Despite increases in recent years, adolescent immunization rates in the United States fall short of Healthy People 2020 goals for several routinely recommended vaccines, leaving millions of teenagers susceptible to preventable diseases. However, data are lacking on the reasoning behind these continued less-than-optimal rates.

 

Shedding Some Light

Between September 26 and October 7, 2016, the non-profit organization Unity Consortium fielded a Harris Poll among 506 adolescents aged 13 to 18, 515 parents of teenagers, 105 pharmacists, and 405 physicians specializing in family practice, general practice, internal medicine, or pediatrics. All surveyed physicians were duly licensed, spent at least 50% of their time in out-patient practice and at least 80% in direct patient care, saw at least and average of 250 patients per month, and regularly saw teenagers for well visits.

According to the survey, 92% of parents and 88% of teens reported that they believe it is important for all teens to be vaccinated. However, national data from 2015 indicate that only 33% of teens aged 17 or older received their second recommended dose of the meningitis ACWY vaccine. Less than 50% of male teens and 65% of female teens received the first dose of the human papillomavirus vaccine. So, why aren’t teens getting vaccinated?

 

Attitudes Impede Action

Misperceptions about needing to visit a healthcare provider create barriers to vaccination (Figure). The survey found that nearly all teens (92%) seemed to trust their doctors, but at the same time:

  • Nearly 60% of teens and 41% of parents said they believe they only need to see a doctor if they are feeling sick.
  • Nearly one-quarter of parents and teens reported that they feel vaccines are important for babies and not as important for teens.

 

Communication Is Key

Healthcare providers also play a role in communicating the importance of preventive health services and vaccination. Nearly 100% of healthcare providers participating in the survey reported that they believe teens should be encouraged to be more engaged in their healthcare. Yet, the survey also found that there may be a communication gap that limits engagement:

  • Less than 65% of healthcare providers reported that their practices have processes in place to remind teens about the next recommended vaccine.
  • Only 44% said they utilize reminders for missed vaccinations.
  • Nearly one-half of teens reported that they do not like talking to their healthcare providers.

 

Educate and Remind

Given these findings, healthcare providers, parents, and teens need to work together to encourage teens to be proactive and responsible about their own health, feel comfortable asking questions, and prioritize vaccination to protect their future health. It is vital that immunizers make sure that teens don’t skip annual check-ups, particularly at 11-12 and 16 years old, when routine vaccinations should be given. The CDC recommends that adolescents receive the following vaccines to protect their health in both the short and long term:

  • Meningococcal (ACWY and B)
  • Tetanus, diphtheria, pertussis (Tdap) booster
  • Human papillomavirus
  • Influenza (annually)

Any time a teen is in a physician’s office for any reason is a good time to discuss the need for immunizations to address any concerns and reduce missed opportunities. Healthcare providers should set up a reminder system to alert teens and their parents—who remain the primary coordinator and influencer of vaccination in their teens—when it is time to make an appointment. To further support clinicians, Unity Consortium has developed programs, accessible on their website:

  • The Three Cs, available as a CME program, helps improve the delivery of a confident, concise, and consistent recommendation for routinely recommended vaccines to adolescents.
  • The INSPECT imperatives, outlined in Adolescent Immunization: Understanding Challenges and Framing Solutions for Healthcare Providers.

Remember that many factors, including a teen’s age or gender, may impact conversations focused around immunizations; communication should be tailored to every teen’s needs.

References

Reagen-Steiner S, Yankey D, Jeyarajah, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2015. MMWR. 2016;65:850-858.

CDC. For Parents: Vaccines for Your Children. For Parents or Preteens and Teens. Available at www.cdc.gov/vaccines/parents/diseases/teen.

Indiana University School of Medicine. Pursuit of the 3Cs: confident, concise and consistent health care provider recommendations for adolescent vaccinations. Available at https://iu.cloud-cme.com/aph.aspx?EID=36620&P=3000&CaseID=781.

Unity Consortium. Adolescent Health and Immunization Poll. Available at http://www.unity4teenvax.org/unity-projects