School-Located Vaccination Clinics for Adolescents: Correlates of Acceptance Among Parents

Abstract

Four vaccines are recommended by The Advisory Committee for Immunization Practices for adolescents: tetanus, diphtheria, acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MCV4), human papillomavirus vaccine (HPV), and annual seasonal influenza vaccine. However, coverage among adolescents is suboptimal. School-located vaccination clinics (SLVCs) offer vaccines to students at school, increasing access. This study seeks to determine the relationship between attitudes of parents of middle- and high-school students and acceptance of SLVCs for all four adolescent recommended vaccines. We conducted a telephone and web-based survey among parents of students enrolled in six middle and five high schools in Georgia. Analyses were conducted to examine associations between parental attitudes and willingness to allow their child to be vaccinated at school. Tdap and influenza vaccine had the highest rates of parental SLVC acceptance while HPV vaccine had the lowest. Parents who accepted SLVCs had higher perceived severity of influenza, meningococcal, and HPV illnesses compared to parents who did not accept SLVC. Intention to vaccinate was associated with SLVC acceptance for Tdap [Adjusted OR (AOR) 7.38; 95% confidence interval (CI) 2.44-22.31], MCV4 (AOR 2.97; 95% CI 1.67-5.28), and HPV vaccines (AOR 7.61; 95% CI 3.43-16.89). Social norms were associated with acceptance of SLVCs for influenza vaccine (AOR 1.44; 95% CI 1.12-1.84). These findings suggest parents of adolescents are generally supportive of SLVCs for recommended adolescent vaccines. Perceived severity of illness and intention to get their adolescent vaccinated were the most consistent correlates of parental SLVC acceptance for all vaccines. Future SLVC planning should focus on perceptions of disease severity and benefits of vaccination.

Facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination in the United States: Systematic review

“…A two-year survey conducted by Cheung et al in urban elementary schools of Los Angeles County, California found that parents with better understanding of influenza risks and influenza vaccine benefits were more likely to consent to SLIV [23]. Gargano et al surveyed middle and high school parents in Richmond County, Georgia and found that SLIV acceptance by parents correlated with parental beliefs of influenza vaccination being a social norm and perception of illness severity prevented by vaccination in general [24]. Kelminson et al conducted a survey of parents in urban/suburban middle schools in Aurora, Colorado and found that belief in vaccine importance was associated with SLIV acceptance; parental absence during vaccination was a major barrier to consent [25].…”

HPV vaccine uptake in a school-located vaccination program

“…One study of a similar study population found that 57% vs. 27% of parents reported willingness to have their child receive an influenza vaccine versus HPV vaccine via SLVP; 6 other research supports this difference in parents' self-reported willingness to vaccinate using influenza (63.5%,67%) vs. HPV vaccine (58%,53%) in the context of an SLVP. 7,8 Previous studies have also indicated that parents report greater willingness to consent to having their child receive HPV vaccine in the context of an SLVP that includes multiple adolescent vaccines versus an SLVP that provides HPV vaccine only. 9,10 An SLVP conducted among middle schools in Denver also experienced good uptake of HPV vaccine among those participating in the program; other than the flu vaccine, HPV vaccines were administered most frequently to participants (the denominator of the proportion was all vaccines administered, not unique recipients).…”

School-located vaccination for adolescents: Past, present, and future and implications for HPV vaccine delivery

“…35 Among a small number of private school parents completing a similar questionnaire, fewer respondents reported being likely to participate in SLV programs overall, and a similar discrepancy was noted between the number willing to consent for the influenza (54%) versus the HPV (6%) vaccines. 36 Studies conducted in Georgia and Colorado revealed a similar disparity with more parents reporting a willingness to have their child vaccinated against flu (63%, 67%, respectively) vs. HPV vaccine (58%, 53%, respectively) via SLV program.…”