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Unlu A, Kalenderoglu MD, Ay H, Kabaoglu C, Koc ZL, Erkan DO, Gunduz S, Kirca O, Kılıckap S, Ozdogan M. National survey study on the approaches of pediatricians, family physicians, medical oncologists and gynecologists to the HPV vaccine. JOURNAL OF ONCOLOGICAL SCIENCES 2018. [DOI: 10.1016/j.jons.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lake P, Kasting ML, Malo T, Giuliano AR, Vadaparampil ST. An environmental scan to examine stakeholder perspectives on human papillomavirus vaccination: A mixed methods study. Vaccine 2018; 37:187-194. [PMID: 29983257 DOI: 10.1016/j.vaccine.2018.06.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/25/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Human papillomavirus (HPV) vaccine series completion rates among females and males remain low in Florida (46.4% and 34.5%, respectively). Multiple stakeholders influence vaccination uptake, including health care providers (HCPs), public health professionals (PHPs), and members of professional organizations. We examined stakeholder efforts related to increasing vaccine uptake and education among parents/adolescents and HCPs. METHODS We conducted an environmental scan of stakeholder efforts and identified stakeholders using our professional networks and a snowball sampling approach. Stakeholders (n = 46) completed a survey about involvement in and barriers to vaccination promotion efforts. A subset (n = 12) of stakeholders participated in follow-up interviews further exploring vaccination efforts and barriers. Survey data were analyzed using descriptive statistics. Interview data were analyzed using deductive analysis and coded using constructs from the PRECEDE-PROCEED model. RESULTS The majority of our survey sample was PHPs (50.0%) and HCPs (32.6%). Stakeholder efforts were focused on adolescent/parent/HCP education including providing: educational materials for HCPs (55.8%) and adolescents/parents (59.6%), one-on-one consultations for adolescents/parents (55.3%), and HCP education (54.7%). Lack of knowledge/understanding and education/information were barriers reported across almost all groups/areas. Office staff/HCP education and distribution of patient education materials were efforts described as important during qualitative interviews. Stakeholders also noted HCP discomfort when recommending HPV vaccine, parental perceptions that the vaccine is unnecessary, and a lack of education/understanding among parents and HCPs. CONCLUSIONS Results suggest the need for parent/adolescent education, specifically targeting key areas we identified: importance and benefits of HPV vaccine, and education and skill building in vaccine communication for HCPs.
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Affiliation(s)
| | - Monica L Kasting
- Moffitt Cancer Center, Tampa, FL, USA; Center for Infection in Cancer Research, Moffitt Cancer Center, Tampa, FL, USA
| | - Teri Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Anna R Giuliano
- Moffitt Cancer Center, Tampa, FL, USA; Center for Infection in Cancer Research, Moffitt Cancer Center, Tampa, FL, USA
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Tampa, FL, USA; College of Medicine, University of South Florida, Tampa, FL, USA.
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Head KJ, Biederman E, Sturm LA, Zimet GD. A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States. Hum Vaccin Immunother 2018; 14:1626-1635. [PMID: 29359986 PMCID: PMC6067847 DOI: 10.1080/21645515.2018.1430539] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 01/06/2023] Open
Abstract
The HPV vaccine debuted more than ten years ago in the United States and many strategies have been evaluated to increase HPV vaccination rates, which include not only improving current vaccination behaviors but also sustaining these behaviors. Researchers and practitioners from a variety of backgrounds have engaged in this work, which has included efforts directed at public health and government policies, health education and health promotion programs, and clinical and patient-provider approaches, as well as work aimed to respond to and combat anti-HPV vaccination movements in society. Using a previously developed conceptual model to organize and summarize each of these areas, this paper also highlights the need for future HPV vaccine promotion work to adopt a multi-level and, when possible, integrated approach in order to maximize impact on vaccination rates.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Lynne A. Sturm
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Gilkey MB, Zhou M, McRee AL, Kornides ML, Bridges JFP. Parents' Views on the Best and Worst Reasons for Guideline-Consistent HPV Vaccination. Cancer Epidemiol Biomarkers Prev 2018; 27:762-767. [PMID: 29903744 PMCID: PMC6035066 DOI: 10.1158/1055-9965.epi-17-1067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/25/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Human papillomavirus (HPV) vaccination could prevent most HPV-associated cancers, but few U.S. adolescents are vaccinated according to guidelines. To inform efforts to counsel parents more effectively, we sought to quantify their views on the best and worst reasons for guideline-consistent HPV vaccination. We hypothesized that parents' views would differ according to their vaccination confidence.Methods: We developed a best-worst scaling experiment to evaluate 11 reasons healthcare providers commonly give for HPV vaccination. The instrument was administered in 2016 via a national online survey to 1,177 parents of adolescents. Parents completed 11 choice tasks of 5 reasons each, indicating the best and worst reason in each task. We used conditional logistic regression to rank reasons for the sample overall and by vaccination confidence (low/high).Results: Parents viewed cancer prevention as the best reason for HPV vaccination (P < 0.001). Other commonly endorsed reasons were preventing a common infection, having lasting benefits, or being a safe vaccine (all P < 0.001). Reasons viewed as worst were: It is a scientific breakthrough; I got it for my own child; and your child is due (all P < 0.001). Stratified analyses indicated small differences in how often parents with low versus high vaccination confidence endorsed messages (P < 0.001), but the two groups ranked reasons similarly overall.Conclusions: Parents prioritized cancer prevention as the best reason for guideline-consistent HPV vaccination. Several other common reasons, including having vaccinated one's own child, may warrant additional testing.Impact: Providers should emphasize cancer prevention when discussing HPV vaccination, as recommended by the Centers for Disease Control and Prevention, the President's Cancer Panel, and others. Cancer Epidemiol Biomarkers Prev; 27(7); 762-7. ©2018 AACR.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
| | - Mo Zhou
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Melanie L Kornides
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - John F P Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Fenton AT, Eun TJ, Clark JA, Perkins RB. Indicated or elective? The association of providers' words with HPV vaccine receipt. Hum Vaccin Immunother 2018; 14:2503-2509. [PMID: 29847201 DOI: 10.1080/21645515.2018.1480237] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Appropriate provider recommendation is crucial to raising HPV vaccination uptake, yet scant research has explored actual conversations between providers and parents, the effect of parental pre-visit vaccine intention on vaccination, or the effect of conversation style on parental satisfaction with that conversation. METHODS We analyzed 146 audio-recorded clinical encounters between providers, parents/guardians, and HPV vaccine-eligible adolescents, from May 2015 to March 2017, at eight practices in Northeastern U.S. Parents completed pre-visit measures of intent to vaccinate and post-visit assessments of satisfaction with vaccine conversations. We qualitatively analyzed transcribed audio recordings and evaluated associations between providers' vaccine introductions and vaccine receipt. RESULTS Provider recommendations were empirically defined as "indicated" (clear recommendation that the child receive HPV vaccination at that visit), "elective" (vaccination presented as optional), or "contraindicated" (delay recommended). The vaccination rates were 87%, 68%, and 0% following "indicated," "elective," and "contraindicated" presentations respectively. Providers' statements attesting to the vaccine's value to the child did not affect receipt. Parental pre-visit intent to vaccinate was associated with vaccine receipt: 100% for likely/very likely compared to 28% for very unlikely. The association between vaccine recommendation style and vaccine receipt was most pronounced with undecided parents, with 92% accepting vaccination after an "indicated" recommendation vs. 68% after an "elective" recommendation. Satisfaction with vaccine conversations was high regardless of recommendation style. CONCLUSIONS The results suggest that the words used to introduce HPV vaccination have the potential to inform parents' HPV vaccination decisions. Providers should be encouraged to simply state, "Your child is due for the HPV vaccine today."
