title: Adolescent Tdap vaccine use among primary care physicians.
abstract: OBJECTIVE
  In 2006 the Advisory Committee on Immunization Practices (ACIP) recommended replacement of the adolescent tetanus and diphtheria toxoids (Td) booster with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap). We examined the degree to which pediatricians and family practitioners have adopted this recommendation.
  
  
  METHODS
  National mail-based survey of a random sample of 725 pediatricians and 725 family practitioners from January through March, 2007.
  
  
  RESULTS
  Overall response rate was 60%. The majority of respondents indicated they routinely recommended Tdap to adolescents at the preferred age for vaccination, 11-12 years old (87%), and also for "catch up" vaccination among adolescents 13-18 years old (89%). In bivariate analyses, pediatrician specialty, specialty society membership, stocking Tdap in the office, and prior experience diagnosing adolescent pertussis were associated with routinely recommending Tdap to adolescents. In multivariable models adjusting for these factors simultaneously, only pediatrician specialty (OR = 4.8, 95% CI = 2.5-9.3) and stocking Tdap in the office (OR = 14.5, 95% CI = 7.5-28.5) remained significantly associated with routine recommendation. Pediatricians were significantly more likely than family practitioners to accept shorter time intervals for administering Tdap following Td vaccination, and to co-administer Tdap with MCV4. Lack of adolescent visits was the most commonly cited major barrier to adolescent Tdap administration.
  
  
  CONCLUSIONS
  Based on self report, our results indicate the majority of physicians have adopted recent recommendations from the ACIP to administer Tdap to adolescents. However, specialty-based disparities in attitudes and practices persist, suggesting that ongoing efforts are needed to motivate physicians to recommend this vaccine to adolescents and to clarify how to integrate Tdap with other adolescent vaccinations.
authors.affiliation: Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5456, USA. adempsey@umich.edu
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Dempsey
authors.forename: Anne E
authors.initials: AE
authors.lastname: Cowan
authors.forename: Karen R
authors.initials: KR
authors.lastname: Broder
authors.forename: Katrina
authors.initials: K
authors.lastname: Kretsinger
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000600:supply & distribution / Q000627:therapeutic use*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D014481:United States; D055815:Young Adult
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines