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

Peter G Szilagyi; Stanley Schaffer; Cynthia M Rand; Nicolas P N Goldstein; Phyllis Vincelli; A Dirk Hightower; Mary Younge; Ashley Eagan; Aaron Blumkin; Christina S Albertin; Kristine DiBitetto; Byung-Kwang Yoo; Sharon G Humiston

doi:10.1016/j.jadohealth.2017.09.021

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

J Adolesc Health. 2018 Feb;62(2):157-163. doi: 10.1016/j.jadohealth.2017.09.021. Epub 2017 Dec 13.

Affiliations

¹ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, California. Electronic address: pszilagyi@mednet.ucla.edu.
² Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York.
³ Department of Clinical and Social Psychology, University of Rochester Children's Institute, Rochester, New York.
⁴ Department of Public Health, Monroe County, Rochester, New York.
⁵ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, California.
⁶ Department of Public Health Sciences, University of California at Davis, Davis, California.
⁷ Department of Pediatrics, Children's Mercy, Kansas City, Missouri.

PMID: 29248390
DOI: 10.1016/j.jadohealth.2017.09.021

Abstract

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.

Trial registration: ClinicalTrials.gov NCT02227186.

Keywords: Adolescents; High school; Immunization rates; Influenza; Influenza vaccinations; Middle school; School health.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Humans
Immunization Programs / organization & administration*
Influenza Vaccines / administration & dosage*
School Health Services*
Vaccination / statistics & numerical data*

Substances

Influenza Vaccines

Associated data

ClinicalTrials.gov/NCT02227186

Grants and funding

R18 HS021163/HS/AHRQ HHS/United States