A national survey of pediatrician knowledge and attitudes regarding human papillomavirus vaccination

Knowledge, attitude, and practices regarding human papilloma virus vaccination among physicians in Qatar

BACKGROUND

The human papilloma virus is a global problem that affects sexually active women and men, with cervical cancer being the most serious associated disease. Most cervical cancer cases can be prevented by vaccination against the human papilloma virus early in life. The objective of this study was to assess the knowledge, attitudes, and practices among physicians working in Qatar, regarding the human papilloma virus, infection, and prevention using vaccines.

STUDY-DESIGN

This was a cross-sectional study using quantitative data collection.

METHODOLOGY

An online survey targeting physicians working in Qatar was conducted, using a web-based pretested questionnaire. The questionnaire comprised four sections capturing a few demographic details, 33 questions in the Knowledge Section, 12 questions eliciting the attitude, and 14 practice-related questions. Mean knowledge score was calculated and those with a score more than the mean score were considered to have sufficient knowledge. Association between knowledge and attitude/practices/independent variables were looked for using bivariate and multivariate analysis. Logistic regression was used to identify the predictors for recommending human papilloma virus vaccines.

RESULTS

Of the 557 physicians who participated, 83.7% had sufficient knowledge, but only 69.1% knew that human papilloma virus vaccines were available in Qatar. The majority (89.4%) knew that human papilloma virus infection could be asymptomatic and 96.1% knew at least one symptom; 77% believed the human papilloma virus vaccine would substantially decrease the chances of human papilloma virus infection and related cancers and 46.5% felt physicians were less motivated to promote the human papilloma virus vaccine. The perceived barriers to community acceptance of the human papilloma virus vaccine were lack of awareness regarding the relationship between human papilloma virus and cervical cancer (61.6%), doubts regarding efficacy (32.5%), fear regarding safety (26.9%), concern that the human papilloma virus vaccination may encourage risky sexual behavior (26.8%), and perceived low-risk (23.3%) and cost (24.6%). Only 21.5% commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. Bivariate analysis showed nationality, specialization, discussing with patients, and recommending vaccine to be significantly associated with knowledge. Bivariate and regression analysis identified that female gender and physician's religion were significant predictors to recommend the human papilloma virus vaccine.

CONCLUSION

Most physicians have good knowledge. Less than one-fourth commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. This issue might affect the human papilloma virus vaccination program implementation if not well addressed.

Parental perceptions of the HPV vaccine for prevention of anogenital and oropharyngeal cancers

Background and Objectives

Human papillomavirus (HPV) is implicated in the development of both anogenital and oropharyngeal cancers. Although HPV vaccination prevents the majority of anogenital and head and neck cancers (HNC), vaccination rates remain low, especially among males. Known barriers to vaccination are knowledge gaps and vaccine acceptability. The objective of this study is to explore parental knowledge, perceptions, and decision-making processes about HPV and HPV vaccination for both anogenital and HNC.

Methods

This qualitative study recruited parents of children and adolescents aged 8-18 to participate in semi-structured telephone interviews. Data were analyzed using thematic analyses, informed by an inductive approach.

Results

A total of 31 parents participated in the study. Six themes emerged: 1) knowledge about HPV vaccines, 2) perceptions and attitudes toward cancers, 3) role of child's sex in HPV vaccination, 4) decision-making processes around HPV vaccination, 5) communication with health care providers about HPV vaccines, and 6) influence of social networks. There were significant knowledge gaps about the vaccine's indications and effects, especially for males and HNC prevention. Parents had concerns related to risks of the HPV vaccine. They cited pediatricians as important sources of information about vaccination and critical to their decision-making.

Conclusions

This study identified many parental knowledge gaps related to HPV vaccination, with information about males, HNC prevention, and risks particularly lacking. As parents identified pediatricians as the most important sources of information regarding HPV vaccination, this should empower pediatricians to educate families about this important preventive health measure, with a focus on addressing concerns about vaccine risks.

Knowledge and perceptions regarding Human Papillomavirus (HPV) and willingness to receive HPV vaccination among university students in a north-eastern city in Turkey

BACKGROUND

For a HPV vaccination program to be successful, it is important that the target population has sufficient knowledge about HPV and HPV vaccines. The aim of this study was to evaluate HPV-related knowledge levels among students at a university in northern Turkey, to assess vaccination willingness, and to determine factors associated with HPV-related knowledge.

METHODS

This cross-sectional study was conducted on 824 (93.1%) students studying at 16 different faculties. The study population was identified through the proportional stratified sampling method. Data were collected through a questionnaire including socio-demographic characteristics and the HPV Knowledge Scale. Multiple linear regression analysis was performed to identify factors that may be associated with knowledge scores.

RESULTS

43.6% of the students had never heard of HPV, 50.6% of them had never heard of HPV screening tests or HPV vaccination. Only 2.7% of the students were vaccinated against HPV and 15.7% were willing to receive HPV vaccination. Awareness of HPV and willingness to receive vaccination were found to be higher among women, while previous experience with sexual intercourse was higher in men (p < 0.05). The mean HPV knowledge score was quite low (6.74 ± 7.13 out of 29 points). The studying in a field related to health sciences, being a senior student, intending to be vaccinated, being a woman, having had sex were found to be associated with high knowledge levels (p < 0.05).

CONCLUSIONS

Educational programmes should be developed to increase university students' knowledge about HPV and the HPV vaccine.

Recommending COVID-19 vaccination for adolescents in primary care

BACKGROUND

COVID-19 vaccines are available for adolescents in the United States, but many parents are hesitant to have their children vaccinated. The advice of primary care professionals strongly influences vaccine uptake.

OBJECTIVE

We examined the willingness of primary care professionals (PCPs) to recommend COVID-19 vaccination for adolescents.

METHODS

Participants were a national sample of 1,047 US adolescent primary care professionals. They participated in an online survey in early 2021, after a COVID-19 vaccine had been approved for adults but before approval for adolescents. Respondents included physicians (71%), advanced practice providers (17%), and nurses (12%). We identified correlates of willingness to recommend COVID-19 vaccination for adolescents using logistic regression.

