Positive Impact of a Shelter-based Hepatitis B Vaccine Program in Homeless Baltimore Children and Adolescents

Abstract

Homeless youth are at increased risk for hepatitis B virus (HBV) infection and HBV vaccine coverage is poor in this group. The purpose of our study was to determine if a shelter-based HBV vaccine program in children and adolescents 2-18 years of age with a randomized controlled trial using a culturally appropriate HBV video could increase HBV vaccine coverage rates. Subjects were randomized to an 8 min HBV video or a control, smoking prevention video. Before exposure to the videos, HBV knowledge, and demographics were assessed in caregivers and adolescents. HBV vaccine no. 1 was offered to all subjects who did not produce a vaccine record; subsequently, an accurate HBV vaccine history was obtained from medical providers. Subjects were asked to return 1 and 3 months after visit 1, HBV vaccine was offered to all with incomplete coverage, and HBV knowledge was reassessed. There were 328 children and adolescents cared for by 170 caregivers enrolled in the study. One hundred and four had incomplete HBV vaccine coverage. Data are reported for all family units with at least one subject needing vaccine. There were 53 children and adolescents randomized to the HBV video vs. 51 to the smoking video. HBV knowledge scores of caregivers improved at Visit no. 2 vs. no. 1 in the HBV video group (p=0.01) but not in the smoking group (p=0.82). Similar results were observed for adolescents in the HBV video group (p=0.05) but not in the smoking group (p=0.40). Exposure to the HBV video vs the smoking video had a significant effect on return rates for vaccine at Visit no. 2 (59 vs. 31%; p=0.05) but not at Visit no. 3 (47 vs. 18%, p=0.06). The shelterbased vaccine program was very effective in increasing HBV coverage rates in the entire group of 328 children and adolescents enrolled in the study, from 68% coverage at baseline to 85% at the conclusion of the study. We conclude that shelter-based HBV vaccine programs can be highly effective in increasing vaccine coverage rates in older children and adolescents. A brief exposure to a culturally appropriate HBV video improves HBV knowledge and may improve return rates for vaccine.

Strategies to improve vaccination rates in people who are homeless: A systematic review

“… (33) A final total of 23 articles were included. [30] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] .…”

Community-Centered Education Improves Vaccination Rates in Children From Low-Income Households

“…These findings support previous studies describing the effectiveness of multicomponent community-based interventions in increasing pediatric immunization coverage rates. 10 The most commonly adopted communitybased immunization programs are school-based vaccination clinics, where vaccines are provided in a convenient manner at little or no cost to families.…”

Homelessness & Health in Canada

“…lgb homeless youth, who report even higher rates of childhood sexual abuse compared to heterosexual homeless youth (Tyler and Cauce 2002), have been found to engage in sex trading at the same rate as heterosexual female homeless youth and at a higher rate than heterosexual male homeless youth (Gangamma et al 2008). Childhood physical and emotional abuse are also correlates of sexual risk behaviours and poor sexual health among homeless youth, including sex trading (Greene, Ennett and Ringwalt 1999) and unintended pregnancy (Thompson et al 2008). …”

“…These services are intended to reduce the impact of barriers preventing homeless persons from accessing services in hospitals and community clinics, such as geographic isolation, lack of identification cards and family physicians, feelings of unwelcomeness and long wait times Podymow et al 2006b;Podymow, Turnbull and Coyle 2006a;. Community and shelter-based health services have also been demonstrated to improve treatment compliance and health outcomes while reducing hospital stays and emergency room visits (Podymow et al 2006b;Podymow, Turnbull and Coyle 2006a;Schwarz et al 2008;) and play an increasingly prominent role in health services delivery in many Canadian cities. As a consequence, health services are now located in many settings not traditionally associated with health care delivery.…”