Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults

ObjectivesIt is unclear if provider recommendations regarding colorectal cancer (CRC) screening modalities affect patient compliance. We evaluated provider–patient communications about CRC screening with and without a specific screening modality recommendation on patient compliance with screening guidelines.MethodsWe used the 2007 Health Information National Trends Survey (HINTS) and identified 4283 respondents who were at least 50 years of age and answered questions about their communication with their care providers and CRC screening uptake. We defined being compliant with CRC screening as the use of fecal occult blood testing (FOBT) within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We used survey weights in all analyses.ResultsCRC screening discussions occurred with 3320 (76.2%) respondents. Approximately 95% of these discussions were with physicians. Overall, 2793 (62.6%) respondents were current with CRC screening regardless of the screening modality. Discussion about screening (odds ratio (OR) = 8.83; 95% confidence interval (CI): 7.20–10.84) and providers making a specific recommendation about screening modality rather than leaving it to the patient to decide (OR = 2.04; 95% CI: 1.54–2.68) were associated with patient compliance with CRC screening guidelines.ConclusionCompliance with CRC screening guidelines is improved when providers discuss options and make specific screening test recommendations.     

Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States – 2008–2012

BackgroundPrevention of pre-invasive cervical lesions is an important benefit of HPV vaccines, but demonstrating impact on these lesions is impeded by changes in cervical cancer screening. Monitoring vaccine-types associated with lesions can help distinguish vaccine impact from screening effects. We examined trends in prevalence of HPV 16/18 types detected in cervical intraepithelial neoplasia 2, 3, and adenocarcinoma in situ (CIN2+) among women diagnosed with CIN2+ from 2008 to 2012 by vaccination status. We estimated vaccine effectiveness against HPV 16/18-attributable CIN2+ among women who received ≥1 dose by increasing time intervals between date of first vaccination and the screening test that led to detection of CIN2+ lesion.MethodsData are from a population-based sentinel surveillance system to monitor HPV vaccine impact on type-specific CIN2+ among adult female residents of five catchment areas in California, Connecticut, New York, Oregon, and Tennessee. Vaccination and cervical cancer screening information was retrieved. Archived diagnostic specimens were obtained from reporting laboratories for HPV DNA typing.ResultsFrom 2008 to 2012, prevalence of HPV 16/18 in CIN2+ lesions statistically significantly decreased from 53.6% to 28.4% among women who received at least one dose (P_trend < .001) but not among unvaccinated women (57.1% vs 52.5%; P_trend = .08) or women with unknown vaccination status (55.0% vs 50.5%; P_trend = .71). Estimated vaccine effectiveness for prevention of HPV 16/18-attributable CIN2+ was 21% (95% CI: 1–37), 49% (95% CI: 28–64), and 72% (95% CI: 45–86) in women who initiated vaccination 25–36 months, 37–48 months, and >48 months prior to the screening test that led to CIN2+ diagnosis.ConclusionsPopulation-based data from the United States indicate significant reductions in CIN2+ lesions attributable to types targeted by the vaccines and increasing HPV vaccine effectiveness with increasing interval between first vaccination and earliest detection of cervical disease.     

Effect of number of human papillomavirus vaccine doses on guideline adherent cervical cytology screening among 19–26 year old females

PurposeLittle is known about how the number of HPV vaccine doses affect adherence to screening guidelines. This study compared adherence to cervical cancer screening by the number of HPV vaccine doses received by young women and assessed whether the specialty of vaccinating providers affected behavior.MethodsThis retrospective cohort study using administrative insurance claims records included 24,964 19–26 year old women who received at least 1 injection of the HPV vaccine between January 2006 and November 2009. Vaccinated young women continuously enrolled in a nationally-representative private insurance plan for 6 months prior to and 37 months after HPV vaccine administration were included. Logistic regression was used to compare the odds of Papanicolaou (Pap) testing 3 years after vaccine initiation by number of vaccine doses and provider type.ResultsIn this sample, 79.3% had a Pap test 3 years following vaccine initiation. Receiving 1 (aOR: 0.60, 95% CI 0.55–0.65) or 2 (aOR: 0.80, 95% CI 0.74–0.87) doses was associated with decreased odds of Pap testing compared to 3 doses. Many young women in our sample (16.5%) were diagnosed with cervical dysplasia prior to HPV vaccination. Patients vaccinated by non-obstetrician/gynecologists were less likely to get a Pap test following vaccination.ConclusionsWomen who received 1 or 2 doses of the HPV vaccine were less likely than those who received 3 doses to be screened for cervical cancer 3 years following vaccine initiation. Pediatricians and primary care physicians should convey the importance of initiating and continuing screening to HPV vaccinated patients.     

Factors related to vaccine uptake by young adult women in the catch-up phase of the National HPV Vaccination Program in Australia: Results from an observational study

BackgroundAustralia commenced a publically-funded, National Human Papillomavirus (HPV) Vaccination Program in 2007 with a two year catch-up phase for females aged 12–26 years.ObjectiveTo identify the factors associated with the uptake of the HPV vaccine (which has a recommended 3-dose schedule in Australia) by young adult women vaccinated by general practitioners and community-based programs within the catch-up phase.Methods1139 women who were eligible to receive the free HPV vaccine during the catch-up period were recruited in 2008–2009 (age 20–29 years at recruitment), in New South Wales, after having a normal (negative) cervical smear result recorded on the NSW Pap Test Register. Participants completed a self-administered questionnaire providing information on vaccination status, and sociodemographic and other factors.ResultsOverall, 880 (77%) women reported receiving ≥1 dose of the vaccine and 777 women (68%) reported receiving ≥2 doses. In multivariable analysis (adjusting for the period for which each woman was eligible for free HPV vaccination), uptake of ≥1 dose of the vaccine was significantly associated with being born in Australia (p < 0.01), being single (p = 0.02), being nulliparous (p < 0.01), living in a higher socioeconomic status area (p-trend = 0.03), living in more remote areas (p = 0.03), drinking alcohol (p < 0.01) and using hormonal contraceptives (p < 0.01). Although vaccinated women were more likely to have fewer sexual partners than unvaccinated women (p-trend = 0.02), they were also more likely to report a prior sexually transmitted infection (STI) (p = 0.03). Similar factors were associated with receiving ≥2 doses.ConclusionsIn this group, women living in higher socioeconomic status areas were more likely to be vaccinated against HPV in the catch-up phase of the national program. Although vaccinated women tended to have fewer sexual partners, they also reported prior STIs, which may be a marker of increased risk of prior exposure to HPV. The findings of this study reinforce the continuing need to prioritise equitable delivery of vaccination to various population subgroups.     

General practitioners’ attitudes and behaviors toward HPV vaccination: A French national survey

ObjectiveGeneral practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations.MethodsCross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general.ResultsOverall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR = 0.13; 95%CI = 0.09–0.21; partial R² = 0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR = 0.13; 95%CI = 0.07–0.24; partial R² = 0.05), and doubts about vaccine utility in general (OR = 0.78; 95%CI = 0.71–0.86; partial R² = 0.03).ConclusionAlthough nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.     

HPV vaccination coverage of teen girls: The influence of health care providers

BackgroundBetween 2010 and 2014, the percentage of 13–17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine (“fully vaccinated”) increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine (“not immunized”) decreased by 11.3 percentage points to 40.0%.ObjectiveTo evaluate the complex interactions between parents’ vaccine-related beliefs, demographic factors, and HPV immunization status.MethodsVaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n = 8490) were analyzed. HPV vaccination status was determined from teens’ health care provider (HCP) records.ResultsAmong teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p < 0.05). Among teen girls administered 1–2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration.ConclusionResults suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses.     

Comparative effectiveness of two outreach strategies for cervical cancer screening

ObjectiveTest-specific reminder letters can improve cancer screening adherence. Little is known about the effectiveness of a reminder system that targets the whole person by including multiple screening recommendations per letter.MethodsWe compared the effectiveness of a Pap-specific reminder letter sent 27 months after a woman's last Pap, to a reminder letter that included up to seven preventive service recommendations sent before a woman's birthday (“birthday letter”) on Pap smear adherence from a natural experiment occurring in routine clinical care. Participants included 82,016 women from Washington State who received 72,615 Pap-specific letters between 2003 and 2007 and 100,218 birthday letters between 2009 and 2012. We defined adherence as having a Pap test within a six month window around the Pap test due date. Using logistic regression, we calculated adjusted odds ratios (OR) for adherence with 95% confidence intervals (CI) following the birthday letter with 1–2 recommendations, 3–5 recommendations, and 6–7 recommendations compared to the Pap-specific letter. All analyses were stratified by whether a woman was up-to-date or overdue for screening at the time she received a letter.ResultsAdjusted ORs showed reduced adherence following the birthday letter compared with the Pap-specific letter for up-to-date women whether the letter had 1–2 recommendations (OR = 0.37, 95%CI = 0.36–0.39), 3–5 recommendations (OR = 0.44, 95%CI = 0.42–0.45), or 6–7 recommendations (OR = 0.36, 95%CI = 0.32–0.40). We noted no difference in Pap-test adherence between letter types for overdue women.ConclusionsIn conclusion, for women regularly adherent to screening, an annual birthday letter containing reminders for multiple preventive services was less effective at promoting cervical cancer screening compared with a Pap-specific letter.     

