The research reported in this Article was sponsored by the Harry Frank Guggenheim Foundation and Duke University. A number of people have been helpful to us and require special thanks. Joel Rosch of the SBI and Bill Bridgewater of the National Alliance of Stocking Gun Dealers Association both served as important guides in understanding gun control issues. A handful of other law enforcement officers from BATF and local police departments were also instructive guides. The local police and sheriff departments committed substantial efforts to filling out our questionnaires; we especially appreciate the efforts of Tom Moss and the Gamer Police Department. Most of all we appreciate the help of the ten students from CA Dillon School who agreed, with their parents, to be interviewed and then gave substantive answers to Stephanie's questions. We thank the Dillon School officials for their help in organizing these interviews.

Managed care organizations (MCOs) joined local and state public health agencies in a pilot effort to improve hepatitis B immunization rates of adolescents in an urban and a suburban/rural school district. The pilot also explored issues inherent in public and private collaboration on population health improvement. Local public health agencies provided links to schools in their communities, took the lead in implementing school-based immunization programs, and provided health education materials. MCOs contributed financial support necessary for the project. The final cost per fully vaccinated student, not taking into account the work group's planning and coordination time, was little more than the catalog price of the vaccine alone. Managed care organizations face challenges that complicate their participation and funding of school-based vaccinations: 1) Limited data on health plans of participating students complicate allocation of costs to each MCO; 2) Double-paying occurs for MCOs paying clinics a monthly, per-member rate that already includes adolescent immunizations; 3) When schools provide adolescent immunizations, MCOs lose the "hook" that draws adolescents to clinics for comprehensive health services. When self-consenting is permitted, schools can achieve a high consent and completion rates for multi-dose adolescent immunizations such as hepatitis B. At the same time, MCOs have the responsibility to provide members with comprehensive care and should continue to examine both internal modifications and external partnerships as opportunities to improve their services to adolescents.