The Effect of Grade on Compliance Using Nonpharmaceutical Interventions to Reduce Influenza in an Urban Elementary School Setting

Objectives: The Pittsburgh Influenza Prevention Project (PIPP) has previously shown that school-aged children in grades K-5 can learn hygiene-based, nonpharmaceutical interventions (NPIs) and persist in these behaviors over the duration of an influenza season. The purpose of this study was to determine whether age (as estimated by grade) plays any role in this ability. Methods: The Pittsburgh Influenza Prevention Project is a prospective, controlled, randomized trial of the effectiveness of a suite of NPIs in 10 elementary schools. The project measured adoption of NPIs by students through surveys of intervention homeroom teachers before, during, and after the influenza season and control home-room teachers after influenza season. Results: There were large, statistically significant improvements and persistence over time across all grade levels, in students' concern about influenza and their daily practice of NPIs that promote health behaviors-wash or sanitize your hands often and cover your coughs and sneezes. Nonpharmaceutical interventions characterized as extinguishing unhealthy behaviors, such as avoid touching your eyes, nose, and mouth or home is where you stay when you are sick, showed no reliable improvement. Conclusions: The study provides evidence that elementary school-aged children, across all grades, can understand and implement protective NPIs and maintain these activities throughout influenza season and beyond. Improvements were most prominent when teaching students to engage in health-promoting behaviors. Habitual behaviors (unconscious touching) and changing family behaviors (staying home) seem less susceptible to intervention. These results will be useful to public health policy makers and health care practitioners considering methods of infectious disease prevention in school-based settings.