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Kluczynski MA, Rodriguez EM, McGillicuddy CS, Schlecht NF. Human Papillomavirus Vaccination in Pediatric, Adolescent, and Young Adult Cancer Survivors-Opportunity to Address Gaps in Cancer Prevention and Survivorship. Vaccines (Basel) 2024; 12:114. [PMID: 38400098 PMCID: PMC10892003 DOI: 10.3390/vaccines12020114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
The risks of secondary cancers associated with human papillomavirus (HPV) infection are as much as three times higher for survivors of pediatric, adolescent, and young adult cancer (PYAC) compared to the general population. Despite this, HPV vaccination rates among PYAC survivors remain low. Whereas pediatric oncology providers endorse HPV vaccination of PYAC survivors, many lack the resources or opportunities to intervene. The responsibility of HPV vaccination, therefore, falls to primary care providers and practices. This article provides an overview of the challenges with HPV vaccination that are distinct to PYAC survivors and discusses potential strategies to increase HPV vaccine coverage in this population.
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Affiliation(s)
| | | | | | - Nicolas F. Schlecht
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.A.K.); (E.M.R.); (C.S.M.)
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2
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Santos WM, Santos DM, Fernandes MS. HPV immunization in Brazil and proposals to increase adherence to vaccination campaigns. Rev Saude Publica 2023; 57:79. [PMID: 37937653 PMCID: PMC10609638 DOI: 10.11606/s1518-8787.2023057005410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVES To identify the possible causes of low adherence to vaccination campaigns in Brazil, find and analyze campaigns regarding human papillomavirus (HPV) in Brazil and abroad, and apply quality tools to prepare proposals to increase vaccination coverage (VC) and prevent HPV in the country. METHOD This is a qualitative and deductive-hypothetical research. A narrative review of the literature (especially on the narratives and formats applied in vaccination campaigns in Brazil) was the technique used to develop our method. RESULTS Brazil had a 49.6% VC in 2019, unlike countries such as Australia (80.2% in 2017), Mexico (97.5% in 2019), and Peru (91% in 2019). This study found evidence of the use of social marketing strategies to engage communities as good practices in the vaccination campaigns of these countries. CONCLUSION With the retrieved information, three quality tools (Ishikawa diagram, Pareto graph, and 5W2H) classified and quantified the causes of low VC in Brazil and enabled proposals that can direct its Ministry of Health to take more effective strategies to achieve the HPV VC goal recommended by the WHO.
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Affiliation(s)
- Wagner Mesojedovas Santos
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegrePrograma de Pós-graduação em Pesquisa ClínicaPorto AlegreRSBrasil Universidade Federal do Rio Grande do Sul. Hospital de Clínicas de Porto Alegre. Programa de Pós-graduação em Pesquisa Clínica. Porto Alegre, RS, Brasil
| | - Debora Mesojedovas Santos
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegrePrograma de Pós-graduação em Pesquisa ClínicaPorto AlegreRSBrasil Universidade Federal do Rio Grande do Sul. Hospital de Clínicas de Porto Alegre. Programa de Pós-graduação em Pesquisa Clínica. Porto Alegre, RS, Brasil
| | - Márcia Santana Fernandes
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegreLaboratório de Pesquisa de Bioética e Ética na CiênciaPorto AlegreRSBrasil Universidade Federal do Rio Grande do Sul. Hospital de Clínicas de Porto Alegre. Laboratório de Pesquisa de Bioética e Ética na Ciência. Porto Alegre, RS, Brasil
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Thaker J, Albers AN, Newcomer SR. Nurses' perceptions, experiences, and practices regarding human papillomavirus vaccination: results from a cross-sectional survey in Montana. BMC Nurs 2023; 22:211. [PMID: 37337180 PMCID: PMC10278302 DOI: 10.1186/s12912-023-01379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Nationally, much of the focus on improving human papillomavirus (HPV) vaccine uptake has been on effective strategies that physicians use to promote vaccination. However, in large, predominately rural states like Montana, nurses and medical assistants play critical roles in immunization services delivery, and their viewpoints are imperative in designing strategies to increase vaccination rates. We conducted a cross-sectional, descriptive study to determine nurses' perceptions, experiences, and practices regarding human papillomavirus vaccination in a rural and medically underserved region of the United States. METHODS We designed, pilot-tested, and disseminated an online survey instrument to nurses and medical assistants working in clinics participating in the Vaccines for Children program in Montana. The online surveys were administered from November 2020 to March 2021. Survey questions focused on clinic vaccination practices, respondents' perceptions of the HPV vaccine, perceived barriers to vaccine uptake, and general opinions on potential strategies to improve HPV vaccination rates. RESULTS We analyzed data from 227 respondents. Overall, 90% of nurses strongly agreed or agreed that the HPV vaccine is important and had confidence in the vaccine's safety. More nurses reported experiencing greater parental vaccine refusal or delay for male patients regardless of age. About 53.7% of nurses reported that their clinics had reminder/recall systems to encourage parents to bring their children for vaccination. Nurses identified misinformation from social media, infrequent wellness visits, and vaccine safety concerns as barriers to HPV vaccine uptake. CONCLUSIONS Study findings identified several promising initiatives to accelerate vaccination in primarily rural states like Montana, including promoting widespread adoption of reminder/recall systems, training nurses in evidence-based techniques to provide strong vaccine recommendations, and leveraging social media to disseminate consistent messages about the HPV vaccine recommendations for both sexes and its role in cancer prevention.
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Affiliation(s)
- Juthika Thaker
- School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs 173, Missoula, MT, 59803, USA.
- Center for Population Health Research, The University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Alexandria N Albers
- School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs 173, Missoula, MT, 59803, USA
- Center for Population Health Research, The University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Sophia R Newcomer
- School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs 173, Missoula, MT, 59803, USA
- Center for Population Health Research, The University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
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Chang RS, Shing JZ, Erves JC, Du L, Koyama T, Deppen S, Rentuza AB, McAfee C, Stroebel C, Cates J, Harnack L, Andrews D, Bramblett R, Hull PC. Measurement of provider fidelity to immunization guidelines: a mixed-methods study on the feasibility of documenting patient refusals of the human papillomavirus vaccine. BMC Med Inform Decis Mak 2022; 22:339. [PMID: 36550466 PMCID: PMC9783975 DOI: 10.1186/s12911-022-02083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Assessment and feedback is a common implementation strategy to improve healthcare provider fidelity to clinical guidelines. For immunization guidelines, fidelity is often measured with doses administered during eligible visits. Adding a patient refusal measure captures provider fidelity more completely (i.e., all instances of a provider recommending a vaccine, resulting in vaccination or refusal) and enables providers to track patient vaccine hesitancy patterns. However, many electronic health record (EHR) systems have no structured field to document multiple instances of refusals for specific vaccines, and existing billing codes for refusal are not vaccine specific. This study assessed the feasibility of a novel method for refusal documentation used in a study focused on human papillomavirus (HPV) vaccine. METHODS An observational, descriptive-comparative, mixed-methods study design was used to conduct secondary data analysis from an implementation-effectiveness trial. The parent trial compared coach-based versus web-based practice facilitation, including assessment and feedback, to increase HPV vaccination in 21 community-based private pediatric practices. Providers were instructed to document initial HPV vaccine refusals in the EHR's immunization forms and subsequent refusals using dummy procedure codes, for use in assessment and feedback reports. This analysis examined adoption and maintenance of the refusal documentation method during eligible well visits, identified barriers and facilitators to documentation and described demographic patterns in patient refusals. RESULTS Seven practices adopted the refusal documentation method. Among adopter practices, documented refusals started at 2.4% of eligible well visits at baseline, increased to 14.2% at the start of implementation, peaked at 24.0%, then declined to 18.8%. Barriers to refusal documentation included low prioritization, workflow integration and complication of the billing process. Facilitators included high motivation, documentation instructions and coach support. Among adopter practices, odds of refusing HPV vaccine were 25% higher for patients aged 15-17 years versus 11-12 years, and 18% lower for males versus females. CONCLUSIONS We demonstrated the value of patient refusal documentation for measuring HPV vaccination guideline fidelity and ways that it can be improved in future research. Creation of vaccine-specific refusal billing codes or EHR adaptations to enable documenting multiple instances of specific vaccine refusals would facilitate consistent refusal documentation. Trial Registration NCT03399396 Registered in ClinicalTrials.gov on 1/16/2018.
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Affiliation(s)
- Rachel S. Chang
- grid.152326.10000 0001 2264 7217School of Medicine, Vanderbilt University, Nashville, TN USA
| | - Jaimie Z. Shing
- grid.412807.80000 0004 1936 9916Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jennifer C. Erves
- grid.259870.10000 0001 0286 752XDepartment of Internal Medicine, Meharry Medical College, Nashville, TN USA
| | - Liping Du
- grid.412807.80000 0004 1936 9916Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Tatsuki Koyama
- grid.412807.80000 0004 1936 9916Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Stephen Deppen
- grid.412807.80000 0004 1936 9916Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Alyssa B. Rentuza
- grid.412807.80000 0004 1936 9916Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Caree McAfee
- grid.266539.d0000 0004 1936 8438Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY 40504-3381 USA
| | - Christine Stroebel
- grid.266539.d0000 0004 1936 8438Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY 40504-3381 USA ,Cumberland Pediatric Foundation, Nashville, TN USA
| | - Janet Cates
- Cumberland Pediatric Foundation, Nashville, TN USA
| | - Lora Harnack
- Cumberland Pediatric Foundation, Nashville, TN USA
| | | | | | - Pamela C. Hull
- grid.266539.d0000 0004 1936 8438Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY 40504-3381 USA ,grid.266539.d0000 0004 1936 8438Department of Behavioral Science, University of Kentucky, Lexington, KY USA
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Richman AR, Torres E, Wu Q, Eldridge D, Lawson L. The Evaluation of a Digital Health Intervention to Improve Human Papillomavirus Vaccine Recommendation Practices of Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022:10.1007/s13187-022-02250-z. [PMID: 36526919 DOI: 10.1007/s13187-022-02250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
We investigated what is being taught about HPV in US medical schools and evaluated a digital health intervention for medical students to increase their intention to provide a high-quality HPV vaccine recommendation. An online survey was emailed to Academic Deans at the 124 accredited US Schools of Medicine and Osteopathic Medicine between February and April 2018. A digital educational module was emailed to medical students in June 2020. A single-subject longitudinal study design was employed. Pre- post-survey administration measured change in knowledge, attitudes, subjective norms, perceived behavioral control, and intention to recommend HPV vaccine. Gaps in medical school curricula were found. Very few schools (~ 9%) reported teaching content on HPV prevention strategies or patient education. For the digital intervention, independent and dependent variables increased positively. Perceived behavioral control improved at significant levels as participants felt more confident addressing parents' concerns about the vaccine (p < 0.001) and more confident recommending the vaccine for patients (p < 0.05) post module. On the pre-survey, only 6% of the sample knew the most effective HPV vaccine communication style and on the post-survey 81% correctly identified it (p < 0.001). The intervention increased HPV and HPV vaccine knowledge, self-efficacy, and intention to provide a high-quality HPV vaccine recommendation to patients.
