Provider Communication and Mothers' Willingness to Vaccinate Against Human Papillomavirus and Influenza: A Randomized Health Messaging Trial.

Objective: To understand the effect of a health messaging intervention focused on provider communication about vaccination on mothers' willingness to vaccinate children against human papillomavirus (HPV) and seasonal influenza.

Methods: A total of 2476 mothers of 9- to 13-year-olds in the United States completed a Web-based survey in August 2014. Mothers were randomized to 1 of 2 groups targeting HPV or influenza vaccine.

Predictors of influenza vaccination in the U.S. among children 9-13years of age.

Background And Objectives: U.S. estimates of seasonal influenza (flu) vaccine uptake in 2014-2015 were 62% for 5-12year olds, dropping to 47% for 13-17year olds.

Trends in Use and Cost of Second-Generation Antipsychotics Among Children and Teens in Indiana Medicaid, 2004-2012.

Objective: To replicate and extend a study by the Agency for Healthcare Research and Quality (AHRQ) and Rutgers on antipsychotic use among youths in Medicaid, the authors analyzed Indiana Medicaid claims from 2004 to 2012, extending the earlier study by focusing on second-generation antipsychotics, including both fee-for-service (FFS) and non-FFS patients, and analyzing cost trends.

Methods: The authors evaluated the impact of several Indiana Medicaid policy changes on medication utilization and cost among children enrolled for at least one month during 2004-2012 (N=683,716-793,637), using an exhaustive antipsychotic list to search the database.

Results: Annual utilization rates for antipsychotics were 2%-3% but were much higher among foster children (10%-15%).

Ethics and Childhood Vaccination Policy in the United States.

Childhood immunization involves a balance between parents' autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals. In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice.

Human Papillomavirus Vaccine Initiation among 9-13-Year-Olds in the United States.

Objective: The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9-26-year-old males and females, with routine vaccination recommended for 11-12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13-17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9-13-year-olds in the United States.

Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?

Objective: Physicians typically respond to roughly half of the clinical decision support prompts they receive. This study was designed to test the hypothesis that selectively highlighting prompts in yellow would improve physicians' responsiveness.

Methods: We conducted a randomized controlled trial using the Child Health Improvement Through Computer Automation clinical decision support system in 4 urban primary care pediatric clinics.

An emerging field of research: challenges in pediatric decision making.

There is growing interest in pediatric decision science, spurred by policies advocating for children's involvement in medical decision making. Challenges specific to pediatric decision research include the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this article are to describe each of these challenges, to provide decision researchers with insight into pediatric decision making, and to establish a blueprint for future research that will contribute to high-quality pediatric medical decision making.

Vaccine message framing and parents' intent to immunize their infants for MMR.

Background And Objective: Emphasizing societal benefits of vaccines has been linked to increased vaccination intentions in adults. It is unclear if this pattern holds for parents deciding whether to vaccinate their children. The objective was to determine whether emphasizing the benefits of measles-mumps-rubella (MMR) vaccination directly to the vaccine recipient or to society differentially impacts parents' vaccine intentions for their infants.

Screen exposure and body mass index status in 2- to 11-year-old children.

Objective: To measure the relationship between screen exposure and obesity in a large, urban sample of children and to examine whether the relationship is moderated by sociodemographics.

Methods: We asked parents of 11 141 children visiting general pediatrics clinics if the child had a television (TV) in the bedroom and/or watched more than 2 hours of TV/computer daily. We measured children's height and weight, then used logistic regression to determine whether screen exposure indicators predicted obesity (body mass index ≥ 85th percentile) and interacted with race/ethnicity, sex, age, and health care payer.

Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.

Unlabelled: Both the American Academy of Pediatrics (AAP) and the Institute of Medicine (IOM) recommend delaying the introduction of cow's milk until after 1 year of age due to its low absorbable iron content. We used a novel computerized decision support system to gather data from multiple general pediatrics offices. We asked families whether their child received cow's milk before 1 year of age, had a low-iron diet, or used low-iron formula.

Attitudes about the use of newborn dried blood spots for research: a survey of underrepresented parents.

Objective: To identify the relative importance of factors that impact parents' attitudes toward use of their child's dried newborn blood spots for research purposes.

Methods: Respondents were parents aged 18 and older with at least one child aged 17 or younger born in Indiana visiting an urban pediatrics clinic. They were asked to rate the acceptability of hypothetical scenarios involving the research use of blood spots.

Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.

Objective: Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings.

Methods: Threshold analysis was based on the 2006 model by Quiñonez et al.

The role of herd immunity in parents' decision to vaccinate children: a systematic review.

Background And Objective: Herd immunity is an important benefit of childhood immunization, but it is unknown if the concept of benefit to others influences parents' decisions to immunize their children. Our objective was to determine if the concept of "benefit to others" has been found in the literature to influence parents' motivation for childhood immunization.

Methods: We systematically searched Medline through October 2010 for articles on parental/guardian decision-making regarding child immunization.

Effect of an annual benefit limit on adult dental expenditure and utilization: a cross-sectional analysis.

Objectives: Despite widespread use of dental benefit limits in terms of the types of services provided, an annual maximum on claims, or both, there is a dearth of literature examining their impact on either cost to the insurer or health outcomes. This study uses a natural experiment to examine dental care utilization and expenditure changes following Indiana Medicaid's introduction of a $600 individual annual limit on adult dental expenditure in 2003.

Methods: In a before and after comparison, we use two separate cross-sections of paid claims for 96+ percent of the Medicaid adult population.