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Sertkaya D, Şen Bayturan S. Pediatric and Family Physicians' Attitudes Regarding Childhood Optional Vaccines During the COVID-19 Pandemic. Cureus 2023; 15:e37338. [PMID: 37182049 PMCID: PMC10169092 DOI: 10.7759/cureus.37338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION To maintain high vaccination rates, vaccination interventions should be targeted according to interests such as parents' knowledge, attitudes, beliefs, and vaccine hesitancy. METHODS This research was conducted between June 2020 and April 2021 using a questionnaire about optional vaccines (OVs) in Turkey. RESULTS A total of 241 physicians participated and 14 physicians were excluded due to insufficient data. Finally, a total of 227 physicians, including 115 pediatricians and 112 family physicians, were included in the study. The mean age of pediatricians and family physicians was 33.42 ± 8.25 years and 35.46 ± 11.09 years, respectively. There was no significant difference between pediatricians and family physicians in terms of age and gender (p > 0.05). Nearly half of all physicians (49%) stated that they do not have sufficient knowledge about OVs. Pediatricians (64%) stated that they have sufficient knowledge at a higher rate than family physicians (37%) (p = 0.000). Physicians who declared having sufficient knowledge informed families about OVs more frequently than those with insufficient knowledge (p = 0.000). Pediatricians provide information about OVs more frequently than family physicians (p = 0.001). Rotavirus and meningococcal vaccines were the most frequently recommended vaccines. CONCLUSIONS Rotavirus and meningococcal B were the most recommended OVs. About half of the physicians participating in the study stated that they did not have sufficient knowledge about OVs. Physicians with sufficient knowledge of OVs recommend OVs more frequently.
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Affiliation(s)
| | - Semra Şen Bayturan
- Pediatric Infectious Diseases, Faculty of Medicine, Manisa Celal Bayar University, Manisa, TUR
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2
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Brennan LP, Rodriguez NM, Head KJ, Zimet GD, Kasting ML. Obstetrician/gynecologists' HPV vaccination recommendations among women and girls 26 and younger. Prev Med Rep 2022; 27:101772. [PMID: 35321213 PMCID: PMC8935521 DOI: 10.1016/j.pmedr.2022.101772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/10/2022] [Accepted: 03/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Obstetrician/gynecologists (OB/GYNs) are well poised to vaccinate girls and young women against HPV, however little is known about if and how they recommend the HPV vaccine. This study aims to understand factors associated with strong and frequent HPV vaccine recommendations among OB/GYNs for patients 26 years and younger. Methods 224 practicing U.S. OB/GYNs were surveyed for how strongly and frequently they recommend the HPV vaccine to patients 26 and younger. Provider beliefs, knowledge, and preferences surrounding the vaccine, as well as clinic and patient-level variables were examined as covariates. We then examined the relationships using multivariable logistic regression analyses. Results Of the 224 respondents, 205 were included in the analysis, with 57% (n = 116) reporting strongly and frequently recommending the HPV vaccination to eligible patients 26 and younger. The regression showed two provider beliefs and two clinic-level attributes to be strongly associated with strong and frequent recommendations. Being a strong and frequent recommender was positively associated with believing other gynecologists frequently recommend the vaccine (aOR 24.33 95%CI[2.56-231.14]) and believing that 50% or more of their patients are interested in receiving the vaccine (aOR 2.77 95%CI[1.25-6.13]). The clinic-level attributes were having the vaccine stocked (aOR 2.66 95%CI[1.02-6.93]) and suburban (aOR 3.31 95%CI[1.07-10.19]) or urban (aOR 3.54 95%CI[1.07-11.76]) location versus rural. Conclusions These findings suggest that OB/GYN peer support and educating OB/GYN about patients' interest in HPV vaccination may improve HPV vaccination. This work can inform clinic-level interventions including stocking the vaccine and focusing improvement efforts on rural clinics.
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Affiliation(s)
- Luke P Brennan
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr, West Lafayette, IN 47907, USA
- Indiana University Medical Scientist/Engineer Training Program, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Natalia M Rodriguez
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr, West Lafayette, IN 47907, USA
- Department of Public Health, Purdue University, Matthews Hall, 812 W State St, West Lafayette, IN 47907, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd, Indianapolis, IN 46202, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN 46202, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Monica L Kasting
- Department of Public Health, Purdue University, Matthews Hall, 812 W State St, West Lafayette, IN 47907, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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Human Papilloma Virus Vaccination and Oropharyngeal Cancer: Knowledge, Perception and Attitude among Italian Pediatric Dentists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020790. [PMID: 35055612 PMCID: PMC8776129 DOI: 10.3390/ijerph19020790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 01/27/2023]
Abstract
Background: Pediatric dentists could play a key role in the prevention of human papilloma virus (HPV)-related oropharyngeal cancer (OP-cancer). The aim of this study was to assess knowledge, perception, and attitude on HPV-related OP-cancer, HPV infection, and HPV vaccination among Italian pediatric dentists. Methods: A cross-sectional study was conducted. Pediatric dentists received, by email, a link to participate in the questionnaire online. The questionnaire comprised four parts: (i) demographic information, (ii) knowledge on HPV-related OP-cancer, HPV infection, and HPV vaccine, (iii–iiii) perceptions and attitude on HPV-related OP-cancer, HPV infection, and HPV vaccine. Data were statistically analyzed with Kruskal–Wallis and Mann–Whitney test and Pearson’s chi-square test. Results: A total of 271 pediatric dentists completed the questionnaire. Results showed a good overall knowledge; a positive perception of their role in HPV disease prevention; a good attitude in discussing sensitive topics; a need for acquiring more information about HPV’s connection to cancer, HPV infection, and HPV vaccine. Conclusions: Improving educational training programs, as well as informing about prevention of HPV-related OP-cancer, will place pediatric dentists in the front line of HPV diseases primary prevention.
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Lin C, Mullen J, Smith D, Kotarba M, Kaplan SJ, Tu P. Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review. Vaccines (Basel) 2021; 9:vaccines9070713. [PMID: 34358132 PMCID: PMC8310254 DOI: 10.3390/vaccines9070713] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Jewel Mullen
- Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Danielle Smith
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Michaela Kotarba
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Samantha J. Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC 27710, USA;
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
- Correspondence:
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New targets for Turkish childhood national immunization schedule. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.746878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Karafillakis E, Simas C, Jarrett C, Verger P, Peretti-Watel P, Dib F, De Angelis S, Takacs J, Ali KA, Pastore Celentano L, Larson H. HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe. Hum Vaccin Immunother 2019; 15:1615-1627. [PMID: 30633623 PMCID: PMC6783136 DOI: 10.1080/21645515.2018.1564436] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022] Open
Abstract
Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.