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Affiliation(s)
- Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 300 Curry Court, Carol Belk Building, Greenville, NC, 27858, USA.
| | - Essie Torres
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 300 Curry Court, Carol Belk Building, Greenville, NC, 27858, USA
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, 2150 West 5th Street, Greenville, NC, 27858, USA
| | - David Eldridge
- Department of Pediatrics, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Luan Lawson
- Department of Emergency Medicine, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
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Ayres S, Gee A, Kim S, Hashibe M, Praag A, Kaiser D, Chang CP, Brandt HM, Kepka D. Human Papillomavirus Vaccination Knowledge, Barriers, and Recommendations Among Healthcare Provider Groups in the Western United States. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1816-1823. [PMID: 34236651 PMCID: PMC8745488 DOI: 10.1007/s13187-021-02047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
This study compared human papillomavirus (HPV) vaccination occurrences on the same day as provider recommendations at clinics in the Western United States stratified by healthcare provider groups. In addition, the relationships between provider groups' perceived challenges associated with HPV vaccination, HPV vaccination knowledge, HPV recommendation practices, and same-day HPV vaccinations and recommendations are described. Eligible participants included pediatric healthcare providers and staff with influence on patient/parental-level decisions regarding HPV vaccination. Participants filled out a 40-question survey. Results for study participants (N = 99) showed providers reported a higher number of challenges limiting HPV vaccination, higher HPV vaccination knowledge, and more favorable HPV vaccination recommendation practices compared to other healthcare team members (OTM) suggesting providers may have a better overall understanding of the HPV vaccination climate than OTMs. Clinics should examine OTMs' training, expectations, and opportunities to increase the frequency and strength of HPV vaccination recommendations to adolescent patients and parents.
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Affiliation(s)
- Shauna Ayres
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - Alexandra Gee
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Seungmin Kim
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Aisha Praag
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Danielle Kaiser
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Chun-Pin Chang
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Heather M Brandt
- St. Jude Children's Research Hospital, St. Jude Comprehensive Cancer Center, Memphis, TN, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Fields EJ, Hopfer S, Warren JR, BeLue R, Lebed J, Hecht ML. Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood. Vaccines (Basel) 2022; 10:vaccines10071126. [PMID: 35891290 PMCID: PMC9317585 DOI: 10.3390/vaccines10071126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.
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Affiliation(s)
- Emilia J. Fields
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
| | - Suellen Hopfer
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
- Correspondence: ; Tel.: +1-(949)-824-6996
| | - Jennifer R. Warren
- Department of Communication, Women and Gender Studies, African and African American Studies, George Mason University, Fairfax, VA 22030, USA;
| | - Rhonda BeLue
- Department of Public Health, University of Texas San Antonio, San Antonio, TX 78249, USA;
| | - Joel Lebed
- Planned Parenthood Southeastern Pennsylvania, Philadelphia, PA 19107, USA;
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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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Occa A, Stahl HM, Julien-Bell S. Helping Children to Participate in Human Papillomavirus-Related Discussions: Mixed Methods Study of Multimedia Messages. JMIR Form Res 2022; 6:e28676. [PMID: 35404265 PMCID: PMC9039810 DOI: 10.2196/28676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/13/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). OBJECTIVE This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health-in particular when such conversations center around the HPV vaccination-and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children's knowledge and perceptions of HPV prevention. METHODS A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children's experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. RESULTS Both the animated video and a web-based game increased children's knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. CONCLUSIONS This study shows that both materials were effective for improving children's education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns.
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Affiliation(s)
- Aurora Occa
- Department of Communication, University of Kentucky, Lexington, KY, United States
| | - Hayley M Stahl
- Department of Communication, University of Kentucky, Lexington, KY, United States
| | - Sarah Julien-Bell
- Department of Communication, University of Illinois at Urbana, Urbana, IL, United States
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10
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Margolis MA, Brewer NT, Boynton MH, Lafata JE, Southwell BG, Gilkey MB. Provider response and follow-up to parental declination of HPV vaccination. Vaccine 2022; 40:344-350. [PMID: 34887133 PMCID: PMC8755625 DOI: 10.1016/j.vaccine.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Parents often decline HPV vaccination, but little is known about how healthcare providers should promote vaccination at a later visit for secondary acceptance. We examined the associations of two factors, providers' response to declination during the visit and follow-up after the visit, with secondary acceptance. METHODS We conducted a cross-sectional survey of US parents whose 9- to 17-year-old child had not yet completed the HPV vaccination series. Parents who declined HPV vaccination during an initial discussion with a provider (n = 447) reported whether their provider engaged in any active response during the visit (e.g., giving information, trying to change their mind) or any follow-up after the visit (e.g., scheduling another visit). We conducted multivariable logistic regression to determine whether an active response or follow-up was associated with secondary acceptance of HPV vaccination. RESULTS Only about one-third of parents reported an active response during the visit (35%) or follow-up after the visit (39%) following HPV vaccination declination. Parents had higher odds of secondary acceptance of HPV vaccine if they received any provider follow-up after the visit (43% vs. 20%, aOR:3.19; 95% CI:2.00:5.07). Receipt of an active provider response was not associated with secondary acceptance. More parents thought a provider should actively respond and follow-up (61% and 68% respectively), compared with those who received such a response (both p < .01). CONCLUSIONS Providers' follow-up after the visit may be important for promoting secondary acceptance of HPV vaccination. Parents who decline HPV vaccination often prefer to receive an active response or follow-up from a provider.
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Affiliation(s)
- Marjorie A Margolis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marcella H Boynton
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, NC, USA
| | - Brian G Southwell
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Science in the Public Sphere, RTI International, Research Triangle Park, NC, USA; Duke Forge, School of Medicine, Duke University, Durham, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
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Recommending Human Papillomavirus Vaccination at Age 9: A National Survey of Primary Care Professionals. Acad Pediatr 2022; 22:573-580. [PMID: 35081470 PMCID: PMC9081141 DOI: 10.1016/j.acap.2022.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Several US health organizations, including the American Academy of Pediatrics, now encourage primary care professionals to recommend human papillomavirus (HPV) vaccination before the traditionally targeted ages of 11 to 12 years as a strategy to increase vaccination timeliness. To understand the feasibility of this approach, we sought to evaluate primary care professionals' current recommendation timing and willingness to recommend HPV vaccination at age 9. METHODS A national sample of 1047 primary care professionals completed our online survey in 2021. Respondents were physicians (71%), advanced practitioners (17%), and nurses (12%). RESULTS About one-fifth (21%) of primary care professionals reported that they already routinely recommend HPV vaccination at ages 9 to 10. Among the remaining 822 respondents, over half (61%) reported being somewhat or more willing to start recommending at age 9. Willingness was higher among those working in family medicine versus pediatrics (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI] 1.03, 1.92), but lower among those with ≥20 years of practice experience versus ≤9 years (aOR: 0.65, 95% CI 0.44, 0.96). Many primary care professionals believed age 9 recommendations would have the advantage of protecting adolescents before HPV exposure (67%) or increasing vaccination timeliness (55%). The most commonly perceived disadvantage was that parents are not ready to talk about HPV vaccination at age 9 (73%). CONCLUSION Over two-thirds of primary care professionals in our national sample reported they recommend HPV vaccination at ages 9 to 10 or are somewhat or more willing to do so. Training may be needed to help primary care professionals address perceived parental hesitancy toward age 9 recommendations.
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Bishop JM, Real FJ, McDonald SL, Klein M, DeBlasio D, Kahn JA, Kreps GL, Rosen BL. Evaluation of HPV Vaccine: Same Way, Same Day TM: A Pilot Study. JOURNAL OF HEALTH COMMUNICATION 2021; 26:839-845. [PMID: 34985403 DOI: 10.1080/10810730.2021.2021459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Missed clinical opportunities and the lack of strong and consistent vaccine recommendations are key reasons for low HPV vaccination rates. The purpose of this study was to conduct a pilot evaluation of a web-based training's impact on knowledge, attitudes, and self-efficacy related to providing evidence-based HPV vaccine recommendations. Participants completed three online interactive learning modules and the HPV Vaccine: Same Way, Same Day™ smartphone application (app). Participants completed a pre-training survey, immediate post-training survey, and two-month post-survey. Participants demonstrated a statistically significant increase in knowledge scores from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for female patients increased from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for male patients increased from T1 to T2 and T1 to T3. Mean self-efficacy scores increased from T1 to T2 and T1 to T3. The HPV Vaccine: Same Way, Same Day™ app is a promising strategy for improving HPV vaccine recommendations among physicians. Future research should explore long-term effects and enroll attending and community physicians to examine its efficacy in other physician populations.
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Affiliation(s)
- James M Bishop
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA
| | - Francis J Real
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Skye L McDonald
- School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Melissa Klein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dominick DeBlasio
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gary L Kreps
- Department of Communication, George Mason University, Fairfax, Virginia, USA
| | - Brittany L Rosen
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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Cataldi JR, O'Leary ST, Markowitz LE, Allison MA, Crane LA, Hurley LP, Brtnikova M, Beaty BL, Gorman C, Meites E, Lindley MC, Kempe A. Changes in Strength of Recommendation and Perceived Barriers to Human Papillomavirus Vaccination: Longitudinal Analysis of Primary Care Physicians, 2008-2018. J Pediatr 2021; 234:149-157.e3. [PMID: 33689710 PMCID: PMC10207027 DOI: 10.1016/j.jpeds.2021.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate among pediatricians and family physicians human papillomavirus (HPV) vaccination recommendation practices for 11- to 12-year-old youth; report parental refusal/deferral of HPV vaccination; and report barriers to HPV vaccination changed over time. STUDY DESIGN We surveyed nationally representative networks of pediatricians and family physicians in 2008, 2010, 2013-2014, and 2018. Male vaccination questions were not asked in 2008; barriers and parental vaccine refusal questions were not asked in 2010. RESULTS Response rates were 80% in 2008 (680/848), 72% in 2010 (609/842), 70% in 2013-2014 (582/829), and 65% in 2018 (588/908). The proportion of physicians strongly recommending HPV vaccination for 11- to 12-year-old patients increased from 53% in 2008 to 79% in 2018 for female patients and from 48% in 2014 to 76% in 2018 for male patients (both P < .0001). The proportion of physicians indicating ≥50% of parents refused/deferred HPV vaccination remained steady for female patients (24% in 2008 vs 22% in 2018, P = .40) and decreased for male patients (42% in 2014 vs 28% in 2018, P < .001). Physician barriers to providing HPV vaccination were rare and decreased over time. Increasing numbers of physicians reported perceived parental barriers of vaccine safety concerns (5% "major barrier" in 2008 vs 35% in 2018, P < .0001) and moral/religious concerns (5% in 2008 vs 25% in 2018, P < .0001). CONCLUSIONS Between 2008 and 2018, more primary care physicians reported recommending HPV vaccination for adolescents, fewer reported barriers, and more physicians reported parents who had vaccine safety or moral/religious concerns.
