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Kharbanda EO, Asche SE, Sinaiko A, Nordin JD, Ekstrom HL, Dehmer SP, Bredeson D, O'Connor PJ. Improving Hypertension Recognition in Adolescents, a Small but Important First Step in Cardiovascular Disease Prevention. Acad Pediatr 2020; 20:163-165. [PMID: 31445203 PMCID: PMC7032989 DOI: 10.1016/j.acap.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Elyse Olshen Kharbanda
- HealthPartners Institute (EO Kharbanda, SE Asche, JD Nordin, HL Ekstrom, SP Dehmer, D Bredeson, and PJ O'Connor), Minneapolis, Minn.
| | - Stephen E Asche
- HealthPartners Institute (EO Kharbanda, SE Asche, JD Nordin, HL Ekstrom, SP Dehmer, D Bredeson, and PJ O'Connor), Minneapolis, Minn
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota (A Sinaiko), Minneapolis, Minn
| | - James D Nordin
- HealthPartners Institute (EO Kharbanda, SE Asche, JD Nordin, HL Ekstrom, SP Dehmer, D Bredeson, and PJ O'Connor), Minneapolis, Minn
| | - Heidi L Ekstrom
- HealthPartners Institute (EO Kharbanda, SE Asche, JD Nordin, HL Ekstrom, SP Dehmer, D Bredeson, and PJ O'Connor), Minneapolis, Minn
| | - Steven P Dehmer
- HealthPartners Institute (EO Kharbanda, SE Asche, JD Nordin, HL Ekstrom, SP Dehmer, D Bredeson, and PJ O'Connor), Minneapolis, Minn
| | - Dani Bredeson
- HealthPartners Institute (EO Kharbanda, SE Asche, JD Nordin, HL Ekstrom, SP Dehmer, D Bredeson, and PJ O'Connor), Minneapolis, Minn
| | - Patrick J O'Connor
- HealthPartners Institute (EO Kharbanda, SE Asche, JD Nordin, HL Ekstrom, SP Dehmer, D Bredeson, and PJ O'Connor), Minneapolis, Minn
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Kharbanda EO, Asche SE, Sinaiko A, Nordin JD, Ekstrom HL, Fontaine P, Dehmer SP, Sherwood NE, O’Connor PJ. Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated BP in Adolescents. Acad Pediatr 2018; 18:43-50. [PMID: 28723587 PMCID: PMC5756693 DOI: 10.1016/j.acap.2017.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate, among adolescents 10 to 17 years of age with an incident hypertensive blood pressure (BP; ≥95th percentile) at a primary care visit, whether TeenBP, a novel electronic health record-linked clinical decision support tool (CDS), improved recognition of elevated BP, and return for follow-up BP evaluation. METHODS We conducted a pragmatic cluster randomized trial in 20 primary care clinics in a large Midwestern medical group. Ten clinics received the TeenBP CDS, including an alert to remeasure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1 to 3 weeks, and patient-specific order sets. In the 10 usual care (UC) clinics, elevated BPs were displayed in red font in the electronic health record. For comparisons between CDS and UC we used generalized linear mixed models. RESULTS The study population included 607 CDS patients and 607 UC patients with an incident hypertensive BP. In adjusted analyses, at the index visit, CDS patients were more likely to have their hypertensive BP on the basis of ≥2 BP measurements (47.1% vs 27.6%; P = .007) and to have elevated BP (International Classification of Diseases, Ninth Revision code 796.2) diagnosed (28.2% vs 4.2%; P < .001). In a multivariate model adjusted for age, sex, systolic BP percentile, and visit type, rates for repeat BP measurement within 30 days were 14.3% at TeenBP CDS clinics versus 10.6% at UC clinics (P = .07). CONCLUSIONS The TeenBP CDS intervention significantly increased repeat BP measurement at the index visit and recognition of a hypertensive BP. Rates for follow-up BP measurement at 30 days were low and did not differ between TeenBP and UC subjects.
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Affiliation(s)
| | | | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | | | | | - Nancy E. Sherwood
- HealthPartners Institute, Minneapolis, MN,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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Kharbanda EO, Vazquez-Benitez G, Romitti PA, Naleway AL, Cheetham TC, Lipkind HS, Klein NP, Lee G, Jackson ML, Hambidge SJ, McCarthy N, DeStefano F, Nordin JD. First Trimester Influenza Vaccination and Risks for Major Structural Birth Defects in Offspring. J Pediatr 2017; 187:234-239.e4. [PMID: 28550954 PMCID: PMC6506840 DOI: 10.1016/j.jpeds.2017.04.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/07/2017] [Accepted: 04/19/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine risks for major structural birth defects in infants after first trimester inactivated influenza vaccine (IIV) exposures. STUDY DESIGN In this observational study, we used electronic health data from 7 Vaccine Safety Datalink sites to examine risks for selected major structural defects in infants after maternal IIV exposure. Vaccine exposures for women with continuous insurance enrollment through pregnancy who delivered singleton live births between 2004 and 2013 were identified from standardized files. Infants with continuous insurance enrollment were followed to 1 year of age. We excluded mother-infant pairs with other exposures that potentially increased their background risk for birth defects. Selected cardiac, orofacial or respiratory, neurologic, ophthalmologic or otologic, gastrointestinal, genitourinary and muscular or limb defects were identified from diagnostic codes in infant medical records using validated algorithms. Propensity score adjusted generalized estimating equations were used to estimate prevalence ratios (PRs). RESULTS We identified 52 856 infants with maternal first trimester IIV exposure and 373 088 infants whose mothers were unexposed to IIV during first trimester. Prevalence (per 100 live births) for selected major structural birth defects was 1.6 among first trimester IIV exposed versus 1.5 among unexposed mothers. The adjusted PR was 1.02 (95% CI 0.94-1.10). Organ system-specific PRs were similar to the overall PR. CONCLUSION First trimester maternal IIV exposure was not associated with an increased risk for selected major structural birth defects in this large cohort of singleton live births.
