Association of Presence of a School Nurse With Increased Sixth-Grade Immunization Rates in Low-Income Arizona Schools in 2014

Abstract

School nurses often play large roles in implementation of school vaccination requirements aimed at controlling the spread of communicable disease. We analyzed the association between the presence of a school nurse and school-level vaccination rates in Arizona. Using school-level data from Arizona sixth-grade schools (n = 749), we regressed average sixth-grade school-level immunization rates on presence of a school nurse (registered nurse [RN] or licensed practical nurse [LPN]) and school-level socioeconomic status (SES), controlling for other school- and district-level characteristics. Schools with a nurse had higher overall vaccination rates than those without a nurse (96.1% vs. 95.0%, p < .01). For schools in the lowest SES quartile, the presence of a school nurse was associated with approximately 2 percentage point higher immunization rates. These findings add to the growing literature that defines the impact of school nurses on student health status and outcomes, emphasizing the value of school nurses, especially in lower SES schools.

Keywords

immunizations elementary administration/management quantitative research health disparities

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References

Agur

Cojocaru

Mazor

Anderson

R. M.

Danon

Y. L.

(1993). Pulse mass measles vaccination across age cohorts. Proceedings of the National Academy of Sciences, 90, 11698–11702.

Arizona Department of Education. (2017). Health and nutrition services: Free/reduce price percentage. Retrieved from http://www.azed.gov/hns/frp/

Arizona Department of Health Services. (2015). Arizona immunization program: Statistics & reports—Immunization coverage levels. Retrieved from http://azdhs.gov/preparedness/epidemiology-disease-control/immunization/index.php#reports-immunization-coverage

Arizona Department of Health Services. (2017). Arizona state immunization requirements: Birth to 5 years of age—Child care and preschool. Retrieved from http://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/immunization/school-childcare/immunizations-preschool.pdf

Baisch

M. J.

Lundeen

S. P.

Murphy

M. K.

(2011). Evidence-based research on the value of school nurses in an urban school system. Journal of School Health, 81, 74–80.

Birnbaum

M. S.

Jacobs

E. T.

Ralston-King

Ernst

K. C.

(2013). Correlates of high vaccination exemption rates among kindergartens. Vaccine, 31, 750–756.

Bronson-Lowe

Anderson

S. M.

(2009). Effects of a minimum interval immunization schedule for diphtheria and tetanus toxoids and acellular pertussis vaccination during a pertussis outbreak. Archives of Pediatrics and Adolescent Medicine, 163, 417–421.

Centers for Disease Control and Prevention. (2018). National notifiable diseases surveillance system: Weekly tables of infectious disease data. Retrieved from https://wonder.cdc.gov/nndss/static/2018/20/2018-20-table2M.html

Centers for Disease Control and Prevention—National Center for Health Statistics. (2013). NCHS urban-rural classification scheme for counties. Retrieved from https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf

10.

Davis

M. M.

King

J. C.

Moag

Cummings

Magder

L. S.

(2008). Countywide school-based influenza immunization: Direct and indirect impact on student absenteeism. Pediatrics, 122, e260–e265.

11.

Ferson

Fitzsimmons

Christie

Woollett

(1995). School health nurse interventions to increaseimmunisation uptake in school entrants. Public Health, 109, 25–29.

12.

Fogarty

K. J.

Massoudi

M. S.

Gallo

Averhoff

F. M.

Yusuf

Fishbein

(2004). Vaccine coverage levels after implementation of a middle school vaccination requirement, Florida, 1997-2000. Public Health Reports, 119, 163–169.

13.

Gostin

L. O.

(2015). Law, ethics, and public health in the vaccination debates: Politics of the measles outbreak. Journal of the American Medical Association, 313, 1099–1100.

14.

Guttu

Engelke

M. K.

Swanson

(2004). Does the school nurse-to-student ratio make a difference? Journal of School Health, 74, 6–9.

15.

Harper

C. R.

Liddon

Dunville

Habel

M. A.

(2016). High school students’ self-reported use of school clinics and nurses. Journal of School Nursing, 32, 324–328.

16.

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

17.

Keller

L. O.

Strohschein

Lia-Hoagberg

Schaffer

(1998). Population-based public health nursing interventions: A model from practice. Public Health Nursing, 15, 207–215.

18.

Leslie

T. F.

Street

E. J.

Delamater

P. L.

Yang

Y. T.

Jacobsen

K. H.

(2016). Variation in vaccination data available at school entry across the United States. American Journal of Public Health, 106, 2180–2182.

19.

Lieu

T. A.

Cochi

S. L.

Black

S. B.

Halloran

M. E.

Shinefield

H. R.

Holmes

S. J.

… Washington

A. E

. (1994). Cost-effectiveness of a routine varicella vaccination program for us children. Journal of the American Medical Association, 271, 375–381.

20.

Lineberry

M. J.

Ickes

M. J.

(2015). The role and impact of nurses in American elementary schools: A systematic review of the research. Journal of School Nursing, 31, 22–33.

21.

Maughan

E. D.

(2018). School nurses: An investment in student achievement. Phi Delta Kappan, 99, 8–14.

