Human papillomavirus vaccination of males: attitudes and perceptions of physicians who vaccinate females

Vaccine Confidence and Coverage among Medical Students at a Federal University in Brazil

BACKGROUND

Declining vaccination coverage (VC) and vaccine hesitancy among medical students are global challenges. These challenges reflect individual and logistical barriers to a sufficient adherence toward essential vaccines for healthcare professionals, as well as presenting a need for educational strategies during undergraduate training.

METHODS

This is a prospective study for evaluating VC rates, sociodemographic associations, and the vaccine confidence among medical students at a federal university in Brazil. The data collection included questionnaires and individual analyses of the participants' vaccination records.

RESULTS

A total of 237 medical students from all six years of an undergraduate program participated, of whom 124 (52.3%) had a vaccination record. Although the majority considered the vaccines to be "Completely Safe" (86.9%), the VC rates for complete vaccination schedules were relatively low, ranging from 87.9% (hepatitis B vaccine) to 3.2% (meningococcal B vaccine), including the vaccines from the National Immunization Program (NIP) and the private sector. Higher VC rates were found to occur among students in the final years of their undergraduate studies, in those from families with higher monthly incomes, and those from private secondary schools.

CONCLUSIONS

Given the low VC rates among medical students, other factors in addition to vaccine confidence may be determinants, thus highlighting the importance of reviewing policies for the inclusion of priority groups in the NIP and in implementing educational interventions during undergraduate training.

Views of the Pharmacists' Role in HPV Vaccinations: A Qualitative Study in Tennessee

The Human Papillomavirus (HPV) is a frequently occurring sexually transmitted infection in adults and is associated with various cancers that can affect both males and females. Recently, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for the HPV vaccine to include patients aged 27-45 years with shared clinical decision-making. A commonly reported obstacle to receiving the HPV vaccine among adults is a lack of healthcare provider recommendations. Considering the suboptimal HPV vaccine coverage figures and noting that the vast majority of hesitancy research has been conducted among children and adolescents, limited research is available on the adult perception of HPV vaccination in pharmacies. This study focuses on understanding adults' opinions and perceptions regarding the role of pharmacists in the uptake of the HPV vaccine and awareness of its availability in the pharmacy setting.

METHODS

After receiving approval from the Institutional Review Board (IRB), the qualitative study was initiated using virtual focus groups (FGs). Concepts from the Transtheoretical Model, the Health Belief Model, and the Social Cognitive Theory guided the study design. The corpus of data was collected in 2021 and 2022 by two researchers, and a third party transcribed the FGs to avoid any biases. The data were analyzed using Braun and Clarke's Thematic Analysis.

RESULTS

Out of 35 subjects that participated in six FGDs, most identified as female, with ages ranging from 18 to 45 years. The following four themes emerged: (1) HPV vaccine awareness; (2) stigmas leading to reduced education and vaccination rates; (3) education preferences; (4) follow-up in vaccination series reminders and preferences.

CONCLUSION

Participants' views of the HPV vaccine and the ability to receive the vaccine in a pharmacy are influenced by a myriad of factors. Common factors include improved awareness, preferences for educational modalities, avoiding stigmas associated with HPV vaccination, combating gender-focused biases, and preferences for the location of vaccination. These barriers provide opportunities for pharmacists to promote and enhance vaccine uptake.

Helping Children to Participate in Human Papillomavirus-Related Discussions: Mixed Methods Study of Multimedia Messages

BACKGROUND

Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children).

OBJECTIVE

This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health-in particular when such conversations center around the HPV vaccination-and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children's knowledge and perceptions of HPV prevention.

METHODS

A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children's experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials.

RESULTS

Both the animated video and a web-based game increased children's knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements.

CONCLUSIONS

This study shows that both materials were effective for improving children's education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns.

A review of vaccine effects on women in light of the COVID-19 pandemic

The pandemic situation triggered by the spread of COVID-19 has caused great harm worldwide. More than six million people have been infected, and more than 360,000 of them have died. This is the worst catastrophe suffered by mankind in recent history. In the face of this severe disaster, people all over the world are frightened of the prospect of facing an outbreak or an annual recurrence. However, the development of a vaccine will help control the impact of COVID-19. Women in particular have been more seriously affected by the pandemic. Since the pressure and physical load they suffer are often greater than what men endure, women are more threatened by COVID-19. Though women have a poorer quality of life and work and face worse economic conditions, they also tend to have better physiological immunity than men, which can ease the effect of COVID-19. The early development of a vaccine against COVID-19 is an important issue that must take into consideration women's better immune response to the virus along with the technique of hormone regulation. Relevant research has been conducted on female-specific vaccines in the past, and women's issues were considered during those clinical trials to ensure that complications and antibody responses were positive and effective in women. National policies should also propose good strategies for women to be vaccinated. This could improve consciousness, give women a better vaccination experience, enhance their willingness to vaccinate, and protect them from COVID-19 infection.

Evaluation of the acceptability in France of the vaccine against papillomavirus (HPV) among middle and high school students and their parents

BACKGROUND

The pathogenic and oncogenic roles of papillomavirus (HPV) infections have been documented and shown to occur in women as well as in men. While other countries have already extended their vaccination guidelines to include boys, in 2019 the French National Authority for Health validated implementation of HPV vaccination in the 2020 vaccination schedule. There is, however, a climate of distrust in regard to vaccination in France, and there have been few studies to date regarding the acceptability of HPV vaccination in boys in France. The aim of this study was, therefore, to evaluate the acceptability of extending the recommendations for HPV vaccination in men, among middle and high school students and their parents.

METHODS

Our study (HPVac) was a prospective, multicenter, departmental, and descriptive survey applied to a sample of male middle and high school students attending schools in the Loire-Atlantique department and their parents. It took place from January 2017 to January 2018.

RESULTS

We analyzed the information obtained from 127 parent questionnaires and 145 children questionnaires. In terms of acceptability, 36.6% (n = 53) of the children and 37.8% (n = 48) of the parents were in favour of being vaccinated or of having their children vaccinated against HPV (51.7% (n = 75) and 50.4% (n = 64), respectively, were undecided). The perception of a risk stemming from HPV infection was positively associated with acceptability of the HPV vaccine. Being against vaccines in general, being discouraged by their parents, parents thinking that their child is not at risk, and the belief that the vaccine is not mandatory were arguments cited and significantly associated with a willingness to be vaccinated.

CONCLUSION

This study revealed a lack of information among boys and their parents about HPV and its vaccination. It also clearly showed that taking time to discuss the consequences of an infection and the merits of being vaccinated can help parents overcome their reluctance. The children then generally go along with their parent's choice.