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Affiliation(s)
- Jessica R Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mandy A Allison
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Division of General Internal Medicine, Denver Health, Denver, CO
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Carol Gorman
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Elissa Meites
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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14
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Bouza B, Hammig B, Schaefer Whitby P. Physicians’ Experiences of Recommending the HPV Vaccine to Females with an Intellectual Disability. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Suryadevara M, Bonville CA, Cibula DA, Domachowske JB. Multi-component cancer prevention awareness program to improve adolescent HPV vaccine uptake. Hum Vaccin Immunother 2021; 17:1052-1058. [PMID: 33064046 DOI: 10.1080/21645515.2020.1812316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We introduced a multi-component cancer prevention awareness program to primary care practices across New York State to evaluate its impact on adolescent human papillomavirus (HPV) vaccination rates. METHODS Eight pediatric and three family medicine practices were recruited to participate in this program. On-site training sessions were provided for all practice providers and staff to discuss the importance of HPV vaccine and cancer prevention and teach strategies for delivering a strong vaccine recommendation. Each practice received a study-specific booklet that included HPV vaccine information and other commonly provided cancer prevention guidance. These booklets were distributed to all adolescents and their parents during well visits over a one-year period. Practice specific and county-wide HPV vaccination rates were assessed before and 12 months after the program training session. RESULTS One year after program initiation, aggregate data show statistically higher vaccine series initiation rates among 11-12 and 13-18-year-olds and higher vaccine series completion rates among 13-18-year-olds. The greatest and most consistent improvements were seen in vaccine initiation rates for the 11-12-year-old cohort. Disparities in vaccine uptake were observed by gender and medical specialty. CONCLUSION Cancer prevention education targeting providers, office staff, patients, and parents, improved adolescent HPV vaccine series initiation rates.
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Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Cynthia A Bonville
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Donald A Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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16
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Arnell TL, York C, Nadeau A, Donnelly ML, Till L, Zargari P, Davis W, Finley C, Delaney T, Carney J. The Role of the Dental Community in Oropharyngeal Cancer Prevention Through HPV Vaccine Advocacy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:299-304. [PMID: 31728921 DOI: 10.1007/s13187-019-01628-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
As rates of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) continue to rise, the dental community's role in primary prevention efforts related to HPV vaccination will become increasingly important. The aim of this study was to assess knowledge, beliefs, practices, and perceived barriers regarding HPV and HPV vaccine advocacy within the dental community. A sample of 266 dentists and dental hygienists completed an online survey, and responses were then analyzed using frequencies of responses, t tests, chi-square tests, and Spearman's correlations. Ninety percent of providers believe it is important to play an "active role" in their patients' general medical care, yet only 50% believe it is their responsibility to recommend the HPV vaccine. Only 50% feel knowledgeable enough to recommend the vaccine. 78.6% of providers rarely discuss HPV vaccination with their age-appropriate patients, and 82% rarely recommend the vaccine. The two most strongly agreed-upon barriers were "parent concerns about the safety or efficacy of the vaccine" (71.6%) and "parent opposition to HPV vaccination for philosophical or religious reasons" (72.6%). Dentists were more knowledgeable about HPV vaccination and more likely to recommend the vaccine than hygienists. Higher levels of HPV-related knowledge correlated positively with beliefs and practices that support HPV vaccine advocacy. We have identified multiple opportunities for intervention aimed at increasing vaccine advocacy among oral health providers. These include clarification of role from dental professional organizations, alleviation of concerns related to perceived parental objection to the vaccine, and educational interventions targeting knowledge deficits among oral health providers.
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Affiliation(s)
- Thomas Luke Arnell
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA.
| | - Collin York
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Alexis Nadeau
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Maeve Lauren Donnelly
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Laura Till
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Pedram Zargari
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Wendy Davis
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Christine Finley
- Vermont Department of Health, 108 Cherry St, Burlington, VT, 05402, USA
| | - Thomas Delaney
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Jan Carney
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
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17
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Kasting ML, Head KJ, DeMaria AL, Neuman MK, Russell AL, Robertson SE, Rouse CE, Zimet GD. A National Survey of Obstetrician/Gynecologists' Knowledge, Attitudes, and Beliefs Regarding Adult Human Papillomavirus Vaccination. J Womens Health (Larchmt) 2021; 30:1476-1484. [PMID: 33428518 DOI: 10.1089/jwh.2020.8727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Many women see an obstetrician/gynecologist (OB/GYN) annually and receive their primary care from an OB/GYN. Understanding OB/GYNs' human papillomavirus (HPV) vaccination practices, including knowledge of and barriers to vaccination, is essential to design effective interventions to increase vaccination. This study evaluated OB/GYN knowledge, attitudes, and beliefs regarding vaccinating both younger (18-26 years) and mid-adult (27-45 years) women. Materials and Methods: Data were collected from OB/GYN providers in October 2019 through a nationwide web-based survey. Items included the following: HPV-related vaccination practices, recommendation strength, knowledge (seven items), benefits (four items), and barriers (eight items). Results: The sample (n = 224) was majority were White (69%), men (56%), and practice in suburban clinics (55%). Most (84%) reported they usually or always recommend HPV vaccine to eligible patients, but estimated only about half (51%) of other OB/GYNs did the same. Recommendation strength varied by patient age with 84% strongly recommending it to patients ≤18 years, compared with 79% and 25% strongly recommending to younger and mid-adult patients, respectively (p < 0.01). Participants reported lower benefits (p = 0.007) and higher barriers (p < 0.001) for 27- to 45-year-old patients compared with younger patients. Cost was the most frequently reported barrier, regardless of patient age. Overall knowledge was high (m = 5.2/7) but 33% of participants did not know the vaccine was safe while breastfeeding. Conclusions: Although providers reported strongly and consistently recommending the HPV vaccination to their adult patients, there were gaps in knowledge and attitudinal barriers that need to be addressed. Provider performance feedback may be important in improving HPV vaccination awareness among providers.
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Affiliation(s)
- Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA.,Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Monica K Neuman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Allissa L Russell
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Sharon E Robertson
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Caroline E Rouse
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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Polonijo AN. The impact of school-entry mandates on social inequalities in human papillomavirus vaccination. SSM Popul Health 2020; 12:100647. [PMID: 33024808 PMCID: PMC7527746 DOI: 10.1016/j.ssmph.2020.100647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 11/03/2022] Open
Abstract
Fundamental cause theory (FCT) is influential for explaining the enduring relationship between social position and health, yet few empirical studies test FCT's contention that policy supporting the equal distribution of interventions across populations can help reduce health inequalities. Following human papillomavirus (HPV) vaccine approval, complex socioeconomic and racial-ethnic inequalities emerged in distinct stages of the diffusion of this health innovation. Virginia and the District of Columbia were the first U.S. jurisdictions to implement school-entry HPV vaccination mandates for sixth-grade girls, offering an opportunity to test whether inequalities in HPV vaccination are mitigated by policy that seeks to standardize the age of vaccine administration and remove barriers to knowledge about the vaccine. Using data from the 2008, 2009, 2011, 2012, and 2013 National Immunization Survey-Teen (N = 4579) and a triple-difference approach, this study tests whether vaccine mandates are associated with smaller socioeconomic and racial-ethnic inequalities in health provider recommendation and vaccine uptake. It finds mandates were associated with improvements in provider recommendation and vaccine uptake for some socioeconomic and racial-ethnic groups. However, mandates also likely led to a decline in HPV vaccine series completion overall. Implications of these findings for informing FCT and vaccination policy are discussed.
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Affiliation(s)
- Andrea N Polonijo
- Department of Social Medicine, Population, and Public Health, University of California, Riverside, School of Medicine, Riverside, CA, USA
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19
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Wallace-Brodeur R, Li R, Davis W, Humiston S, Albertin C, Szilagyi PG, Rand CM. A quality improvement collaborative to increase human papillomavirus vaccination rates in local health department clinics. Prev Med 2020; 139:106235. [PMID: 32800972 DOI: 10.1016/j.ypmed.2020.106235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
Human papillomavirus (HPV) vaccination rates are well below the Healthy People 2020 goal of 80%. Vaccinating in settings other than primary care, such as local health departments (LHDs), may help achieve higher HPV immunization rates. We tested the effect of a quality improvement (QI) collaborative to reduce missed opportunities (MOs) for HPV vaccine in LHDs. Between 2016 and 2019, we conducted four consecutive cohorts of a virtual QI collaborative at 24 LHDs across multiple states. Participants were trained on topics including how to provide an effective recommendation for HPV vaccine, strategies to reduce MOs, and motivational interviewing. Throughout the 6-month project implementation, LHDs tested strategies to reduce MOs through Plan-Do-Study-Act cycles, performed chart reviews to identify and characterize MOs, and received feedback reports to assess progress on MOs. HPV vaccination rates were assessed pre- and post-intervention. LHDs reduced MOs for HPV vaccine in all four cohorts with aggregated data showing a 25.3 percentage point reduction in MOs. Modified Poisson regression analysis found a 44% reduction in the relative risk of missing the opportunity for an HPV vaccine at a visit (RR = 0.56, 0.46-0.68, p < .001). This project shows that strategies effective in reducing MO for HPV vaccine in primary care settings are also effective in LHD settings. Training LHD staff on these strategies may help the U.S. approach national goals for HPV vaccine coverage.
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Affiliation(s)
- Rachel Wallace-Brodeur
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, United States of America.
| | - Rui Li
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochetester, NY, United States of America
| | - Wendy Davis
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, United States of America
| | - Sharon Humiston
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, United States of America; Universtiy of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Christina Albertin
- Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Peter G Szilagyi
- Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochetester, NY, United States of America
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20
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Aparicio Rodrigo M, Ruiz Canela J, Buñuel Álvarez JC, García Vera C, Esparza Olcina MJ, Barroso Espadero D, González Rodríguez P, Juanes Toledo B, Martínez Rubio V, Ortega Páez E. Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review. Acta Paediatr 2020; 109:1989-2007. [PMID: 32311805 DOI: 10.1111/apa.15324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/26/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
AIM The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. METHODS MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. RESULTS Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. CONCLUSION According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.
