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Rosen BL, Bishop JM, McDonald SL, Kahn JA, Kreps GL. Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment. JMIR Cancer 2018; 4:e3. [PMID: 29453187 PMCID: PMC5834755 DOI: 10.2196/cancer.9114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination. OBJECTIVE The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions. METHODS Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions' content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models. RESULTS A total of 21 interventions were identified, out of which 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention. CONCLUSIONS This analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians.
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Affiliation(s)
- Brittany L Rosen
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
| | - James M Bishop
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
| | - Skye L McDonald
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Gary L Kreps
- Center for Health and Risk Communication, Department of Communication, George Mason University, Fairfax, VA, United States
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Rahman M, Hirth JM, Berenson AB. Adherence to ACIP Recommendation for Human Papillomavirus Vaccine Among US Adolescent Girls. J Community Health 2018; 42:385-389. [PMID: 27704304 DOI: 10.1007/s10900-016-0267-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to examine correlates of human papillomavirus (HPV) vaccine use according to Advisory Committee on Immunization Practices (ACIP)'s recommendations among US adolescent girls. We used National Immunization Survey of Teens 2013 data. Based on provider-verified (n = 9403) information, 57.3, 39.1 and 19.0 % of adolescent girls, initiated, completed and completed the HPV vaccine according to ACIP's recommendation (by age 12), respectively. Hispanic race/ethnicity, a physician recommendation for HPV vaccine and ≥1 influenza vaccine in the past 3 years were all associated with a higher likelihood of compliance with ACIP's recommendation. Girls from a larger family and those whose immunization provider was a STD/school/teen clinic were less likely to receive the vaccine at the recommended age compared to a girl raised in a smaller sized family and received immunization from a hospital facility, respectively. Only one-fifth of 13-17 yo girls receive the HPV vaccine by age 12 as recommended by ACIP. Physician visits and influenza vaccination settings are opportunities to improve vaccine series completion at the recommended age.
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Affiliation(s)
- Mahbubur Rahman
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA. .,Center for Clinical Epidemiology, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Jacqueline M Hirth
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA
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53
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Rosen BL, Shew ML, Zimet GD, Ding L, Mullins TLK, Kahn JA. Human Papillomavirus Vaccine Sources of Information and Adolescents' Knowledge and Perceptions. Glob Pediatr Health 2017; 4:2333794X17743405. [PMID: 29204462 PMCID: PMC5703096 DOI: 10.1177/2333794x17743405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
Abstract
Understanding where adolescents obtain information about human papillomavirus (HPV) vaccines may be helpful in designing public health interventions promoting HPV vaccination. This study assessed the following: (1) exposure to specific sources of information about HPV vaccines, (2) self-reported helpfulness of these sources of information, and (3) whether the specific source of information was associated with knowledge and perceptions about HPV vaccines among adolescent girls. There were 339 adolescent girls (mean age = 16.8 years) recruited into the study. Television advertisements, the Internet, doctors/nurses, and mothers were the most frequently reported sources of vaccine information; more than 90% of participants who received information from these sources reported they were helpful. Adolescents who received information about HPV vaccines from television advertisements, the Internet, clinicians, and mothers had higher knowledge about HPV vaccines and more positive perceptions. Assuring the accuracy of messages from these sources will be essential, given their importance in influencing adolescents' knowledge and perceptions about HPV vaccines.
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Affiliation(s)
| | | | | | - Lili Ding
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tanya L K Mullins
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica A Kahn
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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54
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Bonville CA, Domachowske JB, Cibula DA, Suryadevara M. Immunization attitudes and practices among family medicine providers. Hum Vaccin Immunother 2017; 13:2646-2653. [PMID: 29028414 DOI: 10.1080/21645515.2017.1371380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To describe immunization attitudes and practices among family medicine providers across New York State. METHODS In this cross-sectional survey study, family medicine providers across New York State completed a questionnaire to assess vaccine beliefs and barriers and immunization practices. STATISTICAL ANALYSIS Descriptive statistical methods were used to define provider characteristics, knowledge and vaccine practices. RESULTS Completed questionnaires from 226 family medicine providers were included for analysis. As a group, 207/218 (95%) of providers who answered the question state they always recommend standard pediatric vaccines. Of the 209 providers who answered both questions, 47 (22%) state they always recommend standard pediatric vaccines but do not always recommend HPV vaccine to eligible 11-12 year-old patients. Only 75% of providers strongly disagreed with the statement 'vaccinating adolescents against HPV increases the likelihood of unprotected sex'. Even though 178/190 (94%) and 164/188 (87%) of surveyed family medicine providers reported recommending that their pregnant patients receive influenza vaccine and Tdap vaccine, respectively, only 134/185 (72%) routinely do so in their office. CONCLUSION Most family medicine providers self-report always recommending standard pediatric vaccines, however only a minority are following ACIP recommendations. Educational sessions to update family medicine providers on ACIP recommendations and address individual provider concerns may improve provider vaccine confidence and uptake of vaccines by their patients.
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Affiliation(s)
- Cynthia A Bonville
- a Department of Pediatrics , State University of New York, Upstate Medical University , Syracuse , NY , USA
| | - Joseph B Domachowske
- a Department of Pediatrics , State University of New York, Upstate Medical University , Syracuse , NY , USA
| | - Donald A Cibula
- b Department of Public Health and Preventive Medicine , State University of New York, Upstate Medical University , Syracuse , NY , USA
| | - Manika Suryadevara
- a Department of Pediatrics , State University of New York, Upstate Medical University , Syracuse , NY , USA
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55
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Warner EL, Ding Q, Pappas L, Bodson J, Fowler B, Mooney R, Kirchhoff AC, Kepka D. Health Care Providers' Knowledge of HPV Vaccination, Barriers, and Strategies in a State With Low HPV Vaccine Receipt: Mixed-Methods Study. JMIR Cancer 2017; 3:e12. [PMID: 28801303 PMCID: PMC5572057 DOI: 10.2196/cancer.7345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/17/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents. Objective The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers’ perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt. Methods In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (≤10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed. Results Family practice providers (52.2%, 71/136; P=.001), institutional or university clinics (54.0%, 20/37; P=.001), and busier clinics seeing 20 to 29 patients per day (50.0%, 28/56; P=.04) had the highest proportion of respondents with high HPV vaccination knowledge. Older providers aged 40 to 49 years (85.1%, 57/67; P=.04) and those who were a Vaccines for Children provider (78.7%, 133/169; P=.03) had the highest proportion of respondents with high knowledge of HPV vaccine recommendations. Providers perceived the lack of parental education to be the main barrier to HPV vaccination. They endorsed stronger, consistent, and more direct provider recommendations for HPV vaccination delivered to parents through printed materials available in clinical settings and public health campaigns. Hesitancy to recommend the HPV vaccine to patients persisted among some providers. Conclusions Providers require support to eliminate barriers to recommending HPV vaccination in clinical settings. Additionally, providers endorsed the need for parental educational materials and instructions on framing HPV vaccination as a priority cancer prevention mechanism for all adolescents.
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Affiliation(s)
- Echo L Warner
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Qian Ding
- Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Lisa Pappas
- Biostatistics Core, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Julia Bodson
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Brynn Fowler
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Ryan Mooney
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States.,Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Deanna Kepka
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
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HPV Vaccination: Are We Meeting Our Targets in Cervical Cancer Prevention? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0216-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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57
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Jacobs-Wingo JL, Jim CC, Groom AV. Human Papillomavirus Vaccine Uptake: Increase for American Indian Adolescents, 2013-2015. Am J Prev Med 2017; 53:162-168. [PMID: 28256284 PMCID: PMC5586078 DOI: 10.1016/j.amepre.2017.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/28/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although Indian Health Service, tribally-operated, and urban Indian (I/T/U) healthcare facilities have higher human papillomavirus (HPV) vaccine series initiation and completion rates among adolescent patients aged 13-17 years than the general U.S. population, challenges remain. I/T/U facilities have lower coverage for HPV vaccine first dose compared with coverage for other adolescent vaccines, and HPV vaccine series completion rates are lower than initiation rates. Researchers aimed to assist I/T/U facilities in identifying interventions to increase HPV vaccination series initiation and completion rates. STUDY DESIGN Best practice and intervention I/T/U healthcare facilities were identified based on baseline adolescent HPV vaccine coverage data. Healthcare professionals were interviewed about barriers and facilitators to HPV vaccination. Researchers used responses and evidence-based practices to identify and assist facilities in implementing interventions to increase adolescent HPV vaccine series initiation and completion. Coverage and interview data were collected from June 2013 to June 2015; data were analyzed in 2015. SETTING/PARTICIPANTS I/T/U healthcare facilities located within five Indian Health Service regions. INTERVENTION Interventions included analyzing and providing feedback on facility vaccine coverage data, educating providers about HPV vaccine, expanding access to HPV vaccine, and establishing or expanding reminder recall and education efforts. MAIN OUTCOME MEASURES Impact of evidence-based strategies and best practices to support HPV vaccination. RESULTS Mean baseline first dose coverage with HPV vaccine at best practice facilities was 78% compared with 46% at intervention facilities. Mean third dose coverage was 48% at best practice facilities versus 19% at intervention facilities. Intervention facilities implemented multiple low-cost, evidence-based strategies and best practices to increase vaccine coverage. At baseline, most facilities used electronic provider reminders, had standing orders in place for administering HPV vaccine, and administered tetanus, diphtheria, and acellular pertussis and HPV vaccines during the same visit. At intervention sites, mean coverage for HPV initiation and completion increased by 24% and 22%, respectively. CONCLUSIONS A tailored multifaceted approach addressing vaccine delivery processes and patient and provider education may increase HPV vaccine coverage.