Actions improving HPV vaccination uptake – Results from a national survey in Italy

BackgroundIn Italy, HPV vaccination is offered to 11-year-old girls since 2007. In 2012 coverage was 69%. Strategies for offering and promoting HPV vaccination and coverage rates (26–85%) vary among Regions and Local Health Authorities (LHAs). We conducted a national study to identify strategies to improve HPV vaccination uptake.MethodsIn 2011–2012 we invited the 178 LHAs to fill a web-questionnaire, inquiring implementation of HPV vaccination campaigns (immunization practices, logistics of vaccine delivery, training, activities to promote vaccination, barriers, local context). We described type of offer and vaccination promotion in each LHA and studied the association of these factors with vaccination coverage rates.ResultsWe analyzed 133 questionnaires. The communication tools more frequently used to promote vaccination were: brochures/leaflets (92% of LHAs), fliers/posters (72%). Television (24%) and radio (15%) were less used. Using ≥3 communication channels was associated to a coverage ≥70% (OR_adj = 5.9, 95%CI 2.0–17.4). The probability to reach a coverage ≥70% was higher if the invitation letter indicated a pre-assigned date for HPV vaccination (OR_adj = 7.0, 95%CI 1.2–39.8) and >1 recall for non-respondents was planned (OR_adj = 4.1, 95%CI 1.8–9.3). Immunization services and paediatricians were involved in informative and training activities in most LHAs (80–90%), instead general practitioners, women and family's healthcare services and public gynaecologists in 60–70%, cervical cancer screening services and private gynaecologists in 20–40%. The main factors that negatively affected vaccination uptake were: poor participation to training events of professional profiles different from personnel of immunization services (reported by 58% LHAs), their mistrust towards HPV vaccination (55%) and insufficient resources (56%).ConclusionThe synergy of multiple interventions is necessary for a successful vaccination programme. Practices such as pre-assigning vaccination date and repeatedly recalling non-respondents could improve vaccination uptake. Efforts are required to strengthen the training of different professional profiles and services and encourage their collaboration. Economical resources are needed to promote vaccination.     

Relationship status impacts primary reasons for interest in the HPV vaccine among young adult women

IntroductionThe HPV vaccine prevents HPV-related cancers and genital warts, which cause significant morbidity and mortality in the US. The vaccine is targeted toward 11–12 year old males and females, but is recommended for “catch-up” vaccination until age 26 for females. Young adult females (18–26 years) represent a unique group that may face distinct barriers to HPV vaccination, one of which is relationship status. The purpose of this study was to assess how relationship status impacts interest in HPV vaccination and primary reasons for non-vaccination among 18–26 year old young adult women.MethodsThe National Health Interview Survey 2010 was examined among unvaccinated females, 18–26 years (N = 1457). A survey-weighted logistic regression analysis with conversion to prevalence ratios assessed how interest in the HPV vaccine (yes/no) was influenced by relationship status (married, living with a partner, other, single) among young adult women. A Rao-Scott chi-square test examined differences between primary reasons for non-vaccination and relationship status among HPV vaccine uninterested women.ResultsAmong unvaccinated women, 31.4% were interested in the HPV vaccine. Women who were living with a partner (PR = 1.45, 95%CI 1.06–1.90) and single (PR = 1.42, 95%CI 1.11–1.76) were significantly more likely than married women to be interested in the HPV vaccine, while controlling for socio-demographic and other known risk factors. Additionally, primary reasons for non-vaccination differed based on relationship status among uninterested women (p < 0.01). Women who were married were more likely to cite not needing the vaccine compared to never married women (p < 0.05).ConclusionRelationship status in young adulthood impacts HPV vaccine interest and decision-making among a national sample of women. Primary reasons for non-interest in the vaccine may be shaped by attitudes and knowledge about the HPV vaccine that differ by relationship status. Future research is needed to elucidate ways to overcome relationship status as a barrier to HPV vaccination.     