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Affiliation(s)
| | | | - Jack A Clark
- c Boston University School of Public Health , Boston , MA , USA
| | - Rebecca B Perkins
- b Boston Medical Center , Boston , MA , USA.,d Boston University School of Medicine , Boston , MA , USA
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St Laurent J, Luckett R, Feldman S. HPV vaccination and the effects on rates of HPV-related cancers. Curr Probl Cancer 2018; 42:493-506. [PMID: 30041818 DOI: 10.1016/j.currproblcancer.2018.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
Globally, human papillomavirus (HPV) infection is one of the most common sexually transmitted infection. HPV is linked to at least five malignancies including vulvar, vaginal, anal penile, oropharyngeal, and cervical cancer. Three HPV vaccines are currently available: bivalent (HPV 16,18), quadrivalent (HPV 6,11,16,18), and nonavalent (6,11,16,18,31,33,45,52,58) targeting between 2 and 7 oncogenic HPV serotypes. This review highlights the currently epidemiologic burden of HPV-related cancers, efficacy of current HPV vaccines, and speculates about the benefits of widespread HPV vaccination. At present, all three vaccines are effective in reducing cervical disease and anogenital dysplasia in industry sponsored clinical trials and in limited study of clinical effectiveness. Models predict elimination of HPV infection with global vaccination rates of 80% and benefits in reducing malignancy at 20% global coverage. Large population-based clinical efficacy studies of these vaccines will be necessary to assess the true impact of vaccination. HPV vaccines provide a promising primary approach to preventing malignancy and barriers to vaccine access must be addressed to meet vaccination goals.
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Affiliation(s)
- Jessica St Laurent
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Rebecca Luckett
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Bednarczyk RA, Chamberlain A, Mathewson K, Salmon DA, Omer SB. Practice-, Provider-, and Patient-level interventions to improve preventive care: Development of the P3 Model. Prev Med Rep 2018; 11:131-138. [PMID: 30003011 PMCID: PMC6040109 DOI: 10.1016/j.pmedr.2018.06.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/28/2018] [Accepted: 06/14/2018] [Indexed: 12/19/2022] Open
Abstract
For adequate provision of preventive services, there is an interplay between activities at the healthcare practice, healthcare provider, and patient levels of the clinical encounter. Commonly used health promotion and behavior theoretical models address some of these three levels, but none fully account for all three. Building off of key components of many existing theoretical models, including the Health Belief Model, Theory of Planned Behavior/Theory of Reasoned Action, Social Cognitive Theory, Social Ecological Model, and the Systems Model of Clinical Preventive Care, we describe the development of the P3 (Practice-, Provider-, and Patient-level) Model for preventive care interventions. The P3 Model accounts for all three levels of the clinical encounter, and the factors that impact these levels, concurrently. This yields a model for preventive care that is applicable and adaptable to different settings, and that provides a framework for the development, implementation, and evaluation of preventive care promotion interventions. The applicability of the P3 Model is shown through two exemplar preventive care programs – immunization and colorectal cancer screening. The P3 Model allows interventions to be developed and evaluated in a modular approach, to allow more practical refinement and optimization of the intervention.
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Affiliation(s)
- Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.,Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, Atlanta, GA, United States of America.,Emory Vaccine Center, Emory University, Atlanta, GA, United States of America
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Kara Mathewson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Daniel A Salmon
- Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.,Emory Vaccine Center, Emory University, Atlanta, GA, United States of America.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, United States of America
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Garbutt JM, Dodd S, Walling E, Lee AA, Kulka K, Lobb R. Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research. BMC FAMILY PRACTICE 2018; 19:53. [PMID: 29734944 PMCID: PMC5938801 DOI: 10.1186/s12875-018-0750-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. Methods We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Results Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Conclusions Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation.
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Affiliation(s)
- Jane M Garbutt
- Departments of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Sherry Dodd
- Department of Pediatrics, Washington University School of Medicine, Campus Box 8116, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Emily Walling
- Department of Pediatrics, Washington University School of Medicine, Campus Box 8116, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.,Department of Pediatrics, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, USA
| | - Amanda A Lee
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Katharine Kulka
- Department of Pediatrics, Washington University School of Medicine, Campus Box 8116, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Rebecca Lobb
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Malo TL, Hall ME, Brewer NT, Lathren CR, Gilkey MB. Why is announcement training more effective than conversation training for introducing HPV vaccination? A theory-based investigation. Implement Sci 2018; 13:57. [PMID: 29673374 PMCID: PMC5907716 DOI: 10.1186/s13012-018-0743-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 03/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Improving healthcare providers' communication about HPV vaccination is critical to increasing uptake. We previously demonstrated that training providers to use presumptive announcements to introduce HPV vaccination improved uptake, whereas training them to use participatory conversations had no effect. To understand how communication training changed provider perceptions and communication practices, we evaluated intermediate outcomes and process measures from our randomized clinical trial, with a particular focus on identifying mechanisms that might explain the announcement training's impact. METHODS In 2015, a physician educator delivered 1-h in-clinic HPV vaccination recommendation trainings at 20 primary care clinics in North Carolina serving 11,578 patients age 11 or 12. Clinics were randomized to receive training to use "announcements" that presume parents are ready to vaccinate or "conversations" that invite dialog about vaccination. Training participants were 83 HPV vaccine providers. Pre- and post-training surveys assessed constructs from the theory of planned behavior (TPB), including providers' attitudes and subjective norms about HPV vaccination and their perceived behavioral control to recommend HPV vaccination. Surveys also assessed providers' perceptions of the announcement and conversation communication strategies. RESULTS Both trainings improved TPB-related constructs, including providers' positive attitudes toward HPV vaccination, subjective norms, and perceived behavioral control to recommend the vaccine (all p < .001, Cohen's d = .62-.90). Furthermore, in both trainings, the amount of time providers reported needing to discuss HPV vaccination with parents decreased from pre-training to 1-month follow-up (mean = 3.8 vs. 3.2 min, p = .01, d = .28). However, announcement trainings outperformed conversation trainings on other measures. For example, providers who received announcement training more often reported that the communication strategy saved them time, was easy to use, helped them promote HPV vaccination as routine care, and increased HPV vaccination coverage in their clinics (all p < .05; d = .44-.60). CONCLUSIONS Both announcement and conversation trainings improved providers' HPV vaccine-related perceptions. However, providers viewed announcements as easier to use and more effective, which may help to explain the success of this training approach. Future provider communication interventions should consider implementation outcomes, including acceptability, alongside more traditional TPB constructs. TRIAL REGISTRATION clinicaltrials.gov, NCT02377843 . Registered on February 27, 2015.
