, 70% [95% CI, 64%-75%] of non-Hispanic Black infants aged 7 months were UTD vs 82% [95% CI, 81%-83%] in all infants aged 7 months combined). CONCLUSIONS AND RELEVANCE As of September 2020, childhood vaccination rates and the proportion who were UTD remained lower than 2019 levels. Interventions are needed to promote catch-up vaccination, particularly in populations at risk for underimmunization.
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Affiliation(s)
| | | | | | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | | | | | | | | | | | | | | | - Lei Qian
- Kaiser Permanente Southern California, Pasadena
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne Gee
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric S. Weintraub
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Affiliation(s)
- Noel T Brewer
- University of North Carolina at Chapel Hill, Chapel Hill
| | - Neetu Abad
- US Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Colón-López V, Medina-Laabes DT, Abreu RS, Díaz Miranda OL, Ortiz AP, Fernández ME, Hull PC. Understanding parents' views toward the newly enacted HPV vaccine school entry policy in Puerto Rico: a qualitative study. BMC Public Health 2021; 21:1938. [PMID: 34696745 PMCID: PMC8544631 DOI: 10.1186/s12889-021-11952-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Human papillomavirus vaccine (HPV) is an essential tool for the prevention of HPV-related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least one dose of HPV vaccination in girls and boys aged 11 and 12 years, taking effect in August 2018. Our study aimed to examine parents' and guardians' views of unvaccinated children about the process of implementation of the new HPV vaccination school entry policy in Puerto Rico and identify potential barriers and facilitators related to the implementation of this requirement. METHODS During April through November 2019, we conducted three focus groups (n = 12) and eight in-depth semi-structured interviews with parents of children aged 11 and 12 who had not yet initiated the HPV vaccine series. The interview topics addressed were: perception of vaccination, HPV vaccine and it is inclusion as new school entry requirement practice, procedure of the sources of information, influencers, and willingness to change. The interviews were recorded and transcribed by our staff members. We identified emergent themes through thematic analysis. RESULTS The participants' perspective on the HPV vaccine school requirement was mixed. Lack of information of the HPV vaccines and lack of communication about the school-entry requirement were the themes most mentioned in the interviews. Moreover, previous negative experiences from friends or family members and adverse effects deterred some participants from vaccinating their kids. We discussed barriers in the process of soliciting an exemption. CONCLUSION Most barriers mentioned by study participants are modifiable. Information about the HPV vaccine mandate's implementation and educational materials regarding HPV vaccine safety need to be provided to address parents' concerns related to the vaccine's side effects. Schools (teachers, principal directors, and administrative staff), the government, and parent organizations need to be part of these efforts. This multilevel approach will help to improve disseminating information about HPV vaccination to clarify doubts and misinformation among parents.
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Affiliation(s)
- Vivian Colón-López
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico.
- Department of Health Services Administration, Graduate School of Public Health, University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico.
| | - Diana T Medina-Laabes
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Roxana Soto Abreu
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Olga L Díaz Miranda
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Ana P Ortiz
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico
| | - María E Fernández
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States
| | - Pamela C Hull
- The University of Kentucky, Department of Behavioral Science, College of Medicine, Markey Cancer Center, Lexington, Kentucky, United States
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21
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Berenson AB, Hirth JM, Chang M, Kuo YF, Richard P, Jones DL. A brief educational intervention can improve nursing students' knowledge of the human papillomavirus vaccine and readiness to counsel. Hum Vaccin Immunother 2021; 17:1952-1960. [PMID: 33517843 DOI: 10.1080/21645515.2020.1852871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Provider recommendation is a primary reason for patient uptake of the human papillomavirus (HPV) vaccine. Most provider-focused educational interventions are focused on physicians, even though nurses are also important sources of vaccine-related information for their patients. This study examined whether a HPV educational intervention could improve nursing students' HPV knowledge, beliefs, and comfort with counseling. The same lecture on HPV and HPV vaccination was given to both medical and nursing students. To determine the effects of the lecture, students were asked to complete identical pre- and post-lecture tests with questions on demographics, knowledge, attitudes, and comfort with counseling on the HPV vaccine. Pre- and post-lecture test scores were compared between nursing and medical students to assess whether there were differences in pre-lecture test scores and/or changes in post-lecture test scores. On the pre-lecture tests, fewer nursing students responded correctly to knowledge questions, indicated positive attitudes or comfort with counseling about the HPV vaccine compared to medical students. However, similar frequencies of nursing and medical students responded correctly to knowledge questions and indicated a positive attitude, as well as a high comfort level with counseling on the post-lecture tests. Study results show that integrating lectures in a nursing program curriculum could be a feasible way to increase students' HPV knowledge. Having health-care providers with similar levels of knowledge, attitudes, and comfort with counseling on HPV vaccination is ideal, as all share the responsibility of recommending the vaccine to patients.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Patricia Richard
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
| | - Deborah L Jones
- Center for Interdisciplinary Research in Women's Health (ABB, JMH, MC, YFK), Department of Obstetrics and Gynecology (ABB, JMH, MC), Office of Biostatistics, Department of Preventive Medicine and Community Health (YFK), School of Nursing (PR, DLJ), The University of Texas Medical Branch, Galveston, TX, USA
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22
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Dubé È, Ward JK, Verger P, MacDonald NE. Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health. Annu Rev Public Health 2021; 42:175-191. [PMID: 33798403 DOI: 10.1146/annurev-publhealth-090419-102240] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An often-stated public health comment is that "vaccination is a victim of its own success." While the scientific and medical consensus on the benefits of vaccination is clear and unambiguous, an increasing number of people are perceiving vaccines as unsafe and unnecessary. The World Health Organization identified "the reluctance or refusal to vaccinate despite availability of vaccines" as one of the 10 threats to global health in 2019. The negative influence of anti-vaccination movements is often named as a cause of increasing vaccine resistance in the public. In this review, we give an overview of the current literature on the topic, beginning by agreeing on terminology and concepts before looking at potential causes, consequences, and impacts of resistance to vaccination.
