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Lake P, Fuzzell L, Brownstein NC, Fontenot HB, Michel A, McIntyre M, Whitmer A, Rossi SL, Perkins RB, Vadaparampil ST. HPV vaccine recommendations by age: A survey of providers in federally qualified health centers. Hum Vaccin Immunother 2023; 19:2181610. [PMID: 36882951 PMCID: PMC10054304 DOI: 10.1080/21645515.2023.2181610] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Clinician recommendation remains a critical factor in improving HPV vaccine uptake. Clinicians practicing in federally qualified health centers were surveyed between October 2021 and July 2022. Clinicians were asked how they recommended HPV vaccination for patients aged 9-10, 11-12, 13-18, 19-26, and 27-45 y (strongly recommend, offer but do not recommend strongly, discuss only if the patient initiates the conversation, or recommend against). Descriptive statistics were assessed, and exact binomial logistic regression analyses were utilized to examine factors associated with HPV vaccination recommendation in 9-10-y-old patients. Respondents (n = 148) were primarily female (85%), between the ages of 30-39 (38%), white, non-Hispanic (62%), advanced practice providers (55%), family medicine specialty (70%), and practicing in the Northeast (63%). Strong recommendations for HPV vaccination varied by age: 65% strongly recommended for ages 9-10, 94% for ages 11-12, 96% for ages 13-18, 82% for age 19-26, and 26% for ages 27-45 y. Compared to Women's Health/OBGYN specialty, family medicine clinicians were less likely to recommend HPV vaccination at ages 9-10 (p = .03). Approximately two-thirds of clinicians practicing in federally qualified health centers or safety net settings strongly recommend HPV vaccine series initiation at ages 9-10. Additional research is needed to improve recommendations in younger age groups.
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Affiliation(s)
- Paige Lake
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Lindsay Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Naomi C Brownstein
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Alexandra Michel
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - McKenzie McIntyre
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ashley Whitmer
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Sarah L Rossi
- Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, MA, USA
| | - Rebecca B Perkins
- Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, MA, USA
| | - Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Osaghae I, Chandra M, Talluri R, Shete S. Individual, systemic and state factors associated with provider recommendation of HPV vaccination: Findings from NIS-Teen, 2020. Hum Vaccin Immunother 2023; 19:2239678. [PMID: 37550623 PMCID: PMC10408691 DOI: 10.1080/21645515.2023.2239678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
The most important determinant of HPV vaccination uptake is healthcare provider recommendation, yet not all eligible patients receive HPV vaccination recommendations. We used data from the 2020 National Immunization Survey-Teen to determine individual, systemic, and state factors associated with provider recommendation of HPV vaccination. A total of 18,534 teens were included, with 81.4% receiving provider recommendations for HPV vaccination. HPV vaccination recommendation was higher among females compared to males (AOR: 1.57; 95% CI: 1.27-1.93), teens who received a well-child exam at 11 or 12 years compared to those who did not (AOR: 2.10; 95% CI: 1.61-2.74), and teens whose mothers had college, some college or at least a high school education compared to those with less than high school education. In addition to individual factors, provider recommendation of HPV vaccination was higher in hospitals (AOR: 1.51; 95% CI: 1.00-2.29) and STD/school/teen clinics (AOR: 2.47; 95% CI: 1.05-5.78) compared to public facilities. However, the odds of provider recommendation were lower when none of the teen's providers ordered vaccines from the state compared to when all teen providers ordered vaccines from the state (AOR: 0.69; 95% CI: 0.52-0.93). Moreover, the state's mean prevalence of provider recommendations of HPV vaccination was 7.2% lower (Coefficient: -0.072; 95% CI: -0.107 - -0.036) in states with high religious ideology compared to those with low religious ideology. Interventions to increase provider recommendation of HPV vaccination should take a multiprong and comprehensive approach that addresses religious and systemic barriers to HPV vaccination recommendation.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monalisa Chandra
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Hanley K, Chung TH, Nguyen LK, Amadi T, Stansberry S, Yetman RJ, Foxhall LE, Bello R, Diallo T, Le YCL. Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients. Vaccines (Basel) 2023; 11:vaccines11040872. [PMID: 37112784 PMCID: PMC10145812 DOI: 10.3390/vaccines11040872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The COVID-19 pandemic led to delays in routine preventative primary care and declines in HPV immunization rates. Providers and healthcare organizations needed to explore new ways to engage individuals to resume preventive care behaviors. Thus, we evaluated the effectiveness of using customized electronic reminders with provider recommendations for HPV vaccination to increase HPV vaccinations among adolescents and young adults, ages 9-25. Using stratified randomization, participants were divided into two groups: usual care (control) (N = 3703) and intervention (N = 3705). The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS, email or patient portal message) at least once, and up to three times (spaced at an interval of 1 reminder per month). The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (Adjusted Odds Ratio: 1.17, 95% CI: 1.01-1.36). This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers.
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Affiliation(s)
- Kathleen Hanley
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Tong Han Chung
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Linh K Nguyen
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Tochi Amadi
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Sandra Stansberry
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Robert J Yetman
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Lewis E Foxhall
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rosalind Bello
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The HPV Vaccination Initiative, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Talhatou Diallo
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yen-Chi L Le
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Rodriguez AM, Do TQN, Eyada MF, Chen L, Schmeler KM, Montealegre JR. Human Papillomavirus Vaccination Uptake in the Rio Grande Valley: Results from a Pilot Community-Based Educational and School-Based Vaccination Program and Its Expansion. Vaccines (Basel) 2023; 11. [PMID: 36851207 DOI: 10.3390/vaccines11020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Human papillomavirus (HPV) vaccine is a safe and effective strategy for reducing HPV morbidity and mortality. Schools have become an increasingly attractive setting for delivering vaccinations and supporting vaccination health literacy and decisional support. This study assesses the effectiveness of a community-based, physician-led HPV education campaign (starting in 2016) and onsite middle school-based HPV vaccination program across six school districts (2017, 2019, 2020) in a rural, medically underserved Texas area (Rio Grande Valley). Pre- and post-intervention HPV vaccination rates were tracked against the 2016 National Immunization Survey-Teen target rates (initiation: 49.3%; completion: 32.9%). Summary statistics were stratified by gender, school district, and grade level. The study reached 19,951 students who received HPV vaccines directly or indirectly through our program (10,289 females; 9662 males) (August 2016-August 2022). Of those, 2145 students (1074 females; 1071 males) were vaccinated directly through our program. The overall HPV up-to-date (UTD) rates were 58.8%. The overall median age at HPV vaccine initiation and HPV-UTD (range) was 11 years (9-21) and 12 years (9-20). The overall median interval between HPV vaccine doses (range) was 291 days (146-2968). Recommending HPV vaccine initiation at younger ages increases HPV vaccine completion and providing access to HPV vaccines encourages on-time vaccination and completion.
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Lu PJ, Srivastav A, Vashist K, Black CL, Kriss JL, Hung MC, Meng L, Zhou T, Yankey D, Masters NB, Fast HE, Razzaghi H, Singleton JA. COVID-19 Booster Dose Vaccination Coverage and Factors Associated with Booster Vaccination among Adults, United States, March 2022. Emerg Infect Dis 2023; 29:133-140. [PMID: 36480674 PMCID: PMC9796208 DOI: 10.3201/eid2901.221151] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Centers for Disease Control and Prevention recommends a COVID-19 vaccine booster dose for all persons >18 years of age. We analyzed data from the National Immunization Survey-Adult COVID Module collected during February 27-March 26, 2022 to assess COVID-19 booster dose vaccination coverage among adults. We used multivariable logistic regression analysis to assess factors associated with vaccination. COVID-19 booster dose coverage among fully vaccinated adults increased from 25.7% in November 2021 to 63.4% in March 2022. Coverage was lower among non-Hispanic Black (52.7%), and Hispanic (55.5%) than non-Hispanic White adults (67.7%). Coverage was 67.4% among essential healthcare personnel, 62.2% among adults who had a disability, and 69.9% among adults who had medical conditions. Booster dose coverage was not optimal, and disparities by race/ethnicity and other factors are apparent in coverage uptake. Tailored strategies are needed to educate the public and reduce disparities in COVID-19 vaccination coverage.