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Affiliation(s)
- Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, CB7293, Chapel Hill, NC, 27599, USA. .,Department of Health Behavior, Gillings School of Global Pubic Health, University of North Carolina, CB7440, Chapel Hill, NC, 27599, USA.
| | - Megan E Hall
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, CB7355, Chapel Hill, NC, 27599, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, CB7293, Chapel Hill, NC, 27599, USA.,Department of Health Behavior, Gillings School of Global Pubic Health, University of North Carolina, CB7440, Chapel Hill, NC, 27599, USA
| | - Christine R Lathren
- Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina, CB7590, Chapel Hill, NC, 27599, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Pubic Health, University of North Carolina, CB7440, Chapel Hill, NC, 27599, USA
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Supporting Human Papillomavirus Vaccination in Adolescents: Perspectives From Commercial and Medicaid Health Plans. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:283-290. [PMID: 27798527 DOI: 10.1097/phh.0000000000000440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT An estimated 79 million Americans are infected with human papillomavirus (HPV). Vaccination can reduce the burden of infection and HPV-associated cancers; yet, vaccination rates remain low. Little is known about why some health plans achieve higher vaccination rates. OBJECTIVE This study sought to identify strategies used by higher-performing health plans to support HPV vaccination. DESIGN We used 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS) Human Papillomavirus Vaccine for Female Adolescents measure to identify high-performing plans. The measure examines the percentage of female adolescent plan members who received 3 doses of HPV vaccine by their 13th birthday. High performers were defined as the subset of commercial plans with the top 10 rates and the subset of Medicaid plans with the top 10 rates. An interview guide was developed to assess activities related to providing HPV vaccination. Interviews were conducted with selected plans and audio-recorded. Transcripts were reviewed independently by 2 interviewers and analyzed by hand to identify key themes. PARTICIPANTS Staff members representing 10 plans agreed to be interviewed, representing a diversity of plan size (range, 5500 to >2.7 million members); plan type (about half were commercial, half were Medicaid plans); patient population, from predominantly white to predominantly nonwhite; and geographic region. RESULTS Plans Participants highlighted multiple strategies that support HPV vaccination, particularly the "normalizing" of the vaccine. Plans' efforts highlighted patient and provider education, reminders, feedback loops, community collaborations, immunization registries, and use of medical home concepts-including team-driven efforts and coordination. IMPLICATIONS There is an important need to improve the uptake of HPV vaccination. As health coverage expands to more organizations and individuals, it will be critical for health plans to consider the strategies implemented by higher-performing organizations. CONCLUSION Although HPV immunization rates are low nationally, health plans can employ multiple efforts to encourage vaccination by implementing activities that involve the patient, the provider, and the community.
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Kornides ML, Fontenot HB, McRee AL, Panozzo CA, Gilkey MB. Associations between parents' satisfaction with provider communication and HPV vaccination behaviors. Vaccine 2018; 36:2637-2642. [PMID: 29627236 DOI: 10.1016/j.vaccine.2018.03.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite increasing awareness of the importance of a provider recommendation for HPV vaccine, the U.S. has yet to achieve the Healthy people 2020 goal of 80% series completion among adolescents. This failure indicates a need for further examination of the modifiable influences on parents' decision-making. Healthcare providers can influence parents' HPV vaccination decision-making, but little is known about parents' perspectives on the counseling they receive. We sought to assess U.S. parents' satisfaction with provider communication about HPV vaccine and associations with vaccination behaviors. METHODS Parents of 11-to-17-year-old adolescents who discussed HPV vaccination with a healthcare provider at least once (n = 795) completed our online survey in Fall 2016. We assessed their satisfaction with the discussion using the HPV Vaccine Communication Satisfaction Scale (α = 0.94). We examined associations between satisfaction (categorized as low, moderate, or high), and three vaccination behaviors: refusal/delay, series initiation (≥1 dose), and continuation (≥2 doses among initiators) using multivariable logistic regression. RESULTS Most parents reported high (36%) or moderate (38%) satisfaction with provider communication about HPV vaccination; fewer reported low (26%) satisfaction. Moderately satisfied parents (vs. low) had lower odds of refusal/delay (aOR = 0.59, 95% CI: 0.38-0.89), and higher odds of initiation (aOR = 1.71, 95% CI:1.15-2.55) and continuation (aOR = 2.05, 95% CI: 1.24-3.40). The associations were stronger for highly satisfied parents (refusal/delay aOR = 0.45, 95% CI: 0.29-0.70, initiation aOR = 3.59, 95% CI: 2.23-5.78, and continuation aOR = 4.08, 95% CI: 2.38-7.01). CONCLUSIONS Our study suggests that parent satisfaction with provider communication may play an important role in HPV vaccination decision-making. Yet, communication satisfaction has been largely unexamined in the HPV-vaccine literature to date. We introduce a brief, 7-item HPV Vaccine Communication Scale that can be used to assess parents' level of satisfaction with their provider's communication specific to HPV vaccine. We identify communication areas for providers to prioritize when discussing HPV vaccine with parents.
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Affiliation(s)
- Melanie L Kornides
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA.
| | - Holly B Fontenot
- WF Connell School of Nursing, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA 02467, USA.
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, 1932K (Campus Delivery Code) 717 Delaware St SE, Minneapolis, MN 55414, USA.
| | - Catherine A Panozzo
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA.
| | - Melissa B Gilkey
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Campus Box 7440, Chapel Hill, NC 27599, USA.
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Cunningham-Erves J, Forbes L, Ivankova N, Mayo-Gamble T, Kelly-Taylor K, Deakings J. Black mother's intention to vaccinate daughters against HPV: A mixed methods approach to identify opportunities for targeted communication. Gynecol Oncol 2018; 149:506-512. [PMID: 29588103 DOI: 10.1016/j.ygyno.2018.03.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The cervical cancer disparity continues to exist and has widened between Black and non-Hispanic White women. Human Papillomavirus (HPV) vaccines could potentially reduce this disparity, yet remain underused among Black female adolescents. We investigated psychosocial and cultural factors associated with Black mothers' intentions to vaccinate their daughters against HPV, and explored views toward a HPV vaccine mandate. METHODS In this quantitative dominant, mixed methods study, cross sectional surveys (n=237) and follow-up semi-structured interviews (n=9) were conducted with Black mothers of daughters. A 2-step logistic regression determined factors associated with Black mothers' intention. Thematic content analysis determined emerging themes. RESULTS Perceived susceptibility (p=.044), perceived barriers (p<.001), and subjective norms (p=.001) were significant predictors of maternal HPV vaccination intentions. Follow-up interviews provided insight into factors influencing mothers' intentions. Mothers with low intentions did not perceive their daughter to be currently sexually active or in near future, thus, not at HPV risk. Pediatricians were identified as the most influential person on maternal decision-making if there was a pre-existing relationship. However, many mothers had not received a pediatricians' recommendation for their daughters. Barriers influencing mother's decision-making include knowledge, daughters' age, and mistrust in pharmaceutical companies and physicians. Mothers were not in favor of the HPV vaccine mandate. CONCLUSIONS Findings demonstrate the need to develop and evaluate physician-led interventions on HPV and vaccine importance, and engage these mothers in intervention development to build trust between physicians, researchers, and Black mothers to improve HPV vaccine uptake in Black female adolescents.
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Affiliation(s)
- Jennifer Cunningham-Erves
- Department of Human Studies, University of Alabama at Birmingham, 1720 2nd Ave S., EB 207, Birmingham, AL 35294-1250, United States.
| | - Laura Forbes
- Department of Human Studies, University of Alabama at Birmingham, 1720 2nd Ave S., EB 207, Birmingham, AL 35294-1250, United States
| | - Nataliya Ivankova
- Departments Health Services Administration and Acute, Chronic, and Continuing Care, University of Alabama at Birmingham, 569 SHPB, 1716 9th Ave S, Birmingham, AL 35294-1212, United States
| | - Tilicia Mayo-Gamble
- Department of Family Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208-3599, United States
| | - Kendria Kelly-Taylor
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN 37208-3599, United States
| | - Jason Deakings
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN 37208-3599, United States
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Meaningful Methods for Increasing Human Papillomavirus Vaccination Rates: An Integrative Literature Review. J Pediatr Health Care 2018; 32:119-132. [PMID: 28918994 DOI: 10.1016/j.pedhc.2017.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/13/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is a well-known cause of oropharyngeal, cervical, vaginal, vulvar, penile, and anal cancers. Despite the proven efficacy of the HPV vaccine, vaccination rates remain persistently low. Much literature has focused on attitudes toward the HPV vaccine; however, researchers have also investigated strategies clinicians can use to improve vaccination attitudes and acceptance. Such strategies include provider education, vaccine reminder/recall, and chart audit and feedback. The purpose of this integrative review is to uncover the best evidence-based practice interventions, with the aim of improving HPV knowledge, patient-provider conversations, and immunization uptake. This integrative review concludes that multicomponent interventions have a synergistic effect, resulting in increased provider vaccine support, improved patient/parental attitudes toward HPV vaccination, and increased immunization uptake. Such strategies hold much promise for today's pediatric providers as they work to combat current vaccination disparities.
