South-central Pennsylvania Research Articles

Individual differences in developmental trajectories of affective attention and relations with competence and social reticence with peers.

This study examined individual differences in affective attention trajectories in infancy and relations with competence and social reticence at 24 months. Data collection spanned 2017 to 2021. Infants (N = 297, 53% White, 49% reported as assigned male at birth) recruited in South Central and Central Pennsylvania and Northern New Jersey provided eye-tracking data at five assessments. Caregivers self-reported anxiety symptoms, infant temperamental negative affect, and infant competence at the final assessment. A subgroup of infants participated in a peer social dyad at the final assessment. Using group-based trajectory modeling, we found three groups of infants with different affective attention trajectories: affective attention increasers (n = 73), affective attention shifters (n = 156), and affective attention decreasers (n = 50). Affective attention increasers exhibited low intercepts with steep attention increases, particularly to angry facial configurations. Affective attention shifters exhibited middle intercepts with attention decreases to facial configurations but an attention increase to angry facial configurations. Affective attention decreasers exhibited high intercepts with steep attention decreases. Infants in the affective attention increasers group exhibited more competence when accounting for caregiver anxiety symptoms and infant temperamental negative affect. Group membership was not related to social reticence during the peer social dyad. Infants higher in temperamental negative affect exhibited more social reticence, particularly as the social dyad continued. Our results provide evidence for individual differences in developmental trajectories of affective attention and relations with toddler social behavior. Our results are primarily generalizable to rural and urban populations in the Midatlantic United States. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Personal, health system, and geosocial disparities in appointment nonadherence at family medicine clinics in southcentral Pennsylvania, United States.

To assess the relationship between patients' demographic, health system-related, and geosocial characteristics and the risk of missed appointments among patients in family medicine practice. The study was based on a retrospective cross-sectional design using electronic health records and neighborhood-level social determents of health metrics linked by geocoded patients' home address. The study population consisted of patients who had a primary care provider and at least one appointment at 14 family medicine clinics in rural and suburban areas in January-December 2022. Negative binomial regression was utilized to examine the impact of personal, health system, and geosocial effects on the risk of no-shows and same-day cancellations. A total of 258,614 appointments were made from 75,182 patients during the study period, including 7.8% no-show appointments from 20,256 patients. The analysis revealed that individuals in the ethnic minority groups were 1.24-1.65 times more likely to miss their appointments than their White counterpart. Females and English speakers had 14% lower risk for no-show. A significant increase (32%-64%) in the odds of no-shows was found among individuals on Medicaid and uninsured. Persons with prior history of no-shows or same day cancellations were 6%-27% more likely to miss their appointments. The no-show risk was also higher among people living in areas experiencing socioeconomic disadvantage. The risk of missed appointments is affected by personal, health system, and geosocial contexts. Future efforts aiming to reduce no-shows could develop personalized interventions targeting the at-risk populations identified in the analysis.

Exogenous Insulin Therapy Is Associated with the Risk of Advanced Colorectal Adenoma in Patients with Diabetes Mellitus.

Exogenous insulin therapy increases systemic exposure to insulin which may promote the development of colorectal neoplasia. We sought to evaluate the association between exogenous insulin therapy and the incidence of advanced adenoma in type 2 diabetes mellitus. A retrospective cohort study was conducted from January 1, 2007, to January 1, 2018, in a regional health system serving the United States Philadelphia metropolitan area, Central New Jersey, and South Central Pennsylvania. Study patients consisted of a random sample of patients with type 2 diabetes mellitus aged 40-80years who had undergone two rounds of colonoscopy examinations. The exposure was cumulative duration of insulin therapy (i.e., no use, 1-365days and > 365days). The outcome was time to incident advanced adenoma. Of the 975 eligible patients, 184 patients accumulated > 365days of insulin therapy before the follow-up colonoscopy. The mean (standard deviation) duration between the two rounds of colonoscopy examination was 5.1 (2.9) years among the insulin users and 5.3 (3.9) years among non-users. Compared to no insulin exposure, receiving > 365days of insulin therapy was associated with an increased incidence of advanced adenoma (adjusted hazard ratio [aHR] 4.84, 95% confidence interval [CI] 2.82-8.30), right-sided advanced adenoma (aHR 5.48, 95% CI 2.90-10.35), and 3 or more adenomas (aHR 2.61, 95% CI 1.46-4.69) at the follow-up colonoscopy examination. Insulin therapy is associated with an increased risk of advanced adenoma and may serve as a novel risk-stratification factor to enhance the efficiency of existing colorectal cancer screening and surveillance programs.

