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Systematic Review
To determine whether monetary sanction policies increase vaccination rates among children in families receiving government assistance.
The CPSTF finds insufficient evidence to determine the effectiveness of monetary sanction policies to increase vaccination rates among children in families receiving government assistance. The Task Force finding is based on the small number of studies; differences in the type of sanction policies evaluated; inconsistent results on vaccination rates; and limited information on potential harms of these policies.
The Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (2 studies, search period January 1980-November 2009). A more recent search for evidence (search period 2009-February 2012) did not identify any new studies to be included in the systematic review. Both of the included studies were conducted in the United States and evaluated the implementation of state monetary sanction policies for families receiving assistance through the Aid to Families with Dependent Children (AFDC) program. The first study, a two-year randomized controlled trial of AFDC recipients in Maryland, evaluated outcomes in 1,324 children aged 3 to 24 months and observed no significant improvements in vaccination rates (decrease of -0.7 percentage points). The second study, a three-year randomized controlled trial of 2,500 families on AFDC assistance in Georgia, observed significant improvements in vaccination rates in children (increase of 11.8 percentage points).
This CPSTF report concludes that evidence on the broad range of potential outcomes of monetary sanction policies is insufficient to inform considerations on their use as an intervention option to increase vaccination rates. Programs that are considering the adoption of monetary sanctions should first determine the range of potential harms that may occur from these policies. Barriers to implementing monetary sanctions include: agencies might not adopt these policies because of concerns about harms to families or they may not enforce these policies with case workers unwilling to apply sanctions to families. The Georgia study examined the issuance of warnings and sanctions to families and found that both were infrequently applied.
Additional evidence is needed to determine if monetary sanction policies are effective and beneficial to the communities they address. If so, research is needed to identify common elements of successful policies and programs and explore the health and financial effects of these policies on families requiring assistance.