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

项目总结/摘要 儿童早期接种疫苗是上世纪最重要的公共卫生干预措施之一; 然而，美国农村地区的疫苗覆盖率落后于城市地区。蒙大拿州是一个以农业为主的州， 由于疫苗接种率持续偏低， 年幼的孩子。目前还缺乏证据来解释蒙大拿州儿童早期疫苗接种率低的原因 rates.结构性障碍可能是一个因素，包括医疗服务不足地区的比例很高， 运输障碍，以及缺乏提醒父母返回接种额外疫苗的系统。 我们的初步分析表明，在蒙大拿州，父母对疫苗的犹豫也可能在增加， 越来越多的父母选择推迟或拒绝为孩子接种疫苗。有效地瞄准 为了提高疫苗接种率，有必要系统地区分 蒙大拿州的疫苗接种不足问题是由于结构性障碍与父母的疫苗犹豫， 在蒙大拿州的某些地区，某些障碍是否更常见。我们将量化 蒙大拿州早期儿童疫苗接种率低的结构性障碍与父母疫苗犹豫障碍 率（目标1），确定与蒙大拿州疫苗接种率低相关的因素，包括是否特定 疫苗接种的障碍在地理上是聚集的（目标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（目标3）。这些目标将通过分析 蒙大拿州0-3岁儿童集中免疫信息系统中的免疫记录 2015-2017年出生于蒙大拿州的儿童，通过全州范围内的儿科和家庭医学调查， 提供商这项拟议中的工作对提高蒙大拿州的疫苗覆盖率至关重要，因为干预措施 增加疫苗摄取的方法因所处理的障碍类型而异。例如，结构性障碍 可以通过招募额外的疫苗提供者，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、家长教育计划和互动社交媒体工具。基于我们 研究结果，我们将确定具体的干预措施，以增加蒙大拿州的幼儿疫苗覆盖率， 我们将向国家过敏和传染病研究所提交R 01申请， 测试这些干预措施。这项工作是消除全国城乡差距的重要一步， 儿童早期疫苗接种率。

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.