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Publications
Publications (104)
Purpose:
Adolescent human papillomavirus (HPV) vaccine uptake in the United States dropped during the COVID-19 pandemic due to a decrease in well visits. This study sought to identify opportunities for primary care professionals (PCPs) to get adolescent vaccination back on track.
Methods:
In early 2021, we recruited 1,047 PCPs (71% physicians) w...
Proactive HPV vaccination at age 9 better prevents infection and improves vaccine series completion. Because national organizations recommend starting the vaccine at different ages, we sought to understand the impact of these recommendation frames. In 2022, we surveyed 2,527 US clinical staff (45% physicians) who provide HPV vaccine for children. W...
To increase Soldiers’ access to HPV vaccination, we evaluated the feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing procedures for Soldiers. We partnered with nursing staff to introduce HPV vaccine into existing vaccination services at a nurse-led clinic that serves Soldiers at Fort Brag...
Background:
Health departments in the United States routinely conduct quality improvement (QI) coaching to help primary care providers optimize vaccine delivery. In a prior trial focusing on multiple adolescent vaccines, this light-touch intervention yielded only short-term improvements in HPV vaccination. We sought to evaluate the impact of an en...
Background
Childhood cancer survivors are at high risk for developing new cancers (such as cervical and anal cancer) caused by persistent infection with the human papillomavirus (HPV). HPV vaccination is effective in preventing the infections that lead to these cancers, but HPV vaccine uptake is low among young cancer survivors. Lack of a healthcar...
BACKGROUND AND OBJECTIVES
US health departments routinely conduct in-person quality improvement (QI) coaching to strengthen primary care clinics’ vaccine delivery systems, but this intervention achieves only small, inconsistent improvements in human papillomavirus (HPV) vaccination. Thus, we sought to evaluate the effectiveness of combining QI coac...
One of the most compelling arguments for telemedicine is its potential to increase healthcare access by making care more affordable for patients and families, including those affected by asthma. This goal is critically important in the U.S. where the high cost of asthma care is associated with nonadherence to preventive care regimens and suboptimal...
Healthcare organizations have been early adopters of Covid-19 vaccine mandates as a strategy to end the pandemic. We sought to evaluate support for such mandates among pediatric primary care professionals (PCPs) in the United States. In February-March 2021, we conducted a national online survey of 1,047 PCPs (71% physicians). We used multivariable...
Background and objective
Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference.
Methods
In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11–17. The national sample included physicians...
Objective:
Several U.S. health organizations, including the American Academy of Pediatrics, now encourage primary care professionals to recommend HPV vaccination before the traditionally targeted ages of 11-12 years as a strategy to increase vaccination timeliness. To understand the feasibility of this approach, we sought to evaluate primary care...
Objective
Parents often decline HPV vaccination, but little is known about how healthcare providers should promote vaccination at a later visit for secondary acceptance. We examined the associations of two factors, providers’ response to declination during the visit and follow-up after the visit, with secondary acceptance.
Methods
We conducted a c...
The US’s 64 CDC-funded immunization programs are at the forefront of efforts to improve the quality of adolescent vaccination services. We sought to understand immunization program managers’ perspectives on partnering with healthcare systems to improve HPV vaccine uptake. Managers of 44 state and local immunization programs completed our online sur...
Infrequent provider recommendations continue to be a key barrier to human papillomavirus (HPV) vaccination, including among adolescents at higher risk for future HPV cancers. To inform future interventions, we sought to characterize disparities in healthcare providers' HPV vaccine recommendation for US adolescents. We systematically reviewed studie...
Lay Summary
Our cluster randomized trial compared two interventions that health departments commonly use to increase HPV vaccination coverage: quality improvement (QI) coaching and physician communication training. We found that QI coaching cost less and was more often adopted by primary care clinics, but communication training reached more staff m...
