The Comparative Impact of Middle School Immunization Laws and Voluntary Schoolbased Immunization Pro

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The Comparative Impact of Middle School
Immunization Laws and Voluntary School-based
Immunization Programs in Increasing Immunization
Coverage in Adolescents
National Immunization Conference 2004
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Authors

• Thad Wilson, APRN, Phd
• University of Missouri-Kansas City
• Mid America Immunization Coalition
• Stan Edlavitch, PhD
• University of Missouri-Kansas City
• School of Medicine
• Daniel Fishbein, MD
• National Immunization Program
• Centers for Disease Control and Prevention

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Funding

• This research was funded by a grant from the
  Centers for Disease Control and Prevention
  through the Association of Teachers of Preventive
  Medicine (TS-0777, 2002)
• Thanks to Mid America Immunization Coalition and
  Deb Bumgardner.

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Background
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Overview of Kansas City Metropolitan Hepatitis B
Program 1997 - 2000

• 16 23 School Districts
• 1 30 private schools
• 106 195 school buildings
• Two states (KS 97-99 only)
• 4 6 Health Departments
• 7 13 volunteer organizations or agencies

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Overview 1997 - 2000

• 46,749 students were offered school-based
  immunizations
• 79.26 returned consent forms
• 23.7 chose not to participate
• Most because already immunized
• 94.7 received at least one dose
• 80.9 completed series (urban schools much lower)

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Research Design

• Retrospective
• Purposive sampling matching schools (7 each
  site)
• From each site 2 urban, 3 suburban, 1 rural and
  1 private
• Missing 1 private from KCKS, 1 suburban KCMO
• School immunization records
• random sample, up to 75 students in 9th, 11th,
  and 12th grades
• Data gathered in Oct 2002 and Apr 2003

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Results - Sample

• 3,498 records pulled in 17 schools two CASA
  results used in St. Louis schools
• 99.6 (3484) had a record for review

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Results MMR2

• KCMO 90.5
• KCKS 95.8
• STLMO 97.7
• MMR 2 laws at all three sites for all grades
• No statistical difference between sites

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Results HepB 3

• KCMO 49.9
• KCKS 28.0
• STLMO 60.6
• Compare Law (KCMO STLMO 55.7) vs no Law
  (KCKS 28.0) (p.005)
• Compare SB program (KCMO 49.9) vs no SB
  program (STLMO 30.3) - (p.36)

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Results Td (during shortage)

• KCMO 68.0
• KCKS 47.6
• STLMO 68.3
• Compare Law (KCMO STLMO 68.2) vs no Law
  (KCKS 47.6) (p.13)

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Results Varicella

• KCMO 1.2
• KCKS 1.4
• STLMO 1.1
• Limited information on having disease
• Expected non-immunity about 10
• Compare Law (KCMO STLMO) vs no Law (KCKS) no
  significant difference (p.96)

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Results Suburban vs Urban vs Rural
p lt 0.05 p lt .01
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Results Further analysis
p lt 0.05 p lt .01
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School-based Program
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Results School-based Program
p lt .01
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Percent of students on Free/Reduced Lunches

• High SES low percent on F/R lunches (lt10)
• Mod SES mod percent on F/R lunches (12 - 37)
• Low SES high percent on F/R lunches (gt60)

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SES and Immunization Rates
p lt 0.05 p lt .01
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Percent Minority Immunization Rates
p lt 0.05 p lt .01
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Conclusions

• Middle school immunization laws were effective at
  raising adolescent immunization rates for schools
  in the study.
• School-based immunization programs were effective
  for schools in the study, in absence of a law.
• The effects of a hepatitis B law on rates of
  other recommended vaccines were mixed.

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Conclusions continued

• Economic and/or racial immunization rate
  disparities continue into adolescence.

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Thank You!
Any questions??