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Affiliation(s)
- Jasmine L Jacobs-Wingo
- Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Cheyenne C Jim
- IHRC, Inc., Atlanta, Georgia; Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy V Groom
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, Maryland
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58
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McLean HQ, VanWormer JJ, Chow BDW, Birchmeier B, Vickers E, DeVries E, Meyer J, Moore J, McNeil MM, Stokley S, Gee J, Belongia EA. Improving Human Papillomavirus Vaccine Use in an Integrated Health System: Impact of a Provider and Staff Intervention. J Adolesc Health 2017; 61:252-258. [PMID: 28462786 PMCID: PMC6749828 DOI: 10.1016/j.jadohealth.2017.02.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/26/2017] [Accepted: 02/14/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE Acceptance and coverage of the human papillomavirus (HPV) vaccine in the United States has been suboptimal. We implemented a multifaceted provider and staff intervention over a 1-year period to promote HPV vaccination in a regional health care system. METHODS The intervention was conducted in nine clinical departments from February 2015 to March 2016; 34 other departments served as controls. The intervention included in-person provider and staff education, quarterly feedback of vaccine coverage, and system-wide changes to patient reminder and recall notifications. Change in first-dose HPV vaccine coverage and series completion were estimated among 11- to 12-year-olds using generalized estimating equations adjusted for age and sex. RESULTS HPV vaccine coverage in the intervention departments increased from 41% to 59%, and the increase was significantly greater than that seen in the control departments (32%-45%, p = .0002). The largest increase occurred in the quarter after completion of the provider and staff education and a patient reminder and recall postcard mailing (p = .004). Series completion also increased significantly system wide among adolescents aged 11-12 years following mailing of HPV vaccine reminder letters to parents of adolescents aged 12 years rather than 16 years. CONCLUSIONS HPV vaccine uptake can be improved through a multifaceted approach that includes provider and staff education and patient reminder/recall. System-level change to optimize reminder and recall notices can have substantial impact on HPV vaccine utilization.
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Affiliation(s)
- Huong Q. McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin,Address correspondence to: Huong Q. McLean, Ph.D., M.P.H., Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue (ML2), Marshfield, WI 54449. (H.Q. McLean)
| | - Jeffrey J. VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Brian D. W. Chow
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin,Pediatrics, Marshfield Clinic, Marshfield, Wisconsin
| | - Becky Birchmeier
- Institute for Quality Innovation & Patient Safety, Marshfield Clinic, Marshfield, Wisconsin
| | - Elizabeth Vickers
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Edna DeVries
- Pediatrics, Marshfield Clinic, Marshfield, Wisconsin
| | - James Meyer
- Pediatrics, Marshfield Clinic, Marshfield, Wisconsin
| | - Jeffrey Moore
- Family Medicine, Marshfield Clinic, Merrill, Wisconsin
| | - Michael M. McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne Gee
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edward A. Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
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Ragan KR, Bednarczyk RA, Butler SM, Omer SB. Missed opportunities for catch-up human papillomavirus vaccination among university undergraduates: Identifying health decision-making behaviors and uptake barriers. Vaccine 2017; 36:331-341. [PMID: 28755837 DOI: 10.1016/j.vaccine.2017.07.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Suboptimal adolescent human papillomavirus (HPV) vaccine rates in the US highlight the need for catch-up vaccination. When teenagers enter college, there may be a shift in healthcare decision-making from parents and guardians to the students themselves. Little is known about factors influencing college students' healthcare decision-making processes. STUDY DESIGN We evaluated HPV vaccine decision-making among 18-to-26-year-old college students through a self-administered, anonymous, cross-sectional survey. This survey was distributed to a sample of men and women in classroom settings at two universities. Categorical data comparisons were conducted using Chi-square and Fisher's exact tests. Multivariate Poisson regression was used to model initiation of HPV vaccine and compute prevalence ratios while controlling for key influential covariates at the 0.05 alpha level. RESULTS A total of 527 students participated (response proportion=93.1%). Overall, 55.8% of participants received the HPV vaccine. Encouraging conversations with doctors and/or parents/guardians were identified as one of the most influential factors to increase vaccine uptake. Among students who received encouragement from both a doctor and parent, 95.8% received the vaccine. Campaigns about cancer prevention were viewed as more influential than those that focus on preventing genital warts. Approximately one-third of students indicated they didn't know where to get the HPV vaccine. Women were more likely to report that their parents would not let them get the HPV vaccine compared to men (26.7% vs. 2.3%). The majority of students (77.3%) indicated their parents were sometimes, equally, or mostly involved in making decisions about receiving vaccines (other than flu). CONCLUSION Students' decision-making is greatly influenced by their parents; therefore, interventions for this population should work to increase students' control over decision-making while also addressing parental concerns.
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Affiliation(s)
- Kathleen R Ragan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - Robert A Bednarczyk
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Cancer Prevention and Control Program, Winship Cancer Institute, 1365-C Clifton Rd NE, Atlanta, GA 30322, USA; Emory Vaccine Center, 954 Gatewood Rd, Atlanta, GA 30329, USA.
| | - Scott M Butler
- School of Health and Human Performance, Georgia College, 231 W. Hancock St, Milledgeville, GA 31061, USA.
| | - Saad B Omer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Emory Vaccine Center, 954 Gatewood Rd, Atlanta, GA 30329, USA; Department of Pediatrics, School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA.
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60
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Berenson AB, Brown VG, Fuchs EL, Hirth JM, Chang M. Relationship between maternal experiences and adolescent HPV vaccination. Hum Vaccin Immunother 2017; 13:2150-2154. [PMID: 28604258 DOI: 10.1080/21645515.2017.1332551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The human papillomavirus (HPV) vaccine has been available for over a decade but its uptake rate is still low. To explore the relationship between the HPV vaccination status of a child and their mother's beliefs, behaviors and knowledge, we surveyed 1497 women with at least one child aged 9-17 y between September 2011 and November 2015. Physician recommendation was the most important factor associated with reported child vaccination status. Mothers who reported receiving a provider recommendation for the HPV vaccine were 32 times more likely to have a child who had been vaccinated compared with mothers who did not report provider recommendation (aOR) = 32.17; 95% CI: 21.77, 47.54). Knowing someone who had received the vaccine was also strongly associated with vaccination uptake (59% vs 12%, p < .001). Additionally, prior HPV diagnosis (aOR = 1.91; 95% CI: 1.18, 3.10) and knowing someone with cervical cancer (aOR = 1.38; 95% CI: 1.01, 1.89) were associated with child vaccination status. Mothers who perceived moderate to high risk for their child contracting HPV or developing genital warts or cervical cancer were more likely to report that their daughters (but not their sons) had been vaccinated.
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Affiliation(s)
- Abbey B Berenson
- a Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston , TX , USA.,b Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston , TX , USA
| | - V Gnaukita Brown
- a Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston , TX , USA.,b Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston , TX , USA
| | - Erika L Fuchs
- a Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston , TX , USA.,b Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston , TX , USA
| | - Jacqueline M Hirth
- a Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston , TX , USA.,b Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston , TX , USA
| | - Mihyun Chang
- a Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston , TX , USA.,b Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston , TX , USA
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Barroeta JE, Adhikari-Guragain D, Grotkowski CE. Cervical cancer screening in the era of HPV vaccination: A review of shifting paradigms in cytopathology. Diagn Cytopathol 2017; 45:903-914. [PMID: 28589649 DOI: 10.1002/dc.23737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/16/2017] [Accepted: 04/07/2017] [Indexed: 01/14/2023]
Abstract
Significant changes in cervical cancer screening practice, guidelines, and prevention of cervical cancer have taken place in recent years including the raising of initial cervical cancer screening age, changes in frequency of cytology screening, and the adoption of high risk HPV and cytology co-testing for some patients; the introduction of the bivalent, quadrivalent, and 9-valent HPV vaccines; and the recent approval of high risk HPV testing as primary screening with the use of cytology as triage in positive cases. This review discusses the significance of primary HPV screening, the impact of HPV vaccination in the prevalence of cervical cancer and its precursors, the interplay between high risk HPV testing and vaccination, and the implications for clinical and cytological management. Future strategies for cervical screening in the post-vaccination era are also discussed.
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Affiliation(s)
- Julieta E Barroeta
- Department of Pathology, Cooper University Hospital, M.D. Anderson Cancer Center at Cooper, Camden, New Jersey
| | - Deepti Adhikari-Guragain
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carolyn E Grotkowski
- Department of Pathology, Cooper University Hospital, M.D. Anderson Cancer Center at Cooper, Camden, New Jersey
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Verger P, Collange F, Fressard L, Bocquier A, Gautier A, Pulcini C, Raude J, Peretti-Watel P. Prevalence and correlates of vaccine hesitancy among general practitioners: a cross-sectional telephone survey in France, April to July 2014. ACTA ACUST UNITED AC 2017; 21:30406. [PMID: 27918262 PMCID: PMC5291145 DOI: 10.2807/1560-7917.es.2016.21.47.30406] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/11/2016] [Indexed: 01/21/2023]
Abstract
This article sought to estimate the prevalence of vaccine hesitancy (VH) among French general practitioners (GPs) and to study its demographic, professional and personal correlates. We conducted a cross-sectional telephone survey about GPs' vaccination-related attitudes and practices in 2014 in a national panel of 1,712 GPs in private practice, randomly selected from an exhaustive database of health professionals in France. A cluster analysis of various dimensions of VH (self-reported vaccine recommendations, perceptions of vaccine risks and usefulness) identified three clusters: 86% of GPs (95% confidence interval (CI): 84-88) were not or only slightly vaccine-hesitant, 11% (95% CI: 9-12) moderately hesitant and 3% (95% CI: 3-4) highly hesitant or opposed to vaccination. GPs in the latter two clusters were less frequently vaccinated and reported occasional practice of alternative medicine more often than those in the first cluster; they also described less experience with vaccine-preventable diseases and more experience with patients who they considered had serious adverse effects from vaccination. This study confirms the presence of VH among French GPs but also suggests that its prevalence is moderate. Given GPs' central role in vaccination, these results nevertheless call for a mobilisation of stakeholders to address VH among GPs.