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Affiliation(s)
| | | | | | | | | | | | | | - Grace Lee
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
| | | | - Simon J. Hambidge
- Institute for Health Research, Kaiser Permanente Colorado and Ambulatory Care Services, Denver Health, Colorado Springs, CO
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Kharbanda EO, Vazquez-Benitez G, Romitti PA, Naleway AL, Cheetham TC, Lipkind HS, Sivanandam S, Klein NP, Lee GM, Jackson ML, Hambidge SJ, Olsen A, McCarthy N, DeStefano F, Nordin JD. Identifying birth defects in automated data sources in the Vaccine Safety Datalink. Pharmacoepidemiol Drug Saf 2017; 26:412-420. [PMID: 28054412 DOI: 10.1002/pds.4153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/10/2016] [Accepted: 11/16/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE The Vaccine Safety Datalink (VSD), a collaboration between the Centers for Disease Control and Prevention and several large healthcare organizations, aims to monitor safety of vaccines administered in the USA. We present definitions and prevalence estimates for major structural birth defects to be used in studies of maternal vaccine safety. METHODS In this observational study, we created and refined algorithms for identifying major structural birth defects from electronic healthcare data, conducted formal chart reviews for severe cardiac defects, and conducted limited chart validation for other defects. We estimated prevalence for selected defects by VSD site and birth year and compared these estimates to those in a US and European surveillance system. RESULTS We developed algorithms to enumerate >50 major structural birth defects from standardized administrative and healthcare data based on utilization patterns and expert opinion, applying criteria for number, timing, and setting of diagnoses. Our birth cohort included 497 894 infants across seven sites. The period prevalence for all selected major birth defects in the VSD from 2004 to 2013 was 1.7 per 100 live births. Cardiac defects were most common (65.4 per 10 000 live births), with one-fourth classified as severe, requiring emergent intervention. For most major structural birth defects, prevalence estimates were stable over time and across sites and similar to those reported in other population-based surveillance systems. CONCLUSIONS Our algorithms can efficiently identify many major structural birth defects in large healthcare datasets and can be used in studies evaluating the safety of vaccines administered to pregnant women. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Allison L Naleway
- Center for Health Research Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | | | - Nicola P Klein
- Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Grace M Lee
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | | | - Simon J Hambidge
- Institute for Health Research, Kaiser Permanente Colorado and Ambulatory Care Services, Denver Health, Denver, CO, USA
| | | | | | - Frank DeStefano
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Klein NP, Cheetham TC, Naleway AL, Lee GM, Hambidge S, Jackson ML, Omer SB, McCarthy N, Nordin JD. Maternal Tdap vaccination: Coverage and acute safety outcomes in the vaccine safety datalink, 2007-2013. Vaccine 2016; 34:968-73. [PMID: 26765288 DOI: 10.1016/j.vaccine.2015.12.046] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Since October 2012, the combined tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine (Tdap) has been recommended in the United States during every pregnancy. METHODS In this observational study from the Vaccine Safety Datalink, we describe receipt of Tdap during pregnancy among insured women with live births across seven health systems. Using a retrospective matched cohort, we evaluated risks for selected medically attended adverse events in pregnant women, occurring within 42 days of vaccination. Using a generalized estimating equation, we calculated adjusted incident rate ratios (AIRR). RESULTS Our vaccine coverage cohort included 438,487 live births between January 1, 2007 and November 15, 2013. Across the coverage cohort, 14% received Tdap during pregnancy. By 2013, Tdap was administered during pregnancy in 41.7% of live births, primarily in the 3rd trimester. Our vaccine safety cohort included 53,885 vaccinated and 109,253 matched unvaccinated pregnant women. There was no increased risk for a composite outcome of medically attended acute adverse events within 3 days of vaccination. Similarly, across the safety cohort, over a 42 day window, incident neurologic events, thrombotic events, and new onset proteinuria did not differ by maternal receipt of Tdap. Among women receiving Tdap at 20 weeks gestation or later, as compared to their matched controls, there was no increased risk for gestational diabetes or cardiac events while venous thromboembolic events and thrombocytopenia were diagnosed within 42 days of vaccination at slightly decreased rates. CONCLUSION Tdap coverage during pregnancy increased from 2007 through 2013, but was still below 50%. No acute maternal safety signals were detected in this large cohort.