Human papillomavirus (HPV) vaccination could prevent most of the ~34,000 HPV-attributable cancers diagnosed annually in the US, but uptake remains suboptimal. Healthcare systems are key partners in implementing HPV vaccination quality improvement (QI) programs. To inform future system-level HPV vaccine initiatives, we sought to understand HPV vacci...
BACKGROUND
The Covid-19 pandemic has led to an unprecedented use of telehealth, including among primary care professionals (PCPs) who serve adolescents.
OBJECTIVE
To inform future practice and policies, we sought to characterize PCPs’ recent experience using adolescent telehealth, as well as their support for it after the pandemic is over.
METHOD...
Background:
The Covid-19 pandemic has led to an unprecedented use of telehealth, including among primary care professionals (PCPs) who serve adolescents.
Objective:
To inform future practice and policies, we sought to characterize PCPs' recent experience using adolescent telehealth, as well as their support for it after the pandemic is over.
Me...
Our study examined how misinformation and other elements of social media messages affect antecedents to human papillomavirus (HPV) vaccination of adolescents. In 2017–2018, we randomly assigned a national sample of 1206 U.S. parents of adolescents to view one tweet using a 2 × 2 × 2 × 2 between-subjects factorial experiment. The 16 experimental twe...
HPV vaccination is recommended for U.S. adolescents at ages 11-12 and requires two versus three doses if the series is started before age 15. We evaluated how talking about recommended age or fewer doses motivates on-time HPV vaccination. Our national, online experiment randomized 1,263 parents of adolescents to view one of three messages about HPV...
Introduction
The Announcement Approach using presumptive announcements increases human papillomavirus vaccine uptake. This study seeks to understand the impact of the final Announcement Approach steps—easing parents’ vaccine concerns and then encouraging them to get human papillomavirus vaccine for their children—on parents’ human papillomavirus va...
Rationale:
Receiving a healthcare provider's recommendation is a well-documented predictor of human papillomavirus (HPV) vaccination, and yet recommendations remain understudied and undertheorized.
Objective:
To qualitatively describe strategies providers use to motivate HPV vaccination.
Method:
We surveyed a national sample of 771 U.S. primar...
Purpose and objectives:
Quality improvement (QI) coaching improves human papillomavirus (HPV) vaccination coverage, but effects of coaching have been small, and little is known about how and when QI coaching works. To assess implementation outcomes and explore factors that might explain variation in outcomes, we conducted a process evaluation of a...
Background:
High-quality evidence indicates that intervening with health care providers improves human papillomavirus (HPV) vaccine delivery. However, scaling up evidence-based strategies in real-world clinical practice remains challenging. We sought to improve the reach and impact of strategies for HPV vaccination quality improvement (QI) through...
Clinical guidelines for HIV pre-exposure prophylaxis (PrEP) include risk prediction tools to identify appropriate candidates. We conducted a qualitative interview study to explore the potential acceptability, interpretation, and anticipated impact of such tools from the perspectives of men who have sex with men (MSM) and primary care providers (PCP...
Background. Prior research has identified diverse worries that parents have about HPV vaccination. We sought to understand how parents prioritize worries and to identify subgroups of parents according to shared patterns of worry.
Methods. We surveyed a national sample of 431 U.S. parents of adolescents who reported never having talked to their chil...
Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their population reach, convenience, and existing infrastructure for vaccine delivery. However, pharmacies in the US are rarely used for adolescent HPV vaccination. We sought to document challenges and opportunities of implementing pharmacy-located H...
Background. Health insurers are well-positioned to address low HPV vaccination coverage in the US through initiatives such as provider assessment and feedback. However, little is known about the feasibility of using administrative claims data to assess provider performance on vaccine delivery.
Methods. We used administrative claims data from a regi...
OBJECTIVES: We sought to identify effective responses to parents’ questions and concerns about human papillomavirus (HPV) vaccine.