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Abstract
Studies have consistently shown that vaccination rates against human papillomavirus (HPV) lag far behind other adolescent vaccinations recommended at the same age, resulting in exposing adolescents to unnecessary future risk of infection, and genital and head and neck cancers. Studies also have demonstrated that a major barrier to vaccination is lack of a strong provider recommendation. Factors that providers offer for failing to give a strong recommendation range from perception that the child is not at risk or the need to explain that the vaccine is not mandated (lack of equity and justice) or respect for parental autonomy. We look at the issue through a different lens, and reframe the above viewpoint by describing how failing to make a strong recommendation means the provider is not meeting the four principles of medical ethics (justice, beneficence, non-maleficence and autonomy).
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Affiliation(s)
- C Mary Healy
- Department of Pediatrics, Infectious Disease Section, Baylor College of Medicine, Houston, TX, USA
| | - Lara S Savas
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ross Shegog
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rebecca Lunstroth
- McGovern Center for Humanities & Ethics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sally W Vernon
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Rodriguez AM, Do TQN, Chen L, Schmeler KM, Montealegre JR, Kuo YF. Human papillomavirus vaccinations at recommended ages: How a middle school-based educational and vaccination program increased uptake in the Rio Grande Valley. Hum Vaccin Immunother 2022; 18:2133315. [PMID: 36252275 DOI: 10.1080/21645515.2022.2133315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Human papillomavirus (HPV) vaccination is recommended for U.S. adolescents at ages 11-12 requiring two or three doses depending on if the vaccine series started before age 15. The objective was to compare HPV vaccination rates among medically underserved, economically disadvantaged, students in rural middle school districts (Rio Grande Valley [RGV], Texas) by age of initiation (≤ age 11 years vs. age 12 years and older). This quasi-experimental study included 1,766 students (884 females; 882 males) who received at least one HPV vaccine dose through our school-based vaccination program between 08/2016-06/2022. Summary statistics were stratified by age at initiation and gender. The overall HPV up-to-date (UTD) rate was 59.7% (95% Confidence Interval: 57.4-62.0%). The median age at HPV UTD (range) was 12 years (9-19) and median interval between HPV vaccine doses (range) was 316 days (150-2,855). Most students received the HPV vaccine bundled with other vaccinations (72.4%, 1,279/1,766). There was a higher HPV UTD rate among students who initiated the HPV vaccine on or before age 11 than those who initiated on or after age 12 (73.6% versus 45.1%, respectively). The median age of HPV UTD was age 12 for those initiating on or before 11 years versus age 13 for those initiating on or after 12 years of age. Initiating the HPV vaccine at age ≤11 years increased completion of the HPV vaccine series. Improving HPV vaccine coverage and introduction of pan-gender vaccination programs will significantly decrease HPV-related diseases in the RGV.
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Affiliation(s)
- Ana M Rodriguez
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Thuy Quynh N Do
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Lu Chen
- Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jane R Montealegre
- School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Bernstein HH, McNally VV, Orenstein WA. Is It Time for Coronavirus Disease-2019 Vaccine Mandates? J Pediatr 2022; 242:235-237. [PMID: 34788680 PMCID: PMC8590634 DOI: 10.1016/j.jpeds.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Henry H. Bernstein
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY,Reprint requests: Henry H. Bernstein, DO, MHCM, FAAP, 410 Lakeville Rd, Suite 311, New Hyde Park, NY 11042
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Bernstein TA, Broome M, Millman J, Epstein J, Derouin A. Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting. J Pediatr Health Care 2022; 36:e36-e41. [PMID: 35120779 DOI: 10.1016/j.pedhc.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/07/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Evaluation of a quality improvement project designed to improve HPV vaccine uptake in a pediatric primary care setting for young adolescents. METHOD Three strategies were implemented in one private pediatric practice to promote HPV vaccine uptake for 11- and 12-year-old adolescents. 1) a standardized vaccine policy change was made to include HPV vaccine with other adolescent vaccines, 2) a pre-visit email was sent to parents of teens to provide factual vaccine information in preparation for the visit, and 3) a provider communication initiative was implemented to ensure all providers communicated consistent messages and delivered an effective cancer prevention recommendation for HPV vaccination. A pre/post design was used to compare vaccine rates. Data was obtained via the electronic health records. RESULTS The post-intervention group demonstrated HPV vaccine rates increased substantially from 17.8% to 63.6%. DISCUSSION Strategically implementing standardized clinical vaccine policies and presumprive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations.