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Affiliation(s)
- Pierre Verger
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France.,INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Fanny Collange
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille University, URMITE, IRD 198, UMR CNRS 7278, INSERM 1095, Faculté de Médecine, Marseille, France
| | - Lisa Fressard
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France
| | - Aurélie Bocquier
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France
| | - Arnaud Gautier
- Santé publique France (the French national public health agency), Saint-Maurice, France
| | - Céline Pulcini
- CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Hôpitaux de Brabois, Vandœuvre-lès-Nancy, France.,Lorraine University, Paris Descartes University, EA 4360 Apemac, Vandœuvre-lès-Nancy, France
| | - Jocelyn Raude
- EHESP, Sorbonne Paris Cité, Rennes, France.,Aix-Marseille University, IRD French Institute of Research for Development, EHESP, UMR_D 190 'Emergence des Pathologies Virales', Marseille, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France
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Petrosky EY, Liu G, Hariri S, Markowitz LE. Human Papillomavirus Vaccination and Age at First Sexual Activity, National Health and Nutrition Examination Survey. Clin Pediatr (Phila) 2017; 56:363-370. [PMID: 27609513 PMCID: PMC5342939 DOI: 10.1177/0009922816660541] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The National Health and Nutrition Examination Survey (NHANES) collects information on human papillomavirus (HPV) vaccination history as well as sexual activity. We evaluated data from NHANES to assess report of HPV vaccination with ≥1 dose and 3 doses among females and males aged 11 to 26 years during 2007-2014. We also examined age at first vaccine dose and age at first sexual activity among females aged 14 to 26 years. Vaccination significantly increased in females aged 13 to 26 years, but not among 11- to 12-year-old girls, and remained low for both females and males. In NHANES 2011-2014, among females with known age at first vaccine dose, 43.1% reported having had sex before or in the same year they received their first HPV vaccine, and this varied by race/ethnicity. Clinicians should provide strong recommendations consistent with guidelines, including routine vaccination of girls and boys at age 11 or 12 years.
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Affiliation(s)
- Emiko Y. Petrosky
- National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gui Liu
- National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Hariri
- National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri E. Markowitz
- National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lechuga J, Vera-Cala L, Martinez-Donate A. HPV Vaccine Awareness, Barriers, Intentions, and Uptake in Latina Women. J Immigr Minor Health 2017; 18:173-8. [PMID: 25432149 DOI: 10.1007/s10903-014-0139-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Latina women are at heightened risk of cervical cancer incidence and mortality. The human papillomavirus (HPV) is the principal cause of the majority of cervical cancer cases. A vaccine that protects against HPV was licensed in 2006. Eight years post-licensure, mixed research findings exist regarding the factors that predict vaccine uptake in Latinas. We conducted a population-based phone survey with a random sample of 296 Latinas living in a Midwestern U.S. City. Intention to vaccinate was significantly associated with health care provider recommendations, worry about side effects, knowing other parents have vaccinated, perceived severity of HPV, and worry that daughter may become sexually active following vaccination. Worry that daughter may become sexually active was the only factor related to vaccine uptake. Findings suggest that training providers to discuss the low risk of severe side effects, consequences of persistent HPV, and sexuality related concerns with Latino women may encourage vaccination.
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Affiliation(s)
- Julia Lechuga
- Psychology Department, The University of Texas at El Paso, 500 W. University Avenue, El Paso, TX, 79912, USA.
| | - Lina Vera-Cala
- Department of Public Health, Universidad Industrial de Santander, Bucaramanga, Colombia
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 605 WARF, Madison, WI, 53705, USA
| | - Ana Martinez-Donate
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 605 WARF, Madison, WI, 53705, USA
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Hofstetter AM, Lappetito L, Stockwell MS, Rosenthal SL. Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists. J Pediatr Adolesc Gynecol 2017; 30:88-95. [PMID: 27542999 PMCID: PMC5279719 DOI: 10.1016/j.jpag.2016.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/06/2016] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE Many adolescents with chronic medical conditions (CMCs) are at risk of human papillomavirus (HPV) infection, associated complications, and underimmunization and often identify a pediatric subspecialist as their main provider. This study aimed to assess the HPV-related understanding, beliefs, and practices of pediatric subspecialists, which are largely unknown. DESIGN AND SETTING National cross-sectional study. PARTICIPANTS Pediatric endocrinologists, hematologist/oncologists, pulmonologists, and rheumatologists identified using the American Medical Association Physician Masterfile (n = 418). INTERVENTIONS Subspecialists who care for adolescents with CMCs in the outpatient setting were recruited to complete a Web-based survey on their HPV-related knowledge, attitudes, comfort, and practices. MAIN OUTCOME MEASURES HPV vaccination recommendation. RESULTS Over half of respondents (50.4%; n = 196/389) reported sometimes or always recommending HPV vaccination to adolescent patients with CMCs. Factors positively associated with recommendation included hematology/oncology (adjusted odds ratio [AOR], 4.69; 95% confidence interval [CI], 1.86-11.81) or rheumatology (AOR, 6.55; 95% CI, 1.67-25.74) specialization, seeing more adolescent patients with CMCs (AOR, 1.01; 95% CI, 1.00-1.02), and sometimes or always discussing sexual health (AOR, 2.53; 95% CI, 1.05-6.08) or checking vaccine status (AOR, 3.83; 95% CI, 1.59-9.20) with these patients. Those who thought it was important, but were uncomfortable discussing sexual health when recommending HPV vaccination (AOR, 0.28; 95% CI, 0.12-0.70) or who reported insufficient HPV vaccine information (AOR, 0.45; 95% CI, 0.23-0.88) or lack of primary-subspecialty care provider communication (AOR, 0.38; 95% CI, 0.16-0.93) as barriers to HPV vaccination were less likely to recommend HPV vaccination. CONCLUSION This study revealed that many subspecialists fail to recommend HPV vaccination to adolescents with CMCs and highlights potential targets for future interventions.
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Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics, Columbia University, New York, New York; Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Lauren Lappetito
- Department of Pediatrics, Columbia University, New York, New York
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Mailman School of Public Health, Columbia University, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University, New York, New York
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66
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Afonso NM, Kavanagh MJ, Swanberg SM, Schulte JM, Wunderlich T, Lucia VC. Will they lead by example? Assessment of vaccination rates and attitudes to human papilloma virus in millennial medical students. BMC Public Health 2017; 17:35. [PMID: 28056900 PMCID: PMC5217643 DOI: 10.1186/s12889-016-3969-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023] Open
Abstract
Background Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. It is also well established that HPV viruses are responsible for a variety of cancers. Little is known about the prevailing knowledge and attitudes toward the HPV vaccine in our future healthcare providers, a majority of whom were among the first in the target age group to receive the vaccine; the same vaccine that they will in turn be expected to recommend to their patients. The aims of this pilot study were to examine the HPV vaccination rate among medical students and determine their knowledge about HPV and attitudes toward vaccination. Methods To aid in the development of an HPV educational intervention, a needs assessment survey was administered to discover medical students’ knowledge and attitudes toward the HPV vaccine. All medical students at a Midwestern US medical school were invited to complete the survey. Results Two hundred fourteen of 390 medical students completed the survey with 44% having been previously vaccinated. Although 82% of all respondents believed they would recommend the vaccine to family and friends, only 40% felt knowledgeable about the vaccine and 40% felt comfortable counseling patients. More positive attitudes and better knowledge scores were found in fully vaccinated students compared to non-vaccinated students. Provider recommendation was strongly associated with HPV vaccination status. Conclusions This study revealed the unique perspectives of U.S. millennial medical students as the first group of future healthcare providers to have personally encountered the HPV vaccine. Overall, students’ knowledge as well as their comfort level in counseling patients was lacking. This assessment has guided the development of targeted educational interventions to address knowledge gaps and prepare students to appropriately discuss the vaccine with patients and parents and help protect young people from life threatening cancers.
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Affiliation(s)
- Nelia M Afonso
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, 2200 North Squirrel Rd., Rochester, MI, 48309, USA. .,Clinical Skills Training & Simulation Center, Oakland University William Beaumont School of Medicine, 44300 Dequindre Rd., Sterling Heights, MI, 48314, USA.