A human rights approach to understanding provider knowledge and attitudes toward the human papillomavirus vaccine in São Paulo, Brazil

Objective

To determine the extent to which human rights considerations influence the attitudes of healthcare providers in Brazil with regard to access to the human papillomavirus (HPV) vaccine for females over 13 and males of all ages.

Methods

From May to August 2015, we conducted a cross-sectional study among healthcare providers in eight public health clinics in the city of Mauá, Brazil. Frequency analysis was conducted across three subject areas: access, knowledge, and attitudes.

Results

A total of 154 surveys were analyzed. Providers reported their perception that Brazilians do not have equal access to health (80%) and the vaccine exclusions limit an individual's right to health (72%). Providers stated it is medically effective to vaccinate females over the age of 13 (77%), these females should be vaccinated (84%), and they would vaccinate them (82%). Similar responses were reported for males.

Conclusion

Cervical cancer is the 4th leading cause of cancer among females in Brazil. Most cervical cancer cases are caused by persistent HPV infection, preventable through HPV vaccination. Limiting access to the HPV vaccine when medically efficacious is a perceived infringement of an individual's right to health. Brazil has a constitutional responsibility to reduce these access barriers.

Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review

Objectives

HPV vaccination rates in the United States lag behind other developed countries. Educational interventions are primarily directed at patients and parents rather than healthcare providers (HCPs), despite evidence that provider recommendation is a key determinant of vaccine uptake. The objectives for this review are to synthesize the available evidence related to the knowledge, attitudes, and beliefs of HCPs surrounding HPV vaccination, to summarize provider-specific educational interventions which have been evaluated, and to review existing provider-specific educational resources from national organizations and whether they align with the gaps identified.

Methods

A systematic search was performed using PubMed, Web of Science, CINAHL, and ERIC with MeSH terms human papillomavirus, vaccine, education, workshop, training, knowledge, attitude, belief, intention, and healthcare provider. Full text articles were obtained for studies that described the knowledge and attitudes of providers and/or impact of educational interventions. Data extraction was performed by four independent reviewers. Websites of American organizations with an interest in HPV vaccination were manually searched for provider resources.

Results

1066 publications were identified, and 98 articles were fully reviewed with 40 ultimately included. Providers’ knowledge on HPV was generally low with a correspondingly low vaccine recommendation rate. Provider-specific education (e.g., didactic session and communication training) with complimentary interventions demonstrated increased knowledge and vaccine series initiation and completion. Themes identified in descriptive studies highlighted providers’ lack of general HPV and vaccine knowledge, low self-confidence in counselling and addressing parental concerns, and discomfort in discussing sexual issues related to vaccination. Many American organizations have provider-specific resources; however, the effectiveness of these materials has not been established.

Conclusions

HPV knowledge among providers remains low. Educational interventions to improve knowledge and communication appear to be effective. A breadth of resources from national organizations are available but their efficacy and level of utilization is largely unknown. Coordinated efforts are needed to evaluate provider-specific educational resources to improve vaccine uptake in the US.

Abandoning Medical Authority: When Medical Professionals Confront Stigmatized Adolescent Sex and the Human Papillomavirus (HPV) Vaccine

Despite authority's centrality to the medical profession, providers routinely forgo their medical authority during clinical encounters. Research focuses on patients challenging medical authority but indicates these confrontations are uncommon and providers seldom relinquish their authority in response. Using rare data of 75 audio recordings of adolescent vaccine discussions during clinical encounters and interviews with and observations of medical staff, I examine how staff leverage or abandon their medical authority to convince parents to vaccinate. I find medical professionals use less authority when at risk of stigmatizing patients: Medical professionals are less authoritative when recommending human papillomavirus (HPV) vaccination versus other adolescent vaccines, particularly when addressing the need to vaccinate before sexual onset due to concerns of labeling the child as sexually active. Medical staff defer to parents in ways that potentially discourage HPV vaccine uptake: They encourage HPV vaccination less than other vaccines and infrequently challenge parents' sex-related reasons for vaccine refusal.

Primary Care Physicians' Role in Parental Decision to Vaccinate with HPV Vaccine: Learnings from a South Texas Hispanic Patient Population

Hispanic populations have low HPV vaccination rates, although the vaccine is safe and efficacious. We surveyed a low-income Hispanic population to characterize knowledge gaps about the HPV vaccine and understand factors associated with the decision to vaccinate a child to determine how physicians can enhance vaccination rates. Surveys in English and Spanish were distributed to parents of children under age 18. Statistical analysis included logistic regression. Knowledge that the vaccine can prevent invasive cervical cancer most impacted intent to vaccinate. Physician recommendation to vaccinate was far more influential in a parent's decision compared to TV and other sources. Girls are more likely to receive the HPV vaccine over boys. While physician recommendation is critical, they have minimal time for education. Our results suggest that physicians should focus on the vaccine's link to cancer prevention, leaving other knowledge areas for the interdisciplinary care team.

US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review

Clinicians' recommendation for the human papillomavirus (HPV) vaccine appears to be an important driver of parental decisions about vaccination. Our aim was to synthesize the best available evidence exploring the perceptions and experiences regarding HPV vaccination, from the perspective of the US clinician. We conducted a comprehensive literature search of Academic Search Complete, CINAHL Plus, Communication & Mass Media Complete, Consumer Health Complete (EBSCOhost), ERIC, Health and Psychosocial Instruments, MEDLINE with full text, and PsycINFO databases. We identified 60 eligible articles: 48 quantitative and 12 qualitative. We extracted the following information: study purpose, use of theory, location, inclusion criteria, and health care provider classification. Results were organized into 5 categories: 1) clinicians' knowledge and beliefs about HPV and the HPV vaccine, 2) clinicians' attitudes and beliefs about recommending HPV vaccines, 3) clinicians' intention to recommend HPV vaccines, 4) clinicians' professional practices regarding HPV vaccination, and 5) patient HPV vaccination rates. Although clinicians were generally supportive of HPV vaccination, there was a discrepancy between clinicians' intentions, recommendation practices, and patient vaccination rates. Studies reported that clinicians tended not to provide strong, consistent recommendations, and were more likely to recommend HPV vaccines to girls versus boys and to older versus younger adolescents. Analyses revealed a number of facilitating factors and barriers to HPV vaccination at the clinician, parent/patient, and systems levels, including clinician knowledge, clinician beliefs, and office procedures that promote vaccination. This review provides an evidence base for multilevel interventions to improve clinician HPV vaccine recommendations and vaccination rates.