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Affiliation(s)
- Emilie Karafillakis
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Clarissa Simas
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Caitlin Jarrett
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Fadia Dib
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Department of Social Epidemiology, Paris, France
- INSERM CIC 1417, F-CRIN, I-REIVAC, Paris, France
- Assistance Publique Hopitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin, Pasteur, Paris, France
| | - Stefania De Angelis
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Judit Takacs
- Centre for Social Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Karam Adel Ali
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lucia Pastore Celentano
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Heidi Larson
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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McSherry LA, O’Leary E, Dombrowski SU, Francis JJ, Martin CM, O’Leary JJ, Sharp L. Which primary care practitioners have poor human papillomavirus (HPV) knowledge? A step towards informing the development of professional education initiatives. PLoS One 2018; 13:e0208482. [PMID: 30543647 PMCID: PMC6292662 DOI: 10.1371/journal.pone.0208482] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/19/2018] [Indexed: 01/09/2023] Open
Abstract
Background Primary care practitioners (PCP) play key roles in cervical cancer prevention. Human papillomavirus (HPV) knowledge is an important influence on PCPs’ cervical cancer prevention-related behaviours. We investigated HPV knowledge, and associated factors, among general practitioners (GPs) and practice nurses. Methods A survey, including factual questions about HPV infection and vaccination, was mailed to GPs and practice nurses in Ireland. Multivariable logistic regression was used to determine which PCPs had low knowledge (questions correctly answered: infection ≤5/11; vaccination: ≤4/10). Questions least often answered correctly were identified. Results 697 PCPs participated. For HPV infection, GPs and practice nurses answered a median of nine and seven questions correctly, respectively (p<0.001). Significantly associated with low HPV infection knowledge were: being a practice nurse/male GP; working fewer hours/week; not having public patients; and having never taken a cervical smear. For HPV vaccination, both GPs and practice nurses answered a median of six questions correctly (p = 0.248). Significantly associated with low HPV vaccination knowledge were: being a practice nurse/male GP; working more years in general practice, fewer hours/week, in a smaller practice or in a practice not specialising in women’s health; and having never taken a smear. Six HPV infection questions, and seven HPV vaccination questions, were not answered correctly by >⅓ of PCPs. Conclusions There are important limitations in HPV infection and vaccination knowledge among PCPs. By identifying factors associated with poor knowledge, and areas of particular uncertainty, these results can inform development of professional education initiatives thereby ensuring women have access to uniformly high-quality HPV-related information and advice.
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Affiliation(s)
| | | | | | - Jill J. Francis
- School of Health Sciences, City University London, London, England
| | - Cara M. Martin
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - John J. O’Leary
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, England
- * E-mail:
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Patel H, Austin-Smith K, Sherman SM, Tincello D, Moss EL. Knowledge, attitudes and awareness of the human papillomavirus amongst primary care practice nurses: an evaluation of current training in England. J Public Health (Oxf) 2018; 39:601-608. [PMID: 27412177 DOI: 10.1093/pubmed/fdw063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 05/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background The incorporation of Human papillomavirus (HPV) testing into the English cervical screening programme has been met with fear and anxiety. Healthcare professionals need to be adequately informed about HPV to help alleviate patient concerns. The aim of this study was to evaluate the HPV training provided to practice nurses (PNs) and determine their level of HPV knowledge. Method A web-based survey was distributed to 147 General Practice surgeries in the Leicester, Leicestershire and Rutland regions, between May and July 2015. The survey explored four broad areas; demographics/level of experience, HPV knowledge, attitudes towards the HPV vaccine and self-perceived adequacy of HPV knowledge. Results A total of 128 surveys were completed, with 94 complete responses. Overall awareness of basic HPV facts was adequate; however, detailed, and in some cases basic, knowledge was lacking. 9.6% failed to identify that HPV can cause cervical cancer and 62.8% believed that HPV requires treatment. Not all PNs felt adequately informed about HPV and a need to improve the provision of training was identified. Conclusion PNs play a key role in increasing public awareness of HPV and implementing cervical cancer screening. The provision of education to PNs needs to be a priority and current methods of training need to be re-evaluated.
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Affiliation(s)
- H Patel
- Department of Gynaecology, University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, UK
| | - K Austin-Smith
- Department of Gynaecology, Kettering General Hospital, Rothwell Road, KetteringNN16 8UZ, UK
| | | | - D Tincello
- University of Leicester, Centre for Medicine, Leicester LE1 7RH, UK
| | - E L Moss
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, UK
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Abstract
The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a "bundle" along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action. Key messages • Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative. • According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer. • First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males. • It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence. • Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s. • The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.
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Affiliation(s)
- Aria C Attia
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Judith Wolf
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Ana E Núñez
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
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Marić G, Birčanin Đ, Kisić V, Dotlić J, Zarić M, Kisić-Tepavčević D, Gazibara T. Parental perspective on human papillomavirus (HPV) vaccination in Serbia: Knowledge, attitudes and practice. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:192-198. [PMID: 29804766 DOI: 10.1016/j.srhc.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVE Assessing knowledge and attitudes of parents towards human papillomavirus (HPV) vaccination of their children and estimating factors associated with parental positive attitude towards HPV immunization. STUDY DESIGN Cross-sectional. SETTING Two Community Health Centers. A total of 282 adult parents of boys and/or girls who presented at the pediatrician's office with their child aged ≤18 years from December 2015 to May 2016. MAIN OUTCOME MEASURES HPV vaccination coverage with one dose, knowledge and attitudes towards HPV vaccination. Parental knowledge was tested through a set of 10 items such as the infectious nature of HPV, mode of transmission, symptoms and its association with cervical cancer and circumstances surrounding HPV vaccine in Serbia. Answers were graded on a 5-point Likert scale from "strongly disagree" to "strongly agree". RESULTS Coverage with one dose of HPV vaccine was 2.0%. Majority of parents knew that the vaccine existed (71.0%). One quarter of parents confirmed that their child should be vaccinated against HPV. Parents expressed highest level of agreement with the statement that HPV vaccination in Serbia is not sufficiently promoted (4.17 ± 1.21 points). Having female child and more knowledge on HPV were independently associated with positive attitude towards vaccination among parents of children aged <9 years. Having received recommendation for HPV vaccination from a pediatrician was independently associated with positive attitude towards HPV vaccination among parents of children aged ≥9 years. CONCLUSION Coverage with one dose of HPV vaccine is low. Health-care authorities are urged to consider inclusion of HPV vaccination in immunization schedule.
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Affiliation(s)
- Gorica Marić
- Institute of Epidemiology, Višegradska 26a, Faculty of Medicine, University of Belgrade, Serbia
| | - Đurđa Birčanin
- Institute of Epidemiology, Višegradska 26a, Faculty of Medicine, University of Belgrade, Serbia
| | - Vesna Kisić
- Community Health Center "Voždovac", Krivolačka 4-6, Belgrade, Serbia
| | - Jelena Dotlić
- Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, Višegradska 26, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića 8, Belgrade, Serbia
| | - Milica Zarić
- Institute of Epidemiology, Višegradska 26a, Faculty of Medicine, University of Belgrade, Serbia
| | - Darija Kisić-Tepavčević
- Institute of Epidemiology, Višegradska 26a, Faculty of Medicine, University of Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Višegradska 26a, Faculty of Medicine, University of Belgrade, Serbia.
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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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Esposito S, Bianchini S, Tagliabue C, Umbrello G, Madini B, Di Pietro G, Principi N. Impact of a website based educational program for increasing vaccination coverage among adolescents. Hum Vaccin Immunother 2018; 14:961-968. [PMID: 28853975 PMCID: PMC5893194 DOI: 10.1080/21645515.2017.1359453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Data regarding the use of technology to improve adolescent knowledge on vaccines are scarce. The main aim of this study was to evaluate whether different web-based educational programmes for adolescents might increase their vaccination coverage. Overall, 917 unvaccinated adolescents (389 males, 42.4%; mean age ± standard deviation, 14.0 ± 2.2 years) were randomized 1:1:1 into the following groups: no intervention (n = 334), website educational program only (n = 281), or website plus face to face lesson (n = 302) groups. The use of the website plus the lesson significantly increased the overall knowledge of various aspects of vaccine-preventable disease and reduced the fear of vaccines (p < 0.001). A significant increase in vaccination coverage was observed for tetanus, diphtheria, acellular pertussis and conjugated meningococcal ACYW vaccines in the 2 groups using the website (p < 0.001), and better results were observed in the group that had also received the lesson; in this last group, significant results were observed in the increase in vaccination coverage for meningococcal B vaccine (p < 0.001). Overall, the majority of the participants liked the experience of the website, although they considered it important to further discuss vaccines with parents, experts and teachers. This study is the first to evaluate website based education of adolescents while considering all of the vaccines recommended for this age group. Our results demonstrate the possibility of increasing vaccination coverage by using a website based educational program with tailored information. However, to be most effective, this program should be supplemented with face-to-face discussions of vaccines at school and at home. Thus, specific education should also include teachers and parents so that they will be prepared to discuss with adolescents what is true and false in the vaccination field.
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Affiliation(s)
- Susanna Esposito
- a Pediatric Clinic, Università degli Studi di Perugia , Perugia , Italy
| | - Sonia Bianchini
- b Department of Pathophysiology and Transplantation , Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Claudia Tagliabue
- b Department of Pathophysiology and Transplantation , Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Giulia Umbrello
- b Department of Pathophysiology and Transplantation , Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Barbara Madini
- b Department of Pathophysiology and Transplantation , Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Giada Di Pietro
- b Department of Pathophysiology and Transplantation , Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Nicola Principi
- b Department of Pathophysiology and Transplantation , Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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Canon C, Effoe V, Shetty V, Shetty AK. Knowledge and Attitudes Towards Human Papillomavirus (HPV) Among Academic and Community Physicians in Mangalore, India. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:382-391. [PMID: 26880357 DOI: 10.1007/s13187-016-0999-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cervical cancer is the most common cancer found in Indian women. Two human papillomavirus (HPV) vaccines were approved for use in India in 2006; however, neither has become readily accepted. Physician attitudes and recommendations are crucial in the uptake of HPV vaccines among adolescent women in the USA; thus, we ought to investigate provider attitudes and practices related to HPV vaccination in India via a survey administered to 210 Indian physicians. Of the 210 physicians, 46 % were community physicians and 54 % were academic physicians. The correct response to HPV knowledge questions was identified around 50 % of the time in 6/11 questions. Only 47 % of the physicians knew that there was an HPV vaccine approved for use in India. Only 11 % and 15 % of physicians strongly agree that the HPV vaccine will lead to long-lasting immunity and has a safe side effect profile, respectively. A total of 30 % of those surveyed reported that they would recommend the HPV vaccine to their patients, while 73 % agreed that the cost of the HPV vaccine is a major barrier to acceptance. After multivariate analysis, there were two significant variables independently associated with a physician's decision to recommend HPV vaccine. These variables were as follows: "whether the vaccine was freely available from the government sector" and "uncertainty about whether HPV must be persistent to cause cervical cancer vs not." Given the lack of knowledge among practicing physicians in Mangalore, increasing the education about HPV infection and HPV vaccination towards health care providers has the potential to increase vaccine recommendations.
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Affiliation(s)
- Chelsea Canon
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Valery Effoe
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Veena Shetty
- Department of Microbiology, K.S. Hegde Medical Academy and Nitte University, Deralakatte, Mangalore, Karnataka, India
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Rohrbach MR, Wieland AM. A Survey of Wisconsin Pediatricians’ Knowledge and Practices Regarding the Human Papillomavirus Vaccine. Otolaryngol Head Neck Surg 2017; 156:636-641. [DOI: 10.1177/0194599817695806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective The human papillomavirus (HPV) is common and carries a significant burden of disease. This is increasingly apparent in males with the rising incidence of HPV-related oropharyngeal cancer. Unfortunately, vaccination rates remain poor and are lowest in males. It is unclear if pediatricians are aware of the alarming rise of HPV-mediated head and neck cancers and the disproportionate effect on males. Study Design This investigation used a cross-sectional descriptive survey research design. Setting The survey was developed by investigators in the University of Wisconsin Division of Otolaryngology. Subjects and Methods The survey was distributed to 831 members of the Wisconsin Chapter of the American Academy of Pediatrics. Results A total response rate of 49.6% was achieved. Most supported routine vaccination in both sexes. Females are regarded as being at higher risk of an HPV-related cancer and are more often recommended vaccination. Most providers are unaware of the magnitude of HPV-related oropharyngeal cancer and the greater affliction in males. Conclusions Male vaccination is overwhelmingly supported by Wisconsin pediatricians, yet there is a preponderance toward vaccinating females, who are perceived as having greater risk for HPV-associated disease. This is likely because providers are unaware of the magnitude of HPV-driven oropharyngeal cancer and its predilection for males. A lack of provider awareness, in combination with out-of-date education material for parents, likely contributes to poor vaccination rates in males.
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Affiliation(s)
- Marc R. Rohrbach
- Division of Otolaryngology–Head & Neck Surgery, Department of Surgery. University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aaron M. Wieland
- Division of Otolaryngology–Head & Neck Surgery, Department of Surgery. University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Mazza D, Petrovic K, Grech C, Harris N. HPV vaccination in women aged 27 to 45 years: what do general practitioners think? BMC WOMENS HEALTH 2014; 14:91. [PMID: 25074404 PMCID: PMC4149036 DOI: 10.1186/1472-6874-14-91] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022]
Abstract
Background Although the Human Papillomavirus (HPV) vaccine is registered in Australia for females aged 9 to 45 years, females aged 27 to 45 years have shown limited vaccine uptake. Our study explored general practitioners’ (GPs) views concerning HPV vaccination of females in this age group, with particular focus on the barriers and the facilitators to the delivery of the HPV vaccine. Methods Semi-structured telephone interviews were conducted with 24 randomly selected general practitioners from metropolitan Melbourne. Questions were based on a theoretical framework that explained the barriers and facilitators to professional behaviour change. Results According to the GPs, the major barriers to the uptake of the HPV vaccine included the cost of the vaccine, time constraints, and the three-dose schedule. Other barriers that were identified included GPs’ and patients’ beliefs that females in this age group were at low risk of contracting HPV, lack of awareness about the vaccine, and uncertainty about the benefits of this vaccine for females in this age group. In contrast, the facilitators that were identified included the availability of the vaccine on site, the availability of vaccine clinics or nurses for administering the vaccine, the availability of information related to the vaccine either on site or online, and positive opinions from experts in the field. Conclusions Our study has identified some of the barriers and facilitators to the delivery and uptake of the HPV vaccine in females aged 27 to 45 years, as perceived by GPs. Further studies should be conducted to determine which of these should be targeted or prioritised for intervention. The views of women in this age group should also be considered as these would also be influential in designing effective intervention strategies for improving the delivery and uptake of the HPV vaccine.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia.
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Principi N, Esposito S. Adolescents and vaccines in the western world. Vaccine 2013; 31:5366-74. [DOI: 10.1016/j.vaccine.2013.08.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
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Zimet GD, Rosberger Z, Fisher WA, Perez S, Stupiansky NW. Beliefs, behaviors and HPV vaccine: correcting the myths and the misinformation. Prev Med 2013; 57:414-8. [PMID: 23732252 DOI: 10.1016/j.ypmed.2013.05.013] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/13/2013] [Accepted: 05/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccine uptake in many countries has been sub-optimal. We examine several issues associated with non-vaccination that have received particular attention, including fears about sexual risk compensation, concerns about vaccine safety, inadequate vaccination recommendations by health care providers (HCPs), and distrust due to the perceived "newness" of HPV vaccines. METHODS Selective review of behavioral and social science literature on HPV vaccine attitudes and uptake. RESULTS There is no evidence of post-vaccination sexual risk compensation, HPV vaccines are quite safe, and they can no longer be considered "new". Nonetheless, research findings point to these issues and, most importantly, to the failure of HCPs to adequately recommend HPV vaccine as major drivers of non-vaccination. CONCLUSION Most fears related to HPV vaccine are more related to myth than reality. In the absence of major health policy initiatives, such as those implemented in Canada, the U.K., and Australia, a multi-level, multi-faceted approach will be required to achieve high rates of HPV vaccination. It will be essential to focus on the education of HCPs regarding indications for HPV vaccination and approaches to communicating most effectively with parents and patients about the safety and benefits of vaccination and the risks associated with non-vaccination.
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Affiliation(s)
- Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410W. 10th St., HS1001, Indianapolis, IN 46260, USA.
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Health care professional communication about STI vaccines with adolescents and parents. Vaccine 2013; 32:1616-23. [PMID: 23791695 DOI: 10.1016/j.vaccine.2013.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/28/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022]
Abstract
Vaccination of adolescents against sexually transmitted infections (STIs) is an important prevention strategy that may reduce the global burden of disease. The World Health Organization, Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, and other national health agencies recommend the use of existing STI vaccines, and many countries have incorporated them into their routine vaccination schedule. Despite this, however, data indicate that STI vaccine uptake is suboptimal for a variety of reasons. Health care professionals (HCP) have been shown to have a strong beneficial effect on STI vaccine uptake, yet studies demonstrate that many HCPs fail to discuss or recommend them to adolescent patients. This review article focuses on HCP communication about STI vaccines with adolescents and their parents. It describes STI vaccine message content and delivery as well as the context in which HCPs formulate their messaging approach. It also examines other contextual factors that may shape communication about STI vaccines. Studies from many countries indicate that HCPs often possess misinformation about adolescents, including their sexual risk behaviors, as well as STIs, vaccine safety and efficacy, and STI vaccination recommendations. They also have misconceptions of parental barriers to STI vaccination. These may impact STI vaccine communication and have a negative influence on STI vaccine uptake. These findings highlight the critical need for improved HCP education related to adolescent health, sexuality, and STI vaccination. This may be particularly important in settings without an existing infrastructure or expertise in caring for this unique patient population.
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Reframing cervical cancer prevention. Expanding the field towards prevention of human papillomavirus infections and related diseases. Vaccine 2013. [PMID: 23199951 DOI: 10.1016/j.vaccine.2012.05.090] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The reframed paradigm of cervical cancer prevention will include strategic combinations of at least four major components: 1) routine introduction of human papillomavirus (HPV) vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. On a global scale, vaccination of newborns and infants is well established and has developed a successful working infrastructure. The hepatitis B virus (HBV) vaccination programs offer a model for HPV introduction in which newborn and infant immunization achieves a rapid reduction in the prevalence of the HBV carrier rates in immunized cohorts of children, and of liver cirrhosis and liver cancer decades later. In contrast, screening for cervical pre-cancer is largely restricted to industrialized populations and upper social classes in developing countries. The expertise gained by vaccination programs worldwide needs to be coordinated with the traditional cervical cancer prevention community of gynecologists and pathologists. Significant political and advocacy efforts at the Global level (World Health Organization, other United Nations agencies and The GAVI Alliance) need to be organized and reinforced to achieve a meaningful reduction in HPV transmission and its related health conditions and cancers. This desirable goal is now scientifically and technologically attainable, and great progress is being made in obtaining financing for global HPV immunization. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Kao CC, Huang SY, Cheng PJ, Shaw SW, Chueh HY, Chang SD, Hsu TY, Kung FT, Hsieh TT. Factors associated with the intention to recommend pertussis vaccination for postpartum women: a survey in Taiwan of obstetrician-gynecologists' knowledge, beliefs, and attitudes. Taiwan J Obstet Gynecol 2013; 51:222-8. [PMID: 22795098 DOI: 10.1016/j.tjog.2012.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2010] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To examine obstetrician-gynecologists' knowledge, beliefs, and attitudes associated with the intention to recommend adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccination to postpartum women. MATERIALS AND METHODS A survey instrument was mailed to a total of 2686 members of the Taiwan Association of Obstetrics and Gynecology to assess provider demographic characteristics, occupational information, pertussis knowledge, and beliefs and attitudes about vaccination. The intention to recommend pertussis vaccination to postpartum women was evaluated. Trend chi-square statistics and multivariate logistic models were used to determine variables that were significantly associated with intention to recommend vaccination. RESULTS Of the 676 surveys returned (25.2%), 510 participants were active in obstetric practice. A statistically significant difference was found in mean ± SD knowledge scores for pertussis disease and pertussis vaccination between obstetrician-gynecologists who intended to recommend and those who did not intend to recommend postpartum Tdap vaccination (disease: 2.99 ± 2.2 vs. 2.31 ± 1.9, respectively, p < .001; vaccination: 2.64 ± 2.2 vs. 1.36 ± 1.8, respectively, p < .001). Obstetrician-gynecologists who were in favor of postpartum Tdap vaccination were more likely to: (1) rate the change in pertussis incidence among adults as increased; (2) rate pertussis disease among newborn infants as highly severe; (3) rate pertussis as highly contagious; and (4) understand the current recommendation of important organizations for protecting infants against pertussis. CONCLUSION Our study of obstetrician-gynecologists' attitudes and intentions concerning postpartum Tdap vaccination may be useful in guiding the design of effective perinatal Tdap immunization programs nationwide.
