title: Increasing childhood influenza vaccination: a cluster randomized trial.
abstract: BACKGROUND
  Since the 2008 inception of universal childhood influenza vaccination, national rates have risen more dramatically among younger children than older children and reported rates across racial/ethnic groups are inconsistent. Interventions may be needed to address age and racial disparities to achieve the recommended childhood influenza vaccination target of 70%.
  
  
  OBJECTIVE
  To evaluate an intervention to increase childhood influenza vaccination across age and racial groups.
  
  
  METHODS
  In 2011-2012, a total of 20 primary care practices treating children were randomly assigned to the intervention and control arms of a cluster randomized controlled trial to increase childhood influenza vaccination uptake using a toolkit and other strategies including early delivery of donated vaccine, in-service staff meetings, and publicity.
  
  
  RESULTS
  The average vaccination differences from pre-intervention to the intervention year were significantly larger in the intervention arm (n=10 practices) than the control arm (n=10 practices); for children aged 9-18 years (11.1 pct pts intervention vs 4.3 pct pts control, p<0.05); for non-white children (16.7 pct pts intervention vs 4.6 pct pts control, p<0.001); and overall (9.9 pct pts intervention vs 4.2 pct pts control, p<0.01). In multi-level modeling that accounted for person- and practice-level variables and the interactions among age, race, and intervention, the likelihood of vaccination increased with younger age group (6-23 months); white race; commercial insurance; the practice's pre-intervention vaccination rate; and being in the intervention arm. Estimates of the interaction terms indicated that the intervention increased the likelihood of vaccination for non-white children in all age groups and white children aged 9-18 years.
  
  
  CONCLUSIONS
  A multi-strategy intervention that includes a practice improvement toolkit can significantly improve influenza vaccination uptake across age and racial groups without targeting specific groups, especially in practices with large percentages of minority children.
authors.affiliation: Department of Family Medicine, Pittsburgh, Pennsylvania. Electronic address: tnowalk@pitt.edu.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.affiliation: Department of Family Medicine, Pittsburgh, Pennsylvania.
authors.forename: Chyongchiou Jeng
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Pittsburgh, Pennsylvania.
authors.forename: Kristin
authors.initials: K
authors.lastname: Hannibal
authors.affiliation: Department of Pediatrics, Pittsburgh, Pennsylvania.
authors.forename: Evelyn C
authors.initials: EC
authors.lastname: Reis
authors.affiliation: University of Pittsburgh School of Medicine Shadyside Family Health Center, Pittsburgh, Pennsylvania.
authors.forename: Gregory
authors.initials: G
authors.lastname: Gallik
authors.affiliation: Department of Family Medicine, Pittsburgh, Pennsylvania.
authors.forename: Krissy K
authors.initials: KK
authors.lastname: Moehling
authors.affiliation: Department of Family Medicine, Pittsburgh, Pennsylvania.
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Huang
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Allred
authors.affiliation: Children's Community Pediatrics, Pittsburgh, Pennsylvania.
authors.forename: David H
authors.initials: DH
authors.lastname: Wolfson
authors.affiliation: Department of Family Medicine, Pittsburgh, Pennsylvania.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D011320:Primary Health Care / Q000379:methods; D044469:Racial Groups / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines
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