College Males' Enduring and Novel Health Beliefs about the HPV Vaccine

College males represent an important and overlooked catch-up population in the pursuit of human papillomavirus (HPV) prevention. An in-depth understanding of college males' health beliefs about HPV and HPV prevention can guide the development of HPV health promotion messages targeted toward college males. We convened 9 focus groups among 84 college-aged males to discuss their perceptions of benefits and barriers toward HPV prevention 4 years after vaccine approval. Through participants' discourse, we identified health beliefs that continue to endure as barriers to HPV prevention (e.g., lack of knowledge/awareness, apathy, dismissiveness, stigma, practical barriers, and skepticism). Prevention and protection endure as perceived benefits to HPV prevention. We also identified novel college male health beliefs that have emerged since vaccine approval and hold great potential for the development of more effective health messaging. One novel barrier that emerged was the perception that it was "too late" for college males to benefit from the vaccine. Several novel benefits also emerged including a perception of wider social benefit beyond the self and partner, reduced worry and anticipated regret, and the belief that "there is no reason not to [vaccinate]." This study was guided by the health belief model (HBM) and implications are discussed.

On the implications of desexualizing vaccines against sexually transmitted diseases: health policy challenges in a multicultural society

Two vaccines against sexually transmitted infections are included in many national vaccination programs: Hepatitis B Virus (HBV) vaccine and Human Papilloma Virus (HPV) vaccine. The trajectories of the implementation of these two programs were marked by differences in the way the sexual context of risk was communicated to the public. These trajectories fluctuated between full accounts of the sexual nature of the infection and attempts to desexualize the vaccines. Vaccine desexualization can be achieved by withholding information of sexual context, blurring information, and distancing the age of vaccination from the age of sexual debut. Desexualization may be advantageous in promoting public health and personal health of people who believe that HPV vaccination leads to increased promiscuity, people who believe that protection against STD is not relevant to their children, and people who are not comfortable discussing the sexuality of their children. On the other hand, desexualizing may be disadvantageous for children to parents who tend to express passiveness towards vaccination, parents who attribute importance to sex education, and teenagers with homosexual orientations. The ethical analysis of vaccine desexualization reveals a complex interplay of considerations related to utility, causation of harm, duty of transparency, right to know, and right not to know. This analysis suggests that the moral merits of applying desexualization are questionable. Lastly, a sociopolitical consideration of the matter, suggests that decisions on vaccine desexualization can have implications on the interrelationships between various social groups and subgroups composing a certain population, and may highlight intercultural schisms. All this indicates that shaping the sexual framework of vaccination programs bears implications far beyond the practical considerations of vaccine promotion.

A study of physicians' experiences with recommending HPV vaccines to adolescent boys

Assessing physicians' experiences in HPV vaccine recommendation and delivery to adolescent boys is essential to providing an understanding of the issues of vaccine acceptance and an insight for policymakers to enhance HPV vaccinations among adolescent boys. Between January and April 2014 a mail survey was conducted using physicians in Malaysia known to provide either one or both HPV vaccine (Gardasil and Cervarix) immunisation services. A total of 357 completed questionnaires were received (response rate 22.5%). Of these, 335 physicians see adolescent boys aged 11 to 18 years old in their practice. Only 26.3% (n = 88) recommended the HPV vaccine to these boys. A total of 46.6% (n = 41) have successfully given the HPV vaccine to adolescent boys. A lack of proper guidelines from the health authorities regarding the recommendation of HPV vaccine to the boys (37.2%) and a lack of awareness of the availability of the vaccine for boys (32.8%) were the most commonly cited reasons for non-recommendation. Impact statement Recommending the HPV vaccine for adolescent boys remains a challenge for physicians. Our study provides evidence of challenges and barriers faced by Malaysian physicians who recommend the HPV vaccines (Gardasil and Cervarix) in their practices. In this study, physicians reported HPV vaccine uptake by adolescent boys was very poor. A lack of proper guidelines from the health authorities regarding the recommendation of HPV vaccine to boys and a lack of awareness of the availability of the vaccine for boys were the most commonly cited reasons for non-recommendation. Physicians viewed that support and encouragement from the health authorities are needed to promote the recommendation of the HPV vaccine to adolescent boys. Physicians were also of the opinion that the lay public should be educated about the availability of the HPV vaccine for boys, and its benefits, safety and efficacy, and the high susceptibility of boys to getting HPV infections. The findings provide insights that could be helpful to policymakers or high-level decision-makers of the potential strategies to enhance HPV uptake among adolescent boys.

Human Papillomavirus Vaccination Among Adults and Children in 5 US States

CONTEXT

The Centers for Disease Control and Prevention Advisory Committee for Immunization Practices has recommended human papillomavirus (HPV) vaccines for use in children and young adults for preventing HPV-related diseases, but HPV vaccine coverage is low in the United States.

OBJECTIVE

To assess HPV vaccination among US adults and children and to identify characteristics associated with HPV vaccination.

METHODS

We used the 2010 Behavioral Risk Factors Surveillance System data to examine HPV vaccine initiation and completion among adults aged 18 to 26 years and children aged 9 to 17 years in 5 US states. We performed a multivariate logistic regression to evaluate factors associated with HPV vaccination.

RESULTS

We assessed the HPV vaccination status of 706 women and 560 men and 2201 girls and 2292 boys. In 2010, a total of 258 (41.6%) women and 21 (4.3%) men had initiated HPV vaccination. Of those vaccinated women, 182 (75%) completed the 3-dose vaccine series. Rural residence (adjusted odds ratio [aOR] = 0.37) and not having a Papanicolaou test (aOR = 0.44) were negatively associated with HPV vaccine initiation among women. Women who were aged 18 to 20 years (aOR = 2.93) were more likely to complete HPV vaccination. A total of 612 (24.6%) girls and 86 (5.2%) boys received 1 or more doses of HPV vaccines; 308 (50.3%) vaccinated girls and 14 (10.8%) vaccinated boys completed the vaccine series. Younger age (9-12 years: aOR = 0.09) and not receiving a seasonal influenza vaccine (aOR = 0.44) were negatively related to HPV vaccine initiation in girls. Girls were less likely to initiate and complete HPV vaccination if their parents did not have a routine checkup within 1 year.

CONCLUSION

HPV vaccination in the United States remains below the Healthy People 2020 objective (80%). To increase HPV vaccination, strategies still need to focus on improving access to HPV vaccines and utilization of health services.

Gender of the Clinician, Child, and Guardian and the Association With Receipt of Routine Adolescent Vaccines

PURPOSE

To analyze the relationship of the gender of the clinician, child, and guardian to the child's receipt of human papilloma virus (HPV) vaccine, which prevents a sexually transmitted infection, compared to tetanus, diphtheria, acellular pertussis (Tdap) and meningococcal dose 1 (MCV4) vaccines, which do not.