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Affiliation(s)
- Chuan-Chi Kao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Mazza D, Petrovic K, Chakraborty S. HPV vaccination of adult women: An audit of Australian general practitioners. Aust N Z J Obstet Gynaecol 2012; 52:528-33. [DOI: 10.1111/ajo.12002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Health Care, Faculty of Medicine Nursing and Health Sciences; Monash University; Notting Hill; Victoria; Australia
| | - Katja Petrovic
- Department of General Practice, School of Primary Health Care, Faculty of Medicine Nursing and Health Sciences; Monash University; Notting Hill; Victoria; Australia
| | - Samantha Chakraborty
- Department of General Practice, School of Primary Health Care, Faculty of Medicine Nursing and Health Sciences; Monash University; Notting Hill; Victoria; Australia
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Chan ZCY, Chan TS, Ng KK, Wong ML. A Systematic Review of Literature about Women's Knowledge and Attitudes toward Human Papillomavirus (HPV) Vaccination. Public Health Nurs 2012; 29:481-9. [PMID: 23078419 DOI: 10.1111/j.1525-1446.2012.01022.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zenobia C. Y. Chan
- School of Nursing; The Hong Kong Polytechnic University; Hong Kong; China
| | - Tak Sing Chan
- School of Nursing; The Hong Kong Polytechnic University; Hong Kong; China
| | - Ka Kui Ng
- School of Nursing; The Hong Kong Polytechnic University; Hong Kong; China
| | - Man Lai Wong
- School of Nursing; The Hong Kong Polytechnic University; Hong Kong; China
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Lutringer-Magnin D, Kalecinski J, Barone G, Borne H, Regnier V, Vanhems P, Chauvin F, Lasset C. [Gynaecologists' attitudes and practices towards HPV vaccination: a quantitative-qualitative study in Rhône-Alpes]. ACTA ACUST UNITED AC 2012; 39:687-93. [PMID: 21856203 DOI: 10.1016/j.gyobfe.2011.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/16/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Acceptance of the human papilloma virus (HPV) vaccine by targeted population will mainly depend on its acceptability among gynaecologists. We examined the perceptions, attitudes and practices of gynaecologists in relation to HPV vaccination 1 year after licensing. POPULATION AND METHODS From November 2007 to April 2008, a cross-sectional survey was carried among a representative 10% sample of gynaecologists in the French Rhône-Alpes region. Both quantitative (self-administered questionnaire) and qualitative (interview) approaches were used. RESULTS Among the 52 respondents, 90.4% of gynaecologists reported a favourable opinion about HPV vaccination, 5.8% were uncertain and 1.9% was opposed (one did not answer). The main justification for a favourable opinion related to the public health effects of the HPV vaccination (cited by 31.9% of those favouring vaccination). The main justification for an uncertain or opposed opinion was the too recent introduction of the vaccine (cited by 100%). During the month preceding the survey, 40.4% had provided HPV vaccination, mainly in 15-23 years old girls (38.5%). The major difficulties in providing HPV vaccination were questions asked by patients (cited by 44.2% of the respondents) and the targeted age of 14 years (13.5%). A total of 87.5% of respondents reported to have discussed with 14-year-old vaccinated girls of Pap-smear and 12.5% of STI prevention. CONCLUSION One year after HPV vaccine licensing, gynaecologists of Rhône-Alpes region had a favourable opinion about it, despite some difficulties. Little information about STI prevention to vaccinated girls was reported opposite to information about Pap-smear.
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Affiliation(s)
- D Lutringer-Magnin
- Département de santé publique, centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France.
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Mills LA, Vanderpool RC, Crosby RA. Sexually related behaviors as predictors of HPV vaccination among young rural women. J Womens Health (Larchmt) 2011; 20:1909-15. [PMID: 22136319 PMCID: PMC4772862 DOI: 10.1089/jwh.2011.3000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To explore whether sexually related behaviors predict refusal of the human papillomavirus (HPV) vaccine among a sample of women aged 18-26 in Appalachian Kentucky. METHODS Using a convenience sample, young women attending health clinics and a community college in southeastern Kentucky were recruited to participate in a Women's Health Study. After completing a questionnaire, women received a free voucher for the three-dose HPV vaccine series. Completion of dose one served as the outcome variable. RESULTS Women with a history of an abnormal Pap test were almost two times more likely to decline the HPV vaccine (adjusted odds ratio [AOR] 1.91, 95% confidence interval [CI] 1.14-3.20, p=0.015), and women who reported they had never had a Pap test were four times more likely to decline the vaccine (AOR 4.02, 95% CI 1.13-14.32, p=0.032). Women engaging in mutual masturbation were nearly two times more likely to decline the free vaccine (AOR 1.91, 95% CI 1.17-3.10, p=0.009). Use of hormonal birth control showed a protective effect against refusal of the free HPV vaccine (AOR 0.593, 95% CI 0.44-0.80, p=0.001). CONCLUSIONS Among this sample of Appalachian women, those engaging in behaviors that increase their risk for HPV infection were more likely to refuse the vaccine. Conversely, those women engaging in protective health behaviors were more likely to accept the vaccine. These findings suggest that those women not being vaccinated may be the very group most likely to benefit from vaccination. Cervical cancer prevention programs need to be creative in efforts to reach young women most in need of the vaccine based on a higher profile of sexually related behaviors and the proxy measure of this risk (having an abnormal Pap test result).
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Affiliation(s)
- Laurel A Mills
- University of Kentucky College of Public Health, Department of Health Behavior, Lexington, Kentucky 40504, USA.
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Krieger JL, Katz ML, Kam JA, Roberto A. Appalachian and non-Appalachian pediatricians' encouragement of the human papillomavirus vaccine: implications for health disparities. Womens Health Issues 2011; 22:e19-26. [PMID: 21907591 DOI: 10.1016/j.whi.2011.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 06/28/2011] [Accepted: 07/13/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND In medically underserved regions such as Appalachia, cervical cancer incidence and mortality are higher than the general U.S. population; therefore, it is important for pediatricians to encourage parents to have their daughters vaccinated against the human papillomavirus (HPV). Unfortunately, little is known about the predictors of pediatricians' encouragement of the HPV vaccine among medically underserved populations. The current study compared attitudes and behaviors of pediatricians with practices in Appalachia with those in non-Appalachia to identify potential strategies for reducing health disparities. METHODS A survey was conducted with 334 pediatricians located in Appalachia and non-Appalachia counties to examine how prior behavior, perceived susceptibility, severity, self-efficacy, response-efficacy, and behavioral intentions are related to self-reported vaccine encouragement. RESULTS Pediatricians in Appalachia perceived their patients to be less susceptible to HPV and reported lower rates of HPV encouragement than pediatricians in non-Appalachia. In addition, self-efficacy had a significant indirect association with vaccine encouragement for pediatricians in non-Appalachia. CONCLUSION This study's findings emphasize the importance of increasing Appalachian pediatricians' awareness of their patients' susceptibility to HPV. Broader efforts to increase encouragement of the HPV vaccine among pediatricians should focus on promoting self-efficacy to encourage the HPV vaccine to parents of young females.
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Affiliation(s)
- Janice L Krieger
- School of Communication, The Ohio State University, Columbus, OH 43221, USA.
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Lutringer-Magnin D, Kalecinski J, Barone G, Leocmach Y, Regnier V, Jacquard A, Soubeyrand B, Vanhems P, Chauvin F, Lasset C. Human papillomavirus (HPV) vaccination: Perception and practice among French general practitioners in the year since licensing. Vaccine 2011; 29:5322-8. [DOI: 10.1016/j.vaccine.2011.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/02/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
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Esposito S, Brivio A, Tagliabue C, Galeone C, Tagliaferri L, Serra D, Foà M, Patria MF, Marchisio P, Principi N. Knowledge of oxygen administration, aerosol medicine, and chest physiotherapy among pediatric healthcare workers in Italy. J Aerosol Med Pulm Drug Deliv 2011; 24:149-56. [PMID: 21361785 DOI: 10.1089/jamp.2010.0850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Oxygen administration, aerosol devices and drugs, or the use of chest physiotherapy are common practices in pediatrics; however, little is known about the knowledge of pediatric healthcare workers concerning the right utilization of these tools. The aim of this study was to fill this gap as a preliminary step in the implementation of appropriate educational programs. METHODS This cross-sectional survey of a nationally representative sample of Italian pediatricians and nurses was carried out between September 1 and October 8, 2008. A self-administered, anonymous questionnaire concerning the approach to respiratory disease in infants and children was distributed to all of the participants at the Annual Congress of the Italian Society of Pediatrics, together with a stamped envelope addressed to the trained study researchers. RESULTS Of the 900 distributed questionnaires, 76.7% were completed and returned by 606 physicians (199 primary care pediatricians, 245 hospital pediatricians, and 162 pediatric residents) and 84 pediatric nurses. The vast majority of the respondents did not know the percentage of hemoglobin saturation indicating hypoxemia that requires oxygen administration. Most of the nurses admitted to overusing mucolytics and inhalatory corticosteroids, did not know the role of ipratropium bromide, were unable to indicate the first-line drug for respiratory distress, and did not know the correct dose of salbutamol. Only a minority of the respondents were able to specify the indications for chest physiotherapy. The nurses gave the fewest correct answers regardless of their age, gender, work setting, or the frequency with which they cared for children with respiratory distress in a year cared. CONCLUSIONS The knowledge of primary care pediatricians, hospital pediatricians, and pediatric nurses in Italy concerning the use of pulse oximetry, aerosol devices and drugs, and chest physiotherapy is far from satisfactory and should be improved. Educational programs are therefore required for both nurses and pediatricians.