RESULTS

The majority (89%) of respondents were willing to recommend COVID-19 vaccination for adolescents, with advanced practice providers and nurses being less likely than paediatricians to recommend vaccination (84% vs. 94%, aOR 0.47, 95% CI 0.23-0.92). Respondents who had received at least one dose of a COVID-19 vaccine were more likely to recommend adolescent vaccination (92% vs. 69%, aOR 4.20, 95% CI 2.56-6.87) as were those with more years in practice (94% vs. 88%, aOR 2.93, 95% CI 1.79-4.99). Most respondents (96%) said they would need some measure of support in order to provide COVID-19 vaccination to adolescents, with vaccine safety and efficacy information being the most commonly cited need (80%).

CONCLUSION

Adolescent primary care professionals were generally willing to recommend COVID-19 vaccination. However, most indicated a need for additional resources to be able to administer COVID-19 vaccines at their clinic.

Screening Awareness of HPV-Related Oropharyngeal Cancers and Attitudes and Concerns towards HPV Vaccination Among Parents : HPV and Oropharyngeal Cancer

Baseline population opinions on human papillomavirus (HPV) and HPV vaccination must be understood before physicians can address knowledge gaps in that population and encourage timely vaccination. To determine the opinions of parents of children age 9 to 18 on HPV-related oropharyngeal cancers (OPC); the associations with education level, socioeconomic status, and having a family member/friend with OPC; and the main concerns against having a vaccination., An anonymous survey was created and administered. Parents were asked to complete the survey if they met the inclusion criteria. After the survey, results were tabulated, and the answers for each question were analyzed. The target population was surveyed in the clinic. The target population was parents with children between 9 and 18 years old: the background knowledge and awareness of HPV-related OPC and associations with education level, socioeconomic status, having a family member/friend with OPC, and concerns about vaccination. Our study results showed that the age of parents, education level, marital status, personal vaccination status, and gender of the child are significant factors for background knowledge about HPV-related diseases. Similarly, the education level, the gender of the child, and personal vaccination status are significant factors towards attitudes against having children vaccinated. There is a strong correlation between background knowledge and attitudes. The main issues about vaccination are concerns about effectiveness and side effects, concerns about safe sex experiences, and the cost of vaccination. This is the first study designed to provide information on parents' knowledge of HPV-related cancers, prevalence of HPV vaccination, and attitudes and concerns about HPV vaccination in the USA. The lack of awareness of HPV-related cancers is a significant factor in attitudes against HPV vaccination.

Imperfect messengers? An analysis of vaccine confidence among primary care physicians

BACKGROUND

Growing narratives emphasize using primary care physicians as leaders in efforts to promote COVID-19 vaccination among the vaccine hesitant. Critically however, little is known about vaccine confidence among primary care physicians themselves. The objective of this study was to assess both physician confidence that in general, vaccines are safe, effective, and important, as well as physician confidence in each COVID-19 vaccine in the United States.

METHODS

We rely on data from a national survey of primary care physicians conducted from May 14-May 25, 2021. We assess the influence of demographic, social, and political factors on physician beliefs that in general, vaccines are safe, effective, and important, as well as physician confidence in the safety of the Moderna, Pfizer, and Johnson & Johnson COVID-19 vaccines.

RESULTS

10.1% of primary care physicians do not agree that, in general, vaccines are safe, 9.3% do not agree they are effective, and 8.3% do not agree they are important. While 68.7% of physicians were 'very confident' in the safety of the Moderna vaccine and 72.7% were 'very confident' in the safety of the Pfizer vaccine, only 32.1% of physicians were 'very confident' in the safety of the Johnson & Johnson COVID-19 vaccine.

CONCLUSION

A troubling proportion of primary care physicians lack high levels of vaccine confidence. These physicians may not be well positioned to actively promote COVID-19 vaccination even as political and media narratives push physicians to lead this effort. Interventions aimed at improving vaccine confidence among some physicians may be needed so that all physicians can fulfill needed roles as trusted vaccine communicators.

Human Papilloma Virus Vaccination and Oropharyngeal Cancer: Knowledge, Perception and Attitude among Italian Pediatric Dentists

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.

Health Care Provider Perceptions of Facilitators and Barriers to Human Papillomavirus Vaccination Delivery in Five Countries

BACKGROUND

National human papillomavirus (HPV) vaccination programs could reduce global cervical cancer morbidity and mortality with support from health care providers. We assessed providers' perceptions of HPV vaccination in 5 countries.

METHODS

We identified providers from 5 countries where national HPV vaccination programs were at various stages of implementation: Argentina, Malaysia, South Africa, South Korea, and Spain. Providers authorized to administer adolescent vaccines completed an in-depth survey, reporting perceptions of barriers and facilitators to initiating and completing HPV vaccination, and logistical challenges to HPV vaccination.

RESULTS

Among 151 providers, common barriers to HPV vaccination initiation across all countries were parents' lack of awareness (39%), concerns about vaccine safety or efficacy (33%), and cost to patients (30%). Vaccination education campaign (70%) was the most commonly cited facilitator of HPV vaccination initiation. Common barriers to series completion included no reminder system or dosing schedule (37%), loss to follow-up or forgetting appointment (29%), and cost to patients (25%). Cited facilitators to completing the vaccine series were education campaigns (45%), affordable vaccination (32%), and reminder/recall systems (22%). Among all countries, high cost of vaccination was the most common logistical challenge to offering vaccination to adolescents (33%).

CONCLUSIONS

Incorporating provider insights into future HPV vaccination programs could accelerate vaccine delivery to increase HPV vaccination rates globally.

Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

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.

Effect of educative reminder telephone calls on human papillomavirus immunization rate: A randomized controlled trial

CONTEXT

Human papillomavirus coverage varies widely among women depending on their race, incomes, geographical location and education level.

OBJECTIVE

To evaluate whether reminder educative phone calls increase human papillomavirus vaccination rates in adult women aged 18-45 with high-risk factors of cervical cancer.

DESIGN

We conducted a single-blind randomized controlled trial in patients who consulted at a Canadian tertiary center in October 2019 during National Cervical Cancer Awareness Week.

INTERVENTIONS

We randomized women to receive three standardized educative phone calls or standard care.

MAIN OUTCOME MEASURE

We assessed the immunization rate at 6 months.

RESULTS

A total of 130 patients were randomized of which 62 patients were randomized to the intervention. Eight patients (15.4%) got immunized at 6 months in the intervention group as compared to seven (11.7%) in the control group (p = 0.5645). The main barrier to vaccination reported by non-immunized patients at 6 months was the cost of vaccination (42.3%).

