Immunizations for adolescents have become much more complex in recent years, with the licensure of a conjugate vaccine to prevent meningococcal disease, another vaccine to prevent human papillomavirus, and new tetanus toxoid-diphtheria-pertussis vaccine. Additional vaccine recommendations affecting adolescents are likely in the near future, including a recommendation for universal influenza vaccination and future development and licensure of vaccines to prevent cytomegalovirus, herpes simplex virus, and potentially Chlamydia trachomatis. In part due to the success of vaccination, the primary causes of morbidity and mortality during adolescence relate to preventable health behaviors, including tobacco, alcohol and drug use, risky sexual activity, mental health, and injury. Adolescent preventive services guidelines have been developed and endorsed by multiple professional organizations, including the American Medical Association (AMA), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the US Maternal and Child Health Bureau (MCHB) to guide physicians in providing preventive counseling and screening for these health issues. Yet it is unclear how physicians prioritize adolescent vaccine delivery along with clinical preventive services (CPS) delivery, and whether vaccine delivery enhances or impedes delivery of other preventive services. This project will assess family physicians' and pediatricians' knowledge, attitude towards and practice of adolescent preventive services delivery through key informant interviews and focus groups. We will also qualitatively evaluate how physicians in a variety of settings (urban, suburban, rural, underserved) and practice types (health maintenance organizations, private, clinic/community health center) prioritize CPS for adolescents, and we will assess potential methods to improve CPS delivery. To quantify the delivery of CPS and immunizations, we will perform chart reviews of 400 adolescents, and interview those adolescents (aged 11-14 and 15-18) and their parents (200 parents of those aged 11-14) in practices in upstate New York. These interviews will also improve our understanding of the attitudes of parents and adolescents toward CPS. The results of this project will guide future educational and practice-based strategies to increase rates of CPS and immunization delivery for adolescents. to Public Health Our project will explore how physicians are balancing the delivery of immunizations concurrently with other preventive services for adolescents. Finding successful methods for delivery of immunizations along with effective counseling and screening will decrease the rate of vaccine preventable diseases in this population, and will reduce the more common morbidities related to risky behaviors in adolescence. ? ? ?
