In 2019, just one-half of Americans received their influenza vaccine, despite it being safe, effective, and important in preventing serious infection, hospitalization, and death. Black children receive fewer influenza vaccines than their White counterparts. Vaccine hesitancy can hinder influenza vaccine uptake and is partially fueled by ongoing systemic racism and historical abuse leading to medical mistrust in communities of color. Building trust may enhance the transfer of reliable vaccine information and may move people along the spectrum of vaccine intention. We sought to partner with faith-based organizations through a community influenza vaccination event to increase vaccination rates. By leveraging the reach and expertise of trusted voices, such as church “first ladies” and local community leaders, we were able to administer 600 pediatric influenza vaccines between 2016 and 2019. In addition, this event served as a platform to assess whether youth attendees had a place for regular medical care (“medical home”) (>80% did in each year assessed) and to conduct preventive screenings. Most children, as reported by their caregivers, had recent medical check-ups (85% in 2016, 84% in 2017, and 82% in 2018). Of the children screened, more than one-third had an abnormal body mass index and one-half had abnormal dentition. By partnering with organizations that are well-embedded in the local community, such as faith-based organizations, health care groups may be able to maximize the impact of their health promotion campaigns.

People 6 months and older can receive an annual influenza vaccination to prevent infection, yet, since 2015, more than 165 000 people have died of influenza, including nearly 1900 children.1  In 2019, 52% of Americans, and 51% of Ohioans, received their influenza vaccine,2  which was a lower percent than the Healthy People 2030 Objective target of 70%. Data suggest that rates are even lower for Black children. During the 2019 to 2020 season, 46% of Black children in Ohio received the influenza vaccine, compared with 56% of White children.2 

Vaccine hesitancy, which is influenced by confidence and convenience, limits vaccine uptake.3  Historical abuse and ongoing systemic racism contribute to medical mistrust by Black communities and may contribute to disparities in health care access and vaccine rates.4,5  Building community trust enhances confidence in preventive services.6  Vaccination access that is colocated with other needed services may help overcome convenience-related barriers.7 

Faith-based organizations desire involvement in health programming and are effective in health promotion.8,9  Partnering with faith-based organizations to tackle issues, such as low vaccination rates, is a form of community engagement, which is “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of these people.”10  Achieving equity in influenza vaccination rates will require advocacy alongside trusted community members, and in leaders in the community and in their respective churches, First Ladies for Health (FLFH) served as a perfect partner in this work. Alongside FLFH, we established and evaluated an influenza vaccination event hosted by predominantly Black churches and organizations in partnership with a pediatric hospital, with the goal of increasing vaccination rates annually. This collaboration examined influenza vaccination rates during a 4-year period (2016-2019) among children participating in the event.

The FLFH Annual Family Health Day was developed by Cincinnati Children’s Hospital Medical Center (CCHMC) and FLFH. FLFH is a faith-based, nonprofit, volunteer organization led by female leaders from Black churches in Cincinnati and by the mayor’s wife (also known as the First Lady). CCHMC is a nonprofit, academic pediatric hospital in Cincinnati, Ohio. Volunteers from CCHMC staffed the annual half-day, multisite event held in early fall. We used local health department data to determine areas with low vaccine uptake. Recruitment events were held on Sundays to coincide with church services. Youth and families were recruited from churches, schools, community organizations, health clinics, and CCHMC using fliers, word of mouth, and endorsement by community leaders. At the annual event, several church leaders were publicly vaccinated and CCHMC staff discussed vaccine safety and importance. Attendees could participate in screenings, learn about community health resources, and interact with the First Ladies. Uniquely, caregivers could receive their vaccines with their children via colocated adult health care services.

Initially, the purpose of the event was to enhance access to influenza vaccinations and other health care services. Starting in 2017, targeted education about vaccine myths, safety, and benefits was incorporated to address low community vaccine acceptance. Sites were added yearly to reach community areas with low vaccination rates.

To assess our advocacy intervention, the authors collected demographic and health information via survey from caregivers who consented to vaccination. Influenza vaccine administration was tracked, and descriptive statistics summarized the data. This study was determined to be “exempted” from further review by the CCHMC institutional review board (#2021-0299).

Demographics

From 2016 through 2019, 1162 youth participated in influenza vaccination event (Table 1). Most participants self-identified as Black/African American. Each year, participants were mostly school-aged; the average age was 8.4 years in 2016, 11.6 years in 2018, and 8.42 years in 2019 (participant age was not collected in 2017). Participants resided in high poverty ZIP codes. Between 2016 and 2019, sites (n = 63) included 46 local churches, 2 schools, and 15 community centers.

