Parent-Reported Reasons for Non-Receipt of Recommended Adolescent Vaccinations, National Immunization Survey-Teen, 2008

Background: US coverage estimates for at least one dose of routinely recommended adolescent vaccines, tetanus-diphtheria-acellular pertussis (Tdap), meningococcal (MCV4), and quadrivalent human papillomavirus (HPV4) (among girls), are below 50%.

Objectives: To examine associations between parent-reported reasons for non-receipt of adolescent vaccinations and sociodemographic characteristics.

Methods: Parental reasons for non-receipt of recommended adolescent vaccines were analyzed using data from the 2008 National Immunization Survey-Teen (n=17,835). Descriptive, bivariate, and multivariate analyses were conducted to examine the frequency of reported reasons and their association with sociodemographic characteristics.

Results: During 2008, 25.9%, 57.7%, 62.8% of adolescents did not receive the Td/Tdap, MCV4, and HPV4 (among girls) vaccines, respectively. The top parent-reported reasons for non-receipt of adolescent vaccines included: ‘not recommended by provider:’ Td/Tdap (34.0%), MCV4 (48.3%), HPV4 (13.6%); ‘lack of knowledge:’ Td/Tdap (21.4%), MCV4 (19.0%), HPV4 (20.4%); ‘not necessary:’ Td/Tdap (21.1%), MCV4 (16.4%), HPV4 (18.8%); ‘daughter is not sexually active:’ HPV4 (21.2%). Parents with incomes below 400% of the federal poverty level (PVL), or who lived in the South, were significantly more likely to say ‘lack of knowledge’ as a reason for not receiving MCV4 (P<0.05). Parents with a high school education or less were significantly more likely to say ‘lack of knowledge’ as a reason for non-receipt of HPV4 (p<0.05). Parents with less than a high school education were significantly less likely to say ‘daughter not sexually active’ as a reason for non-receipt of HPV4 (p<0.05).

Conclusions: Parental reasons vary for why adolescents did not get specific vaccines and were associated with select sociodemographic characteristics. Healthcare provider prompts and perceived parental lack of knowledge represent missed vaccination opportunities. Routine discussion of vaccination status with adolescents/parents at each healthcare visit could increase vaccination coverage.