Running Head: IMMUNIZATION 1
Adolescent Immunization Annotated Bibliography
Name
Institution
IMMUNIZATION 2
Abdullahi, L. H., Kagina, B. M., Ndze, V. N., Hussey, G. D., & Wiysonge, C. S. (2020).
Improving vaccination uptake among adolescents.3The Cochrane database of systematic
reviews,31(1), CD011895. https://doi.org/10.1002/14651858.CD011895.pub2
In this article, Abdullahi et al. (2020) carry out a literature review to evaluate the effects
various interventions have on improving adolescents' immunization rates. This is because
vaccination among adolescents has become an issue of concern due to the suboptimal
vaccination coverage rates. Abdullahi et al. (2020) provide that targeting adolescents has benefits
since it can help identify missed vaccinations, improve body immunity, and create awareness of
new vaccines. In the paper, Abdullahi et al. (2020) cite that adolescents mostly seek physician
care when ill, limiting the opportunity to get information about vaccines. Also, the article
findings provide that vaccination coverage is limited, considering that globally, only 6.1 percent
of adolescent girls received full dose series of HPV vaccine in 2014. However, the data varies
with countries since vaccination rates were higher in high-income countries than in low-income
countries.
The paper provides that the most common barriers to vaccination among adolescents
include predisposing factors such as lack of knowledge about the vaccines, negative attitudes,
and beliefs regarding the vaccines among the adolescents, teachers, parents, and the healthcare
providers. Other factors include financial constraints and poor vaccine delivery infrastructure.
Following the research, Abdullahi et al. (2020) recommend that interventions targeting parents,
adolescent children, and health care providers are required. This includes interventions such as
addressing predisposing factors by improving health education on HPV and other vaccines to
increase knowledge and awareness. Other interventions include the introduction of reinforcing
factors such as financial incentives, mandatory vaccination requirements to improve vaccine
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uptake. Also, enabling factors such as reducing out of pocket expenses and introducing a school-
based vaccination strategy can help improve immunization coverage. However, Abdullahi et al.
(2020) provide that these interventions do not provide certainty, and additional research is
required to improve adolescent immunization programs.
Bar-Shain, D., Stager, M., Leon, J., Kaelber, D., & Runkle, A. (2015). Direct messaging to
parents/guardians to improve adolescent immunizations. Journal of Adolescent Health,
56(5), S21-S26. https://doi.org/10.1016/j.jadohealth.2014.11.023
In this article, the authors recommend using direct messaging and mobile technology to
promote adolescent immunizations. According to Bar-Shain et al. (2015), the CDC reports that
adolescent immunization coverage rates are low. For instance, 15 percent of the population had
not received the recommended tetanus, diphtheria, and pertussis vaccine by 2015. In comparison,
26 percent have not received MCV, and 46 and 79 percent of females and males have not
received HPV vaccines. Also, Bar-Shain et al. (2015) provide that the immunization rates of
adolescents below the poverty line are 1 to 10 percent less than those above poverty line. Other
data provided in the article is that racial and ethnic disparities exist in the completion of various
vaccine doses, with African Americans having the lowest rates of immunization completion
compared to Caucasians and Hispanics.
Bar-Shain et al. (2015) provide that direct messaging to parents can engage them in their
adolescent children's health. The direct messaging intervention aims to create awareness of the
need and importance of ensuring their children's immunization. The authors of the article provide
that this intervention showed a 25 percent rate of effectiveness. The health intervention enablers
included the high utilization of cellphones and emphasized that parents respond to the adolescent
immunization messages.
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In the paper, Bar-Shain et al. (2015) argue that technology innovation can help support
immunization bid since it could help parents receive constant reminders regarding their
adolescent children's immunization schedule. The messaging technology can also help spread
health awareness and educational messages regarding vaccination and immunization to diverse
communities. Bar-Shain et al. (2015) also provide that text messages are becoming more prolific,
and parents have become more interested in utilizing them to improve their children's health.
