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J Adolesc Health. 2005 Jul;37(1):61-8.

An evaluation of school-level factors used in a successful school-based hepatitis B immunization initiative.

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Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.



To examine the effect of different school-level factors on the percent return of consent or refusal forms, the percent student participation/enrollment rate, and the percent completion rate of all 3 immunizations in the vaccination series in a school-based hepatitis B immunization initiative.


The Houston Hepatitis B Immunization Initiative (HBII) was conducted from 1998 through 2001 to provide free hepatitis B immunizations to elementary school students in low socioeconomic areas. At the end of each academic school year, the nurse from each school participating in the initiative was asked to complete a survey evaluating the different strategies utilized in each school to aid in the program's success. The effect of different organizational methods on rate of return of consent/refusal forms, participation rates, and immunization completion rates from the program year 1999-2000 was determined using frequencies, Mann-Whitney analyses, Kruskal-Wallis analyses, and Spearman's correlations.


An increase in percent return of signed consent/refusal forms was more likely when teachers helped in publicity/promotion (p = .012) and educational packet distribution (p = .041). Additionally, when teachers assumed responsibility for collecting the forms, the percent return of signed consent/refusal forms (p = .018) and the percent of students receiving all 3 vaccines in the series through HBII (p = .030) were more likely to increase. An increase in signed consent/refusal forms returned was also associated with increased rates of student participation in the program for each school. In schools where students helped specifically with educational packet distribution (p = .039), the percent of students receiving at least 1 vaccine dose from the program was more likely to be higher.


The involvement of teachers in vaccination programs is very important for program success, especially in the enrollment and return of consent/refusal form phases of immunization initiatives. Student involvement may empower the students and encourage other students to participate in the program. Future school-based immunization initiatives can utilize these data to incorporate the most effective school-level factors into their programs to maximize the number of students immunized.

[Indexed for MEDLINE]

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