METHODS

We extracted electronic health record data from visits by adolescents 11-18 years of age to 27 primary care practices from 2009 to 2014. Visits with pediatricians, physician assistants, and nurse practitioners were included if they were the first at which HPV vaccine was due (n = 102,736). After stratifying by visit type (preventive/acute), generalized estimating equations with robust variance estimators accounted for clustering of visits within practices. Adjusting for all covariates, these models were used to estimate standardized proportions of "captured opportunities" (vaccine due and given) for HPV dose 1 (HPV), Tdap, and MCV4.

RESULTS

Fewer opportunities were captured at acute versus preventive visits. Although rates were low, female clinicians delivered all three vaccines at higher rates than male clinicians at acute (HPV: 2.7% vs. 1.2%, p < .001; Tdap: 6.4% vs. 4.1%, p = .013; MCV4: 6.0% vs. 3.7%, p = .013) but not preventive visits. Girls received HPV vaccine at higher rates than boys early in the study period, but the gap closed over time (p < .001). Guardian gender was not associated with vaccination.

CONCLUSIONS

Clinician gender was associated with vaccination at acute, but not preventive, visits. In the context of efforts to increase acute visit vaccination, differences between female and male clinicians' rates might reflect alternate practice styles by gender that deserve future study.

Provider communication about HPV vaccination: A systematic review

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.

Social marketing to promote HPV vaccination in pre-teenage children: talk about a sexually transmitted infection

A significant barrier to the delivery of HPV vaccine is reluctance by both healthcare providers and parents to vaccinate at age 11 or 12, which may be considered a young age. This barrier has been called “vaccine hesitancy” in recent research. In this commentary, we suggest using social marketing strategies to promote HPV vaccination at the recommended preteen ages. We emphasize a critical public health message of a sexually transmitted infection (STI) as preventable and vaccination against HPV as a way to protect against its consequences. The message tackles the issue of vaccine hesitancy head on, by saying that most people are at risk for HPV and there is a way to prevent HPV's serious consequences of cancer. Our approach to this conversation in the clinical setting is also to engage the preteen in a dialog with the parent and provider. We expect our emphasis on the risk of STI infection will not only lead to increased HPV vaccination at preteen ages but also lay important groundwork for clinical adoption of other STI vaccines in development (HIV, HSV, Chlamydia, and Gonorrhea) as well as begin conversations to promote sexual health.

Sociodemographic Differences in Human Papillomavirus Vaccine Initiation by Adolescent Males

PURPOSE

The purpose of this study was to describe patterns of human papillomavirus (HPV) vaccine initiation by males and characterize sociodemographic differences.

METHODS

We conducted a retrospective cohort study of 11- to 18-year-old males in a large primary care network who had a preventive or acute visit between October 2009 and December 2013. Outcomes measured were HPV vaccine series initiation and initiation at the first eligible visit. Logistic regression measured independent associations between outcomes and sociodemographic characteristics, adjusting for potential confounders including visit frequency, insurance changes, and the presence of complex medical conditions.

RESULTS

Of 58,757 eligible patients, most were white (57%) with private insurance (77%). During the study period, 39% of the cohort initiated the vaccine series, and 7% initiated at their first eligible visit. Black patients with private (adjusted odds ratio [aOR], 1.99; 95% confidence interval [CI], 1.73-2.30) and Medicaid insurance (aOR, 2.90; 95% CI, 2.56-3.30) had significantly higher odds of HPV vaccine initiation compared with white patients with private insurance. A similar trend was found for Hispanic patients with private (aOR, 1.45; 95% CI, 1.26-1.67) and Medicaid insurance (aOR, 2.15; 95% CI, 1.78-2.60). These differences were present both in the preroutine recommendation period (2009-2011) and the postroutine recommendation period (2012-2013).

CONCLUSIONS

Traditionally marginalized populations have higher odds of HPV vaccine initiation, both at the first eligible visit and overall. Although the true mechanism underlying these differences remains unknown, potential candidates include provider recommendation patterns and differential vaccine acceptance within these groups.

Recommendations and administration of the HPV vaccine to 11- to 12-year-old girls and boys: a statewide survey of Georgia vaccines for children provider practices

OBJECTIVE

This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination.

MATERIALS AND METHODS

This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design.

RESULTS

Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices.

CONCLUSIONS

Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.

Human papillomavirus vaccination of females in a large health claims database in the United States, 2006-2012

PURPOSE

Information on vaccine utilization from a variety of sources is useful to give a status of the vaccine program and define opportunities to improve uptake. We evaluated MarketScan Commercial Claims and Encounters database on human papillomavirus (HPV) vaccine initiation and completion of all three doses among girls/women from 2006 to 2012.

METHODS

Data were obtained from the 2006-2012 MarketScan Commercial Claims and Encounters database. The study population included female enrollees aged 11-26 years who were continuously enrolled in the same private insurance plan from 2006 to 2012 (n = 407,371). We evaluated overall and yearly vaccine initiation and completion, demographic characteristics associated with vaccine initiation, clinical visits in which vaccine was given, and missed opportunities for vaccination.

RESULTS

By the end of 2012, 36.9% of females aged 11-26 years had received at least one HPV vaccine dose. Vaccination coverage was highest among females aged 17-18 years (49.3%) and aged 15-16 years (43.1%) and lowest among females aged 11-12 years (16.8%). Between 2007 and 2012, 96.1% of the 246,192 unvaccinated females had at least one missed opportunity (a heath care visit without HPV vaccine administered).

CONCLUSIONS

Over a 6 year period, HPV vaccine initiation was lowest in the girls aged 11-12 years. Importantly, most (96.1%) unvaccinated females had at least one missed vaccination opportunity, and providers and health systems should focus efforts on using existing visits for vaccination.

Human papillomavirus vaccine initiation among 9–13-year-olds in the United States

The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9–26-year-old males and females, with routine vaccination recommended for 11–12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13–17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9–13-year-olds in the United States. A national sample of mothers of 9–13-year-olds in the United States (N = 2446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child's HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child's initiation of the HPV vaccine (i.e., receipt of one or more doses). Approximately 35% of the full sample and 27.5% of the 9–10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers' communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage.

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Approximately 35% of 9–13-year-olds had initiated the HPV vaccine series.

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A quarter of 9–10-year-olds had initiated the HPV vaccine series.

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At age 13, females were more likely than males to have initiated HPV vaccination.

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No gender difference in HPV vaccine initiation was found prior to age 13.

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Provider recommendation was a particularly salient predictor of HPV vaccination

HPV vaccine hesitancy: findings from a statewide survey of health care providers

INTRODUCTION

Health care provider recommendations are critical for human papillomavirus (HPV) vaccine uptake. We sought to describe providers' HPV vaccine recommendation practices and explore their perceptions of parental hesitancy.

