Primary studies included in this systematic review

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Primary study

Unclassified

Effectiveness of state-level vaccination mandates: evidence from the varicella vaccine.

Authors Abrevaya J , Mulligan K
Journal Journal of health economics
Year 2011
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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This paper utilizes longitudinal data on varicella (chickenpox) immunizations in order to estimate the causal effects of state-level school-entry and daycare-entry immunization mandates within the United States. We find significant causal effects of mandates upon vaccination rates among preschool children aged 19-35 months; these effects appear in the year of mandate adoption, peak two years after adoption, and show a minimal difference from the aggregate trend about six years after adoption. For a mandate enacted in 2000, the model and estimates imply that roughly 20% of the short-run increase in state-level immunization rates was caused by the mandate introduction. We find no evidence of differential effects for different socioeconomic groups. Combined with previous cost-benefit analyses of the varicella vaccine, the estimates suggest that state-level mandates have been effective from an economic standpoint.

Primary study

Unclassified

Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population.

Authors Tarrant M , Thomson N
Journal Journal of paediatrics and child health
Year 2008
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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AIM: The aim of this study was to explore childhood immunisations with a sample of parents from a population where children have high vaccination coverage and to identify factors which might encourage uptake in other populations. METHODS: This research was conducted as part of a larger study on childhood immunisations in Hong Kong. In-depth interviews were conducted with a subsample of parents (n = 15) to further explore general perceptions and health beliefs about childhood immunisations. Interview data were analysed using content analysis techniques. RESULTS: Three core themes emerged from the data: individual influences factors, family and social factors, and system factors. [Correction added after online publication 21/8/08: sentence corrected from "Four core themes emerged from the data: individual influences, family influences and system influences."] Parents readily admitted knowledge deficits concerning childhood vaccines but believed that the benefits of immunisation outweighed the risks. Family members and peers were a source of pro-immunisation advice and comprehensive public health programmes and mandatory vaccination requirements for school entry ensured that childhood immunisation recommendations were followed. CONCLUSIONS: Overall, Hong Kong parents are highly supportive of immunisation programmes and insight gained from this study could prove helpful to providers trying to improve uptake rates among other populations.

Primary study

Unclassified

Increases in vaccination coverage for children in child care, 1997 to 2000: an evaluation of the impact of government incentives and initiatives.

Authors Bond L , Davie G , Carlin JB , Lester R , Nolan T
Journal Australian and New Zealand journal of public health
Year 2002
Links Pubmed

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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OBJECTIVE: To compare vaccination coverage of children in child care before (1997) and after (2000) implementation of government immunisation strategies including parent/providers incentives and surveillance of vaccination uptake. METHODS: Cross-sectional parent surveys of vaccination coverage for children (<3 years old regularly attending child care) in 47 child care centres and 19 councils operating family day care in metropolitan Melboume. RESULTS: Data were collected for 1,578 (72%) children in 1997 and 1,793 (72%) in 2000. In 2000, 93% were completely immunised, a 9% (95% CI 6%-11%, p<0.001) increase from 1997. Less than 1% of children were unimmunised (0.8% in 1997, 0.5% in 2000). For those >2 years, 94% were completely immunised before their second birthday in 2000 compared with 80% in 1997. Immunisation levels were 10% (95% Cl 6-12) higher in 2000 than in 1997 for those receiving child care benefits compared with a 7% (95% Cl 3-10) increase for families not receiving benefits. In 1997, 8 (17%) child care centres and 4 (21%) councils reported > or = 90% children completely immunised increasing to 33 (70%) and 16 (84%) in 2000 respectively. Fewer families reported delaying immunisations because of minor illness in 2000 (27%) compared to 1997 (44%, p<.001). Updating immunisation data by child care coordinators increased from 51% in 1997 to 98% in 2000. CONCLUSION: A substantial increase in immunisation uptake has been achieved for this population of young children attending child care. This study provides evidence that the increase in vaccination rates is attributable to some extent to increased surveillance of immunisation rates and both parent and provider incentives to immunise.

Primary study

Unclassified

Using stated preference discrete choice modelling to evaluate the introduction of varicella vaccination.

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Authors Hall J , Kenny P , King M , Louviere J , Viney R , Yeoh A
Journal Health economics
Year 2002
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Applications of stated preference discrete choice modelling (SPDCM) in health economics have been used to estimate consumer willingness to pay and to broaden the range of consequences considered in economic evaluation. This paper demonstrates how SPDCM can be used to predict participation rates, using the case of varicella (chickenpox) vaccination. Varicella vaccination may be cost effective compared to other public health programs, but this conclusion is sensitive to the proportion of the target population immunised. A choice experiment was conducted on a sample of Australian parents to predict uptake across a range of hypothetical programs. Immunisation rates would be increased by providing immunisation at no cost, by requiring it for school entry, by increasing immunisation rates in the community and decreasing the incidence of mild and severe side effects. There were two significant interactions; price modified the effect of both support from authorities and severe side effects. Country of birth was the only significant demographic characteristic. Depending on aspects of the immunisation program, the immunisation rates of children with Australian-born parents varied from 9% to 99% while for the children with parents born outside Australia they varied from 40% to 99%. This demonstrates how SPDCM can be used to understand the levels of attributes that will induce a change in the decision to immunise, the modification of the effect of one attribute by another, and subgroups in the population. Such insights can contribute to the optimal design and targeting of health programs.

