Applying Science to raising immunization coverage levels Robert R. B. Grenwelge, Jr. Public Health Advisor Houston Department of Health and Human Services

Program Goals 90% of our children are fully vaccinated by 24 months of age. Ensure each child receives all immunizations due at each provider visit ( no missed opportunities) Sustain success

Immunization Trends in Houston Historically immunization coverage levels have been low in Houston ( only 11% of children were appropriately immunized by 24 months of age) Measles outbreak of ’89 was among the worst in the nation Ten deaths were associated with the outbreak and total costs exceeded $8,000,000

Immunization Trends in Houston (continued) In response to 1991 results HDHHS implemented evening & weekend clinics HDHHS implemented “immunization only” clinics in non traditional locations 1994 CDC introduced the Vaccines For Children (VFC) Program

Estimated vaccination among children aged months with 4 DTP/DT, 3 Polio, & 1 Measles Houston’s Childhood Immunization Coverage Levels:

Reasons For Low Immunization Coverage Levels in Houston Immunization record fragmentation Poor parental appreciation of the need for immunization Complicated immunization schedule Failure by providers to use every opportunity to immunize

Key Strategies to Raise Immunization Coverage in Houston Implementation of the Houston - Harris County Immunization Registry Educating the community on the importance of timely immunization Promoting the Vaccines For Children (VFC) Program Expanding physician educational activities

Areas Targeted for an Applied Scientific Approach Cost effectiveness of Non-Traditional immunization only clinics Caregiver attitudes and profile for users of Non-Traditional immunization only clinics Caregiver driven development of an immunization marketing campaign Scientifically designed Strategic Plan for Immunization Registry design and roll-out Scientifically designed Strategic Plan for VFC recruitment

Development of an Immunization Marketing Campaign Selected Scientific Technologies Corporation (STC) as vendor Complete community-wide caregiver focus groups, surveys and other data collection techniques Gather information from the community as a whole and also for specific racial and ethnic groups Determine distinct characteristics of targeted audiences

Topics for Focus Group Discussions Caregiver knowledge and beliefs Behaviors and feelings associated with existing immunization services How caregivers remember when shots are due Barriers/reasons for not immunizing on-time Favored mediums and messages Suggestions to make it easy to immunize babies

Focus Group Sites Career Recovery Center (GED classes) Young Scholars Academy (daycare center) Vietnamese School Worthing High School (teen moms) Creative Children (daycare center) Chinese Community Center America’s Best (daycare center) Advance Head Start (two locations) HIS Place Choo Choo Train Academy (daycare center) Early Start (Head Start) Vietnamese Village (daycare/early learning center)

Focus Group Demographics Gender –373 females –27 males Highest Education –23 Elementary School –17 Junior High School –229 High School –5 Technical School –5 Some college –65 College degree –56 Unknown

Focus Group Demographics (cont.) Age group –39 Under Age 20 –26 Aged –59 Aged –66 Aged –192 Over age 35 Ethnic/Racial origin –206 African-American –156 Asian-American –32 Hispanic –6 Caucasion/White –18 Unknown

Focus Group Demographics (cont.) Family income level –36 Annual under 6,000 –14 Annual 6,000 – 9,999 –81 Annual 10,000 – 19,999 –62 Annual 20,000 – 29,999 –55 Annual 30,000 – 39,999 –65 Annual 40,000 or over –87 Unknown Moved in past year –207 Yes –193 No

Recommendations #1 - Shift the source of parental stimulus from keeping child on schedule from external to internal motivation Introduce pamphlets to prenatal clinics and Lamaze classes Target neighborhood billboards in African- American communities Target public transportation in Hispanic communities Target radio and TV ads toward Asian and African-American populations Create educational messages through hotline to all communities

Recommendation # 2 - Maximize parental perception of medical professional/doctor as the best source for immunization information Create a toolkit for providers to include: demographically appropriate posters for the population served, various educational brochures for waiting rooms as well as handouts for the provider

Recommendation # 3 - Specifically address Pockets of Need geographical areas Further investigate the needs of the northwest quadrant of Houston Conduct assertive and aggressive VFC recruitment Develop appropriate contacts to disseminate educational materials

Recommendation # 4 - Assist parents with following the schedule Maximize reminder/recall activities Develop plan for assertive and aggressive recruitment of provider practices in the Houston/Harris County Immunization Registry

Recommendation # 5 - Increase parental use of a medical home by increasing geographic availability with VFC providers Increase awareness and promote VFC services to parents Advertise VFC providers Add VFC provider locating information to HDHHS Web-site Create posters that name VFC providers