to vaccination in an integrated way. They make community members aware of vaccination services, highlight the utility and relevance of these services, and provide information that can help clients take advantage of the services. The interventions may incorporate a variety of associated strategies to improve vaccination, including client and/or provider reminders, provider education, expanded hours or access in clinical settings, lowering of out-of-pocket costs, client-held vaccination records, and WIC interventions.

Having reviewed the relevant research, TFCPS strongly recommends the use of comprehensive interventions that include education for children and adults in communitywide and clinic-based settings in a range of contexts (Briss et al., 2000). Barriers to the implementation of this intervention include the difficulties involved in coordinating strategies among various programs and administrative systems.

Communitywide or Clinic-Based Education Only. Education-only programs provide information to most or all of a target population in a geographic (communitywide) or institutional (medical or public health clinic-based) setting. The information may be provided to clients only, providers only, or both. Educational materials can take the form of brochures (including mail), videotape, posters, vaccine information statements (standardized statements often used to obtain consent for vaccination), and announcements in the media (radio, newspapers, and television). The goal of educational interventions is to increase client acceptance of and demand for vaccinations.

A limited evidentiary base exists for this intervention. TFCPS therefore concluded that there was insufficient evidence regarding the effectiveness of either communitywide or clinic-based education-only interventions (Briss et al., 2000).

Establishing Requirements and Incentives. States or local governments may develop specific requirements or incentives to ensure immunization coverage.

Vaccination Requirements for Child Care, School, and College Attendance. During the 1970s and 1980s, all 50 states adopted immunization requirements for entry to elementary school, and more than 95 percent of children are now appropriately vaccinated with recommended doses of vaccine upon entering school. The required immunization schedule varies from state to state. More recently, immunization requirements have been adopted for child care and college attendance. Enforcement levels for the latter vary greatly among the states.

Having reviewed the relevant body of evidence, TFCPS recommends



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