title: Increasing influenza and pneumococcal immunization rates: a randomized controlled study of a senior center-based intervention.
abstract: BACKGROUND
  Immunizations decrease morbidity from influenza and pneumococcal infections. Immunization levels remain below desired levels despite clinic-based and public education efforts. This paper describes a randomized, controlled trial of a senior center-based program, which used peer-to-peer outreach to increase pneumococcal and influenza immunization rates among an urban senior population.
  
  
  METHODS
  Seniors were randomized to intervention or control groups. The intervention group received educational brochures mailed with reply cards to report immunization status, telephone calls from senior volunteers to unimmunized participants, and computerized immunization tracking. Immunization rates were obtained before and after the intervention by self-report.
  
  
  RESULTS
  Among participants without prior pneumococcal immunization, the pneumococcal immunization rate among the intervention group (52.0%; 95% CI = 46.6%-57.4%) was significantly higher than that of the control group (30.9%; 95% CI = 26.6%-35.2%) (rate ratio = 1.68; 95% CI = 1.40-2.03). Among those without influenza immunization in the prior year, significantly more (50.0%; 95% CI = 40.0%-60.0%) were immunized against influenza in the intervention group than in the control group (23.0%; 95% CI = 15.2%-33.3%) (rate ratio = 2.17; 95% CI = 1.42-3.31). Among those with influenza immunization in the prior year, the rate ratio was 1.04 (95% CI = 1.01-1.07).
  
  
  CONCLUSIONS
  The intervention increased both influenza and pneumococcal immunization rates to high levels, suggesting that further progress in increasing adult immunization coverage is possible.
authors.affiliation: Seattle Partners for Healthy Communities/Public Health, Seattle and King County, Washington 98104-4039, USA. james.krieger@metrokc.gov
authors.forename: J W
authors.initials: JW
authors.lastname: Krieger
authors.forename: J S
authors.initials: JS
authors.lastname: Castorina
authors.forename: M L
authors.initials: ML
authors.lastname: Walls
authors.forename: M R
authors.initials: MR
authors.lastname: Weaver
authors.forename: S
authors.initials: S
authors.lastname: Ciske
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001294:Attitude to Health; D001428:Bacterial Vaccines; D003153:Community Health Services / Q000458:organization & administration; D003365:Costs and Cost Analysis; D004522:Educational Status; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration*; D007182:Income; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control*; D014505:Urban Population; D014861:Washington
chemical_list: D001428:Bacterial Vaccines; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines