INTRODUCTION: The Delta Regional Authority (DRA) consists of 252 counties and parishes in 8 states in the US Mississippi Delta region. DRA areas have high rates of disease, including cancers related to the human papillomavirus (HPV). HPV vaccination coverage in the DRA region has not been documented. METHODS: We analyzed data for 63,299 adolescents aged 13 to 17 years in the National Immunization Survey-Teen, 2015-2017. We compared HPV vaccination initiation coverage estimates (>/=1 dose) in the DRA region with coverage estimates in areas in the 8 Delta states outside the DRA region and non-Delta states. We examined correlates of HPV vaccination coverage initiation and reasons parents did not intend to vaccinate adolescents. RESULTS: Vaccination rates in the DRA region (n = 2,317; 54.3%) and in Delta areas outside the DRA region (n = 6,028; 56.2%) were similar, but these rates were significantly lower than rates in non-Delta states (n = 54,954; 61.4%). Inside the DRA region, reasons for parents' vaccine hesitancy or refusal were similar to those expressed by parents in the Delta areas outside the DRA region. Some parents believed that the vaccine was not necessary or had concerns about vaccine safety. CONCLUSION: HPV vaccination coverage in the DRA region is similar to coverage in other Delta counties and parishes, but it is significantly lower than in non-Delta states. Activities to address parental concerns and improve provider recommendations for the vaccine in the DRA region are needed to increase HPV vaccination rates.

BACKGROUND AND OBJECTIVES: The Vaccines for Children Program (VFC) provides vaccines for children who may not otherwise be vaccinated because of financial barriers. Pediatrician participation is crucial to the VFC's ongoing success. Our objectives were to assess, among a national sample of pediatricians, (1) VFC program participation, (2) perceived burden versus benefit of participation, and (3) knowledge and perception of a time-limited increased payment for VFC vaccine administration under the Patient Protection and Affordable Care Act. METHODS: An electronic and mail survey was conducted from June 2017 to September 2017. RESULTS: Response rate was 79% (372 of 471); 86% of pediatricians reported currently participating in the VFC; among those, 85% reported never having considered stopping, 10% considered it but not seriously, and 5% seriously considered it. Among those who had considered no longer participating (n = 47), the most commonly reported reasons included difficulty meeting VFC record-keeping requirements (74%), concern about action by the VFC for noncompliance (61%), and unpredictable VFC vaccine supplies (59%). Participating pediatricians rated, on a scale from -5 (high burden) to +5 (high benefit), their overall perception of the VFC: 63% reported +4 or +5, 23% reported +1 to +3, 5% reported 0, and 9% reported -1 to -5. Of pediatricians, 39% reported awareness of temporary increased payment for VFC vaccine administration. Among those, 10% reported that their practice increased the proportion of Medicaid and/or VFC-eligible patients served on the basis of this change. CONCLUSIONS: For most pediatricians, perceived benefits of VFC participation far outweigh perceived burdens. To ensure the program's ongoing success, it will be important to monitor factors influencing provider participation.

BACKGROUND: Little is known about the effects of increased parental vaccine safety concerns on physicians' vaccine communication attitudes and practices. PURPOSE: To assess among pediatricians and family medicine (FM) physicians: (1) prevalence of parental requests to deviate from recommended vaccine schedules; (2) responses to such requests; and (3) attitudes about the burden and success of vaccine communications with parents. METHODS: Survey of nationally representative samples of pediatricians and FM physicians (N=696) conducted during February to May 2009 with analysis in 2010. RESULTS: Response rates were 88% for pediatricians and 78% for FM physicians. Overall, 8% of physicians reported that ≥10% of parents refused a vaccine and 20% reported that ≥10% of parents requested to spread out vaccines in a typical month. More pediatricians than FM physicians reported always/often requiring parents to sign a form if they refused vaccination (53% vs 31%, p<0.0001); 64% of all physicians would agree to spread out vaccines in the primary series at least sometimes. When talking with parents with substantial concerns, 53% of physicians reported spending 10-19 minutes and 8% spending ≥20 minutes. Pediatricians were more likely than FM physicians to report their job less satisfying because of parental vaccine concerns (46% vs 21%, p<0.0001). Messages most commonly reported as "very effective" were personal statements such as what they would do for their own children. CONCLUSIONS: The burden of communicating with parents about vaccines is high, especially among pediatricians. Physicians report the greatest success convincing skeptical parents using messages that rely on their personal choices and experiences.