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Affiliation(s)
| | - Marion Broome
- Dean and Vice-Chancellor for Nursing Affairs, School of Nursing, Duke University, Associate Vice-President for Academic Nursing, Duke University School of Nursing, Durham, NC
| | | | - Jessica Epstein
- Pediatrician, Greenwich Pediatric Associates, Old Greenwich, CT
| | - Anne Derouin
- Professor and Assistant Dean, MSN program at Duke University School of Nursing, Durham, NC
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Kong WY, Huang Q, Thompson P, Grabert BK, Brewer NT, Gilkey MB. Recommending Human Papillomavirus Vaccination at Age 9: A National Survey of Primary Care Professionals. Acad Pediatr 2022; 22:573-80. [PMID: 35081470 DOI: 10.1016/j.acap.2022.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Matos S, Boakye EA, Crosby D, Sharma A. Prevalence and Factors Associated With Oral Cavity and Pharyngeal Cancer Screening in a Rural Population. OTO Open 2021; 5:2473974X211065018. [PMID: 34926974 PMCID: PMC8671683 DOI: 10.1177/2473974x211065018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022] Open
Abstract
Objective (1) To quantify the prevalence of provider recommendation and receipt of oral cavity and pharyngeal cancer (OCPC) screening and (2) to examine the factors associated with OCPC screening recommendation and receipt among adults. Study Design Cross-sectional. Setting Rural counties in central Illinois. Methods This study among adults (N = 145) was conducted between January 1 and June 30, 2017. The outcomes of interest were provider recommendation and receipt of OCPC screening. Multivariable logistic regression models were used to examine the association between (1) sociodemographic, health care access and utilization, and OCPC risk factors and (2) provider recommendation and receipt of OCPC screening. Results The prevalence of provider recommendation and receipt of OCPC screening was 12.4% and 28.3%, respectively. Approximately 15% of current smokers, 13% of participants who consume alcohol, and 10% of participants with ≥5 lifetime sexual partners had received an OCPC screening recommendation. OCPC screening rates were 19% for current smokers, 30% for those who consume alcohol, and 32% for those with ≥5 lifetime sexual partners. In the adjusted analyses, respondents with ≥5 partners (adjusted odds ratio, 3.10 [95% CI, 1.25-7.66]) had a higher odds of receiving OCPC screening than those with <5. There were no significant associations between other OCPC risk factors and provider recommendation and receipt of OCPC screening. Conclusion OCPC screening recommendation and receipt were low; only number of lifetime sexual partners was associated with OCPC screening receipt. Our findings suggest that rural populations may be vulnerable to late-stage diagnosis of OCPC, and interventions to help improve screening rates are warranted.
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Affiliation(s)
- Sophia Matos
- School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
- Simmons Cancer Institute, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Dana Crosby
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Arun Sharma
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
- Arun Sharma, MD, MS, School of Medicine, Southern Illinois University, 720 Bond St, Springfield, IL 62702, USA.
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Abstract
Data are needed on the acceptability of Covid-19 vaccination among young, low-income, diverse populations. To assess this, we surveyed 18-45-year-old women on their intent to be vaccinated, experiences with Covid-19, and uptake of other vaccines. Among the 342 who completed the survey, only one-third were likely to accept the Covid-19 vaccine as soon as it was available. Less than half would accept it even if recommended by their doctor. Most (69%) wanted more information on its safety and 48% wanted proof it works. Likelihood of accepting the vaccine with a doctor's recommendation was associated with fear of catching Covid-19 and exposure to social media as well as HPV and annual flu vaccination. This demonstrates it will be necessary to help vaccine-hesitant individuals overcome their concerns to reach herd immunity in the US. Physician recommendation and social media may play important roles.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
| | - Manasa Kanukurthy
- Center for Interdisciplinary Research in Women's Health (ABB, MC, JMH), Department of Obstetrics and Gynecology (ABB, MC, JMH), School of Medicine (MK), The University of Texas Medical Branch, Galveston, TX, USA
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13
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Jessica G. Myrick. A National Survey Assessing SARS-CoV-2 Vaccination Intentions:
Implications for Future Public Health Communication Efforts. Sci Commun 2020; 42. [ DOI: 10.1177/1075547020960463] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
With SARS-CoV-2 vaccines under development, research is needed to assess
intention to vaccinate. We conducted a survey (N = 3,159) with
U.S. adults in May 2020 assessing SARS-CoV-2 vaccine intentions, intentions with
a provider recommendation, and sociodemographic and psychosocial variables.
