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Di Lorenzo A, Bianchi FP, Martinelli A, Lattanzio S, Carbonara A, Diella G, Tafuri S, Stefanizzi P. Safety Profile of Recommended Vaccinations in Adolescents: Data from Surveillance of Adverse Events Following Immunization in Puglia (Italy), 2016-2020. Vaccines (Basel) 2021; 9:vaccines9111302. [PMID: 34835232 PMCID: PMC8625412 DOI: 10.3390/vaccines9111302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022] Open
Abstract
Adolescence is a critical period for immunization, in which the adhesion rate to recommended vaccinations is often lower than desired. Since the safety of new vaccines is one of the most important factors determining vaccination hesitancy, post-marketing surveillance of adverse events following immunization (AEFIs) is recommended by the World Health Organization (WHO) to better understand the safety of these drugs. This report describes AEFIs notified in Puglia (Italy) after recommended vaccinations in adolescents aged 12 to 18 years in 2016–2020 to determine the safety profile of these products in a real-life scenario. This is a retrospective observational study. Data were gathered from the list of AEFIs notified in subjects between 12 and 18 years of age following administration of recommended vaccines in Puglia in 2016–2020. AEFIs were classified according to the WHO’s decisional algorithm, and causality assessment was carried out for serious AEFIs. From 2016 to 2020, 323,627 doses of vaccine were administered to adolescents in Puglia and 50 AEFIs were reported (reporting rate: 15.4 × 100,000 doses). Of these, 17 (34.0%) were classified as serious, and causality assessment identified 13 of them (76.5%) as vaccine related. The most common symptoms were local reactions, fever and neurological symptoms. No deaths were notified. The benefits of immunization in adolescents appear to be greater than the risk of AEFIs for all studied vaccines; in fact, AEFIs occur in less than 0.1‰ of patients and are generally mild and self-limiting.
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Affiliation(s)
| | | | | | | | | | | | - Silvio Tafuri
- Correspondence: ; Tel.: +39-0805594275; Fax: +39-0805478472
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Van Cleave J. New Directions to Improve Preventive Care Discussions for Adolescents and Young Adults. Pediatrics 2019; 143:peds.2018-3618. [PMID: 30651305 DOI: 10.1542/peds.2018-3618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeanne Van Cleave
- Children's Hospital Colorado and Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado
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Abstract
The adolescent period heralds the pediatric patient's transition into adulthood. It is a time of dynamic development during which effective preventive care measures can promote safe behaviors and the development of lifelong health habits. One of the foundations of preventive adolescent health care is timely vaccination, and every visit can be viewed as an opportunity to update and complete an adolescent's immunizations.In the past decade, the adolescent immunization schedule has expanded to include 2 doses of quadrivalent meningococcal conjugate vaccine, 1 dose of tetanus, diphtheria, acellular pertussis, absorbed vaccine, 2 or 3 doses of human papillomavirus vaccine, depending on the child's age, and an annual influenza vaccine. In addition, during adolescent visits, health care providers can determine whether catch-up vaccination is needed to meet early childhood recommendations for hepatitis B; hepatitis A; measles, mumps, rubella; poliovirus; and varicella vaccines. New serogroup B meningococcal vaccines are now available for those at increased risk for meningococcal disease; in addition, these serogroup B meningococcal vaccines received a Category B recommendation for healthy adolescents, where individual counseling and risk-benefit evaluation based on health care provider judgements and patient preferences are indicated. This clinical report focuses on the epidemiology of adolescent vaccine-preventable diseases by reviewing the rationale for the annual universally recommended adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. In addition, the barriers that negatively influence adherence to this current adolescent immunization schedule will be highlighted.
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Affiliation(s)
- Henry H Bernstein
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York; and
| | - Joseph A Bocchini
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Ramos MM, Sebastian RA, Murphy M, Oreskovich K, Condon TP. Adolescent substance use: Assessing the knowledge, attitudes, and practices of a school-based health center workforce. Subst Abus 2017; 38:230-236. [PMID: 28328312 DOI: 10.1080/08897077.2017.1287149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent attention has focused on the potential for school-based health centers (SBHCs) to provide access points for adolescent substance use care. In 2015, the University of New Mexico began screening, brief intervention, and referral to treatment (SBIRT) training for providers at New Mexico Department of Health (NMDOH)-funded SBHCs across the state. This study assesses baseline knowledge, attitudes, and practices of the New Mexico SBHC provider workforce regarding adolescent substance use and provision of services. METHODS In early 2015, the NMDOH administered an SBHC provider workforce survey (N = 118) and achieved a 44.9% response rate. This descriptive analysis includes all survey respondents who self-identified as a primary care or behavioral health provider in an SBHC serving middle or high school students (n = 52). RESULTS Among respondents, the majority (57.7%) were primary care providers, including nurse practitioners, physicians, and physician assistants. The remaining 42.3% of respondents were master's-level behavioral health providers. Only 44.2% of providers reported practicing the full SBIRT model at their SBHC, and 21.2% reported having received continuing education on SBIRT within the previous 3 years. Most respondents, 84.6%, agreed that it is the responsibility of SBHC providers to screen students for substance use using a standardized tool, and 96.2% agreed that it is the responsibility of the SBHC provider to assess for students' readiness to change. A majority reported self-efficacy in helping students achieve change in their alcohol use, illicit drug use, and prescription drug misuse: 73.1%, 65.4%, and 63.5%, respectively. CONCLUSIONS These results suggest that SBIRT training for New Mexico SBHC providers is timely. The authors identified gaps between recommended SBIRT practices and SBIRT delivery as well as discrepancies between reported provider self-efficacy and actual implementation of the SBIRT model. Further study will determine the effectiveness of efforts to address substance use and implement SBIRT in SBHCs.
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Affiliation(s)
- Mary M Ramos
- a Department of Pediatrics , University of New Mexico School of Medicine , Albuquerque , New Mexico , USA.,b Envision New Mexico , Albuquerque , New Mexico , USA
| | | | - Mary Murphy
- c University of New Mexico School of Medicine , Albuquerque , New Mexico , USA
| | - Kristin Oreskovich
- d Office of School and Adolescent Health , Albuquerque , New Mexico , USA
| | - Timothy P Condon
- e Center on Alcoholism, Substance Abuse and Addictions , University of New Mexico , Albuquerque , New Mexico , USA
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Jeyarajah J, Elam-Evans LD, Stokley S, Smith PJ, Singleton JA. Human Papillomavirus Vaccination Coverage Among Girls Before 13 Years: A Birth Year Cohort Analysis of the National Immunization Survey-Teen, 2008-2013. Clin Pediatr (Phila) 2016; 55:904-14. [PMID: 26603581 PMCID: PMC8591583 DOI: 10.1177/0009922815616245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Routine human papillomavirus (HPV) vaccination is recommended at 11 or 12 years by the Advisory Committee on Immunization Practices. National Immunization Survey-Teen data were analyzed to evaluate, among girls, coverage with one or more doses of HPV vaccination, missed opportunities for HPV vaccination, and potential achievable coverage before 13 years. Results were stratified by birth year cohorts. HPV vaccination coverage before 13 years (≥1 HPV dose) increased from 28.4% for girls born in 1995 to 46.8% for girls born in 2000. Among girls born during 1999-2000 who had not received HPV vaccination before 13 years (57.2%), 80.1% had at least 1 missed opportunity to receive HPV vaccination before 13 years. Opportunities to vaccinate for HPV at age 11 to 12 years are missed. Strategies are needed to decrease these missed opportunities for HPV vaccination. This can be facilitated by the administration of all vaccines recommended for adolescents at the same visit.