CONCLUSION

Reminder educative phone calls did not increase human papillomavirus vaccination rates in adult women with risk factors of cervical cancer.ISRCTN registration number: ISRCTN58518971.

"There's Always Next Year": Primary Care Team and Parent Perspectives on the Human Papillomavirus Vaccine

Acceptance of the human papillomavirus (HPV) vaccination among parents and clinicians is high, but uptake remains low. Little is known about organizational and primary care team factors that influence the uptake of the HPV vaccine. Interviews with clinicians, clinic support staff, and parents of adolescent patients were conducted to better understand the interrelationships among the people and the organizational processes that influence HPV vaccine uptake at the point of care. Between July 2016 and February 2017, semi-structured interviews of 40 participants (18 clinicians, 12 clinic support staff, and 10 parents of adolescent patients) in a primary care network were conducted. Organizational structures and processes, such as electronic provider reminders, availability of "vaccination only" appointments, and knowledgeable primary care team members contributed to HPV vaccine uptake. Consistently high support of HPV vaccination was found among key informants; however, rather than refuse HPV vaccination, parents are opting to delay vaccination to a future visit. When parents express the desire to delay, clinicians and care team members described often recommending addressing HPV vaccination at a future visit, giving parents the impression that receiving the vaccine was not time-sensitive for their child. Discordance in HPV vaccination recommendations among providers and clinic support staff may contribute to delayed HPV vaccination. Strong, high-quality HPV vaccine recommendations are needed from all primary team members. Clinic interventions to accelerate HPV vaccine uptake may benefit from a team-based approach where every member of the primary care team is delivering the same consistent messaging about the importance of timely HPV vaccination.

Exploring factors improving support for vaccinations among Polish primary care physicians

In Poland, primary care physicians are the most used and most trusted source of information on immunisation. We aimed to explore factors influencing support for vaccinations among physicians employed in the childhood immunisation programme, in order to inform education of healthcare workers and programme organization. In June-July 2017, we carried out a national cross-sectional survey of physicians working in randomly selected primary healthcare practices, and interviewed them by telephone. We assessed support for vaccinations using an ordinal scale (0–6) comprised of three equally weighted questions on the respondent support of the programme and vaccination of self and family. We also created a scale (0–3) based on correct answers to vaccination myths. We used ordered logistic regression to investigate factors independently influencing support for vaccinations, reporting the proportional odds ratios and 95% confidence intervals for one unit increase in the support score. Of 2,609 respondents contacted, we interviewed 500 (19%). The median vaccination support score (0–6) was 5 (IQR 2). After adjusting for other variables, we did not find significant effects of sex, medical specialty, adhering to recommendations, attending a conference in previous year, using non-scientific sources of information and self-assessed knowledge on vaccination support score. Age over 60 years, correctly addressing vaccination myths and use of one or more than one scientific sources of knowledge, significantly improved support for vaccinations (aOR = 1.97, 1.57, 3.09 and 2.68, respectively). We recommend to increase the amount, quality and accessibility of evidence-based educational materials for primary care physicians working with childhood immunisations.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Knowledge, attitudes, and practices of Saudi physicians regarding cervical cancer and the human papilloma virus vaccine

BACKGROUND

Cervical cancer is considered the second most common type of cancer in women worldwide, with a reported 570,000 incident cases documented each year. Infection with certain types of the Human Papillomavirus (HPV) has been found to be associated with more than 99% of cervical cancers. The HPV vaccine can prevent HPV infection and most cases of cervical cancers; however the uptake of this vaccine remains low in Saudi Arabia. Physicians can play a vital role in providing their patients with objective information regarding the HPV vaccine, yet little is known about their knowledge, attitudes, and practices in this area.

MATERIALS AND METHODS

We conducted a cross-sectional study in King Abdul-Aziz Medical City (KAMC), Central Region, Saudi Arabia where data were collected through an online questionnaire to assess the knowledge, attitudes, and practices of physicians.

RESULTS

Most physicians (61%) displayed a good level of knowledge about cervical cancer; 94% were knowledgeable of the causative link between (HPV) infection and cervical cancer. Family medicine physicians had better knowledge regarding cervical cancer, HPV, and HPV vaccination than pediatricians (p=0.023). Physicians with >10 years of practice had better knowledge of cervical cancer than other respondents (p=0.041). 80% of the sample thought it was important for women to receive the HPV vaccine and 82% stated they would allow their daughters to be given the HPV vaccine. Lack of parental knowledge of the vaccine was significantly (p=0.034) associated with a lack of knowledge about HPV, and this was one of the most common barriers preventing recommendation of the HPV vaccine.

CONCLUSION

With the increasing prevalence of HPV infections, better knowledge of HPV infection, HPV-related diseases, and the availability of HPV vaccinations from health professionals will assist with the implementation of effective prevention and treatment programmes.

Factors Related to Chinese Parents' HPV Vaccination Intention for Children

Objectives: Successful human papilloma virus (HPV) vaccine delivery depends heavily on parents' attitudes, perceptions, and willingness to have their children vaccinated. In this study, we assessed parental knowledge, attitudes, and beliefs about the HPV vaccine, and examine factors associated with willingness to have eligible children receive HPV vaccination. Methods: From a community health center serving Chinese members in the Greater Philadelphia area, 110 Chinese-American parents with at least one child aged 11 to 18 who had not received HPV vaccine were recruited. Data were collected in face-to-face interviews. Results: Chinese-American parents generally lacked knowledge on HPV and the HPV vaccine, yet had a moderately high level of intention to vaccinate their children against HPV. Ordinal logistic regression results indicated that knowledge, whether or not to involve children, doctor influence, and time lived in the United States were significantly and independently related to parental intention to have their children vaccinated against HPV. Conclusion: Interventions should make efforts to raise awareness of HPV and promote vaccination in doctors' offices. The lower level of parental intention among relatively recent immigrants indicated the necessity to target this population in public health campaigns and intervention efforts.