Participants had high SARS-CoV-2 vaccine intentions (M =
5.23/7-point scale), which increased significantly with a provider
recommendation (M = 5.47). Hierarchical linear regression
showed that less education and working in health care were associated with lower
intent, and liberal political views, altruism, and COVID-19-related health
beliefs were associated with higher intent. This work can inform interventions
to increase vaccine uptake, ultimately reducing COVID-19-related morbidity and
mortality.
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14
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Eun TJ, Hanchate A, Fenton AT, Clark JA, Aurora MN, Drainoni ML, Perkins RB. Relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Hum Vaccin Immunother 2019; 15:2460-2465. [PMID: 30862301 DOI: 10.1080/21645515.2019.1591138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We described the relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Parent-child dyads that were eligible for both meningococcal and HPV vaccines participated in pre-visit surveys and consented to audio recording of their clinical interactions with healthcare providers related to vaccination. Surveys were analyzed for parent and child demographics and parental intention to vaccinate children with HPV and/or meningococcal vaccines. Audio recordings were analyzed for provider recommendation style, defined as indicated (provider stated vaccine was due at that visit) or not, and for child receipt of vaccines. Linear and logistic regression models were used to determine the relative contributions of parental intention and provider recommendation style to vaccine receipt. 56 parents/child dyads participated. 79% of children received HPV vaccines, and 93% received meningococcal vaccines. After controlling for demographic variables, parental intention did not differ by vaccine type. However, providers were less likely to use an indicated recommendation for HPV than for meningococcal vaccine. After controlling for demographic factors, parental intention, and provider recommendation style, vaccine type (HPV or meningococcal) was no longer associated with vaccine receipt Differences that were previously attributed to vaccine-specific factors may be explained by parents' and providers' roles in vaccine receipt. These findings suggest that interventions and policy recommendations regarding adolescent vaccination should focus on increasing parental demand for vaccines and ensuring that providers present all vaccines as the medical standard of care.
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Affiliation(s)
- Terresa J Eun
- Department of Sociology, Stanford University , Palo Alto, CA , California , USA
| | - Amresh Hanchate
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Anny T Fenton
- Department ofSociology, Harvard University , Cambridge, MA , USA.,Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute , Scarborough, ME , USA
| | - Jack A Clark
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Marisa N Aurora
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA
| | - Mari-Lynn Drainoni
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA.,Center for Healthcare Organization and Implementation Research, ENRM VA Hospital , Bedford , MA , USA
| | - Rebecca B Perkins
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center , Boston, MA , USA
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15
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Abstract
Understanding physician recommendation practices for HPV vaccination is a crucial step to developing interventions that can increase high quality recommendations and improve vaccination acceptance. Florida physicians (n = 340) completed a survey assessing recommendation strategies, specifically strength, consistency, and presentation. Physicians were also asked to provide suggestions for improving HPV vaccination in Florida. Responses were dichotomized for each outcome: strength (i.e., strongly recommend vs. other), consistently recommend (i.e., always recommend vs. other), and recommendation presentation (i.e., presented in the same manner as mandatory vaccines for adolescents vs. other). Bivariate logistic regression was conducted to determine the association between physician/practice characteristics and each outcome. Variables significant (p < .05) in bivariate analyses were included in multivariable logistic regression analyses. Vaccines for Children (VFC) provider status (OR = 2.62, 95% CI = 1.23-5.59 [strong]; OR = 2.84, 95% CI = 1.26-6.39 [consistent]) and not limiting the number of vaccines during a visit (OR = .283, 95% = CI .111-.722 [strong]; OR = .210, 95% = CI .066-.673 [consistent]) were significantly associated with strong and consistent recommendation. Reminders from the healthcare team were associated with consistency (OR = 2.26, 95% CI = 1.23-4.16) and EMR-based reminders were associated with presentation (OR = 2.00, 95% CI = 1.11-3.61). Multinomial logistic regression analysis examined factors associated with level of engagement in recommendation strategies. Multinomial regression indicated VFC providers (OR = 12.61, 95% CI = 1.89-82.20), and those receiving EMR-based reminders (OR = 4.02, 95% = CI 1.28-12.63), among others, were more likely to engage in all 3 types of recommendation practices. Physician suggestions for improving HPV vaccination rates included improving parent/patient/provider education and reducing vaccine costs. Future interventions should emphasize key components of delivering effective HPV vaccine recommendations, include information about insurance coverage, and improve provider awareness of VFC benefits.