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Affiliation(s)
- Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec G1V 4G2, Canada.,Institut National de Santé Publique du Québec, Québec G1E 7G9, Canada;
| | - Jeremy K Ward
- CERMES3, INSERM, CNRS, EHESS, Université de Paris, 94076 Villejuif, France; .,Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME, 13005 Marseille, France;
| | - Pierre Verger
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME, 13005 Marseille, France; .,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13005 Marseille, France
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada;
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23
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Hair NL, Gruber A, Urban CJ. Pneumococcal Vaccination Mandates for Child Care: Impact of State Laws on Vaccination Coverage at 19-35 Months. Am J Prev Med 2021; 60:e269-e276. [PMID: 33795181 DOI: 10.1016/j.amepre.2021.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Vaccination mandates for elementary and middle school attendance have been shown to increase vaccination rates and decrease the burden of vaccine-preventable diseases. Fewer studies have evaluated similar requirements for child care attendance. This study provides robust, quasi-experimental estimates of the effect of state laws mandating the pneumococcal conjugate vaccine for child care attendance on vaccination coverage among children aged 19-35 months. METHODS Using provider-verified immunization histories from the 2001-2018 waves of the National Immunization Survey-Child and leveraging the staggered implementation of vaccination requirements across states, a generalized difference-in-differences approach was implemented to compare regression-adjusted changes in vaccination coverage among children in states with and without a child care mandate for the pneumococcal conjugate vaccine. The dynamics of estimated treatment effects were analyzed using an event study analysis. All data analyses were conducted in 2019‒2020. RESULTS State adoption of a child care mandate for the pneumococcal conjugate vaccine increased the likelihood that resident children aged 19-35 months completed the 4-dose pneumococcal conjugate vaccine series by 3.12 percentage points (p<0.01). Statistically significant gains in pneumococcal conjugate vaccine coverage were identified in the first year following policy implementation and were found to persist over a period of ≥7 years. CONCLUSIONS Results indicate that state adoption of a child care mandate for the pneumococcal conjugate vaccine leads to an increase in the proportion of resident children aged 19-35 months who are up to date with pneumococcal conjugate vaccine.
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Affiliation(s)
- Nicole L Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Anja Gruber
- Department of Agricultural Economics and Economics, Montana State University, Bozeman, Montana
| | - Carly J Urban
- Department of Agricultural Economics and Economics, Montana State University, Bozeman, Montana; IZA Institute of Labor Economics, Bonn, Germany
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Qin W, Song J, Wang Y, Nie T, Pan F, Xu X, Tao H, Meng X, Ni R, Cheng S, Xie S, Su H. Upgrading the school entry vaccination record check strategy to improve varicella vaccination coverage: results from a quasi-experiment study. Hum Vaccin Immunother 2021; 17:3137-3144. [PMID: 34019470 DOI: 10.1080/21645515.2021.1904759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The school entry vaccination record check strategy (SECS) is an appropriate opportunity to recommend vaccines for students to improve vaccination coverage (VC). However, it is only utilized for providing necessary catch-up vaccination for students who are missing the Expanded Program on Immunization (EPI) vaccines in China. We aimed to address that gap and quantify the relationship between the SECS policy and the increase of coverage in varicella vaccine (VarV). METHODS We employed a pretest and posttest quasi-experimental design to examine the effect of the upgraded SECS policy on the change of VarV coverage in newly enrolled students in Lu'an, 2019-2020. RESULTS Eight hundred participants were randomly divided into the control group (C group, 31.8%), the telephone-based intervention group (T group, 31.2%), and the written notification intervention group (W group, 37.0%). Totally, 84 students received VarV during the study period, with a VC of 10.5%. The possibility of vaccination in the T group (RR = 4.9, 95% CI:2.2-10.9) and W group (RR = 5.2, 95% CI:2.4-11.5) was significantly higher than that in the C group (p< .001). CONCLUSIONS Our study demonstrates that the upgraded SECS produce a positive effect on improving the VC of VarV. This nudge strategy may decrease varicella outbreaks in schools in China, especially in provinces where VarV is not introduced into EPI.