METHOD

A statewide sample (n = 575) of Minnesota health care providers (20% pediatricians, 47% family medicine physicians, and 33% nurse practitioners) completed our online survey in April 2013.

RESULTS

Only 76% of health care providers reported routinely recommending HPV vaccine for girls ages 11 to 12 years, and far fewer (46%) did so for boys (p < .001). A majority of providers reported asking questions about parents' concerns (74%), but many lacked time to probe reasons (47%) or believed that they could not change parents' minds (55%). Higher levels of self-efficacy and outcome expectations were associated with routine recommendations (p < .05).

DISCUSSION

Findings suggest that providers' perceptions of hesitancy may discourage them from routinely recommending the HPV vaccine. Improving providers' self-efficacy to address hesitancy may be important for improving vaccination rates.

Physicians' human papillomavirus vaccine recommendations in the context of permissive guidelines for male patients: a national study

BACKGROUND

Little is known about physicians' human papillomavirus (HPV) vaccine recommendations for males while the Advisory Committee on Immunization Practices' (ACIP) permissive guidelines for male vaccination were in effect. The purpose of this study was to examine and explore factors associated with U.S. physicians' HPV vaccine recommendations to early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) males.

METHODS

Nationally representative samples of family physicians and pediatricians were selected in 2011 (n = 1,219). Physicians reported the frequency with which they recommended HPV vaccine to male patients ["always" (>75% of the time) vs. other] for each age group. Statistically significant predictors of vaccine recommendation were identified using multivariable logistic regression.

RESULTS

The prevalence of physicians reporting they "always" recommended HPV vaccination for males was 10.8% for ages 11 to 12, 12.9% for ages 13 to 17, and 13.2% for ages 18 to 26. Pediatrician specialty and self-reported early adoption of new vaccines were significantly associated with recommendation for all patient age groups. In addition, physician race and patient payment method were associated with physician recommendations to patients ages 11 to 12, and patient race was associated with recommendations to ages 13 to 17 and 18 to 26.

CONCLUSIONS

Less than 15% of physicians surveyed reported "always" recommending HPV vaccine to male patients following national guidelines for permissive vaccination. Vaccine financing may have affected physicians' vaccine recommendations.

IMPACT

If these recommendation practices continue following the ACIP's routine recommendation for males in October 2011, then interventions designed to increase recommendations should target family physicians and possibly use early adopters to encourage support of HPV vaccination guidelines.

Factors impacting HPV vaccination: lessons for health care professionals

HPV infection leads to significant morbidity and mortality worldwide. The HPV vaccine is currently licensed and recommended for adolescents and young adults in many countries. Nonetheless, coverage levels remain low, especially in settings using a clinic-based rather than school-based delivery model. Health care professionals (HCPs) have the potential to strongly impact HPV vaccine acceptability and uptake, yet often fail to discuss and/or strongly recommend HPV vaccination. This article reviews the myriad factors that influence HPV vaccination, focusing, in particular, on those relevant to HCP communication with patients and families. It also provides a historical framework and highlights recent evidence related to HPV vaccination that may be valuable for these conversations. Lastly, it discusses strategies targeting HCPs and their practices that may increase HPV vaccination initiation and completion rates globally.

Managing uncertainty: healthcare professionals' meanings regarding the HPV vaccine

BACKGROUND

New preventive technologies such as vaccines offer insight into psychological, social, and cultural landscapes. Providers have a key role in parents' decisions for vaccinating their children. Yet, perspectives from providers regarding the human papillomavirus (HPV) vaccine, or vaccination in general, are rarely sought

PURPOSE

Our objective in this paper is to understand how the HPV vaccine is perceived by health care providers and the multiple contextual meanings it elicits.

METHODS

We conducted interviews with 20 health care professionals in Bulgaria about their attitudes and practices related to HPV vaccination and their recommendations for policies. The verbatim-transcribed interviews were analyzed through narrative analysis, with a special focus on language.

RESULTS

We illustrate providers' contradictory and contextualized constructions of the vaccine and the narrative strategies they use to manage any uncertainty it elicits. These include being advocates and missionaries for preventive health, confirming their trust in the medical profession and professional organizations, challenging patients' concerns with rational explanations, normalizing the risk of medical innovations, and avoiding the sexual nature of HPV transmission.

CONCLUSIONS

The introduction of a vaccine to prevent HPV infection, and by implication, possibly cervical and other cancers, created hope, and at the same time, intensified confusion and uncertainty. Providers have been frustrated for years with the rising mortality from cervical cancer in Bulgaria, and their perceived powerlessness in affecting this. HPV vaccination, on the other hand, seems relatively simple and "taming uncertainty" positions them as instrumental in limiting (or even eliminating) morbidity and mortality in future generations.

School-based vaccination of young US males: impact of health beliefs on intent and first dose acceptance

Little is known about adolescent males and their parents with respect to intent and first dose uptake of the human papillomavirus (HPV) vaccine outside of primay care settings. The purpose of this study was to evaluate potential predictors of parental intent to vaccinate (study was conducted in November 2010-December 2012) and of first dose uptake of HPV vaccine among a sample of young adolescent males, 11-15 years of age, who received care at a school-based health center (SBHC). We also examined intent as a potential mediator of the relationships between predictors (health beliefs and perceived spousal agreement) and vaccination. Slightly more than half (n=135 of 249) of parents reported an intention to vaccinate and 28% (n=69) of males received their first dose of the HPV vaccine. Two of three health beliefs were significantly associated with both intention and uptake as was perceived spousal agreement. We found intention to vaccinate was a partial mediatator between the perceived benefits of HPV vaccine and first dose acceptance. We also determined that intent was a strong mediator between both general immunization benefits and perceived spousal agreement and first dose uptake. While vaccine uptake was lower than expected, particularly considering that many barriers to vaccine initiation were eliminated because of the SBHC setting, this rate is higher than in traditional settings. After controlling for intent, only perceived benefits of the HPV vaccine remained a significant predictor of first dose acceptance.

Missed opportunities for adolescent vaccination, 2006-2011

OBJECTIVE

To describe missed opportunities for meningococcal (MCV); tetanus, diphtheria, acellular pertussis (Tdap); and human papillomavirus (HPV) vaccination among adolescents.

METHODS

Retrospective electronic health record data review of adolescents aged 11-18 years at the time of their visit to a university-based pediatric practice in Seattle from 2006 to 2011. The primary outcome was missed vaccination opportunities, defined as the proportion of visits where a patient eligible for MCV, Tdap, and/or HPV remained unvaccinated. HPV vaccine analysis was limited to females. Bivariate and multivariate logistic regression assessed variables associated with missed vaccination opportunities.

