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H-E-B $300,000 Grant Funds Project
Some say three is a crowd.
HEB Fellows Karen Chronister, top, Mark Kabue and
Rachel Burrell look over a computerized mapping
program that tracks child immunization patterns in
Houston. Photo by Michele Mocco
But when the relationship includes The University of Texas School of Public Health at Houston, H-E-B Grocery Company and the City of Houston Department of Health and Human Services, the union is resulting in groundbreaking ways to improve Houston’s historically low immunization rate for young children.
The H-E-B Fellowships in Childhood Immunization Program is funded by a $300,000 grant to the UT School of Public Health from H-E-B, the largest privately held company in Texas. Each year, $20,000 vouchers are awarded to qualified students who then work part-time with the city’s health department.
The collaboration targets a serious problem: Houston’s appallingly low 65 percent immunization rate of young children (19 to 25 months) – a rate that is considered borderline for preventing an outbreak. The U.S. Centers for Disease Control and Prevention (CDC) recommends a vaccination rate nationwide of 90 percent.
Rates in Texas for vaccinating children aged 3 years and younger dropped to 75.4 percent statewide in 2004, placing Texas at 48th in the country. So alarming is this downward trend that the Texas Medical Association has launched a public service campaign called “Be Wise – Immunize” to remind parents of the importance of early immunizations.
Some of the diseases the CDC says vaccines can prevent include: measles, mumps, polio, rubella (German measles), pertussis (whooping cough), diphtheria, tetanus (lockjaw), Haemophilus influenzae type b (Hib disease, a major cause of bacterial meningitis), hepatitis B, varicella (chickenpox), and pneumococcal disease (causes of bacterial meningitis and blood infections).
Complex Reasons for Low Rate
H-E-B Fellowships project is revealing that the underlying reasons for the low vaccination rate are complex, including parents’ lack of information on the importance of immunizing children, fragmented record-keeping for at-risk children who move often, and health care providers who are not entering immunization data into the city and state immunization registry.
The goal of the H-E-B Fellowships is to find out how much each of these factors affects the rate and how many children actually are living unprotected.
“The reason vaccinations are so important is that they prevent death and disease in little kids – and also so that the younger kids don’t infect older kids and adults,” said Beatrice Selwyn, Sc.D., School of Public Health professor of epidemiology and project director. “The reported Houston rate is not as high as it needs to be to prevent outbreaks. You would think we would see an epidemic, but we haven’t – so we think the rate of vaccinations is probably better, but it’s not documented.”
Houston already is beginning to reap the rewards of the project with a Geographical Information System (GIS) that was developed last year, the first year of the project. H-E-B Fellows now are working to add other components, such as daycare centers, into the program. Some of the layers of the program include mapping bus lines and providers onto at-risk areas.
“The CDC is so excited. The GIS is the most wonderful tool. It tracks where babies are born and where the at-risk areas for low immunizations are located. That allows us to throw more resources there,” said Risha L. Jones, a registered nurse and chief of the city’s Immunization Bureau.
Jones said one of the biggest “deliverables” from the H-E-B Fellows this year is an attitude survey for doctors in order to find out, for example, how many are not linked to technology, which may be a stumbling block to reporting.
“We hope we are enriching a public agency,” said Kay Bartholomew, Ed.D., associate professor of behavioral sciences at the School of Public Health. “The H-E-B Fellows are able to spend a lot of time developing something significant and become part of an organization. We’ve been able to do a wide variety of projects, such as immunization service activities, the GIS mapping, and research, including how physicians can be helped.”
Textbook Theory into Practice
For the students, it’s a rare opportunity to put textbook theory into practice, a critical part of the development of future public health professionals.
“It takes practice to translate theory into application,” Selwyn said. “They know how to gather quality data, but they have no practice in how to translate that into a professional setting.”
Graduate students Mark Kabue and Karen J. Chronister, for example, have found that it takes longer than expected to do things such as interviews and inputting data.
“The challenge has been the work itself on the ground, things like interviewing people,” said Kabue, who is working with the city’s Vaccines for Children program to compare the rate of providers who use reminder/re-call systems and regular record updates to those who don’t. “In planning, it’s one thing to say you’re going to interview 100 people and it’s another to find out how long it takes to actually interview those people. It teaches you not to be so ambitious and think more about implementation.”
Chronister, who has worked on the GIS project for more than a year, said inputting data takes longer than she expected, and the experience has been invaluable.
“I have learned what it’s like to work at the health department. Before I didn’t understand the challenges they’re presented with,” Chronister said. “It’s been an eye-opening experience from that viewpoint. The bureau has been great to work with.”
None of this would be possible without the third partner – H-E-B, which has given generously to health care causes throughout the city.
Terrific Partner
“H-E-B has been a terrific partner, from the corporate office to the local store managers and staff. They have been unfailingly helpful and gone beyond funding in ways we could have never seen,” Bartholomew said.
In fact, the immunization project for children has led to another effort that deals with flu vaccinations and the elderly. The School of Public Health proposed mapping H-E-B stores onto the surrounding neighborhoods, interviewing and surveying customers, and holding focus group meetings in store break rooms. The proposal has received CDC funding.
“H-E-B has been more than just a funder,” Bartholomew said. “The flu study happened because of H-E-B’s backing, and it looked more appealing because of the first successful partnership.”
Also named 2005 H-E-B Fellows are graduate students Rachel Burrell and Diana Lemos. The first class of H-E-B Fellows in 2004 included Chronister and graduate students Elizabeth Sablotne and Mary Ann Livoti-DeBellis.
By Deborah Mann Lake