Bernstein, H. H., Bocchini, J. A., & Committee on Infectious Diseases (2017). The Need to
Optimize Adolescent Immunization.3Official Journal of the American Academy of
Pediatrics,3139(3), e20164186. https://doi.org/10.1542/peds.2016-4186
In this paper, Bernstein et al. (2017) provide that adolescence marks a transition from a
pediatric patient to an adult patient. In this case, this is a time where effective measures for
preventive care can be developed to ensure adolescent children engage in safe behaviors in their
adulthood. In this case, Bernstein et al. (2017) provide that vaccination is a crucial foundation for
preventative care in adolescents. However, various data sources show that despite the expansion
of adolescent immunization schedules in the past decade, the immunization rates lag behind. The
current immunization schedule consists of two doses of meningococcal conjugate vaccines, three
doses of the HPV vaccine, and one dose of diphtheria, tetanus, and pertussis. In this article,
Bernstein et al. (2017) compared the immunization uptake rates of HPV, menACWY, and Tdap
and provides that the uptake of meningococcal conjugate and HPV vaccines remain lower with
HPV being the lowest of all. HPV vaccination rates are also lower among boys than girls with a
lower percentage of girls, 43 percent completing the three doses.
Bernstein et al. (2017) recommend that there is a need to understand the barriers to
immunization to help address the challenges. One of the challenges identified is that healthcare
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providers do not show consistency in recommending these vaccines to patients. For instance, one
research showed that only 60% of physicians recommended HPV vaccines to 11 and 12-year-old
girls. Another barrier that is a predisposing factor is individual beliefs and lack of interest, all of
which influence delivery and acceptance of vaccines. The paper also cites the lack of parental
acceptance, where many parents find no need for the vaccine, which is contributed to a lack of
sufficient knowledge on the vaccines. For instance, Bernstein et al. (2017) provide that most
parents of adolescents decline the vaccine citing that their children are not at risk of getting the
disease, lack of trust in the vaccine, and fear of adverse effects. Lastly, misinformation on the
internet influence acceptance to immunization. Bernstein et al. (2017) recommend the need for
creating awareness and educating parents and their adolescent children on the health benefits of
these vaccines and the complications associated with diseases bring to avoid misinformation.
Burns, J. L., Walsh, L. J., & Popovich, J. M. (2010). Continuing Education: Practical Pediatric
and Adolescent Immunization Update. The Journal for Nurse Practitioners, 6(4), 254-
266. https://doi.org/10.1016/j.nurpra.2010.01.012
This article reports that nurse practitioners have a crucial role to play in the immunization
of adolescent children. For instance, Burns et al. (2010) provide that it is the role of NPs to be
aware and understand the new vaccines and immunization schedules to ensure they provide the
most up to date care to the targeted populations in the bid to meet Healthy People 2020
immunization goals. The paper also notes that vaccines played a critical role in eradicating
smallpox and poliomyelitis in the 90s. Burns et al. (2010) also discuss the predisposing factors
that hinder immunization efforts such as parental concerns and health disparities in
immunization, especially among African Americans low-income adolescents, who show low
vaccination rates than their Caucasian counterparts. For instance, the article provides that among
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adolescents between 13 to 17 years, only 36 percent of African Americans were vaccinated
against Varicella and 42 percent against Tdap. Also, Burns et al. (2010) provide that Caucasian
adolescents were more informed about HPV that African American adolescents, who fail to
regard cervical cancer as a threat to themselves. Other issues that are reported to result in low
vaccine uptake in the article include a lack of mandatory visits for adolescent preventive care
Enabling factors that lack include the presence of a nationwide immunization tracking
system, which means parents do not have access to vaccine information systems regarding the
vaccines that their children have received. Burns et al. (2010) provide that the enabling factors
that promote behavior, belief, and attitude change can be reinforced by giving adolescent support
in their health. Parental and teenage education on vaccines can help address the predisposing
factors associated with lack of knowledge and ensure that their children do not miss vaccines.
This article shows that there is a need for improving immunization intervention programs for
adolescents. School-based health care centers are suggested as an effective solution to these
problems.
Federico, S. G., Abrams, L., Everhart, R. M., Melinkovich, P., & Hambidge, S. J. (2010).
Addressing adolescent immunization disparities: a retrospective analysis of school-based
health center immunization delivery.3American journal of public health,3100(9), 1630–
1634. https://doi.org/10.2105/AJPH.2009.176628
The authors in this paper carried out a retrospective analysis to determine the
effectiveness of immunization delivery in community health centers(CHCs) compared to that of
school-based health centers (SBHC). According to Federico et al. (2010), SBHCs are primary
care clinics within the school premises and are considered critical in delivering immunization
among adolescents. Federico et al. (2010) argue that the current healthcare delivery system is
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insufficient in providing immunization services to adolescent children, especially in multi-dose
vaccination series.