Primary study

Unclassified

Effect of a monetary sanction on immunization rates of recipients of aid to families with dependent children.

blocked
Journal JAMA : the journal of the American Medical Association
Year 2000
Links Pubmed DOI www.cochranelibrary.com

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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CONTEXT: Immunization rates among low-income families have lagged behind those for the general community, with several possible barriers cited in the literature. OBJECTIVE: To evaluate the effect of an initiative aimed at improving immunization rates among low-income preschool children by imposing a sanction on families who failed to provide proof of up-to-date immunization status. DESIGN AND SETTING: Randomized, controlled before-after trial conducted from January 1, 1993, through December 31, 1996, in Muscogee County, Georgia. PARTICIPANTS: A total of 2500 families with children aged 6 years or younger who received Aid to Families with Dependent Children assistance. INTERVENTION: Families in the intervention group (n=1500) were informed that receipt of the welfare benefit for any preschool-aged children was contingent on provision of proof of up-to-date immunization status at the beginning of welfare eligibility and, subsequently, semiannually or annually. Case families in the control group (n=1000) were encouraged to immunize their preschool children but were not informed of any aid sanctions nor did such sanctions apply to them. MAIN OUTCOME MEASURE: Age-appropriate rates of 5 immunizations (measles-mumps-rubella; poliovirus; diphtheria and tetanus toxoids and pertussis; Haemophilus influenzae type b; and hepatitis B), based on examination (with family's written consent) of medical provider records, compared among intervention-group vs control-group families. RESULTS: There were no significant differences at baseline between intervention and control families in immunization rates of preschool children. Families in the intervention group were significantly more likely than families in the control group to have up-to-date immunization status in all 4 years of the study for all 5 immunizations (with 3 exceptions). At age 2 years, 72.4% of children in the intervention group vs 60.6% of those in the control group achieved vaccine series completion, which included 4 diphtheria and tetanus toxoids and pertussis, 3 poliovirus, and 1 measles-mumps-rubella (P<.001). Sanctions were implemented only 11 times. There was relatively little increased burden on the part of families to comply with requirements. CONCLUSION: In our study, a monetary sanction in a population receiving welfare benefits stimulated a significant increase in childhood immunization rates, suggesting that when welfare recipients are given an incentive to keep their children's immunizations up-to-date, most are able to do so. JAMA. 2000;284:53-59

Primary study

Unclassified

The effect of parental monetary sanctions on the vaccination status of young children: an evaluation of welfare reform in Maryland.

Journal Archives of pediatrics & adolescent medicine
Year 1999
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To determine whether financial sanctions to Aid to Families With Dependent Children (AFDC) recipients can be used to improve vaccination coverage of young children. DESIGN: Randomized controlled trial. SETTING: Six AFDC jurisdictions in Maryland. INTERVENTION: Recipients of AFDC were randomized to the experimental or control group of the Primary Prevention Initiative. Families in the experimental group were penalized financially for failing to verify that their children received preventive health care, including vaccinations; control families were not. PARTICIPANTS: Children aged 3 to 24 months from assigned families were randomly selected for the evaluation (911 in the experimental, 864 in the control, and 471 in the baseline groups). MAIN OUTCOME MEASURES: Up-to-date for age for diphtheria and tetanus toxoids and pertussis (DTP), polio, and measles-mumps-rubella (MMR) vaccines; missed opportunities to vaccinate; and number of visits per year. ANALYSIS: Comparisons among baseline and postimplementation years 1 and 2. RESULTS: Vaccination coverage of children was low. Less than 70% of children were up-to-date for age for polio and MMR vaccines; slightly more than 50% were up-to-date for DTP vaccine. Up-to-date rates differed little among baseline, experimental, and control groups. Over time, there was a decrease in missed opportunities, and more children made at least 1 well-child visit; however, neither improvement resulted in a change in vaccination status. CONCLUSIONS: The Primary Prevention Initiative did not contribute to an increase in vaccination coverage among these children. Minimal economic sanctions alone levied against parents should not be expected substantially to affect vaccination rates.

Primary study

Unclassified

Immunisation uptake, services required and government incentives for users of formal day care.