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Affiliation(s)
- Susanna Esposito
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Vanderpool RC, Casey BR, Crosby RA. HPV-Related Risk Perceptions and HPV Vaccine Uptake Among a Sample of Young Rural Women. J Community Health 2010; 36:903-9. [DOI: 10.1007/s10900-010-9345-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Esposito S, Azzari C, Bartolozzi G, Fara GM, Giovanetti F, Giudice ML, Galeone C, Atti MCD. Knowledge of vaccination of allergic children among Italian primary care pediatricians, hospital pediatricians and pediatric residents. Vaccine 2010; 28:7569-75. [DOI: 10.1016/j.vaccine.2010.07.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
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Ko EM, Missmer S, Johnson NR. Physician Attitudes and Practice Toward Human Papillomavirus Vaccination. J Low Genit Tract Dis 2010; 14:339-45. [DOI: 10.1097/lgt.0b013e3181dca59c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Daley MF, Crane LA, Markowitz LE, Black SR, Beaty BL, Barrow J, Babbel C, Gottlieb SL, Liddon N, Stokley S, Dickinson LM, Kempe A. Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure. Pediatrics 2010; 126:425-33. [PMID: 20679306 DOI: 10.1542/peds.2009-3500] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this study were to assess, in a nationally representative network of pediatricians and family physicians, (1) human papillomavirus (HPV) vaccination practices, (2) perceived barriers to vaccination, and (3) factors associated with whether physicians strongly recommended HPV vaccine to 11- to 12-year-old female patients. METHODS In January through March 2008, a survey was administered to 429 pediatricians and 419 family physicians. RESULTS Response rates were 81% for pediatricians and 79% for family physicians. Ninety-eight percent of pediatricians and 88% of family physicians were administering HPV vaccine in their offices (P<.001). Among those physicians, fewer strongly recommended HPV vaccination for 11- to 12-year-old female patients than for older female patients (pediatricians: 57% for 11- to 12-year-old patients and 90% for 13- to 15-year-old patients; P<.001; family physicians: 50% and 86%, respectively; P<.001). The most-frequently reported barriers to HPV vaccination were financial, including vaccine costs and insurance coverage. Factors associated with not strongly recommending HPV vaccine to 11- to 12-year-old female patients included considering it necessary to discuss sexuality before recommending HPV vaccine (risk ratio: 1.27 [95% confidence interval: 1.07-1.51]) and reporting more vaccine refusals among parents of younger versus older adolescents (risk ratio: 2.09 [95% confidence interval: 1.66-2.81]). CONCLUSIONS Eighteen months after licensure, the vast majority of pediatricians and family physicians reported offering HPV vaccine. Fewer physicians strongly recommended the vaccine for younger adolescents than for older adolescents, and physicians reported financial obstacles to vaccination.
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Affiliation(s)
- Matthew F Daley
- Department of Pediatrics, University of Colorado, Aurora, CO, USA.
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Pelucchi C, Esposito S, Galeone C, Semino M, Sabatini C, Picciolli I, Consolo S, Milani G, Principi N. Knowledge of human papillomavirus infection and its prevention among adolescents and parents in the greater Milan area, Northern Italy. BMC Public Health 2010; 10:378. [PMID: 20584324 PMCID: PMC2901377 DOI: 10.1186/1471-2458-10-378] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 06/28/2010] [Indexed: 12/20/2022] Open
Abstract
Background In order to be widely accepted by users, the implementation of a new health intervention requires them to be adequately informed about its clinical importance, benefits and risks. The aim of this study was to provide data on the knowledge of Italian adolescents and parents concerning human papillomavirus (HPV) infection and its prevention in order to allow the development of adequate training programmes. Methods Between 2 May and 15 June 2008, we made a cross-sectional survey of 863 high school students and 2,331 parents of middle and high school students using two anonymously completed questionnaires covering the knowledge of HPV infection and related diseases, and attitudes to vaccinations. The approached schools were a convenience sample of the schools of the greater Milan area, Northern Italy. Results More mothers than fathers were aware that HPV infection could concern their children (58% vs 53%; p = 0.004) and were favourable towards vaccinating their children against HPV (68% vs 65%; p = 0.03); among the students, more females than males were aware that HPV infection could concern themselves (45% vs 26%; p < 0.001) and would undergo vaccination against HPV (68% vs 40%; p < 0.001). The parents' propensity to vaccinate their children against HPV was significantly associated with professing the Catholic religion (odds ratio - OR = 0.61, 95% confidence interval - CI 0.46-0.82, being atheist), the gender of the offspring (OR = 1.88, 95% CI 1.53-2.30, having at least one daughter), a propensity to vaccinations in general (OR = 23.1, 95% CI 13.7-38.8), a knowledge that HPV vaccine is aimed at preventing cervical cancer (OR = 2.31, 95% CI 1.69-3.16), and an awareness that HPV could affect their own children (OR = 3.52, 95% CI 2.89-4.29). The students who were aware that HPV infection could affect themselves were more in favour of to HPV vaccination, regardless of whether they were male (OR = 5.73, 95% CI 2.85-11.5) or female (OR = 2.39, 95% CI 1.66-3.46). Conclusions Both students and parents seem to underestimate the likelihood of HPV infection, and this is associated with a lower propensity for vaccination. This is an important indication for future training programmes concerning HPV prevention designed to increase the acceptance of HPV vaccine in families.
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Affiliation(s)
- Claudio Pelucchi
- Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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HPV vaccine and males: Issues and challenges. Gynecol Oncol 2010; 117:S26-31. [DOI: 10.1016/j.ygyno.2010.01.028] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 11/20/2022]
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Global implementation of human papillomavirus (HPV) vaccine: Lessons from hepatitis B vaccine. Gynecol Oncol 2010; 117:S32-5. [DOI: 10.1016/j.ygyno.2010.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 11/18/2022]
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Krupp K, Marlow LAV, Kielmann K, Doddaiah N, Mysore S, Reingold AL, Madhivanan P. Factors associated with intention-to-recommend human papillomavirus vaccination among physicians in Mysore, India. J Adolesc Health 2010; 46:379-84. [PMID: 20307828 DOI: 10.1016/j.jadohealth.2009.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 09/03/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE This qualitative study investigated physician intention-to-recommend the human papillomavirus (HPV) vaccine to parents of adolescent girls in India. There are currently no data on attitudes to HPV vaccination among healthcare providers in India. METHODS Between June and August 2008, 20 semistructured qualitative in-depth interviews were conducted among physicians from a range of specialties and practice settings in Mysore District, India. Physicians were interviewed about their specialty and the types of patients they saw in their practice, attitudes toward recommending HPV vaccination to parents of adolescent girls, perceived subjective norms surrounding the promotion of vaccines in their work settings, and their perceptions regarding self-efficacy in recommending the HPV vaccine. RESULTS The study found that knowledge about HPV infection and its relationship to cervical cancer was low among physicians across specialties. While most physicians expressed positive attitudes toward vaccination in general, and HPV vaccination in particular, the overwhelming majority believed that few of their patients would react positively to a vaccine recommendation. Physicians were concerned about talking to parents about their adolescent daughters' reproductive lives. Certain specialties, particularly obstetrician/gynecologists, suggested that recommending immunization was not appropriate in their work setting. CONCLUSION With the HPV vaccine recently being approved in India, there is a strong need to provide more education for physicians about the relationship of HPV infection and cervical cancer and the benefits of vaccinating adolescent girls to prevent cervical cancer in the future.