The study finding in the article provides that SBHCs were more effective in improving
adolescent uptake of vaccination. Also, adolescents in SBHCs were more likely to complete their
vaccine series dose, despite their financial and insurance status. In this case, Federico et al.
(2010) provide that SBHCs were more superior to CHCs in ensuring completion of the vaccine
doses. The research findings show that SBHCs can overcome utilization barriers in different
ways that are not documented. This includes serving people with significant health disparities,
including those who do not speak English, people without public insurance coverage, since these
characteristics are associated with reduced access to care. Another reason why Federico et al.
(2010) recommends the utilization of SBHCs is that these facilities help overcome traditional
barriers that hinder access to health care since they are located in schools that serve ethnically
and racially diverse students, as well as low-income adolescents. These facilities also have the
resources and infrastructure needed for sufficient and efficient provision of comprehensive
primary care.
Other than the effective delivery of vaccines to underserved and racial/ethnic minorities,
SBHCs can easily see patients for multiple visits than community health centers. They also have
a reminder recall system, a recognized method of improving vaccine dose series completion.
Also, Federico et al. (2010) provide that SBHCs serve populations less prone to migration,
making it easier to implement a tracking system. Other advantages that act as enablers and
reinforce are school-based health centers' ability to reduce cost barriers, in terms of out-of-pocket
expenses, transportation cost, and the troubles of adolescents going away from class/school for
vaccination.
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Greenfield, L. S., Page, L. C., Kay, M., Li-Vollmer, M., Breuner, C.C., & Duchin, J.S. (2015).
Original article: Strategies for Increasing Adolescent Immunizations in Diverse Ethnic
Communities. Journal of Adolescent Health, 56, S547-S53.
https://doi.org/10.1016/j.jadohealth.2014.10.274
This paper's authors purposed to determine the adolescent knowledge and attitudes
towards various vaccines such as Tdap, MCV4, and HPV, among Somali, Ethiopian, Somali and
other communities in Washington. A report of Greenfield et al. (2015) findings shows that
predisposing factors such as reduced knowledge and awareness among adolescents and their
parents resulted in low immunization coverage in these communities. For instance, the report
provides that most of the parents from these communities had not heard of the meningococcal
conjugate, Tdap, and HPV vaccines. At the same time, only a few adolescents knew about them.
The knowledge gap has been identified in different studies to be a common factor hindering
acceptance to vaccination.
Besides the limited knowledge about the recommended vaccines for adolescents,
Greenfield et al. (2015) report that parents and some of the adolescents held various
misconceptions and beliefs about vaccine-preventable diseases, most of which varied with the
country of origin. An example provided by the author is Eritrea, where parents believe that
meningococcal disease is caused by the scorching effects of sun and heat. In this case, this
disease was not a concern for them since they live in areas with tepid climate.
Another factor that hinders uptake of vaccines by adolescents is the lack of
recommendations by healthcare providers, who are regarded as the trusted source of health
information by parents. Other factors include failure to access health information relating to
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vaccines in native languages. In this case, Greenfield et al. (2015) recommend the need for
outreach health education programs to ensure such communities thrive in their health.
Katz, I.T., Bogart, L. M., Fu, C. M., Liu, Y., Cox, J. E., Samuels, R. C., Chase, T., Schubert, P.,
& Schuster, M. A. (2016).3Barriers to HPV immunization among blacks and Latinos: a
qualitative analysis of caregivers, adolescents, and providers.3BMC Public
Health,16,,874. https://doi.org/10.1186/s12889-016-3529-4
In this paper, the barriers that result in low HPV immunization among Latinos and Blacks
were analyzed. Katz et al. (2016) provide that HPV infection is one of the most transmitted STIs
in the IS, with over 26,000 cancers attributed to HPV. Despite this risk and the
recommendations that eleven and twelve years old get the three-dose series of the HPV vaccine,
the immunization coverage rates are still low, compared to other vaccines. Also, Latinos and
Blacks are less likely to complete the doses. Among the challenges that hinder vaccination
among adolescents is that they are directly involved in decision-making compared to younger
children. Also, care providers and caregivers play a critical role. For instance, Katz et al. (2016)
argue that research shows that improving vaccine uptake requires provider recommendation and
effective communication with caregivers.