22.

Maughan

E. D.

Adams

(2011). Educators’ and parents’ perception of what school nurses do: The influence of school nurse/student ratios. Journal of School Nursing, 27, 355–363.

23.

McGirr

Fisman

D. N.

(2015). Duration of pertussis immunity after DTaP immunization: A meta-analysis. Pediatrics, 135, 331–343.

24.

National Conference of State Legislators. (2016). States with religious and philosophical exemptions from school immunization requirements. Retrieved from http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

25.

Olive

J. K.

Hotez

P. J.

Damania

Nolan

M. S.

(2018). The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties. PLoS Medicine, 15, e1002578.

26.

Omer

S. B.

Richards

J. L.

Ward

Bednarczyk

R. A.

(2012). Vaccination policies and rates of exemption from immunization, 2005–2011. New England Journal of Medicine, 367, 1170–1171.

27.

Orenstein

W. A.

Hinman

A. R.

(1999). The immunization system in the United States—The role of school immunization laws. Vaccine, 17, S19–S24.

28.

Robert Wood Johnson Foundation. (2010). Unlocking the potential of school nursing: Keeping children healthy, in school, and ready to learn. Retrieved from http://www.rwjf.org/en/library/research/2010/08/cnf-unlocking-the-potential-of-school-nursing.html

29.

Robert Wood Johnson Foundation. (2014). Nurses continue to top public trust survey. Retrieved from http://www.rwjf.org/en/culture-of-health/2014/01/nurses_continue_tot.html

30.

Ryan

K. M.

(2008). Health promotion of faculty and staff: The school nurse’s role. Journal of School Nursing, 24, 183–189.

31.

Salmon

D. A.

Moulton

L. H.

Omer

S. B.

Chace

L. M.

Klassen

Talebian

Halsey

N. A.

(2004). Knowledge, attitudes, and beliefs of school nurses and personnel and associations with nonmedical immunization exemptions. Pediatrics, 113, e552–e559.

32.

Salmon

D. A.

Omer

S. B.

Moulton

L. H.

Stokley

Dehart

M. P.

Lett

… Halsey

N. A.

(2005). Exemptions to school immunization requirements: The role of school-level requirements, policies, and procedures. American Journal of Public Health, 95, 436–440.

33.

Salmon

D. A.

Teret

S. P.

MacIntyre

C. R.

Salisbury

Burgess

M. A.

Halsey

N. A.

(2006). Compulsory vaccination and conscientious or philosophical exemptions: Past, present, and future. The Lancet, 367, 436–442.

34.

Seither

Calhoun

Knighton

C. L.

Mellerson

Meador

Tippins

… Dietz

. (2015). Vaccination coverage among children in Kindergarten-United States, 2014–15 school year. MMWR Morbidity and Mortality Weekly Report, 64, 897–904.

35.

Skoff

T. H.

Kenyon

Cocoros

Liko

Miller

Kudish

… Martin

S. W

. (2015). Sources of infant pertussis infection in the United States. Pediatrics, 136, 635–641.

36.

Stadlin

Bednarczyk

R. A.

Omer

S. B.

(2012). Medical exemptions to school immunization requirements in the United States—association of state policies with medical exemption rates (2004–2011). Journal of Infectious Diseases, 206, 989–992.

37.

Tetuan

T. M.

Akagi

C. G.

(2004). The effects of budget, delegation, and other variables on the future of school nursing. Journal of School Nursing, 20, 352–358.

38.

Tuckerman

Rajesh

Oeppen

Balachander

Bancsi

Jacklin

… Clegg

(2008). Review of the evidence of the effectiveness and cost effectiveness of interventions to address differences in the uptake of immunisations (including targeted vaccines) in people younger than 19 years. London, England: National Collaborating Centre for Women’s and Children’s Health. Retrieved from https://www.nice.org.uk/guidance/ph21/documents/reducing-differences-in-the-uptake-of-immunisations-evidence-review-full-report2

39.

United Health Foundation. (2016). America’s health rankings: Health of women and children report. Retrieved from http://assets.americashealthrankings.org/app/uploads/hwc-complete-report.pdf

40.

Walker

(2012). Importance of school nurses’ role promoted by government initiative. Nursing Children and Young People, 24, 7.

41.

Wang

L. Y.

Vernon-Smiley

Gapinski

M. A.

Desisto

Maughan

Sheetz

(2014). Cost-benefit study of school nursing services. JAMA Pediatrics, 168, 642–648.

42.

Wiggs-Stayner

K. S.

Purdy

T. R.

G. N.

McLaughlin

N. C.

Tryzynka

P. S.

Sines

J. R.

Hlaing

(2006). The impact of mass school immunization on school attendance. The Journal of School Nursing, 22, 219–222.

43.

Yang

Y. T.

Silverman

R. D.

(2015). Legislative prescriptions for controlling nonmedical vaccine exemptions. Journal of the American Medical Association, 313, 247–248.

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Association of Presence of a School Nurse With Increased Sixth-Grade Immunization Rates in Low-Income Arizona Schools in 2014–2015

Abstract

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