| | - Maurice J Kavanagh
- Clinical Skills Training & Simulation Center, Oakland University William Beaumont School of Medicine, 44300 Dequindre Rd., Sterling Heights, MI, 48314, USA
| | - Stephanie M Swanberg
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, 2200 North Squirrel Rd., Rochester, MI, 48309, USA
| | - Jeanne M Schulte
- Clinical Skills Training & Simulation Center, Oakland University William Beaumont School of Medicine, 44300 Dequindre Rd., Sterling Heights, MI, 48314, USA
| | - Tracy Wunderlich
- Department of Medical Education, Oakland University William Beaumont School of Medicine, 2200 North Squirrel Rd., Rochester, MI, 48309, USA
| | - Victoria C Lucia
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, 2200 North Squirrel Rd., Rochester, MI, 48309, USA
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Brewer NT, Hall ME, Malo TL, Gilkey MB, Quinn B, Lathren C. Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial. Pediatrics 2017; 139:peds.2016-1764. [PMID: 27940512 PMCID: PMC5192091 DOI: 10.1542/peds.2016-1764] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/24/2022] Open
Abstract
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-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (≥1 dose) for adolescents aged 11 or 12 years. RESULTS The immunization registry attributed 17 173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%-9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37 796). CONCLUSIONS Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Megan E. Hall
- Department of Health Behavior, Gillings School of Global Public Health, and
| | - Teri L. Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B. Gilkey
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and
| | - Beth Quinn
- North Carolina Immunization Branch, Raleigh, North Carolina
| | - Christine Lathren
- Department of Health Behavior, Gillings School of Global Public Health, and
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Mohammed KA, Geneus CJ, Osazuwa-Peters N, Adjei Boakye E, Tobo BB, Burroughs TE. Disparities in Provider Recommendation of Human Papillomavirus Vaccination for U.S. Adolescents. J Adolesc Health 2016; 59:592-598. [PMID: 27506278 DOI: 10.1016/j.jadohealth.2016.06.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the prevalence of and examine factors associated with provider recommendation of human papillomavirus vaccination for U.S. adolescents. METHODS Multivariable logistic regression analyses were performed using data from the National Immunization Survey-Teen 2014 on 34,478 adolescents aged 13-17 years. RESULTS Overall prevalence of vaccine recommendation was 72.6% for girls and 51.8% for boys. Lower rates were observed among girls aged 13 years, living below poverty line, adolescents of lesser educated mothers, and those residing in the South. Overall, girls had higher odds of vaccine recommendation (odds ratio [OR] = 2.57; 95% confidence interval [CI] = 2.35-2.82). Correlates of higher vaccine recommendation for girls were: older age-17 versus 13 (OR = 1.51; 95% CI = 1.20-1.89), living above versus below poverty line, and residing in Northeast (OR = 1.45; 95% CI = 1.21-1.73) and Midwest (OR = 1.29; 95% CI = 1.11-1.50) versus South. For boys, correlates of higher vaccine recommendation were: non-Hispanic black (OR = 1.30; 95% CI = 1.07-1.58) and Hispanic (OR = 1.24; 95% CI = 1.03-1.48) versus non-Hispanic white race and residing in Northeast (OR = 1.79; 95% CI = 1.54-2.08) and West (OR = 1.41; 95% CI = 1.17-1.70) versus South. Other factors associated with vaccine recommendation were having a college-educated mother and frequent doctor visits in the past 12 months. CONCLUSIONS This study highlights significant disparities in provider recommendation of human papillomavirus vaccination for U.S. adolescents. Findings suggest possible areas for tailored interventions to bridge the gap in vaccine recommendation and uptake in high-risk populations.
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Affiliation(s)
- Kahee A Mohammed
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri.
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, St Louis University, St Louis, Missouri; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, St Louis University, St Louis, Missouri; St Louis University Cancer Center, St Louis, Missouri
| | - Eric Adjei Boakye
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri
| | - Betelihem B Tobo
- Department of Epidemiology, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
| | - Thomas E Burroughs
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri
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Jeyarajah J, Elam-Evans LD, Stokley S, Smith PJ, Singleton JA. Human Papillomavirus Vaccination Coverage Among Girls Before 13 Years: A Birth Year Cohort Analysis of the National Immunization Survey-Teen, 2008-2013. Clin Pediatr (Phila) 2016; 55:904-14. [PMID: 26603581 PMCID: PMC8591583 DOI: 10.1177/0009922815616245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Routine human papillomavirus (HPV) vaccination is recommended at 11 or 12 years by the Advisory Committee on Immunization Practices. National Immunization Survey-Teen data were analyzed to evaluate, among girls, coverage with one or more doses of HPV vaccination, missed opportunities for HPV vaccination, and potential achievable coverage before 13 years. Results were stratified by birth year cohorts. HPV vaccination coverage before 13 years (≥1 HPV dose) increased from 28.4% for girls born in 1995 to 46.8% for girls born in 2000. Among girls born during 1999-2000 who had not received HPV vaccination before 13 years (57.2%), 80.1% had at least 1 missed opportunity to receive HPV vaccination before 13 years. Opportunities to vaccinate for HPV at age 11 to 12 years are missed. Strategies are needed to decrease these missed opportunities for HPV vaccination. This can be facilitated by the administration of all vaccines recommended for adolescents at the same visit.
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Affiliation(s)
- Jenny Jeyarajah
- Carter Consulting, Atlanta, GA, USA National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurie D. Elam-Evans
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip J. Smith
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James A. Singleton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Vadaparampil ST, Malo TL, Sutton SK, Ali KN, Kahn JA, Casler A, Salmon D, Walkosz B, Roetzheim RG, Zimet GD, Giuliano AR. Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males. Cancer Epidemiol Biomarkers Prev 2016; 25:1435-1446. [PMID: 27486020 DOI: 10.1158/1055-9965.epi-15-1294] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the United States are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. METHODS We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11-12, 13-17, 18-21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with consistent and strong recommendations for 11- to 12-year-olds. RESULTS We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males ages 13 to 17 (39%) compared with ages 11 to 12 (31%) and 18 to 21 (31%). Consistent and strong recommendation for 11- to 12-year-old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty in remembering to discuss HPV vaccination. CONCLUSIONS Physicians' current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians' personal barriers to HPV vaccine delivery. IMPACT As one of the first studies to examine both consistency and strength of physicians' HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians' recommendations. Cancer Epidemiol Biomarkers Prev; 25(10); 1435-46. ©2016 AACR.
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Affiliation(s)
- Susan T Vadaparampil
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida.
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Steven K Sutton
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida
| | - Karla N Ali
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohia
| | - Alix Casler
- Department of Pediatrics, Orlando Health Physician Associates, Orlando, Florida
| | - Daniel Salmon
- Department of International Health and Health Behavior Society, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Richard G Roetzheim
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Department of Family Medicine, College of Medicine, University of South Florida, Tampa, Florida
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anna R Giuliano
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida
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Teplow-Phipps RL, Papadouka V, Benkel DH, Holleran S, Ramakrishnan R, Rosenthal SL, Soren K, Stockwell MS. Influence of Gender and Gender-Specific Recommendations on Adolescent Human Papillomavirus Vaccination. Am J Prev Med 2016; 51:161-169. [PMID: 27032464 DOI: 10.1016/j.amepre.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The human papillomavirus (HPV) vaccine was introduced for female adolescents prior to male adolescents. Understanding coverage patterns related to gender-specific recommendations and factors associated with early adoption and timely completion may be important for future vaccines. METHODS Retrospective analysis of HPV vaccine initiation (one or more dose) and completion (three or more doses) patterns in adolescents aged 11-18 years using 2009-2013 New York Citywide Immunization Registry data. Log binomial models assessed patient-specific (age, insurance) and practice-specific (facility type, number of adolescents, poverty level) variables on early adoption (within 1 year of recommendation) and timely completion (within 12 months) by gender. RESULTS Of 1,494,767 adolescents, 50.2% were male, 57.5% were vaccinated in private practices, 58.7% in practices with more adolescents, and 48.8% in highest poverty locations. More female (54.0%) than male (33.5%) adolescents initiated vaccination (p<0.001). Of those, 56.1% received three or more doses, 34.1% within 12 months (30.0% male, 36.8% female, p<0.001). In 2009-2012, the proportion of still-eligible male adolescents who newly initiated increased from 0.1% to 17.0%; rates for female adolescents increased from 15.4% to 17.3%. Vaccination initiation within 1 year of gender-specific recommendations was similar (27.4% female, 27.3% male). For both genders, the uninsured were less likely to have early adoption and timely completion. Being publicly insured was associated with early adoption in both genders, but with timely completion in male adolescents only. Being seen in a public facility and in a practice with more adolescents was also associated with early adoption. CONCLUSIONS Changing HPV vaccine recommendations had minimal cross-gender impact. Early adoption and timely completion patterns were mostly similar across genders.
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Affiliation(s)
- Randi L Teplow-Phipps
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Vikki Papadouka
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Denise H Benkel
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Stephen Holleran
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Rajasekhar Ramakrishnan
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Susan L Rosenthal
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Karen Soren
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
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Gilkey MB, McRee AL. Provider communication about HPV vaccination: A systematic review. Hum Vaccin Immunother 2016; 12:1454-68. [PMID: 26838681 PMCID: PMC4964733 DOI: 10.1080/21645515.2015.1129090] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/19/2015] [Accepted: 12/03/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving HPV vaccination coverage in the US 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 studies of provider communication about HPV vaccination. RESULTS We identified 101 qualitative and quantitative studies. Providers less often recommended HPV vaccine if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Patients less often received recommendations if they were younger, male, or from racial/ethnic minorities. Despite parents' preference for unambiguous recommendations, providers often sent mixed messages by failing to endorse HPV vaccine strongly, differentiating it from other vaccines, and presenting it as an "optional" vaccine that could be delayed. CONCLUSION Interventions are needed to help providers deliver effective recommendations in the complex communication environment surrounding HPV vaccination.
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Affiliation(s)
- Melissa B. Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA
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Moghtaderi A, Adams S. The Role of Physician Recommendations and Public Policy in Human Papillomavirus Vaccinations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:349-359. [PMID: 26873090 DOI: 10.1007/s40258-016-0225-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Immunization rates for human papillomavirus (HPV) infections remain low among teenagers despite strong evidence of the effectiveness of vaccines. Physician recommendations of the vaccine are far from universal. Several states have enacted policies that mandate HPV vaccination or distribute educational materials. OBJECTIVES To provide policy makers, physicians, and researchers information on the relative importance of physician recommendations and early state-level policies to promote HPV vaccinations among targeted age groups. METHODS We first use probit models to determine the strongest correlates of immunization in a nationally representative US sample of teenagers. We then use instrumental variable probit models to determine the direct role that physician recommendations play in vaccination using plausibly exogenous physician encounters that are likely not the result of more health-conscious parents seeking out information on the vaccine. RESULTS We show that children in the targeted age range who are more likely to encounter physicians for reasons other than seeking out the vaccine, such as through mandatory wellness exams or previous asthma diagnoses, are significantly more likely to get the vaccine. There is no consistent evidence that the state policies we analyze have been effective. CONCLUSION Encouraging recommendations by physicians may be the most effective path toward increasing HPV vaccination. State-level mandates and policies are yet to exhibit effectiveness.
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Affiliation(s)
- Ali Moghtaderi
- School of Medicine and Health Science, George Washington University, Washington, DC, USA
| | - Scott Adams
- Department of Economics, University of Wisconsin-Milwaukee, Bolton Hall 802, 3210 N. Maryland Ave., Milwaukee, WI, 53201, USA.