RESULTS

During the study period, 1,628 adolescents made 9,180 visits. The percentage of visits that were missed opportunities was 82% for MCV, 85% for Tdap, and 82% for the first HPV dose (HPV1), 63% for the second, and 71% for the third. Adolescents with at least one preventive care visit were significantly less likely to have missed opportunities for MCV, Tdap, or HPV1. Nonpreventive visits were associated with more missed opportunities for MCV (OR = 19.2, 95% CI 15.3-24.0), Tdap (OR = 25.8, 95% CI 19.3-34.6), and HPV1 (OR = 12.1, 95% CI 9.0-16.1) than preventive visits. Adolescent females were more likely to have a missed opportunity for HPV1 than Tdap (p < .001) or MCV (p = .03).

CONCLUSIONS

Missed opportunities for adolescent vaccination against MCV, Tdap and HPV are common. Adolescents who utilize preventive care are less likely to have missed vaccination opportunities. Further research is needed to explore why missed vaccination opportunities occur and to develop evidence-based strategies to reduce missed opportunities and improve adolescent vaccination coverage.

Sources of HPV vaccine hesitancy in parents

Despite strong national recommendations to vaccinate adolescents against the human papillomavirus (HPV), only 14% of teenage girls completed all 3 doses in 2010. Parental hesitancy may be one of the strongest reasons behind this low uptake rate. This review investigates sources of parental hesitancy including parental concerns associated with vaccinations in general, parental knowledge as a basis of HPV vaccine hesitancy, social qualms parents may have with regards to the HPV vaccine, and parental attitudes toward allowing their sons to be vaccinated against HPV. By better understanding these sources of hesitancy, we can focus research efforts towards addressing them in an attempt to improve HPV vaccine uptake.

Predictors of three dose on-time compliance with HPV4 vaccination in a disadvantaged, underserved, safety net population in the US Midwest

BACKGROUND

HPV4 is approved as a series of three timed doses expected to result in efficacy against specific HPV infections. Completion rates in the US are quite low at the same time the structure of health care delivery is changing. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population.

METHODS

This is a retrospective study in which patient-, clinic- and systems-level data are abstracted from the electronic medical record (EMR) for all females 10-26 years of age receiving at least one dose of HPV4 between July 1, 2006 and October 1, 2009.

RESULTS

Adults were more likely to complete the three dose series if they had at least one health care visit in addition to their HPV4 visit, (aOR = 1.54 (95% CI:1.10, 2.15). Adults were less likely to complete the three dose series if they received their second HPV4 dose at an acute health care, preventive care or postpartum visits compared to an HPV4-only visit (aOR = 0.31 (95% CI: 0.13, 0.72), 0.12 (0.04, 0.35), 0.30 (0.14, 0.62), respectively). Hispanic adults were less likely than whites to complete the series (aOR = 0.24 (95% CI:0.10, 0.59). 39% of adolescents who completed two doses completed the series.

CONCLUSIONS

HPV4 is more likely to be effectively administered to adults in a safety net population if multiple health care needs can be met within the health care system.

Towards the eradication of HPV infection through universal specific vaccination

BACKGROUND

The Human Papillomavirus (HPV) is generally recognized to be the direct cause of cervical cancer. The development of effective anti-HPV vaccines, included in the portfolio of recommended vaccinations for any given community, led to the consolidation in many countries of immunization programs to prevent HPV-related cervical cancers. In recent years, increasing evidence in epidemiology and molecular biology have supported the oncogenic role of HPV in the development of other neoplasm including condylomas and penile, anal, vulvar, vaginal, and oro-pharyngeal cancers. Men play a key role in the paradigm of HPV infection: both as patients and as part of the mechanisms of transmission. Data show they are affected almost as often as women. Moreover, no screening procedures for HPV-related disease prevention are applied in men, who fail to undergo routine medical testing by any medical specialist at all. They also do not benefit from government prevention strategies.

DISCUSSION

A panel of experts convened to focus on scientific, medical, and economic studies, and on the achievements from health organizations' intervention programs on the matter. One of the goals was to discuss on the critical issues emerging from the ongoing global implementation of HPV vaccination. A second goal was to identify contributions which could overcome the barriers that impede or delay effective vaccination programs whose purpose is to eradicate the HPV infection both in women and men.

SUMMARY

The reviewed studies on the natural history of HPV infection and related diseases in women and men, the increasing experience of HPV vaccination in women, the analysis of clinical effectiveness vs economic efficacy of HPV vaccination, are even more supportive of the economic sustainability of vaccination programs both in women and men. Those achievements address increasing and needed attention to the issue of social equity in healthcare for both genders.

Longitudinal predictors of human papillomavirus vaccination among a national sample of adolescent males

OBJECTIVES

We conducted a longitudinal study to examine human papillomavirus (HPV) vaccine uptake among male adolescents and to identify vaccination predictors.

METHODS

In fall 2010 and 2011, a national sample of parents with sons aged 11 to 17 years (n = 327) and their sons (n = 228) completed online surveys. We used logistic regression to identify predictors of HPV vaccination that occurred between baseline and follow-up.

RESULTS

Only 2% of sons had received any doses of HPV vaccine at baseline, with an increase to 8% by follow-up. About 55% of parents who had ever received a doctor's recommendation to get their sons HPV vaccine did vaccinate between baseline and follow-up, compared with only 1% of parents without a recommendation. Fathers (odds ratio = 0.29; 95% confidence interval = 0.09, 0.80) and non-Hispanic White parents (odds ratio = 0.29; 95% confidence interval = 0.11, 0.76) were less likely to have vaccinated sons. Willingness to get sons HPV vaccine decreased from baseline to follow-up among parents (P < .001) and sons (P = .003).

CONCLUSIONS

Vaccination against HPV remained low in our study and willingness to vaccinate may be decreasing. Physician recommendation and education about HPV vaccine for males may be key strategies for improving vaccination.

Human papillomavirus vaccine uptake among 9-17 year old males in the United States: the National Health Interview Survey, 2010

In 2009, a quadrivalent HPV vaccine was approved and "permissively" recommended for US males aged 9 to 26 y to protect against genital warts. The purpose of this study was to examine parental awareness and HPV vaccine uptake among 9-17 y old males during the first year following this recommendation. Data from the 2010 National Health Interview Survey (NHIS) were obtained to assess vaccination status (n = 2973) of this age group. Univariate logistic regression analysis was performed to examine correlates of parental awareness and uptake of the HPV vaccine. Overall, 55% of parents with sons were aware of the HPV vaccine. The likelihood of parental awareness was lower among minorities and adolescents with low family incomes, and higher among adolescents with insurance, higher parental education, and those who had a well-child check up and dental examination in the past year than their counterparts. Only 2.0% and 0.5% of 9-17 y old males initiated (≥ 1 dose) and completed (≥ 3 doses) the vaccine series, respectively. Adolescents with a Hispanic origin (odds ratio (OR) 2.03, 95% confidence interval (CI) 1.09-3.78), low family income (OR 2.89, 95% CI 1.48 -5.57), and history of influenza vaccination in the past year (OR 1.89, 95% CI 1.11 -3.22) were more likely than their counterparts to initiate the HPV vaccine. On the other hand, adolescents with private insurance (OR 0.44, 95% CI 0.20 -0.94) and those who had college educated parents (OR 0.45, 95% CI 0.22 -0.89) were less likely to initiate the vaccine. This study showed that very few adolescent males received any doses of HPV vaccine during the first year following its recommendation for this gender. Thus, interventional programs are needed to improve vaccine uptake among adolescent males.

