Advertisement

Missed Vaccination Opportunities Among U.S. Adolescents by Area Characteristics

  • Sandi L. Pruitt
    Correspondence
    Address correspondence to: Sandi L. Pruitt, PhD, Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390.
    Affiliations
    Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas

    Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
    Search for articles by this author
  • Jasmin A. Tiro
    Affiliations
    Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas

    Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
    Search for articles by this author
  • Deanna Kepka
    Affiliations
    College of Nursing, The University of Utah, Salt Lake City, Utah

    Huntsman Cancer Institute, Salt Lake City, Utah
    Search for articles by this author
  • Kevin Henry
    Affiliations
    Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania

    Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
    Search for articles by this author
Published:February 03, 2022DOI:https://doi.org/10.1016/j.amepre.2021.10.014

      Introduction

      A total of 3 vaccines are recommended for U.S. adolescents: tetanus, diphtheria, and acellular pertussis; meningococcal conjugate; and human papillomavirus. To understand the disparities in vaccine availability and hesitancy, adolescent-, household-, and area-level characteristics associated with patterns of vaccine coverage are described.

      Methods

      In 2020–2021, the authors generated national estimates among 8 possible combinations of vaccine coverage and identified the associated characteristics using 2015–2017 National Immunization Survey–Teen for male and female adolescents aged 13–17 years (N=63,299) linked to area (ZIP code) characteristics. Next, the factors associated with a missed opportunity for human papillomavirus vaccine (i.e., receipt of tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only compared with coverage of all the 3 vaccines) were identified using logistic regression.

      Results

      Most U.S. adolescents received all the 3 vaccines (42.9%) or tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only (32.1%); fewer received no vaccines (7.7%) or tetanus, diphtheria, and acellular pertussis only (6.6%); and the remainder received some combination of 1–2 vaccines. Missed opportunities for human papillomavirus vaccination were more likely among adolescents who were male, were of White race, were uninsured, were in middle-income households, and were living in rural areas and were less likely among adolescents who were older, who were Medicaid insured, whose parents completed surveys in Spanish, who were in poverty-level households, and who were living in high-poverty areas.

      Conclusions

      A substantial number of U.S. adolescents are not fully vaccinated, and coverage varies by vaccine type, population, and place. Providers should routinely stock all the 3 vaccines and promote simultaneous, same-day vaccination to avoid missed vaccine opportunities. More research and interventions are needed to understand and modify patient, provider, payer, vaccine supply/storage, or other reasons for suboptimal coverage of all the recommended vaccines.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Robinson CL
        • Bernstein H
        • Poehling K
        • Romero JR
        • Szilagyi P.
        Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 130-132https://doi.org/10.15585/mmwr.mm6905a3
        • Rand CM
        • Szilagyi PG
        • Albertin C
        • Auinger P.
        Additional health care visits needed among adolescents for human papillomavirus vaccine delivery within medical homes: a national study.
        Pediatrics. 2007; 120: 461-466https://doi.org/10.1542/peds.2007-0012
        • Elam-Evans LD
        • Yankey D
        • Singleton JA
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1109-1116https://doi.org/10.15585/mmwr.mm6933a1
        • Wong CA
        • Taylor JA
        • Wright JA
        • Opel DJ
        • Katzenellenbogen RA.
        Missed opportunities for adolescent vaccination, 2006-2011.
        J Adolesc Health. 2013; 53: 492-497https://doi.org/10.1016/j.jadohealth.2013.05.009
        • Williams CL
        • Walker TY
        • Elam-Evans LD
        • et al.
        Factors associated with not receiving HPV vaccine among adolescents by metropolitan statistical area status, United States, National Immunization Survey-Teen, 2016-2017.
        Hum Vaccin Immunother. 2020; 16: 562-572https://doi.org/10.1080/21645515.2019.1670036
        • Kepka D
        • Spigarelli MG
        • Warner EL
        • Yoneoka Y
        • McConnell N
        • Balch A.
        Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data.
        Papillomavirus Res. 2016; 2: 128-132https://doi.org/10.1016/j.pvr.2016.06.002
        • Moss JL
        • Reiter PL
        • Brewer NT.
        Concomitant adolescent vaccination in the U.S., 2007-2012.
        Am J Prev Med. 2016; 51: 693-705https://doi.org/10.1016/j.amepre.2016.05.013
        • Doke K
        • Fitzgerald SA
        • Barral RL
        • Griffin P
        • Ellerbeck EF.
        Concomitant HPV and MenACWY vaccination among sixth and seventh graders receiving Tdap.
        Vaccine. 2018; 36: 6819-6825https://doi.org/10.1016/j.vaccine.2018.08.076
        • Robison SG.
        The impact of the number of injections per visit on the likelihood of human papillomavirus immunization.
        J Pediatr X. 2020; 3100024https://doi.org/10.1016/j.ympdx.2020.100024
        • Vielot NA
        • Butler AM
        • Brookhart MA
        • Becker-Dreps S
        • Smith JS.
        Patterns of use of human papillomavirus and other adolescent vaccines in the United States.
        J Adolesc Health. 2017; 61: 281-287https://doi.org/10.1016/j.jadohealth.2017.05.016
        • Henry KA
        • Stroup AM
        • Warner EL
        • Kepka D.
        Geographic factors and human papillomavirus (HPV) vaccination initiation among adolescent girls in the United States.
        Cancer Epidemiol Biomarkers Prev. 2016; 25: 309-317https://doi.org/10.1158/1055-9965.EPI-15-0658
        • Henry KA
        • Swiecki-Sikora AL
        • Stroup AM
        • Warner EL
        • Kepka D.
        Area-based socioeconomic factors and human papillomavirus (HPV) vaccination among teen boys in the United States.
        BMC Public Health. 2017; 18 ([published correction appears in BMC Public Health. 2017;17(1):736]): 19https://doi.org/10.1186/s12889-017-4567-2
        • Do EK
        • Rossi B
        • Miller CA
        • et al.
        Area-level variation and human papillomavirus vaccination among adolescents and young adults in the United States: a systematic review.
        Cancer Epidemiol Biomarkers Prev. 2021; 30: 13-21https://doi.org/10.1158/1055-9965.EPI-20-0617
      1. 2013-2017 ACS 5-year estimates. U.S. Census Bureau.https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2017/5-year.html. Updated October 8, 2021. Accessed January 6, 2020.