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Affiliation(s)
- Karl Krupp
- Public Health Research Institute, Mysore, India
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Oh JK, Lim MK, Yun EH, Lee EH, Shin HR. Awareness of and attitude towards human papillomavirus infection and vaccination for cervical cancer prevention among adult males and females in Korea: A nationwide interview survey. Vaccine 2010; 28:1854-60. [PMID: 20005860 DOI: 10.1016/j.vaccine.2009.11.079] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 11/21/2009] [Accepted: 11/30/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Jin-Kyoung Oh
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 411-760, Republic of Korea
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Liddon N, Hood J, Wynn BA, Markowitz LE. Acceptability of human papillomavirus vaccine for males: a review of the literature. J Adolesc Health 2010; 46:113-23. [PMID: 20113917 DOI: 10.1016/j.jadohealth.2009.11.199] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 11/09/2009] [Accepted: 11/10/2009] [Indexed: 11/19/2022]
Abstract
The quadrivalent human papillomavirus virus vaccine was recently licensed for use in males in the United States. This study reviews available published literature on acceptability among parents, health care providers, and young males. Among 23 published articles, half were conducted in the United States. The majority (87%) used quantitative survey methodology, and 13% used more explorative qualitative techniques. Convenience samples were used in most cases (74%) and 26% relied on nationally representative samples. Acceptability of a human papillomavirus virus (HPV) vaccine that protects against cervical cancer and genital warts was high in studies conducted among male college students (74%-78%) but lower in a community sample of males (33%). Among mothers of sons, support of HPV vaccination varied widely from 12% to 100%, depending on the mother's ethnicity and type of vaccine, but was generally high for a vaccine that would protect against both genital warts and cervical cancer. Health providers' intention to recommend HPV vaccine to male patients varied by patient age but was high (82%-92%) for older adolescent patients. A preference to vaccinate females over males was reported in a majority of studies among parents and health care providers. Messages about cervical cancer prevention for female partners did not resonate among adult males or parents. Future acceptability studies might incorporate more recent data on HPV-related disease, HPV vaccines, and cost-effectiveness data to provide more current information on vaccine acceptability.
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Affiliation(s)
- Nicole Liddon
- Division of STD Prevention, National Centers for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Reiter PL, Brewer NT, Gottlieb SL, McRee AL, Smith JS. How much will it hurt? HPV vaccine side effects and influence on completion of the three-dose regimen. Vaccine 2009; 27:6840-4. [PMID: 19765398 DOI: 10.1016/j.vaccine.2009.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 09/01/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022]
Abstract
We examined the prevalence of reported pain following human papillomavirus (HPV) vaccination and whether it differed from that for other adolescent vaccines or affected completion of the HPV vaccine regimen. In 2008, we conducted cross-sectional surveys with parents of adolescent girls aged 11-20 living in areas of North Carolina with elevated cervical cancer rates who had received at least one dose of HPV vaccine. Pain from HPV vaccination, while commonly reported by parents, was less frequent compared to other adolescent vaccines and did not appear to affect vaccine regimen completion. These findings may be important to increase HPV vaccination coverage.
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Affiliation(s)
- Paul L Reiter
- UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, United States.
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Szarewski A. Raising awareness of human papillomavirus and cervical cancer prevention: the need for clinical education. Future Virol 2009. [DOI: 10.2217/fvl.09.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A variety of health professionals will be involved in dealing with issues surrounding human papillomavirus in the near future, but in many cases their own knowledge is insufficient to allow them to comfortably deal with patients’ concerns. Educational initiatives for health professionals are urgently needed. These must take into account attitudes, cultural issues and communication skills, as well as providing facts. The role of the media and advocacy groups should not be ignored.
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Affiliation(s)
- Anne Szarewski
- Cancer Research UK Centre for Epidemiology, Mathematics & Statistics, Wolfson Institute of Preventive Medicine, Charterhouse Square, London, EC1M 6BQ, UK
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Chiappini E, Galli L, Bonsignori F, Venturini E, Principi N, de Martino M. Self-reported pediatricians' management of the well-appearing young child with fever without a source: first survey in an European country in the anti-pneumococcal vaccine era. BMC Public Health 2009; 9:300. [PMID: 19689826 PMCID: PMC2736943 DOI: 10.1186/1471-2458-9-300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 08/19/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies suggest a substantially reduced risk of invasive bacterial infection in children vaccinated with heptavalent pneumococcal conjugate vaccine (PCV). To investigate whether the introduction of PCV might affect clinical decision making, we conducted a cross-sectional survey aimed at Italian Pediatric physicians. RESULTS The study included 348 (46.5%) primary care pediatricians; 251 (36.4%) hospital pediatricians, and 139 (20.1%) pediatric residents. In an hypothetical scenario, a well-appearing 12-month-old child with fever without source would be sent home with no therapy by 60.7% (419/690) of physicians if the child was not vaccinated with PCV. The proportion increased to 74.2% (512/690) if the child had received PCV (P < 0.0001). Also, physicians would obtain blood tests less frequently in the vaccinated than in unvaccinated children (139/690 [20.1%] vs. 205/690 [29.7%]; P < 0.0001), and started empiric antibiotic therapy less frequently (3.0% vs. 7.5%; P < 0.0001). In the hypothetical event that white blood cell count was 17,500/microL, a significantly lower proportion of physicians would ask for erythrocyte sedimentation rate (P < 0.017), C reactive protein (P < 0.0001), blood culture (P = 0.022), and urine analysis or dipstick (P = 0.028), if the child had received PCV. Only one third of participants routinely recommended PCV. CONCLUSION Our data suggest that implementation of educational programs regarding the proper management of the febrile child is needed.
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Affiliation(s)
- Elena Chiappini
- Department of Pediatrics, University of Florence, Florence, Italy.
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Leddy MA, Anderson BL, Gall S, Schulkin J. Obstetrician-gynecologists and the HPV vaccine: practice patterns, beliefs, and knowledge. J Pediatr Adolesc Gynecol 2009; 22:239-46. [PMID: 19646670 DOI: 10.1016/j.jpag.2008.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 09/04/2008] [Accepted: 09/11/2008] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE Human papillomavirus (HPV), the most common sexually transmitted infection in the United States, can be contracted by young girls shortly after sexual debut. Human papillomavirus can lead to cervical and anogenital cancers and genital warts. A vaccine has been developed to protect against precancerous lesions. We examined obstetrician-gynecologists' practices, opinions, and knowledge regarding this vaccine. DESIGN A 37-item questionnaire was sent out by the American College of Obstetricians and Gynecologists (ACOG) to its fellows and junior fellows between May and November of 2007. PARTICIPANTS Surveys went to 3896 fellows and junior fellows of ACOG. Of these surveys, 771 were Collaborative Ambulatory Research Network (CARN) members who have volunteered to receive several surveys per year. The remaining 3125 questionnaires were sent to all fellows and junior fellows in ACOG's District V (Ohio, Kentucky, Indiana, Michigan and Ontario, Canada). Response rates were 51.0% and 30.7% for CARN and District V, respectively. RESULTS Of those who administer vaccines, most offer the HPV vaccine. Most know this vaccine protects against 4 HPV types. Fewer knew the percentages of cervical cancers and genital warts prevented. Over 20% knew all 3 answers. Only a minority answered all incorrectly. Approximately 15% view HPV vaccine as safe in pregnancy. Many agree cost is a reason for patient refusal and a deterrent from mandating the vaccine. CONCLUSION Obstetrician-gynecologists are knowledgeable of the HPV vaccine and are incorporating it into practice. Financial concerns may limit widespread immunization.
