Schwarz Kathleen, Garrett Beth, Lee Jennifer, Thompson Douglas, Thiel Thelma, Alter Miriam J, Strathdee Stephanie
Johns Hopkins University School of Medicine, 600 N. Wolfe Street-Brady 320, Baltimore, MD 21287, USA.
J Urban Health. 2008 Mar;85(2):228-38. doi: 10.1007/s11524-008-9253-3. Epub 2008 Feb 15.
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 shelter-based 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.
无家可归的青少年感染乙型肝炎病毒（HBV）的风险增加，且该群体的HBV疫苗接种率很低。我们研究的目的是通过一项针对2至18岁儿童和青少年的基于收容所的HBV疫苗接种项目，并采用一个符合文化背景的HBV视频进行随机对照试验，来确定是否可以提高HBV疫苗接种率。研究对象被随机分为观看8分钟HBV视频组或对照组（预防吸烟视频组）。在观看视频之前，对照顾者和青少年进行了HBV知识及人口统计学评估。向所有没有疫苗接种记录的研究对象提供第一剂HBV疫苗；随后，从医疗服务提供者处获取准确的HBV疫苗接种史。要求研究对象在首次就诊后1个月和3个月复诊，向所有接种未完成的研究对象提供HBV疫苗，并重新评估HBV知识。共有328名儿童和青少年由170名照顾者参与了本研究。其中104人HBV疫苗接种未完成。报告了所有至少有一名研究对象需要接种疫苗的家庭单位的数据。53名儿童和青少年被随机分配到HBV视频组，51名被分配到吸烟视频组。在第二次就诊时，HBV视频组照顾者的HBV知识得分较第一次就诊时有所提高（p = 0.01），而吸烟视频组没有提高（p = 0.82）。HBV视频组青少年也观察到了类似结果（p = 0.05），吸烟视频组则没有（p = 0.40）。与吸烟视频相比，观看HBV视频对第二次就诊时的疫苗复诊率有显著影响（59%对31%；p = 0.05），但对第三次就诊时没有影响（47%对18%，p = 0.06）。在本研究纳入的全部328名儿童和青少年中，基于收容所的疫苗接种项目在提高HBV疫苗接种率方面非常有效，从基线时的68%接种率提高到研究结束时的85%。我们得出结论，基于收容所的HBV疫苗接种项目在提高大龄儿童和青少年的疫苗接种率方面可能非常有效。简短观看一个符合文化背景的HBV视频可提高HBV知识，并可能提高疫苗复诊率。