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Affiliation(s)
- Wei Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yao Wang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Tingyue Nie
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fan Pan
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Xiaokang Xu
- Department of Chronic Non-communicable Diseases Prevention and Control, Jin'an District Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Hailin Tao
- Department of Expanded Program on Immunization, Shucheng District Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Xiangmei Meng
- Department of Expanded Program on Immunization, Shucheng District Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Ruyu Ni
- Department of Preventive Medicine, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Shishi Cheng
- Department of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu, Anhui, China
| | - Shaoyu Xie
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Brewer NT. What Works to Increase Vaccination Uptake. Acad Pediatr 2021; 21:S9-S16. [PMID: 33958099 DOI: 10.1016/j.acap.2021.01.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
Behavioral science offers several ideas about what it takes to get people to vaccinate. Colleagues and I previously reviewed the evidence for these propositions and put forward what has become known as the Increasing Vaccination Model. To make the model more accessible to practitioners, the current paper summarizes the main insights from the earlier work. First, observational studies show clearly that thoughts and feelings are correlated with vaccine uptake. Such constructs include perceived risk of harm from infectious disease and confidence in vaccine safety and efficacy. However, interventions have not generally shown that changing thoughts and feelings increases vaccine uptake. Second, social processes are promising in observational studies. Such constructs include social norms, altruism, and sharing through social media. More research is needed in this promising area before it will be possible to conclude whether social processes are effective intervention targets. Third, interventions that directly change behavior-without trying to change what people think or feel or their social experience-are reliably effective ways to increase vaccine uptake. Such interventions include reminders, defaults, and vaccine requirements. Finally, the most potent intervention for increasing vaccine uptake is a health care provider recommendation, but it is still unclear whether such recommendations are effective because they increase confidence, set a social norm, or reflect a direct behavior change technique. The paper ends by describing use of the model by a World Health Organization working group as it considers opportunities to address low vaccination uptake globally.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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Nguyen TM, Christian B, Koshy S, Morgan MV. A Validation and Cost-Analysis Study of a Targeted School-Based Dental Check-Up Intervention: Children's Dental Program. CHILDREN-BASEL 2020; 7:children7120257. [PMID: 33256020 PMCID: PMC7760058 DOI: 10.3390/children7120257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
Background: Limited evidence exists to inform best practice approaches to implement school-based dental screening to address child retention via referral for dental services. This research tested the null hypothesis that a targeted school-based dental check-up program (intervention) has a 75% child retention rate for public dental care (H0 = 0.75). Methods: A prospective non-randomised controlled trial was conducted with a convenience sampling approach in metropolitan Melbourne, Australia. Children in the intervention group were recruited from two preschools and two primary schools from a low socioeconomic area. Children in the standard care group were recruited from the local public dental service. Statistical analysis was performed using Stata IC Version 12. Results: Children in the intervention (45%) were significantly less likely to have never had a dental check-up compared to standard care (20%) (p < 0.001). There was no significant difference for the child retention rate for the intervention group when compared against the null hypothesis (p = 0.954). The total society costs were AU$754.7 and AU$612.2 for the intervention and standard care groups, respectively (p = 0.049). Conclusions: This validation study provides evidence that a targeted school-based dental check-up program can achieve a 75% child retention rate and should be considered for program expansion.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia
- Community Dental Program, Peninsula Health, Frankston, VIC 3199, Australia
- Coburg Hill Oral Care, Coburg North, VIC 3058, Australia
- Correspondence: ; Tel.: +61-432-715-420
| | - Bradley Christian
- Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bundoora, VIC 3552, Australia;
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing & Midwifery, Western Sydney University, Sydney, NSW 2751, Australia
| | - Sajeev Koshy
- Dental Health Services Victoria, Carlton, VIC 3053, Australia;
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Rhode Island Human Papillomavirus Vaccine School Entry Requirement Using Provider-Verified Report. Am J Prev Med 2020; 59:274-277. [PMID: 32430223 DOI: 10.1016/j.amepre.2020.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Human papillomavirus vaccine school entry requirements may be an opportunity to improve the low rates of human papillomavirus vaccination among adolescents. This study evaluates changes in provider-verified human papillomavirus vaccine uptake by age 13 years for adolescents in Rhode Island compared with all other states from 2011 to 2017. METHODS The National Immunization Survey-Teen 2011-2017, a population-based cross-sectional survey, was analyzed in 2019. The survey included telephone interviews and provider-verified reports of vaccination among U.S. adolescents aged 13-17 years. The sample was subset to participants with provider-verified human papillomavirus vaccination reports (n=145,153). A difference-in-differences approach evaluated the Rhode Island human papillomavirus vaccination school entry requirement enacted in 2015. The main outcome was provider-verified human papillomavirus vaccine uptake by age 13 years. RESULTS Compared with boys in other states, boys in Rhode Island had an increase of 14 percentage points in the probability of uptake of human papillomavirus vaccination by age 13 years (β=0.139, 95% CI=0.073, 0.205). No such differences were observed on comparing girls in Rhode Island with girls in other states (β=0.009, 95% CI= -0.068, 0.086). CONCLUSIONS The Rhode Island school entry requirement for human papillomavirus vaccination improved rates of vaccine uptake among boys and may be a useful option for improving human papillomavirus vaccination nationally.
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