Acad Pediatr 2018 May 16. Epub 2018 May 16.

Department of Pediatrics, University of Utah Health, Salt Lake City, UT; University of Utah Health, Salt Lake City, UT.

Purpose: To determine whether residency training represents a net positive or negative cost to academic medical centers, we analyzed the cost of a residency program and clinical productivity of residents and faculty in outpatient primary care practice with or without residents.

Method: Patient volume and revenue data (Current Procedural Terminology codes) from an academic primary care general pediatric clinic were evaluated for faculty clinics (faculty only) and resident teaching clinics (Longitudinal Outpatient Experience [LOE]) with 1-4 residents/faculty. Detailed cost per resident was determined using a departmental financial model that included salary, benefits, faculty and administrative staff effort, non-personnel costs, and institutional GME support. Read More

Acad Pediatr 2018 May 16. Epub 2018 May 16.

Department of Psychiatry, University of California at San Francisco.

Objectives: To (1) examine whether the Information, Motivation, and Behavioral Skills Model predicts maternal screen-related parenting practices and (2) evaluate the relationship of American Academy of Pediatrics(AAP)-recommended parenting practices with child television (TV) use behaviors.

Methods: In this cross-sectional study, 312 Spanish- and/or English-speaking female primary caregivers of Mexican descent with a child 3-5 years of age were recruited from safety-net pediatric clinics. Participants completed a phone interview and screen media diary. Read More

Acad Pediatr 2018 May 3. Epub 2018 May 3.

Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Background: Urban minority children are at risk for poor asthma outcomes and may not receive appropriate primary or subspecialty care.

Objective: We hypothesized that preschool children with asthma whose caregivers reported more barriers to care would be less likely to have seen their primary care provider (PCP) or an asthma subspecialist and more likely to have had a recent emergency department (ED) visit for asthma.

Methods: The Barriers to Care Questionnaire (BCQ) measures expectations, knowledge, marginalization, pragmatics, and skills. Read More

Acad Pediatr 2018 May 2. Epub 2018 May 2.

Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, 3411 Wayne Ave, Bronx, NY 10467; Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 462 1st Avenue, New York, NY 10016.

Objective: Prenatal maternal stresses have been associated with infant temperament patterns linked to later behavioral difficulties. Material hardships, defined as inability to meet basic needs, are important prenatal stressors. Our objective was to determine the associations between prenatal material hardships and infant temperament at 10 months. Read More

Acad Pediatr 2018 Apr 27. Epub 2018 Apr 27.

Seattle Children's Hospital & Research Institute, 2001 Eighth Ave., Seattle, WA 98121, USA.. Electronic address:

Objective: Former youth in foster care (YFC) are at greater risk of chronic health conditions than their peers. Although research in general population samples has demonstrated a dose-response relationship between adverse childhood experiences (ACEs) and adult health outcomes, few studies have conducted similar analyses in highly stress-exposed populations such as YFC. This paper uses person-centered latent class analysis (LCA) methods to examine the relationship between different profiles of ACE exposures and divergent health trajectories amongst this high-risk population. Read More

Acad Pediatr 2018 Apr 27. Epub 2018 Apr 27.

American Academy of Pediatrics, Division of Workforce & Medical Education Policy, Elk Grove Village, IL.

Objective: To update pediatric subspecialty workforce data to support evidence-based legislation and public policy decisions by replicating the American Academy of Pediatrics' 1998 Future of Pediatric Education (FOPE II) workforce survey.

Study Design: A descriptive and comparative analysis of survey responses from 9,950 US pediatric subspecialists who completed an electronic survey.

Results: Pediatric subspecialists are working fewer hours and spending less of their time in direct patient care than they did in 1998 but the mean hours worked differs significantly by subspecialty. Read More

Acad Pediatr 2018 Apr 26. Epub 2018 Apr 26.

Early Start, School of Psychology, Faculty of Social Sciences, University of Wollongong, Australia.