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Affiliation(s)
- Jenny Jeyarajah
- Carter Consulting, Atlanta, GA, USA National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurie D. Elam-Evans
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip J. Smith
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James A. Singleton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Middleman A. School-located vaccination for adolescents: Past, present, and future and implications for HPV vaccine delivery. Hum Vaccin Immunother 2016; 12:1599-605. [PMID: 27171022 DOI: 10.1080/21645515.2016.1168953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Adolescents were first specifically targeted for school-located vaccination (SLV) in the 1990s when hepatitis B catch-up vaccination was recommended for all adolescents. SLV affords the opportunity to access adolescents at a time when their activities have developmental import and the patients have the capacity to decline repeatedly missing school and extracurricular events to get vaccinated. As noted above, SLV has been primarily reserved for brief catch-up interventions among youth, with routine vaccination recommendations quickly defaulting to the primary care provider. Now in 2016, with relatively disappointing adolescent immunization rates for the routinely recommended human papillomavirus (HPV) vaccine, the SLV option is one that could potentially help increase vaccination rates for a particularly effective, life-saving, 3-dose vaccination series. This article will serve as a brief review of the successful use of SLV in other countries, lessons learned when SLV was employed to immunize adolescents against hepatitis B in the United States in the late 1990s and early 2000s, and the current hopes and challenges for the future of adolescent SLV programming in the United States. Overall, the shift to the use of SLV to administer routinely recommend vaccine for adolescents will require careful planning to implement known strategies for accessing youth and in addition to new strategies designed to assure appropriate reimbursement for cost-effect SLV services. While not the best option for all adolescents, SLV provides an important opportunity to immunize youth with limited access to healthcare services in the community at large.
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Affiliation(s)
- Amy Middleman
- a Department of Pediatrics , Section of Adolescent Medicine, University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
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Kempe A, O’Leary ST, Shoup JA, Stokley S, Lockhart S, Furniss A, Dickinson LM, Barnard J, Daley MF. Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial. Pediatrics 2016; 137:e20152857. [PMID: 26921286 PMCID: PMC5884084 DOI: 10.1542/peds.2015-2857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. METHODS All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. RESULTS At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). CONCLUSIONS Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.
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Affiliation(s)
- Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Departments of Pediatrics, and
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Shannon Stokley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Lockhart
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - L. Miriam Dickinson
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Juliana Barnard
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado, Aurora, Colorado,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Aalsma MC, Gilbert AL, Xiao S, Rickert VI. Parent and Adolescent Views on Barriers to Adolescent Preventive Health Care Utilization. J Pediatr 2016; 169:140-5. [PMID: 26681476 DOI: 10.1016/j.jpeds.2015.10.090] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 09/04/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine adolescent and parent views of barriers to annual adolescent preventive care. STUDY DESIGN A nationally recruited cross-sectional study of adolescents between ages 13 and 18 years, and parents of adolescents from different families, were recruited. The primary outcome was self-report of preventive care in the last 12 months. Demographic, family health discussions, physical/emotional health importance, and preventive care barriers were gathered from adolescents and parents. RESULTS The majority of the sample (500 adolescents and 504 parents in different families) reported a primary care visit within 12 months (parents = 78.7%; adolescents = 66.9%). Adolescent participants identified more barriers than parents (parents = 0.69; adolescents = 1.42). Adolescent who reported having discussions with parents about health (aOR 1.57, 95% CI 1.26-1.98) and seeing a subspecialist provider (aOR 3.72, CI 1.21-11.47) were more likely to report preventive visits. Barriers for parents and adolescents include the belief that an appointment is only needed when a child is sick (parent aOR 0.21, CI 0.08-0.61; adolescent aOR 0.29, CI 0.17-0.51) and family cannot afford cost (parent aOR 0.34, CI 0.15-0.81; adolescent aOR 0.50, CI 0.26-0.97). Barriers for parents include the child sees a specialist (aOR 0.26, CI 0.08-0.88) and their child does not need a checkup (aOR 0.12, CI 0.05-0.34). Lastly, a barrier for adolescents was parents never schedule preventive visits (aOR 0.31, CI 0.17-0.58). CONCLUSIONS The Affordable Care Act has the potential to limit preventive care barriers. The results of the current study find there are parental and adolescent issues regarding preventive services that should be addressed.
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Affiliation(s)
| | | | - Shan Xiao
- Indiana University School of Medicine, Indianapolis, IN
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Dempsey AF, Zimet GD. Interventions to Improve Adolescent Vaccination: What May Work and What Still Needs to Be Tested. Am J Prev Med 2015; 49:S445-54. [PMID: 26272849 DOI: 10.1016/j.amepre.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
Since the development of the "adolescent platform" of vaccination in 1997, hundreds of studies have been conducted, identifying barriers to and facilitators of adolescent vaccination. More recent research has focused on developing and evaluating interventions to increase uptake of adolescent vaccines. This review describes a selection of recent intervention studies for increasing adolescent vaccination, divided into three categories: those with promising results that may warrant more widespread implementation, those with mixed results requiring more research, and those with proven effectiveness in other domains that have not yet been tested with regard to adolescent vaccination.
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Affiliation(s)
- Amanda F Dempsey
- Adult and Child Center for Outcomes Research and Dissemination Science program, University of Colorado Denver, Aurora, Colorado.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Immunization Status of Young People Attending a Youth Clinic in Geneva, Switzerland. J Immigr Minor Health 2015; 18:353-9. [DOI: 10.1007/s10903-015-0185-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mayne SL, duRivage NE, Feemster KA, Localio AR, Grundmeier RW, Fiks AG. Effect of decision support on missed opportunities for human papillomavirus vaccination. Am J Prev Med 2014; 47:734-44. [PMID: 25455116 PMCID: PMC4254426 DOI: 10.1016/j.amepre.2014.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/22/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Missed opportunities for human papilloma virus (HPV) vaccination are common, presenting a barrier to achieving widespread vaccine coverage and preventing infection. PURPOSE To compare the impact of clinician- versus family-focused decision support, none, or both on captured opportunities for HPV vaccination. DESIGN Twelve-month cluster randomized controlled trial conducted in 2010-2011. SETTING/PARTICIPANTS Adolescent girls aged 11-17 years due for HPV Dose 1, 2, or 3 receiving care at primary care practices. INTERVENTION Twenty-two primary care practices were cluster randomized to receive a three-part clinician-focused intervention (educational sessions, electronic health record-based alerts, and performance feedback) or none. Within each practice, girls were randomized at the patient level to receive family-focused, automated, educational phone calls or none. Randomization resulted in four groups: clinician-focused, family-focused, combined, or no intervention. MAIN OUTCOME MEASURES Standardized proportions of captured opportunities (due vaccine received at clinician visit) were calculated among girls in each study arm. Analyses were conducted in 2013. RESULTS Among 17,016 adolescent girls and their 32,472 visits (14,247 preventive, 18,225 acute), more HPV opportunities were captured at preventive than acute visits (36% vs 4%, p<0.001). At preventive visits, the clinician intervention increased captured opportunities by 9 percentage points for HPV-1 and 6 percentage points for HPV-3 (p≤0.01), but not HPV-2. At acute visits, the clinician and combined interventions significantly improved captured opportunities for all three doses (p≤0.01). The family intervention was similar to none. Results differed by practice setting; at preventive visits, the clinician intervention was more effective for HPV-1 in suburban than urban settings, whereas at acute visits, the clinician intervention was more effective for all doses at urban practices. CONCLUSIONS Clinician-focused decision support is a more effective strategy than family-focused to prevent missed HPV vaccination opportunities. Given the persistence of missed opportunities even in intervention groups, complementary strategies are needed. This study is registered at clinicaltrials.gov NCT01159093.
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Affiliation(s)
- Stephanie L Mayne
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nathalie E duRivage
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen A Feemster
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute for Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Russell Localio
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert W Grundmeier
- Pediatric Research Consortium (PeRC), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatric Research Consortium (PeRC), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Sebastian RA, Ramos MM, Stumbo S, McGrath J, Fairbrother G. Measuring youth health engagement: development of the youth engagement with health services survey. J Adolesc Health 2014; 55:334-40. [PMID: 24709299 DOI: 10.1016/j.jadohealth.2014.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to create and validate a survey instrument designed to measure Youth Engagement with Health Services (YEHS!). METHODS A 61-item YEHS! survey was created through a multistaged process, which included literature review, subject matter expert opinion, review of existing validated measures, and cognitive interviewing with 41 adolescents in Colorado and New Mexico. The YEHS! was then pilot tested with a diverse group of high school students (n = 354) accessing health services at one of eight school-based health centers in Colorado and New Mexico. We conducted psychometric analyses and examined correlations between the youth health engagement scales and measures of quality of care. RESULTS We created scales to measure two domains of youth health engagement: health access literacy and health self-efficacy. The youth health engagement scales demonstrated strong reliability (Cronbach's α .76 and .82) and construct validity (mean factor loading .71 and .76). Youth health engagement scores predicted higher experiences of care scores (p < .001) and receipt of more anticipatory guidance (p < .01). CONCLUSIONS This study supports the YEHS! as a valid and reliable measure of youth health engagement among adolescents using school-based health centers. We demonstrate an association between youth health engagement and two quality of care measures. Additional testing is needed to ensure the reliability and validity of the instrument in diverse adolescent populations.