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Affiliation(s)
- Paige W Lake
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA
| | - Monica L Kasting
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,b Center for Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,c Department of Health and Kinesiology, Purdue University , West Lafayette , IN , USA
| | - Shannon M Christy
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,d Morsani College of Medicine, University of South Florida , Tampa , FL , USA
| | - Susan T Vadaparampil
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,b Center for Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,d Morsani College of Medicine, University of South Florida , Tampa , FL , USA
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16
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Lu PJ, Yankey D, Fredua B, O'Halloran AC, Williams C, Markowitz LE, Elam-Evans LD. Association of Provider Recommendation and Human Papillomavirus Vaccination Initiation among Male Adolescents Aged 13-17 Years-United States. J Pediatr 2019; 206:33-41.e1. [PMID: 30448270 PMCID: PMC6487492 DOI: 10.1016/j.jpeds.2018.10.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/17/2018] [Accepted: 10/19/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess human papillomavirus (HPV) vaccination coverage among adolescents by provider recommendation status. STUDY DESIGN The 2011-2016 National Immunization Survey-Teen data were used to assess HPV vaccination coverage among male adolescents by provider recommendation status. Multivariable logistic analyses were conducted to evaluate associations between HPV vaccination and provider recommendation status. RESULTS HPV vaccination coverage among male adolescents increased from 8.3% in 2011 to 57.3% in 2016. Likewise, the prevalence of provider recommendation increased from 14.2% in 2011 to 65.5% in 2016. In 2016, HPV coverage was higher in male adolescents with a provider recommendation than in those without a provider recommendation (68.8% vs 35.4%). In multivariable logistic regression, characteristics independently associated with a higher likelihood of HPV vaccination included receipt of a provider recommendation, age 16-17 years, black or Hispanic race/ethnicity, any Medicaid insurance, ≥2 physician contacts in the previous 12 months, and urban or suburban residence. Participants with a mother with some college or a college degree, those with a mother aged 35-44 years, and those who did not have a well-child visit at age 11-12 years had a lower likelihood of HPV vaccination. CONCLUSIONS Receiving a provider recommendation for vaccination was significantly associated with receipt of HPV vaccine among male adolescents, indicating that a provider recommendation for vaccination is an important approach to increase vaccination coverage. Evidence-based strategies, such as standing orders and provider reminders, alone or in combination with health system interventions, are useful for increasing provider recommendations and HPV vaccination coverage among male 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
| | - Benjamin Fredua
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alissa C O'Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lauri E Markowitz
- Division of Viral Diseases, 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
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17
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Abstract
Despite the excellent benefit-to-risk ratio for human papillomavirus (HPV) vaccination and recommendations for its routine use from the Advisory Committee on Immunization Practices (ACIP), significant controversy surrounding HPV vaccination continues to exist. In light of this controversy and continued low rates of vaccination among U.S. adolescents, the Pediatric Pharmacy Advocacy Group (PPAG) endorses the safety and efficacy of HPV vaccination and agrees with ACIP recommendations for protection of the U.S. population against the potentially severe consequences of HPV. The PPAG recommends that all eligible individuals undergo vaccination. We further recommend that pediatric pharmacists participate in the education of patients and their families and serve as advocates for HPV vaccination. This document serves as an update to the 2008 PPAG position statement.1.
