农村青少年免疫接种：实施情况和接种障碍。

Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake.

机构信息

From the ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, SEB, CP, AF, AN, KS, STO, AFD); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO (JRC, STO, AFD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SEB, AN); Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO (KS); Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (CW).

出版信息

J Am Board Fam Med. 2021 Sep-Oct;34(5):937-949. doi: 10.3122/jabfm.2021.05.210107.

DOI:10.3122/jabfm.2021.05.210107

PMID:34535519

Abstract

BACKGROUND

Rural adolescent vaccination rates lag behind urban. We sought to assess rural-urban differences in barriers to adolescent vaccination, perceived parental vaccine attitudes, and immunization delivery practices among public health nursing (PHN), pediatric (Peds), and family medicine (FM) clinicians.

METHODS

Internet and mail survey of Colorado PHN, Peds, and FM clinicians from June-August 2019. Study population was recruited from local health plans and the American Medical Association Physician Masterfile. Rural and urban responses were compared using Cochran Armitage trend, Fisher's exact, and chi-square tests.

RESULTS

Response rate was 38% (163/433; 91 rural, 72 urban). Rural respondents were less likely than urban to agree most patients have insurance that covers vaccination (86% vs 97%; = .02). Rural respondents were less likely than urban to indicate most parents in their practice would agree with statements about vaccine benefits ( = .02) and trust in medical providers ( = .05). Rural respondents were more likely than urban to report adolescents were somewhat/very likely to receive vaccines at public health departments (65% vs 28%; < .0001) and less likely to report adolescents were somewhat/very likely to receive vaccines at pharmacies (26% vs 45%; = .02). Fewer providers strongly recommended HPV vaccine (81% for females, 80% for males 11 to 12 years) than other adolescent immunizations (Tdap: 97%, MenACWY at 11 to 12 years: 87%; influenza at 11 to 17 years: 87%; each < .005, rural-urban responses did not differ).

CONCLUSIONS

Rural barriers to adolescent vaccination include logistic issues and parental vaccine attitudes. Efforts to improve rural adolescent vaccination should include public health departments and address vaccine confidence and access barriers.

摘要

背景

农村青少年的疫苗接种率落后于城市。我们旨在评估农村与城市之间在青少年疫苗接种障碍、家长对疫苗的看法以及公共卫生护士（PHN）、儿科（Peds）和家庭医学（FM）临床医生的免疫接种实施方面的差异。

方法

2019 年 6 月至 8 月，对科罗拉多州 PHN、Peds 和 FM 临床医生进行了互联网和邮件调查。研究人群是从当地卫生计划和美国医学协会医师名录中招募的。使用 Cochran-Armitage 趋势检验、Fisher 精确检验和卡方检验比较农村和城市的反应。

结果

应答率为 38%（163/433；91 名农村，72 名城市）。与城市相比，农村应答者不太可能同意大多数患者都有保险来支付疫苗接种费用（86%比 97%； =.02）。农村应答者不太可能表明他们实践中的大多数父母会同意关于疫苗效益的陈述（ =.02）和对医疗服务提供者的信任（ =.05）。与城市相比，农村应答者更有可能报告青少年在公共卫生部门接种疫苗的可能性较大/非常大（65%比 28%； <.0001），而不太可能报告青少年在药房接种疫苗的可能性较大/非常大（26%比 45%； =.02）。与其他青少年免疫接种相比，推荐 HPV 疫苗的医生较少（女性为 81%，男性为 11 至 12 岁为 80%）（Tdap：97%，MenACWY 在 11 至 12 岁：87%；流感在 11 至 17 岁：87%；每种疫苗均 <.005，农村与城市的反应没有差异）。