This article's research findings show that individual and system-level factors act as
barriers to immunization uptake among adolescents. For instance, mistrust is a common factor
among caregivers and adolescents who argue that the vaccine is new and less trustworthy than
other vaccines that have existed over time. In this case, the view is that the vaccine is potentially
untested. Katz et al. (2016) argue that families feel that they lack sufficient information to make
informed decisions and thus need health education regarding the need and importance of the
HPV vaccine. On the other hand, system-level barriers are attributed to healthcare provider
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perceptions. They feel that the dosage schedule does not match other standard clinical visits,
which contributes to failure in completing the series. Also, there lacks a standardized reminder
and delivery process, and healthcare providers feel that the administration of multiple vaccines in
the same clinic visit is overwhelming for adolescents. In this case, Katz et al. (2016) give an
overview of vaccine uptake barriers that can help design appropriate interventions to address
these barriers.
Salazar, K., Seib, K., Underwood, N., Gargano, L., Sales, J., Diclemente, R., Murray, D.,
Morfaw, C., & Hughes, J. (2016). Recommendations for Structure and Content for a
School-Based Adolescent Immunization Curriculum. Health Promotion Practice, 17(4),
512-520. htttps://doi.org/10.1177/1524839915627458
In this article, Salazar et al. (2016) purposed to develop recommendations for a school-
based immunization curriculum and schedule for adolescents. In the report, the rate of adolescent
immunization coverage lags behind even though there is high utilization of childhood
vaccinations. Salazar et al. (2016) report that the recommended vaccines for adolescents
between 11 and 18 years include HPV; meningococcal conjugate; pertussis, diphtheria, and
tetanus vaccines; and the influenza vaccine. The authors also provide that the current coverage in
Georgia is below the Healthy People 2020 goal of 80%. This calls for action for the development
of an intervention to increase immunization coverage.
The article provides that school communities can play a critical role in educating
adolescents about health-related issues, including preventative measures such as vaccine
utilization. In this case, Salazar et al. (2016) argue that adolescent knowledge and awareness of
immunization is crucial within the school system since this can help ensure communities are
protected from a potential disease outbreak and spread. The authors developed a plan for school
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intervention in adolescent immunization by including the schedule in the school curriculum. This
intervention was informed by the fact that students spend a significant amount of time at school,
which makes the institution an excellent target location of vaccination interventions.
Salazar et al. (2016) report that teachers' recommendations in focus group discussions
could enhance student knowledge and awareness on adolescent immunization and help change
pre-existing negative beliefs, attitudes, and improve acceptance of vaccination among the
teenage population.
Salmon, D.A., Dudley, M.Z., Glanz, J.M., & Omer, S.B. (2015). Vaccine Hesitancy Causes,
Consequences, and a Call to Action. American Journal of Preventive Medicine and
Elsevier Ltd, 49(6S4): S391–S398.
In this article, Salmon et al. (2015) provide an overview of the factors that result in
vaccine hesitancy, the impacts, and call to action to address the problem. According to Salmon et
al. (2015), vaccine hesitancy is the decline or delays that precede acceptance to vaccines
resulting in failure to complete doses or ensure consistency. Findings in the article show that
there exists a wide range of factors that contribute to vaccine hesitancy. This includes factors
such as adverse effects, the mandatory nature of vaccines, lack of trust in public health agencies,
and lack of knowledge or unfamiliarity with the diseases being vaccinated against.
In the article, Salmon et al. (2015) argue that the refusal, delay, and acceptance of
vaccines can be measured by identifying people's beliefs and attitudes (predisposing factors). For
instance, the author provides that parents who are hesitant to accept their adolescent children's
vaccination are usually vulnerable to misinformation factors. According to Salmon et al. (2015),
vaccine hesitance is an issue of concern that needs to be addressed considering that the vaccine's
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effectiveness in preventing the vaccine-preventable disease relies on timely vaccination. In this
case, the issues of hesitancy need to be addressed at individual, health system, provider, and
national levels by understanding the trust issues, promoting transparency, and ensuring effective
communication to doctors, parents, and adolescents with vaccine concerns. Also, Salmon et al.
(2015) provide that even though vaccines have a high potential to prevent illnesses and save
lives, this potential depends on parents' acceptance of the vaccines. This means having
confidence and trust in the vaccines, the presence of healthcare providers who recommend them
and designing systems that ensure vaccines are safe.