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Abstract
Human papillomavirus (HPV) vaccination is recommended for all female survivors of childhood cancer; yet, it is underused. Parent-child sexual communication and health care provider recommendation for HPV vaccination influence familial vaccination decisions. However, caregivers may be less likely to discuss sexual health issues with survivors as compared to healthy peers. Therefore, this study compared mothers of daughters with/without history of childhood cancer on measures of sexual communication, HPV-specific communication, and health care provider recommendation for HPV vaccination, and examined the effects of sociodemographic and medical factors on these measures. There were no differences between mothers of survivors/noncancer survivors on the outcomes (Ps > .05). Among all mothers, daughter's age was associated with sexual communication (Ps < .05). Household income and daughter's age were associated with health care provider recommendation for vaccination (Ps < .05). Among mothers of survivors, daughter's age at diagnosis was associated with sexual communication, HPV-specific communication, and health care provider recommendation for vaccination (Ps < .05). Findings have implications for the role of health care providers as advocates for mother-daughter sexual communication and HPV vaccination, especially among survivors of childhood cancer.
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Affiliation(s)
- Courtney Peasant
- St Jude Children's Research Hospital, Memphis, TN, USA University of Memphis, Memphis, TN, USA Yale University, New Haven, CT, USA
| | - Rebecca H Foster
- St Louis Children's Hospital, St Louis, MO, USA University of Washington, St Louis, MO, USA
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19
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Dempsey AF, Pyrzanowski J, Lockhart S, Campagna E, Barnard J, O'Leary ST. Parents' perceptions of provider communication regarding adolescent vaccines. Hum Vaccin Immunother 2016; 12:1469-75. [PMID: 27078515 DOI: 10.1080/21645515.2016.1147636] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Strong provider recommendations for adolescent vaccines are critical for achieving high vaccination levels. However, little is known about parents' preferred provider communication strategies for adolescent vaccines in general, and for human papillomavirus (HPV) vaccines specifically. We performed a cross-sectional survey of 800 parents of 9-14 year olds in April 2014 to assess current adolescent vaccine communication practices by providers, parents' preferred HPV vaccine-specific communication strategies, and the association of these two outcomes with experiential, attitudinal and demographic characteristics. Among the 356 parents in the study (response rate 48%), HPV vaccines were reported as less likely to have been "very strongly" recommended by their adolescent's provider (39%) than other adolescent-targeted vaccines (45%-59%, <0.05 for all comparisons). Receiving a very strong recommendation for HPV vaccines was associated with a higher likelihood of vaccine receipt (71% versus 39%, p<0.001), or among those not yet vaccinated, increased likelihood of positive vaccination intentions (82% vs. 60%, p = 0.015). Nearly all parents (87%) reported that, if available, they would use a website providing personalized HPV vaccine-related materials before their adolescent's next check-up, and other technology-based communications were also endorsed by the majority of parents. From these data we conclude that parents received weaker recommendations for HPV vaccines than other adolescent vaccines, and that most parents want additional HPV vaccine-related materials, preferably delivered using a variety of technology-based modalities which is not their providers' current practice.
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Affiliation(s)
- Amanda F Dempsey
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
| | | | - Steven Lockhart
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
| | | | - Juliana Barnard
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
| | - Sean T O'Leary
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
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20
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Abstract
Human papillomavirus is the most common sexually transmitted infection in the USA. It is the primary cause of almost all cervical cancers as well as several other cancers that affect both men and women. Adolescents of both genders can now prevent transmission of the most common oncogenic strains of human papillomavirus by obtaining a safe, three-dose vaccine series. However, despite its potential to save lives and reduce severe morbidity, many US adolescents have not been vaccinated. This is in contrast to other countries where high rates of vaccination are already reducing rates of cervical intra-epithelial neoplasia and genital warts. This article describes barriers recently reported among families in the USA and concludes with suggestions for improving uptake.
