title: Increasing adolescent vaccination: barriers and strategies in the context of policy, legal, and financial issues.
abstract: OBJECTIVE
  To increase understanding of the policy, legal, and financial issues influencing efforts to achieve high rates of adolescent vaccination.
  
  
  METHODS
  We conducted semistructured telephone interviews with 49 key informants in nine states, five jurisdictions, and at the national level. We elicited: (a) experiences with human papillomavirus (HPV) and meningococcal vaccine programs; (b) perspectives on policy, legal, and financing issues influencing adolescent vaccine program effectiveness; and (c) strategies to increase rates of adolescent vaccination. Common and informative themes were identified by content analyses.
  
  
  RESULTS
  Participants reported that barriers to adolescent vaccination included: public concerns (insufficient knowledge, negative attitudes, safety concerns, controversy); practitioner concerns (insufficient knowledge or ambivalence about recommendations); delivery issues (insufficient access to or use of healthcare, vaccines not at healthcare site or part of routine care); minor consent issues; cost/financing issues; and lack of coordination in timing of vaccine recommendations, supply, and financing. Many barriers and promising strategies for overcoming them vary depending on adolescent age. For example, concerns about providing vaccines to prevent sexually transmitted diseases are less frequent with respect to older adolescents; issues of consent vary widely between 11 and 25 years of age; and financial barriers/potential solutions vary by age. We develop a framework to address policy, legal, and financial issues influencing adolescent vaccination based on adolescent age.
  
  
  CONCLUSIONS
  A comprehensive description of factors influencing adolescent vaccination reveals variation based on age. A framework that incorporates this complexity may enhance strategies to increase rates of vaccine delivery to adolescent populations.
authors.affiliation: University of North Carolina; CB 7225, Chapel Hill, NC 27599-7225, USA. caf@med.unc.edu
authors.forename: Carol A
authors.initials: CA
authors.lastname: Ford
authors.forename: Abigail
authors.initials: A
authors.lastname: English
authors.forename: Amy F
authors.initials: AF
authors.lastname: Davenport
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Stinnett
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D002648:Child; D005260:Female; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D007258:Informed Consent; D007407:Interviews as Topic; D008297:Male; D008589:Meningococcal Infections / Q000517:prevention & control; D022401:Meningococcal Vaccines; D009657:North Carolina; D055815:Young Adult
chemical_list: D022401:Meningococcal Vaccines