School-Located Influenza Vaccination: Do Vaccine Clinics at School Raise Vaccination Rates?

BACKGROUND

Only half of US schoolchildren receive influenza vaccine. School-located influenza vaccination (SLIV) might raise vaccination rates but conducting flu vaccine clinics at schools is challenging to implement. We compared 2 school-based programs designed to raise influenza vaccination rates: parent reminder/educational messages sent to parents from schools which is a low-intensity intervention vs the combination of reminder/educational messages plus SLIV clinics which is a high-intensity intervention.

METHODS

We assigned 36 schools (6 school districts, 2 per group) to 3 groups: (1) control, ie, no SLIV and no parent reminder/education, (2) parent reminder/education emailed by schools, and (3) parent reminder/education plus SLIV clinics. Some schools had SLIV clinics in prior years. Health department nurses conducted SLIV clinics.

RESULTS

Among 24,832 children at 36 schools, vaccination rates were control (51.3%), parent reminder/education-only (41.2%), and reminder/education + SLIV (58.7%). On multivariate analyses which controlled for vaccination in prior seasons, children in reminder/education + SLIV schools had higher vaccination rates (OR 1.27, 95% CI 1.10-1.47), but children in reminder/education-only schools had lower rates (OR 0.87, 95% CI 0.75-1.00) than children in control schools.

CONCLUSIONS

Parent reminder/education combined with SLIV clinics raise vaccination rates, but parent reminder/education alone does not.

Text Message Reminders for Child Influenza Vaccination in the Setting of School-Located Influenza Vaccination: A Randomized Clinical Trial

Half of US school children receive influenza vaccine. In our previous trials, school-located influenza vaccination (SLIV) raised vaccination rates by 5 to 8 percentage points. We assessed whether text message reminders to parents could raise vaccination rates above those observed with SLIV. Within urban elementary schools we randomized families into text message + SLIV (intervention) versus SLIV alone (comparison). All parents were sent 2 backpack notifications plus 2 autodialer phone reminders about SLIV at a single SLIV clinic. Intervention group parents also were sent 3 text messages from the school nurse encouraging flu vaccination via either primary care or SLIV. Among 15 768 children at 32 schools, vaccination rates were text + SLIV (40%) and SLIV control (40%); 4% of students per group received influenza vaccination at SLIV. Text message reminders did not raise influenza vaccination rates above those observed with SLIV alone. More intensive interventions are needed to raise influenza vaccination rates.

School-located Influenza Vaccinations for Adolescents: A Randomized Controlled Trial

PURPOSE

We aimed to evaluate the effect of school-located influenza vaccination (SLIV) on adolescents' influenza vaccination rates.

METHODS

In 2015-2016, we performed a cluster-randomized trial of adolescent SLIV in middle/high schools. We selected 10 pairs of schools (identical grades within pairs) and randomly allocated schools within pairs to SLIV or usual care control. At eight suburban SLIV schools, we sent parents e-mail notifications about upcoming SLIV clinics and promoted online immunization consent. At two urban SLIV schools, we sent parents (via student backpack fliers) paper immunization consent forms and information about SLIV. E-mails were unavailable at these schools. Local health department nurses administered nasal or injectable influenza vaccine at dedicated SLIV clinics and billed insurers. We compared influenza vaccination rates at SLIV versus control schools using school directories to identify the student sample in each school. We used the state immunization registry to determine receipt of influenza vaccination.

RESULTS

The final sample comprised 17,650 students enrolled in the 20 schools. Adolescents at suburban SLIV schools had higher overall influenza vaccination rates than did adolescents at control schools (51% vs. 46%, p < .001; adjusted odds ratio = 1.27, 95% confidence interval 1.18-1.38, controlling for vaccination during the prior two seasons). No effect of SLIV was noted among urbanschools on multivariate analysis. SLIV did not substitute for vaccinations in primary care or other settings; in suburban settings, SLIV was associated with increased vaccinations in primary care or other settings (adjusted odds ratio = 1.10, 95% confidence interval 1.02-1.19).

CONCLUSIONS

SLIV in this community increased influenza vaccination rates among adolescents attending suburban schools.

Examining the Factorial Structure of the T-CRS 2.1

The factor structure of the Teacher–Child Rating Scale (T-CRS 2.1) was examined using confirmatory factor analysis (CFA). A cross-sectional study was carried out on 68,497 children in prekindergarten through Grade 10. Item reduction was carried out based on modification indices, standardized residual covariance, and standardized factor loadings. A higher order model with a general super-ordinate factor fit the data well, and is consistent with the notion of a unidimensional non-cognitive set of learning-related skills. Model-based reliability estimates are provided.

School-Located Influenza Vaccinations: A Randomized Trial

OBJECTIVE

Assess impact of offering school-located influenza vaccination (SLIV) clinics using both Web-based and paper consent upon overall influenza vaccination rates among elementary school children.

