This continuing medical education Atlas of Care program comprises 12 cards and a CD. Two physicians experts in immunization provide information and strategies to increase utilization of the adolescent immunizations recommended by the Advisory Committee on Immunization Practices. The program focuses on strategies to nurture a partnership between the healthcare provider, members of the office practice, and the patient that will encourage adolescents to participate in maintaining their health through wellness visits, lifestyle behaviors, immunizations, and return visits to complete their vaccination series. The faculty will also consider the feasibility and practicality of clinicians and patient resource tools for which website links will be provided. This program will be posted on myCME.com and Medscape for a period of 1 year.

Adolescent visits to the clinical practice for sports injuries, school-mandated immunizations, and general examinations provide healthcare practitioners with opportunities to initiate discussions about healthful behaviors. With the advent of the 2009 H1N1 influenza virus, practitioners may have an unprecedented number of opportunities to engage their adolescent patients in discussions on healthful practices, such as safe sex, immunization, diet, and not smoking.

Adolescent commonly participate in risky behaviors. Every day in the US, an estimated 3600 adolescent aged 12 to 17 years to initiate smoking and an estimated 1100 adolescents aged <18 years become daily cigarette smokers.^1,2 in 2007, 48% of surveyed high school students had experienced sexual intercourse at sometime in their lives.^3.4 Of those who were sexually active that year, 39% did now use a condom during their last sexual intercourse,^3,4 leaving them vulnerable to unwanted pregnancy and/or sexually transmitted diseases. Adolescents also commonly have poor dietary habits, such as fast foods and lack of fruits, vegetables, and milk, resulting in increased overweight and obesity and a greater prevalence of type 2 diabetes in this age group.⁵

Most immunization rates for adolescents also fall far below the department of Health and Human Services' Healthy People 2010 established goals of 90%,⁶ although the recommended ≥2 doses of measles-mumps-rubella and ≥3 doses of hepatitis B were achieved for the first time in 2008 for adolescents aged 13 to 15 years.⁷ In contrast, only 17.9% of females aged 13 to 17 years completed the 3-dose series of human papillomavirus vaccine, 40.8% received ≥1 dose of Td or Tdap, and 41.8% had ≥1 dose of meningococcal conjugate vaccine.⁷

Barriers to adolescent vaccination include insufficient public and/or provider knowledge, negative attitudes, ambivalence about immunization recommendations, and safety concerns.⁴ Delivery issues, including cost, lack of vaccine availability at the healthcare setting, inaccessibility to the healthcare practice, and parental consent, also play a large role in utilization-rate shortcomings.⁸ As adolescents become older and more independent, they are less likely to have wellness visits to the healthcare practitioner, making it essential not to miss opportunities to vaccinate when adolescents do present for unrelated issues, such as a sprained ankle.

This program focuses on strategies to nurture a partnership between the healthcare provider and the patient that will encourage adolescent to participate in maintaining their health through wellness visits, lifestyle behaviors, immunizations, and return visits to complete their vaccination series. If offers a team approach for all members of a practice involved in immunization delivery and overall patient well-being.

1. Substance Abuse and Mental Health Services Administration. 2007 National Survey on Drug Use and Health. [pdf 1.28 M] (Office of Applied Studies, NSDUH Series H-27, DHHS Publication No. SMA 05-4061). Rockville, MD.
   Accessed January 21, 2010.
    
2. Centers for Disease Control and Prevention. Healthy Youth! Health Topics: Tobbaco Use. http://www.cdc.gov/HealthyYouth/tobacco/index.htm.
   Accessed January 21, 2010.
    
3. Centers for Disease Control and Prevention. Youth risk behavior surveillance--United States, 2007. MMWR. 2008;57(SS-4):1-131.
    
4. Centers for Disease Control and Prevention. Healthy Youth! Health Topics: Sexual Risk Behaviors. http://www.cdc.gov/HealthyYouth/sexualbehaviors/index.htm.
   Accessed January 21, 2010.
    
5. Centers for Disease Control and Prevention. Healthy Youth! Health Topics: Nutrition. http://www.cdc.gov/HealthyYouth/nutrition/facts.htm.
   Accessed January 21, 2010.
    