The Conewago Chapel

ABSTRACT In the 1600s Jesuit priests arrived in Maryland from England to start missions and spread the Catholic faith. Their work took root in Southcentral Pennsylvania with what would become known as the Conewago Chapel. From its beginnings in religious oppression and holding Mass in buildings that were not by law permitted to appear to be churches, with the efforts of many priests and parishioners through the years the Chapel is now an impressive brownstone church known as the Basilica of the Sacred Heart of Jesus.

Improving reflective evaluations of sport through repeated experiences of fun—rationale, design, feasibility, and acceptability of the PlayFit Youth Sport Program

IntroductionAdolescents who drop out of sport often report that it had become less ‘fun’ and ‘enjoyable’ over time. Although preadolescent sport typically emphasizes experiences of fun, emphases on competition and elite performance often dominate during adolescence. We theorized that adherence to adolescent sport might be improved if the overarching goal were to maximize repeated experiences of fun during sport and, subsequently, increase reflective evaluations of sport enjoyment. To that end, this manuscript reports on the rationale and design of the PlayFit Youth Sport Program (PYSP), as well as its preliminary feasibility and acceptability. The main objectives were to evaluate the feasibility of recruitment strategies and data collection procedures and the acceptability of the intervention.SettingAn outdoor, multipurpose grass field at a south-central Pennsylvania middle school.MethodsA mixed-methods, single-arm feasibility trial lasting for 8 weeks (August–October 2021) offered 3-times per week for 1-h per session. The equipment, ruleset, and psychosocial environment of the PYSP sport games were modified to reduce several of the constraints theorized to impair experiences of fun during sport and hamper reflective evaluations of enjoyment afterward. ResultsEleven healthy, but sedentary adolescents in grades 5–7 completed the program. The median number of sessions attended (of 16 possible) was 12 (range = 6–13). Post-intervention, 9/10 respondents indicated that they ‘looked forward’ to the PYSP, 8/10 would recommend it to a friend, and 8/10 were interested in continuing the program. Ten of 11 participant guardians expressed interest in reenrolling their children if the PYSP were offered again. Some changes recommended were to improve recruitment via advertising the positive aspects of the program and “word of mouth” techniques, offering the program immediately following the school day, having contingencies for inclement weather, and minor changes to the sport equipment to improve the experience among the population the PYSP intends to attract.ConclusionsThe adjustments recommended in this preliminary work could be used to further refine the PYSP. A future efficacy trial could explore whether the PYSP may reduce attrition for adolescents who experience existing sport programs negatively by offering an alternative that better matches their unique needs and preferences.

Distribution of Hay-Hole Covers Prevents Injuries from Falls Through Hay Holes.

Hay-holes are openings on the second floor of barns used to drop feed to ground level. Hay-hole falls (HHFs) are a unique problem among Anabaptist communities, especially for children. To follow-up on our previous study that created the Anabaptist Youth Trauma Prevention Consortium with distribution of 231 hay-hole covers in South Central Pennsylvania, we compared a five-year period before cover distribution with the 5-year period after. Data were stratified by phase: Before Cover Implementation (BC): 1/2011-12/2016, After Cover Implementation (AC): 1/2017-12/2021. 49 patients met inclusion criteria. There was a 47% decrease in the number of HHF from the BC phase to the AC phase, suggesting that cover distribution has significantly impacted HHF incidence. Further investigation is needed to elucidate the long-term impact of cover distribution and to guide future interventions, such as another round of cover distribution or improvements in the design of these covers for long-term use.

Demography of a painted turtle intergrade (Chrysemys picta picta X C. p. marginata) population from an altered wetland

The demography of a painted turtle Chrysemys picta picta X C. p. marginata population from a eutrophic habitat was examined at a wetland site in south-central Pennsylvania (USA) during 2011–2019. Males reached sexual maturity at 90 mm carapace length (CL) in half the time taken, but at the same size, as painted turtles studied elsewhere in the north-eastern portion of the United States. Females matured at 130 mm CL at our site, which was larger and began at an earlier age than conspecifics. Our data corroborate findings of faster growth in C. picta juveniles resulting in earlier maturity at body sizes equal to or larger than slower growing juveniles. Our results also conform to previous findings linking wetlands altered by added nutrient input to increased growth patterns of their resident painted turtle population. Rapid growth rates for aquatic turtles are likely to become more common globally as urbanisation continues to expand and alter wetland habitats.