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Affiliation(s)
- Rachel A Sebastian
- Child Policy & Population Health, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Mary M Ramos
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | - Scott Stumbo
- Child and Adolescent Health Measurement Initiative, Oregon Health and Science University, Portland, Oregon
| | - Jane McGrath
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
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School-located vaccination of adolescents with insurance billing: cost, reimbursement, and vaccination outcomes. J Adolesc Health 2014; 54:282-8. [PMID: 24560036 DOI: 10.1016/j.jadohealth.2013.12.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess, in a school-located adolescent vaccination program that billed health insurance, the program costs, the proportion of costs reimbursed, and the likelihood of vaccination. METHODS During the 2010-2011 school year, vaccination clinics were held for sixth- to eighth-grade students at seven Denver public schools. Vaccine administration and purchase costs were compared with reimbursement by insurers. Multivariate analyses were used to compare the likelihood of vaccination among students in intervention schools with students in control schools who did not participate in the program, with analyses stratified by grade (sixth grade vs. seventh-eighth grades). RESULTS Fifteen percent (466 of 3,144) of students attending intervention schools were vaccinated at school-located vaccination clinics. Among students vaccinated at school, 41% were uninsured, 37% publicly insured, and 22% privately insured. Estimated vaccine administration costs were $23.98 per vaccine dose. Seventy-eight percent of vaccine purchase costs and 14% of vaccine administration costs were reimbursed by insurers; 41% of total program costs were reimbursed. Sixth-grade students in intervention schools were more likely than those in control schools to receive tetanus-diphtheria-acellular pertussis (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.08, 1.57), meningococcal conjugate (RR, 1.42; CI, 1.18, 1.70), and human papillomavirus (for females only, RR, 1.69; CI, 1.21, 2.36) vaccines during the 2010-2011 school year, with similar results for seventh- to eighth-grade students. CONCLUSIONS Although school-located adolescent vaccination with billing appears feasible and likely to improve vaccination rates, improvements in insurance coverage and reimbursement rates may be needed for the long-term financial sustainability of such programs.
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Trends and characteristics of preventive care visits among commercially insured adolescents, 2003-2010. J Pediatr 2014; 164:625-30. [PMID: 24286572 PMCID: PMC5778450 DOI: 10.1016/j.jpeds.2013.10.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/19/2013] [Accepted: 10/18/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine preventive care visit patterns among commercially insured adolescents during 2003-2010. In 2005-2007, the Advisory Committee on Immunization Practices (ACIP) recommended 3 vaccines targeted at adolescents. We also investigate the relationship between preventive care visits and immunization. STUDY DESIGN Data were drawn from the MarketScan database. Adolescents aged 11-21 continuously enrolled in the same insurance plan during the calendar year were included. We calculated the annual proportion of adolescents with at least 1 preventive and 1 vaccination-related visit. Longitudinal analyses were conducted by following the 1992 birth cohort for 8 consecutive years. RESULTS The proportion of adolescents making at least 1 preventive visit increased from 24.6%-41.1% during 2003-2010. The rate of vaccination-related visits increased from 12.9%-26.3%. The magnitude of the increase in preventive and vaccination-related visits was greater during the years in which ACIP issued recommendations. The rates of preventive and vaccination-related visits were considerably higher among female and early adolescents and adolescents in managed care plans. Longitudinal analyses indicated that only 2.4% of adolescents had an annual preventive visit during the 8 years. CONCLUSIONS Yearly improvements in preventive care visits by adolescents were substantial. ACIP recommendations may be associated with this improvement. However, ongoing efforts are needed to improve the use and delivery of preventive care services.
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Ford CA, Skiles MP, English A, Cai J, Agans RP, Stokley S, Markowitz L, Koumans EH. Minor consent and delivery of adolescent vaccines. J Adolesc Health 2014; 54:183-9. [PMID: 24074605 PMCID: PMC4916962 DOI: 10.1016/j.jadohealth.2013.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To explore whether, and to what extent, minor consent influences adolescent vaccine delivery in the United States. METHODS A telephone survey was completed by 263 professionals with responsibilities for adolescent health care and/or vaccination in 43 states. Measures included perceived frequency of unaccompanied minor visits and perceived likelihood of vaccine delivery to unaccompanied minors in hypothetical scenarios that varied by adolescent age, vaccine type, visit type, and clinical setting. RESULTS Among the 76 respondents most familiar with private primary care clinics, 47.1% reported perceptions that 17-year-old patients often present without a parent/legal guardian. Among the 104 respondents most familiar with public primary care clinics, 56.7% reported that 17-year-old patients often present alone. In response to hypothetical scenarios, approximately 30% of respondents familiar with private clinics and 50% of respondents familiar with public clinics reported perceptions that unaccompanied 17-year-old adolescents would not receive influenza, Tdap, or human papillomavirus vaccines during routine check-ups because they could not provide consent. Perceived likelihood of unaccompanied minors receiving vaccines when seen for confidential services in primary care, sexually transmitted disease, and Title X/family planning clinics varied significantly by vaccine type and clinical setting. On average, respondents reported that they would support minors having the ability to self-consent for vaccines at age 14. CONCLUSIONS The inability of minors to consent for vaccines is likely one barrier to vaccination. Interventions to increase adolescent vaccination should consider strategies that increase the ability of unaccompanied minors, particularly older minors, to receive vaccines within the context of legal, ethical, and professional guidelines.
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Affiliation(s)
- Carol A Ford
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Martha P Skiles
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Abigail English
- Center for Adolescent Health & The Law, Chapel Hill, North Carolina
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Robert P Agans
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauri Markowitz
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease control and Prevention, Atlanta, Georgia
| | - Emilia H Koumans
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bravender T, Tulsky JA, Farrell D, Alexander SC, Østbye T, Lyna P, Dolor RJ, Coffman CJ, Bilheimer A, Lin PH, Pollak KI. Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight. PATIENT EDUCATION AND COUNSELING 2013; 93:525-31. [PMID: 24021419 PMCID: PMC3851886 DOI: 10.1016/j.pec.2013.08.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 07/29/2013] [Accepted: 08/12/2013] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician-adolescent communication about healthy weight. METHODS Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys. RESULTS Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54min to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients. CONCLUSION The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner. PRACTICE IMPLICATIONS If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated.
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Affiliation(s)
- Terrill Bravender
- Adolescent Medicine, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
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Missed opportunities for adolescent vaccination, 2006-2011. J Adolesc Health 2013; 53:492-7. [PMID: 23809613 DOI: 10.1016/j.jadohealth.2013.05.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe missed opportunities for meningococcal (MCV); tetanus, diphtheria, acellular pertussis (Tdap); and human papillomavirus (HPV) vaccination among adolescents. METHODS Retrospective electronic health record data review of adolescents aged 11-18 years at the time of their visit to a university-based pediatric practice in Seattle from 2006 to 2011. The primary outcome was missed vaccination opportunities, defined as the proportion of visits where a patient eligible for MCV, Tdap, and/or HPV remained unvaccinated. HPV vaccine analysis was limited to females. Bivariate and multivariate logistic regression assessed variables associated with missed vaccination opportunities. RESULTS During the study period, 1,628 adolescents made 9,180 visits. The percentage of visits that were missed opportunities was 82% for MCV, 85% for Tdap, and 82% for the first HPV dose (HPV1), 63% for the second, and 71% for the third. Adolescents with at least one preventive care visit were significantly less likely to have missed opportunities for MCV, Tdap, or HPV1. Nonpreventive visits were associated with more missed opportunities for MCV (OR = 19.2, 95% CI 15.3-24.0), Tdap (OR = 25.8, 95% CI 19.3-34.6), and HPV1 (OR = 12.1, 95% CI 9.0-16.1) than preventive visits. Adolescent females were more likely to have a missed opportunity for HPV1 than Tdap (p < .001) or MCV (p = .03). CONCLUSIONS Missed opportunities for adolescent vaccination against MCV, Tdap and HPV are common. Adolescents who utilize preventive care are less likely to have missed vaccination opportunities. Further research is needed to explore why missed vaccination opportunities occur and to develop evidence-based strategies to reduce missed opportunities and improve adolescent vaccination coverage.
