Barriers to Adolescent Immunization: A Survey of Family Physicians and Pediatricians

Article Figures & Data

Table 1.

Demographic Characteristics of Survey Respondents and Nonrespondents*

Attribute	Respondents [No. (%)]	Nonrespondents [No. (%)]
Specialty^†
Family practice	113 (54)	100 (68)
Pediatrics	97 (46)	48 (32)
Year of medical school graduation
1940 to 1959	8 (5)	4 (4)
1960 to 1979	71 (46)	44 (39)
After 1980	76 (49)	64 (57)
Gender
Male	123 (64)	102 (72)
Female	69 (36)	39 (28)

* Nonrespondent data based on administrative data; respondent based on administrative data plus survey response (99% correspondence).
† P < .05 for differences between respondents and non-respondents.

Table 2.

Immunization Activities and Practices

	PED^* [n = 97 (%)]	FP^* [n = 113 (%)]	Total [n = 210 (%)]
Source of vaccine recommendations
American Academy of Pediatrics	96 (99)	54 (48)	150 (71)
American Academy of Family Practitioners^†	7 (7)	92 (81)	99 (47)
Advisory Committee on Immunization Practices^†	53 (55)	26 (23)	79 (38)
Vaccines routinely recommended for adolescents
Tetanus/diphtheria	97 (100)	108 (96)	205 (98)
Measles, mumps, rubella	86 (87)	90 (80)	176 (84)
Hepatitis B^†	96 (99)	93 (82)	189 (90)
Varicella^†	78 (80)	48 (42)	126 (60)
Immunization activities conducted at preventive health visits
Immunization activity by age
Assess immunization status
11 to 13 years	95 (98)	103 (91)	198 (94)
14 to 18 years	93 (96)	98 (87)	191 (91)
19 to 21 years	72 (74)	84 (74)	156 (74)
Administer needed immunizations
11 to 13 years	96 (99)	105 (93)	201 (96)
14 to 18 years	94 (97)	105 (93)	200 (95)
19 to 21 years^*	67 (69)	95 (84)	162 (77)
Schedule return immunization visits
11 to 13 years	82 (85)	81 (72)	163 (78)
14 to 18 years	79 (81)	77 (68)	156 (74)
19 to 21 years	54 (56)	72 (64)	126 (60)
Self-report that ≥75% adolescent patients up-to-date on vaccinations
Tetanus/diphtheria^†	73 (75)	68 (62)	141 (69)
Measles, mumps, rubella	72 (79)	73 (65)	145 (69)
Hepatitis B^†	33 (34)	21 (19)	54 (26)
Varicella^†	41 (42)	21 (19)	62 (31)
Use of recall/reminder systems	27 (28)	19 (17)	47 (22)

Table 3.

Degree of Importance Placed on Ensuring Adolescents Are Up to Date, by Specialty*

Table 4.

Barriers to Immunizing Adolescents*

	Age 11 to 13 [No. (%)]	Age 14 to 18 [No. (%)]	Age 19 to 21 [No. (%)]
Adolescents rarely make preventive health visits
PEDS^†	44 (45)	68 (69)	61 (63)^‡
FP^†	63 (56)	79 (70)	84 (74)
Overall	107 (51)	147 (70)	145 (69)
Adolescents not aware of need for immunizations
PEDS	44 (45)^‡	62 (64)	59 (61)
FP	70 (62)	74 (65)	76 (67)
Overall	114 (54)	136 (65)	135 (64)
Adolescents/parents underestimate risk of disease
PEDS	42 (43)	55 (57)	44 (45)
FP	58 (51)	61 (54)	60 (53)
Overall	100 (48)	116 (55)	104 (50)
Difficult to obtain verification of previous immunization
PEDS	31 (32)^‡	42 (43)^‡	35 (36)^‡
FP	67 (59)	69 (61)	71 (63)
Overall	98 (47)	111 (53)	106 (50)
Non-compliance with multiple dose vaccines
PEDS	40 (42)	48 (49)	44 (45)
FP	42 (37)	44 (39)	45 (40)
Overall	82 (39)	92 (44)	89 (42)
Adolescents seek care from other facilities
PEDS	23 (24)	32 (33)	40 (41)^‡
FP	21 (19)	23 (20)	29 (26)
Overall	44 (21)	55 (26)	69 (33)
Adolescents/parents overestimate risk of side-effects
PEDS	18 (19)	14 (14)	11 (11)^‡
FP	29 (26)	26 (23)	24 (21)
Overall	47 (22)	40 (19)	35 (17)
Difficult to determine who needs vaccine
PEDS	10 (10)	16 (16)	11 (11)^‡
FP	22 (19)	22 (19)	24 (21)
Overall	32 (15)	38 (18)	35 (17)
Difficult to determine adolescents “at risk”
PEDS	10 (10)	15 (15)	15 (15)
FP	14 (12)	16 (14)	14 (12)
Overall	24 (11)	31 (15)	29 (14)
Adolescents/parents refuse vaccination
PEDS	10 (10)	10 (10)	11 (11)
FP	13 (12)	10 (9)	12 (11)
Overall	23 (11)	20 (10)	23 (11)
Obtaining consent as per state law
PEDS	3 (3)	6 (6)	5 (5)
FP	9 (8)	10 (9)	8 (7)
Overall	12 (6)	16 (8)	13 (6)