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INVEST: Improving immunization coverage in adolescents

Friday, March 8, 2019
Emmanuel "Chip" Walter

In September 2018, a multidisciplinary team of investigators from Duke University and the University of South Carolina started INVEST, “A tailored school-based INtervention to increase VaccinE uptake among adoleScenTs in the rural South”. Emmanuel "Chip" Walter, MD, MPH, professor of pediatrics in the Divisions of Primary Care and Infectious Diseases, and member of the Duke Human Vaccine Institute is leading the project, along with Lavanya Vasudevan, PhD, and Laura Fish, PhD, MPH, both assistant professors in Community and Family Medicine, as well as collaborators from the Duke Center for Health Policy and Inequalities Research (CHPIR). The study aims to improve adolescent immunization coverage, particularly for the human papillomavirus (HPV) vaccine, by examining reasons for rural-urban disparities in vaccine uptake.  

The benefits of adolescent vaccines are well known for preventing meningococcal infection and human papillomavirus (HPV)-related cancers. Yet, many adolescents in the United States (US) remain under-vaccinated, with vaccination rates among rural adolescents significantly lower than among their urban peers. Of all recommended adolescent vaccines, the urban-rural disparity is exceptionally stark for coverage of HPV vaccine, particularly in Southern states like North and South Carolina, which currently fall far below the Healthy People 2020 goal of ≥80% coverage. Barriers to vaccine uptake among rural youth identified in the literature include a paucity of pediatric primary care providers in rural areas, financial barriers to vaccinations, and negative parental attitudes towards vaccines (Thompson El, et al., J Adolesc Health 2017; Gowda C, et al., BMC Public Health 2012).

“It is critically important that all adolescents, despite whether they live in urban or rural areas, have access to these potentially lifesaving vaccines,” said Walter.

Currently, the study team is working to identify contextually-relevant barriers by conducting cross-sectional surveys with rural and urban parents of adolescents, in-depth interviews with rural and urban heath providers, and focus groups with parents of adolescents in rural and urban counties.  Their findings will be used to develop and implement a school-based intervention in rural counties in North and South Carolina, in collaboration with the state and local health departments.


This study is supported by the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention (1U01IP001095-01-00).

This article was originally published on the Duke Human Vaccine Institute website.