Troublesome Women: Gender, Crime, and Punishment in Antebellum Pennsylvania

Troublesome Women: Gender, Crime, and Punishment in Antebellum Pennsylvania

Movement of white‐tailed deer in contrasting landscapes influences management of chronic wasting disease

AbstractChronic wasting disease (CWD) continues to expand in distribution and prevalence across North America. Upon detection, either for the first time in a novel area or in a region with an existing outbreak, wildlife management agencies are tasked with responding to mitigate the disease. This response often entails creation or modification of a management zone with modified rules and regulations that support an agency's disease management plan. To guide the process of creating an appropriately sized CWD management zone, assuming that wild deer movements are a major risk factor for disease spread, we used data from global positioning system (GPS)‐collared white‐tailed deer (Odocoileus virginianus) in southeastern Minnesota and southcentral Pennsylvania, USA, between 2018 and 2021 to estimate long‐distance movements associated with dispersal and migratory behaviors. These contrasting study areas with active CWD outbreaks permitted an evaluation of deer movement dynamics in different parts of their range. We quantified the proportion, distribution, timing, and orientation of dispersing and migratory deer. We observed 21% of female and 58% of male yearlings disperse from their apparent natal home range in Minnesota, while in Pennsylvania 4% of female and 68% of male yearlings dispersed. We also documented 20% of females and 6% of males migrated between seasonal home ranges in Minnesota, while in Pennsylvania no females and 5% of males migrated. The average distance deer dispersed or migrated in Minnesota was 20 km and 11 km, respectively, while in Pennsylvania male deer dispersed only about 4 km. Both sexes in Minnesota tended to disperse in a consistent, westerly direction; however, there was no directional preference observed for migratory deer or for dispersing deer in Pennsylvania. We found differences between natal and adult home range size for both sexes in Minnesota but not for males in Pennsylvania. Our results identify the considerable variability in dispersal and migration dynamics of white‐tailed deer in disparate landscapes, which is important to agencies managing CWD. We summarize the distribution of these movements and suggest agencies use this information to help make decisions about optimal management zone size. We suggest the development of formalized assessments of the tradeoffs associated with optimizing decisions about creation of CWD management zones across white‐tailed deer populations that exhibit variation in dispersal behavior and suggest careful evaluation to avoid using an arbitrary size or shape to create disease management zones.

Implementation of Interprofessional Meetings Preparing Caregivers of Patients With Brain Injury for Discharge: A Pilot Study.

Caregivers are often unprepared to care for patients discharged with brain injury. Interprofessional team meetings with the caregiver used in some specialties improve discharge planning. The purpose of this study was to evaluate the effect of a standardized interprofessional caregiver meeting on caregiver readiness for caregiving. The study was implemented on an eight-bed brain injury unit within a 73-bed Magnet-designated surgery and rehabilitation hospital in south central Pennsylvania. This study used a pre-/post-quasi-experimental retrospective design. Caregivers of patients admitted to the brain injury unit completed the Preparedness for Caregiving Scale at admission and discharge. The intervention group received an interprofessional team meeting focused on the needs of the caregiver in preparation for caregiving within 3-4 days of admission compared with unscheduled meetings as needed. Scores improved significantly from admission to discharge in usual care and intervention groups. Sample size was insufficient to detect differences between groups. Health care providers and caregivers expressed improvement in communication and readiness for discharge. Early interprofessional meetings with the purpose of getting to know and understanding the needs of caregivers of patients with brain injury could guide us to better prepare the caregiver for caregiving at home. The Preparedness for Caregiving Scale can be useful to assess multiple domains of caregiving. This proactive approach may improve communication and discharge readiness for patients with brain injury.

