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Face masks may not be an effective intervention for seasonal or pandemic influenza unless the risk perception of influenza is high. Dissemination of culturally appropriate mask use information by health authorities and providers must be emphasized when educating the public.

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To determine whether provision of vaccine-health-literacy-promoting information in text message vaccine reminders improves receipt and timeliness of the second dose of influenza vaccine within a season for children in need of 2 doses.METHODS: During the 2012-2013 season, families of eligible 6-month through 8-year-old children were recruited at the time of their first influenza vaccination from 3 community clinics in New York City. Children (n = 660) were randomly assigned to "educational" text message, "conventional" text message, and "written reminder-only" arms. At enrollment, all arms received a written reminder with next dose due date. Conventional messages included second dose due date and clinic walk-in hours. Educational messages added information regarding the need for a timely second dose. Receipt of second dose by April 30 was assessed by using x 2 tests. Timeliness was assessed by receipt of second dose by 2 weeks after due date (day 42) using x 2 and over time using a Kaplan-Meier analysis.RESULTS: Most families were Latino and publicly insured with no significant between-arm differences between groups. Children in the educational arm were more likely to receive a second dose by April 30 (72.7%) versus conventional (66.7%) versus written reminder-only arm (57.1%; P = .003). They also had more timely receipt by day 42 (P , .001) and over time (P , .001).CONCLUSIONS: In this low-income, urban, minority population, embedding health literacy information improved the effectiveness of text message reminders in promoting timely delivery of a second dose of influenza vaccine, compared with conventional text messages and written reminder only. WHAT'S KNOWN ON THIS SUBJECT:Influenza vaccine coverage is low, and young children in need of 2 doses in a given season are at particular risk, with less than half receiving both doses. Text message vaccine reminders increase receipt of first dose of influenza vaccine. WHAT THIS STUDY ADDS:Little is known about what types of text message reminders are most effective, including embedding educational information. We demonstrate that text message reminders increase timely receipt of the second dose of influenza vaccine and embedding health literacy information improves effectiveness.