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Kornides ML, McRee AL, Gilkey MB. Parents Who Decline HPV Vaccination: Who Later Accepts and Why? Acad Pediatr 2018; 18:S37-S43. [PMID: 29502636 PMCID: PMC5859546 DOI: 10.1016/j.acap.2017.06.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/24/2017] [Accepted: 06/11/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Parental declination contributes to low human papillomavirus (HPV) vaccination coverage among US adolescents, resulting in missed opportunities for cancer prevention. We sought to characterize parents' acceptance of HPV vaccination after declination ("secondary acceptance"). METHODS In September 2016, we conducted an online survey with a national sample of parents of children ages 11 to 17 years. For those who reported having ever declined HPV vaccination for their children (n = 494), our survey assessed whether they accepted the vaccine at a subsequent visit. We used multivariable logistic regression to assess correlates of secondary acceptance. RESULTS Overall, 45% of parents reported secondary acceptance of HPV vaccination, and an additional 24% intended to vaccinate in the next 12 months. In multivariable analyses, secondary acceptance was associated with receiving follow-up counseling about HPV vaccination from a health care provider (odds ratio, 2.16; 95% confidence interval, 1.42-3.28). However, only 53% of parents overall reported receiving such counseling. Secondary acceptance was also associated with receiving a higher quality HPV vaccine recommendation from a provider during the initial discussion and greater satisfaction with provider communication, as well as higher vaccination confidence. Among the reasons for secondary acceptance, parents most commonly reported the child getting older (45%), learning more about HPV vaccine (34%), and receiving a provider recommendation (33%). CONCLUSIONS Our findings suggest secondary acceptance of HPV vaccination is common, with more than two-thirds of parents in this national sample accepting or intending to accept HPV vaccination after declination. Providers should seek to motivate secondary acceptance by delivering repeated, high-quality recommendations for HPV vaccination.
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Affiliation(s)
- Melanie L Kornides
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
| | | | - Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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Niccolai LM, North AL, Footman A, Hansen CE. Lack of school requirements and clinician recommendations for human papillomavirus vaccination. J Public Health Res 2018; 7:1324. [PMID: 29780768 PMCID: PMC5941259 DOI: 10.4081/jphr.2018.1324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV) vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians' recommendations. DESIGN AND METHODS Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. RESULTS Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. CONCLUSIONS The current lack of school entry requirements for HPV vaccination is an important influence on clinicians' recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians' recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.
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Affiliation(s)
- Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Anna L. North
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Alison Footman
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Caitlin E. Hansen
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Fenton AT, Elliott MN, Schwebel DC, Berkowitz Z, Liddon NC, Tortolero SR, Cuccaro PM, Davies SL, Schuster MA. Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine. Soc Sci Med 2017; 200:238-248. [PMID: 29157686 DOI: 10.1016/j.socscimed.2017.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/19/2022]
Abstract
RATIONALE Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care. OBJECTIVE We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care. METHODS Using a longitudinal multi-site survey of US parents and adolescents, we assessed whether patient-centered care ratings might shape racial/ethnic and socioeconomic gaps at two decision points in the HPV vaccination process: (1) Whether a medical provider recommends the vaccine and (2) whether a parent decides to vaccinate. RESULTS We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' patient-centeredness were significantly associated with racial/ethnic disparities in parents' reports of receiving a HPV vaccine recommendation from a provider: Among parents who rate patient-centered care as low, white parents' odds of receiving such a recommendation are 2.6 times higher than black parents' odds, but the racial/ethnic gap nearly disappears when parents report high patient-centeredness. Moderated mediation analyses suggest that patient-centeredness is a major contributor underlying vaccination uptake disparities: Among parents who report low patient-centeredness, white parents' odds of vaccinating their child are 8.1 times higher than black parents' odds, while both groups are equally likely to vaccinate when patient-centeredness is high. CONCLUSION The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, deserves more attention. Efforts to raise HPV vaccination rates should explore why certain patient groups may be less likely to receive recommendations and should support providers to consistently inform all patient groups about vaccination.
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Affiliation(s)
- Anny T Fenton
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
| | - Marc N Elliott
- 1776 Main Street, RAND Corporation, Santa Monica, CA 90401, USA.
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, CDC, 1600 Clifton Road Atlanta, GA 30329, USA.
| | - Nicole C Liddon
- Division of Adolescent and School Health, CDC, 1600 Clifton Road Atlanta, GA 30329, USA.
| | - Susan R Tortolero
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA.
| | - Paula M Cuccaro
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA.
| | - Suzy L Davies
- Department of Health Behavior, UAB Center for the Study of Community Health, 1665 University Boulevard, Birmingham, AL 35294, USA.
| | - Mark A Schuster
- Division of General Pediatrics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Enders, 300 Longwood Avenue, Boston, MA 02115, USA; Kaiser Permanente School of Medicine, 100 South Los Robles Avenue, Pasadena, CA 91106, USA.
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Perez S, Tatar O, Gilca V, Shapiro GK, Ogilvie G, Guichon J, Naz A, Rosberger Z. Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys. Vaccine 2017; 35:4713-4721. [DOI: 10.1016/j.vaccine.2017.07.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/05/2017] [Accepted: 07/13/2017] [Indexed: 01/27/2023]
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Sturm L, Donahue K, Kasting M, Kulkarni A, Brewer NT, Zimet GD. Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings. J Adolesc Health 2017; 61:246-251. [PMID: 28455129 DOI: 10.1016/j.jadohealth.2017.02.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to establish which human papillomavirus (HPV) vaccine communication approaches by pediatricians were associated with same-day HPV vaccination of 11- to 12-year-olds by evaluating audio recordings of visits. METHODS Verilogue, a market research company maintaining a panel of primary care pediatricians, provided audio recordings and transcriptions of well-child visits for 11- to 12-year-old patients from January through June 2013. Seventy-five transcripts from 19 pediatricians were coded for use of presumptive language (i.e., words conveying assumption of vaccine delivery), offer of delay, recommendation strength, and information provision. Using logistic regression, we evaluated the association between pediatrician communication approaches and agreement to same-day HPV vaccination. Generalized estimating equations accounted for clustering of patients within pediatricians. RESULTS Same-day agreement to HPV vaccination occurred in 29% of encounters. Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine (73% vs. 22%; odds ratio = 8.96; 95% confidence interval = 2.32-34.70). Pediatricians offered or recommended delay in most encounters (65%). HPV vaccine acceptance occurred far more often when pediatricians did not mention delaying vaccination (82% vs. 6%; odds ratio = 80.84; 95% confidence interval = 15.72-415.67). Same-day vaccination was not associated with strength of recommendation or pediatrician reference to vaccinating their own children. CONCLUSIONS Our findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination.