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Hoque ME. Factors influencing the recommendation of the Human Papillomavirus vaccine by South African doctors working in a tertiary hospital. Afr Health Sci 2016; 16:567-75. [PMID: 27605973 DOI: 10.4314/ahs.v16i2.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In South Africa, HPV vaccination programme has been incorporated recently in the school health system. Since doctors are the most trusted people regarding health issues in general, their knowledge and attitudes regarding HPV infections and vaccination are very important for HPV vaccine program nationally. OBJECTIVE The objective of this study was to investigate factors contributing to recommendation of HPV vaccines to the patients. METHODS This was a quantitative cross-sectional study conducted among 320 doctors, using a self-administered anonymous questionnaire. RESULTS All the doctors were aware of HPV and knew that HPV is transmitted sexually. Their overall level of knowledge regarding HPV infections and HPV vaccine was poor. But the majority intended to prescribe the vaccine to their patients. It was found that doctors who knew that HPV 6 and 11 are responsible for >90% of anogenital warts, their patients would comply with the counselling regarding HPV vaccination, and received sufficient information about HPV vaccination were 5.68, 4.91 and 4.46 times respectively more likely to recommend HPV vaccination to their patients, compared to their counterparts (p<0.05). CONCLUSION There was a knowledge gap regarding HPV infection and HPV vaccine among the doctors.
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Affiliation(s)
- Muhammad Ehsanul Hoque
- University of KwaZulu-Natal (Westville Campus) - Graduate School of Business and Leadership
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76
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Gnagi SH, Gnagi FT, Schraff SA, Hinni ML. Human Papillomavirus Vaccination Counseling in Pediatric Training. Otolaryngol Head Neck Surg 2016; 155:87-93. [DOI: 10.1177/0194599816639932] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/29/2016] [Indexed: 11/16/2022]
Abstract
Objective Demonstrate the need for increased education regarding otolaryngology-related manifestations of human papillomavirus (HPV). Highlight a need to incorporate otolaryngology-related manifestations of HPV in vaccine counseling. Study Design Survey. Setting Tertiary care academic children’s hospital. Subjects Pediatric residents, fellows, and staff. Methods An online survey was made available regarding HPV education and vaccination. Results Participants (N = 348) initiated the survey representing 28.4%, 25.6%, and 19.0% postgraduate year 1, 2, and 3 residents, respectively, as well as 17.5% chief residents/fellows and 9.5% attendings. Participants rated their prior education as none or fair regarding recurrent respiratory papillomatosis (63.8%) and oropharyngeal squamous cell carcinoma (68.3%). In contrast, 60.6% and 70.9% rated their education on genital warts and cervical cancer correspondingly as good or excellent. When asked what was routinely discussed during HPV vaccine counseling, 63.3% reported “never” discussing recurrent respiratory papillomatosis and 52.9% “never” discussing oropharyngeal squamous cell carcinoma. A range from 92.7% to 95.5% responded that there was a need for increased education regarding HPV and its role in recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. Conclusions Increased education about HPV and its otolaryngology-related manifestations should be undertaken to increase provider, patient, and parent awareness of recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. We propose that discussing the risks of otolaryngology-related disease be routinely included in HPV vaccination counseling.
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Affiliation(s)
- Sharon H. Gnagi
- Department of Otolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Scott A. Schraff
- Department of Otolaryngology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Michael L. Hinni
- Department of Otolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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77
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Lindley MC, Jeyarajah J, Yankey D, Curtis CR, Markowitz LE, Stokley S. Comparing human papillomavirus vaccine knowledge and intentions among parents of boys and girls. Hum Vaccin Immunother 2016; 12:1519-27. [PMID: 27003108 DOI: 10.1080/21645515.2016.1157673] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/OBJECTIVE Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Previous research suggests some differences between male and female adolescents in correlates of vaccine receipt and reasons for non-vaccination; few studies examine both sexes together. This analysis assessed knowledge and attitudes related to HPV disease and vaccination, intention to vaccinate, and reasons for delayed vaccination or non-vaccination among parents of boys and girls 13-17 y old in 50 states, the District of Columbia, and selected local areas. METHODS National Immunization Survey-Teen 2013 data were analyzed and gender differences examined. RESULTS In this sample, adolescent boys were more likely than girls to be unvaccinated and less likely to have completed the HPV vaccination series (p < 0.005 for both). Parents of girls were more likely than parents of boys to report a provider recommendation for HPV vaccination (65.0% vs. 42.1%). Only 29% of girls' parents reported a provider recommendation to begin vaccination by 11-12 y old. Among unvaccinated teens, parental intention to vaccinate in the next 12 months did not differ by sex, but reasons for vaccination or non-vaccination did. Many parents do not know the recommended number of HPV doses. CONCLUSIONS Gender differences in provider vaccination recommendations and reasons for vaccination might partially explain differential HPV uptake by male and female adolescents. Clinicians should offer strong recommendations for HPV vaccination at 11-12 y old for both girls and boys. To reduce missed opportunities, HPV vaccination should be presented in the context of, and given concurrently with, other routinely administered vaccines.
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Affiliation(s)
- Megan C Lindley
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Jenny Jeyarajah
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - David Yankey
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - C Robinette Curtis
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Lauri E Markowitz
- b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Shannon Stokley
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
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Berenson AB, Rahman M, Hirth JM, Rupp RE, Sarpong KO. A brief educational intervention increases providers' human papillomavirus vaccine knowledge. Hum Vaccin Immunother 2016; 11:1331-6. [PMID: 25945895 DOI: 10.1080/21645515.2015.1022691] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Recommendation by a healthcare provider is critical to increase human papillomavirus (HPV) vaccine uptake in the US. However, current deficits in providers' knowledge of HPV and its vaccine are not fully understood and interventions to amend knowledge gaps are untested. To determine whether attending a structured presentation could increase provider knowledge of the HPV vaccine, we assessed knowledge levels of physicians, non-physician healthcare workers, and medical students before and after attending a 30-minute lecture held between October 2012 and June 2014. Paired t-test and McNemar's test were used to compare knowledge scores and the proportion of correct responses for each question, respectively. Multiple linear regression analyses were performed to examine correlates of baseline knowledge and change in knowledge scores post-intervention. A total of 427 participants, including 75 physicians, 208 medical students, and 144 nurses or other healthcare workers, attended one of 16 presentations and responded to both pre-test and post-test surveys. Baseline knowledge was low among all groups, with scores higher among older participants and physicians/medical students. On average, knowledge scores significantly improved from 8 to 15 after the presentation (maximum possible score 16) (P < .001), irrespective of specialty, race/ethnicity, gender, and age. Although lower at baseline, knowledge scores of younger participants and non-physician healthcare workers (e.g., nurses, physician assistants (PAs), nursing students) improved the most of all groups. We conclude that a brief, structured presentation increased HPV knowledge among a variety of healthcare workers, even when their baseline knowledge was low.
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Affiliation(s)
- Abbey B Berenson
- a Center for Interdisciplinary Research in Women's Health; The University of Texas Medical Branch ; Galveston , TX , USA
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Kempe A, O’Leary ST, Shoup JA, Stokley S, Lockhart S, Furniss A, Dickinson LM, Barnard J, Daley MF. Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial. Pediatrics 2016; 137:e20152857. [PMID: 26921286 PMCID: PMC5884084 DOI: 10.1542/peds.2015-2857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. METHODS All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. RESULTS At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). CONCLUSIONS Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.
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Affiliation(s)
- Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Departments of Pediatrics, and
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Shannon Stokley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Lockhart
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - L. Miriam Dickinson
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Juliana Barnard
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado, Aurora, Colorado,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Hansen CE, Credle M, Shapiro ED, Niccolai LM. "It All Depends": A Qualitative Study of Parents' Views of Human Papillomavirus Vaccine for their Adolescents at Ages 11-12 years. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:147-52. [PMID: 25600376 PMCID: PMC4508236 DOI: 10.1007/s13187-014-0788-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Routine vaccination with three doses of human papillomavirus (HPV) vaccine is recommended for adolescent girls and boys at 11 or 12 years of age; however, vaccine uptake remains suboptimal. To understand the reasons why parents may accept or refuse HPV vaccine for their children at age 11 or 12 years, we conducted a qualitative study. Semi-structured interviews were conducted with parents or guardians (n = 45) whose adolescents receive care at an urban, hospital-based primary care practice. Data were analyzed using an iterative thematic approach. We found that many parents expressed high levels of support for HPV vaccine, including a majority who agreed with vaccination at age 11-12 years. Parents recognized that for prevention of consequences of HPV infection, vaccination of their child early in adolescence was desirable conceptually. However, many parents also expressed that in practice, HPV vaccine should be given to adolescents at the onset of sexual activity, a perception that led to preferences to delay administration of HPV vaccine among certain parents. These apparently contradictory views indicate the need for interventions focused on the benefits of vaccination at the recommended ages. Our findings may be useful in providers' discussions with parents about the vaccine, as pediatric and adolescent health care providers have the unique opportunity to educate parents and clarify misconceptions about vaccination.
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Affiliation(s)
- Caitlin E Hansen
- Department of Pediatrics, Yale School of Medicine, PO Box 208064, New Haven, CT, 06520, USA.
| | - Marisol Credle
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Eugene D Shapiro
- Department of Pediatrics, Yale School of Medicine, PO Box 208064, New Haven, CT, 06520, USA
- Yale Cancer Center, New Haven, CT, USA
- Department of Investigative Medicine, Yale Graduate School of Arts and Sciences, New Haven, CT, USA
| | - Linda M Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
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81
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Oliver K, Frawley A, Garland E. HPV vaccination: Population approaches for improving rates. Hum Vaccin Immunother 2016; 12:1589-93. [PMID: 26890685 DOI: 10.1080/21645515.2016.1139253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To review the literature on interventions to increase HPV vaccinations and assess whether The Community Preventive Services Task Force recommendations are supported by current evidence. METHODS We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs. RESULTS Of the 13 studies identified, 8 included client reminder and recall interventions, 4 included provider assessment and feedback and/or provider reminders and 2 included clinic based education. 11 of the 13 studies demonstrated a positive effect on HPV vaccine initiation or completion. Provider assessment and feedback studies were more likely to report a positive effect on HPV vaccine initiation than on series completion, while client reminder recall interventions more frequently produced an effect on series completion than on initiation. CONCLUSIONS There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.
