Advertisement

School-Located Influenza Vaccination With Third-Party Billing: What Do Parents Think?

      Abstract

      Objective

      School-located influenza vaccination (SLIV) may be instrumental in achieving high vaccination rates among children. Sustainability of SLIV programs may require third-party billing. This study assessed, among parents of elementary school students, the attitudes about SLIV and billing at school, as well as factors associated with being supportive of SLIV.

      Methods

      We conducted a survey (April 2010 to June 2010) of parents of 1000 randomly selected primarily low-income children at 20 elementary schools at which SLIV with billing had occurred.

      Results

      Response rate was 70% (n = 699). Eighty-one percent agreed (61% strongly) they “would be okay” with SLIV for their child. Many agreed it was better to get vaccinated at their child's doctor's office because they could take care of other health issues (72%) and the doctor knows the child's medical history (65%). However, an equal percentage (47%) thought the best place for influenza vaccination was the child's doctor's office and the child's school. Twenty-five percent did not want to give health insurance information necessary for billing at school. Factors independently associated with strongly supporting SLIV included parental education of high school or less (relative risk 1.30; 95% confidence interval 1.09–1.58), Hispanic ethnicity (1.25; 1.08–1.45); believing the vaccine is efficacious (1.49; 1.23–1.84); and finding school delivery more convenient (2.37; 1.82–3.45). Having concerns about the safety of influenza vaccine (0.80; 0.72–0.88) and not wanting their child to be vaccinated without a parent (0.74; 0.64–0.83) were negatively associated.

      Conclusions

      The majority of parents were supportive of SLIV, although parental concerns about not being present for vaccination and about the safety and efficacy of the vaccine will need to be addressed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008.
        MMWR Recomm Rep. 2008; 57: 1-60
        • Rand C.M.
        • Szilagyi P.G.
        • Yoo B.K.
        • et al.
        Additional visit burden for universal influenza vaccination of US school-aged children and adolescents.
        Arch Pediatr Adolesc Med. 2008; 162: 1048-1055
        • Allison M.A.
        • Reyes M.
        • Young P.
        • et al.
        Parental attitudes about influenza immunization and school-based immunization for school-aged children.
        Pediatr Infect Dis J. 2010; 29: 751-755
        • Christensen J.J.
        • Humiston S.G.
        • Long C.E.
        • et al.
        Assessing the acceptability and feasibility of a school-located influenza vaccination program with third-party billing in elementary schools.
        J Sch Nurs. 2012; 28: 344-351
        • Middleman A.B.
        • Short M.B.
        • Doak J.S.
        School-located influenza immunization programs: factors important to parents and students.
        Vaccine. 2012; 30: 4993-4999
      1. Centers for Disease Control and Prevention. Flu vaccination coverage, United States, 2011–12 influenza season. Available at: http://www.cdc.gov/flu/professionals/vaccination/coverage_1112estimates.htm. Accessed January 28, 2013.