Objective: To investigate: i) prospective associations between media exposure (television viewing, computers, and electronic games) at 2 years and self-regulation at 4 and 6 years, and ii) bi-directional associations between media exposure and self-regulation at 4 and 6 years. We hypothesized that media exposure and self-regulation would display a negative prospective association and subsequent bi-directional inverse associations.

Methods: Data from the nationally-representative Longitudinal Study of Australian Children (LSAC) when children were aged 2 (n=2786) and 4/6 years (n=3527) were used. Read More

Acad Pediatr 2018 Apr 25. Epub 2018 Apr 25.

Assistant professor, Director for Competency-based Education, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

Background: The Accreditation Council for Graduate Medical Education requires semiannual Milestone reporting on all residents. Milestone expectations of performance are unknown.

Objective: Determine pediatric program director (PD) minimum Milestone expectations for residents prior to being ready to supervise and prior to being ready to graduate. Read More

Acad Pediatr 2018 Apr 25. Epub 2018 Apr 25.

The Commonwealth Fund, New York, NY.. Electronic address:

Objective: To examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family impact related to care coordination.

Methods: We measured ED utilization and primary care continuity with the Bice-Boxerman continuity of care index for 1477 CMC using administrative data from Minnesota and Washington state Medicaid agencies. For a subset of 186 of these CMC a caregiver survey was used to measure care coordination quality (using items adapted from the Consumer Assessment of Healthcare Providers and System (CAHPS©) Adult Health Plan Survey) and family impact (using items adapted from the National Survey of Children with Special Health Care Needs). Read More

Acad Pediatr 2018 Apr 20. Epub 2018 Apr 20.

Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue Cincinnati, OH 45267, USA; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.

Acad Pediatr 2018 Apr 17. Epub 2018 Apr 17.

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027.

Objective: In 2015, the Advisory Committee on Immunization Practices (ACIP) made a category B recommendation for use of serogroup B meningococcal (MenB) vaccines, meaning individual clinical decision-making should guide recommendations. This was the first use of a category B recommendation pertaining to a large population and the first such recommendation for adolescents. As part of a survey regarding MenB vaccine, our objectives were to assess among pediatricians (Peds) and family physicians (FPs) nationally: 1) knowledge of the meaning of category A versus B recommendations and insurance coverage implications; and 2) attitudes about category A and B recommendations. Read More

Acad Pediatr 2018 Apr 16. Epub 2018 Apr 16.

Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Ave, MSC 561; Charleston, SC 29425. Electronic address:

Objective: Pediatric constipation is common, costly and often managed in the Emergency Department (ED). The objectives of this study were to determine the frequency of constipation-related ED visits in a large commercially insured population, the frequency of an office visit in the month before and after these visits, demographics associated with these office visits and the ED-associated payments.

Methods: Data were extracted from the Truven MarketScan® database for commercially insured children from 2012-2013. Read More

Acad Pediatr 2018 Apr 16. Epub 2018 Apr 16.

From the Division of Research, Connecticut Children's Medical Center, Hartford, CT; and the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT. Electronic address:

Acad Pediatr 2018 Apr 11. Epub 2018 Apr 11.

NYU School of Medicine, Pediatrics. New York, NY.

Objective: To examine pediatricians' attitudes towards public policies for low-income children and the advocacy efforts for the American Academy of Pediatrics (AAP).

Methods: Data from the AAP Periodic Survey in October 2014-March 2015 were used. Respondents ranked 1) Attitudes toward government programs, and 2) Attitudes toward AAP policies on: income support, housing, education, job training, food, and healthcare. Read More

Acad Pediatr 2018 Apr 11. Epub 2018 Apr 11.

Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Brenner FIT (Families In Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC. Electronic address:

Childhood obesity recommendations advise providers to utilize family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Read More

Acad Pediatr 2018 Apr 10. Epub 2018 Apr 10.

The Ohio State University College of Public Health Division of Health Behavior & Health Promotion.

