Consent processes for adolescent vaccination in Canada have been identified as potential barriers to vaccine uptake. This study examined current practices for obtaining consent for adolescent vaccines across Canadian jurisdictions to better understand the variation, complexity and opportunities for improvement.

An environmental scan.

The study was conducted between 25 March 2025 and 27 February 2026, across public health systems in Canada. Data were drawn from relevant written documents and from key informants (KIs) representing public health, vaccine administration and immunisation policy in each province and territory.

We included 76 written records and input from 17 KIs.

The primary outcome was adolescent vaccination consent process, including the age of majority, legal age of consent for vaccination and consent modalities. The secondary outcomes included challenges associated with the existing consent processes and proposed recommendations for improvements.

The age of majority was 18 or 19 years in all jurisdictions. The legal age at which adolescents could consent to vaccination ranged from 13 to 16+ years in some jurisdictions, while others did not specify a formal age threshold. Paper-based consent remained the predominant modality, although implied, verbal (in-person) and telephone consent were also used. Electronic consent (e-consent) was being piloted in some jurisdictions. General challenges include logistical burden of paper-based processes and language barriers, whereas adolescent-specific challenges include inconsistent assessment of adolescent capacity and parental concerns about reduced authority. Suggested improvements included simplifying and standardising consent processes, expanding opportunities for adolescent self-consent and integrating e-consents alongside existing modes.

Despite considerable variation, there is broad recognition of the need to improve the consent process for adolescent vaccination. Simplifying consent processes may promote more timely and equitable access to immunisation and support efforts to improve adolescent vaccination coverage in Canada.

To determine whether the onset of physical health problems/sensory impairments is associated with incident challenging behaviours.

A retrospective, population-based cohort study using longitudinal data from primary care records. HRs were estimated using Cox proportional hazards models accounting for recurrent events and time-varying exposures.

UK primary care data sourced from the Clinical Practice Research Datalink (CPRD) Aurum and Gold databases, covering over 850 000 person-years between 2009 and 2019.

166 989 individuals with recorded intellectual disabilities were included in the cohort.

Incident identification of challenging behaviours before or after a recorded incident of physical health problems/sensory impairment. Physical health problems/sensory impairments assessed included constipation, epilepsy, pain, visual impairment, hearing impairment, bowel incontinence, urinary incontinence and sleep problems.

21.21% (n=35 415) of the cohort had challenging behaviour recorded at least once in primary care records over the 11-year study period, equating to an incidence rate of 0.10 per person-year. 40.9% of episodes of challenging behaviour were associated with an incident physical health problem/sensory impairment. All eight physical health problems/sensory impairments were significantly associated with higher HRs for challenging behaviours after full adjustment for demographic and mental health covariates. These associations held across multiple sensitivity analyses. The strongest associations were found for bowel incontinence (HR=2.24; 95% CI 2.01 to 2.50), urinary incontinence (HR=1.93; 95% CI 1.77 to 2.11), constipation (HR=1.89; 95% CI 1.74 to 2.05) and sleep problems (HR=1.74; 95% CI 1.58 to 1.90).

This is the first longitudinal study to establish a temporal association between the onset of physical health problems/sensory impairments and challenging behaviours in people with intellectual disabilities. These findings highlight the need for proactive identification and management of physical health problems/sensory impairments as part of assessment processes to prevent or reduce the impact of challenging behaviours.