Incentives and motivators in school-based hepatitis B vaccination programs.

During a school-based vaccination program, incentives and education were offered to help motivate students to participate. Each student at all schools in the program received scholastic credit for returning a signed form, material rewards for receiving each vaccine dose, and free attendance at a social event after completing the vaccine series. In two of four schools, classes received a reward if every student in the classroom returned a signed form within five days: in these schools, 91% and 98% of students returned signed forms within five days, compared to 82% and 85%, respectively, in the two schools without this peer incentive. Approximately half the students receiving the peer incentive reported that it played a motivating role, whereas 60% cited wanting to be protected. Few students named individual rewards as motivators. Although peer incentives appeared effective in encouraging some students to return parent consent or refusal forms, the desire to be protected may have been a stronger motivator.

Immunizations from ground zero: lessons learned in urban middle schools.

The Centers for Disease Control and Prevention funded a three-year demonstration project in San Francisco to assess the feasibility of a large-scale school-based vaccination effort. The project overcame a number of barriers, including lack of pre-existing health services, diversity of home languages, and an every-50-minute-bell schedule. The project targeted seventh graders and all special education students for hepatitis B vaccine (HBVac). Of 4,928 students targeted, 3,509 (71%) consented to vaccination and received the first dose. Of these 3,509 students, 3,256 (93%) completed the three-dose series at school. Key lessons learned include emphasizing a collaborative process in the planning stage, offering an educational component for students, providing an incentive to get timely parental consent, planning distribution and collection of parent materials, and planning vaccination clinics to minimize interrupting the school day. The project clearly demonstrated that, with sufficient attention to political and logistical dimensions, school-based vaccination programs are possible in large urban schools.

Parents' attitudes toward school-based hepatitis B vaccination of their children.

OBJECTIVE: As part of a larger hepatitis B vaccination program in San Francisco, hepatitis B vaccine is offered to seventh-grade students in selected middle schools. We investigated attitudes and beliefs about hepatitis B, hepatitis B vaccine, and school-based vaccination among parents of eligible students. METHODS: A survey was conducted of random samples of parents who consented, refused, or did not respond to a request for vaccination consent. RESULTS: A larger proportion of persons who signed a vaccination consent or refusal form were biological parents and were Asian or white than parents who did not return a signed form. The most common reason for refusing vaccination, given by 84% of refusing parents, was that their children had already been vaccinated against hepatitis B. These parents recognized the severity and duration of hepatitis B virus infection as much as parents consenting to vaccination. About one third of parents who refused vaccination did not agree that schools were good places to vaccinate children. Overall, 116 parents (40%) consulted someone before deciding to consent or refuse; 95 (33%) spoke with a health professional. Most parents not returning signed consent or refusal forms reported that they never received forms from their children or that they returned signed forms to their children, who never delivered them to school. CONCLUSIONS: Most parents accepted school-based vaccination, and obtaining parental consent for school-based vaccination was possible. Nonetheless, new approaches may be needed for those students and parents who do not comply with the consent process.