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Affiliation(s)
- Lynne Sturm
- Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Kelly Donahue
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Monica Kasting
- University Fairbanks School of Public Health, Indianapolis, Indiana
| | - Amit Kulkarni
- Global Health Outcomes, Merck & Co., Inc., Kenilworth, New Jersey
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Gregory D Zimet
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Rendle KA, Leskinen EA. Timing Is Everything: Exploring Parental Decisions to Delay HPV Vaccination. QUALITATIVE HEALTH RESEARCH 2017; 27:1380-1390. [PMID: 27557924 DOI: 10.1177/1049732316664499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The delayed uptake of the human papillomavirus (HPV) vaccine offers an opportunity to explore how temporality and risk are at work in everyday life. Drawing from a mixed-methods study with parents ( N = 50) in Northern California, this study explored parents' decision to delay HPV vaccination for their children among parents who had not yet vaccinated ( n = 27). At the core of these decisions were temporal assessments of risk whereby parents weighed their child's (perceived) present risk of HPV exposure against the uncertain perceived risks of the vaccine itself. Our findings are promising as they indicate that given time, and the continued growth of evidence regarding the safety and effectiveness of HPV vaccination, completion rates should increase. However, our results also suggest that vaccination delays are not merely a matter of scientific doubt but also based on parents' (potentially inaccurate) perceptions of their child's sexual readiness, and thus potentially more difficult to overcome.
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Affiliation(s)
- Katharine A Rendle
- 1 University of Michigan, Ann Arbor, Michigan, USA
- 2 National Cancer Institute, Bethesda, Maryland, USA
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70
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Berman RS, Smock L, Bair-Merritt MH, Cochran J, Geltman PL. Giving It Our Best Shot? Human Papillomavirus and Hepatitis B Virus Immunization Among Refugees, Massachusetts, 2011-2013. Prev Chronic Dis 2017. [PMID: 28641071 PMCID: PMC5484014 DOI: 10.5888/pcd14.160442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The receipt rate of hepatitis B virus vaccine among adolescents in the United States is high, while the receipt rate of human papillomavirus vaccine is low. Rates have not been closely studied among refugees, whose home countries have high rates of disease caused by these viruses. METHODS We examined human papillomavirus and hepatitis B virus immunization rates among 2,269 refugees aged 9 to 26 years who resettled in Massachusetts from 2011 through 2013. This was a secondary analysis of data from their medical screenings. We used binary logistic regression to assess characteristics associated with immunization and bivariate analyses to compare refugee immunization rates with those of the general US population. RESULTS Forty-five percent of US adolescents aged 13 to 17 years received 1 dose of human papillomavirus vaccine, compared with 68% of similarly aged refugees. Males (adjusted odds ratio [aOR], 0.62; 95% confidence interval [CI], 0.52-0.74), refugees older than 13 years (aOR, 0.74; 95% CI, 0.60-0.93), and refugees not from Sub-Saharan Africa (aOR, 0.74; 95% CI, 0.59-0.92) were less likely to receive human papillomavirus vaccine, while arrivals in 2012 through 2013 were more likely (aOR, 1.6; 95% CI, 1.3-1.9) than those arriving in 2011. Refugees older than 13 years were less likely to receive 2 doses of hepatitis B virus vaccine (aOR, 0.49; 95% CI, 0.37-0.63) than older refugees. CONCLUSION Specialized post-arrival health assessment may improve refugees' immunization rates.
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Affiliation(s)
- Rachel Stein Berman
- Department of General Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Laura Smock
- Refugee and Immigrant Health Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Megan H Bair-Merritt
- Department of General Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Jennifer Cochran
- Refugee and Immigrant Health Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Paul L Geltman
- Refugee and Immigrant Health Program, Massachusetts Department of Public Health, Boston, Massachusetts
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71
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Polek C, Hardie T. Changing HPV vaccination rates in bisexual and lesbian women. J Am Assoc Nurse Pract 2017; 29:333-339. [DOI: 10.1002/2327-6924.12453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/13/2017] [Accepted: 01/25/2017] [Indexed: 11/08/2022]
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72
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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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Pierre-Victor D, Page TF, Trepka MJ, Stephens DP, Li T, Madhivanan P. Impact of Virginia's School-Entry Vaccine Mandate on Human Papillomavirus Vaccination Among 13–17-Year-Old Females. J Womens Health (Larchmt) 2017; 26:266-275. [DOI: 10.1089/jwh.2016.5869] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Dudith Pierre-Victor
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida
| | - Timothy F. Page
- Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida
| | - Dionne P. Stephens
- Department of Psychology, College of Arts and Science, Florida International University, Miami, Florida
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, Florida
- Public Health Research Institute of India, Karnataka, India
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Bernstein HH, Bocchini JA, Byington CL, Maldonado YA, Barnett ED, Campbell JD, Davies HD, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary S, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE. Practical Approaches to Optimize Adolescent Immunization. Pediatrics 2017; 139:peds.2016-4187. [PMID: 28167515 DOI: 10.1542/peds.2016-4187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
With the expansion of the adolescent immunization schedule during the past decade, immunization rates notably vary by vaccine and by state. Addressing barriers to improving adolescent vaccination rates is a priority. Every visit can be viewed as an opportunity to update and complete an adolescent's immunizations. It is essential to continue to focus and refine the appropriate techniques in approaching the adolescent patient and parent in the office setting. Health care providers must continuously strive to educate their patients and develop skills that can help parents and adolescents overcome vaccine hesitancy. Research on strategies to achieve higher vaccination rates is ongoing, and it is important to increase the knowledge and implementation of these strategies. This clinical report focuses on increasing adherence to the universally recommended vaccines in the annual adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. This will be accomplished by (1) examining strategies that heighten confidence in immunizations and address patient and parental concerns to promote adolescent immunization and (2) exploring how best to approach the adolescent and family to improve immunization rates.
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Affiliation(s)
- Henry H. Bernstein
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York; and
| | - Joseph A. Bocchini
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Patel H, Pčolkina K, Strazdina K, Viberga I, Sherman SM, Tincello DG, Redman CW, Rezeberga D, Moss EL. Awareness of HPV infection and attitudes toward HPV vaccination among Latvian adolescents. Int J Gynaecol Obstet 2017; 137:138-144. [PMID: 28171702 DOI: 10.1002/ijgo.12117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/30/2016] [Accepted: 02/03/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate awareness of HPV and its vaccine among Latvian adolescents. METHODS A cross-sectional survey was conducted in a 2-week period in September 2015 among 270 adolescents attending a secondary school in Riga, Latvia. All students present during sexual-health classes (grades 10-12 [aged 16-21 years]) were included. A self-administered paper-based survey assessed sociodemographic factors, sexual behaviours, smear history and knowledge of sexually transmitted infections, HPV and HPV vaccine knowledge, and sources of information. RESULTS Overall, 121 surveys were completed (62 by male students and 59 by female students). Latvian adolescents lacked awareness of HPV: only 26 (21.5%) had heard of HPV (21 [35.6%] female students vs 5 [8.1%] male students; P<0.001) and 12 (9.9%) of the HPV vaccine. Eighty (66.1%) participants felt inadequately informed about HPV. However, the adolescents partook in high-risk behaviours: 70 (57.9%) students were sexually active, 26 (37.1%) of whom had already had three or more sexual partners. CONCLUSION Despite the high prevalence of HPV in Latvia, poor knowledge about HPV infection among adolescents could explain low uptake of the HPV vaccine by this high-risk population. Therefore, educational strategies that highlight the consequences of HPV could promote acceptance of vaccination.