HPV vaccination of boys in primary care practices

OBJECTIVE

In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians': 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys.

METHODS

We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010.

RESULTS

The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds.

CONCLUSIONS

Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings.

Human papillomavirus infection: knowledge, attitudes, and behaviors among lesbian, gay men, and bisexual in Italy

BACKGROUND

This cross-sectional study assess knowledge, attitudes, and behavior towards the human papillomavirus (HPV) and the vaccination among a random sample of 1000 lesbian, gay men, and bisexual women and men.

METHODS

A face-to-face interview sought information about: socio-demographic characteristics, knowledge about HPV infection, perception of risk towards HPV infection and/or cervical, anal, and oropharyngeal cancers, perception of the benefits of a vaccination to prevent cervical, anal, and oropharyngeal cancers, sexual behaviors, health-promoting behaviors, and willingness to receive the HPV vaccine.

RESULTS

Only 60.6% had heard about the HPV infection and this knowledge was significantly higher in female, in those being a member of a homosexual association, in those having had the first sexual experience at a younger age, in those having received information about the HPV infection from physicians, and in those having no need of information about HPV infection. A higher perceived risk of contracting HPV infection has been observed in those younger, lesbian and gay men, who have heard of HPV infection and knew the risk factors and its related diseases, who have received information about HPV infection from physicians, and who need information about HPV infection. Only 1.7% have undergone HPV immunization and 73.3% professed intent to obtain it in the future. The significant predictors of the willingness to receive this vaccine were belief that the vaccination is useful, perception to be at higher risk of contracting HPV infection, and perception to be at higher risk of developing cervical, anal, and oropharyngeal cancers.

CONCLUSIONS

Information and interventions are strongly needed in order to overcome the lack of knowledge about HPV infection and its vaccination. Inclusion of boys in the national vaccination program and initiate a catch-up program for men who have sex with men up to 26 years may reduce their burden of HPV-related disease.

Provider factors associated with disparities in human papillomavirus vaccination among low-income 9- to 17-year-old girls

BACKGROUND

Many women who develop cervical cancer are eligible for or are participants of Medicaid. Providing human papillomavirus (HPV) vaccination to girls enrolled in Medicaid may reduce cervical cancer disparities in low-income and minority women. This study evaluated provider characteristics associated with HPV vaccination among 9- to 17-year-old female Medicaid enrollees.

METHODS

A random sample of 800 providers from the Florida Medicaid Master Provider File was mailed a survey in October 2009 that evaluated demographic and practice characteristics, HPV information and knowledge, barriers to HPV vaccination, vaccine practices, and vaccine recommendation practices. To measure HPV vaccination, Medicaid claims data were used to calculate the proportion of eligible patients who received at least 1 dose of the vaccine from participating providers within the study period. Provider factors associated with vaccination at the bivariate level were evaluated in a multiple linear regression model.

RESULTS

The response rate was 68.3% (N = 485). After excluding ineligible respondents, the current analysis included 433 providers. HPV vaccination prevalence ranged from 0% to 61.9% (M = 20.4, standard deviation = 14.5). HPV vaccination rates were higher among providers who were pediatricians, had a private practice, practiced in a single specialty setting, were providers under the Vaccines for Children program, saw primarily non-Hispanic white patients, used 2 or more strategies for vaccine series completion, and did not refer out for HPV vaccination.

CONCLUSIONS

Despite financial coverage for Medicaid-eligible girls, HPV vaccination rates are low. Study findings can be used to target health services interventions to providers least likely to administer HPV vaccine to female Medicaid enrollees.

Improving human papillomavirus vaccine delivery: a national study of parents and their adolescent sons

PURPOSE

We examined parents' and adolescents' preferences regarding potential strategies to increase human papillomavirus (HPV) vaccination rates, including offering the vaccine in alternative settings, concomitant administration of vaccines, and optimizing the structure of vaccination medical visits.

METHODS

A national sample of U.S. parents of adolescent boys aged 11-17 years (n = 506) and their sons (n = 391) completed online surveys in August and September 2010. We used analysis of variance for mixed designs to examine preferences for vaccination settings.

RESULTS

Parents and sons were most comfortable with sons receiving HPV vaccine in a doctor's office. Parents of sons who had not visited their regular health care providers in the past year were more comfortable with sons receiving HPV vaccine at a public clinic (p < .001) or school (p < .05) compared with parents whose sons had recent visits. Results from the son survey showed a similar pattern. Parents and sons reported moderate levels of acceptability of concomitant administration. They most preferred to have the three HPV vaccine shots administered during brief nurse visits.

CONCLUSIONS

Offering HPV vaccine in alternative settings and administering it with other recommended adolescent vaccines may increase uptake among adolescent boys. Parents and sons may prefer HPV vaccines be administered during brief nurse visits.

Parents, adolescents, children and the human papillomavirus vaccine: a review

BACKGROUND

Human papillomavirus (HPV) is a sexually transmitted infection (STI). HPV is the most common sexually transmitted infection worldwide. It is also the most common STI in adolescents. This highlights a great clinical and public health concern that must be addressed. Parents are typically involved in the clinical decision-making process of vaccine administration to children and adolescents. Therefore, understanding the acceptability of the HPV vaccination as a method to prevent STIs and certain cancers is critical.

PURPOSE

  To present the three primary themes that emerged from the literature: parental attitudes, parental beliefs and parental barrier towards vaccinating children and adolescents with the HPV vaccine.

METHOD

A literature search using Scopus to determine parents' attitudes and beliefs towards vaccinating children and adolescents with the HPV vaccine. The initial search included the key search terms of 'children' and 'HPV vaccine'. The publication year was limited from 2006 to present.

FINDINGS

The three themes greatly influence parents' decisions to vaccinate their children. In the future, more attention needs to be paid to specific subgroups. Future research should include groups that are currently under-represented: fathers, urban populations, low socio-economic status and ethnic minorities.