METHODS: In 2017–2018, we surveyed a national sample of 1196 US parents of children aged 9 to 17 years. We recorded brief videos of a pediatrician providing messages that addressed 7 HPV vaccination topics that commonl...
How stories from media and social interactions shape parents' HPV vaccination decisions is poorly understood. We sought to characterize parents' exposure to such stories, as well as associations between story exposure and vaccination behavior. Study participants were 1263 parents of U.S. adolescents who had not yet completed the HPV vaccine series....
Parents have varied HPV vaccine communication needs, which presents a challenge for healthcare providers. To improve communication resources for providers, we sought to characterize HPV vaccination messages available in existing educational materials. In fall 2016, we searched PubMed, educational material clearinghouses, and Google for English lang...
Background and purpose:
Few studies have examined human papillomavirus (HPV) vaccine communication in the context of the health care team.
Methods:
In 2016, the investigators conducted a national, online survey of U.S. parents who reported having discussed HPV vaccination with their adolescent's health care team. Multivariable logistic regressio...
Absract
Indoor tanning greatly increases skin cancer risk, with exposure before age 35 associated with a 60% increase in the risk of melanoma. Unfortunately, despite recent declines, indoor tanning remains common among U.S. adolescents with 1.2 million high school students reporting use in 2015. Parental permission to tan and positive parental atti...
Background: Human papillomavirus (HPV) vaccination could prevent most HPV-associated cancers, but few U.S. adolescents are vaccinated according to guidelines. To inform efforts to counsel parents more effectively, we sought to quantify their views on the best and worst reasons for guideline-consistent HPV vaccination. We hypothesized that parents'...
Background:
State laws about pharmacists providing HPV vaccine vary considerably, limiting many pharmacists' ability to provide this important cancer prevention service. We characterized physician and parent support for pharmacist-provided HPV vaccination for adolescents who are past due for vaccination.
Methods:
In 2014-2015, we conducted two n...
Abstract Background Improving healthcare providers’ communication about HPV vaccination is critical to increasing uptake. We previously demonstrated that training providers to use presumptive announcements to introduce HPV vaccination improved uptake, whereas training them to use participatory conversations had no effect. To understand how communic...
Changes in the routine immunization schedule are common and may pose challenges to primary care clinics. We sought to assess the experiences of U.S. providers and clinic staff during the introduction of 9-valent HPV vaccine. In 2015–2016, we conducted a survey in a probability sample of 127 pediatric (40%) and family medicine (60%) clinics in three...
Background:
Despite increasing awareness of the importance of a provider recommendation for HPV vaccine, the U.S. has yet to achieve the Healthy people 2020 goal of 80% series completion among adolescents. This failure indicates a need for further examination of the modifiable influences on parents' decision-making. Healthcare providers can influe...
Vaccine delivery is a substantive portion of pediatric practice and addressing vaccine hesitancy is time-consuming. This collection of articles will assist providers by providing vaccine information and policy statements in a single, easily accessible platform.
https://shop.aap.org/pediatric-collections-immunization-strategies-and-practices-paperba...
Objective:
Parental declination contributes to low human papillomavirus (HPV) vaccination coverage among US adolescents, resulting in missed opportunities for cancer prevention. We sought to characterize parents' acceptance of HPV vaccination after declination ("secondary acceptance").
Methods:
In September 2016, we conducted an online survey wi...
State health departments commonly use quality improvement coaching as an implementation strategy for improving low human papillomavirus (HPV) vaccination coverage, but such coaching can be resource intensive. To explore opportunities for improving efficiency, we compared in-person and webinar delivery of coaching sessions on implementation outcomes...
Poster presented at SAHM 2018 Annual Meeting
Poster presented at 2018 Annual Meeting of SAHM
Introduction:
Offering HPV vaccine in settings beyond the traditional medical home holds promise for increasing the currently low levels of coverage. As adolescents frequently visit dentists, dental practices may be one such alternative vaccination setting. This study assessed parent attitudes about the roles dental providers could play in HPV pre...