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Affiliation(s)
| | | | - Heather S Lipkind
- Yale University School of Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, New Haven, CT, United States
| | - Nicola P Klein
- Kaiser Permanente of Northern California, Oakland, CA, United States
| | - T Craig Cheetham
- Kaiser Permanente of Southern California, Pasadena, CA, United States
| | | | - Grace M Lee
- Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, MA, United States
| | - Simon Hambidge
- Institute for Health Research, Kaiser Permanente Colorado and Department of Ambulatory Care Services, Denver Health, Denver, CO, United States
| | | | - Saad B Omer
- Kaiser Permanente Georgia, Atlanta, GA, United States
| | - Natalie McCarthy
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James D Nordin
- HealthPartners Institute for Education and Research, Minneapolis, MN, United States
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Parker ED, Sinaiko AR, O'Connor PJ, Ekstrom H, Appana D, Amundson J, Kharbanda EO. Potential Misclassification of Blood Pressure Status in Children and Adolescents With Short or Tall Stature. Am J Epidemiol 2016; 183:79-83. [PMID: 26646294 DOI: 10.1093/aje/kwv208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/10/2015] [Indexed: 01/04/2023] Open
Abstract
Blood pressure (BP) is measured in percentiles that are adjusted for sex, age, and height percentile in children and adolescents. Standard tables for the conversion of BP percentiles do not present exact BP percentile cutoffs for extremes in stature, either short (<5th percentile) or tall (>95th percentile). An algorithm can be used to calculate exact BP percentiles across a range of height z scores. We compared values from standard BP tables with exact calculations of BP percentiles to see which were better at identifying hypertension in more than 5,000 children with either short or tall stature. Study subjects were 3-17-year-old patients within HealthPartners Medical Group, an integrated health care delivery system in Minnesota, at any time between 2007 and 2012. Approximately half of the subjects who met the criteria for hypertension using exact calculation would be misclassified as normal using available thresholds in the published BP tables instead of the recommended algorithm, which was not included in the tables.
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Hofstetter AM, Vargas CY, Camargo S, Holleran S, Vawdrey DK, Kharbanda EO, Stockwell MS. Impacting delayed pediatric influenza vaccination: a randomized controlled trial of text message reminders. Am J Prev Med 2015; 48:392-401. [PMID: 25812465 DOI: 10.1016/j.amepre.2014.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/21/2014] [Accepted: 10/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Influenza vaccination coverage is low, especially among low-income populations. Most doses are generally administered early in the influenza season, yet sustained vaccination efforts are crucial for achieving optimal coverage. The impact of text message influenza vaccination reminders was recently demonstrated in a low-income population. Little is known about their effect on children with delayed influenza vaccination or the most effective message type. PURPOSE To determine the impact of educational plus interactive text message reminders on influenza vaccination of urban low-income children unvaccinated by late fall. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Parents of 5,462 children aged 6 months-17 years from four academically affiliated pediatric clinics who were unvaccinated by mid-November 2011. INTERVENTION Eligible parents were stratified by their child's age and pediatric clinic site and randomized using a 1:1:1 allocation to educational plus interactive text message reminders, educational-only text message reminders, or usual care. Using an immunization registry-linked text messaging system, parents of intervention children received up to seven weekly text message reminders. One of the messages sent to parents in the educational plus interactive text message arm allowed selection of more information about influenza and influenza vaccination. MAIN OUTCOME MEASURES Influenza vaccination by March 31, 2012. Data were collected and analyzed between 2012 and 2014. RESULTS Most children were publicly insured and Spanish speaking. Baseline demographics were similar between groups. More children of parents in the educational plus interactive text message arm were vaccinated (38.5%) versus those in the educational-only text message (35.3%; difference=3.3%, 95% CI=0.02%, 6.5%; relative risk ratio (RRR)=1.09, 95% CI=1.002, 1.19) and usual care (34.8%; difference=3.8%, 95% CI=0.6%, 7.0%; RRR=1.11, 95% CI=1.02-1.21) arms. CONCLUSIONS Text message reminders with embedded educational information and options for interactivity have a small positive effect on influenza vaccination of urban, low-income, minority children who remain unvaccinated by late fall.
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Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics, Columbia University; NewYork-Presbyterian Hospital, New York, New York
| | | | | | | | - David K Vawdrey
- Department of Biomedical Informatics, Mailman School of Public Health, Columbia University
| | | | - Melissa S Stockwell
- Department of Pediatrics, Columbia University; Department of Population and Family Health, Mailman School of Public Health, Columbia University; NewYork-Presbyterian Hospital, New York, New York.
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Abstract
Pregnant women and children are at increased risk of severe influenza infections. Despite existing recommendations, uptake of influenza vaccine in these vulnerable groups remains low. Text message reminder-recalls are a feasible and scalable method for promoting influenza vaccination. In randomized controlled trials, text message interventions have demonstrated small but significant increases in influenza vaccine coverage. They should be considered one of many tools available for increasing vaccination and thus improving maternal and child health.
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Affiliation(s)
- Elyse Olshen Kharbanda
- HealthPartners Institute for Education and Research, PO Box 1524, MS 21111R, Minneapolis, MN 55440-1524, USA
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Kharbanda EO, Parker ED, Sinaiko AR, Daley MF, Margolis KL, Becker M, Sherwood NE, Magid DJ, O'Connor PJ. Initiation of oral contraceptives and changes in blood pressure and body mass index in healthy adolescents. J Pediatr 2014; 165:1029-33. [PMID: 25189822 PMCID: PMC4252822 DOI: 10.1016/j.jpeds.2014.07.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/13/2014] [Accepted: 07/25/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI) associated with initiation and continued use of combined oral contraceptives (COCs) in healthy adolescents. STUDY DESIGN This observational, matched cohort study was conducted in 2 large health systems. Utilizing claims and electronic medical records, we identified adolescents 14-17.9 years of age initiating medium-dose COCs (containing 30 or 35 (μg of ethinyl estradiol or equivalent and a progestin) between July 1, 2007 and December 31, 2009 with a baseline and at least 1 follow-up blood pressure (BP) and BMI. COC-users were matched 1:2 by age, race/ethnicity, and site to controls (COC-nonusers). All BPs and BMIs recorded during outpatient visits starting 1 month prior to COC initiation (index date for controls), through December 31, 2010 were collected. Mixed model linear regression with random intercepts and slopes were then used to estimate changes in SBP, DBP, and BMI over time. RESULTS The 510 adolescent COC-users and 912 controls did not differ significantly by age, race/ethnicity, insurance, and baseline SBP, DBP, or BMI. After adjusting for baseline values, over a median of 18 months follow-up, COC-users had an decrease in SBP of 0.07 mm Hg/mo, and controls had an increase of 0.02 mm Hg/mo (P = .65). Similarly, DBP decreased by 0.007 mm Hg/mo in COC-users vs 0.006 mm Hg/mo in controls (P = .99). BMI increased by 0.04 (kg/m(2))/mo in COC-users vs 0.025 (kg/m(2))/mo in controls (P = .09). CONCLUSIONS These data should provide reassurance to patients and providers regarding the lack of significant associations between COC-use and BMI or BP changes in adolescents.