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Affiliation(s)
- Kristin Oliver
- a Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Alean Frawley
- a Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Elizabeth Garland
- a Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Malo TL, Ali KN, Sutton SK, Perkins RB, Giuliano AR, Vadaparampil ST. The content and context of physicians' communication with males about human papillomavirus vaccination. Hum Vaccin Immunother 2016; 12:1511-8. [PMID: 26835599 DOI: 10.1080/21645515.2015.1132963] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
A physician's recommendation for human papillomavirus (HPV) vaccine is a key predictor of vaccine uptake; however, little is known about how physicians communicate about HPV vaccine with male patients. We sought to describe physicians' HPV vaccine communication practices with males who are of vaccine-eligible age (9-26 years). We surveyed representative samples of pediatric and family medicine physicians in Florida, and assessed whether physicians present HPV vaccine as optional or routine, and as a vaccine that prevents cancer. We also assessed the type of visit during which physicians discuss HPV vaccine with adolescent males and whether other healthcare providers in the practice discuss HPV vaccine or make the initial recommendation. We received 367 completed surveys (50.7% response rate). Few physicians (29.9%) reported they typically present HPV vaccine as routine to males ages 11-12 years, who constitute the target group for routine vaccination. When discussing HPV vaccination, many physicians reported somewhat or strongly emphasizing cancer prevention (80.0%). Physicians most often discussed HPV vaccine when they saw patients for well-child visits (93.0%) and least often at acute care visits (15.3%). Over half reported that at least one other healthcare professional in their practice discusses (56.1%) or makes the initial recommendation for (54.9%) HPV vaccination. Many physicians in our sample are presenting HPV vaccine as optional rather than routine and are missing opportunities to communicate with males about the vaccine. Our findings identify areas for future interventions to improve physicians' HPV vaccine communication and, ultimately, increase the use of this cancer-preventing vaccine.
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Affiliation(s)
- Teri L Malo
- a Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA.,b Department of Health Behavior , Gillings School of Global Pubic Health, University of North Carolina , Chapel Hill , NC , USA
| | - Karla N Ali
- c Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa , FL , USA
| | - Steven K Sutton
- d Biostatistics and Bioinformatics Department , Moffitt Cancer Center , Tampa , FL , USA
| | - Rebecca B Perkins
- e Department of Obstetrics and Gynecology , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA
| | - Anna R Giuliano
- f Cancer Epidemiology Program, Moffitt Cancer Center , Tampa , FL , USA.,g Center for Infection Research in Cancer, Moffitt Cancer Center , Tampa , FL , USA.,h Department of Oncologic Sciences , College of Medicine, University of South Florida , Tampa , FL , USA
| | - Susan T Vadaparampil
- c Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa , FL , USA.,g Center for Infection Research in Cancer, Moffitt Cancer Center , Tampa , FL , USA.,h Department of Oncologic Sciences , College of Medicine, University of South Florida , Tampa , FL , USA
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Suryadevara M, Bonville JR, Kline RM, Magowan C, Domachowske E, Cibula DA, Domachowske JB. Student HPV vaccine attitudes and vaccine completion by education level. Hum Vaccin Immunother 2016; 12:1491-7. [PMID: 26836052 DOI: 10.1080/21645515.2015.1123359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE We describe HPV vaccine attitudes among students of different education levels. METHODS High school, college, and graduate-level health care professional students were surveyed regarding HPV vaccine knowledge, attitudes, and receipt. Relationships between categorical variables were analyzed using chi-square tests of independence and z-tests for proportions. Means for quantitative variables were compared using t-tests and one-way analysis of variance. RESULTS 57% and 42% of the 889 students reported starting and completing HPV vaccine series, respectively, with no statistical difference by education level. 61% of students who reported receiving a provider recommendation had completed the series, compared to 6% of those who did not receive recommendation (p<0.001). The belief that HPV vaccine prevents cancer was strongly associated with vaccine completion (p=0.003). CONCLUSION HPV vaccine coverage rates remain suboptimal. Future interventions should focus on improving provider recommendation and patient belief that HPV vaccine prevents cancer.
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Affiliation(s)
- Manika Suryadevara
- a Department of Pediatrics , SUNY Upstate Medical University , Syracuse , NY , USA
| | - Joshua R Bonville
- a Department of Pediatrics , SUNY Upstate Medical University , Syracuse , NY , USA
| | | | | | | | - Donald A Cibula
- e Department of Public Health and Preventive Medicine , SUNY Upstate Medical University , Syracuse , NY , USA
| | - Joseph B Domachowske
- a Department of Pediatrics , SUNY Upstate Medical University , Syracuse , NY , USA
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Beavis AL, Levinson KL. Preventing Cervical Cancer in the United States: Barriers and Resolutions for HPV Vaccination. Front Oncol 2016; 6:19. [PMID: 26870696 PMCID: PMC4733925 DOI: 10.3389/fonc.2016.00019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
Human papillomavirus (HPV) vaccination rates for preadolescent and adolescent girls in the United States are far behind those of other developed nations. These rates differ substantially by region and state, socioeconomic status, and insurance status. In parents and young women, a lack of awareness and a misperception of the risk of this vaccine drive low vaccination rates. In physicians, lack of comfort with discussion of sexuality and the perception that the vaccine should be delayed to a later age contribute to low vaccination rates. Patient- and physician-targeted educational campaigns, systems-based interventions, and school-based vaccine clinics offer a variety of ways to address the barriers to HPV vaccination. A diverse and culturally appropriate approach to promoting vaccine uptake has the potential to significantly improve vaccination rates in order to reach the Healthy People 2020 goal of over 80% vaccination in adolescent girls. This article reviews the disparities in HPV vaccination rates in girls in the United States, the influences of patients’, physicians’, and parents’ attitudes on vaccine uptake, and the proposed interventions that may help the United States reach its goal for vaccine coverage.
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Affiliation(s)
- Anna Louise Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Kimberly L Levinson
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
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Collange F, Fressard L, Pulcini C, Sebbah R, Peretti-Watel P, Verger P. General practitioners' attitudes and behaviors toward HPV vaccination: A French national survey. Vaccine 2016; 34:762-8. [PMID: 26752063 DOI: 10.1016/j.vaccine.2015.12.054] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs' perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. METHODS Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs' HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. RESULTS Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09-0.21; partial R(2)=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07-0.24; partial R(2)=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71-0.86; partial R(2)=0.03). CONCLUSION Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.
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Affiliation(s)
- Fanny Collange
- Aix Marseille University, URMITE, IRD 198, UMR CNRS 7278, INSERM 1095, Faculté de Médecine, 13005 Marseille, France; INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France
| | - Lisa Fressard
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France
| | - Céline Pulcini
- CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France; Lorraine University, Paris Descartes University, EA 4360 Apemac, 54505 Vandœuvre-lès-Nancy cedex, France
| | - Rémy Sebbah
- Regional Unions of Healthcare Professionals (Southeastern Region) - Self-employed Physicians (URPS-ML PACA), 13006 Marseille, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France
| | - Pierre Verger
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France; INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 75014 Paris, France.
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Cates JR, Coyne-Beasley T. Social marketing to promote HPV vaccination in pre-teenage children: talk about a sexually transmitted infection. Hum Vaccin Immunother 2015; 11:347-9. [PMID: 25692313 PMCID: PMC4514322 DOI: 10.4161/21645515.2014.994458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A significant barrier to the delivery of HPV vaccine is reluctance by both healthcare providers and parents to vaccinate at age 11 or 12, which may be considered a young age. This barrier has been called “vaccine hesitancy” in recent research. In this commentary, we suggest using social marketing strategies to promote HPV vaccination at the recommended preteen ages. We emphasize a critical public health message of a sexually transmitted infection (STI) as preventable and vaccination against HPV as a way to protect against its consequences. The message tackles the issue of vaccine hesitancy head on, by saying that most people are at risk for HPV and there is a way to prevent HPV's serious consequences of cancer. Our approach to this conversation in the clinical setting is also to engage the preteen in a dialog with the parent and provider. We expect our emphasis on the risk of STI infection will not only lead to increased HPV vaccination at preteen ages but also lay important groundwork for clinical adoption of other STI vaccines in development (HIV, HSV, Chlamydia, and Gonorrhea) as well as begin conversations to promote sexual health.
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Affiliation(s)
- Joan R Cates
- a School of Journalism and Mass Communication ; University of North Carolina at Chapel Hill ; Chapel Hill , NC USA
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87
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Identifying and Overcoming Perceived Barriers of Providers towards HPV Vaccination: A Literature Review. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/869468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Human papillomavirus (HPV) is a common sexually transmitted infection in the United States associated with nearly 26,000 cases of cancer annually. With the recent addition of Gardasil 9, three vaccines are now licensed by the Food and Drug Administration (FDA) and recommended by the Advisory Committee on Immunization Practices (ACIP) for HPV prevention. While providers are the preferred source in educating individuals on HPV and HPV vaccination, low uptake percentages indicate that providers are missing valuable opportunities to educate and strongly recommend HPV vaccination. It is critical to examine perceived barriers and attitudes among providers related to HPV and HPV vaccination to identify factors that influence vaccination coverage. This paper aims to expand provider knowledge and awareness of factors that may facilitate an increase in HPV vaccination coverage and subsequent cancer prevention.
