Tag Archive for: vaccination

boy getting vaccinated

Adolescents with ADHD more hesitant to get COVID-19 vaccine

boy getting vaccinatedAdolescents with attention-deficit/hyperactivity disorder (ADHD) report greater hesitancy and less confidence in COVID-19 vaccine safety compared to adolescents without ADHD, a new study finds.

For all adolescents in the study, those who identified as Black or Latino — and came from families with lower income levels — were more likely to be vaccine hesitant and report lower confidence in the safety of COVID-19 vaccines.

Whereas greater COVID-19 concerns, compliance to social distancing guidelines, media use and perceived negative impact of COVID-19 on relationships was associated with greater vaccination willingness.

The study, led by Melissa Dvorsky, Ph.D., director of ADHD & Learning Differences Program at Children’s National Hospital, also highlighted that:

  • Adolescents with ADHD who engage in large gatherings indoors are at greater risk for vaccine hesitancy.
  • Interventions should target social-cognitive processes for adolescent vaccination.

“Adolescents with ADHD being more vaccine hesitant is perhaps in part due to core risk mechanisms associated with ADHD, likely impacting planning, motivation and execution of vaccination, adolescents’ risk appraisal, and perceived susceptibility to COVID-19,” Dr. Dvorsky said. “Our study also found key social mechanisms predicted increased vaccine acceptance and uptake, and these factors should be leveraged in ongoing initiatives addressing vaccine uptake among teens.”

Findings have important implications for health and mental health providers and educational strategies aimed at promoting COVID-19 vaccinations in adolescents.

Earlier this month, Mayor Muriel Bowser and DC Health announced amplified efforts to encourage families to vaccinate youth ahead of the upcoming 2022-2023 school year, sending a message that students must get caught up on vaccinations over the summer. In addition to expanding access to vaccination services, a concerted effort, Dvorsky added, is needed to increase trust, confidence, motivation and social relevance among adolescents. This is especially true for those with ADHD and from lower socio-economic backgrounds.

“As health and mental health care providers, we are uniquely positioned to offer effective communication using strong, presumptive language with all adolescents in our community to address vaccine hesitancy. Adolescents with ADHD, in particular, can benefit from frequent behavioral ‘nudges’ (such as prompts or reminders, automatic appointments) and social/motivational strategies (such as social network interventions, peer-delivered approaches, motivational interviewing) to increase vaccine uptake.”

It’s important to note that research addressing adolescent COVID-19 vaccination willingness and readiness remains scarce.

The study included 196 adolescents (87 male) ages 16-18 from two sites in the Southeastern and Midwestern United States. Participants were high school students in 11th and 12th grade during the 2020-2021 school year. Participants came from a range of socioeconomic backgrounds, with 21% of families falling below the 2019 U.S. median household income ($68,703). Approximately half of the participants were comprehensively diagnosed with ADHD prior to COVID-19.

Alexandra M. Sim

From the mouths of babes: Lessons in humility

Alexandra M. Sims

A poem written by Alexandra M. Sims, M.D., FAAP, was published Jan. 7, 2020, in JAMA, as part of its series of works by artists and physicians that explore the meaning of healing and illness.

Each encounter is like a single shard in a mosaic that, taken as a whole, presents a picture of amazing optimism despite myriad challenges.

Alexandra M. Sims, M.D., FAAP, a General Academics Pediatric Fellow at Children’s National Hospital, captured the anonymized vignettes in her journal, using writing as a way to help process both the unbounded joy and sobering trauma experienced by her young patients.

Dr. Sims distilled the snippets into a 27-line poem published Jan. 7, 2020, in JAMA, as part of “Poetry and Medicine,” poems penned by artists and physicians to explore the meaning of healing and illness.

One of the vignettes collapses eye-opening comments she heard during a number of clinical encounters, including a childhood immunization session for a 4-year-old: Doesn’t flinch with the vaccines, but tells me not to call them ‘shots’ / His classmate was shot last year / And she died

“When I’m talking about a ‘shot,’ the first thing that comes to my mind – because of what I do for a living and how my life has unfolded – is a vaccination,” Dr. Sims explains. “That caught me off guard. Even though I have been doing this job for a while, I can always learn from patients and families. It really made me shift the language I use, avoiding words that I might think are innocuous that can be translated in ways that can be scary for a child.”

And the poem’s title, “Keep That Same Energy,” was inspired by a young man who, like many patients, calls her Dr. Seuss, and ended his visit by doing 10 pushups: Keep that same energy, sweet Black boy, I silently pray / That agency, that confidence / When the world tries to tell you who you are

During each clinical encounter, Dr. Sims says she tries to instill a sense of pride and competence in the hopes it helps her patients continue to persevere in the face of adversity.