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Affiliation(s)
| | - Emily D Parker
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Alan R Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | - Karen L Margolis
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Mary Becker
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - David J Magid
- Kaiser Permanente Institute for Health Research, Denver, CO
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Nordin JD, Kharbanda EO, Vazquez-Benitez G, Lipkind H, Lee GM, Naleway AL. Monovalent H1N1 influenza vaccine safety in pregnant women, risks for acute adverse events. Vaccine 2014; 32:4985-92. [PMID: 25045808 DOI: 10.1016/j.vaccine.2014.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/12/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess risks for acute adverse events and pregnancy complications in pregnant women following monovalent 2009 H1N1 inactivated influenza (MIV) vaccination. METHODS Within the Vaccine Safety Datalink, we compared rates of pre-specified medically attended events (MAE) occurring within 42 days of MIV vaccination to those occurring in matched cohorts that at the same gestational age were either unvaccinated or received seasonal trivalent inactivated influenza (TIV) vaccine. Using generalized estimating equation method, with a Poisson distribution and log link, we calculated adjusted incident rate ratios (AIRR). RESULTS Among 9349 women receiving MIV in any trimester, only one MAE occurred 0-3 days following MIV, an allergic reaction. No cases of Guillain-Barré syndrome, Bell's palsy, or transverse myelitis occurred 1-42 days after MIV. Compared to women receiving TIV and to unvaccinated women, risks for acute MAEs were not increased following MIV for any outcome. Hyperemesis was the most common adverse event in the MIV, TIV, and unvaccinated groups, occurring at a rate of about 4% over a 42-day period in all groups. Over a 42-day window, among all groups, incident gestational diabetes occurred at a rate of 3% and thrombocytopenia occurred at a rate of approximately 0.3%. Among women receiving MIV during pregnancy, increased risks for these and other less common obstetric events were not detected. CONCLUSION In this large cohort of pregnant women no acute safety signals were identified within 6 weeks of receipt of MIV.
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Affiliation(s)
- James D Nordin
- HealthPartners Institute for Education and Research, PO Box 1524, MS 21111R, Minneapolis, MN 55425, United States.
| | - Elyse Olshen Kharbanda
- HealthPartners Institute for Education and Research, PO Box 1524, MS 21111R, Minneapolis, MN 55425, United States.
| | - Gabriela Vazquez-Benitez
- HealthPartners Institute for Education and Research, PO Box 1524, MS 21111R, Minneapolis, MN 55425, United States
| | - Heather Lipkind
- Yale University School of Medicine Department of Obstetrics, Gynecology, & Reproductive Sciences, 333 Cedar Street PO Box 208063; Ste 302 FMB New Haven, CT 06520-8063, United States.
| | - Grace M Lee
- Department of Population Medicine Harvard Pilgrim Health Care Institute & Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, United States.
| | - Allison L Naleway
- Center for Health Research Northwest, Kaiser Permanente Northwest 3800 N. Interstate Avenue, Portland, OR 97227 United States.
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Kharbanda EO, Parker ED, Nordin JD, Hedblom BD, Rolnick SJ. Influenza and pertussis vaccination coverage among privately insured women of reproductive age. Matern Child Health J 2014; 17:1631-7. [PMID: 23108738 DOI: 10.1007/s10995-012-1176-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An increasing number of vaccines are now designated as maternal vaccines, recommended prior to, during, or immediately following pregnancy. The influenza and pertussis (Tdap) vaccines have the potential to improve the health of women and their offspring. Among privately insured women of reproductive age, goals of this study were to describe influenza and Tdap vaccination coverage and to explore variation in coverage by age and race/ethnicity. This cross-sectional, observational study included women 18-44 years of age with continuous enrollment from 1 January 2007-31 March 2011 in a single, Midwestern health insurance plan and at least one visit to a plan affiliated practice. Data on vaccine coverage came from insurance claims, supplemented by electronic medical record data. Primary outcomes were: receipt of Tdap ever, receipt of Tdap or Tetanus vaccination (Td) in the past 10 years, and receipt of influenza vaccination during the 2010-2011 influenza season. Coverage was compared by race/ethnicity. Among 12,657 women with continuous private insurance, 45.5 % had received Tdap ever, 82.5 % had received Td or Tdap in the past 10 years, and 39.8 % received the influenza vaccine in the 2010-2011 season. Marked disparities in influenza vaccination coverage by race/ethnicity were observed, only 30.0 % of African American women received influenza vaccine compared to 40.7 % of white, non-Hispanic women (p < .0001). Among insured women of reproductive age, there is a need for interventions to increase Tdap and influenza vaccination uptake. Further research is needed to understand and address disparities in influenza vaccination coverage in this population.