Small anthropogenic landforms from past charcoal production control moisture dynamics and chemistry in northcentral Appalachian soils

Throughout the northeastern United States (U.S.) and Europe, relict charcoal hearths (RCHs) are regularly being discovered in proximity to furnaces once used for the extraction of metal from ore or quick-lime production; charcoal produced in hearths was used as a furnace fuel. Given previous research has shown that topographic and subsurface disturbance can be great when a hearth is constructed, we hypothesize that hearth construction alters surface hydrology and soil chemistry in environments in and near hearths. We used a landscape classification process to identify 6758 hearths near furnaces at Greenwood and Pine Grove Furnace State Park, central and southcentral Pennsylvania, U.S. Two types of digital elevation model wetness indexes were used to quantify surface hydrology effects in and around hearths. Modeled wetness conditions were compared to field soil volumetric water content in RCHs near Greenwood Furnace State Park. Modeled wetness indexes indicate that RCH interiors are significantly wetter than RCH rim areas; RCHs are acting as a landscape moisture sink. Results also indicate that RCHs on slopes result in downslope drier conditions below RCHs. Field measured volumetric water content indicates that as distance from the center of the hearth increases, soil moisture significantly decreases. Geomorphic position was found to not be related to RCH wetness. Soil from RCHs, compared to nearby native soils, has significantly higher total C, a lower Mehlich 3 extractable acidity, higher Ca and P. No trend was evident with RCH soil chemistry and geomorphic position. The high frequency of RCH occurrence, in proximity to the furnace's RCHs supported, suggests that RCHs today could locally be an important niche for understory flora and fauna. Further research could explore how RCHs might be affecting surrounding plant populations and how within RCH patterns, especially on hillslopes, might represent a distinctly different scale of physical and chemical variability.

Larval Growth to Metamorphosis in the Northern Green Frog (Lithobates clamitans melanota) in a South Central Pennsylvania Pond during 2009–2016

Abstract A measure of predictability exists in geographic variation in some of the life history traits of the green frog, Lithobates clamitans. A long breeding and larval transformation season and a small transformation body size of this species in the southern United States give way to opposite patterns farther north. Overwintering of tadpoles occurs northward in its range and eventually typifies many northern populations. Our examination of larval growth and transformation in the northern green frog, L. clamitans melanota, corroborated findings of intermediacy in duration of transformation season (May–August) and mean transformation body size (30 mm) of mid-Atlantic populations. The latter finding may be obscured by metamorphoslings (32 mm) during May–June, presumed to have overwintered and therefore larger than those that transformed in August (29 mm) of the same year they hatched. It remains unknown how often two cohorts emerge within or between years in Pennsylvania. The potential for a warming climate to predispose this species to more frequent within-year transformation of smaller individuals akin to present-day southerly populations should be investigated.

“It Can Be Done Much Faster!”: The Transition from the Samuel G. Dixon State Hospital to the South Mountain Restoration Center

ABSTRACT The South Mountain Restoration Center currently is a Pennsylvania state-owned long-term care center, but it traces its beginnings to a small camp for consumptives in the early 1900s. From this camp, high atop a mountain in rural southcentral Pennsylvania, the Center transformed itself in the 1930s into a state-of-the art tuberculosis sanatorium. In the 1960s it reinvented itself as a geriatric center that stood at the forefront of the Commonwealth’s services for the aging. An examination of the pivotal years 1965–68, when the sanatorium gave way to the restoration center, will show how the state government’s rush to empty overcrowded state schools and hospitals led to the successful creation of the Center, even though its rural location meant it did not meet all of the state’s criteria. This article demonstrates the challenges the state experienced in transitioning the facility from one type to another.

The use of emotional intelligence skills in combating burnout among residency and fellowship program directors

BackgroundCurrent rates of burnout among physicians are alarming when compared to nonphysician U.S. workers, and numerous interventions have been introduced to mitigate the issue. However, no interventions have specifically targeted the 30% burnout rate among physician program directors. The complex and demanding role of program directors necessitates building relationships, solving crises, securing jobs for residents and maintaining well-being of trainees. The aim of this study is to investigate the impact of emotional intelligence (EQ) on burnout levels among program directors.MethodsA cross-sectional survey was administered from May 17 to June 30, 2021 to program directors and assistant/ associate program directors at an academic medical center in south-central Pennsylvania. A self-report questionnaire was used to collect data. The survey included an open-ended question along with the Trait Emotional Intelligence Questionnaire- Short Form (TEIQue-SF), Copenhagen Burnout Inventory (CBI), and demographic questions. All data were analyzed using SAS Version 9.4.ResultsOf the 109 program directors and assistant/associate program directors invited in the survey, 34 (31.20%) responded. The findings indicate that there is a moderate inverse association between EQ and burnout, suggesting EQ as a protective factor against burnout. We also found that program directors who were considering leaving their position demonstrated higher levels of burnout compared to those who did not. Results from the open-ended question suggest that perceived lack of support, micromanagement, criticism, and extra duties with less payment were among the reasons program directors and associates were considering steeping down from their position. The results showed no association between EQ skills and years of practicing.ConclusionsBurnout among program directors and assistant/associate program directors is not as alarming as rates of burnout among physicians-in-training. However, despite high level of EQ skills and low burnout level, nearly 43% of program directors were considering leaving their position. Nurturing EQ skills may be useful in improving retention and reducing turnover among medical leaders.