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Affiliation(s)
- Meaghan A Leddy
- Research Department, American College of Obstetricians and Gynecologists, 409 12th Street, SW, Washington, DC 20024, USA.
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Change in knowledge of women about cervix cancer, human papilloma virus (HPV) and HPV vaccination due to introduction of HPV vaccines. Eur J Obstet Gynecol Reprod Biol 2009; 145:93-5. [PMID: 19409688 DOI: 10.1016/j.ejogrb.2009.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 03/16/2009] [Accepted: 04/01/2009] [Indexed: 11/23/2022]
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Tozzi AE, Ravà L, Stat D, Pandolfi E, Marino MG, Ugazio AG. Attitudes towards HPV immunization of Italian mothers of adolescent girls and potential role of health professionals in the immunization program. Vaccine 2009; 27:2625-9. [DOI: 10.1016/j.vaccine.2009.02.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/19/2009] [Accepted: 02/18/2009] [Indexed: 11/16/2022]
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Duval B, Gilca V, Boulianne N, Pielak K, Halperin B, Simpson MA, Sauvageau C, Ouakki M, Dube E, Lavoie F. Cervical cancer prevention by vaccination: nurses’ knowledge, attitudes and intentions. J Adv Nurs 2009; 65:499-508. [DOI: 10.1111/j.1365-2648.2008.04900.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW The present review describes recent advances in our understanding about the epidemiology of human papillomavirus infection among female adolescents and describes several adolescent-specific issues related to administering human papillomavirus vaccines. RECENT FINDINGS National estimates demonstrate that human papillomavirus infection is most prevalent among adolescents and young adults. Parents, patients, and providers have a high interest in vaccination against this virus, but current patterns of adolescent healthcare utilization suggest that changes in adolescent preventive care delivery may be needed to provide these vaccines in a timely manner. Debate over whether adolescents should be legally allowed to self-consent to vaccination is another issue that remains unresolved and could have a substantial impact on vaccination rates. Legislation on school entry requirements related to human papillomavirus vaccination has been introduced in many states as a mechanism to circumvent some of these concerns, but the details of this legislation and its effect on adolescent vaccine utilization remain to be determined. SUMMARY Female adolescents are at a high risk for human papillomavirus infection and are likely to derive significant benefits from vaccination against this virus. However, administering human papillomavirus vaccines to this age group will require providers to be familiar with several issues unique to the adolescent population.
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Höglund AT, Tydén T, Hannerfors AK, Larsson M. Knowledge of human papillomavirus and attitudes to vaccination among Swedish high school students. Int J STD AIDS 2009; 20:102-7. [DOI: 10.1258/ijsa.2008.008200] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study was to investigate knowledge of and attitudes to sexually transmitted infection (STI) and STI prevention with special focus on human papillomavirus (HPV) and the new vaccine against HPV, among 16-year-old high school students in a Swedish context. A study-specific questionnaire was distributed to 572 first year high school students from five different high schools in a medium-sized town in Sweden. The students lacked knowledge of HPV and its association with cervical cancer. Similarly, their knowledge of the new vaccine was limited. Their attitude to condom use when having sex with a new partner was positive, but decreased if oral contraceptives were used and if they were vaccinated against an STI. The main source of information was the school, followed by youth clinics and the media. The results highlight the clinical importance for school nurses and personnel at youth clinics to inform adolescents about HPV and its association with cancer.
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Affiliation(s)
- A T Höglund
- Department of Public Health and Caring Sciences
| | - T Tydén
- Department of Public Health and Caring Sciences
| | | | - M Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala Science Park, S-751 85 Uppsala, Sweden
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Medical education and attitudes about acute otitis media guidelines: a survey of Italian pediatricians and otolaryngologists. Pediatr Infect Dis J 2009; 28:1-4. [PMID: 19034062 DOI: 10.1097/inf.0b013e318184ef02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical education and guidelines have been advocated as major means of improving the management of otitis media. Limited data are available concerning medical education in acute otitis media (AOM), and the association between medical education and attitudes about AOM guidelines has never been explored. OBJECTIVES To assess the prevalence of medical education concerning AOM, of a positive attitude toward AOM guidelines and of appropriate diagnostic methods in a large sample of Italian pediatricians (PEDs) and otolaryngologist (ENTs) and to look for possible associations between them. SUBJECTS AND METHODS This cross-sectional survey was based on the responses of 2012 physicians (1160 PEDs and 852 ENTs) to a mailed anonymous questionnaire. RESULTS Very few (9%) of the responders had received any AOM medical education during medical school, but the number increased during residency (38%) and peaked in the postresidency period (53%) with slight differences between PEDs and ENTs. Forty percent reported a positive attitude toward AOM guidelines, with PEDs having a better attitude than ENTs (46% vs. 32%, P < 0.001). An appropriate diagnostic method for AOM was reported by only 21% of the physicians (PEDs 11% vs. ENTs 35%, P < 0.001). AOM medical education during postresidency and reporting the use of appropriate diagnostic methods were significantly associated with a positive attitude about AOM guidelines. CONCLUSIONS Specific educational programs concerning AOM should be implemented and rigorously evaluated, before physicians become fully trained PEDs and ENTs, and maintained during postresidency. Evidence-based guidelines should be further incorporated into everyday practice of both PEDs and ENTs.
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Current world literature. Adolescent and paediatric gynaecology. Curr Opin Obstet Gynecol 2008; 20:506-8. [PMID: 18797277 DOI: 10.1097/gco.0b013e328312c012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Initial lessons learned in HPV vaccination. Gynecol Oncol 2008; 109:S4-11. [PMID: 18482557 DOI: 10.1016/j.ygyno.2008.01.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 01/17/2008] [Indexed: 11/20/2022]
Abstract
In the recent period following the approval of the first vaccine targeted against human papillomavirus, it is imperative that we re-evaluate the past, present, and future of cervical cancer prevention. It is clear that the subject of vaccinating young women against a sexually transmitted infection has incited a candid debate among all groups involved. Therefore, we must make the most appropriate and accurate information available to the public and medical communities. The development of vaccines targeted against oncogenic human papillomavirus (HPV) types has made it possible to eliminate approximately 70% of all invasive cervical cancers in women worldwide. However, knowledge about HPV infection and cervical cancer, as well as the need to vaccinate against oncogenic HPV infection, is still lacking among women and physicians. This deficiency could be a key reason why some parents continue to have reservations about vaccinating their daughters. In order for HPV vaccination programs to be highly successful, multiple barriers must be overcome. Review of lessons learned to date has demonstrated that continued tailored and targeted educational and awareness initiatives are required for healthcare professionals, media, patients, and parents. This article also examines the impact of the HPV vaccination awareness campaign on media and public policy dynamics.
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