Objectives: Secondhand smoke exposure (SHSe) in children is changing due to new public policy and electronic nicotine products (e-cigarettes). We examined factors related to self-imposed indoor household tobacco restrictions, with emphasis on children in the household and associations with combustible and non-combustible product use.

Methods: A cross-sectional survey of urban and rural Ohio adult tobacco users classified participants as exclusive combustible users, smokeless tobacco (SLT) users, e-cigarette users, or dual users. Read More

Acad Pediatr 2018 Apr 10. Epub 2018 Apr 10.

Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205; Johns Hopkins Bloomberg School of Public Health, 615 Wolfe Street, Baltimore, MD 21205. Electronic address:

Paternal involvement in children's lives is associated with a variety of child outcomes, from improved cognition and mental health to reduced obesity rates and asthma exacerbations. Given this evidence, the American Academy of Pediatrics has promoted actions by pediatricians to engage fathers in pediatric care. Despite these recommendations, the mother-child dyad remains a frequent focus of care, rather than the mother-father-child triad. Read More

Acad Pediatr 2018 Apr 3. Epub 2018 Apr 3.

Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.

Objective: The quality of children's health is compromised by poor care coordination between primary care providers (PCPs) and specialists. Our objective was to determine how an electronic consultation and referral system impacts referral patterns and PCP-specialist communication.

Methods: The primary care clinic at Boston Children's Hospital piloted an electronic referral and consultation system with the Neurology and Gastroenterology departments from 4/1/14-10/31/16. Read More

Acad Pediatr 2018 Mar 28. Epub 2018 Mar 28.

Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colo.

Objectives: Some parents are concerned the childhood immunization schedule could increase risk for allergic disorders, including asthma. To inform future safety studies of this speculated association, a parent survey was conducted to examine the risk of misclassification of vaccination status in electronic health record data, and to assess the potential for confounding if asthma risk factors varied by vaccination status.

Methods: A survey was conducted among parents of children 19 to 35 months old at 6 medical organizations within the Vaccine Safety Datalink. Read More

Acad Pediatr 2018 Mar 28. Epub 2018 Mar 28.

Cohen Children's Medical Center of New York, 420 Lakeville Road, Suite 176, Lake Success, NY 11042 USA -. Electronic address:

Objective: The number of pediatric Global Health (GH) Tracks has more than doubled in less than ten years. The goal of this study was to describe the characteristics of the pediatric GH Tracks to identify commonalities and differences in track structure, funding and education. In addition, we also identified demographic, institutional or residency-related factors that were significantly associated with educational offerings and logistical challenges. Read More

Acad Pediatr 2018 Mar 23. Epub 2018 Mar 23.

Division of Primary Care Pediatrics, Stony Brook University School of Medicine & Stony Brook Children's Hospital, Stony Brook, NY.

Objective: Administrative data are often used to estimate state Medicaid/CHIP duration of enrollment and insurance continuity, but generally not used to estimate participation (the fraction of eligible children enrolled) because administrative data do not include reasons for disenrollment and cannot observe eligible never-enrolled children, causing estimates of eligible unenrolled to be inaccurate. Analysts are therefore forced to either utilize survey information that is not generally linkable to administrative claims, or rely on duration and continuity measures derived from administrative data and forgo estimating claims-based participation. We introduce "Appendectomy Based Participation" (ABP) to estimate statewide participation rates using claims, by taking advantage of a natural experiment around statewide appendicitis admissions to improve the accuracy of participation rate estimates. Read More

Acad Pediatr 2018 Mar 19. Epub 2018 Mar 19.

Pediatric Residency Training Program, Kaiser Permanente Northern California, Department of Pediatrics, Oakland Medical Center, Oakland, CA.

Background: Parents and patients are actively involved in the clinical learning environment, yet scant literature exists about their involvement in the residency interview process. We aimed to pilot a process of including parents in resident interviews and to determine its value.