Genetic Diversity and Wolbachia (Rickettsiales: Anaplasmataceae) Prevalence Within a Remnant Population of Regal Fritillary, Argynnis idalia (Lepidoptera: Nymphalidae), in South-Central Pennsylvania.

Eastern populations of the North American regal fritillary, Argynnis idalia Drury (1773), have been largely extirpated over the past half century. Here we report on the last remaining population of eastern regal fritillaries, located within a military installation in south-central Pennsylvania. Samples were obtained from field specimens during two years of annual monitoring, and from females collected for captive rearing over a five year period. Nuclear microsatellite and mitochondrial sequence data do not suggest subdivision within this population, but excess nuclear homozygosity indicates negative impacts on genetic diversity likely due to small population size and potential inbreeding effects. Molecular assays did not detect Wolbachia endosymbionts in field specimens of regal fritillary, but sympatric Argynnis sister species showed high prevalence of Wolbachia infected individuals. Our results inform ongoing conservation and reintroduction projects, designed to protect the last remaining regal fritillary population from extirpation in the eastern United States.

Toward the Development of a Unified Process and Methodology Guide for Environmental Justice Analysis in Planning and Programming

Federal Environmental Justice directives require transportation agencies responsible for planning and programming federal funds, including state departments of transportation and metropolitan planning organizations (MPOs), to identify and address disproportionately high and adverse human health and environmental impacts on minority and low-income populations. Despite issuance of federal and state guidance and training programs, many MPOs nationwide continue to seek clarity on effective environmental justice (EJ) approaches and procedural considerations. The South Central Pennsylvania Unified EJ Process and Methodology study was a year-long effort undertaken by a consortium of MPOs in Pennsylvania Department of Transportation (PennDOT) District 8 to identify a unified and replicable approach to implementing EJ in transportation planning. PennDOT, Federal Highway Administration PA Division, and Federal Transit Administration Region III provided technical assistance and support to the effort. The consortium engaged a technical assistance consultant to facilitate a collaborative process to identify a process framework, a set of analytical methodologies, and effective strategies for advancing EJ in the regional transportation planning process. The study demonstrated a model for convening regional, state, and federal partners to reach consensus around an effective EJ process and methodology. This paper provides an overview of the study process, findings related to the concerns of the participating MPOs, and a brief description of the recommended analytical approaches. The paper discusses lessons learned during the course of the study and considers additional work required to further enhance the EJ process.

Evidence of Intraguild Predation in a Snake Assemblage: Bigger Seems Better

Intraguild predation can play a significant role in structuring species composition with intraguild prey under both competitive and predatory pressure from intraguild predators. How intraguild prey are able to persist at sites with their predators is a complex issue with empirical evidence not always supporting theoretical models, indicating a need for more in situ research. A prominent grassland predator in the south central region of Pennsylvania, Coluber constrictor constrictor (Northern Black Racer), co-occurs with potential prey snakes including Lampropeltis triangulum (Eastern Milksnake) and Thamnophis sirtalis sirtalis (Eastern Gartersnake). Starting in 2008, this 7-year study examined how intraguild predation may differentially influence the body size and demographic traits of prey species in south-central Pennsylvania at sites with and without Northern Black Racers. The body size of adult Eastern Milksnakes was unaffected by the presence of racers. Eastern Milksnakes were more abundant, but with fewer juveniles, at racer-present sites. Adult female Eastern Gartersnakes were larger in body size, and adult males were less frequently encountered, in racer-present sites. These results indicate that intraguild predation in a snake community may affect the body size and demographic traits of prey species differentially, likely through predatory exclusion. However, the exact mechanisms behind our findings, and the resulting dynamics of snake diversity, are unclear and require further analyses.