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Coyne-Beasley T, Reiter PL, Liberty AC, Ford CA, Miles DR, Brewer NT. Awareness is not enough: the need to increase meningococcal vaccine uptake. Clin Pediatr (Phila) 2013; 52:441-50. [PMID: 23539687 DOI: 10.1177/0009922813481847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Adolescent meningococcal vaccine uptake remains low. We examined vaccine awareness among parents of adolescents and uptake. METHODS Parents of adolescents aged 11 to 17 years (n = 1281) participated in a statewide survey. Logistic regression with weighted data provided population-based estimates. RESULTS In all, 65% had heard of meningococcal vaccine; parents more likely to report awareness had adolescents aged 16 to 17 years, in private school, or with health insurance. In total, 44% of aware parents reported vaccination; vaccinated teens were more likely to be black (odds ratio [OR] = 2.17), had a preventive checkup within 12 months (OR = 3.03), or resided with another child ≤18 years (OR = 1.83). Many parents of unvaccinated adolescents (38.5%) did not plan to vaccinate them within 12 months. The most common reasons for not vaccinating were providers not recommending it and believing adolescents did not need it. CONCLUSION Many parents aware of meningococcal vaccine did not vaccinate their adolescents. Interventions that include increasing provider recommendation and annual visits may increase uptake.
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Szilagyi PG, Albertin C, Humiston SG, Rand CM, Schaffer S, Brill H, Stankaitis J, Yoo BK, Blumkin A, Stokley S. A randomized trial of the effect of centralized reminder/recall on immunizations and preventive care visits for adolescents. Acad Pediatr 2013; 13:204-13. [PMID: 23510607 PMCID: PMC4594853 DOI: 10.1016/j.acap.2013.01.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the impact of a managed care-based patient reminder/recall system on immunization rates and preventive care visits among low-income adolescents. METHODS We conducted a randomized controlled trial between December 2009 and December 2010 that assigned adolescents aged 11-17 years to one of three groups: mailed letter, telephone reminders, or control. Publicly insured youths (n = 4115) were identified in 37 participating primary care practices. The main outcome measures were immunization rates for routine vaccines (meningococcus, pertussis, HPV) and preventive visit rates at study end. RESULTS Intervention and control groups were similar at baseline for demographics, immunization rates, and preventive visits. Among adolescents who were behind at the start, immunization rates at study end increased by 21% for mailed (P < .01 vs control), 17% for telephone (P < .05), and 13% for control groups. The proportion of adolescents with a preventive visit (within 12 months) was: mailed (65%; P < .01), telephone (63%; P < .05), and controls (59%). The number needed to treat for an additional fully vaccinated adolescent was 14 for mailed and 25 for telephone reminders; for an additional preventive visit, it was 17 and 29. The intervention cost $18.78 (mailed) or $16.68 (phone) per adolescent per year to deliver. The cost per additional adolescent fully vaccinated was $463.99 for mailed and $714.98 for telephone; the cost per additional adolescent receiving a preventive visit was $324.75 and $487.03. CONCLUSIONS Managed care-based mail or telephone reminder/recall improved adolescent immunizations and preventive visits, with modest costs and modest impact.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Allison MA, Dunne EF, Markowitz LE, O'Leary ST, Crane LA, Hurley LP, Stokley S, Babbel CI, Brtnikova M, Beaty BL, Kempe A. HPV vaccination of boys in primary care practices. Acad Pediatr 2013; 13:466-74. [PMID: 24011749 PMCID: PMC5848092 DOI: 10.1016/j.acap.2013.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/04/2013] [Accepted: 03/14/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians': 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys. METHODS We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010. RESULTS The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds. CONCLUSIONS Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings.
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Affiliation(s)
- Mandy A Allison
- Children's Outcomes Research Program , Children's Hospital Colorado, Aurora, CO; Department of Pediatrics , Colorado School of Public Health , Colorado Health Outcomes Program , University of Colorado Anschutz Medical Campus, Aurora, CO.
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Bundy DG, Muschelli J, Clemens GD, Strouse JJ, Thompson RE, Casella JF, Miller MR. Ambulatory care connections of Medicaid-insured children with sickle cell disease. Pediatr Blood Cancer 2012; 59:888-94. [PMID: 22422739 DOI: 10.1002/pbc.24129] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/10/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) requires coordinated ambulatory care from generalists and hematologists. We examined when children with SCD establish ambulatory care connections, whether these connections are maintained, and how these connections are used before and after hospitalizations. PROCEDURE We conducted a retrospective cohort study of Medicaid-insured Maryland children with SCD from 2002 to 2008. For children enrolled from birth, time to first, second, and third generalist and first hematologist visits was plotted. For all children, we analyzed ambulatory visits by age group, by emergency department (ED) and hospital use, and before and after hospitalizations. RESULTS The overall study cohort comprised 851 children; 178 provided data from birth. Ambulatory care connections to generalists were made rapidly; connections to hematologists occurred more slowly, if at all (38% of children had not seen a hematologist by age 2 years). Visits with generalists decreased as patients aged, as did visits with hematologists (54% of children in the 12-17 year age group had no hematology visits in 2 years). Children with higher numbers of ED visits or hospitalizations also had higher numbers of ambulatory visits (generalist and hematologist). Most children had visits with neither generalists nor hematologists in the 30 days before and after hospitalizations. CONCLUSIONS Medicaid-insured children with SCD rapidly connect with generalists after birth; connections to hematologists occur more slowly. The observation that connections to generalists and hematologists diminish with time and are infrequently used around hospitalizations suggests that the ambulatory care of many Medicaid-insured children with SCD may be inadequate.
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Affiliation(s)
- David G Bundy
- Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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McCormick EV, Durfee J, Vogt TM, Daley MF, Hambidge SJ, Shlay J. Physician attitudes regarding school-located vaccinations. Pediatrics 2012; 130:887-96. [PMID: 23027169 DOI: 10.1542/peds.2011-2962] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess physician attitudes regarding school-located adolescent vaccination and influenza vaccination. METHODS From July through September 2010, a 20-item survey was mailed to 1337 practicing Colorado family physicians and pediatricians. Standard statistical methods were used to examine unadjusted and adjusted odds ratios of factors associated with physician support for school-located vaccination programs. RESULTS Overall, 943 physicians were survey-eligible, and 584 (62%) responded. More than half of physicians supported both school-located influenza and adolescent vaccination. However, fewer physicians supported school-located adolescent vaccination compared with influenza vaccination. More physicians supported school-located vaccination for their publicly insured patients compared with their privately insured patients. Some family physicians (32%) and pediatricians (39%) believed that school-located vaccination would make their patients less likely to attend well-child visits, and half of respondents believed that school-located vaccination would have a negative financial impact on their practice. In multivariate analyses, physicians concerned about the financial impact of school-located vaccination were less likely to support such programs. CONCLUSIONS Although a majority of Colorado physicians supported influenza and adolescent vaccination at school, they expressed concerns regarding the implications on their practice. Lesser support for vaccination of their privately insured patients and concerns regarding attendance at well-child visits suggests the perceived financial impact from school-located vaccination is a barrier and merits additional examination.
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Affiliation(s)
- Emily V McCormick
- Public Health Prevention Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Burns ME, Leininger LJ. Understanding the Gap in Primary Care Access and Use Between Teens and Younger Children. Med Care Res Rev 2012; 69:581-601. [DOI: 10.1177/1077558712453335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary health care use among teenagers falls short of clinical recommendations and consistently lags behind that of younger children. Using the Medical Expenditure Panel Survey, the authors explore three explanations for this age-related gap: family composition, parental awareness of children’s health care needs, and the relative role of predisposing, enabling, and need-based factors for teens and younger children. Teenagers are 64% more likely to have no usual source of care and 25% more likely to have had no health care visit in the prior year relative to younger children. The gap narrows in families with children from both age-groups and among children with special health care needs. The largest disparity in primary care access exists between teens in families with no younger sibling(s) and younger children in families with no teen(s). A resolution to the age-related access gap will likely require understanding of, and intervention into, family-level determinants of poor access.
