There is a critical need to better control the current burden of influenza. Despite the availability of vaccines and vaccination strategies targeted to those most at risk of complications from the disease, approximately 36,000 deaths and more than 200,000 hospitalizations occur annually. This proposal addresses two potential delivery systems for a new control strategy currently under consideration by national policy makers for annual vaccination of all school children. Specifically, we will determine whether vaccinating adolescents at school as compared to their usual source of medical care (i.e., doctor's office or health department clinic) leads to higher immunization coverage. The focus on adolescents is particularly important because many do not make the recommended preventive care visits, and determining the best means of reaching them for vaccination has relevance for a number of new vaccines recommended for this age group. We will conduct a three- armed controlled trial using a systematic replication design to compare influenza vaccination rates in three racially diverse rural counties of southeast Georgia, specifically, Warren, Lincoln and Jenkins counties. In Lincoln and Warren counties we will implement two cycles of the multicomponent interventions designed to motivate parents and adolescents to be vaccinated and distribute vouchers for free vaccine. In Warren County (N=437 middle- and high-school students), we also will conduct vaccination clinics in the school. In contrast, in Lincoln County (N = 783), we will ask parents to take their child, along with the voucher, to their usual source of care where vaccine will be provided, free. Providers will also be reimbursed for vaccine administration at the Medicare fee, $17.05 per dose. Jenkins (N = 869) will serve as a control county where we will implement no intervention. As a secondary outcome we will assess the delivery of other recommended preventive health services to determine whether bringing adolescents to their usual source of medical care for vaccination (provider-based intervention) can improve the overall delivery of preventive healthcare compared to the school-based intervention and the control condition. Other outcomes will include the effect of the two interventions on mediators of vaccine acceptance. Findings from this study could have important health policy implications, laying the foundation for recommendations on how best to implement a universal influenza vaccination strategy of adolescents.
