An education in contrast: state-by-state assessment of school immunization records requirements

An Assessment of Horse-Drawn Vehicle Incidents from U.S. News Media Reports within AgInjuryNews

Some old-order Anabaptist communities rely on animal-drawn vehicles for transportation and farm work. This research examines reports involving horse-drawn vehicles found in the AgInjuryNews dataset, which provides a publicly accessible collection of agricultural injury reports primarily gathered from news media. The goals of this research are to characterize the reports and to compare results with previous research to assess the utility of using AgInjuryNews to examine horse-drawn vehicle incidents. A total of 38 reports representing 83 victims were identified. Chi-square tests comparing victim and incident traits for fatal and nonfatal injuries were significant for the victim’s role in the incident, vehicle type, presence of a motor vehicle, rear-ending by a motor vehicle, spooked horses, a victim being run over or struck by a vehicle, and a victim being ejected or falling from a vehicle. Additional analysis of incidents involving horse-drawn farm equipment showed that a significantly higher proportion of off-road incidents were fatal compared to on-road incidents. The proportion of fatal injuries in the AgInjuryNews dataset was approximately 10 times higher than observed in a study using Pennsylvania Department of Transportation (DOT) data. Compared to previous research, the AgInjuryNews reports contained a higher proportion of incidents where a motor vehicle rear-ended a horse-drawn vehicle, and fewer cases of horse-drawn vehicles being struck by motor vehicles while crossing or entering a main road and making left turns. Reports of buggy crashes found in AgInjuryNews differed from those found in a Nexis Uni search in that the bulk of the articles from Nexis Uni referred to cases involving criminal charges for impaired driving or hit-and-run crashes. While it is evident that the reports included in the sample are incidents that media sources find compelling rather than comprehensive injury surveillance, it is possible to gain new insights using the AgInjuryNews reports.

School staff as vaccine advocates: Perspectives on vaccine mandates and the student registration process

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school employees (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors.

High Deductible Health Plans and Use of Free Preventive Services Under the Affordable Care Act

The Affordable Care Act aimed to increase use of preventive services by eliminating cost-sharing to consumers. However, patients may be unaware of this benefit or they may not seek preventive services if they anticipate that the cost of potential diagnostic or treatment services will be too high, both more likely among those in high deductible health plans. We used nationally representative private health insurance claims (100% sample of IBM® MarketScan®) for the United States from 2006 to 2018, restricting the data to enrollment and claims for non-elderly adults who were enrolled for the full plan year. The cross-sectional sample (185 million person-years) is used to describe trends in preventive service use and costs from 2008 through 2016. The cohort sample (9 million people) focuses on the elimination of cost-sharing for certain high-value preventive services in late 2010, requiring continuous enrollment across 2010 and 2011. We examine whether HDHP enrollment is associated with use of eligible preventive services using semi-parametric difference-in-differences to account for endogenous plan selection. Our preferred model implies that HDHP enrollment was associated with a reduction of the post-ACA change in any use of eligible preventive services by 0.2 percentage points or 12.5%. Cancer screenings were unaffected but HDHP enrollment was associated with smaller increases in wellness visits, immunizations, and screening for chronic conditions and sexually transmitted infections. We also find that the policy was ineffective at reducing out-of-pocket costs for the eligible preventive services, likely due to implementation issues.

School staff and immunization governance: Missed opportunities for public health promotion

BACKGROUND

In US states, childhood immunization mandates are enforced for school registration by front-line school staff, usually secretaries. Despite substantial changes to mandate policies in several states and many countries, little attention has been paid to the people who enforce them. This qualitative pilot study aimed to uncover beliefs, attitudes, and practices regarding immunization governance of Michigan school staff.

METHOD

Front-line administrative workers from Michigan schools and district offices were solicited by email. Sixteen were interviewed remotely.

RESULTS

Front-line school staff believed in vaccines, but did not advocate for vaccination while registering children. Instead, they sought low-friction bureaucratic transactions, privileging the collection of data over the promotion of public health goals. This revealed a mismatch between the goals of the front-line staff who enforce vaccine mandates in schools and the goals of the policymakers who created school vaccine mandates.

CONCLUSIONS

This study found low mobilization of front-line enforcers of mandates in public-facing school administration roles, a problem likely to afflict the majority of American states with the 'mandates + exemptions' model of immunization governance. Schools would have stronger incentives to promote vaccination if state funding were better tied to immunization compliance. Front-line staff could better enforce vaccine mandates if they were provided with resources and training about vaccine promotion.

A Comprehensive Assessment Of Child Care Vaccination Laws Across The US

All fifty US states and Washington, D.C., require children from birth through age five to be vaccinated against certain communicable diseases as a condition of attending child care settings such as day care, Head Start, preschools, pre-kindergarten, and other early childhood programs. However, the nuances and implementation of these laws vary greatly across jurisdictions. To date, a comprehensive analysis of all child care vaccination laws in the US has not been performed. We have developed the first compilation of child care vaccination laws across the US. This compilation is the culmination of an exhaustive examination of multiple components of the laws, such as which vaccines are required, provisions that enable unvaccinated children to temporarily attend child care until they are fully vaccinated, attendance provisions for unvaccinated students during an outbreak, methods of enforcement of vaccination policy, and child care personnel vaccination requirements. This comprehensive analysis provides a critical and foundational framework to inform policy makers and public health professionals involved in policy planning and implementation and policy research. It provides a benchmark for further evaluation of existing and future vaccination laws and their impact on vaccine coverage rates.