A Systematic Literature Review of HPV Vaccination Barriers Among Adolescent and Young Adult Males

The human papillomavirus (HPV) causes several cancers and genital warts among sexually active adolescent and young adult (AYA) males. Quadrivalent HPV vaccines were approved for use in the AYA male population in 2010, but vaccination rates have plateaued at around 10%-15%. A better understanding of the barriers AYA male patients, their parents, and their health care providers (HCPs) experience with respect to vaccination uptake is necessary for tailoring interventions for this population. A literature search was conducted through the PubMed and PsycINFO databases in October 2017. Studies were included if they specified at least one barrier to vaccination uptake in AYA males. Studies were excluded if they did not focus on AYA males, their parents, or their HCP; were conducted outside the United States; or were published before 2010. A total of 23 studies were reviewed, and analysis found that these three groups (i.e., AYA males, parents, and HCPs) had significantly different concerns regarding vaccination. The identified themes included the lack of HPV vaccine awareness/information, misinformation about HPV, lack of communication, financial issues relating to uptake, demographic/perceived social norms, and sexual activity. Health care professionals working directly with AYA males and their parents should provide an open route of communication regarding these sensitive issues, and further educate families on the importance of HPV vaccines in reducing the incidence of certain cancers among men in later adulthood.

Importance of a team approach to recommending the human papillomavirus vaccination

BACKGROUND AND PURPOSE

Few studies have examined human papillomavirus (HPV) vaccine communication in the context of the health care team.

METHODS

In 2016, the investigators conducted a national, online survey of U.S. parents who reported having discussed HPV vaccination with their adolescent's health care team. Multivariable logistic regression assessed associations between HPV vaccine initiation (≥1 dose) and having: 1) discussed HPV vaccination with multiple team members and 2) received congruent recommendations about HPV vaccination.

CONCLUSIONS

Of the 795 parents in the sample, about half (52%) reported discussing HPV vaccination with multiple team members, including nurse practitioners, nurses, and physicians. Most reported receiving congruent recommendations for (76%) or against (12%) HPV vaccination; few (12%) received mixed recommendations. Parents who discussed HPV vaccination with multiple team members had greater odds of series initiation (odds ratio [OR] = 2.34, 95% CI: 1.61-3.40), whereas those who received mixed versus congruent recommendations for HPV vaccination had lower odds of vaccination (OR = 0.56, 95% CI: 0.33-0.95).

IMPLICATIONS FOR PRACTICE

Findings suggest that a coordinated team approach to recommendations may encourage HPV vaccination. Nurse practitioners are well positioned to facilitate coordination efforts within their clinical practices.

Decline in HPV-vaccination uptake in Denmark - the association between HPV-related media coverage and HPV-vaccination

BACKGROUND

In 2014, Denmark experienced a rapid decline in vaccination uptake for the human papillomavirus (HPV) vaccine after a successful introduction of the vaccine in 2009. Before the decline, the uptake of the first HPV vaccine was around 90% for girls born in the period 1998 to 2000, while it dropped to 54% for girls born in 2003. The decline followed negative public attention from 2013 coinciding with increasing suspected adverse-event reporting to the Danish Medicines Agency. The aim of this study is to describe the HPV-vaccination uptake, to quantify relevant HPV-related media coverage, and analyse the relation between media coverage and HPV-vaccination acceptance in Denmark in year 2009-2016.

METHODS

Three types of data were used for the analysis: Immunisation data from 243,415 girls, media coverage (8524 news items) and Google search activity. We used changes in the correlation between media coverage and vaccination uptake to identify a changing point in their relationship. The relationship before and after the changing point was analysed determined on the interactions between vaccination uptake, media and search activity, with search activity as a proxy for public attention.

RESULTS

We identified July 2013 as a changing point in the relationship between media coverage and vaccination uptake. We found no significant relationship between media coverage and vaccination uptake in the first part of the time series (June 2009 to June 2013), whereas from July 2013 and onwards there was a negative Pearson's correlation of - 0.52. The changing point coincides with both an increase in Google searches for "HPV side effects" and media coverage with negative content.

CONCLUSIONS

Following a successful launch of the HPV-vaccination programme, concerns about vaccine safety shifted the public opinion and the coverage by the media. The noticeable shift in correlation between vaccination uptake and media coverage before and after July 2013 could indicate that increased media coverage influenced the decline in vaccination uptake. Media monitoring may represent an important tool in future monitoring and assessment of confidence in vaccination programmes.

Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination

HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08-1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02-12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20-2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08-8.43), daily patient load (<20 vs. 20-24: aOR = 9.05;95%CI = 2.72-30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11-8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.

Knowledge, attitudes and awareness of the human papillomavirus amongst primary care practice nurses: an evaluation of current training in England

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.

Improving Physician Recommendations for Human Papillomavirus Vaccination: The Role of Professional Organizations

BACKGROUND

To address low human papillomavirus (HPV) vaccination coverage, the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have launched national campaigns encouraging physicians to deliver strong HPV vaccine recommendations. We surveyed family physicians and pediatricians to examine the impact of these efforts on physicians' recommendation practices.

METHODS

A national sample of family physicians and pediatricians (n = 776) completed our online survey in 2014. The survey assessed reach, content, and influence of AAFP and AAP communications about HPV vaccination. The survey also assessed quality of physicians' communication practices for recommending HPV vaccination.

RESULTS

Forty-seven percent of family physicians reported receiving information on HPV vaccination from AAFP, whereas 62% of pediatricians reported receiving information from AAP. Among physicians reached by AAFP or AAP, most reported receiving the message to give strong recommendations to adolescent boys (71%) and girls (78%). Although receiving information was not associated with HPV vaccine recommendation quality, receiving the message to give strong recommendations correlated with delivering higher-quality recommendations for boys (odds ratio, 4.19, 95% confidence interval, 2.64-6.64) and girls (odds ratio, 3.15, 95% confidence interval, 1.91-5.18). Over half of physicians reported improving their HPV vaccine communication after receiving information from AAFP (69%) or AAP (53%).

CONCLUSIONS

Our findings suggest that it is important for AAFP and AAP to communicate the need for strong HPV vaccine recommendations. Given that many physicians reported improving their recommendation practices, professional organizations stand to contribute to increasing HPV vaccination coverage, but they will likely need to increase the intensity of quality improvement efforts to do so.

Knowledge, attitude & practice on human papillomavirus vaccination: A cross-sectional study among healthcare providers

Background & objectives:

Cervical cancer is a major health problem and a leading cause of death among women in India. Of all the associated risk factors, high-risk human papillomavirus (HPV) infections being the principal aetiologic agent, two HPV vaccines are in use for the control of cervical cancer. The present study was undertaken to explore the knowledge, attitude and practice (KAP) on HPV vaccination among the healthcare providers in India.