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Affiliation(s)
- Abbey B Berenson
- a The University of Texas Medical Branch at Galveston, Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, 301 University Boulevard, Mail Route 0587, Galveston, TX 77555-0587, USA
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21
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Rahman M, Laz TH, McGrath CJ, Berenson AB. Provider recommendation mediates the relationship between parental human papillomavirus (HPV) vaccine awareness and HPV vaccine initiation and completion among 13- to 17-year-old U.S. adolescent children. Clin Pediatr (Phila) 2015; 54:371-5. [PMID: 25238779 PMCID: PMC4366339 DOI: 10.1177/0009922814551135] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the association between parental human papillomavirus (HPV) awareness and HPV vaccine initiation/completion based on 13- to 17-year-old US adolescent children and to explore whether these associations were mediated by provider recommendation. METHODS We used publicly available National Immunization Survey-Teen 2011 data (11 236 adolescent girls and 12 328 boys). RESULTS Weighted logistic regression analysis showed that parental HPV awareness and provider recommendation predicted HPV vaccine initiation and completion separately among both girls and boys, after adjusting for demographic and health care use variables. When provider recommendation and parental HPV awareness were entered in the model simultaneously, only provider recommendation was independently associated with HPV vaccine initiation and completion, demonstrating a mediation effect of provider recommendation. CONCLUSIONS Future studies are needed to better understand why physicians may not provide a recommendation for the HPV vaccine as well as to identify strategies to improve providers' ability to effectively communicate their recommendations.
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Affiliation(s)
- Mahbubur Rahman
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
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22
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Frongillo M, Feibelmann S, Belkora J, Lee C, Sepucha K. Is there shared decision making when the provider makes a recommendation? Patient Educ Couns 2013; 90:69-73. [PMID: 22999786 PMCID: PMC4144163 DOI: 10.1016/j.pec.2012.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 07/25/2012] [Accepted: 08/25/2012] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To compare the amount of shared decision making in breast cancer surgery interactions when providers do and do not make a treatment recommendation. METHODS We surveyed breast cancer survivors who were eligible for mastectomy and lumpectomy. Patients reported whether the provider made a recommendation and the recommendation given. They completed items about their interaction including discussion of options, pros, cons, and treatment preference. A total involvement score was calculated with higher scores indicating more shared decision making. RESULTS Most patients (85%) reported that their provider made a recommendation. Patients who did not receive a recommendation had higher involvement scores compared to those who did (52% vs. 39.1%, p=0.004). Type of recommendation was associated with involvement. Patients given different recommendations had the highest total involvement scores followed by those who received mastectomy and lumpectomy recommendations (65.5% vs. 42.5% vs. 33.2%, respectively, p<0.001). CONCLUSION Providers were less likely to present a balanced view of the options when they gave a recommendation for surgery. Patients who received a recommendation for lumpectomy had the lowest involvement score. PRACTICE IMPLICATIONS Providers need to discuss both mastectomy and lumpectomy and elicit patients' goals and treatment preferences regardless of whether or not a recommendation is given.
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Affiliation(s)
- Marissa Frongillo
- Department of General Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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23
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Abstract
BACKGROUND AND OBJECTIVE Many women with increased breast cancer risk have not been screened recently. Provider recommendation for mammography is an important reason many women undergo screening. We examined the association between breast cancer risk and reported provider recommendation for mammography in recently unscreened women. DESIGN Cross-sectional study using 2000 National Health Interview Survey. PARTICIPANTS In all, 1673 women ages 40 to 75 years without cancer who saw a health care provider in the prior year and had no mammogram within 2 years. MEASUREMENTS AND ANALYSIS We assessed breast cancer risk by Gail score and risk factors. We used multivariable logistic regression models in SUDAAN adjusted for age, race and illness burden, to examine the association between risk and reported recommendation for mammography within 1 year for all women and women ages 50 to 75 years. RESULTS Of 1673 recently unscreened women, 29% reported a recommendation. Twelve percent of women had increased Gail risk and of these recently unscreened, high-risk women, 25% reported a recommendation. After adjustment, high-risk women were not more likely to report a recommendation than average-risk women. Results were similar for women 50 to 75 years old. No individual breast cancer factors other than age were associated with reporting a recommendation. CONCLUSIONS Approximately 70% of recently unscreened women seen by a health care provider in the prior year reported no recommendation for mammography, regardless of breast cancer risk. This did not include women who received a recommendation and were screened. Increasing reported recommendation rates may represent an opportunity to increase screening participation among recently unscreened women, particularly for women with increased breast cancer risk.
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Affiliation(s)
- Susan A Sabatino
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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