title: Universal hepatitis B immunization of infants: reactions of pediatricians and family physicians over time.
abstract: OBJECTIVE
  In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hepatitis B immunization of infants. In February 1992 the American Academy of Pediatrics (AAP) and in August 1992 the American Academy of Family Physicians (AAFP) issued similar recommendations. The purpose of this study was to assess over time the effectiveness and impact of the dissemination efforts of the ACIP, AAP, and AAFP regarding this new recommendation and to determine the factors affecting its adoption.
  
  
  METHODS
  Cohort survey over time.
  
  
  METHODS
  North Carolina.
  
  
  METHODS
  All 778 pediatricians and a random sample of 300 family physicians in North Carolina were surveyed by mail 3 months after publication of the ACIP recommendation (January/February 1992), but before the AAP and AAFP recommendations. Response rate was 78%. Of these, 83% responded to a follow-up survey 8 months later (October 1992).
  
  
  METHODS
  Rates of agreement and adoption of the recommendation for universal infant immunization with hepatitis B vaccine; factors affecting agreement and adoption of the recommendation.
  
  
  RESULTS
  In the first survey (3 months after the ACIP recommendation) more pediatricians than family physicians were aware of the new recommendation (82% vs 48%), yet only 37% of pediatricians and 23% of family physicians agreed that immunization of all newborns in their practice was warranted. Eight months later, after the AAP and AAFP recommendation, 66% of pediatricians and 32% of family physicians agreed universal immunization was warranted, but still only 53% of pediatricians and 23% of family physicians had adopted it into practice. Factors associated with these low rates of adoption include physician and practice characteristics, cost, perceived need for the vaccine, and aversion to multiple injections.
  
  
  CONCLUSIONS
  Federal, AAP, and AAFP efforts have not been effective thus far in fostering widespread agreement and adoption of this recommendation. If this and future vaccine programs are to succeed, research is needed to determine influences on implementation of new recommendations and to address the economic and noneconomic concerns of physicians and parents.
authors.affiliation: Division of Community Pediatrics, University of North Carolina, Chapel Hill 27599-7590.
authors.forename: G L
authors.initials: GL
authors.lastname: Freed
authors.forename: W C
authors.initials: WC
authors.lastname: Bordley
authors.forename: S J
authors.initials: SJ
authors.lastname: Clark
authors.forename: T R
authors.initials: TR
authors.lastname: Konrad
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000592:standards*; D007223:Infant; D009657:North Carolina; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D017325:Hepatitis B Vaccines