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Affiliation(s)
- Marguerite E. Burns
- Department of Population Health Sciences, University of Wisconsin- Madison, WI, USA
| | - Lindsey Jeanne Leininger
- Department of Health Policy and Administration, School of Public Health, University of Illinois-Chicago, IL, USA
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Wong CA, Berkowitz Z, Dorell CG, Price RA, Lee J, Saraiya M. Human papillomavirus vaccine uptake among 9- to 17-year-old girls: National Health Interview Survey, 2008. Cancer 2011; 117:5612-20. [PMID: 21692069 PMCID: PMC3179804 DOI: 10.1002/cncr.26246] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/01/2011] [Accepted: 04/25/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since 2006, the human papillomavirus (HPV) vaccine has been routinely recommended for preadolescent and adolescent girls in the United States. Depending on uptake patterns, HPV vaccine could reduce existing disparities in cervical cancer. METHODS HPV vaccination status and reasons for not vaccinating were assessed using data from the 2008 National Health Interview Survey. Households with a girl aged 9-17 years were included (N = 2205). Sociodemographic factors and health behaviors associated with vaccine uptake were assessed using multivariate logistic regression. RESULTS Overall, 2.8% of 9- to 10-year-olds, 14.7% of 11- to 12-year-olds, and 25.4% of 13- to 17-year-olds received at least 1 dose of HPV vaccine; 5.5% of 11- to 12-year-olds and 10.7% of 13- to 17-year-olds received all 3 doses. Factors associated with higher uptake in multivariate analysis included less than high school parental education, well-child check and influenza shot in the past year, and parental familiarity with HPV vaccine. Parents' primary reasons for not vaccinating were beliefs that their daughters did not need vaccination, that their daughters were not sexually active, or had insufficient vaccine knowledge. More parents with private insurance (58.0%) than public (39.8%) or no insurance (39.5%) would pay $360-$500 to vaccinate their daughters. CONCLUSIONS Less than one quarter of girls aged 9-17 years had initiated HPV vaccination by the end of 2008. Efforts to increase HPV uptake should focus on girls in the target age group, encourage providers to educate parents, and promote access to reduced-cost vaccines.
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Affiliation(s)
| | | | | | | | - Jennifer Lee
- Division of Cancer Prevention and Control, CDC, Atlanta, GA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, CDC, Atlanta, GA
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Anhang Price R, Tiro JA, Saraiya M, Meissner H, Breen N. Use of human papillomavirus vaccines among young adult women in the United States: an analysis of the 2008 National Health Interview Survey. Cancer 2011; 117:5560-8. [PMID: 21732336 PMCID: PMC3189421 DOI: 10.1002/cncr.26244] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 01/12/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends catch-up administration of human papillomavirus (HPV) vaccines to girls and women ages 13 to 26 who have not been vaccinated previously. In response to debate regarding catch-up vaccination of young adult women, this study examined whether 18- to 26-year-old women most likely to benefit from catch-up vaccination were aware of the HPV vaccine, and initiated the vaccine series by the end of 2008. METHODS We used data from the 2008 National Health Interview Survey to assess HPV vaccine awareness and use, and reasons for not vaccinating, among women aged 18-26 years (n = 1583). Sociodemographic, health care access, and health history factors associated with vaccine initiation were assessed using multivariate logistic regression. RESULTS Overall, 11.7% of women aged 18-26 years reported receiving at least 1 dose of the HPV vaccine by the end of 2008. In multivariate analyses, younger age, history of previous HPV infection, unmarried status, health insurance, flu shot in the past year, and receipt of 1 or more recommended lifetime vaccines were significantly associated with HPV vaccine initiation. Two-fifths (39.6%) of unvaccinated women were interested in receiving the HPV vaccine (n = 1327). Primary reasons for lack of interest in the vaccine were belief that it was not needed, not knowing enough about it, concerns about safety, and not being sexually active. CONCLUSION HPV vaccine coverage among young adult women was low, and lower among the uninsured than the insured. Public financing and care provision programs have the potential to expand vaccine coverage among uninsured women, who are at increased risk of cervical cancer.
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Dorell C, Yankey D, Strasser S. Parent-reported reasons for nonreceipt of recommended adolescent vaccinations, national immunization survey: teen, 2009. Clin Pediatr (Phila) 2011; 50:1116-24. [PMID: 21856964 DOI: 10.1177/0009922811415104] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify parent-reported reasons for non-receipt of adolescent vaccinations by provider recommendation status. METHODS Parental reasons for non-receipt of adolescent vaccines were analyzed among adolescents 13-17 years using data from the 2009 National Immunization Survey-Teen (n=20,066). RESULTS Among unvaccinated adolescents, 87.9% (Td/Tdap), 90.9% (MenACWY), and 66.0% (HPV) of parents reported that they did not receive a healthcare provider recommendation for their adolescent to receive the vaccine. Among those without a provider recommendation, the most common reasons for not receiving the vaccines were 'vaccine not recommended' [Td/Tdap, MenACWY] and 'not needed' [HPV]. Among those with a recommendation, the most common parental reasons were 'lack of knowledge' [Td/Tdap], 'vaccine not needed' [MenACWY], and 'lack of knowledge' [HPV]. CONCLUSIONS Non-receipt of provider recommendations was a main parent-reported reason for not getting vaccinated. Increasing parental knowledge and vaccination coverage through increased provider-parent communication about disease risk and vaccine benefits is needed.
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Dorell CG, Yankey D, Santibanez TA, Markowitz LE. Human papillomavirus vaccination series initiation and completion, 2008-2009. Pediatrics 2011; 128:830-9. [PMID: 22007006 DOI: 10.1542/peds.2011-0950] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to describe factors associated with human papillomavirus (HPV) vaccination series initiation (≥1 dose) and completion (≥3 doses) and parents' intent to have their daughters vaccinated. METHODS Data from the 2008 and 2009 National Immunization Survey-Teen were analyzed to estimate HPV vaccination coverage among girls 13 to 17 years of age (N = 18,228) and to examine associations of vaccination coverage with demographic characteristics. RESULTS Overall, 40.5% of girls had received ≥1 HPV vaccine dose, and 53.3% of those girls completed the series. Factors independently associated with vaccination initiation included older age, having an 11- to 12-year preventive visit, insurance status, mother's age and marital status, not receiving all vaccines at public facilities, and provider recommendation, which was the factor most strongly associated with initiation (prevalence ratio: 2.6 [95% confidence interval: 2.4-2.9]). Compared with white girls (60.4%), black (46.0%) and Hispanic (40.3%) girls were less likely to complete the series. Lack of knowledge of the vaccine (19.4%), vaccination was not needed (18.8%), the daughter was not sexually active (18.3%), and a provider did not recommend (13.1%) were the most common reasons for parents' nonintent to have their daughters vaccinated. CONCLUSIONS Although HPV vaccine coverage rates are increasing, they are still below target levels. Recommendations by providers to adolescent patients and parents likely would improve vaccine uptake. Parental education regarding disease risks and benefits of HPV vaccination before exposure is needed to promote vaccine uptake.
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Affiliation(s)
- Christina G Dorell
- Division of Immunization Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Middleman AB. Coordinating the delivery of vaccinations and other preventive health care recommendations for adolescents. Prev Med 2011; 53 Suppl 1:S22-8. [PMID: 21962467 DOI: 10.1016/j.ypmed.2011.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although recommendations for annual preventive care for adolescents have been in place for decades, the need to bring adolescents to the medical setting for newly recommended vaccines has placed this issue in the public health spotlight. Aggressive efforts have been ongoing to increase adolescent adherence to new vaccine recommendations--a measured outcome variable, and the hope has been that enhanced adherence to comprehensive health care visits will follow. Evidence indicates that the implementation of more comprehensive preventive health care elements among adolescents may be improving; however, a passive approach to bringing more adolescents to preventive health visits using vaccine as an incentive may not be effective for all youth. This paper reviews the history of recommendations for new vaccines as well as comprehensive health care visit recommendations for adolescents, how these recommendations may synergistically improve preventive care for adolescents, and how we may need to continue to think creatively to further access all youth for preventive health care using vaccination implementation as a model for reaching out beyond the providers' office walls.
