Changes in Strength of Recommendation and Perceived Barriers to Human Papillomavirus Vaccination: Longitudinal Analysis of Primary Care Physicians, 2008-2018

Overview

Journal J Pediatr

Specialty Pediatrics

Date 2021 Mar 10

PMID 33689710

Citations 11

Authors

Jessica R Cataldi

Sean T OLeary

Lauri E Markowitz

Mandy A Allison

Lori A Crane

Laura P Hurley

Michaela Brtnikova

Brenda L Beaty

Carol Gorman

Elissa Meites

Megan C Lindley

Allison Kempe

Affiliations

Soon will be listed here.

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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References

Rahman M, Laz T, McGrath C, Berenson A . 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). 2014; 54(4):371-5. PMC: 4366339. DOI: 10.1177/0009922814551135. View

Elam-Evans L, Yankey D, Singleton J, Sterrett N, Markowitz L, Williams C . National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020; 69(33):1109-1116. PMC: 7439984. DOI: 10.15585/mmwr.mm6933a1. View

Cook E, Venkataramani A, Kim J, Tamimi R, Holmes M . Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors. Pediatrics. 2018; 142(3). PMC: 6317562. DOI: 10.1542/peds.2018-0458. View

Liddon N, Hood J, Leichliter J . Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: findings from the 2006-2008 National Survey of Family Growth. Vaccine. 2012; 30(16):2676-82. DOI: 10.1016/j.vaccine.2012.02.007. View

Radisic G, Chapman J, Flight I, Wilson C . Factors associated with parents' attitudes to the HPV vaccination of their adolescent sons : A systematic review. Prev Med. 2016; 95:26-37. DOI: 10.1016/j.ypmed.2016.11.019. View

. Recommendations on the use of quadrivalent human papillomavirus vaccine in males--Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011; 60(50):1705-8. View

Allison M, Hurley L, Markowitz L, Crane L, Brtnikova M, Beaty B . Primary Care Physicians' Perspectives About HPV Vaccine. Pediatrics. 2016; 137(2):e20152488. PMC: 6104512. DOI: 10.1542/peds.2015-2488. View

Galbraith K, Lechuga J, Jenerette C, Moore L, Palmer M, Hamilton J . Parental acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United States: A literature review. Soc Sci Med. 2016; 159:116-26. DOI: 10.1016/j.socscimed.2016.04.028. View

Mohanty S, Leader A, Gibeau E, Johnson C . Using Facebook to reach adolescents for human papillomavirus (HPV) vaccination. Vaccine. 2018; 36(40):5955-5961. DOI: 10.1016/j.vaccine.2018.08.060. View

10.

Schmuhl N, Mooney K, Zhang X, Cooney L, Conway J, Loconte N . No association between HPV vaccination and infertility in U.S. females 18-33 years old. Vaccine. 2020; 38(24):4038-4043. PMC: 7255493. DOI: 10.1016/j.vaccine.2020.03.035. View

11.

Meites E, Szilagyi P, Chesson H, Unger E, Romero J, Markowitz L . Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019; 68(32):698-702. PMC: 6818701. DOI: 10.15585/mmwr.mm6832a3. View

12.

Dunn A, Leask J, Zhou X, Mandl K, Coiera E . Associations Between Exposure to and Expression of Negative Opinions About Human Papillomavirus Vaccines on Social Media: An Observational Study. J Med Internet Res. 2015; 17(6):e144. PMC: 4526932. DOI: 10.2196/jmir.4343. View

13.

Naleway A, Mittendorf K, Irving S, Henninger M, Crane B, Smith N . Primary Ovarian Insufficiency and Adolescent Vaccination. Pediatrics. 2018; 142(3). PMC: 6719304. DOI: 10.1542/peds.2018-0943. View

14.

Rand C, Goldstein N . Patterns of Primary Care Physician Visits for US Adolescents in 2014: Implications for Vaccination. Acad Pediatr. 2018; 18(2S):S72-S78. DOI: 10.1016/j.acap.2018.01.002. View

15.

Meites E, Kempe A, Markowitz L . Use of a 2-Dose Schedule for Human Papillomavirus Vaccination - Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016; 65(49):1405-1408. DOI: 10.15585/mmwr.mm6549a5. View

16.

Allison M, Dunne E, Markowitz L, OLeary S, Crane L, Hurley L . HPV vaccination of boys in primary care practices. Acad Pediatr. 2013; 13(5):466-74. PMC: 5848092. DOI: 10.1016/j.acap.2013.03.006. View

17.

Gilkey M, Moss J, McRee A, Brewer N . Do correlates of HPV vaccine initiation differ between adolescent boys and girls?. Vaccine. 2012; 30(41):5928-34. PMC: 3438656. DOI: 10.1016/j.vaccine.2012.07.045. View

18.

Moss J, Reiter P, Brewer N . HPV vaccine for teen boys: Dyadic analysis of parents' and sons' beliefs and willingness. Prev Med. 2015; 78:65-71. PMC: 4547865. DOI: 10.1016/j.ypmed.2015.07.002. View

19.

Markowitz L, Dunne E, Saraiya M, Lawson H, Chesson H, Unger E . Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007; 56(RR-2):1-24. View

20.

Brtnikova M, Crane L, Allison M, Hurley L, Beaty B, Kempe A . A method for achieving high response rates in national surveys of U.S. primary care physicians. PLoS One. 2018; 13(8):e0202755. PMC: 6107210. DOI: 10.1371/journal.pone.0202755. View