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88
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Berkowitz Z, Malone M, Rodriguez J, Saraiya M. Providers' beliefs about the effectiveness of the HPV vaccine in preventing cancer and their recommended age groups for vaccination: Findings from a provider survey, 2012. Prev Med 2015; 81:405-11. [PMID: 26598805 PMCID: PMC6711477 DOI: 10.1016/j.ypmed.2015.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 11/24/2022]
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 11-12 years 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 (9-26 years). 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 11-26 years. 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 11-12 years. 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.
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Affiliation(s)
- Z Berkowitz
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F76, Atlanta, GA 30341, USA.
| | - M Malone
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - J Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F76, Atlanta, GA 30341, USA
| | - M Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F76, Atlanta, GA 30341, USA
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89
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Klosky JL, Favaro B, Peck KR, Simmons JL, Russell KM, Green DM, Hudson MM. Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer. J Cancer Surviv 2015; 10:449-56. [PMID: 26572902 DOI: 10.1007/s11764-015-0495-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/30/2015] [Indexed: 01/23/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is a sexually transmitted infection and the cause of cervical and other cancers. Vaccination is available to protect against genital HPV and is recommended for individuals aged 9-26 years. This study aimed to estimate the prevalence of HPV vaccination among childhood cancer survivors and to identify factors associated with vaccine outcomes. METHODS Young adult females with (n = 114; M age = 21.18 years, SD = 2.48) and without (n = 98; M age = 20.65 years, SD = 2.29) a childhood cancer history completed surveys querying HPV vaccination initiation/completion, as well as sociodemographic, medical, and health belief factors. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for vaccine outcomes. RESULTS Among survivors, 38.6 % (44/114) and 26.3 % (30/114) initiated or completed vaccination compared to 44.9 % (44/98) and 28.6 % (28/98) among controls, respectively. In the combined survivor/control group, physician recommendation (OR = 11.24, 95 % CI 3.15-40.14) and familial HPV communication (OR = 7.28, 95 % CI 1.89-28.05) associated with vaccine initiation. Perceptions of vaccine benefit associated with vaccine completion (OR = 10.55, 95 % CI 1.59-69.92), whereas perceptions of HPV-related severity associated with non-completion (OR = 0.14, 95 % CI 0.03-0.71). CONCLUSION Despite their increased risk for HPV-related complication, a minority of childhood cancer survivors have initiated or completed HPV vaccination. Modifiable factors associated with vaccine outcomes were identified. IMPLICATIONS FOR CANCER SURVIVORS HPV vaccination is a useful tool for cancer prevention in survivorship, and interventions to increase vaccine uptake are warranted.
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Affiliation(s)
- James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA.
| | - Brianne Favaro
- Department of Psychology, Winona State University, 175 W Mark St, Winona, MN, 55987, USA
| | - Kelly R Peck
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA.,Department of Psychology, University of Mississippi, 205 Peabody, University, MS, 38677, USA
| | - Jessica L Simmons
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA
| | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA
| | - Daniel M Green
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA.,Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA.,Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA
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90
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Ward G, Mehta V, Moore M. Morbidity, mortality and cost from HPV-related oropharyngeal cancer: Impact of 2-, 4- and 9-valent vaccines. Hum Vaccin Immunother 2015; 12:1343-7. [PMID: 26566988 DOI: 10.1080/21645515.2015.1095415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The incidence of oropharyngeal squamous cell carcinoma (OPSCC) related to human papillomavirus (HPV) is increasing at a dramatic rate, with men affected more commonly than women. Individuals who develop this disease suffer significant morbidity and potential mortality from their cancer and its associated treatment. We aim to evaluate the possible impact that the currently available HPV vaccines will have on this group of cancers. DATA SOURCES Available peer-reviewed literature, practice guidelines, and statistics published by the Center for Disease Control and Prevention. REVIEW METHODS Contemporary peer-reviewed medical literature was selected based on its scientific validity and relevance to the impact HPV vaccination may have on the morbidity, mortality and cost resulting from HPV-related OPSCC in the United States. CONCLUSIONS The incidence of HPV-related OPSCC is increasing at a near epidemic rate in the United States. The cost of treatment of HPV-related OPSCC is high, and the disease and its therapy result in significant morbidity and potential mortality to individuals. Using a cut-off of $50,000/Quality-Adjusted Life Year, expansion of current HPV vaccine indications to include prevention of OPSCC in both men and women should be recommended.
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Affiliation(s)
- Greg Ward
- a Department of Otolaryngology-Head and Neck Surgery , Indiana University School of Medicine , Indianapolis , IN USA
| | - Vikas Mehta
- b Department of Otolaryngology-Head and Neck Surgery , Louisiana State University Health , Shreveport , LA USA
| | - Michael Moore
- a Department of Otolaryngology-Head and Neck Surgery , Indiana University School of Medicine , Indianapolis , IN USA
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91
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Ng J, Ye F, Roth L, Sobel K, Byron S, Barton M, Lindley M, Stokley S. Human Papillomavirus Vaccination Coverage Among Female Adolescents in Managed Care Plans - United States, 2013. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:1185-9. [PMID: 26513219 DOI: 10.15585/mmwr.mm6442a1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection, with a reported 79 million persons aged 15–59 years in the United States currently infected with HPV, and approximately 14 million new cases diagnosed each year. Although most HPV infections are asymptomatic, transient, and do not cause disease, persistent HPV infection can lead to cervical, vulvar, vaginal, anal, penile, and oropharyngeal cancer. In the United States, approximately 27,000 HPV-attributable cancers occur each year. HPV vaccination is an effective primary prevention strategy that can reduce many of the HPV infections that lead to cancer, and is routinely recommended for adolescents aged 11–12 years. To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who receive the recommended 3-dose HPV vaccination series by age 13 years. In 2013, in the United States, the median HPV vaccination coverage levels for female adolescents among commercial and Medicaid plans were 12% and 19%, respectively (ranges = 0%–34% for commercial plans; 5%–52% for Medicaid plans). Improving HPV vaccination coverage and understanding of what health plans might do to support HPV vaccination are needed, including understanding the barriers to, and facilitators for, vaccination coverage.
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92
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Kulczycki A, Qu H, Shewchuk R. Primary Care Physicians' Adherence to Guidelines and Their Likelihood to Prescribe the Human Papillomavirus Vaccine for 11- and 12-Year-Old Girls. Womens Health Issues 2015; 26:34-9. [PMID: 26344447 DOI: 10.1016/j.whi.2015.07.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/11/2015] [Accepted: 07/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inadequate physician adherence to guidelines has received scant attention as a possible cause of suboptimal human papillomavirus (HPV) vaccination rates. We assessed the extent to which primary care physicians (PCPs) adhere to clinical guidelines and their reported intentions to prescribe HPV vaccine to females in the targeted age group, and how this is influenced by perceptions of guideline clarity and other factors. METHODS We surveyed 301 PCPs to explore their sociodemographic and practice-related characteristics, beliefs, professional norms, and perceived barriers to administer HPV vaccine. Logistic regression predicted the likelihood to prescribe HPV vaccine to 11- and 12-year-old girls on an array of variables hypothesized to influence physicians' recommendations. RESULTS Only 67% of PCPs reported being likely to prescribe HPV vaccine to 11- and 12-year-old patients. PCPs were more likely to prescribe vaccine to 11- and 12-year-old girls if they believed HPV vaccine guidelines were clear (odds ratio [OR], 1.85; 95% CI, 1.03-3.35), agreed with a mandate requirement (OR, 2.39; 95% CI, 1.01-5.61), felt comfortable discussing HPV vaccination with early adolescent girls (OR, 5.10; 95% CI, 2.75-9.45), and had at least 25% of their patients using public assistance to pay for their clinic visits (OR, 3.82; 95% CI, 1.91-7.34). Practice specialty (family physicians or pediatricians) and region were not significant predictors. CONCLUSIONS PCPs exhibit moderate levels of adherence to professional guidelines regarding HPV vaccination. Potential public health benefits will not be realized without stronger efforts to improve the rates at which PCPs administer the vaccine, particularly to 11- and 12-year-olds for whom it is preferentially recommended.
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Affiliation(s)
- Andrzej Kulczycki
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Haiyan Qu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Shewchuk
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
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93
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Abstract
The increase in pertussis cases in Minnesota in the last decade has been mainly attributed to the switch from whole cell to acellular pertussis [as part of the diphtheria, tetanus and acellular pertussis vaccine (DTaP)]. It is unclear, however, to what degree community-level risk factors also contribute. Understanding these factors can help inform public health policy-makers about where else to target resources. We performed an ecological analysis within Minnesota to identify risk factors at the county level using a Bayesian Poisson generalized linear areal model to account for spatial dependence. Univariate analyses suggested an association between increased pertussis rates at the county level and white maternal ethnicity, being US born, urban counties and average household size. In the multivariable analysis, the rate of pertussis was 1·79 times greater for urban vs. rural counties and 4·75 times greater for counties with a one-person larger average household size. Pertussis rates in counties with higher (i.e. 4+DTaP) receipt in children were 0·97 times lower. Examining county-level factors associated with varying levels of pertussis may help identify those counties that would most benefit from targeted interventions and increased resource allocation.