Human papillomavirus vaccine series completion in boys before and after recommendation for routine immunization

BackgroundAlthough the incidence of HPV-attributable cancers in males is rapidly increasing, HPV vaccine uptake in males remains poor. While quadrivalent human papillomavirus vaccine (4vHPV) series initiation in males increased following the Advisory Committee Immunization Practices (ACIP) male routine use recommendation, its impact on 4vHPV series completion in males at ACIP-recommended intervals has not been evaluated in large male cohorts. We examined trends and correlates of 4vHPV completion since licensure in males in a large cohort of insured boys before and after the ACIP routine use recommendation.MethodsWe grouped data from electronic medical records of males aged 9–17 years from Kaiser Permanente Southern California health plan who initiated 4vHPV into 3 cohorts by 4vHPV initiation date: licensure and ACIP permissive use: 2009–2010; addition of anal cancer indication: 2010–2011; ACIP routine use: 2011–2013. We estimated adjusted hazard ratios (AHRs) between patient and provider characteristics and vaccination using Marginal Cox proportional hazards models.ResultsOf 80,800 boys initiating 4vHPV, 24.3% completed the series within 12 months with minimal differences across cohorts. Completion decreased with increasing age at initiation (13–17 vs. 11–12 year olds: AHR = 0.85; 95% confidence interval [CI] = 0.80, 0.89) and was greater among patients with a primary care provider (AHR = 1.28, 95%CI = 1.17, 1.41), influenza vaccine recipients (AHR = 1.50, 95% CI = 1.43, 1.57), and Asian/Pacific Islanders (AHR = 1.07, 95% CI = 1.00, 1.15), and lower among non-Hispanic Blacks (AHR = 0.72, 95% CI = 0.65, 0.80) and Hispanics (AHR = 0.86, 95% CI = 0.81, 0.90) compared to non-Hispanic Whites.ConclusionsDespite the ACIP routine use recommendation in males, 4vHPV series completion remained low. 4vHPV initiation at 11–12 years and identification of a provider responsible for the adolescents’ health care may increase 4vHPV series completion. Given the rapidly increasing incidence of HPV-related cancers in males, it is important to identify measures to increase HPV vaccine series completion, particularly among non-Hispanic Black and Hispanic males.     

Human papillomavirus vaccination receipt and provider counseling rates among high-risk patients

ObjectiveWe describe provider documented counseling patterns and perception regarding HPV vaccination among patients with a history of cervical dysplasia.MethodsAll patients ages 21–45 who underwent colposcopy at a single academic medical center from 2018 to 2020 were sent a self-administered survey through the electronic medical record patient portal to assess their attitudes regarding human papillomavirus (HPV) vaccination. Demographic information, HPV vaccination history, and documented obstetrics and gynecology provider counseling at the time of colposcopy were examined.ResultsOf 1465 patients, 434 (29.6 %) reported or had documented receipt of at least one dose of the human papillomavirus vaccine. The remainder reported they were not vaccinated or had no documentation of vaccination. Proportion of vaccinated patients was higher among White compared to Black and Asian patients (P = 0.02). On multivariate analysis, private insurance (aOR 2.2, 95 % CI 1.4–3.7) was associated with vaccinated status while Asian race (aOR 0.4, 95 % CI 0.2–0.7) and hypertension (aOR 0.2, 95 % CI 0.08–0.7) were less likely to be associated with vaccination status. Among patients with unvaccinated or unknown vaccination status, 112 (10.8 %) received documented counseling regarding catch-up human papillomavirus vaccination at a gynecologic visit. Patients seen by a sub-specialist obstetrics and gynecologic provider were more likely to have documented provider counseling regarding vaccination compared to those seen by a generalist obstetric/gynecologist provider (26 % vs 9.8 %, p < 0.001). Patients cited lack of physician discussion (53.7 %) and the belief that they were too old to receive the HPV vaccine (48.8 %) as the main reasons for remaining unvaccinated.ConclusionHPV vaccination and the rate of obstetric and gynecologic provider counseling regarding HPV vaccination among patients undergoing colposcopy remains low. When surveyed, many patients with a history of colposcopy cited provider recommendation as a factor in their decision to undergo adjuvant HPV vaccination, demonstrating the importance of provider counseling in this group.     