Methods: During the 2016-17 residency interview cycle, 22 parent volunteers, blinded to applicant credentials, conducted brief structured interviews with 118 applicants. Read More

Acad Pediatr 2018 Mar 14. Epub 2018 Mar 14.

RAND Corporation, Santa Monica, Calif.

Objectives: To validate new caregiver-reported quality measures assessing care coordination services for children with medical complexity (CMC).

Methods: A cross-sectional analysis of the associations between 20 newly developed Family Experiences with Coordination of Care (FECC) quality measures and 3 validation measures among 1209 caregivers who responded to a telephone or mailed survey from August to November 2013 in Minnesota and Washington. Validation measures included an access composite, a provider rating item, and a care coordination outcome measure, all derived from Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey items. Read More

Acad Pediatr 2018 Mar 12. Epub 2018 Mar 12.

University of Central Florida College of Medicine, Orlando, Fla. Electronic address:

Acad Pediatr 2018 Mar 9. Epub 2018 Mar 9.

Child Health Advocacy Institute, Children's National Health System, Washington, DC.

A community bus tour with a focus on social determinants of health created through a partnership between the pediatric residency program and the hospital's Child Health Advocacy Institute was shown to increase knowledge of health disparities among pediatric interns. Read More

Acad Pediatr 2018 Mar 7. Epub 2018 Mar 7.

Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.

Background: Depression and burnout are highly prevalent among residents, but little is known about modifiable personality variables, such as resilience and stress from uncertainty, that may predispose to these conditions. Residents are routinely faced with uncertainty when making medical decisions.

Objective: To determine how stress from uncertainty is related to resilience among pediatric residents and whether these attributes are associated with depression and burnout. Read More

Acad Pediatr 2018 Mar 6. Epub 2018 Mar 6.

Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colo.

Objective: To assess the impact of the 2011 changes in pediatric single-ingredient liquid acetaminophen product packaging and standardization of the acetaminophen concentration (160 mg/5 mL) on poison control center exposures due to medication errors.

Methods: National Poison Data System (NPDS) data from January 1, 2007, through December 31, 2016, were used to identify medication error exposures involving single-ingredient liquid acetaminophen in children younger than 12 years of age. Surveys were conducted through 6 regional poison control centers to obtain additional information on a subset of exposures. Read More

Acad Pediatr 2018 Mar 5. Epub 2018 Mar 5.

Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio.

Despite increasing numbers of patients with neurodisability, residents lack training to develop physical examination skills. Following a blended educational intervention combining online and bedside teaching, residents demonstrated desired patient-care behaviors on standardized clinical exam assessment. Read More

Acad Pediatr 2018 Mar 2. Epub 2018 Mar 2.

Division of General Pediatrics, Boston, Mass; Harvard Medical School, Boston, Mass.

Objective: To test whether an eczema care plan (ECP) would improve provider documentation and management, decrease eczema severity, and increase patient quality of life (QOL) in the pediatric primary care setting.

Methods: We conducted a randomized controlled trial from June 2015 to September 2016 at a large hospital-based pediatric primary care clinic. Participants included children from 1 month to 16 years of age with a diagnosis of eczema. Read More

Acad Pediatr 2018 Mar 2. Epub 2018 Mar 2.

Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Injury Prevention Center, Rhode Island Hospital, Providence, RI.

Background: Problem behaviors, such as substance use and peer aggression, frequently coexist and are common among youth seen in emergency departments (EDs). EDs are increasingly urged to screen for both psychological distress and problem behaviors.

Objective: To inform screening and intervention efforts, we aimed to identify classes of problematic substance use and peer aggression in a sample of adolescents from 16 pediatric EDs, and to examine the relative prevalence of psychological distress in identified classes. Read More

Acad Pediatr 2018 Mar;18(2S):S93-S100

Departments of Medicine and Pediatrics, University of Illinois at Chicago, Chicago, Ill.

