Trusted School Messengers Promoting Non-Mandated Vaccination

This application addresses the CDC SIP-24-013 ‘Understanding the potential of schools in promoting non- mandated childhood vaccinations.’ Influenza results in thousands of deaths and millions of illnesses in the US each year. Children under age 4, those with high-risk conditions, and individuals over age 65 are most likely to be hospitalized due to influenza, and healthy school-aged children and adolescents often spread influenza to their more vulnerable family members. Influenza vaccine provides 68% protection against pediatric hospitalization, but only half of children receive the vaccine (rates are lower for rural and Black children). Each year in the U.S., ≥20,000 women and 15,000 men develop HPV-related cancers. Almost all cases of cervical cancer and ~70% of oropharyngeal cancer are caused by HPV. Fortunately, if given prior to exposure, HPV vaccine is nearly 100% effective, so the vaccine series is recommended to start at ages 9-12. Schools play a role in making sure students receive those vaccines that are mandated by law, but also have the potential to promote influenza and HPV vaccination. Increasing confidence in the safety and efficacy of vaccines and building trust are crucial to enhance vaccine uptake. School-based trusted messengers, including school nurses, school physicians and health teachers, as well as administrators, have the potential to act as trusted messengers for vaccine information. In addition, schools communicate with parents by email and messaging apps, where vaccine reminders can be sent. Our novel ‘Theater for Vaccine Hesitancy’ (TVH) training, based in social determination theory, trains trusted messengers in productive conversations with vaccine hesitant patients. It will be combined with education and resources about influenza and HPV vaccination, as well as direct parent messaging from school, to encourage vaccination. Specifically, we will: 1) Modify existing vaccine promotion toolkits and interactive TVH workshops to focus on trusted school messengers supporting influenza and HPV vaccination, 2) Measure the effect of the revised educational toolkit + TVH on influenza vaccination rates in urban and rural schools. Assess intervention feasibility, acceptability, and cost, and 3) Measure the effect of the intervention on HPV vaccination (any dose) in schools randomized in Aim 2. Assess intervention feasibility, acceptability, and cost. At the conclusion of the interventions, we will have a model and revised toolkit to implement a parent focused school-based education/reminder program to increase rates of non-mandated recommended vaccines in rural and urban schools.