Purpose
Adolescence is a high-risk period for ultraviolet radiation exposure, a primary cause of skin cancer later in life. We sought to characterize receipt of health care provider-delivered counseling about skin cancer prevention (SCP) among parents of adolescents.
Methods
In 2016, we conducted an online survey with a national sample of parents...
Background:
Addressing low HPV vaccination coverage will require U.S. health care providers to improve their recommendation practices and vaccine delivery systems. Because readily available continuing medical education (CME) could be an important tool for supporting providers in this process, we sought to assess the content of web-based CME activi...
Introduction:
Regulatory agencies, including the U.S. Food and Drug Administration, are considering policies to ban indoor tanning for youth aged <18 years. Using data from a nationally representative sample, this study assessed parental support for age-based bans as well as less restrictive parental permission requirements.
Methods:
Data came f...
Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their accessibility and existing infrastructure for vaccine delivery. We sought to examine parents' willingness to get HPV vaccination for their children at pharmacies. In 2014, we conducted a national, online survey of 1255 parents of 11- to 17-year...
Objective:
Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive "announcements" or participatory "conversations."
Methods:
In 2015, we conducted a parallel-gro...
Background:
To address low human papillomavirus (HPV) vaccination coverage, the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have launched national campaigns encouraging physicians to deliver strong HPV vaccine recommendations. We surveyed family physicians and pediatricians to examine the impact of the...
Background. We sought to estimate the national prevalence of HPV vaccine refusal and delay in a population-based sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences.
Methods. In 2014 to 2015, we conducted an online survey of 1,...
Objective:
Risk beliefs are central to most theories of health behavior, yet many unanswered questions remain about an increasingly studied risk construct, anticipated regret. The authors sought to better understand anticipated regret's role in motivating health behaviors.
Method:
The authors systematically searched electronic databases for stud...
Objective:
To support efforts to address parental hesitancy towards early childhood vaccination, we sought to validate the Vaccination Confidence Scale using data from a large, population-based sample of U.S. parents.
Methods:
We used weighted data from 9,354 parents who completed the 2011 National Immunization Survey. Parents reported on the im...
Transparency document.
Healthcare providers have a strong influence on human papillomavirus (HPV) vaccination decisions, yet they often fail to recommend the vaccine to the 11- and 12-year-olds who are targeted by practice guidelines. We sought to understand how providers interpret and value age-based guidelines.
We conducted a secondary analysis of data from two qualita...
School-entry requirements in the U.S. have led to high coverage for several vaccines, but few states and jurisdictions have adopted these policies for human papillomavirus (HPV) vaccination. Because physicians play a key role in advocating for vaccination policies, we assessed physician support of requiring HPV vaccine for school entry and correlat...
Background:
Improving HPV vaccination coverage in the U.S. will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of provider communication about HPV vaccination.
Methods:
We searched MEDLINE, CINAHL, EMBASE, and POPLINE in August 2015 to identify stu...
Background:
Receiving a healthcare provider's recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.
Methods:
In 2014, we conducted...
Background:
Healthcare providers may vary their communications with different patients, which could give rise to differences in vaccination coverage. We examined demographic disparities in parental report of collaborative provider communication and implications for human papillomavirus (HPV) vaccination.
Methods:
Participants were 4,124 parents...
To validate a brief measure of vaccination confidence using a large, nationally representative sample of parents.
We analyzed weighted data from 9018 parents who completed the 2010 National Immunization Survey-Teen, an annual, population-based telephone survey. Parents reported on the immunization history of a 13- to 17-year-old child in their hous...
Electronic cigarette (e-cigarette) use now surpasses the use of conventional cigarettes among U.S. adolescents. Given the important role of physicians in preventing adolescent risk behaviors, we sought to understand how physicians communicate about e-cigarettes when counseling adolescent patients and their parents. We also explored physicians' supp...