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21
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Investigating HPV- and HPV Vaccine-Related Knowledge, Perceptions, and Information Sources among Health Care Providers in Three Big Cities in China. Vaccines (Basel) 2020; 8:vaccines8030499. [PMID: 32887401 PMCID: PMC7564272 DOI: 10.3390/vaccines8030499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/17/2022] Open
Abstract
The limited access to vaccination and vaccine hesitancy are prevalent even among health care providers in less developed countries. This study assessed the relationships between (i) health care providers' knowledge on human papillomavirus (HPV) and vaccination for HPV and (ii) their perceptions, demographic characteristics, and the use of information sources. In this large-scale online survey, participants (n = 1394) were recruited from hospitals of three big cities in China (Shanghai, Guangzhou, and Shenzhen). Descriptive analysis, the chi-square test, and logistic regression analysis were used to answer different research questions. Health care providers' overall knowledge scores are consistent with their perceptions about HPV and HPV vaccine. Occupation, specialty, the type of hospitals, and the frequency of participants' search for information using professional informational sources are the most significant characteristics that are closely associated with their knowledge of HPV and its vaccine. Targeted educational interventions are needed to improve health care providers' engagement in the promotion of the HPV vaccine. Such interventions, besides increasing knowledge, should also emphasize the importance of appropriate information sources to acquire information.
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22
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Szilagyi PG, Albertin CS, Gurfinkel D, Saville AW, Vangala S, Rice JD, Helmkamp L, Zimet GD, Valderrama R, Breck A, Rand CM, Humiston SG, Kempe A. Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine 2020; 38:6027-6037. [PMID: 32758380 DOI: 10.1016/j.vaccine.2020.06.074] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND While many clinicians encounter parents or adolescents who refuse HPV vaccine, little is known about the prevalence of hesitancy for HPV vaccine nationally or its association with vaccination. METHODS In April 2019, we surveyed families with adolescents 11-17 years using a national online panel (Knowledge Panel®) as the sampling frame. We assessed the prevalence of HPV vaccine hesitancy with the validated 9-item Vaccine Hesitancy Scale (VHS). We used multivariate analyses to assess demographic factors associated with HPV vaccine hesitancy. We also assessed practical barriers to receipt of HPV vaccine and the relationship between barriers and hesitancy. Finally, we evaluated the association between both HPV vaccine hesitancy and practical barriers on HPV vaccine receipt or refusal. RESULTS 2,177 parents out of 4,185 sampled (52%) completed the survey, 2,020 qualified (lived with adolescent). Using a VHS cut-off score > 3 out of 5 points, 23% of US parents were hesitant about HPV vaccine. Hesitancy was lower among those with Hispanic ethnicity. At least one out of five parents disagreed that the HPV vaccine is beneficial for their adolescent, that the vaccine is effective, protects against HPV-related cancers, or that they followed their adolescent's health-care provider's recommendation about the vaccine. Many were concerned about vaccine side effects and the novelty of the vaccine. Adolescents living with vaccine-hesitant parents were less than one-third as likely to have received the vaccine (RR = 0.29, 95% CI 0.24, 0.35) or completed the vaccine series (RR = 0.29, 95% CI 0.23, 0.36), and were 6-fold more likely to have refused the vaccine because of parental vaccine-related concerns (RR = 6.09, 95% CI = 5.26, 7.04). Most practical barriers were independently associated with vaccine receipt but not with vaccine refusal. CONCLUSIONS HPV vaccine hesitancy is common nationally and strongly related to both under-vaccination and vaccine refusal.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Christina S Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Sitaram Vangala
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - John D Rice
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Cynthia M Rand
- Department of Pediatrics, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| | | | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
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Askelson NM, Ryan G, Seegmiller L, Pieper F, Kintigh B, Callaghan D. Implementation Challenges and Opportunities Related to HPV Vaccination Quality Improvement in Primary Care Clinics in a Rural State. J Community Health 2020; 44:790-795. [PMID: 31102115 DOI: 10.1007/s10900-019-00676-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Efforts to understand low human papillomavirus vaccine coverage led us to explore quality improvement (QI) decision-making programs and processes to increase vaccine uptake. These QI programs often include interventions recommended by the AFIX (Assessment Feedback Incentives eXchange) Program that supports Vaccines for Children (VFC) clinics. However, little is known about decision-making around intervention selection or extent of implementation. In collaboration with the state public health department in the rural Midwestern, investigators developed a survey to explore vaccine-related QI in VFC clinics. The survey was distributed via email to all VFC clinics (n = 605); results presented are from the primary care clinics (n = 115). Respondents (VFC liaisons) reported decisions about vaccine QI were made by multiple actors within their own clinics (45.1%), by a clinic manager in charge of multiple clinics (33.0%) and/or at a centralized administrative office (35.2%). Additionally, the majority of respondents considered external actors, like insurance companies (52.7%) or Medicaid/Medicare (50.5%), important to the decision-making process. Most commonly implemented interventions focused on provider knowledge and patient education. Least commonly implemented interventions required systematic changes, such as reminder/recall and follow-up after missed appointments. This preliminary research indicates there are multiple points of decision-making within clinics and health care systems, and therefore change agents at all points need to be involved. The most commonly implemented interventions focus on providers and patients, with an emphasis on education. Interventions requiring system-level changes and use of electronic health records are less common and more attention should be directed towards such interventions.
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Affiliation(s)
- Natoshia M Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
- Public Policy Center, University of Iowa, 310 S Grand Ave, Iowa City, Iowa, USA
| | - Grace Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
- Public Policy Center, University of Iowa, 310 S Grand Ave, Iowa City, Iowa, USA.
| | - Laura Seegmiller
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
| | - Felicia Pieper
- Public Policy Center, University of Iowa, 310 S Grand Ave, Iowa City, Iowa, USA
| | - Bethany Kintigh
- Bureau of Immunization and Tuberculosis, Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Donald Callaghan
- Bureau of Immunization and Tuberculosis, Iowa Department of Public Health, Des Moines, Iowa, USA
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Faisal-Cury A, Levy RB, Tourinho MF, Grangeiro A, Eluf-Neto J. Vaccination coverage rates and predictors of HPV vaccination among eligible and non-eligible female adolescents at the Brazilian HPV vaccination public program. BMC Public Health 2020; 20:458. [PMID: 32252705 PMCID: PMC7137475 DOI: 10.1186/s12889-020-08561-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background Since March 2014, the quadrivalent HPV vaccine has been incorporated into the Brazilian Unified Health Care System and began to be offered, without direct costs, for girls from 9 to 13 years of age. Older female adolescents would have the option to be vaccinated at private health care system being responsible for the payment of HPV vaccine. The present study aimed to evaluate the coverage rates and predictors of HPV vaccination in Brazil among two groups of female adolescents: eligible and non-eligible for the HPV vaccination public program. Methods We used data from the 2015 Brazilian National Adolescent School-Based Health Survey, which involved a probabilistic sample of 5404 female adolescents students at public and private schools. Using a questionnaire, we gathered information on sociodemographic characteristics, sexual behavior, and respondent perception of parental supervision and have been vaccinated for HPV. Age-specific vaccination rates were analyzed in girls aged 9 to 13 at the time of public vaccination (eligible for public policy), as well among those 14 to 17 years old not eligible by the Ministry of Health for vaccination. We used Poisson regression models to investigate associated factors. Results HPV vaccine coverage was 83.5 and 21.8% among eligible and non-eligible populations, respectively. In both populations, the chance of being vaccinated decreased with older age. In the eligible population there is a greater chance of being vaccinated among ethnic group “pardas” but not with other indicators of socioeconomic status. In the non-eligible population, there was a clear association between higher vaccine coverage and greater maternal education and living with the mother. Conclusion Our findings highlight the importance of public policies to minimize inequities in access to cancer prevention measures in vulnerable adolescents. A public policy of HPV vaccination for older female adolescents would increase coverage with possible reduction of HPV-related diseases in this group of women.
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Affiliation(s)
- Alexandre Faisal-Cury
- Department of Preventive Medicine Department, University of São Paulo School of Medicine, Avenida Dr Arnaldo 455, São Paulo, 01246-903, Brazil.
| | - Renata Bertazzi Levy
- Department of Preventive Medicine Department, University of São Paulo School of Medicine, Avenida Dr Arnaldo 455, São Paulo, 01246-903, Brazil
| | - Maria Fernanda Tourinho
- Department of Preventive Medicine Department, University of São Paulo School of Medicine, Avenida Dr Arnaldo 455, São Paulo, 01246-903, Brazil
| | - Alexandre Grangeiro
- Department of Preventive Medicine Department, University of São Paulo School of Medicine, Avenida Dr Arnaldo 455, São Paulo, 01246-903, Brazil
| | - José Eluf-Neto
- Department of Preventive Medicine Department, University of São Paulo School of Medicine, Avenida Dr Arnaldo 455, São Paulo, 01246-903, Brazil
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Schmuhl NB, Mooney KE, Zhang X, Cooney LG, Conway JH, LoConte NK. No association between HPV vaccination and infertility in U.S. females 18-33 years old. Vaccine 2020; 38:4038-4043. [PMID: 32253100 DOI: 10.1016/j.vaccine.2020.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines have been recommended as primary prevention of HPV-related cancers for over 10 years in the United States, and evidence reveals decreased incidence of HPV infections following vaccination. However, concerns have been raised that HPV vaccines could decrease fertility. This study examined the relationship between HPV immunization and self-reported infertility in a nationally representative sample. METHODS Data from the 2013-2016 National Health and Nutrition Examination Survey were analyzed to assess likelihood of self-reported infertility among women aged 20 to 33, who were young enough to have been offered HPV vaccines and old enough to have been queried about infertility (n = 1114). Two logistic regression models, stratified by marital history, examined potential associations between HPV vaccination and infertility. Model 1 assessed the likelihood of infertility among women who had never been pregnant or whose pregnancies occurred prior to HPV vaccination. Model 2 accounted for the possibility of latent and/or non-permanent post-vaccine infertility by including all women 20-33 years old who reported any 12-month period of infertility. RESULTS 8.1% reported any infertility. Neither model revealed any association between HPV vaccination at any age and self-reported infertility, regardless of marital status. CONCLUSION There was no evidence of increased infertility among women who received the HPV vaccine. These results provide further evidence of HPV vaccine safety and should give providers confidence in recommending HPV vaccination. Further research should explore protective effects of HPV vaccines on female and male fertility.