        • Centers for Disease Control and Prevention
        National immunization survey-teen: a user’s guide for the 2017 public-use data file.
        Centers for Disease Control and Prevention, Atlanta, GA2018 (Accessed February 11, 2021)
      2. Documentation 2010 Rural-Urban Commuting Area (RUCA) Codes. U.S. Department of Agriculture (USDA), Economic Research Service.https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation/. Updated August 17, 2020. Accessed February 27, 2021.

      3. State laws and mandates by vaccine. Immunization Action Coalition. https://www.immunize.org/laws/. Updated May 24, 2021. Accessed January 24, 2022.

        • Zahnd WE
        • Rodriguez C
        • Jenkins WD.
        Rural-urban differences in human papillomavirus-associated cancer trends and rates.
        J Rural Health. 2019; 35: 208-215https://doi.org/10.1111/jrh.12305
        • Brandt HM
        • Vanderpool RC
        • Pilar M
        • Zubizarreta M
        • Stradtman LR
        A narrative review of HPV vaccination interventions in rural U.S. communities.
        Prev Med. 2021; 145106407https://doi.org/10.1016/j.ypmed.2020.106407
        • Swiecki-Sikora AL
        • Henry KA
        Kepka D. HPV vaccination coverage among U.S. teens across the rural-urban continuum.
        J Rural Health. 2019; 35: 506-517https://doi.org/10.1111/jrh.12353
        • Ranganathan R
        • Zahnd WE
        • Harrison SE
        • Brandt HM
        • Adams SA
        • Eberth JM.
        Spatial access to vaccines for children providers in South Carolina: implications for HPV vaccination.
        Prev Chronic Dis. 2020; 17: E163https://doi.org/10.5888/pcd17.200300
        • Wishner J
        • Solleveld P
        • Rudowitz R
        • Paradise J
        • Antonisse L.
        A look at rural hospital closures and implications for access to care: three case studies. Kaiser Family Foundation Issue Brief.
        Kaiser Family Foundation, San Francisco, CA2016 (Published July 7, 2016. Accessed May 25, 2021)
      4. CDC vaccine price list. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html#pediatric. Updated January 1, 2022. Accessed January 24, 2022.