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94
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Gerend MA, Shepherd MA, Lustria MLA, Shepherd JE. Predictors of provider recommendation for HPV vaccine among young adult men and women: findings from a cross-sectional survey. Sex Transm Infect 2015; 92:104-7. [PMID: 26297720 DOI: 10.1136/sextrans-2015-052088] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/05/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although physician recommendation is one of the strongest predictors of human papillomavirus (HPV) vaccination, it is unclear for whom physicians are recommending the vaccine. To help guide intervention efforts, this study investigated predictors of participant-reported physician recommendation for HPV vaccine among young adults in the USA. METHODS Women and men (N=223) aged 18-26 years were recruited online through Craigslist, a popular classified advertisements website. Ads were posted in the 25 largest US cities from September 2013 to March 2014. Participants completed a survey that assessed demographic and sociopolitical characteristics, sexual history, HPV vaccination history, and whether they had ever received a recommendation for HPV vaccine from a physician or healthcare provider. RESULTS Fifty-three per cent reported receiving a recommendation for HPV vaccine and 45% had received ≥1 dose of HPV vaccine. Participants who received a recommendation were over 35 times more likely to receive ≥1 dose of HPV vaccine relative to participants without a recommendation. Bivariable and multivariable correlates of provider recommendation were identified. Results from the multivariable model indicated that younger (aged 18-21 years), female, White participants with health insurance (ie, employer-sponsored or some other type such as military-sponsored) were more likely to report receiving a recommendation for HPV vaccine. CONCLUSIONS Results suggest that physician recommendation practices for HPV vaccination vary by characteristics of the patient. Findings underscore the key role of the healthcare provider in promoting HPV vaccination and have important implications for future HPV vaccine interventions with young adults.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences & Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA Departments of Medical Social Sciences and Psychology, Northwestern University, Chicago, Illinois, USA
| | - Melissa A Shepherd
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Mia Liza A Lustria
- College of Communication & Information, Florida State University, Tallahassee, Florida, USA
| | - Janet E Shepherd
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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95
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Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O, Raude J, Pulcini C, Peretti-Watel P. Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France. EBioMedicine 2015; 2:891-7. [PMID: 26425696 PMCID: PMC4563133 DOI: 10.1016/j.ebiom.2015.06.018] [Citation(s) in RCA: 222] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to assess: 1) vaccine hesitancy (VH) prevalence among French general practitioners (GPs) through the frequency of their vaccine recommendations, and 2) the determinants of these recommendations. METHODS Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France. We constructed a score of self-reported recommendation frequency for 6 specific vaccines to target populations. RESULTS 16% to 43% of GPs sometimes or never recommended at least one specific vaccine to their target patients. Multivariable logistic regressions of the dichotomized score showed that GPs recommended vaccines frequently when they felt comfortable explaining their benefits and risks to patients (OR = 1.87; 1.35-2.59), or trusted official sources of information highly (OR = 1.40; 1.01-1.93). They recommended vaccines infrequently when they considered that adverse effects were likely (OR = 0.71; 0.52-0.96) or doubted the vaccine's utility (OR = 0.21; 0.15-0.29). INTERPRETATION Our findings show that after repeated vaccine controversies in France, some VH exists among French GPs, whose recommendation behaviors depend on their trust in authorities, their perception of the utility and risks of vaccines, and their comfort in explaining them. Further research is needed to confirm these results among health care workers in other countries.
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Affiliation(s)
- Pierre Verger
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
- INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lisa Fressard
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
| | - Fanny Collange
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
| | - Arnaud Gautier
- Institut national de prévention et d'éducation pour la santé, 42 boulevard de la Libération, 93203 Saint Denis Cedex, France
| | - Christine Jestin
- Institut national de prévention et d'éducation pour la santé, 42 boulevard de la Libération, 93203 Saint Denis Cedex, France
| | - Odile Launay
- INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, INSERM CIC 1417, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Jocelyn Raude
- EHESP Rennes, Sorbonne Paris Cité, avenue du Professeur Léon-Bernard, 35043 Rennes, France
| | - Céline Pulcini
- Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, 34 Cours Léopold, 54000 Nancy, France
- CHU de Nancy, Service de Maladies Infectieuses, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
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Mitos y realidades de la vacunación contra el virus del papiloma humano. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sussman AL, Helitzer D, Bennett A, Solares A, Lanoue M, Getrich CM. Catching Up With the HPV Vaccine: Challenges and Opportunities in Primary Care. Ann Fam Med 2015; 13. [PMID: 26195681 PMCID: PMC4508177 DOI: 10.1370/afm.1821] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Data confirm that high rates of human papillomavirus (HPV) vaccination have not been achieved despite strong clinician endorsement of the vaccine. We conducted a study of primary care clinicians to assess the broad range of health care delivery, health policy, and attitudinal factors influencing vaccination uptake and opportunities for informed decision making. METHODS We implemented a mixed methods study in RIOS Net, a primary care practice-based research network in New Mexico. We first conducted qualitative, in-depth interviews with primary care clinicians, health policy makers, and immunization experts, and followed up with a confirmatory survey distributed to RIOS Net clinician members. RESULTS Health service delivery challenges emerged as the greatest barrier to HPV vaccination, specifically the lack of capacity to track and distribute reminders to eligible patients. Clinicians also reported variations in counseling approaches attributable to both age and emphasis on the cancer prevention benefits of the vaccine. There was no evidence of sociocultural influences on vaccine decision making, nor did concerns about perceived overprotection emerge. CONCLUSIONS Our findings, based on a long-term program of research, suggest that both patients' attributes and health system delivery are most influential in HPV vaccination coverage challenges. Interventions targeting innovative communication techniques, as well as health system changes that build on efforts toward coordinated care and utilization of other venues to promote vaccination, will be necessary to address these challenges.
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Affiliation(s)
- Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Deborah Helitzer
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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Recommendations and administration of the HPV vaccine to 11- to 12-year-old girls and boys: a statewide survey of Georgia vaccines for children provider practices. J Low Genit Tract Dis 2015; 18:298-303. [PMID: 24633170 DOI: 10.1097/lgt.0000000000000011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination. MATERIALS AND METHODS This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design. RESULTS Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices. CONCLUSIONS Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.
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99
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Jena AB, Goldman DP, Seabury SA. Incidence of sexually transmitted infections after human papillomavirus vaccination among adolescent females. JAMA Intern Med 2015; 175:617-23. [PMID: 25664968 PMCID: PMC4465086 DOI: 10.1001/jamainternmed.2014.7886] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Human papillomavirus (HPV) vaccination rates among US females remain low, in part because of concerns that HPV vaccination may promote unsafe sexual activity by lowering perceived risks of acquiring a sexually transmitted infection (STI). OBJECTIVE To study whether HPV vaccination of females is associated with increases in STI rates. DESIGN, SETTING, AND PARTICIPANTS Using a large, longitudinal insurance database of females aged 12 to 18 years insured from January 1, 2005, through December 31, 2010, in the United States, we examined whether HPV vaccination was associated with an increase in incident STIs among females who were vaccinated compared with those who were not. We defined STIs as one or more medical claims for any of the following infections in a given quarter: chlamydia, gonorrhea, herpes, human immunodeficiency virus or AIDS, or syphilis. We used difference-in-difference analysis to compare changes in STI rates among HPV-vaccinated females before and after vaccination (index quarter) to changes among age-matched nonvaccinated females before and after the index quarter. We analyzed whether effects varied according to age and prior contraceptive medication use. MAIN OUTCOMES AND MEASURES Rates of STIs. RESULTS The rates of STIs in the year before vaccination were higher among HPV-vaccinated females (94 of 21 610, 4.3 per 1000) compared with age-matched nonvaccinated females (522 of 186 501, 2.8 per 1000) (adjusted odds ratio, 1.37; 95% CI, 1.09-1.71; P = .007). The rates of STIs increased for the vaccinated (147 of 21 610, 6.8 per 1000) and nonvaccinated (781 of 186 501, 4.2 per 1000) groups in the year after vaccination (adjusted odds ratio, 1.50; 95% CI, 1.25-1.79; P < .001). The difference-in-difference odds ratio was 1.05 (95% CI, 0.80-1.38; P = .74), implying that HPV vaccination was not associated with an increase in STIs relative to growth among nonvaccinated females. Similar associations held among subgroups aged 12 through 14 years and aged 15 through 18 years and among females with contraceptive use in the index quarter. CONCLUSIONS AND RELEVANCE Human papillomavirus vaccination was not associated with increases in STIs in a large cohort of females, suggesting that vaccination is unlikely to promote unsafe sexual activity.
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Affiliation(s)
- Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts2Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts3National Bureau of Economic Research, Cambridge, Massachusetts
| | - Dana P Goldman
- National Bureau of Economic Research, Cambridge, Massachusetts4Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Seth A Seabury
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles5Department of Emergency Medicine, University of Southern California, Los Angeles
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Dunne EF, Stokley S, Chen W, Zhou F. Human papillomavirus vaccination of females in a large health claims database in the United States, 2006-2012. J Adolesc Health 2015; 56:408-13. [PMID: 25797632 PMCID: PMC5905697 DOI: 10.1016/j.jadohealth.2015.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 12/16/2014] [Accepted: 01/08/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Information on vaccine utilization from a variety of sources is useful to give a status of the vaccine program and define opportunities to improve uptake. We evaluated MarketScan Commercial Claims and Encounters database on human papillomavirus (HPV) vaccine initiation and completion of all three doses among girls/women from 2006 to 2012. METHODS Data were obtained from the 2006-2012 MarketScan Commercial Claims and Encounters database. The study population included female enrollees aged 11-26 years who were continuously enrolled in the same private insurance plan from 2006 to 2012 (n = 407,371). We evaluated overall and yearly vaccine initiation and completion, demographic characteristics associated with vaccine initiation, clinical visits in which vaccine was given, and missed opportunities for vaccination. RESULTS By the end of 2012, 36.9% of females aged 11-26 years had received at least one HPV vaccine dose. Vaccination coverage was highest among females aged 17-18 years (49.3%) and aged 15-16 years (43.1%) and lowest among females aged 11-12 years (16.8%). Between 2007 and 2012, 96.1% of the 246,192 unvaccinated females had at least one missed opportunity (a heath care visit without HPV vaccine administered). CONCLUSIONS Over a 6 year period, HPV vaccine initiation was lowest in the girls aged 11-12 years. Importantly, most (96.1%) unvaccinated females had at least one missed vaccination opportunity, and providers and health systems should focus efforts on using existing visits for vaccination.
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Affiliation(s)
- Eileen F Dunne
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, Georgia.
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Weiwei Chen
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Fangjun Zhou
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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