“The patients we see here experience trauma in a lot of big and small ways,” she says. “I’m blown away by their positivity and resilience and ability to deal with a lot of things life is throwing at them. My worry is when – and if – the resiliency will wear down and what things we should be doing as providers to build up that self-efficacy and resiliency so it will last a lifetime.”

LISTEN: Dr. Sims reads “Keep That Same Energy”

Research and Education Week 2017 recap: The immunization battle

Boris D. Lushniak

Boris D. Lushniak, M.D., M.P.H., Dean of University of Maryland School of Public Health and former deputy surgeon general speaks at Research and Education Week 2017 at Children’s National.

Children’s National Health System recently held its 7th Annual Research and Education Week, inviting many keynote and special lecturers to share insights on the most recent research and education findings. Boris D. Lushniak, M.D., M.P.H., dean of the School of Public Health at the University of Maryland and former deputy surgeon general, was just one of many renowned keynote speakers to grace the stage.

In his presentation, “The immunization battle: Perspectives from a public health guy,” Dr. Lushniak described public health as the “science and art of preventing disease, prolonging health and preventing disease through the organized efforts and informed choices of all.” He discussed immunizations across the years, highlighting past achievements in the public health world, the current state of childhood immunizations, and how to improve the view and impact of immunizations and vaccinations in the future.

Since the 1900s, there have been great achievements in the public health world from vaccinations and child immunizations to the recognition of tobacco as a health hazard. Statistics have revealed how child immunizations are the most cost-effective clinical preventive service with a high return on investment. According to Healthy People 20/20, birth cohorts vaccinated according to the childhood immunization schedule provided by the Center for Disease Control saved 33,000 lives, prevented 14 million cases of disease, reduced direct health care costs by $9.9 billion and saved $33.4 billion in indirect health care costs.

Although the statistics have value to medical professionals, Dr. Lushniak explained how the personal views of patients and families create barriers for advancement. The March 2016 Journal of American Medical Association reported that 300 children in the United States die from vaccine-preventable diseases each year; each case representing a failed opportunity to prevent disease due to vaccine refusal and a decrease in community  immunity.

Based on the views of the Journal of Health Management & Practice¸ Dr. Lushniak recommends following these tips to increase vaccine rates:

  • Creating or supporting effective interventions (client reminder, recall systems, provider assessment/feedback/reminder)
  • Generating and evaluating public health response to outbreaks
  • Facilitating vaccine management and accountability
  • Determining client vaccination status or decisions made by clinicians, health departments, schools
  • Aiding surveillance and investigations on vaccination rates, missed opportunities, invalid doses and disparities in coverage

Dr. Lushniak concluded his presentation by encouraging the audience to keep working towards the advancement of immunization, despite any perceptions against getting children vaccinated.

vaccination

How to talk with parents who are vaccine hesitant

vaccination

The single most important factor in parents deciding to accept vaccines is one-on-one contact with an informed, caring and concerned pediatrician.

When facing vaccine-hesitant parents, the key for me is to be collaborative and not to dismiss their questions or concerns.  That’s why the American Academy of Pediatrics advises pediatricians to talk with parents to determine their individual concerns so we can address them. The decision whether to immunize a child ultimately rests with the parents. It’s understandable for parents to be worried – but it also critical that they get the facts.

The conversation can begin simply.

Here’s what I say to vaccine-hesitant parents: You work hard to protect your child every day. Vaccines are as important as feeding your child healthy foods, using a car seat or seat belt and installing a smoke detector.

Here’s what I ask vaccine-hesitant parents: What information can I provide to help you make an informed decision, or to help you feel comfortable with vaccinating your child?  As with most of what we pediatricians do, my goal is to partner with the parent so that we help their child to attain optimal health as a team.

I am a parent. Although my husband and I did not hesitate in vaccinating our daughter, I understand why parents want to feel comfortable about the choices they make for their children.

I also am a pediatrician. I have seen children die from the flu or develop a life-threatening brain infection from chickenpox.  Thanks to the herd immunity that results from decades of vaccination, many of these diseases are now rare in the United States, but there are still episodic outbreaks throughout the country that remind us why we vaccinate children.

Vaccinating is the norm.  Only about 1 percent of children in the United States receive no vaccinations. Most parents who are hesitant about vaccines are not opposed to immunizing their children; they are unsure or have unanswered questions. Fortunately, most vaccine-hesitant parents are responsive to receiving information about vaccines, consider vaccinating their children and do not oppose all vaccines.

When it comes to vaccine-hesitant parents, one-on-one counseling is effective. The single most important factor in parents deciding to accept vaccines is one-on-one contact with an informed, caring and concerned pediatrician.

About the Author

Lanre Omojokun FalusiLanre Omojokun Falusi, M.D., F.A.A.P.
General pediatrician and Associate Medical Director for Municipal and Regional Affairs at Child Health Advocacy Institute