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Affiliation(s)
- Elyse Olshen Kharbanda
- HealthPartners Institute for Education and Research, PO Box 1524, MS 21111R, Minneapolis, MN, 55425, USA,
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Nordin JD, Kharbanda EO, Vazquez Benitez G, Lipkind H, Vellozzi C, Destefano F. Maternal influenza vaccine and risks for preterm or small for gestational age birth. J Pediatr 2014; 164:1051-1057.e2. [PMID: 24582484 DOI: 10.1016/j.jpeds.2014.01.037] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/03/2013] [Accepted: 01/17/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To study the impact of influenza vaccine administered to pregnant women during all trimesters on the rates of preterm and small for gestational age (SGA) births, evaluating both increased and decreased risk. STUDY DESIGN This retrospective observational matched cohort study involved 7 Vaccine Safety Datalink sites across the US for the 2004-05 through 2008-09 influenza seasons. Cohort eligibility and outcomes were determined from administrative, claims, medical records, and birth data. In propensity score- and vaccine exposure time-matched analyses, ORs for preterm and SGA births were calculated. RESULTS Among 57 554 matched vaccinated and unvaccinated pregnant women, including 16 240 women in the first trimester, maternal vaccination was not associated with increased or decreased risk for preterm birth (OR for delivery at <37 weeks gestation, 0.97 [95% CI, 0.93-1.02]; for delivery at ≤32 weeks gestation, 0.98 [95% CI, 0.86-1.12]; and for delivery at ≤34 weeks gestation, 0.96 [95% CI, 0.88-1.04]) or SGA birth (OR for <5th percentile weight for gestational age, 1.02 [95% CI, 0.96-1.09], and for <10th percentile weight for gestational age, 1.00 [95% CI, 0.96-1.04]). Similarly, first trimester vaccination was not associated with increased or decreased risk for preterm or SGA birth. CONCLUSION Receipt of trivalent inactivated influenza vaccine during pregnancy was not associated with increased or decreased risk of preterm or SGA birth. These findings support the safety of vaccinating pregnant women against influenza during the first, second, and third trimesters, and suggest that a nonspecific protective effect of the influenza vaccine for these outcomes does not exist.
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Affiliation(s)
- James D Nordin
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | | | | | - Heather Lipkind
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT
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Affiliation(s)
- Abigail English
- Center for Adolescent Health & the Law, Chapel Hill, North Carolina
| | - Carol A Ford
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica A Kahn
- Division of Adolescent Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Amy B Middleman
- Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Kharbanda EO, Ipp LS, Maehr J, Middleman AB, Rickert VI, Zimet GD. Influenza vaccine: an updated position statement of the Society for Adolescent Health and Medicine. J Adolesc Health 2014; 54:241-2. [PMID: 24445181 DOI: 10.1016/j.jadohealth.2013.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 11/25/2022]
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Stockwell MS, Westhoff C, Kharbanda EO, Vargas CY, Camargo S, Vawdrey DK, Castaño PM. Influenza vaccine text message reminders for urban, low-income pregnant women: a randomized controlled trial. Am J Public Health 2013; 104 Suppl 1:e7-12. [PMID: 24354839 DOI: 10.2105/ajph.2013.301620] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the impact of influenza vaccine text message reminders in a low-income obstetric population. METHODS We conducted a randomized controlled trial that enrolled 1187 obstetric patients from 5 community-based clinics in New York City. The intervention group received 5 weekly text messages regarding influenza vaccination starting mid-September 2011 and 2 text message appointment reminders. Both groups received standard automated telephone appointment reminders. The prespecified endpoints were receipt of either pre- or postpartum influenza vaccination calculated cumulatively at the end of each month (September-December 2011). RESULTS After adjusting for gestational age and number of clinic visits, women who received the intervention were 30% more likely to be vaccinated as of December 2011 (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.003, 1.69 end of September: AOR = 1.34; 95% CI = 0.98, 1.85; October: AOR = 1.35; 95% CI = 1.05, 1.75; November: AOR = 1.27; 95% CI = 0.98, 1.65). The subgroup of women early in the third trimester at randomization showed the greatest intervention effect (December 31: 61.9% intervention vs 49.0% control; AOR = 1.88; 95% CI = 1.12, 3.15). CONCLUSIONS In this low-income obstetric population, text messaging was associated with increased influenza vaccination, especially in those who received messages early in their third trimester.
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Affiliation(s)
- Melissa S Stockwell
- Melissa S. Stockwell is with the Departments of Pediatrics and Population and Family Health, Columbia University, and New York-Presbyterian Hospital, New York, NY. Carolyn Westhoff is with the Departments of Obstetrics and Gynecology and Epidemiology, Columbia University. Elyse Olshen Kharbanda is with HealthPartners Institute for Education and Research, Minneapolis, MN. Celibell Y. Vargas and Stewin Camargo are with the Department of Pediatrics, Columbia University. David K. Vawdrey is with the Department of Biomedical Informatics, Columbia University, and New York-Presbyterian Hospital. Paula M. Castaño is with the Department of Obstetrics and Gynecology, Columbia University
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English A, Ford CA, Kahn JA, Kharbanda EO, Middleman AB. Adolescent consent for vaccination: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health 2013; 53:550-3. [PMID: 24054082 DOI: 10.1016/j.jadohealth.2013.07.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 11/26/2022]
Abstract
Vaccines currently recommended for adolescents by the Advisory Committee on Immunization Practices have the potential to improve the health of youth by preventing conditions such as: tetanus, pertussis, meningococcal disease, influenza, and genital warts, as well as later adult outcomes such as cervical and other human papillomavirus-related cancers. Adolescent vaccine coverage lags behind that for younger age groups. A requirement to obtain parental consent for vaccination can present a significant barrier to improving adolescent vaccine uptake across all health care settings in which adolescents access care. The ability of minors to consent to vaccination can influence whether adolescents receive indicated vaccines during adolescent health care visits when parents are absent and when adolescents are seen for confidential services. State laws govern consent for the delivery of health care to minors. All states have some laws that allow minors to consent to health care based either on their status or on the services they are seeking. Some of these laws would allow them to consent to vaccination. It is the Position of the Society for Adolescent Health and Medicine that, within ethical and legal guidelines, it will be important to develop strategies that maximize opportunities for minors to receive vaccinations when parents are not physically present, including opportunities for them to give their own consent.