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Affiliation(s)
- Hersha Patel
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kristine Pčolkina
- Department of Obstetrics and Gynecology, University of Latvia, Riga, Latvia
| | - Kristine Strazdina
- Department of Obstetrics and Gynecology, University of Latvia, Riga, Latvia
| | - Ilza Viberga
- Department of Obstetrics and Gynecology, University of Latvia, Riga, Latvia
| | - Susan M Sherman
- School of Psychology, Keele University, Newcastle-under-Lyme, UK
| | | | - Charles W Redman
- Department of Gynecology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Dace Rezeberga
- Department of Obstetrics and Gynecology, Riga Stradiņš University, Riga, Latvia
| | - Esther L Moss
- Department of Cancer Studies, University of Leicester, Leicester, UK
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Ackerson B, Hechter R, Sidell M, Sy LS, Slezak J, Chao C, Patel N, Tseng HF, Jacobsen S. Human papillomavirus vaccine series completion in boys before and after recommendation for routine immunization. Vaccine 2017; 35:897-902. [DOI: 10.1016/j.vaccine.2017.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 02/03/2023]
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The Association of Health Seeking Behaviors With Human Papillomavirus Vaccination Status Among High-Risk Urban Youth. Sex Transm Dis 2016; 43:771-777. [DOI: 10.1097/olq.0000000000000521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Important considerations in adolescent health maintenance: long-acting reversible contraception, human papillomavirus vaccination, and heavy menstrual bleeding. Curr Opin Pediatr 2016; 28:778-785. [PMID: 27676642 DOI: 10.1097/mop.0000000000000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present article addresses recent research related to three key facets of adolescent preventive care and health maintenance: long-acting reversible contraception, human papillomavirus vaccination, and heavy menstrual bleeding. RECENT FINDINGS Recent studies suggest that long-acting reversible contraception use results in significantly lower rates of unintended pregnancies, and is well tolerated by nulliparous adolescent females. Additionally, a strong recommendation from a pediatric primary care provider is extremely effective in ensuring human papillomavirus vaccination prior to sexual debut. Finally, heavy menstrual bleeding is often under-recognized in adolescents, and evaluation and treatment of these patients are variable. SUMMARY Based on the recent literature findings, the pediatric primary care provider should be encouraged to, first, recommend long-acting reversible contraception for prevention of unintended pregnancy in adolescent patients; second, strongly endorse vaccination to protect against human papillomavirus in all patients prior to sexual debut; and, third, screen adolescent females for signs and symptoms of heavy menstrual bleeding.
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Farmar ALM, Love-Osborne K, Chichester K, Breslin K, Bronkan K, Hambidge SJ. Achieving High Adolescent HPV Vaccination Coverage. Pediatrics 2016; 138:peds.2015-2653. [PMID: 27940751 DOI: 10.1542/peds.2015-2653] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite national recommendations for adolescent human papillomavirus (HPV) vaccination, rates have lagged behind those of other adolescent vaccines. We implemented interventions and examined rates of vaccination coverage in a large, urban, safety net health care system to understand whether our tactics for achieving high rates of adolescent vaccination were successful. METHODS Denver Health is an integrated urban safety net health system serving >17 000 adolescents annually. The process for achieving high vaccination rates in our health system includes "bundling" of vaccines, offering vaccines at every visit, and standard orders. Data from vaccine registry and utilization statistics were used to determine vaccination rates in adolescents aged 13 to 17 years from 2004 to 2014, and these findings were compared with state and national rates for 2013. Regression analysis was used to identify characteristics associated with vaccination. RESULTS In 2013 (N = 11 463), HPV coverage of ≥1 dose was 89.8% (female subjects) and 89.3% (male subjects), compared with national rates of 57.3% and 34.6%. Rates of HPV coverage (≥3 doses) were 66.0% for female subjects and 52.5% for male subjects, versus 37.6% and 13.9% nationally. For both sexes, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed, vaccine coverage was 95.9% (86.0% nationally), and meningococcal conjugate vaccine coverage was 93.5% (77.8% nationally). Female subjects, Hispanic subjects, non-English speakers, and teenagers <200% below the federal poverty level were more likely to have received 3 doses of HPV. CONCLUSIONS Through low-cost, system-wide standard procedures, Denver Health achieved adolescent vaccination rates well above national coverage rates. Avoiding missed opportunities for vaccination and normalizing the HPV vaccine were key procedures that contributed to high coverage rates.
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Affiliation(s)
- Anna-Lisa M Farmar
- Ambulatory Care Services, Denver Health, Denver, Colorado; and .,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Kathryn Love-Osborne
- Ambulatory Care Services, Denver Health, Denver, Colorado; and.,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | | | - Kristin Breslin
- Ambulatory Care Services, Denver Health, Denver, Colorado; and
| | - Kristi Bronkan
- Ambulatory Care Services, Denver Health, Denver, Colorado; and
| | - Simon J Hambidge
- Ambulatory Care Services, Denver Health, Denver, Colorado; and.,Department of Pediatrics, University of Colorado, Aurora, Colorado
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80
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Gilkey MB, Calo WA, Marciniak MW, Brewer NT. Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences. Hum Vaccin Immunother 2016; 13:680-686. [PMID: 27763818 DOI: 10.1080/21645515.2016.1247134] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences. METHODS In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay. RESULTS Overall, 28% of parents reported that they had ever "refused or decided not to get" HPV vaccine for their child, and an additional 8% of parents reported that they had "delayed or put off getting" HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48-0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50-0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65-4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08-2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often. CONCLUSIONS Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy.
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Affiliation(s)
- Melissa B Gilkey
- a Department of Population Medicine , Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - William A Calo
- b Department of Health Policy and Management , University of North Carolina , Chapel Hill , NC , USA
| | - Macary W Marciniak
- c Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Noel T Brewer
- d Department of Health Behavior & Lineberger Comprehensive Cancer Center , University of North Carolina , Chapel Hill , NC , USA
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81
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Niccolai LM, Pettigrew MM. The Role of Cognitive Bias in Suboptimal HPV Vaccine Uptake. Pediatrics 2016; 138:peds.2016-1537. [PMID: 27613774 DOI: 10.1542/peds.2016-1537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Linda M Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Melinda M Pettigrew
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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82
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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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83
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Katz IT, Bogart LM, Fu CM, Liu Y, Cox JE, Samuels RC, Chase T, Schubert P, Schuster MA. Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers. BMC Public Health 2016; 16:874. [PMID: 27558506 PMCID: PMC4997748 DOI: 10.1186/s12889-016-3529-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/16/2016] [Indexed: 01/05/2023] Open
Abstract
Background Despite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates. Methods We conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24), their caregivers (n = 24), and nurses (n = 18), and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion. Results Themes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, “newer” vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections. Conclusions Optimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families’ concerns about vaccine safety and efficacy.
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Affiliation(s)
- Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. .,Massachusetts General Hospital, Center for Global Health, Boston, MassachusettsMA, USA. .,Harvard Medical School, Boston, Massachusetts, USA. .,Division of Women's Health, 1620 Tremont Street, 3rd Floor BWH, Boston, MA, 02120, USA.
| | - Laura M Bogart
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,RAND Corporation, Santa Monica, California, USA
| | - Chong Min Fu
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yingna Liu
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joanne E Cox
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ronald C Samuels
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tami Chase
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Pamela Schubert
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mark A Schuster
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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84
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North AL, Niccolai LM. Human Papillomavirus Vaccination Requirements in US Schools: Recommendations for Moving Forward. Am J Public Health 2016; 106:1765-70. [PMID: 27552264 DOI: 10.2105/ajph.2016.303286] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Safe and effective human papillomavirus (HPV) vaccines have been available and recommended for adolescents for a decade in the United States, yet vaccination rates remain suboptimal. School entry requirements have increased uptake of other vaccines for adolescents and made coverage more equitable. However, only 3 jurisdictions require HPV vaccine for school. We summarize the current status of HPV vaccine requirements and discuss the rationales for and against these policies. The rationales for requirements include HPV vaccine efficacy and safety, effectiveness of requirements for increasing vaccine uptake and making it more equitable, and use of requirements as "safety nets" and to achieve herd immunity. The rationales against requirements include low parental acceptance of HPV vaccine, the financial burden on educational systems and health departments, and the possibility for alternatives to increase vaccine uptake. Many challenges to HPV vaccine requirements are addressable, and we conclude with recommendations on how to approach these challenges.
