title: Keen on teen vaccines: improvement of adolescent vaccine coverage in rural North Carolina.
abstract: OBJECTIVE
  To improve adolescent immunization coverage in a rural North Carolina county.
  
  
  METHODS
  Adolescent immunization coverage rates in an intervention and four comparison counties were compared over 1 year. We introduced practice-based interventions in seven practices centering on immunization registry-driven recall of adolescents for immunizations with postcard reminders (Phase 1), and 6 months later employed nontargeted school-generated telephone reminders to parents of adolescents (Phase 2).
  
  
  RESULTS
  Improvements in the intervention county among 11- to 12-year-olds occurred for first-dose human papillomavirus vaccine in both boys (overall change, 14.2%-32.1%) and girls (27.4%-43.4%) and the meningococcal vaccine (34.6%-49.4%). Improvements among adolescents 13-18 years were limited to human papillomavirus vaccine completion in boys (1.6%-4.2%). Improvements were greater during Phase 1 than Phase 2 and among younger adolescents. Coverage improvements in the comparison counties were smaller than those observed in the intervention county.
  
  
  CONCLUSIONS
  A resource-light two-phase intervention led to modest improvements in immunization coverage, most notably in the largest adolescent practice in the county, and suggested potential for further gains, particularly among younger adolescents.
authors: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina. Electronic address: richard.chung@dm.duke.edu.
authors: Richard J
authors: RJ
authors: Chung
authors: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors: Emmanuel B
authors: EB
authors: Walter
authors: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; North Carolina Immunization Branch, Raleigh, North Carolina.
authors: Alex R
authors: AR
authors: Kemper
authors: North Carolina Immunization Branch, Raleigh, North Carolina.
authors: Amanda
authors: A
authors: Dayton
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D002648:Child; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D008297:Male; D009657:North Carolina; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D011634:Public Health / Q000379:methods; D012042:Registries; D019035:Rural Health Services / Q000458:organization & administration*; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescent; Health services; Human papillomavirus vaccines; Immunization; Quality improvement; Rural