Methods:

A cross-sectional study was conducted among 590 healthcare professionals from 232 hospitals and 80 PHCs of nine districts of Delhi-NCR (National Capital Region). A total of 590 (526 female, 64 male) healthcare providers were surveyed.

Results:

Only 47 per cent of respondents recommended young women to get vaccinated against HPV. Majority of respondents (81%) were found to be aware about the existence of vaccines for cervical cancer prevention. District-wise, highest (88.3%) awareness about the existence of vaccines against HPV was reported from Gautam Budh Nagar and lowest (64%) in Faridabad. Although 86 per cent of gynaecologists were aware about the names of HPV vaccines available in the market, only 27 per cent of paramedical staff had this knowledge. There was a significant difference between the respondents from government and private sectors regarding their awareness about HPV vaccines. Lack of awareness about the principal cause, risk factors and symptoms for cervical cancer and HPV vaccination was significantly (P< 0.05) reported in the respondents from paramedical staff category.

Interpretation & conclusions:

The findings reinforce continued medical education of healthcare providers, particularly those from the government sector on HPV vaccination for cervical cancer prevention. Public education is also pertinent for a successful HPV vaccination programme in the country.

Gynecologists' Knowledge, Attitudes, and Intentions Toward Human Papillomavirus Vaccination in Serbia

OBJECTIVES

The aims of this study were to estimate the level of knowledge, attitudes, and intentions about human papillomavirus (HPV) infection and HPV vaccine among gynecologists and to explore predictors of gynecologists' intention to recommend the HPV vaccine.

METHOD

This research was conducted between April and June 2014 among all gynecologists working at women's health departments in all primary health centers in Belgrade, the capital of Serbia, using a specially designed questionnaire.

RESULTS

The response rate was 88.2%. The knowledge of gynecologists was estimated as average. The most frequently reported obstacles to HPV vaccination was the financial concern (59.8%). More than two thirds of the gynecologists were willing to recommend the vaccine (68.4%). The factors associated with the gynecologists' intention to recommend the vaccine included their positive attitudes toward boys' vaccination (odds ratio [OR], 8.96; 95% confidence interval [CI], 2.85-28.16), negative attitudes toward frequent changes the recommendations (OR, 0.31; 95% CI, 0.10-0.93), and beliefs that the vaccine application would decrease condom usage (OR, 0.31; 95% CI, 0.06-0.68).

CONCLUSIONS

The findings provide an important insight into the current point of view of the gynecologists, which confirms that the better the knowledge of HPV and vaccine, the higher the likelihood of recommending it.

A Survey of Wisconsin Pediatricians’ Knowledge and Practices Regarding the Human Papillomavirus Vaccine

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.

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

BACKGROUND

Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the United States are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males.

METHODS

We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11-12, 13-17, 18-21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with consistent and strong recommendations for 11- to 12-year-olds.

RESULTS

We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males ages 13 to 17 (39%) compared with ages 11 to 12 (31%) and 18 to 21 (31%). Consistent and strong recommendation for 11- to 12-year-old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty in remembering to discuss HPV vaccination.

CONCLUSIONS

Physicians' current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians' personal barriers to HPV vaccine delivery.

IMPACT

As one of the first studies to examine both consistency and strength of physicians' HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians' recommendations. Cancer Epidemiol Biomarkers Prev; 25(10); 1435-46. ©2016 AACR.

Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico

BACKGROUND

It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements.

METHODS

A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables.

RESULTS

Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work.

CONCLUSIONS

This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.

Provider communication about HPV vaccination: A systematic review

BACKGROUND

Improving HPV vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of provider communication about HPV vaccination.

METHODS

We searched MEDLINE, CINAHL, EMBASE, and POPLINE in August 2015 to identify studies of provider communication about HPV vaccination.

RESULTS

We identified 101 qualitative and quantitative studies. Providers less often recommended HPV vaccine if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Patients less often received recommendations if they were younger, male, or from racial/ethnic minorities. Despite parents' preference for unambiguous recommendations, providers often sent mixed messages by failing to endorse HPV vaccine strongly, differentiating it from other vaccines, and presenting it as an "optional" vaccine that could be delayed.

CONCLUSION

Interventions are needed to help providers deliver effective recommendations in the complex communication environment surrounding HPV vaccination.

Factors influencing the recommendation of the Human Papillomavirus vaccine by South African doctors working in a tertiary hospital

BACKGROUND

In South Africa, HPV vaccination programme has been incorporated recently in the school health system. Since doctors are the most trusted people regarding health issues in general, their knowledge and attitudes regarding HPV infections and vaccination are very important for HPV vaccine program nationally.

OBJECTIVE

The objective of this study was to investigate factors contributing to recommendation of HPV vaccines to the patients.

METHODS

This was a quantitative cross-sectional study conducted among 320 doctors, using a self-administered anonymous questionnaire.

RESULTS

All the doctors were aware of HPV and knew that HPV is transmitted sexually. Their overall level of knowledge regarding HPV infections and HPV vaccine was poor. But the majority intended to prescribe the vaccine to their patients. It was found that doctors who knew that HPV 6 and 11 are responsible for >90% of anogenital warts, their patients would comply with the counselling regarding HPV vaccination, and received sufficient information about HPV vaccination were 5.68, 4.91 and 4.46 times respectively more likely to recommend HPV vaccination to their patients, compared to their counterparts (p<0.05).

CONCLUSION

There was a knowledge gap regarding HPV infection and HPV vaccine among the doctors.

Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis

Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices "often or very often" (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.