Non-Invasive Core Temperature Monitoring System: Providing Consistent, Reliable Temperature Measurement in the Perianesthesia Patient

<h3>Background Information</h3> Maintaining normothermia (core body temperature 96.8°F to 100.4°F) is imperative in the perianesthesia patient. Anesthesia and environmental factors affect the patient's ability to regulate body temperature. An average adult's core body temperature may drop approximately 2.7°F (1.5°C) with general anesthesia. Undetected hypothermia in the perianesthesia setting can increase the incidence of surgical site infection, cardiac arrythmias, blood loss, altered medication metabolism, pain perception, and increase length of recovery time and length of hospital stay. One hospital in South Central Pennsylvania identified inconsistent temperature measurement practices throughout each phase of surgical care. Various forms of temperature measurements were used on the same patient (oral, rectal, temporal-artery, esophageal, pulmonary artery temperatures). Each of these techniques has varying reliability, which created variability and inconsistency in hypothermia treatment. <h3>Objectives of Project</h3> Develop a consistent technique for temperature measurement throughout the perioperative setting. Non-invasive core temperature monitoring is evidenced as a valid and reliable tool for perianesthesia patients. <h3>Process of Implementation</h3> Implemented a non-invasive core temperature monitoring system and educated all nursing and anesthesia staff members in the perianesthesia and perioperative settings. <h3>Statement of Successful Practice</h3> Non-invasive core temperature monitoring was utilized throughout all phases of surgical patient care. Initial data shows undetected hypothermia as a significant problem previously undetected with less reliable, inconsistently used measures. Heightened awareness among staff has increased active warming measures in the Post Anesthesia Care Unit prior to discharge. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Early identification and intervention for hypothermia is imperative for improved outcomes with the surgical patient. The literature lacks recommendations for a standard length of time for temperature monitoring after normothermia returns and active warming has ceased. This project has stimulated an interest in a multidisciplinary original research project regarding thermoregulation after anesthesia and the reoccurrence of hypothermia after active warming measures have ceased.

Preparation to Prevent, Detect, and Manage Fraud: A Study of Not-for-Profits in South Central Pennsylvania

Fraud is an expanding problem in not-for-profit organizations; the lack of fraud-prevention preparation by NFP financial professionals contributes to the problem. A gap in existing research yields limited data regarding fraud prevention training and preparation of NFP professionals. This study examines existing research regarding fraud, and techniques used to train and prepare professionals to prevent, detect, and manage fraud. A qualitative exploratory case study design is used; fifteen participants achieved data saturation. The data revealed one major theme and four minor themes. Those themes indicate a need for additional fraud research in NFPs. Suggestions for further preparation for NFP professionals are offered.

Early influenza vaccination rates decline in children during the COVID-19 pandemic

BackgroundThis investigation sought to determine whether early season rates of pediatric influenza vaccination changed in a season when there was a concurrent COVID-19 pandemic. MethodsThis study used cohort and cross sectional data from an academic primary care division in Southcentral Pennsylvania that serves approximately 17,500 patients across 4 practice sites. Early season (prior to November 1) vaccination rates in 2018, 2019 and 2020 were recorded for children, age 6 months to 17 years. To explore the impact of COVID-19 on vaccination, we fit a model with a logit link (estimated via generalized estimating equations to account for clustering by patient over time) on calendar year, adjusted for race, ethnicity, age, and insurance type. We examined interaction effects of demographic covariates with calendar year. ResultsEarly vaccination rates were lower in 2020 (29.7%) compared with 2018 and 2019 (34.2% and 33.3%). After adjusting for covariates and accounting for clustering over time, the odds of early vaccination in 2020 were 19% lower compared to 2018 (OR 0.81, 95% CI: 0.78–0.85). In 2020, children with private insurance were more likely to receive early vaccination than in 2018 (OR 1.51, 95% CI: 1.04–1.15), whereas children with public insurance were less likely to receive early vaccination in 2020 than in 2018 (OR 0.62, 95% CI: 1.38–1.65). ConclusionsEarly influenza vaccination rates declined in a year with a concurrent COVID-19 pandemic. Modeling that accounts for individual trends and demographic variables identified specific populations with lower odds of early vaccination in 2020. Additional research is needed to investigate whether the COVID-19 pandemic impacted parental intent to obtain the influenza vaccine, or introduced barriers to healthcare access.