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Randomized Controlled Trial
. 2017 Jul 24;35(33):4213-4219.
doi: 10.1016/j.vaccine.2017.06.029. Epub 2017 Jun 21.

The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake

Amy L Baxter  1 , Lindsey L Cohen  2 , Mark Burton  3 , Anaam Mohammed  4 , M Louise Lawson  5
Affiliations
Randomized Controlled Trial

The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake

Amy L Baxter et al. Vaccine. .

Abstract

Purpose: Fear of needles develops at approximately five years of age, and decreases compliance with healthcare. We sought to examine the relationship of preschool vaccine history, parent and preadolescent needle fear, and subsequent compliance with optional vaccines.

Methods: As part of a private practice randomized controlled trial, parents and 10-12year olds rated needle anxiety on a 100mm visual analog scale. This follow-up cohort study compared their needle anxiety to previous vaccination records, including number of vaccinations between ages four and six years (total and same-day maximum), and subsequent initiation of the HPV vaccine through age 13.

Results: Of the 120 preadolescents enrolled between 4.28.09 and 1.19.2010, 117 received preschool vaccinations between ages four and six years. The likelihood of being in the upper quartile of fear (VAS≥83) five years later increased with each additional same-day injection (OR=3.108, p=0.0100 95%CI=1.311, 7.367), but was not related to total lifetime or total four-to-six year injections. Only 12.5% (15) of parents reported anxiety about their preadolescents' vaccines (VAS>50). Parent and child anxiety was weakly correlated (r=0.15). Eight children in the upper fear quartile began their HPV series (26.67%) compared to 14 in the lower quartile (48.28% VAS<32) (OR 2.57, p=0.0889, 95%CI 0.864-7.621); there was no difference in HPV uptake between upper and lower quartile of parent anxiety.

Conclusions: The more same-day preschool injections between 4 and 6years of age, the more likely a child was to fear needles five years later. Preadolescent needle fear was a stronger predictor than parent vaccine anxiety of subsequent HPV vaccine uptake.

Keywords: Adherence; HPV; Needle fear; Pain; Vaccine Hesitancy; phobia.

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Conflict of interest statement

Conflict of Interest: Dr. Baxter invented Buzzy and is the CEO of MMJ Labs, the manufacturer of Buzzy®. This conflict of interest was disclosed to participants in the informed consent. After orientation of enrollers employed by the hospital, Dr. Baxter was not present for data collection. Dr. Cohen, who has no financial conflict of interest to disclose, recruited study coordinators.

Declaration of Interests

The initial NIH grant supported research and development of a needle pain device created by Amy Baxter MD. Dr. Baxter created a company to manufacture and market the device, and has subsequent conflict of interest; this study does not refer to the device. Lindsey Cohen PhD, M. Louise Lawson PhD, and Mark Burton have no conflicts of interest. Anaam Mohammed worked as a study coordinator for Dr. Baxter when she ran a pediatric emergency research division but otherwise has no conflict of interest. All funding for the study was provided by the NIH grant 4R44HD056647-02.

Figures

Figure 1
Figure 1
Consort Diagram
Figure 2
Figure 2
Vaccine anxiety of parents and vaccination fear of children at age 10–12 Parents (blue) and children (red) rated their anxiety on a VAS with the prompt “How anxious are you about your (your child’s) injections today?” Anchors were “Not at all anxious” and “Most anxiety possible”. Parent and child anxiety correlated poorly, with the mode pediatric response being “most anxiety possible” and mode parent response least anxiety possible.
Figure 3
Figure 3
Parent’s assessment of their child’s anxiety compared to child’s report. Parent and child anxiety was poorly correlated, suggesting that older children’s anxiety is not linked to parental anxiety at the time of vaccination.
Figure 4
Figure 4
Quartile of needle fear at age 10–12 compared to maximum number of same day injections at age 4–6 years. Fear of injections at age 10–12 related to the maximum number of injections children received on the same day during the preschool vaccination period.
Figure 5
Figure 5
Subsequent initiation of HPV Vaccine by high and low quartiles of parent anxiety and child fear. Initiation of the HPV vaccine series was more strongly influenced by the child’sfear of needles than the parent’s anxiety about vaccination.
See this image and copyright information in PMC

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