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Research ArticleOriginal Research

Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake

Jessica R. Cataldi, Sarah E. Brewer, Cathryn Perreira, Anna Furniss, Andrea Nederveld, Krithika Suresh, Charnetta Williams, Sean T. O'Leary and Amanda F. Dempsey
The Journal of the American Board of Family Medicine September 2021, 34 (5) 937-949; DOI: https://doi.org/10.3122/jabfm.2021.05.210107
Jessica R. Cataldi
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
MD, MSCS
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Sarah E. Brewer
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
PhD, MPA
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Cathryn Perreira
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
MA
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Anna Furniss
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
MS
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Andrea Nederveld
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
MD, MPH
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Krithika Suresh
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
PhD
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Charnetta Williams
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
MD
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Sean T. O'Leary
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
MD, MPH
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Amanda F. Dempsey
From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).
MD, PhD, MPH
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Article Figures & Data

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    Figure 1.

    Provider Agreement with Statements About Logistic Barriers and Facilitators of Adolescent Vaccination Among Colorado Clinicians in 2019 (n = 148). *P = .02, chi-square test comparing rural and urban responses between strongly agree or somewhat agree versus strongly disagree or somewhat disagree; P < .01, Cochran Armitage trend test comparing rural and urban responses across all 4 response categories.

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    Figure 2.

    Provider Report of the Proportion of Parents in Their Practice Who Would Agree with Adolescent Vaccine Confidence Statements Among Colorado Clinicians in 2019 (n = 147). *P ≤ .05, Fisher's exact test comparing rural and urban responses across all response categories for each item.

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    Figure 3.

    Provider Report of the Proportion of Parents in Their Practice Who Would Agree with Human Papillomavirus (HPV) Vaccination Belief Statements Among Colorado Clinicians in 2019 (n = 147). There were no significant differences between rural and urban responses for perceived parental HPV vaccination beliefs.

  • Figure 4.
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    Figure 4.

    Strength of Provider Recommendation for Vaccination by Vaccine type and Patient Age Among Colorado Clinicians in 2019 (n = 146). Proportion of respondents who strongly recommend HPV vaccine for 11- to 12-year-old females was significantly lower than the proportion of respondents who strongly recommend Tdap at 11 to 12 years(a), MenACWY at 11 to 12 years(b), and influenza at 11 to 17 years(c) [Chi-square test, P < .005 for each bivariate comparison]. The proportion of respondents who strongly recommend HPV vaccine for 11- to 12-year-old males was also significantly lower than the proportion of respondents who strongly recommend Tdap at 11 to 12 years(d), MenACWY at 11 to 12 years(e), and influenza at 11 to 17 years(f) [P < .001 for each bivariate comparison]. HPV, human papillomavirus; MenACWY, meningococcal conjugate, Tdap, tetanus, diphtheria, and acellular pertussis.

Tables

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    Table 1.

    Characteristics of Respondents and Non-Respondents for a Survey of Colorado in Clinicians 2019. Percentages May Not Add to 100 Due to Rounding

    CharacteristicRespondents N = 163 n (%)Nonrespondents N = 240 (%)P value*
    Location.32
        Rural91 (56)122 (51)
        Urban72 (44)118 (49)
    Provider specialty<.001
        Pediatrics73 (45)95 (40)
        Family Medicine48 (29)125 (52)
        Public Health31 (19)3 (1)
        Unknown11 (7)17 (7)
    • ↵* Chi-square test comparing respondents and nonrespondents.

    • View popup
    Table 2.

    Respondent Characteristics for a Survey of Colorado Clinicians in 2019 (n = 148). Percentages May Not Add to 100 Due to Rounding. *Chi-Square Test Comparing Rural and Urban Respondents

    CharacteristicAll Respondents N = 148 n (%)Rural N = 79 n (%)Urban N = 69 n (%)P value*
    Female95 (64)53 (67)42 (61).43
    Job role.0002
        Medical doctor119 (80)54 (68)65 (94)
        Advanced practice provider (nurse practitioner, physician assistant)5 (3)4 (5)1 (1)
        Nurse or medical assistant16 (11)15 (19)1 (1)
        Public health provider8 (5)6 (8)2 (3)
    Medical specialty<.001
        Pediatric73 (50)22 (28)51 (74)
        Family Medicine50 (33)37 (47)13 (19)
        Public Health23 (16)19 (24)4 (6)
        General/Internal Medicine2 (1)1 (1)1 (1)
    Years practicing in current geographic area (n = 146).33
        <1047 (32)29 (38)18 (26)
        10 to 1958 (40)28 (36)30 (44)
        ≥2041 (28)20 (26)21 (30)
    Number of adolescents practice sees in a typical week.004
    <5067 (45)43 (54)24 (35)
        50 to 9940 (27)23 (29)17 (25)
        ≥10041 (28)13 (17)28 (41)
    Percentage of patients Hispanic/Latino (n = 136).44
        0% to 9%27 (20)16 (22)11 (18)
        10% to 24%43 (32)19 (26)24 (38)
        25% to 49%36 (27)22 (30)14 (22)
        50% to 100%30 (22)16 (22)14 (22)
    Percentage of patients Black/African American (n = 136)<.001
        0% to 9%111 (82)70 (95)41 (66)
        10% to 24%23 (17)4 (5)19 (31)
        25% to 49%1 (1)0 (0)1 (2)
        50% to 100%1 (1)0 (0)1 (2)
    Percentage of patients insured by Medicaid (n = 136)<.001
        0% to 9%13 (10)3 (4)10 (16)
        10% to 24%30 (22)9 (12)21 (34)
        25% to 49%35 (26)24 (32)11 (18)
        50% to 100%58 (43)38 (51)20 (32)
    Percentage of patients uninsured (n = 129).12
        0% to 9%99 (77)49 (69)50 (86)
        10% to 24%18 (14)12 (17)6 (10)
        25% to 49%5 (4)4 (6)1 (2)
        50% to 100%7 (5)6 (9)1 (2)
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The Journal of the American Board of Family   Medicine: 34 (5)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 5
September/October 2021
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Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake
Jessica R. Cataldi, Sarah E. Brewer, Cathryn Perreira, Anna Furniss, Andrea Nederveld, Krithika Suresh, Charnetta Williams, Sean T. O'Leary, Amanda F. Dempsey
The Journal of the American Board of Family Medicine Sep 2021, 34 (5) 937-949; DOI: 10.3122/jabfm.2021.05.210107

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Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake
Jessica R. Cataldi, Sarah E. Brewer, Cathryn Perreira, Anna Furniss, Andrea Nederveld, Krithika Suresh, Charnetta Williams, Sean T. O'Leary, Amanda F. Dempsey
The Journal of the American Board of Family Medicine Sep 2021, 34 (5) 937-949; DOI: 10.3122/jabfm.2021.05.210107
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Keywords

  • Adolescent Health
  • Chi-Square Test
  • Colorado
  • Immunization
  • Pediatrics
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