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Affiliation(s)
- Anna L North
- The authors are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Linda M Niccolai
- The authors are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
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85
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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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86
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Clark SJ, Cowan AE, Filipp SL, Fisher AM, Stokley S. Parent Perception of Provider Interactions Influences HPV Vaccination Status of Adolescent Females. Clin Pediatr (Phila) 2016; 55:701-6. [PMID: 26450982 DOI: 10.1177/0009922815610629] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Human papillomavirus (HPV) vaccination coverage among adolescent females is well below national public health goals. Many known barriers to HPV vaccine receipt can be addressed in parent-physician conversations. This study sought to explore parent experiences and attitudes related to HPV vaccination of adolescent girls, focused on interactions with providers. We conducted a cross-sectional survey of parents using a nationally representative online panel. Among parents with ≥1 daughter aged 11 to 17 years, provider recommendations for HPV vaccine and specified age to begin the HPV vaccine series were associated with HPV vaccine status. Parents who reported their daughters were unlikely to complete the HPV series were more likely to have had no discussion of HPV vaccine with the provider. Efforts to increase HPV vaccination rates among adolescent females should continue to focus on improving provider discussion of HPV vaccine.
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Affiliation(s)
- Sarah J Clark
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI, USA
| | - Anne E Cowan
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie L Filipp
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI, USA
| | - Allison M Fisher
- 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
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87
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Ogunbajo A, Hansen CE, North AL, Okoloko E, Niccolai LM. "I think they're all basically the same": parents' perceptions of human papilloma virus (HPV) vaccine compared with other adolescent vaccines. Child Care Health Dev 2016; 42:582-7. [PMID: 26990908 PMCID: PMC4899198 DOI: 10.1111/cch.12331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/25/2016] [Accepted: 02/04/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination is recommended for routine administration at ages 11-12 years. However, uptake is lower than for other vaccines that are also routinely recommended for adolescents (MCV4 and Tdap). Understanding parental perceptions of HPV vaccine compared with other vaccines may help to inform strategies to increase uptake. METHODS Parents and caregivers (n = 45) of adolescents ages 10-18 years from a low-income, ethnic minority population participated in a qualitative study. Interviews were transcribed verbatim and coded for emergent themes. RESULTS Many participants perceived the HPV vaccine to be similar to other routine vaccines. Noted similarities included the vaccines' ability to prevent disease, similar methods of administration and belief in health care providers' recommendation. Some parents noted the greater benefit of HPV vaccine in preventing cancer, which was viewed as a serious disease. Parents also noted the different mode of transmission (sexual) for HPV, which evoked mixed opinions. CONCLUSION Overall, most participants viewed the HPV vaccine in a positive light and similar to other adolescent vaccines with the added benefit of cancer prevention. Strategies that treat all three vaccines equally such as presenting them similarly as a 'bundle' to parents or considering policy initiatives such as school entry requirements might help increase raise coverage for HPV vaccine.
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Affiliation(s)
| | | | - Anna L. North
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Edirin Okoloko
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Linda M. Niccolai
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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88
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Perkins RB, Chigurupati NL, Apte G, Vercruysse J, Wall-Haas C, Rosenquist A, Lee L, Clark JA, Pierre-Joseph N. Why don't adolescents finish the HPV vaccine series? A qualitative study of parents and providers. Hum Vaccin Immunother 2016; 12:1528-35. [PMID: 26810765 PMCID: PMC4964719 DOI: 10.1080/21645515.2015.1118594] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/17/2015] [Accepted: 11/05/2015] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To describe why adolescent females who initiated HPV vaccination completed or did not complete the series. METHODS Semi-structured interviews were conducted with parents/guardians of 11-17 year old female adolescents and their pediatric primary care providers in one inner-city public clinic and three private practices to ascertain why girls who initiated HPV vaccination did or did not complete the series. Qualitative analysis was used to identify perceived barriers and facilitators of completion. RESULTS 65 parents/guardians participated: 37 whose daughters received 1 or 2 HPV vaccine doses and 28 whose daughters completed the series. 89% (n = 33) of parents who did not complete the series intended to do so, but were not reminded by the clinic or encountered logistical barriers. Four (11%) decided to stop the vaccine series. 33 providers participated: 24 physicians, 3 nurse practitioners, and 6 registered nurses. Half (n = 14, 52%) of the providers said they told parents when the next doses were due but relied on parents to schedule appointments, 11 (41%) scheduled the second dose when the first dose was given, and 2 (7%) tried to immunize patients when they returned for other appointments. None of the four practices had a reminder/recall system in place to ensure series completion. Of note, neither parents nor providers stated that the need for three doses was a barrier to series completion. CONCLUSIONS Most failure to complete the HPV vaccine series occurred because providers expected parents to make appointments while parents expected to be reminded. Increased use of reminder/recall systems and team-based care with clear communication of expectations regarding appointment scheduling could increase completion rates.
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Affiliation(s)
| | | | - Gauri Apte
- Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Laura Lee
- Harvard Vanguard Medical Associates, Chelmsford, MA, USA
| | - Jack A. Clark
- Edith Nourse Rogers Memorial Veterans Hospital-Bedford/Boston University School of Public Health, Boston, MA, USA
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89
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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: 216] [Impact Index Per Article: 27.0] [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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90
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Update on barriers to human papillomavirus vaccination and effective strategies to promote vaccine acceptance. Curr Opin Pediatr 2016; 28:407-12. [PMID: 27093354 DOI: 10.1097/mop.0000000000000353] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides a clinically relevant review and analysis of the latest research regarding barriers to human papillomavirus (HPV) vaccination and strategic efforts to promote this vaccine. RECENT FINDINGS HPV vaccines are safe, effective, and could prevent the majority of HPV-attributable cancers, if vaccination coverage is high. However, uptake of HPV vaccine lags behind other vaccines recommended for 11 to 12-year olds. A lack of provider recommendation has consistently been found to be a key barrier to increasing vaccination rates. Lack of knowledge about the vaccine among parents coupled with an overestimation of parental vaccine hesitancy among providers also hinder vaccine uptake. Strongly recommending the vaccine as a safe, routine immunization that prevents cancer, and coadministering it with tetanus, diphtheria, and acellular pertussis vaccine and quadrivalent meningococcal conjugate vaccine, enhance vaccine uptake. In some cases, reminder and recall systems result in additional increases in vaccination rates. SUMMARY Recent publications reveal new information about the implementation of HPV vaccines. Provider recommendation is a key approach, as is offering it routinely at the same time as other universally recommended adolescent immunizations. With the integration of these concepts into the clinical setting, adolescents can be better protected against HPV and its associated diseases.