Recent trends in adherence to continuous screening for breast cancer among Medicare beneficiaries

ObjectiveThe aim of this study is to examine recent trends in adherence to continuous screening, especially the rate of subsequent screening mammography following an initial screening before and after the U.S. Preventive Services Task Force (USPSTF) revised its guidelines on breast cancer in November 2009.MethodsWe retrospectively analyzed Medicare fee-for-service claims data to: 1) compare rate of subsequent screening mammography over 27 month periods for 317,150 women screened in either 2004 or 2009; and 2) examine patterns of subsequent screening by age and race.ResultsWhen adjusted for age, race, state of residence, county-level covariates, and clustered on ordering provider, the rate of subsequent screening decreased in 2009 relative to 2004 (OR = 0.75; 95% CI: 0.74–0.76). Adjusted odds ratios are similar for alternative follow-up windows (15 months, 0.71; 24 months, 0.70; 30 months 0.75). The decline was mostly attributable to women 75 and older who are now less likely to return for a subsequent screening. Although USPSTF guidelines call for 24 months, approximately half of women continue screening at 12-month intervals in both cohorts.ConclusionsThe rate of subsequent screening mammography has declined after 2009. Older women seem to follow the revised USPSTF guideline, but confusion by physicians and patients about competing guidelines may be contributing to these findings.     

HPV vaccine for teen boys: Dyadic analysis of parents' and sons' beliefs and willingness

ObjectiveParents and adolescents often decide together whether the child should receive human papillomavirus (HPV) vaccine. However, few studies have investigated the dyadic nature of beliefs that affect this process.MethodData came from the 2010 HPV Immunization in Sons (HIS) Study, a national sample of 412 parents and their adolescent sons. We conducted dyadic multivariate logistic regression to examine the relationships between parents' and sons' HPV vaccine beliefs and their willingness to have the son receive the vaccine.ResultsLess than half of parents and sons were willing to have the sons receive HPV vaccine (43% and 29%, respectively). Willing parents and sons anticipated greater regret if the son did not receive HPV vaccine but later contracted an HPV infection (parent odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.24–2.40; son OR = 1.51, 95% CI = 1.04–2.19) (both p < .05). Lower concerns about side effects, such as pain and fainting, were also associated with willingness.ConclusionParents and sons were more willing to have the son receive HPV vaccine if they had higher anticipated regret about potential HPV infection and lower concerns about side effects. Communication campaigns may be able to target these beliefs to increase parents' and sons' willingness to seek HPV vaccination.     

Modification and validation of the Treatment Self Regulation Questionnaire to assess parental motivation for HPV vaccination of adolescents

BackgroundAccording to Self-Determination Theory, the extent to which the motivation underlying behavior is self-determined or controlled influences its sustainability. This is particularly relevant for behaviors that must be repeated, such as completion of the human papillomavirus (HPV) vaccine series. To date, no measures of motivation for HPV vaccination have been developed.MethodsAs part of a larger study, parents (N = 223) whose adolescents receive care at safety-net clinics completed a telephone questionnaire about HPV and the vaccine. We modified the Treatment Self-Regulation Questionnaire to assess parents’ motivation for HPV vaccination in both Spanish and English. We used confirmatory factor analysis to test a three-factor measurement model.ResultsThe three-factor model fit the data well (RMSEA = 0.04, CFI = 0.98, TLI = 0.96), and the scales’ reliabilities were adequate (autonomous: α = 0.87; introjected: α = 0.72; external: α = 0.72). The factor loading strength for one item was stronger for Spanish- than English-speaking participants (p < 0.05); all others were equivalent. The intercorrelations among the scales ranged from −0.17 to 0.32, suggesting discriminant factors. The scales displayed the expected pattern of correlations with other psychosocial determinants of behavior. Vaccination intentions showed a strong correlation with autonomous motivation (r = 0.52), but no correlation with external motivation (r = 0.02), suggesting autonomous motivation may be particularly important in vaccine decision-making.ConclusionFindings support the use of three subscales to measure motivation in HPV vaccination and suggest possible cultural differences in motivation.     

