Human Papillomavirus Vaccination Practices: A Survey of US Physicians 18 Months After Licensure

Department of Pediatrics, University of Colorado, Aurora, CO, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2010; 126(3):425-33. DOI: 10.1542/peds.2009-3500
Source: PubMed


The objectives of this study were to assess, in a nationally representative network of pediatricians and family physicians, (1) human papillomavirus (HPV) vaccination practices, (2) perceived barriers to vaccination, and (3) factors associated with whether physicians strongly recommended HPV vaccine to 11- to 12-year-old female patients.
In January through March 2008, a survey was administered to 429 pediatricians and 419 family physicians.
Response rates were 81% for pediatricians and 79% for family physicians. Ninety-eight percent of pediatricians and 88% of family physicians were administering HPV vaccine in their offices (P<.001). Among those physicians, fewer strongly recommended HPV vaccination for 11- to 12-year-old female patients than for older female patients (pediatricians: 57% for 11- to 12-year-old patients and 90% for 13- to 15-year-old patients; P<.001; family physicians: 50% and 86%, respectively; P<.001). The most-frequently reported barriers to HPV vaccination were financial, including vaccine costs and insurance coverage. Factors associated with not strongly recommending HPV vaccine to 11- to 12-year-old female patients included considering it necessary to discuss sexuality before recommending HPV vaccine (risk ratio: 1.27 [95% confidence interval: 1.07-1.51]) and reporting more vaccine refusals among parents of younger versus older adolescents (risk ratio: 2.09 [95% confidence interval: 1.66-2.81]).
Eighteen months after licensure, the vast majority of pediatricians and family physicians reported offering HPV vaccine. Fewer physicians strongly recommended the vaccine for younger adolescents than for older adolescents, and physicians reported financial obstacles to vaccination.

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    • "Our study shows that approximately one third of physicians who provide care to populations at high-risk of HPV infection report offering the HPV vaccine routinely to their eligible patients in accordance with national guidelines. These results are in contrast to a national survey of pediatricians and family practice physicians where 98% of pediatricians and 88% of family practice physicians reported offering HPV vaccine to their female patients [25]. Our results are cause for concern since prior studies have demonstrated that the strongest predictor of HPV vaccination is physician discussion and recommendation [14] [16]. "
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    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
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    • "opportunities for prevention. Provider recommendation plays an important role in increasing vaccine acceptance among parents, yet providers report concern about parental pushback for vaccinating at younger ages [3] "
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    ABSTRACT: Despite official recommendation for routine HPV vaccination of boys and girls at age 11-12 years, parents and providers are more likely to vaccinate their children/patients at older ages. Preferences for vaccinating older adolescents may be related to beliefs about an adolescent's sexual experience or perceived parental resistance to vaccinating children who are assumed to be sexually inexperienced. Using data from the 1995 wave of the National Longitudinal Study of Adolescent Health (ADD Health), a subset of a nationally representative sample of adolescents in grades 7 through 12 and their parents (n = 13,461), we investigated maternal underestimation of adolescent sexual experience. About one third (34.8%) of adolescents reported being sexually experienced and of these, 46.8% of their mothers inaccurately reported that their child was not sexually experienced. Underestimation varied by adolescent age with 78.1% of mothers of sexually active 11-13-year-olds reporting their child was not sexually active, compared with 56.4% of mothers of sexually active 14-16-year-olds and only 34.4% of mothers of 17-18-year-olds. Although most adolescents are not sexually active at age 11 or 12 years, waiting until a parent thinks a child is sexually active could result in missed opportunities for prevention.
    Full-text · Article · Sep 2013 · Journal of Adolescent Health
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    • "Journal of Forensic Nursing 151 vaccine as well as perceived concern that vaccination implies condoning sexual activity (Daley et al., 2011; Kahn et al., 2009; McCave, 2010). Vadaparampil and colleagues (2011) also reported that providers with low perceived barriers were more likely to recommend the HPV vaccine to their patients. "
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    ABSTRACT: An opportunity exists for nurses to integrate HPV education and prevention strategies into the care for adolescent and young adult sexual assault patients. An exploratory, cross-sectional, E-mail survey was conducted to explore forensic nurses' (1) level of support and (2) facilitators and barriers that may influence nurses' level of support regarding incorporating HPV preventative strategies into their care. Eligibility for inclusion was nurse members of the International Association of Forensic Nurses who are stakeholders in the care of sexual assault patients. 541 nurses completed the survey. 98% were supportive of at least providing patients with written educational information regarding HPV and the HPV vaccine; 86% were supportive of providing written information plus making changes to the discharge instructions to incorporate HPV vaccination recommendations; and 53% were supportive of providing written information, making changes to the discharge instructions, and initiating HPV vaccination at the point of care. The strongest predictor of level of support was having positive perceived benefits for HPV vaccination. A one standard deviation increase in perceived benefit was associated with a 50% increased odds of having the highest level of support (OR = 1.5, CI [1.1, 1.9]). Nurses provide care for many adolescent and young adult sexual assault patients who are at risk for acquiring HPV and are within the age range for HPV vaccination. There is an opportunity to update current practice guidelines and recommendations. The nurses in this national sample were overwhelmingly supportive of integrating HPV prevention strategies into care.
    Full-text · Article · Jan 2013 · Journal of Forensic Nursing
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