        • Yu SWY
        • Hill C
        • Ricks ML
        • Bennet J
        • Oriol NE.
        The scope and impact of mobile health clinics in the United States: a literature review.
        Int J Equity Health. 2017; 16: 178https://doi.org/10.1186/s12939-017-0671-2
        • Federico SG
        • Abrams L
        • Everhart RM
        • Melinkovich P
        • Hambidge SJ.
        Addressing adolescent immunization disparities: a retrospective analysis of school-based health center immunization delivery.
        Am J Public Health. 2010; 100: 1630-1634https://doi.org/10.2105/AJPH.2009.176628
        • Walsh B
        • Doherty E
        • O'Neill C
        Since the start of the Vaccines For Children Program, uptake has increased, and most disparities have decreased.
        Health Aff (Millwood). 2016; 35: 356-364https://doi.org/10.1377/hlthaff.2015.1019
        • Walker AT
        • Smith PJ
        • Kolasa M
        • Centers for Disease Control and Prevention (CDC)
        Reduction of racial/ethnic disparities in vaccination coverage, 1995-2011.
        MMWR Suppl. 2014; 63: 7-12https://doi.org/10.1377/hlthaff.2015.1019
        • Hegde ST
        • Wagner AL
        • Clarke PJ
        • Potter RC
        • Swanson RG
        • Boulton ML.
        Neighbourhood influence on the fourth dose of diphtheria-tetanus-pertussis vaccination.
        Public Health. 2019; 167: 41-49https://doi.org/10.1016/j.puhe.2018.11.009
        • Dempsey AF
        • Schaffer S
        • Singer D
        • Butchart A
        • Davis M
        • Freed GL.
        Alternative vaccination schedule preferences among parents of young children.
        Pediatrics. 2011; 128: 848-856https://doi.org/10.1542/peds.2011-0400
        • Cunningham RM
        • Minard CG
        • Guffey D
        • Swaim LS
        • Opel DJ
        • Boom JA.
        Prevalence of vaccine hesitancy among expectant mothers in Houston, Texas.
        Acad Pediatr. 2018; 18: 154-160https://doi.org/10.1016/j.acap.2017.08.003
        • Rodriguez SA
        • Mullen PD
        • Lopez DM
        • Savas LS
        • Fernández ME.
        Factors associated with adolescent HPV vaccination in the U.S.: a systematic review of reviews and multilevel framework to inform intervention development.
        Prev Med. 2020; 131105968https://doi.org/10.1016/j.ypmed.2019.105968
        • Institute of Medicine (U.S.)
        Committee on Review of Priorities in the National Vaccine Plan.
        National Academies Press, Washington, DC2010 (Accessed January 31, 2022)
        • Kroger A
        • Bahta L
        • Hunter P.
        General Best practice guidelines for immunization.
        Centers for Disease Control and Prevention, 2021 (Updated May 4, 2021. Accessed November 5, 2021)
        • Keim-Malpass J
        • Mitchell EM
        • Camacho F.
        HPV vaccination series completion and co-vaccination: pairing vaccines may matter for adolescents.
        Vaccine. 2015; 33: 5729-5732https://doi.org/10.1016/j.vaccine.2015.09.077
        • Farmar AM
        • Love-Osborne K
        • Chichester K
        • Breslin K
        • Bronkan K
        • Hambidge SJ.
        Achieving high adolescent HPV vaccination coverage.
        Pediatrics. 2016; 138e20152653https://doi.org/10.1542/peds.2015-2653
      5. Top 10 tips for HPV vaccination success attain and maintain high HPV vaccination rates.
        Centers for Disease Control and Prevention, 2018 (Updated May 2018. Accessed April 30, 2021)
      6. National HPV Vaccination Roundtable. Cancer prevention through HPV vaccination in your practice: an action guide for physicians, physician assistants, and nurse practitioners. WAshington, DC: National HPV Vaccination Roundtable. http://hpvroundtable.org/wp-content/uploads/2018/04/PROVIDERS-Action-Guide-WEB.pdf. Published September 2019. Accessed April 30, 2021.

        • Stokley S
        • Jeyarajah J
        • Yankey D
        • et al.
        Human papillomavirus vaccination coverage among adolescents, 2007–2013, and postlicensure vaccine safety monitoring, 2006–2014–United States.
        MMWR Morb Mortal Wkly Rep. 2014; 63 (Accessed January 31, 2022): 620-624
      7. ACIP meeting minutes. Centers for Disease Control and Prevention.https://www.cdc.gov/vaccines/acip/meetings/minutes-archive.html. Updated May 12, 2021. Accessed October 25, 2021.

        • Saslow D
        • Andrews KS
        • Manassaram-Baptiste D
        • Smith RA
        • Fontham ETH
        • American Cancer Society Guideline Development Group
        Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation.
        CA Cancer J Clin. 2020; 70: 274-280https://doi.org/10.3322/caac.21616
        • Abdullahi LH
        • Kagina BM
        • Ndze VN
        • Hussey GD
        • Wiysonge CS.
        Improving vaccination uptake among adolescents.
        Cochrane Database Syst Rev. 2020; 1CD011895https://doi.org/10.1002/14651858.CD011895.pub2
        • Delamater PL
        • Leslie TF
        • Yang YT.
        Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000-2013.
        BMC Public Health. 2018; 18: 458https://doi.org/10.1186/s12889-018-5368-y
        • Staples JN
        • Nelamangala SL
        • Morris S
        • Wells K
        Exploring socio-demographic and geospatial variation in human papillomavirus vaccination uptake in Virginia.
        Vaccine. 2021; 39: 5385-5390https://doi.org/10.1016/j.vaccine.2021.07.079