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Chernick L, Kharbanda EO, Santelli J, Dayan P. Identifying adolescent females at high risk of pregnancy in a pediatric emergency department. J Adolesc Health 2012; 51:171-8. [PMID: 22824448 DOI: 10.1016/j.jadohealth.2011.11.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 11/29/2011] [Accepted: 11/30/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Emergency departments (EDs) care for adolescent females with unmet reproductive health care needs. Our objective was, among adolescents presenting to a pediatric ED, to estimate pregnancy risk, describe pregnancy intentions, and identify potentially modifiable factors associated with pregnancy risk. METHODS Using a paper-based questionnaire, we surveyed females aged 15-19 years presenting to our ED, assessing health care access, sexual behaviors, pregnancy intentions, and receptivity to interventions. We calculated the pregnancy risk index (PRI), which estimates pregnancy risk in the subsequent 12 months, by assessing recent sexual activity, contraception at last intercourse, and known contraceptive failure rates. Independent sample t tests and analysis of variance were used to identify risk factors associated with increased PRI. RESULTS Of 459 females enrolled, 13% were pregnant and 20% reported prior pregnancy. Among 399 nonpregnant females, 238 (60%) had intercourse in the prior 3 months and 73 (31%) used no contraception at last intercourse. Among nonpregnant adolescents, the PRI was 19.5, which equates to 19.5 expected pregnancies per 100 females per year. Factors associated with higher PRI included lacking a primary provider, prior ED visits, wanting a baby now, and reported partner wantedness of pregnancy. Half believed ED doctors should discuss pregnancy prevention, and one-quarter were interested in starting contraception in the ED. CONCLUSIONS Nearly one-third of adolescent females in a pediatric ED were either pregnant or could be expected to become pregnant within a year. Screening questions can identify adolescents at high risk of pregnancy in the ED setting. These females should be the target for future pregnancy prevention interventions.
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Affiliation(s)
- Lauren Chernick
- Division of Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.
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Stockwell MS, Kharbanda EO, Martinez RA, Vargas CY, Vawdrey DK, Camargo S. Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. JAMA 2012; 307:1702-8. [PMID: 22535855 DOI: 10.1001/jama.2012.502] [Citation(s) in RCA: 260] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Influenza infection results in substantial costs, morbidity, and mortality. Vaccination against influenza is particularly important in children and adolescents who are a significant source of transmission to other high-risk populations, yet pediatric and adolescent vaccine coverage remains low. Traditional vaccine reminders have had a limited effect on low-income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination. OBJECTIVE To evaluate targeted text message reminders for low-income, urban parents to promote receipt of influenza vaccination among children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial of 9213 children and adolescents aged 6 months to 18 years receiving care at 4 community-based clinics in the United States during the 2010-2011 influenza season. Of the 9213 children and adolescents, 7574 had not received influenza vaccine prior to the intervention start date and were included in the primary analysis. INTERVENTION Parents of children assigned to the intervention received up to 5 weekly immunization registry-linked text messages providing educational information and instructions regarding Saturday clinics. Both the intervention and usual care groups received the usual care, an automated telephone reminder, and access to informational flyers posted at the study sites. MAIN OUTCOME MEASURES Receipt of an influenza vaccine dose recorded in the immunization registry via an electronic health record by March 31, 2011. Receipt was secondarily assessed at an earlier fall review date prior to typical widespread influenza activity. RESULTS Study children and adolescents were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. As of March 31, 2011, a higher proportion of children and adolescents in the intervention group (43.6%; n = 1653) compared with the usual care group (39.9%; n = 1509) had received influenza vaccine (difference, 3.7% [95% CI, 1.5%-5.9%]; relative rate ratio [RRR], 1.09 [95% CI, 1.04-1.15]; P = .001). At the fall review date, 27.1% (n = 1026) of the intervention group compared with 22.8% (n = 864) of the usual care group had received influenza vaccine (difference, 4.3% [95% CI, 2.3%-6.3%]; RRR, 1.19 [95% CI, 1.10-1.28]; P < .001). CONCLUSIONS Among children and adolescents in a low-income, urban population, a text messaging intervention compared with usual care was associated with an increased rate of influenza vaccination. However, the overall influenza vaccination rate remained low. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01146912.
