Kristin S. Hendrix

The Role of Herd Immunity in Parents’ Decision to Vaccinate Children: A Systematic Review

BACKGROUND AND OBJECTIVE: Herd immunity is an important benefit of childhood immunization, but it is unknown if the concept of benefit to others influences parents’ decisions to immunize their children. Our objective was to determine if the concept of “benefit to others” has been found in the literature to influence parents’ motivation for childhood immunization. METHODS: We systematically searched Medline through October 2010 for articles on parental/guardian decision-making regarding child immunization. Studies were included if they presented original work, elicited responses from parents/guardians of children <18 years old, and addressed vaccinating children for the benefit of others. RESULTS: The search yielded 5876 titles; 91 articles were identified for full review. Twenty-nine studies met inclusion criteria. Seventeen studies identified benefit to others as 1 among several motivating factors for immunization by using interviews or focus groups. Nine studies included the concept of benefit to others in surveys but did not rank its relative importance. In 3 studies, the importance of benefit to others was ranked relative to other motivating factors. One to six percent of parents ranked benefit to others as their primary reason to vaccinate their children, and 37% of parents ranked benefit to others as their second most important factor in decision-making. CONCLUSIONS: There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator is largely unknown. Further work is needed to explore this concept as a possible motivational tool for increasing childhood immunization uptake.

An Emerging Field of Research Challenges in Pediatric Decision Making

There is growing interest in pediatric decision science, spurred by policies advocating for children’s involvement in medical decision making. Challenges specific to pediatric decision research include the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this article are to describe each of these challenges, to provide decision researchers with insight into pediatric decision making, and to establish a blueprint for future research that will contribute to high-quality pediatric medical decision making. Much work has been done to address gaps in pediatric decision science, but substantial work remains. Understanding and addressing the challenges that exist in pediatric decision making may foster medical decision-making science across the age spectrum.

Bullying Behavior by Athletic Coaches

A parent recently sought help addressing an individual bullying her child. When she provided more details, it became apparent the bully was not another student, but rather a high school basketball coach. One afternoon, the mother was early picking up her daughter from practice, so she went into the gym. She found the head coach screaming at the team that they lacked intelligence and were lazy because they had not executed a play properly. Horrified by this behavior, the mother waited until practice was over, then confronted the coach, telling him what she had observed and how upset she was by the screaming and name-calling. The coach responded by refocusing the conversation on the mother’s own transgression: parents knew that no one was allowed in the gym during practice “for safety reasons.” The mother felt as though she had to defend her own behavior. After the incident, she began asking around and discovered this coach had a long history of intimidating his athletes. She was not just witnessing a “bad day,” so she reported her concerns to the school and, again, was confused by the response. The principal told her he had spoken to the coach and the coach had apologized. He explained that the coach was very successful and won a state title last year, but sometimes got “overexcited.” Confused and angered by the school’s and coach’s reactions, she went to her pediatrician for advice. Although the study of bullying has made considerable strides over the last 2 decades, the definition remains vague. Bullying is generally defined as a systematic abuse of power, … Address correspondence to Nancy L. Swigonski, MD, MPH, Children’s Health Services Research, Indiana University School of Medicine, 410 W 10th St, HS Suite 1000, Indianapolis, IN 46202. E-mail: nswigons{at}iupui.edu

Screen Exposure and Body Mass Index Status in 2- to 11-Year-Old Children

Objective. To measure the relationship between screen exposure and obesity in a large, urban sample of children and to examine whether the relationship is moderated by sociodemographics. Methods. We asked parents of 11 141 children visiting general pediatrics clinics if the child had a television (TV) in the bedroom and/or watched more than 2 hours of TV/computer daily. We measured children’s height and weight, then used logistic regression to determine whether screen exposure indicators predicted obesity (body mass index ≥85th percentile) and interacted with race/ethnicity, sex, age, and health care payer. Results. Having a TV in the bedroom predicted obesity risk (P = .01); however, watching TV/computer for more than 2 hours a day did not (P = 0.54). There were no interactions. Conclusions. Asking whether a child has a TV in the bedroom may be more important than asking about duration of screen exposure to predict risk for obesity.

