American Journal of Preventive Medicine
Volume 47, Issue 4, p375-530, e7-e10 October 2014
http://www.ajpmonline.org/current

Increasing Childhood Influenza Vaccination
A Cluster Randomized Trial
Mary Patricia Nowalk, PhD, RD, Chyongchiou Jeng Lin, PhD, Kristin Hannibal, MD, Evelyn C. Reis, MD, Gregory Gallik, DO, Krissy K. Moehling, MPH, Hsin-Hui Huang, MD, MPH, Norma J. Allred, PhD, David H. Wolfson, MD, Richard K. Zimmerman, MD, MPH, MA
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%.
Purpose
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.