Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008–2010 WHAT’S KNOWN ON THIS SUBJECT: The reasons why teens are not immunized are related to parental lack of knowledge and the need for provider recommendations. WHAT THIS STUDY ADDS: The reasons for vaccine refusal for human papillomavirus vaccine differ from other teen vaccines, and concerns about its safety are increasing over time. abstract OBJECTIVE: To determine the reasons adolescents are not vaccinated for specific vaccines and how these reasons have changed over time. METHODS: We analyzed the 2008–2010 National Immunization Survey of Teens examining reasons parents do not have their teens immu- nized. Parents whose teens were not up to date (Not-UTD) for Tdap/Td and MCV4 were asked the main reason they were not vaccinated. Parents of female teens Not-UTD for human papillomavirus vaccine (HPV) were asked their intent to give HPV, and those unlikely to get HPV were asked the main reason why not. RESULTS: The most frequent reasons for not vaccinating were the same for Tdap/Td and MCV4, including “Not recommended” and “Not needed or not necessary. ” For HPV, the most frequent reasons included those for the other vaccines as well as 4 others, including “Not sexually active” and “ Safety concerns/Side effects. ”“Safety concerns/Side effects” increased from 4.5% in 2008 to 7.7% in 2009 to 16.4% in 2010 and, in 2010, approaching the most common reason “Not Needed or Not Necessary” at 17.4% (95% CI: 15.7–19.1). Although parents report that health care professionals increasingly recommend all vaccines, including HPV, the intent to not vaccinate for HPV increased from 39.8% in 2008 to 43.9% in 2010 (OR for trend 1.08, 95% CI: 1.04–1.13). CONCLUSIONS: Despite doctors increasingly recommending adolescent vaccines, parents increasingly intend not to vaccinate female teens with HPV. The concern about safety of HPV grew with each year. Addressing specific and growing parental concerns about HPV will require differ- ent considerations than those for the other vaccines. Pediatrics 2013;131:645–651 AUTHORS: Paul M. Darden, MD, a,c David M. Thompson, PhD, b James R. Roberts, MD, MPH, c Jessica J. Hale, MS, a Charlene Pope, PhD, MPH, RN, d,e Monique Naifeh, MD, MPH, a and Robert M. Jacobson, MD f a Department of Pediatrics, College of Medicine, and b Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; c Department of Pediatrics, College of Medicine and d College of Nursing, Medical University of South Carolina, Charleston, South Carolina; e Ralph H. Johnson VA Medical Center, Charleston South Carolina; and f Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota KEY WORDS adolescent, preventive health services, vaccination, immunization, adolescent health services, preventive health services, vaccines, meningococcal vaccines, papillomavirus vaccines, tetanus vaccine, diphtheria-tetanus vaccine, attitude to health, patient acceptance of health care, treatment refusal ABBREVIATIONS CI—confidence interval HPV—human papillomavirus vaccine MCV4—quadrivalent meningococcal conjugate vaccine NIS-Teen—National Immunization Survey of Teens Not-UTD—not up to date OR—odds ratios Td—tetanus toxoid and reduced diphtheria toxoid vaccine Tdap—tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine Dr Darden conceptualized and designed the study, participated in the analyses, drafted the initial manuscript, and approved the final manuscript as submitted. Dr Thompson helped with the design of the study, designed the analytic plan, oversaw the analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. Mrs Hale carried out the analyses, interpreted results, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr Roberts helped with the design of the study, interpreted results, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr Naifeh interpreted results, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr Pope helped with the design of the study, interpreted results, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr Jacobson helped with the design of the study, interpreted results, reviewed and revised the manuscript, and approved the final manuscript as submitted. (Continued on last page) PEDIATRICS Volume 131, Number 4, April 2013 645 ARTICLE by guest on June 9, 2020 www.aappublications.org/news Downloaded from