Predictors of influenza vaccination in the U.S. among children 9–13 years of age

BACKGROUND AND OBJECTIVES U.S. estimates of seasonal influenza (flu) vaccine uptake in 2014-2015 were 62% for 5-12year olds, dropping to 47% for 13-17year olds. The Healthy People 2020 goal for these age groups is 80%. It is important to understand factors associated with influenza vaccination, especially for those ages where rates begin to decline. The objective of this study was to identify factors associated with influenza vaccination acceptance in 9-13year old children. METHODS An online U.S. survey of mothers of children aged 9-13 assessed childrens influenza vaccine uptake in the previous season, healthcare utilization, sociodemographics, and vaccine attitudes. Multivariable logistic regression identified independent predictors of influenza vaccine status. RESULTS There were 2363 respondents (Mean age=38years old). Referent children were 57% female and 66% non-minority race/ethnicity with a mean age of 10.6years. By maternal report, 59% of children had received an influenza vaccine in the previous season. Predictors of influenza vaccine uptake included a recommendation or strong recommendation from a health care provider, seeing a health care provider in the past year, positive attitudes regarding the influenza vaccine, and being a minority race. Child gender, age, insurance coverage, and whether the child had a regular healthcare provider were not associated with influenza vaccine uptake (p=n.s.). CONCLUSIONS This sample reported overall rates of influenza vaccine uptake similar to national surveillance data, but still lower than national goals. Provider recommendations along with health attitudes and seeing a health care provider were associated with vaccine uptake. Promising interventions may include more directive physician messaging for influenza vaccine uptake in youth, encouraging more regular well-child visits during the adolescent years, and promoting influenza vaccination at alternative sites.

POINT: Should Childhood Vaccination Against Measles Be a Mandatory Requirement for Attending School? Yes

A measles outbreak linked to California’s Disneyland has led to > 300 cases in at least seven states, Mexico, and Canada through March 2015. Most cases occurred in people choosing to forego vaccination.1,2 The costs associated with this outbreak exceed those borne by individuals opting out of vaccination: > 10% of the California cases occurred in children too young to be vaccinated, schools and daycares were forced either to close or to enforce policies excluding unvaccinated and vulnerable children for multiple weeks, and health departments spent scores of personnel hours—and hundreds of thousands of dollars from limited budgets—containing the spread of this vaccine-preventable illness.1,2

Trends in Use and Cost of Second-Generation Antipsychotics Among Children and Teens in Indiana Medicaid, 2004-2012.

OBJECTIVE To replicate and extend a study by the Agency for Healthcare Research and Quality (AHRQ) and Rutgers on antipsychotic use among youths in Medicaid, the authors analyzed Indiana Medicaid claims from 2004 to 2012, extending the earlier study by focusing on second-generation antipsychotics, including both fee-for-service (FFS) and non-FFS patients, and analyzing cost trends. METHODS The authors evaluated the impact of several Indiana Medicaid policy changes on medication utilization and cost among children enrolled for at least one month during 2004-2012 (N=683,716-793,637), using an exhaustive antipsychotic list to search the database. RESULTS Annual utilization rates for antipsychotics were 2%-3% but were much higher among foster children (10%-15%). Policies implemented in 2007 or later were associated with a significant plateauing of utilization in 2008-2012. CONCLUSIONS Growth of second-generation antipsychotic utilization and costs was similar to trends described in the AHRQ-Rutgers study. Several containment strategies appeared effective in addressing these trends.

Effect of an annual benefit limit on adult dental expenditure and utilization: A cross-sectional analysis

OBJECTIVES Despite widespread use of dental benefit limits in terms of the types of services provided, an annual maximum on claims, or both, there is a dearth of literature examining their impact on either cost to the insurer or health outcomes. This study uses a natural experiment to examine dental care utilization and expenditure changes following Indiana Medicaids introduction of a

Psychological and neuropsychological assessment in the juvenile justice system: recommendations for protocols

600 individual annual limit on adult dental expenditure in 2003. METHODS In a before and after comparison, we use two separate cross-sections of paid claims for 96+ percent of the Medicaid adult population. Paid claims were available as a per-member-per-year (PMPY) figure. RESULTS Between 2002 and 2007, the eligible population decreased 3 percent (from 323,209 to 313,623), yet the number of people receiving any dental services increased 60 percent and total Medicaid dental claims increased 18 percent (from

General practice web-based decision aid improves MMR vaccination uptake

34.1 million to