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92
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Henrikson NB, Tuzzio L, Gilkey MB, McRee AL. "You're never really off time": Healthcare providers' interpretations of optimal timing for HPV vaccination. Prev Med Rep 2016; 4:94-7. [PMID: 27413667 PMCID: PMC4929064 DOI: 10.1016/j.pmedr.2016.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/02/2016] [Accepted: 05/16/2016] [Indexed: 11/22/2022] Open
Abstract
Healthcare providers have a strong influence on human papillomavirus (HPV) vaccination decisions, yet they often fail to recommend the vaccine to the 11- and 12-year-olds who are targeted by practice guidelines. We sought to understand how providers interpret and value age-based guidelines. We conducted a secondary analysis of data from two qualitative studies of healthcare providers' HPV vaccination attitudes and practices. Participants were physicians, nurse practitioners, and physician assistants in Minnesota (n = 27) and in Washington (n = 17) interviewed in 2012 and 2014 respectively. Verbatim transcripts from each study were analyzed independently using content analysis, and collective findings were then jointly analyzed. The research team worked via consensus to derive codes and describe representative themes. A high proportion of providers reported either a lack of concern about HPV vaccine completion, or concern beginning several years past the recommended target age. Many providers perceived a gradient of HPV vaccination timeliness ranging from age 12 to 26. Instead of age-based recommendations, providers timed recommendations based on perceptions of access to care and patient risk. They often offered “gentle” recommendations and deferred vaccination discussions as a tool to building trust with families. Interventions aimed at helping providers deliver effective recommendations for timely HPV vaccination are needed. Our findings suggest that changing the norm of provider culture to one in which “catch-up” schedules are seen as a suboptimal way to achieve vaccine uptake may be an important goal. Many healthcare providers report a lack of concern for HPV vaccine completion by age 12. Providers reported concern about HPV vaccine initiation or completion beginning several years past the recommended target age. Providers described a gradient of on-time HPV vaccination ranging from age 12 to age 26. Providers refined their HPV vaccine recommendations based on perceptions of access to care and patient risk. Future interventions aimed at providers should emphasize messages on the importance of HPV vaccination by age 12.
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Affiliation(s)
- Nora B Henrikson
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; School of Public Health, University of Washington, Seattle, WA, USA
| | - Leah Tuzzio
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA
| | - Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 133 Brookline Ave, Boston, MA 02215, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota, 717 Delaware St SE, Minneapolis, MN 55414, USA
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93
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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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94
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Fiks AG, Luan X, Mayne SL. Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements. Pediatrics 2016; 137:e20150675. [PMID: 26908681 DOI: 10.1542/peds.2015-0675] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many pediatricians are now required to participate in American Board of Pediatrics Maintenance of Certification (MOC) Part IV programs focused on improving health care quality, but the benefits of participation are unproven. METHODS Twenty-seven primary care pediatricians from 11 primary care practices participated in a 1-year MOC program for human papillomavirus (HPV) vaccine. Participants received education and electronic health record (EHR)-generated performance feedback reports with their rates of captured HPV immunization opportunities (dose given at eligible visit) and those of peers. In each of 3 cycles, clinicians collectively identified a goal for improvement. Rates of captured opportunities among adolescents 11 to <18 years old were tabulated, and statistical process control charts were created to evaluate changes over time among participants compared with 200 nonparticipants. Provider perceptions of the program and time invested were recorded via survey. RESULTS Participating clinicians missed fewer opportunities for HPV vaccination than nonparticipants. MOC participants significantly increased their captured opportunities relative to nonparticipating clinicians by 5.7 percentage points for HPV dose 1 at preventive visits and by 0.7 and 5.6 percentage points for doses 1 and 2, respectively, at acute visits. There were no significant differences for other doses. The estimated program cost was $662/participant. Of the participating pediatricians, 96% felt the effort to participate was warranted, and half would not have joined the project without the MOC requirement. CONCLUSIONS Participation in MOC Part IV improved vaccination at modest cost and with high pediatrician satisfaction, demonstrating benefits of the program that may help to inform future initiatives.
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Affiliation(s)
- Alexander G Fiks
- The Pediatric Research Consortium (PeRC), Department of Biomedical and Health Informatics, Center for Pediatric Clinical Effectiveness (CPCE), PolicyLab, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xianqun Luan
- Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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95
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Valentino K, Poronsky CB. Human Papillomavirus Infection and Vaccination. J Pediatr Nurs 2016; 31:e155-66. [PMID: 26586310 DOI: 10.1016/j.pedn.2015.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 01/16/2023]
Abstract
UNLABELLED Human papillomavirus (HPV) is an infection that can be sexually transmitted and result in health consequences including genital warts and cancers. Two vaccines, Gardasil® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant] and Cervarix™ [Human Papillomavirus Bivalent (Types 16 and 18) Vaccine], have been approved for the prevention of HPV and HPV-related diseases. OBJECTIVES To explore facilitators and barriers associated with HPV vaccine utilization and compliance regarding vaccine series completion in school-aged, adolescent, and young adult females in the United States; to discuss HPV infection and highlight the safety and efficacy of the HPV vaccine; and to illustrate delivery strategies that can improve immunization rates and review implications for healthcare providers. METHODS A literature review was performed using health-related online databases (CINAHL, MEDLINE, PubMED, Web of Science, EBSCOHost and Google Scholar) and archival searching to identify current vaccination rates and factors associated with vaccine uptake. RESULTS Despite the availability of vaccines that prevent cancer, acceptance and utilization rates of both HPV vaccines are less than recommended by the Advisory Committee for Immunization Practices (ACIP). Some of the barriers to HPV vaccination include lack of provider recommendation, negative parent or patient attitudes and beliefs, cost, and missed clinical opportunities. The primary facilitator to HPV vaccination is a strong provider recommendation. CONCLUSIONS Healthcare providers can enhance HPV vaccine utilization by taking an active role with patients. Strategies include education and advocacy for receiving the vaccine, maximizing access to the HPV vaccine, and implementing new strategies for vaccine-delivery.
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96
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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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97
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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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98
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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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99
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Allison MA, Hurley LP, Markowitz L, Crane LA, Brtnikova M, Beaty BL, Snow M, Cory J, Stokley S, Roark J, Kempe A. Primary Care Physicians' Perspectives About HPV Vaccine. Pediatrics 2016; 137:e20152488. [PMID: 26729738 PMCID: PMC6104512 DOI: 10.1542/peds.2015-2488] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Because physicians' practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3)identify characteristics associated with not discussing it. METHODS A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined. RESULTS Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11-12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1-3.5), be male (aOR: 1.8 [95% CI: 1.1-3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3-4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1-6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4-17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8-6.4]). CONCLUSIONS Addressing physicians' perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates.
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Affiliation(s)
- Mandy A. Allison
- Department of Pediatrics,Adult and Child Center for Health Outcomes Research and Delivery Science
| | - Laura P. Hurley
- Adult and Child Center for Health Outcomes Research and Delivery Science,Division of Internal Medicine, Denver Health, Denver, Colorado
| | - Lauri Markowitz
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
| | - Lori A. Crane
- Adult and Child Center for Health Outcomes Research and Delivery Science,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, and Children’s Hospital Colorado, Aurora, Colorado
| | - Michaela Brtnikova
- Department of Pediatrics,Adult and Child Center for Health Outcomes Research and Delivery Science
| | - Brenda L. Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science
| | - Megan Snow
- Adult and Child Center for Health Outcomes Research and Delivery Science
| | - Janine Cory
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jill Roark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Kempe
- Department of Pediatrics,Adult and Child Center for Health Outcomes Research and Delivery Science
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100
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Obulaney PA, Gilliland I, Cassells H. Increasing Cervical Cancer and Human Papillomavirus Prevention Knowledge and HPV Vaccine Uptake through Mother/Daughter Education. J Community Health Nurs 2016; 33:54-66; quiz 66-7. [DOI: 10.1080/07370016.2016.1120595] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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