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Affiliation(s)
- Nicholas B Schmuhl
- Department of Obstetrics and Gynecology, University of Wisconsin, School of Medicine and Public Health, 4th Floor, McConnel Hall, 1010 Mound St, Madison, WI 53715, USA.
| | - Katherine E Mooney
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Xiao Zhang
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792, USA.
| | - Laura G Cooney
- Department of Obstetrics and Gynecology, University of Wisconsin, School of Medicine and Public Health, 4th Floor, McConnel Hall, 1010 Mound St, Madison, WI 53715, USA.
| | - James H Conway
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792, USA.
| | - Noelle K LoConte
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792, USA.
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Chaparro RM, Rodríguez B, Maza Y, Moyano D, Hernández-Vásquez A. Factors associated with hindering the acceptance of HPV vaccination among caregivers - A cross-sectional study in Argentina. PLoS One 2020; 15:e0229793. [PMID: 32155183 PMCID: PMC7064251 DOI: 10.1371/journal.pone.0229793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/14/2020] [Indexed: 12/09/2022] Open
Abstract
Background The northeastern region of Argentina has the highest age-adjusted cervical cancer mortality rates. Given the strong link between HPV infections and cervical cancer, one of the main interventions is the population-based use of HPV vaccines. However, the acceptability is not very clear in low- and middle-income countries. The purpose of this study was to estimate the level of HPV vaccine acceptance and associated determinants among caregivers of girls in a northeastern city of Argentina. Methods A school-based survey was conducted in 2015 using a multistage sampling method. The primary sample unit were schools stratified by socioeconomic status selected at random, and caregivers of school girls were interviewed. The acceptability was determined using the adapted Theory of Planned Behavior. We performed logistic regression models to assess associated determinants. Results The study included 347 caregivers. The intention to vaccinate was 59.88%. A positive attitude of caregivers (aOR 4.67; 3.11–7.03) and positive influence of social norms (aOR 1.95; 1.03–3.70) were the main predictors independently associated to the intention to vaccinate against HPV. In contrast, practicing a Christian non-Catholic religion decreased the intention to vaccinate against HPV (OR 0.59; 0.36–0.95). All other factors evaluated were not significantly associated with intention to vaccinate against HPV. Conclusions This study shows that evaluating attitudes, normative social beliefs, and perceived self-efficacy regarding HPV vaccination can be of utmost importance for mapping and planning of health-related strategies in developing countries.
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Affiliation(s)
| | | | - Yanina Maza
- Universidad Nacional del Nordeste, Chaco, Argentina
| | - Daniela Moyano
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- * E-mail:
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Knowledge, attitudes, and practices of Saudi physicians regarding cervical cancer and the human papilloma virus vaccine. J Infect Public Health 2019; 13:584-590. [PMID: 31570271 DOI: 10.1016/j.jiph.2019.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/23/2019] [Accepted: 09/03/2019] [Indexed: 11/22/2022] Open
Abstract
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.
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Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review. Vaccine X 2019; 3:100037. [PMID: 31463471 PMCID: PMC6708991 DOI: 10.1016/j.jvacx.2019.100037] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/25/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives HPV vaccination rates in the United States lag behind other developed countries. Educational interventions are primarily directed at patients and parents rather than healthcare providers (HCPs), despite evidence that provider recommendation is a key determinant of vaccine uptake. The objectives for this review are to synthesize the available evidence related to the knowledge, attitudes, and beliefs of HCPs surrounding HPV vaccination, to summarize provider-specific educational interventions which have been evaluated, and to review existing provider-specific educational resources from national organizations and whether they align with the gaps identified. Methods A systematic search was performed using PubMed, Web of Science, CINAHL, and ERIC with MeSH terms human papillomavirus, vaccine, education, workshop, training, knowledge, attitude, belief, intention, and healthcare provider. Full text articles were obtained for studies that described the knowledge and attitudes of providers and/or impact of educational interventions. Data extraction was performed by four independent reviewers. Websites of American organizations with an interest in HPV vaccination were manually searched for provider resources. Results 1066 publications were identified, and 98 articles were fully reviewed with 40 ultimately included. Providers’ knowledge on HPV was generally low with a correspondingly low vaccine recommendation rate. Provider-specific education (e.g., didactic session and communication training) with complimentary interventions demonstrated increased knowledge and vaccine series initiation and completion. Themes identified in descriptive studies highlighted providers’ lack of general HPV and vaccine knowledge, low self-confidence in counselling and addressing parental concerns, and discomfort in discussing sexual issues related to vaccination. Many American organizations have provider-specific resources; however, the effectiveness of these materials has not been established. Conclusions HPV knowledge among providers remains low. Educational interventions to improve knowledge and communication appear to be effective. A breadth of resources from national organizations are available but their efficacy and level of utilization is largely unknown. Coordinated efforts are needed to evaluate provider-specific educational resources to improve vaccine uptake in the US.
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Tsai Y, Lindley MC, Zhou F, Stokley S. Insurance reimbursements for human papillomavirus vaccination in the private sector, 2007-2014. Prev Med Rep 2019; 15:100917. [PMID: 31223560 PMCID: PMC6580314 DOI: 10.1016/j.pmedr.2019.100917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/10/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022] Open
Abstract
This study aims to assess payments to private providers for HPV vaccination. We used the 2007–2014 MarketScan Commercial Claims and Encounters Database and included 3,456,180 HPV vaccination visits made by adolescents aged 11–17 years and enrolled in a non-capitated insurance plan in 37 states. We examined insurance reimbursements and its time trend for vaccine purchase and vaccine administration. Using the vaccine purchase price published by the Centers for Disease Control and Prevention (CDC) and the vaccination payment recommended by the American Academy of Pediatrics (AAP), we evaluated the financial concerns of administering HPV vaccines among private providers. In 2007–2014, the mean vaccine purchase reimbursement was $159.17 and the mean vaccine administration reimbursement was $23.91. During the study period, vaccine purchase reimbursements did not significantly change, but vaccine administration reimbursements increased. On average, 89.9% of the HPV claims received vaccine purchase reimbursements greater than the CDC-published price and 14.1% of HPV claims received vaccine purchase reimbursements above the AAP-recommended payment. Our results suggest that private providers are likely to receive sufficient reimbursements to cover the costs of administering HPV vaccines. However, the profit margin is likely to be small.
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Affiliation(s)
- Yuping Tsai
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fangjun Zhou
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rosen BL, Bishop JM, Anderson R, Real FJ, Klein MD, Kreps GL. A content analysis of HPV vaccine online continuing medical education purpose statements and learning objectives. Hum Vaccin Immunother 2019; 15:1508-1518. [PMID: 30932718 DOI: 10.1080/21645515.2019.1587273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Numerous online HPV vaccine education interventions for clinicians have been created to improve HPV vaccinations rates. The aims for this study were to (1) assess the content of the purpose statements and learning objectives of online HPV vaccine continuing medical education (CME) activities developed for clinicians and (2) identify themes and gaps in the purpose statements and learning objectives. A content analysis was conducted of the purpose statements and learning objectives for each HPV vaccine online CME activity. Open coding identified the following purpose statements topics: 1) delivering recommendations, 2) HPV epidemiology, 3) HPV vaccine, 4) guidelines, and 5) medical news. The following topics for learning objectives were identified: 1) delivering recommendations, 2) strategies, 3) HPV epidemiology, 4) HPV vaccine, 5) guidelines, 6) prevention services, 7) HPV vaccination advocacy, and 8) disparities. Phrases about guidelines for vaccine administration and vaccine recommendation guidelines were the most common for purpose statements and learning objectives, respectively. One learning objective focused on behavior/skill change, which is concerning considering clinicians do not feel well prepared to provide strong vaccine recommendations. Clear and intentional purpose statements and learning objectives must be used to guide the development of effective CME activities.
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Affiliation(s)
| | | | - Ryan Anderson
- b Public Health Student College of Medicine, University of Cincinnati
| | - Francis J Real
- c Pediatrics Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | - Melissa D Klein
- c Pediatrics Cincinnati Children's Hospital Medical Center, University of Cincinnati.,d Department of Communication, Center for Health and Risk Communication, George Mason University
| | - Gary L Kreps
- e Department of Communication, Center for Health and Risk Communication,George Mason University , Fairfax , Virginia
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Suryadevara M, Bonville CA, Cibula DA, Domachowske JB. Cancer Prevention Education for Providers, Staff, Parents, and Teens Improves Adolescent Human Papillomavirus Immunization Rates. J Pediatr 2019; 205:145-152.e2. [PMID: 30314663 DOI: 10.1016/j.jpeds.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop a program to educate providers, office staff, patients, and parents on life-long cancer prevention strategies, including the use of human papillomavirus (HPV) vaccine to improve adolescent HPV vaccination rates. STUDY DESIGN A 2-phase program was implemented at 6 pediatric practices across upstate New York. Phase 1 included provider and staff education regarding practice-specific vaccination challenges and discussion of the contents of a study-specific cancer-prevention booklet, which included HPV vaccine information. Throughout phase 2, the booklets were distributed to all adolescents and their parents during office visits over a 12-month period. Practice-specific, countywide, and statewide HPV vaccination rates were assessed before phase 1, and 6 and 12 months after the launch of phase 2. RESULTS One year after implementing phase 2 in 6 practices, adolescent HPV vaccine series initiation increased by at least 10% in 3 practices, and at least 5% in 5 practices. Similarly, adolescent vaccine series completion rates increased by more than 10% in 3 practices. The percent change in vaccine series completion rates across all study sites postintervention ranged from 12% to 20% for 11- to 12-year-olds, and from 7% to 23% for 13- to 18-year-olds. CONCLUSIONS Cancer prevention education targeting providers, office staff, patients, and parents was modestly effective for improving adolescent HPV vaccination rates.
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Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY.
| | | | - Donald A Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
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Suryadevara M, Bonville CA, Cibula DA, Domachowske JB, Suryadevara AC. Associations between population based voting trends during the 2016 US presidential election and adolescent vaccination rates. Vaccine 2019; 37:1160-1167. [PMID: 30691983 DOI: 10.1016/j.vaccine.2019.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Politics play a role in the dissemination of public health information, including immunization-related issues. We aim to describe relationships between HPV vaccination rates and state voting patterns during the 2016 US presidential election. METHODS We classified each of the 50 states as either "Red" or "Blue," based on whether a higher proportion of the state's casted votes were for the Republican or Democratic nominee during the 2016 US presidential election. State-specific HPV, Tdap, and meningococcal vaccination rates were obtained from the 2016-National Immunization Survey-Teen. State socio-demographic factors and HPV vaccine legislation were obtained from the US Census Bureau and National Conference of State Legislatures. Vaccination rates and socio-demographic variables were compared using independent t-tests. Multiple linear regression compared vaccination rates between "Red" and "Blue" states, adjusting for percentage of both uninsured children and educational attainment. RESULTS Compared to "Blue" states, "Red" states had significantly lower unadjusted HPV vaccine series initiation (56% vs 66%, p < 0.05) and completion (39% vs 50%, p < 0.05) rates; yet had similar rates of Tdap (88% vs 89%, p > 0.05) and meningococcal (79% vs 83%, p > 0.05) vaccinations. After adjusting for potential confounders, the regression-adjusted mean rate for HPV vaccine initiation and completion remained significantly lower for "Red" states compared to "Blue" states (57% vs 65%, p < 0.05, and 41% vs 48%, p < 0.05, respectively). CONCLUSION HPV vaccination rates are associated with statewide-level voting patterns. Future interventions aimed at improving HPV vaccination rates should consider engaging local and national elected leaders to be proactive in disseminating accurate and authoritative immunization information.