        • Vogt T.M.
        • Wortley P.M.
        Epilogue: school-located influenza vaccination during the 2009–2010 pandemic and beyond.
        Pediatrics. 2012; 129: S107-S109
        • Cawley J.
        • Hull H.F.
        • Rousculp M.D.
        Strategies for implementing school-located influenza vaccination of children: a systematic literature review.
        J Sch Health. 2010; 80: 167-175
        • Loeb M.
        • Russell M.L.
        • Moss L.
        • et al.
        Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial.
        JAMA. 2010; 303: 943-950
        • Glezen W.P.
        Universal influenza vaccination and live attenuated influenza vaccination of children.
        Pediatr Infect Dis J. 2008; 27: S104-S109
        • Longini Jr., I.M.
        A theoretic framework to consider the effect of immunizing schoolchildren against influenza: implications for research.
        Pediatrics. 2012; 129: S63-S67
        • Schieber R.A.
        • Kennedy A.
        • Kahn E.B.
        Early experience conducting school-located vaccination programs for seasonal influenza.
        Pediatrics. 2012; 129: S68-S74
        • Carpenter L.R.
        • Lott J.
        • Lawson B.M.
        • et al.
        Mass distribution of free, intranasally administered influenza vaccine in a public school system.
        Pediatrics. 2007; 120: e172-e178
        • Effler P.V.
        • Chu C.
        • He H.
        • et al.
        Statewide school-located influenza vaccination program for children 5–13 years of age, Hawaii, USA.
        Emerg Infect Dis. 2010; 16: 244-250
        • King Jr., J.C.
        • Stoddard J.J.
        • Gaglani M.J.
        • et al.
        Effectiveness of school-based influenza vaccination.
        N Engl J Med. 2006; 355: 2523-2532
        • Piedra P.A.
        • Gaglani M.J.
        • Kozinetz C.A.
        • et al.
        Herd immunity in adults against influenza-related illnesses with use of the trivalent-live attenuated influenza vaccine (CAIV-T) in children.
        Vaccine. 2005; 23: 1540-1548
        • Monto A.S.
        • Davenport F.M.
        • Napier J.A.
        • Francis Jr., T.
        Modification of an outbreak of influenza in Tecumseh, Michigan by vaccination of schoolchildren.
        J Infect Dis. 1970; 122: 16-25
        • Kempe A.
        • Wortley P.
        • O’Leary S.
        • et al.
        Pediatricians’ attitudes about collaborations with other community vaccinators in the delivery of seasonal influenza vaccine.
        Acad Pediatr. 2012; 12: 26-35
        • McCormick E.V.
        • Durfee J.
        • Vogt T.M.
        • et al.
        Physician attitudes regarding school-located vaccinations.
        Pediatrics. 2012; 130: 887-896
        • Keane V.A.
        • Hudson A.R.
        • King Jr., J.C.
        Pediatrician attitudes concerning school-located vaccination clinics for seasonal influenza.
        Pediatrics. 2012; 129: S96-S100
        • Kelminson K.
        • Saville A.
        • Seewald L.
        • et al.
        Parental views of school-located delivery of adolescent vaccines.
        J Adolesc Health. 2012; 51: 190-196
      2. Centers for Disease Control and Prevention. Vaccines for Children Program (VFC). About VFC. Available at: http://www.cdc.gov/vaccines/programs/vfc/about/index.html. Accessed February 8, 2013.

        • Janz N.K.
        • Champion V.L.
        • Strecher V.J.
        The health belief model.
        in: Glanz K. Rimer B.K. Lewis F.M. Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. Jossey-Bass, San Francisco, Calif2002: 45-66
        • Kleinman L.C.
        • Norton E.C.
        What’s the risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression.
        Health Serv Res. 2009; 44: 288-302
        • Daley M.F.
        • Crane L.A.
        • Chandramouli V.
        • et al.
        Influenza among healthy young children: changes in parental attitudes and predictors of immunization during the 2003 to 2004 influenza season.
        Pediatrics. 2006; 117: e268-e277
        • Daley M.F.
        • Crane L.A.
        • Chandramouli V.
        • et al.
        Misperceptions about influenza vaccination among parents of healthy young children.
        Clin Pediatr (Phila). 2007; 46: 408-417
        • Nowalk M.P.
        • Zimmerman R.K.
        • Lin C.J.
        • et al.
        Parental perspectives on influenza immunization of children aged 6 to 23 months.
        Am J Prev Med. 2005; 29: 210-214
        • Zimmerman R.K.
        • Nowalk M.P.
        • Raymund M.
        • et al.
        Tailored interventions to increase influenza vaccination in neighborhood health centers serving the disadvantaged.
        Am J Public Health. 2003; 93: 1699-1705
        • Chi R.C.
        • Neuzil K.M.
        The association of sociodemographic factors and patient attitudes on influenza vaccination rates in older persons.
        Am J Med Sci. 2004; 327: 113-117
      3. Centers for Disease Control and Prevention. Reasons reported by Medicare beneficiaries for not receiving influenza and pneumococcal vaccinations—United States, 1996.
        MMWR Morb Mortal Wkly Rep. 1999; 48: 886-890
        • Gnanasekaran S.K.
        • Finkelstein J.A.
        • Hohman K.
        • et al.
        Parental perspectives on influenza vaccination among children with asthma.
        Public Health Rep. 2006; 121: 181-188
        • Clevenger L.M.
        • Pyrzanowski J.
        • Curtis C.R.
        • et al.
        Parents’ acceptance of adolescent immunizations outside of the traditional medical home.
        J Adolesc Health. 2011; 49: 133-140