CONCLUSION

Since nurses worldwide are often sought as healthcare resources by parents in the clinical decision-making process, their understanding of the attitude, beliefs and barriers parents have towards the HPV vaccine is paramount.

Providers' attitudes toward human papillomavirus vaccination in young men: challenges for implementation of 2011 recommendations

Providers' attitudes toward male human papillomavirus (HPV) vaccination may influence the implementation of new guidelines. Although 24 of 31 (77%) Pediatric and Family Medicine providers interviewed between 2009 and 2010 favored vaccinating males, only 3 (12%) offered vaccination. Providers who did not offer vaccination felt that parents would not be interested in vaccinating sons and were largely unaware of serious HPV-related disease in males.

Designing messages to motivate parents to get their preteenage sons vaccinated against human papillomavirus

CONTEXT

Human papillomavirus (HPV) vaccine, licensed for use in 9--26-year-olds, is most effective when given before sexual activity begins. HPV causes genital warts, is associated with several cancers and disproportionately affects racial and ethnic minorities. Parents are typically unaware of male HPV vaccine; messages that might motivate them to get their preteenage sons vaccinated are unexplored.

METHODS

Messages promoting vaccination of preteenage boys were designed and tested in 2009 and 2010. Five focus groups were conducted with 29 black parents of 11-12-year-old boys, recruited through three churches and a middle school in North Carolina, and a racially diverse sample of 100 parents of 9-13-year-old boys in a university-based adolescent health clinic was interviewed. A constant comparison method was used to code transcripts and interpret themes. Chi-square and t tests or analyses of variance were used to assess differences in quantitative data.

RESULTS

Focus group parents knew little about HPV in males. Although concerned about safety and cost, parents supported vaccination for their sons. They wanted to see racial diversity and both parents in motivational materials. In interviews, 89% of parents reported never having heard of male HPV vaccine. The largest proportion said that a message stressing the prevalence and possible consequences of HPV infection was the most motivating (32%); the design favored by the largest proportion (43%) showed two parents.

CONCLUSIONS

Messages that may most motivate parents to get preteenage boys vaccinated against HPV focus on infection risk and include images of parents with their sons.

Human papillomavirus vaccine and men: what are the obstacles and challenges?

PURPOSE OF REVIEW

The present review describes the indications for vaccinating men with the quadrivalent human papillomavirus (HPV) vaccine, reports on the US rates of male vaccination, and reviews the recent research on acceptability of vaccinating men and research on the cost-effectiveness of adding men to existing female HPV immunization programs.

RECENT FINDINGS

Recent evidence shows that the quadrivalent HPV vaccine prevents several HPV-related diseases in men. However, despite the licensure of the vaccine in the USA for men 9 through 26 years of age, rates of male vaccination are very low. Research on acceptability, in general, indicates strong interest in vaccination among men, parents, and healthcare providers, though female vaccination is typically seen as a higher priority. Cost-effectiveness studies indicate that in the context of modest female vaccination rates and with the specification of a broad range of disease outcomes (e.g. genital warts, anogenital cancers, and oropharyngeal cancers), male vaccination can be quite cost-effective.

SUMMARY

Men are at high risk for HPV infection and can benefit from vaccination, but vaccination rates among men remain extremely low. More research needs to be done on the predictors of uptake of HPV vaccine among men and on the development of interventions to increase male vaccination.

Acceptance on the move: public reaction to shifting vaccination realities

This review examines four events related to vaccination that have occurred in recent years: (a) the ongoing recovery from the MMR/Autism scare in the UK, (b) the upgrading of the Varicella vaccine to a universal childhood vaccine, (c) the major effort of authorities to provide a vaccine for A/H1N1 influenza and its rejection by the public, and, d) the current attempts to change the HPV vaccine target from girls only to boys and girls. All of these changes have been met with shifts in the public acceptance of the relevant vaccine. These shifts are characterized not only by the number of people willing to be vaccinated, but also by the attitudes and the motives related to acceptance. Examination of the interrelationship between changes in vaccination realities, and changes in acceptance patterns suggests that today, the public has a better understanding of vaccination, is acting in a more reflexive way, and is capable of changing attitudes and behavior. All together, changes in vaccination enhance debates and dialogues about vaccines, and lead to higher awareness and more conscious acceptance.

Missed clinical opportunities: provider recommendations for HPV vaccination for 11-12 year old girls are limited

OBJECTIVE

The purpose of this study was to determine the prevalence of physician recommendation of human papillomavirus (HPV) vaccination in early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) female patients by physician specialty, and to identify factors associated with recommendation in early adolescents.

METHODS

A 38-item survey was conducted April 2009 through August 2009 among a nationally representative random sample of 1538 Family Physicians, Pediatricians, and Obstetricians and Gynecologists obtained from the American Medical Association Physician Masterfile. A multivariable model was used to assess factors associated with frequency of physician recommendation of HPV vaccination ("always"=76-100% of the time vs. other=0-75%) within the past 12 months.

RESULTS

Completed surveys were received from 1013 physicians, including 500 Family Physicians, 287 Pediatricians, and 226 Obstetricians and Gynecologists (response rate=67.8%). Across the specialties, 34.6% of physicians reported they "always" recommend the HPV vaccine to early adolescents, 52.7% to middle adolescents, and 50.2% to late adolescents/young adults. The likelihood of "always" recommending the HPV vaccine was highest among Pediatricians for all age groups (P<0.001). Physician specialty, age, ethnicity, reported barriers, and Vaccines for Children provider status were significantly associated with "always" recommending HPV vaccination for early adolescents.

CONCLUSIONS

Findings suggest missed clinical opportunities for HPV vaccination, and perceived barriers to vaccination may drive decisions about recommendation. Results suggest the need for age and specialty targeted practice and policy level interventions to increase HPV vaccination among US females.

Ethnic and racial differences in HPV knowledge and vaccine intentions among men receiving HPV test results

We examined factors associated with HPV vaccine intentions by racial/ethnic group among men participating in a HPV natural history study. HPV knowledge, vaccine intentions and perceived barriers were assessed among non-Hispanic White, non-Hispanic Black and Hispanic men. Men were tested for HPV every 6 months. After receiving test results from their previous visit, participants (N=477) reported their intentions for HPV vaccination in a computer-assisted survey instrument (CASI). Vaccine intentions were high among all respondents, although differences were found between racial and ethnic groups in awareness and knowledge of HPV and, vaccine intentions and perceived access and barriers to receiving the HPV vaccine. In order to effectively disseminate the vaccine among men, factors that may promote or inhibit vaccine acceptability need to be identified. Identifying these factors related to vaccine intentions among minority and majority men offers an opportunity for addressing barriers to health equity and, in turn, reductions in HPV-related disparities.