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Correira JW, Pettigrew SM, Kamstra R, Megyeri PR, Silverstein GJ, Kambrich S, Ma J, Doll MK. Exploring the impact of the New York State repeal of nonmedical vaccination exemptions on student enrollment, absenteeism, and school workload: Perspectives from a survey of school administrators. Hum Vaccin Immunother 2023; 19:2261176. [PMID: 37750393 PMCID: PMC10524776 DOI: 10.1080/21645515.2023.2261176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
In June 2019, New York State (NYS) adopted Senate Bill 2994A eliminating nonmedical vaccine exemptions from school entry laws. Since student noncompliance with the law required school exclusion, we sought to evaluate the law's effects on student enrollment and absenteeism, and school workloads related to its implementation. In November 2019, we sent an electronic survey to NYS (excluding New York City) schools. Due to the COVID-19 pandemic, outreach was curtailed in March 2020 with 525 (14%) of 3,759 eligible schools responding. To account for non-response, results were analyzed using inverse probability weighting. After weighting, 39% (95% CI: 34%, 44%) of schools reported enrollment changes and 31% (95% CI: 26%, 36%) of schools reported absenteeism related to the law. In addition, 95% (95% CI: 93%, 98%) of schools reported holding meetings and/or preparing correspondence about the law, spending a mean of 14 (95% CI: 11, 18) hours on these communication efforts. Schools in the highest pre-mandate nonmedical exemption tertile (vs. lowest) were more likely to report enrollment and absenteeism changes, and higher workloads. While our results should be interpreted with caution, changes in student enrollment, absenteeism, and school workloads may represent important considerations for policymakers planning similar legislation.
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Affiliation(s)
- John W. Correira
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | - Stacy M. Pettigrew
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | | | - Perrie Rose Megyeri
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | - Gabriel J. Silverstein
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | | | - Julia Ma
- Precision Analytics, Montreal, Quebec, Canada
| | - Margaret K. Doll
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
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Doll MK, Pettigrew SM, Ma J, Verma A. Effects of Confounding Bias in Coronavirus Disease 2019 (COVID-19) and Influenza Vaccine Effectiveness Test-Negative Designs Due to Correlated Influenza and COVID-19 Vaccination Behaviors. Clin Infect Dis 2022; 75:e564-e571. [PMID: 35325923 PMCID: PMC9129127 DOI: 10.1093/cid/ciac234] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The test-negative design is commonly used to estimate influenza and coronavirus disease 2019 (COVID-19) vaccine effectiveness (VE). In these studies, correlated COVID-19 and influenza vaccine behaviors may introduce a confounding bias where controls are included with the other vaccine-preventable acute respiratory illness (ARI). We quantified the impact of this bias on VE estimates in studies where this bias is not addressed. METHODS We simulated study populations under varying vaccination probabilities, COVID-19 VE, influenza VE, and proportions of controls included with the other vaccine-preventable ARI. Mean bias was calculated as the difference between estimated and true VE. Absolute mean bias in VE estimates was classified as low (<10%), moderate (10% to <20%), and high (≥20%). RESULTS Where vaccination probabilities are positively correlated, COVID-19 and influenza VE test-negative studies with influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ARI controls, respectively, underestimate VE. For COVID-19 VE studies, mean bias was low for all scenarios where influenza represented ≤25% of controls. For influenza VE studies, mean bias was low for all scenarios where SARS-CoV-2 represented ≤10% of controls. Although bias was driven by the conditional probability of vaccination, low VE of the vaccine of interest and high VE of the confounding vaccine increase its magnitude. CONCLUSIONS Where a low percentage of controls is included with the other vaccine-preventable ARI, bias in COVID-19 and influenza VE estimates is low. However, influenza VE estimates are likely more susceptible to bias. Researchers should consider potential bias and its implications in their respective study settings to make informed methodological decisions in test-negative VE studies.
