DESCRIPTION (provided by applicant): Although most adults realize the significance of immunizations for infant and child health, many do not recognize that vaccines offer a safe, cost-effective way to prevent morbidity and mortality among adolescents and adults. Nearly 45,000 US adults die each year from vaccine preventable diseases. The Institute of Medicine has called for the development of innovative strategies to improve vaccine coverage among adolescents and adults. Obstetrician-Gynecologists (Ob/Gyns) are uniquely positioned to immunize women of all ages against vaccine-preventable diseases. They are often the first point of contact for young women seeking care for reproductive health. Ob/Gyns function as primary care physicians, providing ? of all medical visits to women aged 17- 21 years. However, many Ob/Gyns do not routinely assess immunization status or administer vaccines in their offices. Commonly noted obstacles to providing vaccinations include cost/inadequate reimbursement, beliefs about their role in primary care, inadequate vaccine handling capability, lack of vaccine information, and safety/liability concerns in pregnancy. Our primary objective is to conduct a clinic-based study to develop and assess the effectiveness of a vaccination program for adolescent and adult women in the community Ob/Gyn setting. We propose to evaluate 4 Ob/Gyn offices in the Raleigh-Durham, NC area through in-depth, structured interviews of Ob/Gyn providers and office staff. In addition to details on current vaccine practices, medical record documentation, and encounter coding reimbursement, personnel will be queried on attitudes about vaccination, perceived barriers to an Ob/Gyn-based program, and ideas on overcoming such barriers. Findings will be used to design a program for adolescent and adult women, tailored for implementation in 2 of the 4 Ob/Gyn offices. Limited to vaccines for human papillomavirus and influenza & pertussis in pregnancy/postpartum, the program will cover a 12-month period, including 1 influenza season. Effectiveness of the intervention will be determined by pre- and post-program vaccination rates, program satisfaction, and willingness to continue the program. Detailed recording of all development and implementation strategies will allow for direct and immediate quantification of the resources and financial support required for vaccine program development and performance.

PUBLIC HEALTH STATEMENT This study has the potential to improve the capacity of the health care system to effectively deliver vaccines to adolescent and adult women. If successful, Ob/Gyns may tailor and implement the vaccination program in their offices, ultimately serving as a major force in the reduction of vaccine-preventable diseases in the US.