TABLE 1

Participant Demographics and Site Information: First Ladies for Health Annual Family Health Day, Cincinnati, OH, 2016-2019 (N = 1162 Total Pediatric Participants)

 2016201720182019
Pediatric attendee demographics     
 Number of pediatric attendees 313 304 278 267 
 Average age, y 8.4 NA 11.6 8.4 
 Race/ethnicity, %  
  Black/African American 87 95 85 69 
  White <1 
  Hispanic/Latino <1 
  Mixed/multiracial, other race 
  No answer NA 19 
Site information 
 Total number of sites 22 16 13 12 
 School 
 Community center 
 Church 21 11 
Self-reported medical home     
 Child… (%)     
  With a medical home 87 86 82 NA 
  Had a medical check-up in the past year 85 84 82 NA 
 2016201720182019
Pediatric attendee demographics     
 Number of pediatric attendees 313 304 278 267 
 Average age, y 8.4 NA 11.6 8.4 
 Race/ethnicity, %  
  Black/African American 87 95 85 69 
  White <1 
  Hispanic/Latino <1 
  Mixed/multiracial, other race 
  No answer NA 19 
Site information 
 Total number of sites 22 16 13 12 
 School 
 Community center 
 Church 21 11 
Self-reported medical home     
 Child… (%)     
  With a medical home 87 86 82 NA 
  Had a medical check-up in the past year 85 84 82 NA 

Beginning in 2017, targeted intervention was implemented to address low acceptance of influenza vaccinations.

NA, not available.

Influenza Vaccine

All participants were screened on whether their child had received an influenza vaccine for the current season; 31% (n = 360) reported already receiving an influenza vaccine. The eligible 802 children were offered the vaccine. We administered 600 pediatric influenza vaccinations between 2016 and 2019 (74.8% uptake among those eligible). Influenza vaccines increased in 2017 and 2018 and remained stable in 2019 (Table 2).

TABLE 2

Pediatric Influenza Vaccines and Preventive Screenings Administered at First Ladies for Health Annual Family Health Day, Cincinnati, OH, 2016-2019 (N = 802 Children Eligible for Influenza Vaccine of 1162 Total Pediatric Attendees)

2016201720182019
Influenza vaccines administered
Total: 600 (74.8% uptake) 
74 156 186 184 
Total preventive screenings provided 686 595 551 701 
2016201720182019
Influenza vaccines administered
Total: 600 (74.8% uptake) 
74 156 186 184 
Total preventive screenings provided 686 595 551 701 

Medical Home and Preventive Health Screening

Our event also included body mass index (BMI) calculation and dental, hearing, vision, and developmental screenings for participants. Over the 4 years, 2533 screenings were administered among 1162 youth participants. In each year that it was measured, >80% of children reported having a medical home and medical check-up in the past year (Table 1). Self-reported medical home was not collected in 2019. Of the children screened, 37.9% had abnormal BMI, 52.5% had abnormal dentition, and 29.7% had abnormal vision. Referrals and recommendations were made during the event for abnormalities. There was inconsistency in screenings conducted year-to-year and site- to-site, and screenings were optional for attendees.

By combining efforts with local leaders, we were able to provide influenza vaccinations to a local community and maintain vaccination levels for 3 years. We were able build on established trust between faith-based organizations and community members, and through this platform were able to provide reliable, accurate health information.

Our findings were limited in that measures used to collect data were not consistent year-to-year (eg, self-reported medical home was not collected in 2019; screenings were not collected consistently). In addition, there are no data on subspecialty visits resulting from abnormal screening assessments (ie, dental, developmental, vision, hearing, and BMI screenings). Ensuring the collection of consistent measures year-to-year will be an area of improvement for this advocacy work.

Our event targeted health care gaps in Black communities, where mistrust and vaccine hesitancy may be high, and was scheduled on Sunday to coincide with church service. This innovative advocacy intervention demonstrates how clinical staff, community volunteers, and faith-based organizations can collaborate to decrease disparities in vaccination rates for Black children. This may be even more relevant during the current COVID-19 pandemic, where vaccine hesitancy and misinformation hinder vaccination.1113  This collaboration with a faith-based organization may be an appropriate venue to expand access to COVID-19 and other vaccines. Future efforts may also be more successful with broader publicizing, such as through social media. As this event continues to grow, we are seeking additional ways to connect community members with needed services based on gaps identified through screening and facilitated by partnerships with trusted community leaders.

We intend to continue this event annually, to bolster influenza vaccination rates in our local community, build community trust in vaccination campaigns, and enhance community knowledge about vaccine safety, efficacy, and myths.

Sustaining this work will require continued relationship building with FLFH, as well as with the stakeholders at the schools, churches, and community groups that served as sites. This collaboration will prioritize the needs and desires of community members; continued relational investment will be key to ensuring that this event’s goals remain aligned with the values and needs of children and their families. Given the increase in vaccination over the 4-year period, it is evident that faith-based organizations can be effective partners in public health. These community connections can be leveraged for future health promotion and prevention campaigns.

Dr Corley analyzed the data and drafted the initial manuscript; Dr Crosby conceptualized the intervention, designed data collection instruments, collected data, and drafted the initial manuscript; Dr Mitchell conceptualized the intervention, designed data collection instruments, collected data, and drafted the initial manuscript; Ms Gomes conceptualized the intervention, designed data collection instruments, collected data, analyzed the data, and drafted the initial manuscript; Ms Hopkins, Ms Cranley, and Ms Lynch conceptualized the intervention, designed data collection instruments, and collected data. All authors reviewed, revised, and approved of the final manuscript, and agree to be accountable to all aspects of this work. All authors have volunteered participation in this advocacy event.

FUNDING: The First Ladies for Health is a nonprofit organization that relies on grants, donations, and volunteers.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

BMI

body mass index

CCHMC

Cincinnati Children’s Hospital Medical Center

FLFH

The First Ladies for Health

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