title: Barriers to adolescent immunization: a survey of family physicians and pediatricians.
abstract: BACKGROUND
  Although early childhood vaccination rates have increased, many adolescents are not up to date on recommended vaccinations. We assessed attitudes and practices of family physicians and pediatricians regarding adolescent vaccination to identify provider-level barriers that may contribute to low immunization rates.
  
  
  METHODS
  A 94-item self-report questionnaire was mailed to 400 physicians contracted with a managed care organization. Physicians were queried about demographic characteristics, source of vaccine recommendations, adolescent immunization practices, barriers to immunizing adolescents, and use of reminder/recall systems.
  
  
  RESULTS
  Response rate was 59%. Most respondents reported routinely recommending vaccines for tetanus and diphtheria toxoids (98%), Hepatitis B (90%), and measles, mumps, and rubella (84%), whereas 60% routinely recommended varicella vaccine. Physicians reported that they were more likely to assess immunization status, administer indicated immunizations, and schedule return immunization visits to younger adolescents (11 to 13 years old) than to older adolescents (14 to 18 and 19 to 21 years old).
  
  
  CONCLUSIONS
  Most respondents reported recommending the appropriate vaccinations during preventive health visits; however, older adolescents were least likely to be targeted for immunization assessment and administration of all recommended vaccines.
authors.affiliation: Emory Center on Health Outcomes and Quality, Rollins School of Public Health, Atlanta, GA 30322, USA. noster@sph.emory.edu
authors.forename: Natalia Vukshich
authors.initials: NV
authors.lastname: Oster
authors.forename: Carol A
authors.initials: CA
authors.lastname: McPhillips-Tangum
authors.forename: Francisco
authors.initials: F
authors.lastname: Averhoff
authors.forename: Kelly
authors.initials: K
authors.lastname: Howell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D019433:Chickenpox Vaccine / Q000008:administration & dosage; D002648:Child; D022422:Diphtheria-Tetanus Vaccine / Q000008:administration & dosage; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D008297:Male; D008329:Managed Care Programs; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D010372:Pediatrics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D019433:Chickenpox Vaccine; D022422:Diphtheria-Tetanus Vaccine; D017325:Hepatitis B Vaccines; D022542:Measles-Mumps-Rubella Vaccine