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Affiliation(s)
- Melissa S Stockwell
- Department of Pediatrics, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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Stockwell MS, Kharbanda EO, Martinez RA, Lara M, Vawdrey D, Natarajan K, Rickert VI. Text4Health: impact of text message reminder-recalls for pediatric and adolescent immunizations. Am J Public Health 2011; 102:e15-21. [PMID: 22390457 DOI: 10.2105/ajph.2011.300331] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted 2 studies to determine the impact of text message immunization reminder-recalls in an urban, low-income population. METHODS In 1 study, text message immunization reminders were sent to a random sample of parents (n = 195) whose children aged 11 to 18 years needed either or both meningococcal (MCV4) and tetanus-diphtheria-acellular pertussis (Tdap) immunizations. We compared receipt of MCV4 or Tdap at 4, 12, and 24 weeks with age- and gender-matched controls. In the other study, we compared attendance at a postshortage Haemophilus influenzae B (Hib) immunization recall session between parents who received text message and paper-mailed reminders (n = 87) and those who only received paper-mailed reminders (n = 87). RESULTS Significantly more adolescents with intervention parents received either or both MCV4 and Tdap at weeks 4 (15.4% vs 4.2%; P < .001), 12 (26.7% vs 13.9%; P < .005), and 24 (36.4% vs 18.1%; P < .001). Significantly more parents who received both Hib reminders attended a recall session compared with parents who only received a mailed reminder (21.8% vs 9.2%; P < .05). After controlling for age, gender, race/ethnicity, insurance status, and language, text messaging was still significantly associated with both studies' outcomes. CONCLUSIONS Text messaging for reminder-recalls improved immunization coverage in a low-income, urban population.
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Affiliation(s)
- Melissa S Stockwell
- Division of Child and Adolescent Health and the Heilbrunn Department of Population and Family Health, Columbia University, New York, NY, USA.
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Kharbanda EO, Stockwell MS, Fox H, Ipp LS, Rickert VI. The role of human papillomavirus vaccination in promoting delivery of other preventive and medical services. Acad Pediatr 2011; 11:326-32. [PMID: 21393081 DOI: 10.1016/j.acap.2010.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 12/10/2010] [Accepted: 12/16/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Adolescents infrequently present for preventive health visits. The 3-dose human papillomavirus (HPV) vaccine may result in increased health care visits and thus indirectly improve health services for teens. We examined whether other health services were delivered in conjunction with the second (HPV2) or third (HPV3) dose of the HPV vaccine. METHODS We conducted a chart review for girls 9 to 20 years of age (n = 571) who received HPV2 or HPV3 within 4 months of its due date at any of 9 clinical sites. Analyses were limited to the 422 visits (72%) where HPV vaccine was specified as a reason for the visit. A generalized linear model was used to evaluate the impact of site of care on delivery of other health services. RESULTS Nearly half (43%) of adolescents received another medical or preventive health service at the time of HPV2 or HPV3 vaccine administration. Most common services were 1 or more other vaccines (30%) or medical services (35%). Older teens were more likely than younger teens to receive reproductive health services and sexually transmitted infection screening. After controlling for age and adjusting for clustering within sites, receiving care at an academic health center versus a private practice was strongly associated with increased odds of receiving other medical or preventive health services at follow-up (odds ratio 2.07; 95% confidence interval 1.44-2.97). CONCLUSIONS Adolescents, especially those receiving care at an academic health center, often received other health services at the time of HPV2 or HPV3 vaccination. Because visits occurred within 6 to 8 months of the prior vaccine dose, our findings suggest vaccine visits may lead to improved delivery of adolescent health services.
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Kharbanda EO, Lee GM, Koenigs L. Financing vaccines for adolescents: a position paper of the society for adolescent health and medicine. J Adolesc Health 2011; 48:320-1. [PMID: 21338909 DOI: 10.1016/j.jadohealth.2010.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 12/29/2010] [Indexed: 11/16/2022]
Abstract
An increasing number of vaccines are now recommended for adolescents. These vaccines may greatly improve the health of adolescents and their communities. However, adolescent vaccine coverage rates lag behind those for infants and behind goals set by Healthy People 2010 [1]. Financial constraints have been reported to be a significant obstacle to immunizing adolescents and young adults [2]. At the Society for Adolescent Health and Medicine, we believe that to achieve increased vaccine coverage in this age group, financial barriers to immunization must be removed.
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Kharbanda EO, Vargas CY, Castaño PM, Lara M, Andres R, Stockwell MS. Exploring pregnant women's views on influenza vaccination and educational text messages. Prev Med 2011; 52:75-7. [PMID: 21047526 DOI: 10.1016/j.ypmed.2010.10.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/07/2010] [Accepted: 10/24/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND The influenza vaccine has the potential to reduce morbidity among pregnant women and newborns but immunization coverage remains low. Effective interventions are needed to promote vaccine uptake in this population. PURPOSE The goal of this study was to explore attitudes toward influenza vaccination and interest in targeted educational text messages among urban pregnant women. METHODS English and Spanish language focus groups were conducted with pregnant women in New York City in April 2010. Transcripts were independently coded using content analysis. RESULTS The 40 participants ranged in age from 19-35 years (mean=26, SD=5). Their gestational age ranged from 8-40 weeks (mean=27, SD=8). Most were Latina (85%), had other children (70%), and were publicly insured (78%). Nearly half had received the seasonal influenza or influenza A (H1N1) 2009 monovalent vaccine. Barriers to vaccination included concerns regarding vaccine safety and efficacy, misperceptions regarding risks for influenza, and lack of provider recommendation. Pregnant women expressed interest in receiving educational text messages regarding influenza. Even women who had refused the influenza vaccine thought the text messages would encourage vaccine-related discussions during prenatal visits. CONCLUSION Among urban pregnant women, educational text messages regarding influenza would be well received and may effectively address current barriers to vaccination.