In 2013, National Immunization Survey-Teen data indicated that >40% of female adolescents had not initiated the human papillomavirus (HPV) vaccine series and >60% had not completed the series, documenting vaccination rates much lower than those for other vaccines recommended for adolescents. The Chicago Department of Public Health (CDPH) was 1 of 22 jurisdictions nationwide to receive a Prevention and Public Health Fund award through the Centers for Disease Control and Prevention to improve HPV vaccination rates among adolescents. The CDPH implemented 5 interventions targeting the public, clinicians and their staff, and diverse immunization and cancer prevention stakeholders. Read More

Acad Pediatr 2018 Mar;18(2S):S85-S92

Center for Health Research, Kaiser Permanente Northwest, Portland, Ore.

Background: Human papillomavirus (HPV) vaccination has been recommended in the United States for female and male adolescents since 2006 and 2011, respectively. Coverage rates are lower than those for other adolescent vaccines. The objective of this study was to evaluate an assessment and feedback intervention designed to increase HPV vaccination coverage and quantify missed opportunities for HPV vaccine initiation at preventive care visits. Read More

Acad Pediatr 2018 Mar;18(2S):S79-S84

American Cancer Society, Atlanta, Ga.

Objective: Human papillomavirus (HPV) vaccine coverage in the United States remains low compared with other adolescent vaccines. As the largest primary care network in the United States, safety net clinics such as federally qualified health centers (FQHCs) serve patients at a disproportionate risk of HPV-related cancers. In this pilot project, the American Cancer Society (ACS) leveraged its primary care workforce to implement quality improvement interventions in the unique context of 30 FQHC systems across the country, including 130 clinic sites reaching >20,000 adolescents in a variety of geographic settings. Read More

Acad Pediatr 2018 Mar;18(2S):S72-S78

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.

Objective: Because most adolescent vaccinations are delivered in primary care, opportunities to vaccinate depend on the presence of visits and types of visits. We evaluated: 1) national visit patterns (having an annual preventive visit with a physician, provider type seen, visit types) for adolescents across the United States, and 2) the type of physician visits at which vaccines are administered for this age group.

Methods: We performed a secondary data set analysis of the 2014 Medical Expenditure Panel Survey. Read More

Acad Pediatr 2018 Mar;18(2S):S66-S71

Department of Pediatrics-Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Ind; The Regenstrief Institute, Indianapolis, Ind.

Objective: To evaluate the effects of simple and elaborated health care provider (HCP) reminder prompts on human papillomavirus (HPV) vaccine initiation rates.

Methods: Twenty-nine pediatric HCPs serving 5 pediatric clinics were randomized to 1 of 3 arms: 1) usual practice control, 2) simple reminder prompt, and 3) elaborated reminder prompt, which included suggested language for recommending the early adolescent platform vaccines. Prompts were delivered via a computer-based clinical decision support system deployed in the 5 clinics. Read More

Acad Pediatr 2018 Mar;18(2S):S53-S65

Cincinnati Children's Hospital Medical Center, Division of Adolescent and Transition Medicine, Cincinnati, Ohio; University of Cincinnati, College of Medicine, Cincinnati, Ohio.

Clinicians' recommendation for the human papillomavirus (HPV) vaccine appears to be an important driver of parental decisions about vaccination. Our aim was to synthesize the best available evidence exploring the perceptions and experiences regarding HPV vaccination, from the perspective of the US clinician. We conducted a comprehensive literature search of Academic Search Complete, CINAHL Plus, Communication & Mass Media Complete, Consumer Health Complete (EBSCOhost), ERIC, Health and Psychosocial Instruments, MEDLINE with full text, and PsycINFO databases. Read More

Acad Pediatr 2018 Mar;18(2S):S46-S52

Department of Pediatrics, Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, Calif.

Objective: Human papillomavirus (HPV) vaccination rates remain low, in part because of missed opportunities (MOs) for vaccination. We used a learning collaborative quality improvement (QI) model to assess the effect of a multicomponent intervention on reducing MOs.