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Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
| | - Cynthia A Bonville
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Donald A Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Joseph B Domachowske
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Amar C Suryadevara
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, United States
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Reno JE, Thomas J, Pyrzanowski J, Lockhart S, O'Leary ST, Campagna EJ, Dempsey AF. Examining strategies for improving healthcare providers' communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial. Hum Vaccin Immunother 2019; 15:1592-1598. [PMID: 30433845 DOI: 10.1080/21645515.2018.1547607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
There is a critical need for campaigns and interventions to increase rates of human papillomavirus (HPV) vaccination among U.S. adolescents. Healthcare providers are key stakeholders in parents' HPV vaccine decision-making. The current study presents the evaluation of secondary outcomes in a multi-component communication-based intervention to improve healthcare providers' communication about HPV vaccination. Evaluation was conducted via surveys of providers participating in a 12-month randomized controlled trial. Findings suggest use of communication components (combined use of the presumptive approach [PA] with all patients, and motivational interviewing and a fact sheet with vaccine hesitant parents) contributed to providers in the intervention group reporting higher perceived levels of parental HPV vaccine acceptance than control providers, as well as increased vaccination rates in the intervention arm in the main RCT.
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Affiliation(s)
- Jenna E Reno
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Jacob Thomas
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Jennifer Pyrzanowski
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Steven Lockhart
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Sean T O'Leary
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Elizabeth J Campagna
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
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Walling EB, Dodd S, Bobenhouse N, Reis EC, Sterkel R, Garbutt J. Implementation of Strategies to Improve Human Papillomavirus Vaccine Coverage: A Provider Survey. Am J Prev Med 2019; 56:74-83. [PMID: 30573149 PMCID: PMC6948017 DOI: 10.1016/j.amepre.2018.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccine coverage in the U.S. is persistently suboptimal, despite research describing barriers to vaccination and strategies to increase vaccination coverage. The objective was to assess providers' approach to the HPV vaccine and their implementation of strategies to increase HPV vaccination coverage. The hypothesis was that adoption of improvement measures to address underuse of the HPV vaccine has not occurred. METHODS Community pediatric providers from two Midwestern practice-based research networks completed self-administered electronic surveys. Data were collected over 6 months in 2015 and organized and analyzed in 2016. RESULTS There were 100 providers that participated. Despite agreement with national recommendations, some providers delayed their recommendation until the adolescent was older and many reported missed vaccination opportunities. Many providers experienced parental concerns including safety of the HPV vaccine, belief their child was not at risk of HPV infection, and their child's resistance to receiving multiple shots. Providers identified the following as barriers to adherence to Advisory Committee on Immunization Practices guidelines: bad publicity of the HPV vaccine, information about the HPV vaccine on the web, and a lack of a follow-up system for those who delayed HPV vaccine initiation. Approximately half of the participants had implemented strategies to address these barriers beyond offering immunization-only appointments. CONCLUSIONS Participants were aware of barriers to HPV vaccine use, but many had not adopted a systematic approach to increase vaccine coverage. A better understanding of the challenges facing providers to adopting improvement measures and a strategy to address barriers to implementation are needed to improve HPV coverage.
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Affiliation(s)
- Emily B Walling
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, School of Medicine, St. Louis, Missouri; Department of Pediatrics and Communicable Diseases, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Sherry Dodd
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Neil Bobenhouse
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Evelyn Cohen Reis
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Randy Sterkel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jane Garbutt
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Calo WA, Gilkey MB, Malo TL, Robichaud M, Brewer NT. A content analysis of HPV vaccination messages available online. Vaccine 2018; 36:7525-7529. [PMID: 30366803 DOI: 10.1016/j.vaccine.2018.10.053] [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: 08/02/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022]
Abstract
Parents have varied HPV vaccine communication needs, which presents a challenge for healthcare providers. To improve communication resources for providers, we sought to characterize HPV vaccination messages available in existing educational materials. In fall 2016, we searched PubMed, educational material clearinghouses, and Google for English language HPV vaccination messages. We extracted messages that a provider might use when raising the topic of HPV vaccination, answering common questions, and motivating vaccination. Two reviewers independently coded each message. The search identified 267 unique messages about HPV vaccination. Messages generally were long (mean no. of words = 44, standard deviation [SD] = 33) and required a high level of education to read (mean reading grade level = 10, SD = 3). Only 32% of messages were shorter than 25 words, and 12% had a readability at or below grade 6. Most frequent were messages to address common parent questions or concerns (62%); the most common topics were diseases prevented by HPV vaccine (18%) and safety and side effects (16%). Many messages included information about cancer prevention (26%) and same-day vaccination (13%). Few messages (6%) used a presumptive style to recommend HPV vaccination. In conclusion, available messages about HPV vaccination were markedly varied. We identified few messages that were both brief (to facilitate providers memorizing them) and accessible (to facilitate parents understanding them). Future research should identify which messages lead to HPV vaccine uptake.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; Penn State Cancer Institute, Hershey, PA 17033, USA.
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Meagan Robichaud
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
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Tsai Y, Lindley MC, Zhou F, Stokley S. Provider Payments And The Receipt Of Human Papillomavirus Vaccine Among Privately Insured Adolescents. Health Aff (Millwood) 2018; 37:1587-1595. [DOI: 10.1377/hlthaff.2018.0545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yuping Tsai
- Yuping Tsai is a health economist in the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Megan C. Lindley
- Megan C. Lindley is an epidemiologist in the Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Fangjun Zhou
- Fangjun Zhou is a health scientist in the Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Shannon Stokley
- Shannon Stokley is a lead epidemiologist in the Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
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Goleman MJ, Dolce M, Morack J. Quality Improvement Initiative to Improve Human Papillomavirus Vaccine Initiation at 9 Years of Age. Acad Pediatr 2018; 18:769-775. [PMID: 29842924 DOI: 10.1016/j.acap.2018.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/15/2018] [Accepted: 05/19/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Adolescent human papillomavirus (HPV) vaccine rates remain low. Early vaccination may improve the efficacy of the vaccine and immunization rates; however, clinicians have not routinely made a strong recommendation for younger adolescents. This study assessed the feasibility of routine vaccination at 9 years of age. METHODS Three sequential quality improvement (QI) interventions were implemented to shift the initiation of the HPV vaccine to 9 years of age in a primary care network in low-income neighborhoods in Columbus, Ohio. The first intervention changed the electronic medical record alert for the HPV vaccine from 11 to 9 years of age and focused on cancer prevention when discussing the vaccine with families. The second intervention was formation of an HPV QI team. The third intervention was a clinic incentive for HPV captured opportunity rates. Immunization rates were monitored using statistical process control charts to compare the HPV immunization rate in a sample of 9- and 10-year-old children with a sample of 11- and 12-year-old children. RESULTS The percentage of patients receiving an HPV vaccine before 11 years increased from 4.6% to 35.7% during the 6 months after the QI initiative began and to 60.8% 18 months after the project began. In comparison, the HPV vaccination rate in the sample of 11- and 12-year-olds increased from 78.7% to 82.8% 18 months later. CONCLUSIONS This QI project used multiple interventions to increase HPV vaccination at 9 years of age in a large primary care network serving a diverse low-income population.
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Affiliation(s)
- Martha J Goleman
- Nationwide Children's Hospital (Drs Goleman and Dolce, and Ms Morack); The Ohio State University College of Medicine (Dr Goleman), Columbus, Ohio.
| | - Millie Dolce
- Nationwide Children's Hospital (Drs Goleman and Dolce, and Ms Morack)
| | - Jennifer Morack
- Nationwide Children's Hospital (Drs Goleman and Dolce, and Ms Morack)
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Townsend JS, Puckett M, Gelb CA, Whiteside M, Thorsness J, Stewart SL. Improving Knowledge and Awareness of Human Papillomavirus-Associated Gynecologic Cancers: Results from the National Comprehensive Cancer Control Program/Inside Knowledge Collaboration. J Womens Health (Larchmt) 2018; 27:955-964. [PMID: 30129896 DOI: 10.1089/jwh.2018.7289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over 16,000 women are diagnosed with a human papillomavirus (HPV)-associated gynecologic cancer every year. Because most of these cancers are preventable, correct and appropriate information about the HPV vaccine and cervical cancer screening can help reduce incidence. MATERIALS AND METHODS The Centers for Disease Control and Prevention created Inside Knowledge: Get the Facts About Gynecologic Cancer campaign materials, which were used by seven National Comprehensive Cancer Control Program recipients in tailored educational sessions on gynecologic cancer with women and healthcare providers in the community setting. Session participants completed presession and postsession questionnaires. Differences in knowledge and intentions were assessed using chi-square tests for women in the general public, obstetricians/gynecologists (OB/GYNs), primary care physicians (PCPs), and other healthcare providers. RESULTS Women's knowledge improved significantly presession to postsession that HPV causes vaginal (39%-65%, p < 0.001) and vulvar cancers (26%-60%, p < 0.001), but postsession few women correctly identified all HPV-associated gynecologic cancers (15%). From presession to postsession, more women were able to correctly identify recommended age groups for whom the HPV vaccine is recommended (15%-30%, p < 0.001), and that the Pap test only screens for cervical cancer (58%-73%, p < 0.001). Among providers, OB/GYNs had more baseline knowledge of HPV-associated gynecologic cancers than other providers. Postsession, PCPs and other providers increased their knowledge of HPV vaccine recommended age groups (33%-71% and 23%-61%, respectively), and the 3-year recommended screening interval for the Pap test (73%-91% and 63%-85%, respectively). HPV vaccine knowledge did not show significant improvement among OB/GYNs postsessions. CONCLUSIONS Women and healthcare providers who attended the Inside Knowledge sessions significantly improved their knowledge of HPV-associated gynecologic cancers. Additional educational activities during the sessions that support distinguishing between HPV-associated versus other gynecologic cancers and clarify HPV vaccine recommendations may help with further increases in knowledge.