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Affiliation(s)
- Amy B Middleman
- Adolescent Medicine and Sports Medicine Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Bergman DA, Beck A. Moving from research to large-scale change in child health care. Acad Pediatr 2011; 11:360-8. [PMID: 21783449 DOI: 10.1016/j.acap.2011.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/30/2011] [Accepted: 06/05/2011] [Indexed: 10/18/2022]
Abstract
There is a large and persistent failure to achieve widespread dissemination of evidence-based practices in child health care. Too often studies demonstrating evidence for effective child health care practices are not brought to scale and across different settings and populations. This failure is not due to a lack of knowledge, but rather a failure to bring to bear proven methods in dissemination, diffusion, and implementation (DD&I) science that target the translation of evidence-based medicine to everyday practice. DD&I science offers a framework and a set of tools to identify innovations that are likely to be implemented, and provides methods to better understand the capabilities and preferences of individuals and organizations and the social networks within these organizations that help facilitate widespread adoption. Successful DD&I is dependent on making the intervention context sensitive without losing fidelity to the core components of the intervention. The achievement of these goals calls for new research methods such as pragmatic research trials that combine hypothesis testing with quality improvement, participatory research that engages the target community at the beginning of research design, and other quasi-experimental designs. With the advent of health care reform, it will be extremely important to ensure that the ensuing large demonstration projects that are designed to increase integrated care and better control costs can be rapidly brought to scale across different practices settings, and health plans and will be able to achieve effectiveness in diverse populations.
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Affiliation(s)
- David A Bergman
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California , USA.
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Rand CM, Humiston SG, Schaffer SJ, Albertin CS, Shone LP, Blumkin AK, Stokley S, Szilagyi PG. Parent and adolescent perspectives about adolescent vaccine delivery: practical considerations for vaccine communication. Vaccine 2011; 29:7651-8. [PMID: 21839793 DOI: 10.1016/j.vaccine.2011.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/27/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
We surveyed parents of adolescents (n=430) and their adolescents ages 15-17 years (n=208) in 9 primary-care settings in Monroe County, NY to assess perceptions about adolescent vaccine delivery. Parents and adolescents most wanted to discuss vaccine side effects and the diseases prevented with the adolescents' provider. Those who perceived vaccines as very safe were more accepting of adolescent vaccines. Most participants agreed with vaccinating the teen during a mild illness and with providing multiple vaccines concomitantly. Participants most preferred medical, as opposed to other settings, for receipt of adolescent vaccines. For parents and adolescents who are wary of vaccination, strategies are needed to enhance communication about risks and benefits of vaccinations.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Cynthia
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Parents' acceptance of adolescent immunizations outside of the traditional medical home. J Adolesc Health 2011; 49:133-40. [PMID: 21783044 DOI: 10.1016/j.jadohealth.2011.04.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 04/13/2011] [Accepted: 04/15/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE Numerous barriers to vaccination exist for adolescents. Using the medical home as the sole source of adolescent vaccination has potential limitations. The objectives of the present study were to examine parents' acceptance of adolescent vaccination outside of the medical home and parents' preferred setting for adolescent vaccination. METHODS A standardized, pilot-tested telephone survey was administered to a stratified random sample (n = 1,998) of Colorado households between August 2007 and February 2008. Households with English-speaking parents and adolescent(s) aged 11-17 years were eligible. RESULTS Survey response rate was 43%; there were no significant differences between respondents and nonrespondents for three known demographic variables. Although most parents (78%) preferred a doctor's office for adolescent vaccination, a majority were also definitively or probably accepting of vaccination in public health clinics (74%), school health clinics (70%), obstetrics and gynecology clinics (69%; asked for females only), and emergency departments (67%). Parents were less accepting of vaccination in family planning clinics (41%) and retail-based clinics (36%). Perceived convenience and adolescents' comfort in the setting were positively associated with vaccination acceptance in most settings; concern with keeping track of vaccines given outside of the medical home was negatively associated with acceptance. Parents in rural areas were more likely than parents in urban areas to identify a setting outside of the medical home as the preferred "best" setting for vaccination. CONCLUSIONS Most parents assessed a doctors' office as the best setting for adolescent vaccination. However, vaccination in certain settings outside of the medical home seems to be acceptable to many parents.
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Kharbanda EO, Stockwell MS, Fox H, Ipp LS, Rickert VI. The role of human papillomavirus vaccination in promoting delivery of other preventive and medical services. Acad Pediatr 2011; 11:326-32. [PMID: 21393081 DOI: 10.1016/j.acap.2010.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 12/10/2010] [Accepted: 12/16/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Adolescents infrequently present for preventive health visits. The 3-dose human papillomavirus (HPV) vaccine may result in increased health care visits and thus indirectly improve health services for teens. We examined whether other health services were delivered in conjunction with the second (HPV2) or third (HPV3) dose of the HPV vaccine. METHODS We conducted a chart review for girls 9 to 20 years of age (n = 571) who received HPV2 or HPV3 within 4 months of its due date at any of 9 clinical sites. Analyses were limited to the 422 visits (72%) where HPV vaccine was specified as a reason for the visit. A generalized linear model was used to evaluate the impact of site of care on delivery of other health services. RESULTS Nearly half (43%) of adolescents received another medical or preventive health service at the time of HPV2 or HPV3 vaccine administration. Most common services were 1 or more other vaccines (30%) or medical services (35%). Older teens were more likely than younger teens to receive reproductive health services and sexually transmitted infection screening. After controlling for age and adjusting for clustering within sites, receiving care at an academic health center versus a private practice was strongly associated with increased odds of receiving other medical or preventive health services at follow-up (odds ratio 2.07; 95% confidence interval 1.44-2.97). CONCLUSIONS Adolescents, especially those receiving care at an academic health center, often received other health services at the time of HPV2 or HPV3 vaccination. Because visits occurred within 6 to 8 months of the prior vaccine dose, our findings suggest vaccine visits may lead to improved delivery of adolescent health services.
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Kharbanda EO, Lee GM, Koenigs L. Financing vaccines for adolescents: a position paper of the society for adolescent health and medicine. J Adolesc Health 2011; 48:320-1. [PMID: 21338909 DOI: 10.1016/j.jadohealth.2010.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 12/29/2010] [Indexed: 11/16/2022]
Abstract
An increasing number of vaccines are now recommended for adolescents. These vaccines may greatly improve the health of adolescents and their communities. However, adolescent vaccine coverage rates lag behind those for infants and behind goals set by Healthy People 2010 [1]. Financial constraints have been reported to be a significant obstacle to immunizing adolescents and young adults [2]. At the Society for Adolescent Health and Medicine, we believe that to achieve increased vaccine coverage in this age group, financial barriers to immunization must be removed.
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Daley MF, Crane LA, Markowitz LE, Black SR, Beaty BL, Barrow J, Babbel C, Gottlieb SL, Liddon N, Stokley S, Dickinson LM, Kempe A. Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure. Pediatrics 2010; 126:425-33. [PMID: 20679306 DOI: 10.1542/peds.2009-3500] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this study were to assess, in a nationally representative network of pediatricians and family physicians, (1) human papillomavirus (HPV) vaccination practices, (2) perceived barriers to vaccination, and (3) factors associated with whether physicians strongly recommended HPV vaccine to 11- to 12-year-old female patients. METHODS In January through March 2008, a survey was administered to 429 pediatricians and 419 family physicians. RESULTS Response rates were 81% for pediatricians and 79% for family physicians. Ninety-eight percent of pediatricians and 88% of family physicians were administering HPV vaccine in their offices (P<.001). Among those physicians, fewer strongly recommended HPV vaccination for 11- to 12-year-old female patients than for older female patients (pediatricians: 57% for 11- to 12-year-old patients and 90% for 13- to 15-year-old patients; P<.001; family physicians: 50% and 86%, respectively; P<.001). The most-frequently reported barriers to HPV vaccination were financial, including vaccine costs and insurance coverage. Factors associated with not strongly recommending HPV vaccine to 11- to 12-year-old female patients included considering it necessary to discuss sexuality before recommending HPV vaccine (risk ratio: 1.27 [95% confidence interval: 1.07-1.51]) and reporting more vaccine refusals among parents of younger versus older adolescents (risk ratio: 2.09 [95% confidence interval: 1.66-2.81]). CONCLUSIONS Eighteen months after licensure, the vast majority of pediatricians and family physicians reported offering HPV vaccine. Fewer physicians strongly recommended the vaccine for younger adolescents than for older adolescents, and physicians reported financial obstacles to vaccination.