BACKGROUND: Hispanic females have the highest cervical cancer incidence rate of any racial or ethnic group in the US, yet relatively little research has examined HPV vaccination among this fast-growing population. We examined HPV vaccination among a national sample of Hispanic adolescent females.
METHODS: We analyzed provider-verified vaccination...
Background:
Human papillomavirus (HPV) infection is common among Hispanic males, but to the authors' knowledge little is known regarding HPV vaccination in this population. The authors examined the early adoption of the HPV vaccine among a national sample of Hispanic adolescent males.
Methods:
The authors analyzed provider-verified HPV vaccinati...
Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer preventio...
Objectives:
To assess the effectiveness of in-person and webinar-delivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage.
Methods:
We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX...
BACKGROUND
Uptake of human papillomavirus (HPV) vaccine remains low among adolescents in the United States. We sought to assess barriers to HPV vaccine provision in school health centers to inform subsequent interventions.METHODS
We conducted structured interviews in the fall of 2010 with staff from all 33 school health centers in North Carolina th...
Background:
Hispanic females have the highest cervical cancer incidence rate of any racial or ethnic group in the United States, yet relatively little research has examined human papillomavirus (HPV) vaccination among this fast-growing population. We examined HPV vaccination among a national sample of Hispanic adolescent females.
Methods:
We ana...
Immunization quality improvement programs are often limited by the cost and inconvenience associated with delivering face-to-face consultations to primary care providers. To investigate a more efficient mode of intervention delivery, we conducted a process evaluation that compared in-person consultations to those delivered via interactive webinar....
Introduction
Health care provider recommendations are critical for human papillomavirus (HPV) vaccine uptake. We sought to describe providers' HPV vaccine recommendation practices and explore their perceptions of parental hesitancy.
Method
A statewide sample (n = 575) of Minnesota health care providers (20% pediatricians, 47% family medicine physi...
Vaccination in alternative settings, defined here as being outside of traditional primary care, can help address the pressing public health problem of low human papillomavirus vaccine coverage among adolescents in the United States. Pharmacies are promising because they are highly accessible and have well established immunization practices. However...
The Carolina Framework for Cervical Cancer Prevention describes 4 main causes of cervical cancer incidence: human papillomavirus (HPV) infection, lack of screening, screening errors, and not receiving follow-up care. We present 2 applications of the Carolina Framework in which we identify high-need counties in North Carolina and generate recommenda...
Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery systems that may serve as a "gateway" to tobacco use by adolescents. Use of e-cigarettes by U.S. adolescents rose from 3% in 2011 to 7% in 2012. We sought to describe healthcare providers' awareness of e-cigarettes and to assess their comfort with and attitudes toward discus...
Purpose. CDC's AFIX (Assessment, Feedback, Incentives, and eXchange) program improves the provision of early childhood vaccines via brief quality improvement consultations with primary care providers. We sought to evaluate whether a modified AFIX program could also boost uptake of under-used adolescent vaccines, including human papillomavirus (HPV)...
BACKGROUND: US guidelines began recommending HPV vaccine for males in 2009, but data on vaccine uptake remain sparse. We analyzed data from a nationally representative sample of adolescent males to provide further insight into HPV vaccination coverage and correlates of vaccine uptake. METHODS: We analyzed 2010-2011 data from the National Immunizati...
Purpose. The ability of human papillomavirus (HPV) self-testing to expand access to cervical cancer screening rests on the test's acceptability to higher-risk women. We sought to assess perceptions related to HPV self-testing in a sample of low-income, under-screened women. Methods. We conducted a telephone survey of at-risk women in North Carolina...
To analyze organization-level correlates of immunization coverage among adolescents served by high-volume primary care providers in North Carolina.
We randomly selected 91 clinics with at least 200 active records for patients ages 11-18 in the North Carolina Immunization Registry. For the 105,121 adolescents served by these clinics, we obtained imm...