The content and context of physicians' communication with males about human papillomavirus vaccination

A physician's recommendation for human papillomavirus (HPV) vaccine is a key predictor of vaccine uptake; however, little is known about how physicians communicate about HPV vaccine with male patients. We sought to describe physicians' HPV vaccine communication practices with males who are of vaccine-eligible age (9-26 years). We surveyed representative samples of pediatric and family medicine physicians in Florida, and assessed whether physicians present HPV vaccine as optional or routine, and as a vaccine that prevents cancer. We also assessed the type of visit during which physicians discuss HPV vaccine with adolescent males and whether other healthcare providers in the practice discuss HPV vaccine or make the initial recommendation. We received 367 completed surveys (50.7% response rate). Few physicians (29.9%) reported they typically present HPV vaccine as routine to males ages 11-12 years, who constitute the target group for routine vaccination. When discussing HPV vaccination, many physicians reported somewhat or strongly emphasizing cancer prevention (80.0%). Physicians most often discussed HPV vaccine when they saw patients for well-child visits (93.0%) and least often at acute care visits (15.3%). Over half reported that at least one other healthcare professional in their practice discusses (56.1%) or makes the initial recommendation for (54.9%) HPV vaccination. Many physicians in our sample are presenting HPV vaccine as optional rather than routine and are missing opportunities to communicate with males about the vaccine. Our findings identify areas for future interventions to improve physicians' HPV vaccine communication and, ultimately, increase the use of this cancer-preventing vaccine.

[Practices and attitudes regarding HPV vaccination among general practitioners from Besançon]

OBJECTIVES

To assess opinions, practices and difficulties of general practitioners (GP) of Besançon concerning human papillomavirus (HPV) vaccination.

MATERIALS AND METHODS

A survey among the 140 GP of Besançon, France, was conducted in 2015.

RESULTS

A percentage of 77.1 reported being favourable to HPV vaccination and 72.9% practices HPV vaccination. The 2 main concerns about HPV vaccination for GP are the fear of side effects (for 40.6% of GP) and the doubt on efficacy. According to GP, the hepatitis B vaccination controversy, the fear of side effects, the limited clinical efficacy experience and the lack of confidence in health authorities are concerns about HPV vaccination for 77.1%, 76%, 74% and 49% of patients, respectively.

CONCLUSION

Courses for GP on HPV vaccination must be pursued and reinforced. A school-based program could be developed to facilitate communication between GP and patients to improve HPV vaccination coverage.

Awareness and acceptance of human papillomavirus vaccination among health sciences students in Malaysia

The major cause of cervical cancer is human papillomavirus (HPV) for which vaccination is available. The success HPV vaccination programme largely depend on the degree of knowledge of the healthcare providers who can recommend to the public. Health sciences students as future healthcare providers play a major role in HPV vaccination initiatives. The objective of this study was to evaluate the knowledge, attitude, practice and to find out the willingness to pay for HPV vaccination among the health sciences students in a private university. The cross-sectional study was conducted among the university students studying health sciences program using a validated questionnaire to measure their awareness and acceptance of HPV vaccination. The students demonstrated moderate knowledge about HPV infection and vaccination with mean knowledge scores of 9.3 out of 17. Students were showing positive attitude towards HPV vaccination with mean scores of 3.80 out of 5. However, low HPV vaccination uptake rate was reported among the students. Most of the students were willing to recommend HPV vaccine. The participants felt that the cost is the major barrier towards HPV vaccination and they felt the government should cover the cost of vaccination for all. The results of this study may be helpful in establishing educational policies on cervical cancer-related topics in the universities.

Pediatricians Support Initiation of Asthma Controller Medications in the Emergency Department: A National Survey

OBJECTIVES

Although National Asthma Guidelines recommend that emergency department (ED) physicians consider initiating controller medications, research suggests that this practice occurs infrequently. The goal of this study was to assess primary care pediatricians' (PCP) beliefs and attitudes regarding ED initiation of controller medications for children with persistent asthma symptoms.

METHODS

This was a cross-sectional mail survey of a randomly selected national sample of pediatricians from the American Academy of Pediatrics. The survey posed questions regarding beliefs, barriers, and support for national guideline recommendations.

RESULTS

Eight hundred eighty-six (44.3%) of 2000 subjects responded. Five hundred seventy-two (64.5%) respondents met eligibility for analysis. When presented with a vignette of a child with persistent asthma, 476 (83%) of PCPs felt it was appropriate for the ED physician to initiate controller medications. Most (80%) PCPs supported the national guideline recommendation, although a similar proportion reported they have never or rarely experienced this practice before. Only 11% opposed the practice in all circumstances. Beliefs supporting this practice included the following: opportunity to capture patients lost to follow-up (85%), reinforcement of daily use of controller medications (83%), and controller medication may shorten an acute exacerbation (53%). Barriers included lack of time for education in ED (65%), reinforcement of ED use for primary care (64%), lack of PCP communication (62%), and inability to assess severity appropriately (41%). Most (90%) PCPs expect communication from the ED provider.

CONCLUSIONS

A majority of pediatricians support the practice of ED physicians initiating controller medication during an acute visit for asthma. Communication with the PCP, appropriate screening of severity, and education about controller medications were important considerations expressed by these providers.

Incidence of sexually transmitted infections after human papillomavirus vaccination among adolescent females

IMPORTANCE

Human papillomavirus (HPV) vaccination rates among US females remain low, in part because of concerns that HPV vaccination may promote unsafe sexual activity by lowering perceived risks of acquiring a sexually transmitted infection (STI).

OBJECTIVE

To study whether HPV vaccination of females is associated with increases in STI rates.

DESIGN, SETTING, AND PARTICIPANTS

Using a large, longitudinal insurance database of females aged 12 to 18 years insured from January 1, 2005, through December 31, 2010, in the United States, we examined whether HPV vaccination was associated with an increase in incident STIs among females who were vaccinated compared with those who were not. We defined STIs as one or more medical claims for any of the following infections in a given quarter: chlamydia, gonorrhea, herpes, human immunodeficiency virus or AIDS, or syphilis. We used difference-in-difference analysis to compare changes in STI rates among HPV-vaccinated females before and after vaccination (index quarter) to changes among age-matched nonvaccinated females before and after the index quarter. We analyzed whether effects varied according to age and prior contraceptive medication use.

MAIN OUTCOMES AND MEASURES

Rates of STIs.

RESULTS

The rates of STIs in the year before vaccination were higher among HPV-vaccinated females (94 of 21 610, 4.3 per 1000) compared with age-matched nonvaccinated females (522 of 186 501, 2.8 per 1000) (adjusted odds ratio, 1.37; 95% CI, 1.09-1.71; P = .007). The rates of STIs increased for the vaccinated (147 of 21 610, 6.8 per 1000) and nonvaccinated (781 of 186 501, 4.2 per 1000) groups in the year after vaccination (adjusted odds ratio, 1.50; 95% CI, 1.25-1.79; P < .001). The difference-in-difference odds ratio was 1.05 (95% CI, 0.80-1.38; P = .74), implying that HPV vaccination was not associated with an increase in STIs relative to growth among nonvaccinated females. Similar associations held among subgroups aged 12 through 14 years and aged 15 through 18 years and among females with contraceptive use in the index quarter.

