Project 3: Investigating barriers to timely early childhood vaccination in Montana

项目 3：调查蒙大拿州及时进行幼儿疫苗接种的障碍

• 批准号: 10132362
• 负责人: Sophia Raff Newcomer
• 金额: $ 20.39万
• 依托单位: UNIVERSITY OF MONTANA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10132362
• 关键词: Address; Age; Area; Attitude; Censuses; Centers for Population Health; Cessation of life; Child; Childhood; Chronic; Clinic; Communities; Data; Disease; Dose; Education; Family Practice; Future; Geographic Distribution; Geography; Goals; Health; Health Resources; Healthy People 2020; Home; Hospitalization; Hot Spot; Immunization; Immunization Programs; Individual; Information Systems; Intervention; Life; Measles; Medical; Medically Underserved Area; Methods; Modeling; Montana; National Institute of Allergy and Infectious Disease; Parents; Perception; Pertussis; Population; Prevalence; Provider; Public Health; Records; Research; Risk Factors; Rural; Rural Population; Scanning; Series; Structure; Surveys; System; Testing; Time; Transportation; Vaccination; Vaccines; Visit; Work; base; disorder risk; early childhood; experience; improved; motivational enhancement therapy; novel; programs; provider factors; public health intervention; recruit; rural area; social media; tool; urban area; urban disparity; vaccine acceptance; vaccine hesitancy

Project Summary/Abstract Early childhood vaccinations are one of the most important public health interventions of the past century; however, vaccine coverage in the rural U.S. has lagged behind urban areas. Montana, a largely rural state, has suffered from persistently low vaccination rates and a resurgence of vaccine-preventable diseases among young children. There is currently a lack of evidence explaining Montana's low early childhood vaccination rates. Structural barriers may be a factor, including a high proportion of medically-underserved areas, transportation obstacles, and a lack of systems for reminding parents to return for additional vaccine doses. Our preliminary analyses suggest that parental vaccine hesitancy may also be on the rise in Montana, with an increasing number of parents choosing to delay or refuse vaccines for their children. To effectively target interventions to increase vaccination rates, there is a need to systematically distinguish how much of Montana's undervaccination problem is due to structural barriers versus parental vaccine hesitancy, and whether certain barriers are more common in certain areas of Montana. We will quantify the impact of structural barriers versus parental vaccine hesitancy barriers on Montana's low early childhood vaccination rates (Aim 1), identify factors associated with low vaccination rates in Montana, including whether specific barriers to vaccination are geographically clustered (Aim 2), and identify interventions to increase vaccination rates supported by the Montana medical community (Aim 3). These aims will be achieved through analysis of immunization records in Montana's centralized immunization information system for children ages 0-3 years who were born in Montana 2015-2017, and through a state-wide survey of pediatric and family medicine providers. The proposed work is fundamental to improving Montana's vaccine coverage because interventions to increase vaccine uptake differ based on the type of barrier being addressed. For example, structural barriers may be addressed by recruiting additional vaccine providers, implementing reminder/recall programs, or establishing vaccine clinics in non-traditional settings. In contrast, interventions to address vaccine hesitancy include motivational interviewing, parent education programs, and interactive social media tools. Based on our findings, we will pinpoint specific interventions to increase early childhood vaccine coverage in Montana, and we will submit a R01 application to the National Institutes of Allergy and Infectious Diseases to implement and test such interventions. This work is an important step toward eliminating national rural-urban disparities in early childhood vaccination rates.

项目摘要/摘要 幼儿疫苗接种是过去一个世纪最重要的公共卫生干预措施之一。 但是，美国农村的疫苗覆盖范围落后于城市地区。蒙大拿州，主要是农村国家， 遭受了持续低的疫苗接种率和可预防疫苗可预防疾病的复兴 年幼的孩子。目前缺乏解释蒙大拿州低幼儿疫苗接种的证据 费率。结构性障碍可能是一个因素，包括高部分医疗区域， 运输障碍，以及缺乏提醒父母返回额外疫苗剂量的系统。 我们的初步分析表明，父母疫苗犹豫也可能在蒙大拿州上升， 越来越多的父母选择延迟或拒绝给孩子的疫苗。有效靶向 提高疫苗接种率的干预措施，需要系统地区分多少 蒙大拿州的缺乏疫苗问题是由于结构性障碍与父母疫苗的犹豫以及 某些障碍在蒙大拿州的某些地区是否更常见。我们将量化 蒙大拿州低幼儿疫苗接种的结构性障碍与父母疫苗的犹豫障碍 费率（AIM 1），确定与蒙大拿州疫苗接种率低相关的因素，包括特定的 接种疫苗的障碍是地理上的（AIM 2），并确定增加疫苗接种的干预措施 蒙大拿州医学界支持的费率（AIM 3）。这些目标将通过分析 蒙大拿州的集中式免疫信息系统的免疫记录0-3岁儿童 他们出生于蒙大拿州2015-2017，并通过全州范围的小儿和家庭医学调查 提供者。拟议的工作对于改善蒙大拿州的疫苗承保范围至关重要，因为干预措施 为了增加疫苗的吸收，取决于所解决的障碍的类型。例如，结构障碍 可以通过招募其他疫苗提供者，实施提醒/召回计划或 在非传统环境中建立疫苗诊所。相反，解决疫苗犹豫的干预措施 包括动机访谈，父母教育计划和互动社交媒体工具。基于我们 调查结果，我们将确定特定的干预措施，以增加蒙大拿州的幼儿疫苗覆盖范围，并 我们将向美国国家过敏和传染病研究所提交R01申请，以实施和 测试此类干预措施。这项工作是消除国家农村城市差异的重要一步 幼儿疫苗接种率。