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Affiliation(s)
- Julie S Townsend
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Mary Puckett
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Cynthia A Gelb
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Martin Whiteside
- 2 Office of Cancer Surveillance , Division of Policy, Planning and Assessment, Tennessee Department of Health, Nashville, Tennessee
| | - Julia Thorsness
- 3 Alaska Comprehensive Cancer Control Program , Chronic Disease Prevention Health Promotion, Division of Public Health, Alaska Department of Health and Human Services, Anchorage, Alaska
| | - Sherri L Stewart
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
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Sakanishi Y, Yamamoto Y, Hara M, Fukumori N, Goto Y, Kusaba T, Tanaka K, Sugioka T, Vaccine Project Team JPCA, Fukuhara S. Public subsidies and the recommendation of child vaccines among primary care physicians: a nationwide cross-sectional study in Japan. BMJ Open 2018; 8:e020923. [PMID: 30030315 PMCID: PMC6059295 DOI: 10.1136/bmjopen-2017-020923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Although public subsidies and physician recommendations for vaccination play key roles in increasing childhood vaccination coverage, the association between them remains uncertain. This study aimed to identify the association between awareness of public subsidies and recommendations for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcal conjugate vaccine (PCV)) and human papillomavirus (HPV) vaccinations among primary care physicians in Japan. DESIGN This is a cross-sectional study. SETTING In 2012, a questionnaire was distributed among 3000 randomly selected physicians who were members of the Japan Primary Care Association. PARTICIPANTS From the questionnaire, participants were limited to physicians who administered childhood vaccinations. PRIMARY AND SECONDARY OUTCOME MEASURES The primary measures were participants' awareness of public subsidies and their recommendation levels for Hib, PCV and HPV vaccines. Multiple logistic regression analysis was performed to investigate the association between awareness and recommendation, with adjustment for possible confounders. RESULTS The response rate was 25.8% (743/2880). Of 743 physician respondents, 434 were included as analysis subjects. The proportions of those who recommended vaccinations were 57.1% for Hib, 54.1% for PCV and 58.1% for HPV. For each vaccine, multivariable analyses showed physicians who were aware of the subsidy were more likely to recommend vaccination than those who were not aware: the adjusted ORs were 4.21 (95% CI 2.47 to 7.15) for Hib, 4.96 (95% CI 2.89 to 8.53) for PCV and 4.17 (95% CI 2.00 to 8.70) for HPV. CONCLUSIONS Primary care physicians' awareness of public subsidies was found to be associated with their recommendations for the Hib, PCV and HPV vaccines. Provision of information about public subsidies to these physicians may increase their likelihood to recommend vaccination.
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Affiliation(s)
- Yuta Sakanishi
- Faculty of Medicine, Community Medical Support Institute, Saga University, Saga, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Norio Fukumori
- Faculty of Medicine, Community Medical Support Institute, Saga University, Saga, Japan
| | - Yoshihito Goto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tesshu Kusaba
- The Hokkaido Centre for Family Medicine, Sapporo, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Sugioka
- Faculty of Medicine, Community Medical Support Institute, Saga University, Saga, Japan
| | | | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
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Implementing a Multipartner HPV Vaccination Assessment and Feedback Intervention in an Integrated Health System. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:589-592. [PMID: 28257408 DOI: 10.1097/phh.0000000000000562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Human papillomavirus (HPV) vaccine initiation rates are persistently lower than rates for other adolescent-recommended vaccines. Assessment and feedback interventions are a recommended strategy for improving vaccination rates. OBJECTIVE To provide a guide for implementing a multipartner intervention to increase HPV vaccine initiation rates. SETTING Nine primary care facilities within the Kaiser Permanente Northwest (KPNW) health care system. INTERVENTION In 2015-2016, we implemented a system-wide assessment and feedback intervention to promote HPV vaccination. In partnership with the Centers for Disease Control and Prevention, the Oregon Immunization Program, and KPNW's leadership, we developed an education session combining information on HPV infection, parental communication strategies, and facility-specific coverage data. RESULTS Twelve months postintervention, HPV dose 1 vaccination coverage increased from 71% to 72% among females and from 65% to 68% among males. CONCLUSIONS A collaborative approach was critical to engaging leadership and enlisting support from providers and to developing appropriate materials for clinical audiences. Information provided here can be used as a guide for conducting assessment and feedback interventions focused on HPV vaccination initiation.
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Henninger ML, Mcmullen CK, Firemark AJ, Naleway AL, Henrikson NB, Turcotte JA. User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination. Perm J 2018; 21:16-191. [PMID: 28898195 DOI: 10.7812/tpp/16-191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. OBJECTIVE To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. METHODS Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. RESULTS Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. CONCLUSION User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings.
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Affiliation(s)
| | - Carmit K Mcmullen
- Senior Investigator at the Center for Health Research in Portland, OR.
| | - Alison J Firemark
- Research Associate at the Center for Health Research in Portland, OR.
| | - Allison L Naleway
- Senior Investigator at the Center for Health Research in Portland, OR.
| | - Nora B Henrikson
- Research Associate at the Group Health Research Institute in Seattle, WA.
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Impact of a clinical interventions bundle on uptake of HPV vaccine at an OB/GYN clinic. Vaccine 2018; 36:3599-3605. [PMID: 29759380 DOI: 10.1016/j.vaccine.2018.05.039] [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: 02/28/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION HPV vaccine uptake is lowest among young adults. Little is known about the most effective way to decrease missed opportunities (MO) and increase uptake of the vaccine in this vulnerable population. OBJECTIVES To determine the impact of a clinical intervention bundle on the rate of MO and uptake of the vaccine among young adult women. METHODS From 2/2014 to 7/2015, an intervention bundle (designating physician and nurse champions, pre-screening patients' charts, empowering nurses to recommend immunization, providing no-cost vaccinations, placing prompts in clinic note templates, eliminating requirement for pre-vaccination pregnancy test) was implemented at an urban, hospital-based OB/GYN clinic. Medical records were reviewed for all vaccine-eligible (non-pregnant, 11-26 years) women seen between 2/2013 and 9/2016. Impact of the bundled interventions on the monthly rates of MO and vaccine uptake was estimated by analyzing immunization trends with an interrupted time-series model using counterfactual comparison groups in order to control for pre-existing trends. RESULTS There were 6,463 vaccine-eligible visits during our study period. The prevalence of women who had both completed and initiated the series was significantly higher, 20.3% and 29.7% respectively, in the last month, compared to their counterfactuals (p < 0.01). In the last study month, the rate of MO was significantly lower than its counterfactual (19.73 per 100 encounters lower, p < 0.01). Hispanic women had attributable reductions in their rates of MO that were twice that of White women. Statistically significant attributable reductions were also seen among Spanish speakers, publicly insured, and uninsured women. CONCLUSIONS Implementation of this intervention bundle effectively reduced the monthly rate of MO and increased the prevalence of women who had initiated and completed the HPV vaccine series. The reduction of MO was most drastic among Hispanic, publicly insured and uninsured women compared to White and privately insured.
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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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Using an Implementation Research Framework to Identify Potential Facilitators and Barriers of an Intervention to Increase HPV Vaccine Uptake. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:e1-e9. [PMID: 27902559 DOI: 10.1097/phh.0000000000000367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although the incidence of cervical cancer has been decreasing in the United States over the last decade, Hispanic and African American women have substantially higher rates than Caucasian women. The human papillomavirus (HPV) is a necessary, although insufficient, cause of cervical cancer. In the United States in 2013, only 37.6% of girls 13 to 17 years of age received the recommended 3 doses of a vaccine that is almost 100% efficacious for preventing infection with viruses that are responsible for 70% of cervical cancers. Implementation research has been underutilized in interventions for increasing vaccine uptake. The Consolidated Framework for Implementation Research (CFIR), an approach for designing effective implementation strategies, integrates 5 domains that may include barriers and facilitators of HPV vaccination. These include the innovative practice (Intervention), communities where youth and parents live (Outer Setting), agencies offering vaccination (Inner Setting), health care staff (Providers), and planned execution and evaluation of intervention delivery (Implementation Process). METHODS Secondary qualitative analysis of transcripts of interviews with 30 community health care providers was conducted using the CFIR to code potential barriers and facilitators of HPV vaccination implementation. RESULTS All CFIR domains except Implementation Process were well represented in providers' statements about challenges and supports for HPV vaccination. CONCLUSION A comprehensive implementation framework for promoting HPV vaccination may increase vaccination rates in ethnically diverse communities. This study suggests that the CFIR can be used to guide clinicians in planning implementation of new approaches to increasing HPV vaccine uptake in their settings. Further research is needed to determine whether identifying implementation barriers and facilitators in all 5 CFIR domains as part of developing an intervention contributes to improved HPV vaccination rates.
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Lacombe-Duncan A, Newman PA, Baiden P. Human papillomavirus vaccine acceptability and decision-making among adolescent boys and parents: A meta-ethnography of qualitative studies. Vaccine 2018; 36:2545-2558. [PMID: 29625768 DOI: 10.1016/j.vaccine.2018.02.079] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/04/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Genital warts and human papillomavirus (HPV)-associated cancers in men can be substantially reduced through HPV vaccination; yet, globally, HPV vaccine uptake among boys remains low. This meta-ethnography synthesizes qualitative studies to understand, in-depth, HPV vaccine acceptability and decision-making among adolescent boys and/or their parents. METHODS A systematic search identified qualitative studies examining HPV vaccines from the perspectives of boys and/or boys' parents. The Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist was used to assess quality of reporting. Using meta-ethnographic techniques, we conducted a structured and iterative process of data analysis, coded original studies, and then developed descriptive and analytic themes to synthesize the findings. RESULTS Review of 15 eligible studies (n = 3362 parents, n = 39 boys) revealed multilevel factors that influence HPV vaccine acceptability and decision-making among adolescent boys and their parents: (1) individual, e.g., low HPV vaccine knowledge/awareness, (2) interpersonal, e.g., key relationships between parents, sons, and healthcare providers (HCP), (3) community/societal, e.g., parental duty to protect, and (4) systemic, e.g., HPV vaccine messaging. Parents generally accepted adolescent boys' sexuality and the need for vaccination, motivated by wanting to protect their sons from HPV and HPV-associated cancers, and valued HCP-initiated discussion and recommendation. Acceptability was mitigated by low awareness/knowledge of HPV vaccines and low perceived benefits for boys, lack of HCP-initiated discussion, out-of-pocket costs, multiple doses, stigma, and mixed messages about HPV. CONCLUSIONS Multilevel factors influence HPV vaccine acceptability and decision-making among parents and their adolescent sons. Providing clear and unambiguous messages about HPV vaccines-for whom (boys and girls), for what (genital warts and cancers in men), and when (before sexual debut)-through increased HCP-initiated discussion and targeted public health campaigns may support HPV vaccine uptake among boys. Future research should consistently disaggregate findings by sex of child and parent, and explore effective messaging tailored for boys and parents.