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Authors Bond L , Nolan T , Lester R
Journal Australian and New Zealand journal of public health
Year 1999
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVES: To determine immunisation uptake in children attending formal day care prior to the introduction of certificates (state) and parent incentives (federal), and to document parent and child carers' attitudes to these strategies. METHOD: In 1997, 60 child care centres and 300 family day carers in suburban Melbourne were randomly sampled. Immunisation dates, service use and preference, and views on government incentives were obtained from parents of children under three years of age. RESULTS: From 2,454 eligible children, information was obtained for 1,779, of whom 84% (95% CI 82-86) were completely immunised. Low income (OR 1.8, 95% CI 1.2-1.9, p < or = 0.001) and larger family size (OR 1.8, 95% CI 1.2-2.7, p = 0.002) and only ever using a doctor (OR 1.6, 95% CI 1.1-2.3) was associated with incomplete immunisation. Main reasons for delaying immunisation were occurrence of minor illness and work commitments. Families would prefer immunisation services at Maternal and Child Health visits (39%), evening sessions (22%) and at day care (22%). Immunisation uptake could increase to 94% if those receiving Childcare Assistance (67%) immunised their children on time but would increase to 87% if these incentive only motivated those for whom Childcare Assistance was essential (15%). While 98% of day care co-ordinators and 71% of family day care co-ordinators documented immunisation status at commencement of child care, only 51% and 33% respectively regularly updated this information. CONCLUSION: Providing client-focused, flexible immunisation services and government incentives and legislation may work together to boost immunisation levels for those in formal child care.

Primary study

Unclassified

Enforcement of age-appropriate immunization laws.

blocked
Authors Freed GL , Freeman VA , Mauskopf A
Journal American journal of preventive medicine
Year 1998
Links Pubmed

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: The state of North Carolina has statutes that require age-appropriate immunization as recommended by the U.S. Public Health Service. Provisions of this statute allow for criminal misdemeanor charges and injunctions to be brought against parents who do not have their children immunized on time. The decision to invoke the age-appropriate immunization statute rests with the health director of each county. This study was performed to determine if the county health directors were aware of this statute and whether they had ever utilized it to enforce age-appropriate immunization. METHODS: All health department directors in the state of North Carolina (N = 86) received letters inviting them to complete a 20-minute structured phone interview at a time of their convenience. Specific questions addressed their knowledge of the statutes and the specific penalties available. Additional questions addressed their attitudes and beliefs about the law and what they believed the state government could do to assist in enforcing the law. RESULTS: Interviews were completed for 75 of the 86 (87%) county health departments or districts. All respondents reported they were aware, prior to receiving the materials informing them of the study, that the state required children to be immunized on time. Over 95% reported they knew the law required age-appropriate immunization and 100% were aware of school/licensed day-care requirements. The vast majority (83%) of county health directors believe that criminal misdemeanor charges and injunctions should be brought against parents for failing to have their child age-appropriately immunized. However, only 5% (n = 4) of health directors reported that their county had ever brought criminal misdemeanor charges, and none had filed an injunction against a parent whose child was not immunized on time. CONCLUSIONS: Despite the presence of legal statutes, there have been only rare efforts to compel age-appropriate immunization through enactment and enforcement of criminal penalties on parents. Much of the hesitancy for such efforts likely comes from the fear of the confusing, hard-to-understand legal procedures and from the potential negative impact on public opinion that these tactics may create. Although such actions should be taken only as a last resort, they may be necessary on some occasions.

Primary study

Unclassified

. Maryland’s Primary Prevention Initiative Final Report

blocked
Report Primary Prevention Initiative Evaluation. Baltimore, MD: Schaefer Centre for Public Policy
Year 1997

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Primary study

Unclassified

Increasing the immunization of preschool children; an evaluation of applied community interventions.

blocked
Authors Yokley JM , Glenwick DS
Journal Journal of applied behavior analysis
Year 1985
Links Pubmed DOI PubMed Central

This article is included in 7 Systematic reviews Systematic reviews (7 references)

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We evaluated the relative impact of four procedures designed to encourage parents to obtain immunizations for their children. In a public health setting, the families of 1,133 immunization-deficient preschool children were randomly assigned to six conditions: (a) a general prompt; (b) a more client-specific prompt; (c) a specific prompt and increased public health clinic access; (d) a specific prompt and monetary incentives; (e) contact control; and (f) no contact control. All interventions, except the general prompt, produced some evidence of improvement when compared with the control groups. The monetary incentive group revealed the largest effect, followed by the increased access group, specific prompt group, and general prompt group, respectively. The data suggest that relatively powerful and immediate effects on preschoolers' clinic attendance for immunization may be produced by monetary incentives in conjunction with client-specific prompts. However, client-specific prompts alone appear to be the most cost-effective of the interventions.