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Affiliation(s)
- Matthew F Daley
- Department of Pediatrics, University of Colorado, Aurora, CO, USA.
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Dempsey AF, Mendez D. Examining future adolescent human papillomavirus vaccine uptake, with and without a school mandate. J Adolesc Health 2010; 47:242-8, 248.e1-248.e6. [PMID: 20708562 PMCID: PMC2923402 DOI: 10.1016/j.jadohealth.2009.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 12/07/2009] [Accepted: 12/08/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a model of adolescent (HPV) human papillomavirus vaccine utilization that explored future HPV vaccination rates, with and without a school mandate, for the vaccine at middle school entry. METHODS A dynamic, population-based, compartmental model was developed that estimated over a 50-year time horizon HPV vaccine uptake among female adolescents living in the United States. The model incorporated data on parental attitudes about this vaccine and adolescent health care utilization levels. RESULTS Without a mandate, our model predicted that 70% coverage, a lower threshold value used in many previous modeling studies of HPV vaccination, would not be achieved until a mean of 23 years after vaccine availability. Maximal coverage of 79% was achieved after 50 years. With a school mandate in place, utilization increased substantially, with 70% vaccination coverage achieved by year 8 and maximal vaccination coverage, 90%, achieved by year 43. CONCLUSIONS Our results suggest that vaccine utilization is likely to be low for several years, though strong school mandates might improve HPV vaccine uptake. These results affect the interpretation of previous modeling studies that estimated the potential clinical effects of HPV vaccination under assumptions of very high vaccine utilization rates.
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Affiliation(s)
- Amanda F Dempsey
- Department of Pediatrics, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan 48109-5456, USA.
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Federico SG, Abrams L, Everhart RM, Melinkovich P, Hambidge SJ. Addressing adolescent immunization disparities: a retrospective analysis of school-based health center immunization delivery. Am J Public Health 2010; 100:1630-4. [PMID: 20634466 DOI: 10.2105/ajph.2009.176628] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared completion rates for adolescent immunization series administered at school-based health centers (SBHCs) to completion rates for series administered at community health centers (CHCs) within a single integrated delivery system. METHODS We performed a retrospective analysis of data from an immunization registry for patients aged 12-18 years. Patients were assigned to either an SBHC or a CHC during the study interval based on utilization. We used bivariate analysis to compare immunization series completion rates between the 2 groups and multivariate analysis to compare risk factors for underimmunization. We performed subanalyses by ages 12-15 years versus ages 16-18 years for human papillomavirus (HPV) and for the combination of HPV; tetanus, diptheria, and pertussis (Tdap); and tetravalent meningococcus virus. RESULTS SBHC users had significantly higher completion rates (P<.001) for hepatitis B, Tdap, inactivated poliovirus, varicella, measles/mumps/rubella, and HPV for ages 16-18 years, and for the combination of HPV, Tdap, and MCV4 for ages 16-18 years. CHC users had higher completion rates for tetanus and diphtheria. CONCLUSIONS SBHCs had higher completion rates than did CHCs for immunization series among those aged 12-18 years, despite serving a population with limited insurance coverage.
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Affiliation(s)
- Steven G Federico
- Denver Health and Hospital Authority, 1001 Yosemite, Suite 200, MC 1916, Denver, CO 80238, USA.
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Benin AL, Wu AC, Holmboe ES, Shapiro ED, Anyan W. How can we communicate about vaccines with adolescents and their parents? Clin Pediatr (Phila) 2010; 49:373-80. [PMID: 20118100 PMCID: PMC3773171 DOI: 10.1177/0009922809351091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe parents' and adolescents' perceptions about vaccination. METHODS Qualitative interviews of 22 mothers/grandmothers and 25 10- to 14-year-olds. RESULTS Themes emerged in 3 focus areas. (a) Understanding: Both adults and adolescents had difficulty understanding concepts of risks, benefits, prevention, and vaccination. (b) Decision making: Adults saw vaccination as an opportunity to help their adolescent develop skills for transition to adulthood. Adolescents worried about being lied to (reinforced by being told "it won't hurt"), physical pain, and cleanliness. ( c) Preventing sexually transmitted infections: Adults were divided between those who felt their child would not need such a vaccine and those who wanted to "be safe" to protect their child in the future. CONCLUSIONS At the same time that even basic concepts about vaccination should be explained to both adults and adolescents, adolescence represents a time for learning about responsible decision making. Discussion regarding the risks and benefits of vaccines can be part of transitioning to adult decision making.
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Affiliation(s)
| | - Ann C. Wu
- Yale School of Medicine, New Haven, CT, USA, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Eric S. Holmboe
- Yale School of Medicine, New Haven, CT, USA, American Board of Internal Medicine, Philadelphia, PA, USA
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Ott MA. Examining the development and sexual behavior of adolescent males. J Adolesc Health 2010; 46:S3-11. [PMID: 20307842 PMCID: PMC2858917 DOI: 10.1016/j.jadohealth.2010.01.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 11/17/2022]
Abstract
A careful examination of young men's sexuality by health professionals in pediatrics, primary care, and reproductive health is foundational to adolescent male sexual health and healthy development. Through a review of existing published data, this article provides background and a developmental framework for sexual health services for adolescent boys. The article first defines and provides an overview of adolescent boys' sexual health, and then discusses developmentally focused research on the following topics: (1) early romantic relationships and the evolution of power and influence within these relationships; (2) developmental "readiness" for sex and curiosity; (3) boys' need for closeness and intimacy; (4) adopting codes of masculinity; (5) boys' communicating about sex; and (6) contextual influences from peers, families, and providers. This article concludes by examining the implications of these data for sexual health promotion efforts for adolescent males, including human papillomavirus vaccination.
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Affiliation(s)
- Mary A Ott
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Dempsey AF, Freed GL. Health care utilization by adolescents on medicaid: implications for delivering vaccines. Pediatrics 2010; 125:43-9. [PMID: 19948567 DOI: 10.1542/peds.2009-1044] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the degree to which current health care utilization patterns of Medicaid-enrolled adolescents living in Michigan would allow opportunities for adolescent immunizations to be provided. METHODS Outpatient claims data from 2001-2005 were analyzed for 11- to 18-year-old Medicaid-enrolled adolescents living in Michigan. Visits were classified as either health-maintenance examinations (HMEs) or problem focused by using diagnostic and procedural codes. Data were divided into 4 overlapping 2-year time periods, and the age-specific proportion of adolescents who attended these 2 visit types was calculated for each. chi(2) tests were used to evaluate associations of visit patterns with gender. RESULTS Of the 718847 adolescents included in the study, <50% had >or=1 HME visit within any 2-year time period, and substantially fewer (<15%) had annual HMEs. In contrast, at least 75% of the adolescents had >or=1 problem-focused visit in any given 2-year period, and approximately half had participated in at least 2 problem-focused visits. Problem-focused, but not HME, visit utilization was significantly associated with gender, with girls increasing, but boys decreasing, visit utilization as they aged. CONCLUSIONS Similar to privately insured adolescents, most Medicaid-enrolled adolescents do not have annual preventive-care visits, which calls into question the feasibility of providing immunizations primarily at annual HMEs. Participation in problem-focused encounters was generally high in our study. However, even problem-focused visit utilization was low among older adolescent boys. This suggests that in addition to strengthening immunization within the medical home, alternative venues for reaching certain subpopulations of adolescents should also be developed.
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Affiliation(s)
- Amanda F Dempsey
- Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan 48109-5456, USA.
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Dempsey AF, Singer D, Clark SJ, Davis MM. Parents' views on 3 shot-related visits: implications for use of adolescent vaccines like human papillomavirus vaccine. Acad Pediatr 2009; 9:348-52. [PMID: 19487172 DOI: 10.1016/j.acap.2009.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 04/07/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Multidose adolescent-targeted vaccines, for example the human papillomavirus (HPV) vaccine, require parents and adolescents to have repeated interactions with the physician's office. We sought to evaluate parental views on participating in frequent vaccine-related encounters and their preferences for how these encounters should ideally be implemented. METHODS A Web-based survey about a hypothetical 3-dose adolescent vaccine was provided to a national sample of 1025 US parents of adolescents (aged 9-17 years) in 2007. RESULTS Survey completion rate among parents was 69%. Most (86%) were amenable to having their adolescent visit the provider's office at least 3 times in a year for vaccination. The highest proportion of parents (47%) preferred that the first dose be administered at a comprehensive doctor visit, followed by 2 nurse "shots-only" visits. However, many parents (30%) wanted each dose to be given as part of a comprehensive visit with a physician. The most commonly cited barriers included a belief that healthy adolescents needn't be seen frequently in the doctor's office (15%) and concerns about missing school (14%). CONCLUSIONS Compliance with multidose adolescent vaccines like HPV could require a shift in the expected frequency of health care visits. Our results suggest that most parents are amenable to more frequent adolescent vaccine-related visits, though the feasibility of implementing these visits within the current medical system remains to be determined.