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Affiliation(s)
- Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper Street, Box 19129, Arlington, Texas, USA.
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Lu PJ, Yankey D, Jeyarajah J, O'Halloran A, Fredua B, Elam-Evans LD, Reagan-Steiner S. Association of Health Insurance Status and Vaccination Coverage among Adolescents 13-17 Years of Age. J Pediatr 2018; 195:256-262.e1. [PMID: 29398056 PMCID: PMC6201297 DOI: 10.1016/j.jpeds.2017.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess selected vaccination coverage among adolescents by health insurance status and other access-to-care characteristics. STUDY DESIGN The 2015 National Immunization Survey-Teen data were used to assess vaccination coverage disparities among adolescents by health insurance status and other access-to-care variables. Multivariable logistic regression analysis and a predictive marginal modeling were conducted to evaluate associations between health insurance status and vaccination coverage. RESULTS Overall, vaccination coverage was significantly lower among uninsured compared with insured adolescents for all vaccines assessed for except ≥3 doses of human papillomavirus vaccine (HPV) among male adolescents. Among adolescents 13-17 years of age, vaccination of uninsured compared with insured adolescents, respectively, for tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine was 77.4% vs 86.8%; for ≥1 dose of meningococcal conjugate vaccine was 72.9% vs 81.7%; for ≥1 dose of HPV was 38.8% vs 50.2% among male and 42.9% vs 63.8% among female adolescents; for 3 doses of HPV was 24.9% vs 42.8% among female adolescents. In addition, vaccination coverage differed by the following: type of insurance among insured adolescents, having a well-child visit at 11-12 years of age, and number of healthcare provider contacts in the past year. Uninsured were less likely than insured adolescents to be vaccinated for HPV (female: ≥1 dose and 3 doses; and male: ≥1 doses) after adjusting for confounding variables. CONCLUSIONS Overall, vaccination coverage was lower among uninsured adolescents. HPV vaccination coverage was lower than tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine Tdap and meningococcal conjugate vaccine in both insured and uninsured adolescents. Wider implementation of effective evidence-based strategies is needed to help improve vaccination coverage among adolescents, particularly for those who are uninsured. Limitation of current federally funded vaccination programs or access to healthcare would be expected to erode vaccine coverage of adolescents.
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Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jenny Jeyarajah
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alissa O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Benjamin Fredua
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah Reagan-Steiner
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Napolitano F, Navaro M, Vezzosi L, Santagati G, Angelillo IF. Primary care pediatricians' attitudes and practice towards HPV vaccination: A nationwide survey in Italy. PLoS One 2018; 13:e0194920. [PMID: 29596515 PMCID: PMC5875794 DOI: 10.1371/journal.pone.0194920] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/13/2018] [Indexed: 11/18/2022] Open
Abstract
This national online cross-sectional survey in Italy assessed primary care pediatricians’ (PCPs) attitudes and practices regarding Human papillomavirus (HPV) vaccination and the contribution of several characteristics. The questionnaire was distributed from September 2016 to June 2017 to a random sample of 640 PCPs by email via an internet-link leading to a web-based survey platform (Lime Survey). Only 18.4% of PCPs always recommend the HPV vaccine to 11–12 year old boys. PCPs with longer practice activity, working in solo practice, always recommended the HPV vaccine to 11–12 year old girls, and believed that the vaccine was effective for boys were more likely to always recommend the HPV vaccine. PCPs working in a Region where the vaccination was actively recommended and provided free of charge to 11–12 year old boys had higher odds of recommending vaccination. More than two thirds of PCPs (77.4%) always recommend the HPV vaccine to 11–12 year old girls. PCPs who believed that the vaccine was effective for girls and safe in both boys and girls, who always talk with patients of 11–18 years or their parents about HPV infection and vaccination, and who obtain vaccine information from scientific journals were more likely to always recommend the vaccine. PCPs should employ evidence-based educational strategies in order to achieve a better coverage and to reduce the morbidities and mortality of diseases associated with HPV.
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Affiliation(s)
- Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Monica Navaro
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Vezzosi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella Santagati
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Italo Francesco Angelillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- * E-mail:
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48
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Porter RM, Amin AB, Bednarczyk RA, Omer SB. Cancer-salient messaging for Human Papillomavirus vaccine uptake: A randomized controlled trial. Vaccine 2018; 36:2494-2500. [PMID: 29599089 DOI: 10.1016/j.vaccine.2018.01.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Vaccination with Human Papillomavirus (HPV) vaccine is recommended for 11-12 years-old, but uptake is suboptimal. Current messaging focuses on HPV infection transmission and prevention. Parents and providers are often uncomfortable discussing sexual practices of adolescents, contributing to the delay/refusal of vaccine. We created a cervical cancer-salient message encouraging HPV vaccination, emphasizing disease salience and disease threat, while promoting self-efficacy. We hypothesized this message would have greater effects on vaccine confidence and intent to vaccinate compared to Centers for Disease Control and Prevention (CDC) and non-vaccine control messages. METHODS A 3-arm randomized trial was conducted. Parents of girls aged 9-17 were eligible for the study. We measured participants' vaccine confidence and intent to vaccinate at baseline and post intervention message. Recruitment and surveys were administered online through Amazon Mechanical Turk. RESULTS 762 participants completed both surveys. We saw modest increases in vaccine confidence when comparing cervical cancer arm and control arm, and CDC arm and control arm; estimates were not statistically significant. The odds of reporting intent to vaccinate among the cervical cancer message arm were 1.13 times the odds of reporting intent to vaccinate in the control arm (95% CI: 0.30. 4.29). Intent to vaccinate was also not statistically significantly different between CDC message arm and control arm (OR = 1.25, 95%CI: 0.66, 2.37). CONCLUSION Neither message had effect on intent to vaccinate, highlighting need for research to identify successful messaging strategies for HPV. Exploratory analyses suggest among parents with 'Low' vaccine confidence at baseline, the cervical cancer framed message may be more effective in changing intention than the CDC message or non-vaccine control. Future work should target groups with 'Low' or 'Medium' vaccine confidence at baseline - they may be more amenable to change, and more receptive to disease-salient messaging. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, Reference #: NCT03002324.
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Affiliation(s)
- Rachael M Porter
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Avnika B Amin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Robert A Bednarczyk
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Saad B Omer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States; Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, United States
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49
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Irving SA, Groom HC, Stokley S, McNeil MM, Gee J, Smith N, Naleway AL. Human Papillomavirus Vaccine Coverage and Prevalence of Missed Opportunities for Vaccination in an Integrated Healthcare System. Acad Pediatr 2018; 18:S85-S92. [PMID: 29502643 PMCID: PMC6541918 DOI: 10.1016/j.acap.2017.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/15/2017] [Accepted: 09/03/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination has been recommended in the United States for female and male adolescents since 2006 and 2011, respectively. Coverage rates are lower than those for other adolescent vaccines. The objective of this study was to evaluate an assessment and feedback intervention designed to increase HPV vaccination coverage and quantify missed opportunities for HPV vaccine initiation at preventive care visits. METHODS We examined changes in HPV vaccination coverage and missed opportunities within the adolescent (11-17 years) population at 9 Oregon-based Kaiser Permanente Northwest outpatient clinics after an assessment and feedback intervention. Quarterly coverage rates were calculated for the adolescent populations at the clinics, according to age group (11-12 and 13-17 years), sex, and department (Pediatrics and Family Medicine). Comparison coverage assessments were calculated at 3 nonintervention (control) clinics. Missed opportunities for HPV vaccine initiation, defined as preventive care visits in which a patient eligible for HPV dose 1 remained unvaccinated, were examined according to sex and age group. RESULTS An average of 29,021 adolescents were included in coverage assessments. Before the intervention, 1-dose and 3-dose quarterly coverage rates were increasing at intervention as well as at control clinics in both age groups. Postimplementation quarterly trends in 1-dose or 3-dose coverage did not differ significantly between intervention and control clinics for either age group. One-dose coverage rates among adolescents with Pediatrics providers were significantly higher than those with Family Medicine providers (56% vs 41% for 11- to 12-year-old and 82% vs 69% for 13- to 17-year-old girls; 55% vs 40% for 11- to 12-year-old and 78% vs 62% for 13- to 17-year-old boys). CONCLUSIONS No significant differences in HPV vaccine coverage were identified at intervention clinics. However, coverage rates were increasing before the start of the intervention and might have been influenced by ongoing health system best practices. HPV vaccine coverage rates varied significantly according to department, which could allow for targeted improvement opportunities.
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Affiliation(s)
| | - Holly C. Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Ore
| | | | - Michael M. McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Julianne Gee
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Ore
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Rosen BL, Shepard A, Kahn JA. US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review. Acad Pediatr 2018; 18:S53-S65. [PMID: 29502639 PMCID: PMC7305794 DOI: 10.1016/j.acap.2017.10.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022]
Abstract
Clinicians' recommendation for the human papillomavirus (HPV) vaccine appears to be an important driver of parental decisions about vaccination. Our aim was to synthesize the best available evidence exploring the perceptions and experiences regarding HPV vaccination, from the perspective of the US clinician. We conducted a comprehensive literature search of Academic Search Complete, CINAHL Plus, Communication & Mass Media Complete, Consumer Health Complete (EBSCOhost), ERIC, Health and Psychosocial Instruments, MEDLINE with full text, and PsycINFO databases. We identified 60 eligible articles: 48 quantitative and 12 qualitative. We extracted the following information: study purpose, use of theory, location, inclusion criteria, and health care provider classification. Results were organized into 5 categories: 1) clinicians' knowledge and beliefs about HPV and the HPV vaccine, 2) clinicians' attitudes and beliefs about recommending HPV vaccines, 3) clinicians' intention to recommend HPV vaccines, 4) clinicians' professional practices regarding HPV vaccination, and 5) patient HPV vaccination rates. Although clinicians were generally supportive of HPV vaccination, there was a discrepancy between clinicians' intentions, recommendation practices, and patient vaccination rates. Studies reported that clinicians tended not to provide strong, consistent recommendations, and were more likely to recommend HPV vaccines to girls versus boys and to older versus younger adolescents. Analyses revealed a number of facilitating factors and barriers to HPV vaccination at the clinician, parent/patient, and systems levels, including clinician knowledge, clinician beliefs, and office procedures that promote vaccination. This review provides an evidence base for multilevel interventions to improve clinician HPV vaccine recommendations and vaccination rates.
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