METHODS

We conducted a cluster-randomized trial (stratified by suburban/urban districts) in upstate New York in 2014-2015. We randomized 44 elementary schools, selected similar pairs of schools within districts, and allocated schools to SLIV versus usual care (control). Parents of children at SLIV schools were sent information and vaccination consent forms via e-mail, backpack fliers, or both (depending on school preferences) regarding school vaccine clinics. Health department nurses conducted vaccine clinics and billed insurers. For all children registered at SLIV/control schools, we compared receipt of influenza vaccination anywhere (primary outcome).

RESULTS

The 44 schools served 19 776 eligible children in 2014-2015. Children in SLIV schools had higher influenza vaccination rates than children in control schools county-wide (54.1% vs 47.4%, P < .001) and in suburban (61.9% vs 53.6%, P < .001) and urban schools (43.9% vs 39.2%; P < .001). Multivariate analyses (controlling for age, grade, vaccination in previous season) confirmed bivariate findings. Among parents who consented for SLIV, nearly half of those notified by backpack fliers and four-fifths of those notified by e-mail consented online. In suburban districts, SLIV did not substitute for primary care influenza vaccination. In urban schools, some substitution occurred.

CONCLUSIONS

SLIV raised seasonal influenza vaccination rates county-wide and in both suburban and urban settings. SLIV did not substitute for primary care vaccinations in suburban settings where pediatricians often preorder influenza vaccine but did substitute somewhat in urban settings.

Relations among family discord, caregiver communication, and children's family representations

This study examined associations among family discord, caregiver communication quality about emotionally stressful family events, and child internal representations of family security in 50 preschool children and their primary caregivers. Consistent with risk and protective models, findings indicate that children's representations were predicted by the interaction between family discord and caregiver communication quality. Children exhibiting the highest level of secure representations of the family experienced a consistency between low levels of family discord and communications emphasizing family security. Conversely, incongruency between family experiences and communication, reflected in high levels of family discord and communications underscoring family security, was associated with the lowest level of child secure representations. Results suggest that child representations hinge on the fit between caregiver communication quality and family experience.

Behavior problems among inner-city children with asthma: findings from a community-based sample

OBJECTIVE

Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms.

METHODS

In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the child's background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1-4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes.

RESULTS

A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, >20% scored >1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms.

CONCLUSIONS

Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma.

Maternal Depressive Symptoms Are Adversely Associated With Prevention Practices and Parenting Behaviors for Preschool Children

OBJECTIVE

To determine the relationship between maternal depressive symptoms and select prevention practices and parenting behaviors for older preschool children.

METHODS

A telephone survey of mothers and female guardians of children entering kindergarten in Monroe County, New York, was administered to 400 eligible parents in 2001. The Mental Health Inventory-5 was used to determine maternal depressive symptoms. We examined the impact of maternal depression on well-child care, immunizations, routine dental care, tooth brushing, frequent reading, safe motor vehicle seating location, car seat or booster seat use, discipline consistency, and parenting confidence.

RESULTS

A total of 17.7% of mothers had depressive symptoms, with increased rates among women who were poor, less educated, and single parents. Children of mothers with depressive symptoms were more likely to have not received routine dental care in the past year (21.1% vs 8.2%, P = .001), brush their teeth less than twice a day (37.1% vs 25.2%, P = .041), or be read to less than 3 times per week (31.0% vs 13.7%, P < .001) compared with children of mothers without depressive symptoms. In addition, mothers with depressive symptoms were more likely to describe inconsistent discipline practices (36.6% vs 20.1%, P = .005) and less confidence in their parenting (39.4% vs 18.5%, P < .001). All associations remained significant in multivariate analyses controlling for maternal race, ethnicity, education, income, age, and household structure.

CONCLUSIONS

Maternal depressive symptoms are associated with diminished positive parenting behaviors including dental care, reading, and discipline consistency for older preschoolers. These findings have implications for clinical pediatrics as well as preventive public health efforts.

School readiness among urban children with asthma

BACKGROUND

Children with chronic illnesses, including asthma, are at risk for school problems. Developmental problems, however, may begin before school entry, and the developmental status of preschool children with asthma has not been evaluated.

OBJECTIVE

To test the hypothesis that urban preschool children with asthma have lower parent-reported developmental scores compared with children without asthma.

METHODS

A comprehensive survey of children beginning kindergarten in 1998 in the urban school system in Rochester, NY, collected parent reports of demographic, medical, and developmental data. We compared children with asthma with and without limitation of activity to children without asthma for motor, language, socioemotional, and school readiness skills and the need for extra help with learning. Linear and logistic regression were used to determine associations between asthma and developmental outcomes.

RESULTS

Among the 1058 children in this sample, 9% had asthma, including 5% with asthma with limitation of activity. After adjustment for multiple potential confounding variables, the children with asthma with limitation had lower scores on school readiness skills compared with children without asthma (2.0 vs 2.5, P <.001). Further, the parents of children with asthma with limitation were substantially more likely (P <.05) to describe them as needing extra help with learning (74% vs 56%; odds ratio, 3.2; 95% confidence interval, 1.5--7.8).

CONCLUSIONS

Urban preschool children with significant asthma had poorer parent-reported school readiness skills and a greater need for extra help with learning compared with children without asthma. This finding suggests that developmental problems for children with asthma may begin before school entry.