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Affiliation(s)
- Margaret K Doll
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Stacy M Pettigrew
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Julia Ma
- Precision Analytics, Montreal, Quebec, Canada
| | - Aman Verma
- Precision Analytics, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Pettigrew SM, Pan WK, Berky A, Harrington J, Bobb JF, Feingold BJ. In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. Sci Total Environ 2019; 687:1046-1054. [PMID: 31412442 DOI: 10.1016/j.scitotenv.2019.05.484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 06/10/2023]
Abstract
Road development has been a major driver of the transition from traditional to calorie-dense processed 'Western' diets in lower and middle-income countries. The paving of the Interoceanic Highway (IOH) facilitated rapid development to the Madre de Dios (MDD) region in the Peruvian Amazon. As traditional foods such as Brazil nuts and fish are known to be rich in the essential micronutrient selenium, people further along the nutrition transition to a Western diet may have lower selenium (Se) intake. To test this hypothesis, in 2014 the Investigacion de Migracion, Ambiente, y Salud (IMAS Study) (Migration, Environment, and Health Study) collected household surveys from 310 households in 46 communities along the IOH and nails for Se analysis from 418 adults. Principal component analysis of 25 commonly consumed food items identified a factor resembling Western diet, which was used to calculate household Western diet weighted sum factor scores (WSFS). WSFS means were interpolated into a 10 km buffer around the IOH using inverse distance weighting. Western diet adoption was higher in urban compared to rural areas (p < 0.0001), and geographic variation was observed between mining and agricultural areas. Mean nail Se was 730 ng/g, SD 198 ng/g (range: 200-1390 ng/g). Generalized estimating equation (GEE) models assessed the association between food consumption and nail Se. Household chicken consumption was positively associated with Se in rural areas only. Urban/rural status modified the effect of western diet adoption on nail Se, and Se was inversely associated with WSFS in urban areas only. Conclusion: In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. As the essential micronutrient selenium is a vital part of antioxidant proteins, lower intake could compound the chronic health effects that may result from transition to a calorie-dense diet.
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Affiliation(s)
- Stacy M Pettigrew
- Department of Environmental Health Sciences, State University of New York at Albany, School of Public Health, 1 University Place, Rensselaer, NY 12144, United States of America
| | - William K Pan
- Global Health Institute, Duke University, Durham, NC 27710, USA; Nicholas School of the Environment, Duke University, Durham, NC 27710, USA
| | - Axel Berky
- Nicholas School of the Environment, Duke University, Durham, NC 27710, USA
| | - James Harrington
- Analytical Sciences Department, Research Triangle Institute, East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194, United States of America
| | - Jennifer F Bobb
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, #1600, Seattle, WA 98101, United States of America
| | - Beth J Feingold
- Department of Environmental Health Sciences, State University of New York at Albany, School of Public Health, 1 University Place, Rensselaer, NY 12144, United States of America.
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Pettigrew SM, Bell EM, Van Zutphen AR, Rocheleau CM, Shaw GM, Romitti PA, Olshan A, Lupo PJ, Soim A, Makelarski JA, Michalski AM, Sanderson W. Paternal and joint parental occupational pesticide exposure and spina bifida in the National Birth Defects Prevention Study, 1997 to 2002. ACTA ACUST UNITED AC 2017; 106:963-971. [PMID: 27891778 DOI: 10.1002/bdra.23551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Because of persistent concerns over the association between pesticides and spina bifida, we examined the role of paternal and combined parental occupational pesticide exposures in spina bifida in offspring using data from a large population-based study of birth defects. METHODS Occupational information from fathers of 291 spina bifida cases and 2745 unaffected live born control infants with estimated dates of delivery from 1997 to 2002 were collected by means of maternal report. Two expert industrial hygienists estimated exposure intensity and frequency to insecticides, herbicides, and fungicides. Multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for exposure to any pesticide and to any class of pesticide (yes/no; and by median), and exposure to combinations of pesticides (yes/no) and risk of spina bifida. Adjusted odds ratios were also estimated by parent exposed to pesticides (neither, mother only, father only, both parents). RESULTS Joint parental occupational pesticide exposure was positively associated with spina bifida (aOR, 1.5; 95% CI, 0.9-2.4) when compared with infants with neither maternal nor paternal exposures; a similar association was not observed when only one parent was exposed. There was a suggested positive association between combined paternal insecticide and fungicide exposures and spina bifida (aOR, 1.5; 95% CI, 0.8-2.8), however, nearly all other aORs were close to unity. CONCLUSION Overall, there was little evidence paternal occupational pesticide exposure was associated with spina bifida. However, the small numbers make it difficult to precisely evaluate the role of pesticide classes, individually and in combination. Birth Defects Research (Part A) 106:963-971, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Stacy M Pettigrew
- Department of Epidemiology and Biostatistics, The University at Albany, State University of New York, Rensselaer, New York.,Department of Environmental Health Sciences, The University at Albany, State University of New York, Rensselaer, New York
| | - Erin M Bell
- Department of Epidemiology and Biostatistics, The University at Albany, State University of New York, Rensselaer, New York.,Department of Environmental Health Sciences, The University at Albany, State University of New York, Rensselaer, New York
| | - Alissa R Van Zutphen
- Department of Epidemiology and Biostatistics, The University at Albany, State University of New York, Rensselaer, New York.,Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York
| | - Carissa M Rocheleau
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Stanford, California
| | - Paul A Romitti
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa
| | - Andrew Olshan
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Aida Soim
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
| | - Adrian M Michalski
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York
| | - Wayne Sanderson
- Departments of Epidemiology, and Preventative Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky
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