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Affiliation(s)
- Amanda F Dempsey
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-5456, USA.
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Ford CA, English A, Davenport AF, Stinnett AJ. Increasing adolescent vaccination: barriers and strategies in the context of policy, legal, and financial issues. J Adolesc Health 2009; 44:568-74. [PMID: 19465321 DOI: 10.1016/j.jadohealth.2008.11.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 11/07/2008] [Accepted: 11/12/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To increase understanding of the policy, legal, and financial issues influencing efforts to achieve high rates of adolescent vaccination. METHODS We conducted semistructured telephone interviews with 49 key informants in nine states, five jurisdictions, and at the national level. We elicited: (a) experiences with human papillomavirus (HPV) and meningococcal vaccine programs; (b) perspectives on policy, legal, and financing issues influencing adolescent vaccine program effectiveness; and (c) strategies to increase rates of adolescent vaccination. Common and informative themes were identified by content analyses. RESULTS Participants reported that barriers to adolescent vaccination included: public concerns (insufficient knowledge, negative attitudes, safety concerns, controversy); practitioner concerns (insufficient knowledge or ambivalence about recommendations); delivery issues (insufficient access to or use of healthcare, vaccines not at healthcare site or part of routine care); minor consent issues; cost/financing issues; and lack of coordination in timing of vaccine recommendations, supply, and financing. Many barriers and promising strategies for overcoming them vary depending on adolescent age. For example, concerns about providing vaccines to prevent sexually transmitted diseases are less frequent with respect to older adolescents; issues of consent vary widely between 11 and 25 years of age; and financial barriers/potential solutions vary by age. We develop a framework to address policy, legal, and financial issues influencing adolescent vaccination based on adolescent age. CONCLUSIONS A comprehensive description of factors influencing adolescent vaccination reveals variation based on age. A framework that incorporates this complexity may enhance strategies to increase rates of vaccine delivery to adolescent populations.
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Affiliation(s)
- Carol A Ford
- University of North Carolina; CB 7225, Chapel Hill, NC 27599-7225, USA.
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Dempsey AF, Cowan AE, Broder KR, Kretsinger K, Stokley S, Clark SJ. Adolescent Tdap vaccine use among primary care physicians. J Adolesc Health 2009; 44:387-93. [PMID: 19306798 DOI: 10.1016/j.jadohealth.2008.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 08/22/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE In 2006 the Advisory Committee on Immunization Practices (ACIP) recommended replacement of the adolescent tetanus and diphtheria toxoids (Td) booster with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap). We examined the degree to which pediatricians and family practitioners have adopted this recommendation. METHODS National mail-based survey of a random sample of 725 pediatricians and 725 family practitioners from January through March, 2007. RESULTS Overall response rate was 60%. The majority of respondents indicated they routinely recommended Tdap to adolescents at the preferred age for vaccination, 11-12 years old (87%), and also for "catch up" vaccination among adolescents 13-18 years old (89%). In bivariate analyses, pediatrician specialty, specialty society membership, stocking Tdap in the office, and prior experience diagnosing adolescent pertussis were associated with routinely recommending Tdap to adolescents. In multivariable models adjusting for these factors simultaneously, only pediatrician specialty (OR = 4.8, 95% CI = 2.5-9.3) and stocking Tdap in the office (OR = 14.5, 95% CI = 7.5-28.5) remained significantly associated with routine recommendation. Pediatricians were significantly more likely than family practitioners to accept shorter time intervals for administering Tdap following Td vaccination, and to co-administer Tdap with MCV4. Lack of adolescent visits was the most commonly cited major barrier to adolescent Tdap administration. CONCLUSIONS Based on self report, our results indicate the majority of physicians have adopted recent recommendations from the ACIP to administer Tdap to adolescents. However, specialty-based disparities in attitudes and practices persist, suggesting that ongoing efforts are needed to motivate physicians to recommend this vaccine to adolescents and to clarify how to integrate Tdap with other adolescent vaccinations.
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Affiliation(s)
- Amanda F Dempsey
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5456, USA.
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Szilagyi PG. Translational research and pediatrics. Acad Pediatr 2009; 9:71-80. [PMID: 19329097 DOI: 10.1016/j.acap.2008.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/02/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Abstract
PURPOSE OF REVIEW The present review describes recent advances in our understanding about the epidemiology of human papillomavirus infection among female adolescents and describes several adolescent-specific issues related to administering human papillomavirus vaccines. RECENT FINDINGS National estimates demonstrate that human papillomavirus infection is most prevalent among adolescents and young adults. Parents, patients, and providers have a high interest in vaccination against this virus, but current patterns of adolescent healthcare utilization suggest that changes in adolescent preventive care delivery may be needed to provide these vaccines in a timely manner. Debate over whether adolescents should be legally allowed to self-consent to vaccination is another issue that remains unresolved and could have a substantial impact on vaccination rates. Legislation on school entry requirements related to human papillomavirus vaccination has been introduced in many states as a mechanism to circumvent some of these concerns, but the details of this legislation and its effect on adolescent vaccine utilization remain to be determined. SUMMARY Female adolescents are at a high risk for human papillomavirus infection and are likely to derive significant benefits from vaccination against this virus. However, administering human papillomavirus vaccines to this age group will require providers to be familiar with several issues unique to the adolescent population.
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Luedtke S. Human papillomavirus vaccine: are the concerns unfounded? Am J Health Syst Pharm 2008; 65:2150-1. [PMID: 18997145 DOI: 10.2146/ajhp080392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sherry Luedtke
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, 1300 Coulter, Room 112J, Amarillo, TX 79106, USA.
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Szilagyi PG, Rand CM, McLaurin J, Tan L, Britto M, Francis A, Dunne E, Rickert D. Delivering adolescent vaccinations in the medical home: a new era? Pediatrics 2008; 121 Suppl 1:S15-24. [PMID: 18174317 DOI: 10.1542/peds.2007-1115c] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Medical homes are health care settings that offer continuous, comprehensive, accessible primary care; these settings generally involve pediatric and family physician practices or community health centers but can also involve gynecologists or internists. OBJECTIVES In this article, we review available evidence on the role of the medical home in optimizing adolescent immunization delivery, particularly with respect to health care utilization patterns and barriers to vaccinations in medical homes, and solutions. METHODS We conducted a systematic review of the existing immunization and adolescent literature and used a Delphi process to solicit opinions from content experts across the United States. RESULTS Most adolescents across the United States do have a medical home, and many pay a health care visit to their medical home within any given year. Barriers exist in regards to the receipt of adolescent immunizations, and they are related to the adolescent/family, health care provider, and health care system. Although few studies have evaluated adolescent vaccination delivery, many strategies recommended for childhood or adult vaccinations should be effective for adolescent vaccination delivery as well. These strategies include education of health care providers and adolescents/parents; having appropriate health insurance coverage; tracking and reminder/recall of adolescents who need vaccination; practice-level interventions to ensure that needed vaccinations are provided to eligible adolescents at the time of any health care visit; practice-level audits to measure vaccination coverage; and linkages across health care sites to exchange information about needed vaccinations. Medical homes should perform a quality improvement project to improve their delivery of adolescent vaccinations. Because many adolescents use a variety of health care sites, it is critical to effectively transfer vaccination information across health care settings to identify adolescents who are eligible for vaccinations and to encourage receipt of comprehensive preventive. CONCLUSIONS Medical homes are integral to both the delivery of adolescent immunizations and comprehensive adolescent preventive health care. Many strategies recommended for childhood and adult vaccinations should work for adolescent vaccinations and should be evaluated and implemented if they are successful. By incorporating evidence-based strategies and coordinating effectively with other health care sites used by adolescents, medical homes will be the pivotal settings for the delivery of adolescent vaccinations.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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