Methods: Study design: pre-post using a QI intervention in 33 community practices and 14 pediatric continuity clinics over 9 months to reduce MOs for HPV vaccination at all visit types. Read More

Acad Pediatr 2018 Mar;18(2S):S44-S45

Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH.

Acad Pediatr 2018 Mar;18(2S):S37-S43

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.

Objective: Parental declination contributes to low human papillomavirus (HPV) vaccination coverage among US adolescents, resulting in missed opportunities for cancer prevention. We sought to characterize parents' acceptance of HPV vaccination after declination ("secondary acceptance").

Methods: In September 2016, we conducted an online survey with a national sample of parents of children ages 11 to 17 years. Read More

Acad Pediatr 2018 Mar;18(2S):S3-S10

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.

Since human papillomavirus (HPV) vaccine was first introduced for females in the United States in 2006, vaccination policy has evolved as additional HPV vaccines were licensed and new data became available. The United States adopted a gender neutral routine HPV immunization policy in 2011, the first country to do so. Vaccination coverage is increasing, although it remains lower than for other vaccines recommended for adolescents. Read More

Acad Pediatr 2018 Mar;18(2S):S28-S36

Department of Pediatrics, NYU School of Medicine-Bellevue Hospital, New York, NY; Department of Population Health, NYU School of Medicine, New York, NY.

Background And Objectives: Despite recommendations supporting human papillomavirus (HPV) vaccination, pediatric vaccination rates remain suboptimal in the United States; lack of tools to support provider counseling is one barrier. We sought to evaluate HPV-related counseling materials for readability, suitability, and content, and assess parent perceptions of materials, using a health literacy perspective.

Methods: A systematic search was conducted for written materials developed for HPV vaccination counseling by examining state Department of Health Web sites and associated links to local and national organizations. Read More

Acad Pediatr 2018 Mar;18(2S):S23-S27

Adult and Child Consortium for Outcomes Research and Dissemination Science, Aurora, Colo; Division of Pediatric Infectious Diseases, University of Colorado Denver.

The burden of human papillomavirus (HPV) infections is substantial, causing thousands of cancers and deaths in the United States yearly. Safe and effective vaccines exist, yet remains underutilized, particularly among younger adolescents for whom the vaccine is targeted. Provider communication techniques are known to affect parents' and adolescents' acceptance of this vaccine. Read More

Acad Pediatr 2018 Mar;18(2S):S21-S22

Cervivor, Upper Marlboro, MD.

Acad Pediatr 2018 Mar;18(2S):S19-S20

Voices for Vaccines, Decatur, Ga.

Acad Pediatr 2018 Mar;18(2S):S17-S18

Centers for Disease Control and Prevention, Atlanta, Ga. Electronic address:

Acad Pediatr 2018 Mar;18(2S):S14-S16

Gillings School of Global Public Health, University of North Carolina, Chapel Hill.

Acad Pediatr 2018 Mar;18(2S):S11-S13

Department of Health Behavior, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.

Acad Pediatr 2018 Mar;18(2S):S101-S105

Institute for Health Research, Kaiser Permanente Colorado, Denver.

School-local vaccination (SLV) has been a highly effective method of increasing rates of human papillomavirus (HPV) vaccination in many countries internationally in which vaccines are purchased by national, regional, or local public health authorities and offered free of charge within schools. However, the effectiveness of SLV for increasing HPV vaccination rates in the United States is likely to be substantially limited due to a number of identified barriers, the most significant of which is with the need to bill for vaccines among adolescents not covered under the Vaccines for Children Program. HPV vaccination within school-based health centers (SBHCs) has been much more effective than SLV, but SBHCs exist in only 2% of schools in the United States. Read More

Acad Pediatr 2018 Mar;18(2S):S1-S2

Department of Pediatrics, University of California, Los Angeles, Calif.