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Kharbanda EO, Stockwell MS, Colgrove J, Natarajan K, Rickert VI. Changes in Tdap and MCV4 vaccine coverage following enactment of a statewide requirement of Tdap vaccination for entry into sixth grade. Am J Public Health 2010; 100:1635-40. [PMID: 20634463 DOI: 10.2105/ajph.2009.179341] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated changes in tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap), and tetravalen meningococcal (MCV4) vaccine coverage following enactment of a New York State mandate requiring Tdap before entering sixth grade. METHODS Using data from a hospital-based immunization registry, we measured Tdap and MCV4 coverage among youths aged 11 to 14 years in New York City at 3 time points: premandate, mandate year 1, and mandate year 2. RESULTS Among overlapping cohorts of 4316 (premandate), 4131 (mandate year 1), and 3639 (mandate year 2) youths, Tdap coverage increased steadily over time (29%, 58%, and 83%, respectively). Increases were observed among all ages. Across the same time points, MCV4 coverage also increased (10%, 30%, and 60%, respectively). Most adolescents did not receive MCV4 during the same visit they received Tdap. CONCLUSIONS A Tdap school-entry mandate was associated with substantial increases in immunization coverage, even in age groups not directly affected by the mandate. At the postmandate time points, MCV4 coverage remained lower than Tdap coverage. Provider education should emphasize the importance of reviewing vaccine records and administering all recommended vaccines at every clinical encounter.
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Affiliation(s)
- Elyse Olshen Kharbanda
- Department of Pediatrics, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, 622 West 168th St, VC 402, New York, NY 10032, USA.
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Affiliation(s)
- Elyse Olshen Kharbanda
- Elyse Olshen Kharbanda and Melissa S. Stockwell are with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, New York City, NY, and the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City. Harrison W. Fox is with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York City. Vaughn I. Rickert is with the Division of
| | - Melissa S. Stockwell
- Elyse Olshen Kharbanda and Melissa S. Stockwell are with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, New York City, NY, and the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City. Harrison W. Fox is with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York City. Vaughn I. Rickert is with the Division of
| | - Harrison W. Fox
- Elyse Olshen Kharbanda and Melissa S. Stockwell are with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, New York City, NY, and the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City. Harrison W. Fox is with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York City. Vaughn I. Rickert is with the Division of
| | - Vaughn I. Rickert
- Elyse Olshen Kharbanda and Melissa S. Stockwell are with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, New York City, NY, and the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City. Harrison W. Fox is with the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York City. Vaughn I. Rickert is with the Division of
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Kharbanda EO, Stockwell MS, Fox HW, Rickert VI. Text4Health: a qualitative evaluation of parental readiness for text message immunization reminders. Am J Public Health 2009; 99:2176-8. [PMID: 19833982 DOI: 10.2105/ajph.2009.161364] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We conducted focus groups and individual interviews in a diverse population of parents to qualitatively explore preferences and readiness for text message immunization reminders. We used content analysis to review and independently code transcripts. Text message reminders were well-accepted by parents; many thought they would be more effective than standard phone or mail reminders. Parents preferred text message reminders to be brief and personalized. Most parents were able to retrieve sample text messages but many had difficulty with interactive texting.
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Affiliation(s)
- Elyse Olshen Kharbanda
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 622 West 168th St, VC402, New York, NY 10032, USA.
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Soren K, Kharbanda EO, Chen S, Westhoff C. A 6-year experience with Pap smears in an urban adolescent practice: the scope and burden of abnormalities. J Pediatr Adolesc Gynecol 2009; 22:217-22. [PMID: 19646666 DOI: 10.1016/j.jpag.2008.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 05/08/2008] [Accepted: 05/12/2008] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To determine the prevalence of cervical dysplasia and adherence to recommendations for referral/follow-up in a group of adolescent girls undergoing routine reproductive health care in a primary care setting. DESIGN Retrospective review of all screening Papanicolaou (Pap) smears performed between 12/99 and 12/05. SETTING An urban academic adolescent medicine practice in New York City. PARTICIPANTS 824 sexually active adolescent girls. MAIN OUTCOMES Cytology and cervical biopsy results and adherence to follow-up and colposcopy recommendations. RESULTS Among 824 adolescents ages 12-21 years (mean = 17) who underwent 1 to 6 screening Paps, 81% (n = 666) had normal Pap smears only and 19% (n = 158) had at least one abnormal Pap. Of the 1214 screening Pap smears reviewed, only one was suggestive of a high grade lesion, 85 (7%) revealed atypical squamous cells of undetermined significance (ASCUS), 81 (6.6%) showed low-grade squamous intraepithelial lesions (LGSIL), and the rest were normal. Fifteen percent of patients (n = 123) were referred for at least one colposcopy; only 72% (n = 88) complied. Biopsy identified 5 high-grade lesions; 3 patients required cervical Loop Electrosurgical Excision Procedures: Despite appropriate referrals and access to services, 32% of patients with ASCUS and 28% of patients with LGSIL lacked evidence of either follow-up Pap or colposcopy by the time of last review. CONCLUSIONS High-grade lesions were rare in our sample, supporting new guidelines for less colposcopy in this age group. Although many adolescents were followed within primary care, achieving appropriate follow-up for those with cervical dysplasia was challenging and often unsuccessful.
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Affiliation(s)
- Karen Soren
- Departments of Pediatrics and Obstetrics/Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA.
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Kharbanda EO, Maehr J, Middleman AB, Rickert VI, Zimet GL. Influenza vaccine: a position statement of the society for adolescent medicine. J Adolesc Health 2007; 41:216-7. [PMID: 17659233 DOI: 10.1016/j.jadohealth.2007.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Indexed: 11/17/2022]
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