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Association of State Laws and Healthcare Workers’ Influenza Vaccination Rates

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Abstract

State laws are being used to increase healthcare worker (HCW) influenza vaccine uptake. Approximately 40% of states have enacted such laws but their effectiveness has been infrequently studied. Data sources for this study were the 2000-2011 U.S. National Health Interview Survey Adult Sample File and a summary of U.S. state HCW influenza vaccination laws. Hierarchical linear modeling was used for two time periods: 1) 2000-2005 (before enactment of many state laws) and 2) 2006-2011 (a time of increased enactment of state HCW influenza vaccination legislation). During 2000-2005, two states had HCW influenza vaccination laws and HCW influenza vaccination rates averaged 22.5%. In 2006-2011, 19 states had such laws and vaccination rates averaged 50.9% (p < 0.001). The likelihood of HCW vaccination increased with the scope and breadth, measured by a law score. Although laws varied widely in scope and applicability, states with HCW influenza vaccination laws reported higher HCW vaccination rates.

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Background

The Advisory Committee on Immunization Practices (ACIP) has long recommended annual influenza vaccination for all healthcare workers (HCW) to reduce the spread of influenza, and decrease staff illness and absenteeism,1 and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that all accredited institutions offer influenza vaccination to staff.2 Previously stagnant, HCW influenza vaccination rates have been gradually increasing over the past several seasons (49% in

Data Sources

Primary data included the National Health Interview Survey (NHIS) 2000-2011 public use sample adult files. To merge the NHIS data with state law data, state identifiers were necessary. State identifier is a restricted variable in the NHIS data, therefore, the data were accessed through the National Center for Health Statistics Research Data Center.

The NHIS is a cross-sectional household interview survey conducted annually by the U.S. Census Bureau for the NCHS, which collects self-reported data

Selected Descriptive Statistics of Health Care Workers in the United States

The overall influenza vaccination rate for HCWs in 2000-2005 (weighted N=15,971,315) was 22.5% and in 2006-2011 (weighted N=14,983,857) was 50.9% (P<0.001; data not shown). Only Maine and New Hampshire had laws regarding influenza vaccination of HCWs during 2000-2005 while 19 states enacted such laws during 2006-2011 (Alabama, Arkansas, California, Illinois, Kentucky, Maine, Maryland, Massachusetts, New Hampshire, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina,

Discussion

Previous research has demonstrated a clear and marked effect of individual hospital policies on HCW influenza vaccination rates in acute care facilities.16, 17 In a direct comparison of hospital policy and state law based on national survey data, state laws were ineffective in the presence of hospital policies mandating vaccination.18 Few studies have examined the direct effect of state law on HCW influenza vaccination rates. In a recent study using 2009-2010 data, from the Behavioral Risk

Conclusion

Despite a growing number of states with HCW influenza vaccination laws, few state laws mandate vaccination, hence lack the more powerful impact of individual facility policies requiring HCW vaccination. However, state law may be a viable option for improving HCW vaccine uptake especially in states where the health care environment is not conducive to individual facility-based mandates.

Acknowledgement

This research was conducted with funding from the Robert Wood Johnson Foundation’s Public Health Law Research program, Grant #68394. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the funding agency and the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention.

References (20)

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