Health Care Provider Recommendation, Human Papillomavirus Vaccination, and Race/Ethnicity in the US National Immunization Survey

Kelly R. Ylitalo is with the Department of Epidemiology, University of Michigan, Ann Arbor. Hedwig Lee is with the Department of Sociology, University of Washington, Seattle. Neil K. Mehta is with the Department of Global Health at the Rollins School of Public Health, Emory University, Atlanta, GA.
American Journal of Public Health (Impact Factor: 4.55). 06/2012; 103(1). DOI: 10.2105/AJPH.2011.300600
Source: PubMed


Human papillomavirus (HPV) is a common sexually transmitted infection in the United States, yet HPV vaccination rates remain relatively low. We examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and the association between recommendation and vaccination.

We used the 2009 National Immunization Survey-Teen, a nationally representative cross-section of female adolescents aged 13 to 17 years, to assess provider-verified HPV vaccination (≥ 1 dose) and participant-reported health care provider recommendation for the HPV vaccine.

More than half (56.9%) of female adolescents received a recommendation for the HPV vaccine, and adolescents with a recommendation were almost 5 times as likely to receive a vaccine (odds ratio = 4.81; 95% confidence interval = 4.01, 5.77) as those without a recommendation. Racial/ethnic minorities were less likely to receive a recommendation, but the association between recommendation and vaccination appeared strong for all racial/ethnic groups.

Provider recommendations were strongly associated with HPV vaccination. Racial/ethnic minorities and non-Hispanic Whites were equally likely to obtain an HPV vaccine after receiving a recommendation. Vaccine education efforts should target health care providers to increase recommendations, particularly among racial/ethnic minority populations.

21 Reads
    • "Even with a low HPV vaccination coverage, there has been a 56% reduction in vaccine-specific HPV infections among females aged 14–19 years in the US from 2003–2006, the period before vaccine initiation, to 2007–2010, the period after initiation. Provider recommendation of the vaccine has repeatedly been associated with much greater odds of vaccination uptake (Reiter et al., 2009); (Daley et al., 2010); (Brewer et al., 2011); (Rosenthal et al., 2011); (Lau et al., 2012); (Gargano et al., 2013); (Ylitalo et al., 2013). Providers with knowledge and understanding of the burden of disease may be more likely to recommend the vaccine, consistent with guidelines (Daley et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The human papillomavirus (HPV) vaccine was recommended in 2007 by the Advisory Committee on Immunization Practices (ACIP) to preadolescent and adolescent girls. Vaccination initiation was recommended at age 11-12years with the option to start at age 9. Catchup vaccination was recommended to females aged 13-26 previously not vaccinated. However, vaccination coverage remains low. Studies show that the HPV vaccine can prevent cervical, vulvar, vaginal, anal and some oropharyngeal cancers and that provider recommendation of vaccines can improve low vaccination rates. Methods: Using data from 2012 DocStyles, an annual, web-based survey of U.S. healthcare professionals including physicians and nurse practitioners (n=1753), we examined providers' knowledge about the effectiveness of the HPV vaccine in preventing cancer and their vaccine recommendation to all age-eligible females (9-26years). Descriptive statistics and Chi-square tests were used to assess differences across specialties. Results: Knowledge about HPV vaccine effectiveness in preventing cervical cancer was highly prevalent (96.9%), but less so for anal, vaginal, vulvar and oropharyngeal cancers. Only 14.5% of providers recommended the vaccine to all age-eligible females and 20.2% recommended it to females aged 11-26years. Knowledge assessment of cancers associated with HPV and vaccination recommendations varied significantly among providers (p<0.01). Providers more frequently recommended the vaccine to girls older than 11-12years. Conclusions: Improving providers' knowledge about HPV-associated cancers and the age for vaccination initiation, communicating messages focusing on the vaccine safety and benefits in cancer prevention and on the importance of its delivery prior to sexual onset, may improve HPV vaccine coverage.
    No preview · Article · Oct 2015 · Preventive Medicine
  • Source
    • "opinions about influenza vaccinations (Ylitalo et al., 2013; Department of Health & Human Servces (DHHS), 2012). We compare HCP recommendation rates with respondent characteristics to investigate associations between demographic, socioeconomic, health, access variables, and HCP recommendation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Investigate determinants of receiving healthcare provider (HCP) recommendations for seasonal and H1N1 influenza vaccinations. Methods: Using a United States national sample of adults 18 + from the National 2009 H1N1 Flu Survey, multivariate regression models estimated the likelihood of receiving a HCP recommendation. Covariates included demographics, socioeconomic status, and Advisory Committee on Immunization Practices (ACIP) priority groups. Results: Adults age 55-64 and 65 + were more likely to report a HCP recommendation when compared to adults age 18-34 (OR: 1.483, 95%CI: 1.237-1.778 and OR: 1.738, 95%CI: 1.427-2.116, respectively). Chronically ill adults had 58.0% (95%CI: 1.414-1.765) higher odds of receiving a HCP recommendation than non-chronically ill adults. Patients visiting a doctor once and twice had 28.7% (95%CI: 0.618-0.821) and 17.1% (95%CI: 0.721-0.952) lower odds of receiving a HCP recommendation when compared to adults visiting their doctor at least four times. And, compared to Non-Hispanic Whites, Non-Hispanic Blacks had 28.4% (95%CI: 1.064-1.549) higher odds of receiving a recommendation. Conclusions: ACIP priority groups experienced higher rates of recommendations compared to non-ACIP groups. Racial differences in HCP recommendations cannot explain racial disparities in flu vaccination rates.
    Full-text · Article · Apr 2015
  • Source
    • "Failure to increase vaccine uptake in these groups may worsen the disparities in HPV-related cancers and fail to prevent many HPV related cancer cases. Prior research has documented the important influence of the medical provider on vaccine decision making among parents and adults, and recent studies have confirmed the importance of the providers' role in parental consent for the HPV vaccine [13] [14] [15] [16] [17] [18] [19] [20]. Given the significant link between provider recommendation and vaccine acceptance and completion, we sought to understand physician practices, beliefs and barriers that could affect their utilization of the HPV vaccine among their racial/ethnic minority patients at higher risk for HPV infection and HPV related cancer [10–12,21]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Minority populations in the United States are disproportionally affected by human papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer. Study design: Cross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates. Results: Of 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine. Conclusions: Our study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers' failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed.
    Full-text · Article · May 2014 · Vaccine
Show more