6. US Department of Health and Human Services. Healthy People 2010. http://www.healthypeople.gov/.
   Accessed January 21, 2010.
    
7. Centers for Disease Control and Prevention. National, State, and Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years --- United States, 2008. MMWR. 2009;58(36);997-1001.
    
8. Ford CA, English A, Davenport AF, Stinnett AJ. Increasing adolescent vaccination: barriers and strategies in context of policy, legal, and financial issues. J Adolesc Health. 2009;44(6):568-574. Epub 2009 Feb 12.

At the conclusion of this program, participants should be able to:

• Discuss the epidemiology of adolescent vaccine-preventable diseases
• Explain the importance of adolescent immunizations for vaccine-preventable diseases recommended by the Advisory Committee on Immunization Practices
• Embrace opportunities for healthcare professionals and the office practice to nurture relationships with patients and initiate discussions about sensitive healthcare concerns
• Encourage adolescent patients to actively participate in maintaining their health by choosing healthful behaviors and scheduling and maintaining wellness visits

This CME activity is intended for Pediatricians and Pediatric Nurse Practitioners, Primary Care Physicians, and Adolescent Medicine Specialists.

Andrew Kroger, MD, MPH
Medical Officer
Education, Information and Partnership Branch
Immunization Services Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Atlanta, GA

Amy B. Middleman, MD, MPH, MSEd
Associate Professor of Pediatrics
Adolescent Medicine and Young Adult Immunization
Texas Children's Center for Vaccine Awareness & Research
Houstan, TX

Course Director
Marguerite M. Mayers, MD
Attending Pediatrician
Consultant Pediatric Infectious Diseases
Children's Hospital at Montefiore
Professor of Clinical Pediatrics
Albert Einstein College of Medicine
Bronx, NY

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME). Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians and other health-care providers.

Albert Einstein College of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 credits^TM_. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release Date: April 2010 Expiration Date: April 30, 2011

There are no fees for participating and receiving CME Credit for this activity. During the period April 2010 through April 30, 2011, participants must:

• Register for the program where prompted on the CD
• Complete the posttest by recording the best answer to each question in the answer key
• Complete the activity evaluation form
• Submit directly online

A statement of credit will be issued immediately online only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Estimated time to complete the actvitiy: 2.0 hours

Release date: April 2010

Expiration date: April 30, 2011

The "Conflict of Interest Disclosure Policy" of Albert Einstein College of medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical or equipment company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity, or who refuses to provide all their conflict-of-interest information, will not be permitted to present.

Faculty Disclosures

Andrew Kroger, MD, MPH, has nothing to disclose.

Amy B. Middleman, MD, MPH, MSEd, receives grant/research support from sanofi pasteur.

Marguerite M. Mayers, MD, has nothing to disclose.

Mildred Shields Adighiuzor, Center for Continuing Medical Education, Albert Einstein College of Medicine, has nothing to disclose.

Susan Basilico, Liz Selkowe, and Debbie Walsh, Haymarket Medical Education, have nothing to disclose.

This educational activity my contain discussion of published and/or investigational uses of agents that are not indicated by the FDA.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of the patient's conditions, review of any applicable manufacturers' product information, and comparison with recommendations of recognized authorities.

The information in this program is provided to medical professionals for information purposes only.

The material contained herein is intended to be a faithful representation of the live presentations to the extent reasonable. The authors/presenters are exclusively responsible for the respective content. Accordingly, no responsibility is assumed by Merck & co., Inc., Albert Einstein College of Medicine of Yeshiva University, Haymarket Medical Education LP, or Scienta MedMedia LLC, for any injury and/or damage to persons or property as a matter of product liability, negligence or otherwise; or from any use of diagnosis or treatment discussed or suggested. This activity should not be used by clinicians without medically appropriate (1) evaluation of (a) their patients' conditions and (b) indications and possible contraindications, warnings, and adverse effects or dangers in use; (2) review of any applicable manufacturers' prescribing and other product information; (3) comparison with recommendations of recognized authorities; and (4) independent verification of diagnostic methods, therapeutic methods, results of research, and measurement of medical doses.