Minor consent and delivery of adolescent vaccines.
OBJECTIVE
To explore whether, and to what extent, minor consent influences adolescent vaccine delivery in the United States.


METHODS
A telephone survey was completed by 263 professionals with responsibilities for adolescent health care and/or vaccination in 43 states. Measures included perceived frequency of unaccompanied minor visits and perceived likelihood of vaccine delivery to unaccompanied minors in hypothetical scenarios that varied by adolescent age, vaccine type, visit type, and clinical setting.


RESULTS
Among the 76 respondents most familiar with private primary care clinics, 47.1% reported perceptions that 17-year-old patients often present without a parent/legal guardian. Among the 104 respondents most familiar with public primary care clinics, 56.7% reported that 17-year-old patients often present alone. In response to hypothetical scenarios, approximately 30% of respondents familiar with private clinics and 50% of respondents familiar with public clinics reported perceptions that unaccompanied 17-year-old adolescents would not receive influenza, Tdap, or human papillomavirus vaccines during routine check-ups because they could not provide consent. Perceived likelihood of unaccompanied minors receiving vaccines when seen for confidential services in primary care, sexually transmitted disease, and Title X/family planning clinics varied significantly by vaccine type and clinical setting. On average, respondents reported that they would support minors having the ability to self-consent for vaccines at age 14.


CONCLUSIONS
The inability of minors to consent for vaccines is likely one barrier to vaccination. Interventions to increase adolescent vaccination should consider strategies that increase the ability of unaccompanied minors, particularly older minors, to receive vaccines within the context of legal, ethical, and professional guidelines.
Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: fordc@email.chop.edu.
Carol A
CA
Ford
Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
Martha P
MP
Skiles
Center for Adolescent Health & The Law, Chapel Hill, North Carolina.
Abigail
A
English
Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
Jianwen
J
Cai
Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
Robert P
RP
Agans
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Shannon
S
Stokley
National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease control and Prevention, Atlanta, Georgia.
Lauri
L
Markowitz
Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Emilia H
EH
Koumans
D000293:Adolescent; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel; D006801:Humans; D057828:Informed Consent By Minors; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D012749:Sexually Transmitted Diseases; D014481:United States; D014611:Vaccination
Adolescent health services; Adolescents; Confidentiality; Informed consent by minors; Privacy; Vaccination