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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
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Impact on Health Department workload
Evaluation Foci Impact on Health Department workload Effectiveness of School-based programs Effectiveness of law
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Impact on Health Department Workload
1999 all 7th grade students required to have HBV Retrospective, statewide analysis MOHSAIC Health Dept survey’s
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Results of Study Statewide % in HBV immunizations given to year-olds Non-rural settings, total number of vaccines administered did NOT rise significantly
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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.
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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
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Overview 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
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Research Studies Conducted
Qualitative Evaluation Research Impact Assessment Descriptive Correlational Cost-effective Analysis
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Qualitative Study Findings
Organization Time Obtaining consent Educational opportunity School support Student tracking
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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
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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)
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Cost-effectiveness Analysis
Yearly program costs $81,972 - $142,485 Vaccine costs $247,051 – $304,276 Total administration cost/dose $ $5.06 Typical private office costs $15.00/dose Typical health department costs $5.62 $53 million of future costs avoided
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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
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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
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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
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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)
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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
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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
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