Evaluating Middle School Immunization Laws and School-based Immunization Programs National Hepatitis Coordinators’ Conference 2003 Thanks for having me! Thad Wilson, RN, Phd University of Missouri-Kansas City Mid America Immunization Coalition

Impact on Health Department workload Evaluation Foci Impact on Health Department workload Effectiveness of School-based programs Effectiveness of law

Impact on Health Department Workload 1999 all 7th grade students required to have HBV Retrospective, statewide analysis MOHSAIC Health Dept survey’s

Results of Study Statewide - +375% in HBV immunizations given to 10-14-year-olds Non-rural settings, total number of vaccines administered did NOT rise significantly

Results of Study Health departments that used “out of office” alternative strategies (school-based, mall, etc) in both 1998 and 1999 had the least change.

Overview of Kansas City Metropolitan Program 1997 - 2000 16 – 23 School Districts 1 – 30 private schools 106 – 195 school buildings Two states 4 – 6 Health Departments 7 – 13 volunteer organizations or agencies

Overview 1997 - 2000 46, 749 students have been 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

Research Studies Conducted Qualitative Evaluation Research Impact Assessment Descriptive Correlational Cost-effective Analysis

Qualitative Study Findings Organization Time Obtaining consent Educational opportunity School support Student tracking

Impact Assessment Immunization rates rose from 8% to 80% 9.9 immunizations per hour of school personnel 8.9 immunizations per hour of health department personnel Hepatitis B incidence in KC – unchanged

Descriptive Correlational Income – high and low don’t participate Race – non-white have lower participation rates Location of school – urban schools had significantly lower participation rate (.58) than suburban schools (.90)

Cost-effectiveness Analysis Yearly program costs $81,972 - $142,485 Vaccine costs $247,051 – $304,276 Total administration cost/dose $3.28 - $5.06 Typical private office costs $15.00/dose Typical health department costs $5.62 $53 million of future costs avoided

Effectiveness of Law – Pilot Study Retrospective, school-base, random, student immunization record review School nurse survey Two urban high schools, 3 suburban & 4 rural middle schools Each group in single district

Preliminary Results Urban High School – 10% UTD Td (shortage) 1300+ students School-based HBV programs as 6th graders NO 7th grade entry requirement Sample 50 juniors and 50 seniors 10% UTD Td (shortage) 82% UTD MMR 8% UTD HBV

Preliminary Results Suburban Middle Schools – all had school-based programs in previous year 1.3% exemption 100% tetanus and MMR 61% - 91% HBV, mean 73.5% 0% varicella

Preliminary Results Rural Middle Schools – no school-based programs 1.7% exemption 100% tetanus and MMR 50% - 90% HBV, mean 61% (2.7% exemption) 0% varicella 0% - 40% HepA (recent outbreak in one area)

Interesting Tib-Bits Suburban middle school School nurse vocally against HBV Almost 5% exemption for HBV Suburban school districts with strong leadership and a nurse in each school <1% exemption 98% HBV

Conclusions School entry laws School-based programs Effective – exemptions, school compliance in urban settings problematic School-based programs Effective, cost effective Urban settings still problematic