Research Projects

MOSAIC: MObile Surveillance for ARI/ILI in the Community

Acute respiratory infections (ARI) including influenza-like illness (ILI) can result in significant morbidity and mortality, direct medical expenses including outpatient visits and hospitalizations, and indirect costs due to lost work and school days. New population-based studies assessing the incidence and etiologies of ARI/ILI need to be conducted as ARI/ILI incidence and transmission as well as factors associated with ARI/ILI epidemiology have changed since previous population-based studies were conducted decades ago. In this study we seek to identify incidence of ARI and ILI in a representative population-based community sample, identify the etiology of these ARIs and ILIs, and assess individual and household factors associated with incidence and transmission of ARI/ILI. Secondarily, we also seek to assess differences in prevalence and etiology of ARI/ILI between this study’s community population and those seeking acute care, and determine effectiveness of influenza vaccination on prevention of influenza illness in the study’s community sample. If successful this project could provide important new information to help plan ARI/ILI interventions including new vaccines, vaccination strategies, and surveillance for viral pathogens, including future outbreaks.

Funding: Centers for Disease for Control and Prevention, U01 IP000618 (PI: Stockwell)

FluSAFE: Flu SMS Alerts to Freeze Exposure

Influenza infection results in an estimated 31 million outpatient visits, 55,000 to 974,200 hospitalizations, and 3,000 to 49,000 deaths. Membership in a household in which someone else has influenza is the major risk factor for contracting influenza. The household secondary attack rate (SAR) is as high as 19 percent based on laboratory-confirmed influenza and 30 percent based on symptoms. Non-pharmaceutical preventive measures, including education, may play a role in decreasing transmission, but are only effective if started within 36 hours of symptom onset in index cases. Yet, most interventions are delayed because they are not initiated until care is sought. We have demonstrated in one primarily Latino, urban community sample, that text messaging can be used to rapidly identify community members with influenza-like illness (ILI) early in an illness. This early identification would enable implementation of an educational intervention in the optimal timeframe to reduce influenza transmission. Providing education within a text message is a proven successful strategy to influence behavior. Text messaging itself is scalable, low-cost, and can be used in low literacy populations. However, using text-message based surveillance to trigger a realtime text-message behavioral educational intervention to decrease household influenza transmission has not been assessed. The purpose of this study is to assess the impact of an educational intervention delivered by text messaging on transmission of influenza within households

Funding: NIH/NIAID, R01NR015247 (PI: Stockwell/Larson/Saiman)

Flu2Text: A Multi-Site Study assessing an Intervention for 2nd Dose of Influenza Vaccine

Influenza infection results in high morbidity and mortality. Young children are at particular risk for incomplete influenza vaccination because, depending on their previous vaccination status, many need two doses in a single season, as one dose does not confer adequate protection. Yet, only half of those who receive the first dose receive the second. Besides forgetting to remember to return for subsequent doses, receipt of two doses in a season can be affected by limited parental knowledge regarding influenza vaccination such as lack of understanding of the need for a second dose, as well as the importance of prompt receipt of that dose.

Even among disadvantaged populations, 90 percent of adults in the US have a cellphone. In a scalable, efficient manner, text messaging can provide vaccine reminders that can both remind families to return for a second dose as well as offer educational information that can promote influenza vaccine health-literacy by addressing common barriers that result in missing or delaying a second dose. While previous text message vaccine reminder studies have demonstrated success, they have been conducted locally and primarily with a low-income population. A study with national scope is therefore vital to understanding the effectiveness and optimal use of text message reminders to parents with varied backgrounds and whose children are cared for in diverse practice settings. To achieve this goal, this study seeks to assess the impact of text message reminders on the receipt of the second dose of influenza vaccine, and takes place in practices from the American Academy of Pediatrics’ Pediatric Research in Office Settings (PROS) network.

Funding: NIH/NICHD, R01HD086045 (PI: Stockwell, Fiks)

PRISM: Personalized Reminders for Immunization using Short Messaging systems

Vaccination is one of the most effective public health interventions, yet fundamental problems exist in translating highly effective vaccines into high vaccination coverage. Emerging communication technologies, such as text messaging offer low-cost, scalable opportunities to improve health literacy and promote healthy behaviors, such as vaccination. While we reported the success of text message vaccine reminders, effects were limited by their untailored approach. The transtheoretical model of behavior change supports tailoring interventions to an individual’s stage of decision-making. Human papillomavirus (HPV) is the most prevalent sexually transmitted virus in the US and can lead to genital warts, and cervical, anal and penile cancer. The three-dose vaccine is 90-100 percent efficacious. Minorities are at greatest risk for such cancers but have low HPV vaccine completion rates. Limited health literacy regarding the vaccine can affect series completion. In this study, we are comparing the effects of enhancing text message vaccination reminders with interactive, vaccine health literacy-promoting information tailored to vaccine decision making-stage on HPV vaccine series completion. The effects of these messages represent a new paradigm in interactive health communications.

Funding: Agency for Healthcare Research and Quality (AHRQ), R01HS022677 (PI: Stockwell)

SINC: Synchronized Immunization NotifiCations

Immunization is one of the most effective public health interventions. Yet, nationally coverage has consistently fallen short of national goals, and has remained for the most part stagnant. The continued presence of vaccine-preventable diseases poses a threat to public health. In addition to needed improvement of immunization coverage for the general pediatric/adolescent population, some children with chronic medical conditions need specific additional immunizations, yet many fail to receive them. Immunization reminders for providers in the electronic health record (EHR) are a type of clinical decision support (CDS) that can reduce missed immunization opportunities. One limitation of these reminders is that they generally depend only on data local to the EHR, which can be incomplete due to record scatter, leading to inaccurate alerts. An Immunization Information System (IIS), also known as an immunization registry, is a population-based system that collects immunization data primarily for children and adolescents from providers at a regional or state level. In this study, we seek to couple bidirectional exchange of IIS immunization information and forecasting tools with patient level medical history from the EHR to deliver accurate, patient-specific EHR immunization reminders.

Funding: Agency for Healthcare Research and Quality (AHRQ), R01HS023582 (PI: Stockwell)