Cervical cytology screening among low-income,minority adolescents in New York City following the 2009 ACOG guidelines

ObjectivesIn December 2009, the American College of Obstetricians and Gynecologists recommended that cervical cancer screening begin at age 21 for young women. In this study, we examine receipt of first lifetime Papanicolaou (Pap) test and predictors of over-screening among adolescents within a large urban ambulatory care network.MethodsWe compared the proportion of first lifetime Pap test of adolescents aged 13–20 years between June 2007 — November 2009 (n = 7700) and December 2009–June 2012 (n = 9637) using electronic health records. We employed multivariable regression models to identify demographic and health care factors associated with receiving a first lifetime Pap test at age < 21 years in the post-guideline period (over-screening).ResultsThe proportion of Pap tests declined from 19.3% to 4.2% (p < 0.001) between the two periods. Multivariable logistic regression results showed receiving care from gynecologic/obstetric/family planning clinics compared to pediatric clinics, having more clinic encounters, and older age were associated with over-screening in the post-guideline period.ConclusionsWe found that guideline adherence differed by clinic type, insurance status, and health care encounters. In the quickly evolving field of cervical cancer control, it is important to monitor practice trends as they relate to shifts in population-based guidelines, especially in high-risk populations.     

Provider communication and HPV vaccination: The impact of recommendation quality

BackgroundReceiving a healthcare provider's recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.MethodsIn 2014, we conducted a national, online survey of 1495 parents of 11–17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥1 dose), follow through (3 doses, among initiators), refusal, and delay.ResultsAlmost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR = 9.31, 95% CI, 7.10–12.22) and over three times the odds of follow through (17% vs. 44%, OR = 3.82, 95% CI, 2.39–6.11). Low-quality recommendations were more modestly associated with initiation (OR = 4.13, 95% CI, 2.99–5.70), but not follow through. Parents who received high- versus low-quality recommendations less often reported HPV vaccine refusal or delay.ConclusionsHigh-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents.     

Effectiveness of HPV vaccines against genital warts in women from Valencia,Spain

ObjectivesTo assess the effectiveness of the HPV vaccines in preventing genital warts in young women.DesignPopulation-based study using health databases.SettingValencian Community (Spain).ParticipantsAll girls and women aged 14–19 years who were registered in the Valencian Community between January 2009 and December 2014 (n = 279,787).Main outcome measuresIncident cases of genital warts were defined as the first activation of diagnosis code ICD-9-CM 078.11 (Condyloma acuminatum) in primary care and outpatient clinics during the study period.ResultsThere were 612 cases of genital warts. The overall incidence rate was 75.8/100,000 person-years (95% CrI 69.7–81.8). There was a decrease in genital warts when female candidates to be vaccinated with quadrivalent HPV vaccine reached the age of 18 (in 2012), compared to previous years. Incidence of genital warts in unvaccinated women and those who received the bivalent vaccine was higher than in girls and women who received the quadrivalent HPV vaccine. The effectiveness of a three-dose regimen of the quadrivalent HPV vaccine was 77% (95 CrI: 66–85%), whereas that of a single dose was 61% (95 CrI: 20–87%). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine.ConclusionsThree doses of the quadrivalent HPV vaccine were effective against genital warts in our population. Moreover, with low vaccine coverage the incidence of genital warts decreased only in the vaccinated.     

Age at HPV vaccine initiation and completion among US adolescent girls: Trend from 2008 to 2012

ObjectiveTo examine the trend of provider-verified HPV vaccine initiation (≥1 dose) and completion (≥3 doses) among adolescent girls at the Advisory Committee on Immunization Practices (ACIP) recommended age (11–12 years).MethodsWe analyzed National Immunization Survey of Teens 2008–2012 data and examined the trend of provider-verified HPV vaccine initiation and completion among <13 year old girls.ResultsData on age at HPV vaccine initiation and completion were available for 24,466 and 15,972 girls, respectively. The weighted proportion of girls who initiated the vaccine at <13 years of age was 14.1%, 24.1%, 35.9%, 47.7% and 55.9% in 2008, 2009, 2010, 2011 and 2012, respectively (p for trend <.001). The similar trend was also observed for mean age at HPV vaccine initiation and completion (p < .001).ConclusionsAdditional efforts are needed to increase HPV vaccine uptake among adolescent girls as only half of them receive this vaccine at ACIP recommended age.