Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

TEXTFLUENZA: Using technology to promote flu vaccination in underserved maternal and child populations

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Project Number: R40 MC 17169-02
Grantee: Columbia University
Department/Center: Pediatrics/General Pediatrics
Project Date: 2/1/2010

Final Report


Principal Investigator

Melissa S. Stockwell, MD, MPH
Assistant Professor of Clinical Pediatrics
622 W 168th VC402
New York, NY  10032
Phone: 212-342-5732


  • Women/Maternal
  • Prenatal
  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)


In 2008, the Advisory Committee on Immunization Practices (ACIP) issued a new recommendation that the flu vaccine be administered annually to all children aged 6 months - 18 years starting in the 2009 -10 influenza season. Pandemic threats such as SARS and H1N1 have highlighted the importance of effective public health strategies to rapidly deliver vaccine to individuals at risk for developing severe disease and to populations most likely to further community-level transmission. Nevertheless, targeting and mobilizing these populations has been difficult and influenza immunization rates nationwide remain low. Immunization reminder-recalls have been shown to be effective, but have had limited ability to rapidly identify and reach large target populations in a cost-effective manner. Targeted text message alerts may offer an innovative opportunity to improve vaccination coverage. Evidence on how to optimally design these systems is not yet available and thus text message immunization alerts have not been widely implemented. Prior research by our team suggests that immunization text message alerts may be both effective and well accepted by parents. Results from our adolescent text messaging project, Text4Health, show great promise with 26.7% of the 183 parents texted returning for a subsequent immunization compared to 12.1% of 173 parents in the control group (p<.001) (unpublished data). Encouraged by these results, we propose to implement and evaluate, using randomized control trials (RCT), tailored, targeted influenza text message reminders in urban pediatric and pregnant populations. Data collection and delivery of text message alerts will be done through the integration of our text messaging platform with an existing immunization registry and the electronic health records of pregnant women. Our methodologies are designed to address key barriers to adoption and scalability and to increase vaccine access for low-income populations. The proposed interventions address several MCH strategic issues. First, they will help to identify strategies to rapidly notify vulnerable children and pregnant women of influenza vaccine need and availability. Our proposal would also fill a knowledge gap, as interventions to improve vaccine coverage among pregnant women are scant. Furthermore, cell phone based interventions may help eliminate disparities in immunization coverage, as text messages may be more effective in reaching low-income populations. Furthermore, the proposed research is aligned with the Healthy People 2010 goals of increasing immunization coverage of children, adolescents and high-risk adults. This research aims to pave the way to develop a "best practice", allowing any immunization registry, electronic medical record, or department of health, or large group practice employ this technology to improve immunization coverage in maternal and child populations.


Listed is descending order by year published.

Stockwell MS, Westhoff C, Kharbanda EO, et al. Influenza vaccine text message reminders for urban, low-income pregnant women: a randomized controlled trial. Am J Public Health. 2014 Feb;104 (Suppl 1):e7-12.

Stockwell MS, Kharbanda EO, Martinez RA, Vargas CY, Vawdrey DK, Camargo S. Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. JAMA. 2012 Apr 25;307(16):1702-8. PubMed PMID: 22535855.

Kharbanda EO, Vargas CY, Castaño PM, Lara M, Andres R, Stockwell MS. Exploring pregnant women's views on influenza vaccination and educational text messages. Prev Med. 2011 Jan;52(1):75-7.


Immunization, Health Information Technology, Pregnancy, Health Disparities, Access to Health Care

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