CONCLUSIONS AND RELEVANCE

Human papillomavirus vaccination was not associated with increases in STIs in a large cohort of females, suggesting that vaccination is unlikely to promote unsafe sexual activity.

Factors influencing the recommendation of the human papillomavirus vaccine by Serbian pediatricians

OBJECTIVES

This research was undertaken to investigate the knowledge and attitudes regarding Human Papillomavirus infection and the Human Papillomavirus (HPV) vaccine among pediatricians who work in primary health care and to determine their intention to recommend the HPV vaccine as an important measure for the primary prevention of cervical cancer. We assessed the factors associated with the intention to recommend the vaccine.

STUDY DESIGN

This cross-sectional study was conducted in March and April 2012. This research included all pediatricians who worked with school children in public primary health care institutions in Belgrade. A research instrument questionnaire had been designed for this study.

RESULTS

The response rate was 78.7%. The knowledge of pediatricians related to HPV infection and the HPV vaccine was estimated as poor. However, pediatricians recognized the need for additional education in this field. The most-frequently reported barrier to HPV vaccination was the financial concern (68.2%). Alternatively, according to the pediatricians, the most common parental barrier to vaccination was the lack of information on the vaccine (67.2%). Nearly two-thirds of the pediatricians were willing to recommend the vaccine (60.2%). The factors associated with the pediatricians' intention to recommend the vaccine included the parents' attitudes.

CONCLUSION

The majority of pediatricians accept the HPV vaccine and recommend it to their patients. It is necessary to improve cooperation between parents and pediatricians to increase immunization coverage and develop national consulting strategies with a focus on the prevention of HPV infection.

Knowledge and attitudes about human papillomaviruses and immunization among Turkish pediatricians

BACKGROUND

Human papillomavirus (HPV) is one of the most common sexually transmitted infectious agents, and the effectiveness of vaccine delivery programs will depend largely upon whether providers recommend vaccines. The objectives of this study were to examine pediatrician characteristics, knowledge, and attitudes associated with HPV and HPV immunization.

MATERIALS AND METHODS

Attendees of the national pediatric meeting in 2011, were asked to complete a questionnaire that, aside from demographic information, elicited level of agreement with statements regarding HPV, its related diseases, and HPV vaccination. It also documented attitudes and beliefs about HPV vaccination.

RESULTS

Of the 480 attendees, 226 (47%) filled in the questionnaire. The level of pediatrician HPV-related knowledge varied. The majority (78%) were aware that HPV infection is the most common sexually transmitted infection, while 51% were unaware that a condom is ineffective protection against HPV infection. Between 60-80% of respondents were aware of the effectiveness of HPV vaccination for women. On the other hand, only 10% were aware of reasons why men should be vaccinated against HPV. The majority (75%) of Turkish pediatricians were likely to recommend HPV vaccination to their daughter, if they had one. Seventy percent of pediatricians agreed that the HPV vaccination should be added to the National Immunization Program (NIP) in Turkey. However, the respondents documented concerns about the cost of the vaccination.

CONCLUSIONS

Increasing pediatricians' knowledge and awareness of HPV and HPV vaccination may assist with the implementation of an effective NIP.

Ethnic and gender differences in HPV knowledge, awareness, and vaccine acceptability among White and Hispanic men and women

The purpose of this study was to examine factors associated with human papillomavirus (HPV) knowledge and awareness, and HPV vaccination among White and Hispanic males and females. Differences in HPV knowledge, sources of information, vaccine awareness, vaccination status, and interest in vaccination were examined. A community sample was recruited from local health care clinics in a medium sized Midwestern city between May 2010 and December 2011. Participants (N = 507) were White (n = 243) and Hispanic, males (n = 202) and females between the ages of 15-30. Results indicate that White and female participants were significantly more likely to have heard of HPV, have higher levels of HPV knowledge, have been diagnosed with HPV, and be aware of the HPV vaccine for women. White and female participants were also more likely to have heard of HPV from their physician and were significantly more interested in receiving the HPV vaccine in the future. There was no effect of ethnicity on interest in the vaccine per a doctor's recommendation, however. Findings suggest that Whites and females have greater levels of HPV awareness and knowledge and that, while Hispanic participants are less likely than White participants to be told about the HPV vaccine from their provider, they may be equally receptive to such a recommendation.

Emergency medicine physician attitudes toward HPV vaccine uptake in an emergency department setting

A physician's recommendation is the most effective published method of motivating HPV vaccination initiation. The emergency department (ED) is the 'public health safety net', and often the only access to care for underserved populations. Recommendation of the HPV vaccine in the ED is a potential avenue to improve vaccination rates among sub-populations who do not have access to routine medical care. We assessed willingness of EM physicians to recommend the vaccine, target high-risk women, and disclose perceived barriers to vaccination in the ED. A cross sectional study using an 11-item survey, was used to assess physician attitudes toward recommending the HPV vaccine in an ED setting to age eligible patients. 67.4% stated they would recommend the vaccine, 23.9% were neutral, and 8.7% would not recommend the vaccine to age eligible patients in the ED. 41% noted lack of adequate reimbursement for vaccination as a barrier to vaccination in the ED (P<0.05). Physicians were comfortable targeting women at high risk for cervical cancer for vaccination (P<0.05). EM physicians are comfortable targeting high-risk women for HPV vaccination in an ED setting. Support of EM physicians in the national effort to improve HPV vaccine uptake is an important step in eradicating a largely preventable yet lethal cancer.

Missed opportunities for HPV vaccination in adolescent girls: a qualitative study

OBJECTIVE

The goal of this study was to identify the rationale by parents/guardians and providers for delaying or administering human papillomavirus (HPV) vaccination to girls.

METHODS

Qualitative interviews were conducted with parents/guardians accompanying their vaccine-eligible 11- to 17-year-old daughters to medical visits. Interviews were conducted in 1 public clinic and 3 private practice settings to ascertain why girls did or did not receive HPV vaccination. Questions probed vaccine decision-making from the point of view of parents/guardians and providers.

