Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake

Abstract

Background: Rural adolescent vaccination rates lag behind urban. We sought to assess rural-urban differences in barriers to adolescent vaccination, perceived parental vaccine attitudes, and immunization delivery practices among public health nursing (PHN), pediatric (Peds), and family medicine (FM) clinicians.Methods: Internet and mail survey of Colorado PHN, Peds, and FM clinicians from June-August 2019. Study population was recruited from local health plans and the American Medical Association Physician Masterfile. Rural and urban responses were compared using Cochran Armitage trend, Fisher's exact, and chi-square tests.Results: Response rate was 38% (163/433; 91 rural, 72 urban). Rural respondents were less likely than urban to agree most patients have insurance that covers vaccination (86% vs 97%; P = .02). Rural respondents were less likely than urban to indicate most parents in their practice would agree with statements about vaccine benefits (P = .02) and trust in medical providers (P = .05). Rural respondents were more likely than urban to report adolescents were somewhat/very likely to receive vaccines at public health departments (65% vs 28%; P < .0001) and less likely to report adolescents were somewhat/very likely to receive vaccines at pharmacies (26% vs 45%; P = .02). Fewer providers strongly recommended HPV vaccine (81% for females, 80% for males 11 to 12 years) than other adolescent immunizations (Tdap: 97%, MenACWY at 11 to 12 years: 87%; influenza at 11 to 17 years: 87%; each P < .005, rural-urban responses did not differ).Conclusions: Rural barriers to adolescent vaccination include logistic issues and parental vaccine attitudes. Efforts to improve rural adolescent vaccination should include public health departments and address vaccine confidence and access barriers.

The Impact of Social Determinants of Health on Meningococcal Vaccination Awareness, Delivery, and Coverage in Adolescents and Young Adults in the United States: A Systematic Review

“…The AAP recommends on-time immunization of all children and adolescents from infancy through adolescence during annual preventive care visits [ 45 ]. There are limited data on barriers to the MenACWY and MenB vaccines for rural adolescents, and more research is needed on barriers such as lack of HCPs, financial constraints, and transportation hindrances [ 31 , 46 , 47 ]. There were three studies presented with estimates of differences in uptake of the MenACWY or MenB vaccine by healthcare access [ 31 , 46 , 47 ].…”

“…There are limited data on barriers to the MenACWY and MenB vaccines for rural adolescents, and more research is needed on barriers such as lack of HCPs, financial constraints, and transportation hindrances [ 31 , 46 , 47 ]. There were three studies presented with estimates of differences in uptake of the MenACWY or MenB vaccine by healthcare access [ 31 , 46 , 47 ]. Cataldi et al [ 46 ] administered an internet and mail survey between June and August 2019 to practicing public health nurses, pediatricians, and family medicine clinicians in the state of Colorado.…”

“…There were three studies presented with estimates of differences in uptake of the MenACWY or MenB vaccine by healthcare access [ 31 , 46 , 47 ]. Cataldi et al [ 46 ] administered an internet and mail survey between June and August 2019 to practicing public health nurses, pediatricians, and family medicine clinicians in the state of Colorado. In this study, the authors assessed rural-urban differences in logistical barriers to adolescent vaccination (MenACWY, Tdap, HPV, and influenza).…”

“…In this study, the authors assessed rural-urban differences in logistical barriers to adolescent vaccination (MenACWY, Tdap, HPV, and influenza). When HCPs were asked whether they agreed with the following statement, “Adolescents do not come to primary care for annual well visit,” the responses from urban and rural providers were as follows: strongly agree, 7% versus 15%; somewhat agree, 49% versus 47%; somewhat disagree, 32% versus 32%; and strongly disagree, 12% versus 5% ( p < 0.01) [ 46 ]. In a retrospective analysis aimed at identifying factors associated with MenACWY vaccine uptake among adolescents, Kurosky et al [ 31 ] found that, based on databases from 2011 to 2016, Medicaid patients’ uptake of ≥one MenACWY vaccine was significantly and consistently lower in older adolescents aged 15.5 through 18 years (48.9%; 205,131/419,814) than in younger adolescents aged 10.5 through 13 years (71.7%; 270,186/376,825) ( p < 0.001).…”

Barriers to Human Papillomavirus Vaccination Initiation and Completion among Adults Aged 18–26 Years in a Large Healthcare System

“…A total of 104,426 patients, with a mean age of 21.89 ± 2.63 years old, received at least one vaccination dose (Table 1). (14,109) of patients covered by private insurance and Medicaid initiated the vaccine, respectively. However, in the adjusted model, patients with Medicaid coverage were 8% less likely (PR: 0.92 (95% CI 0.91-0.94)) to initiate the vaccine than those with private insurance coverage.…”