RESULTS

A total of 124 parents/guardians and 37 providers participated. The most common reasons parents reported for not vaccinating their daughters was the lack of a physician recommendation (44%). Both parents and providers believed that HPV vaccination provided important health benefits, but the timing of vaccination with relation to sexual activity was an important theme related to vaccine delay. Providers with lower self-reported vaccination rates delayed vaccine recommendations in girls perceived to be at low risk for sexual activity, and several parents reported that their providers suggested or supported delaying vaccination until their daughters were older. However, parents/guardians and providers agreed that predicting the timing of sexual debut was extremely difficult. In contrast, providers with high vaccination rates presented HPV vaccination as a routine vaccine with proven safety to prevent cancer, and parents responded positively to these messages.

CONCLUSIONS

Although most parents and providers believe that HPV vaccination is important, missed opportunities result from assumptions about the timing of vaccination relative to sexual activity. Routinely recommending HPV vaccination as cancer prevention to be coadministered with other vaccines at age 11 years can improve vaccination rates.

Acceptability of human papillomavirus vaccine: a survey among master of business administration students in KwaZulu-Natal, South Africa

Cervical cancer is a preventable public health problem. The two new human papillomavirus (HPV) vaccines are available but not accessible to everyone in South Africa, as they are very expensive. This study aimed to investigate educated peoples acceptability regarding HPV vaccination. This was a cross-sectional survey conducted among 146 master of business administration students by self-administered, anonymous questionnaire. The majority (74%) of the participants ever heard of cervical cancer, but only 26.2% heard about HPV. After reading the fact information regarding cervical cancer and HPV, the intention to vaccinate their daughters increased from 88% to 97.2% (P = 0.003). The majority (75.4%) indicated that HPV vaccination should be given before their daughters are mature enough to understand about sex, and 80.3% reported that they will discuss matters related to sex with their daughters if their daughters want to know about the vaccine. Those who did not want to vaccinate their daughters highlighted that they want more information regarding safety of the vaccine which might change their decision towards HPV vaccination. A health education information method can increase the vaccination acceptance rate in South Africa.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPACT

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

Women have a preference for their male partner to be HPV vaccinated

BACKGROUND

Peer influence and social networking can change female adolescent and young adult behavior. Peer influence on preferences for male human papillomavirus (HPV) vaccination has not been documented. The primary aim of this study was to determine if women had preferences about male sexual partner HPV vaccination receipt.

METHODS AND FINDINGS

A prospective survey of women 18-26 years of age was conducted at an urban university student health clinic. Education about the two HPV vaccines, cervical cancer and genital warts was provided. Women self-reported their demographic and medical history data, as well as their own preferences for HPV vaccine and their preferences for their male partner HPV vaccine using a 5 point Likert scale. 601 women, mean age of 21.5 years (SD 2.4), participated between 2011 and 2012. Nearly 95% of respondents were heterosexual; condoms and contraceptives were used in over half of the population. Regardless of the woman's vaccination status, women had significantly higher (strongly agree/agree) preferences for the male partner being vaccinated with HPV4 than not caring if he was vaccinated (63.6% vs. 13.1%, p<0.001). This preference was repeated for sexual risk factors and past reproductive medical history. Women who received HPV4 compared to those choosing HPV2 had a significantly lower proportion of preferences for not caring if the male partner was vaccinated (13% vs. 22%, p = 0.015).

CONCLUSIONS

Women preferred a HPV vaccinated male partner. Peer messaging might change the male HPV vaccination uptake.

Risk perceptions and subsequent sexual behaviors after HPV vaccination in adolescents

OBJECTIVES

Concerns have been raised that human papillomavirus (HPV) vaccination could lead to altered risk perceptions and an increase in risky sexual behaviors among adolescents. The aim of this study was to assess whether adolescent risk perceptions after the first vaccine dose predicted subsequent sexual behaviors.

METHODS

Young women 13 to 21 years of age (N = 339) completed questionnaires immediately after HPV vaccination, and 2 and 6 months later, assessing demographic characteristics, knowledge/attitudes about HPV vaccination, risk perceptions, and sexual behaviors. Risk perceptions were measured by using 2 5-item scales assessing: (1) perceived risk of sexually transmitted infections (STI) other than HPV, and (2) perceived need for safer sexual behaviors after HPV vaccination. We assessed associations between risk perceptions at baseline and sexual behaviors over the next 6 months by using logistic regression, stratifying participants by sexual experience at baseline and age (13-15 vs. 16-21 years).

RESULTS

Among all sexually inexperienced participants (42.5%), baseline risk perceptions were not associated with subsequent sexual initiation; in age-stratified analyses, girls 16 to 21 years of age who reported lower perceived risk for other STI (an inappropriate perception) were less likely to initiate sex (odds ratio [OR] 0.13, 95% confidence interval [CI] 0.03-0.69). Among all sexually experienced participants (57.5%) and in age-stratified analyses, baseline risk perceptions were not associated with subsequent number of sexual partners or condom use.

CONCLUSIONS

Risk perceptions after HPV vaccination were not associated with riskier sexual behaviors over the subsequent 6 months in this study sample.

Sexual experiences in relation to HPV vaccination status in female high school students in Sweden

OBJECTIVES

To investigate sexual experiences, sexually transmitted infections (STIs) and use of condoms in relation to human papillomavirus (HPV)-vaccination status in female high school students.

METHODS

In 2013, 355 female students with a median age of 18 years from randomly selected high schools in Sweden answered a classroom questionnaire on sexual experiences and HPV-vaccination status.

RESULTS

In total 227/348 (65%) of the women reported having received at least one HPV vaccine dose. Median age at first intercourse was 15 and 16 years respectively, in the 141/227 (62%) vaccinated after, and the 86/227 (38%) vaccinated before their sexual debut. There were no differences between the HPV-vaccinated and non-vaccinated groups regarding condom use, STIs, and experiences of oral and anal sex, or friends- with-benefit relationships. However, having had sexual intercourse and 'one-night stands' were more common in the vaccinated group (both p < 0.05).

CONCLUSION

Many students (62%) were vaccinated against HPV, with two-thirds after their sexual debut. There were no differences in condom use and STIs, and only a few differences in sexual experiences between the HPV-vaccinated and non-vaccinated groups. Initiating HPV vaccination before sexual debut is important, as is information about the link between HPV, sexual behaviour and cancer.