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HPV Vaccination of Boys in Primary Care Practices

      Abstract

      Objective

      In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians': 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys.

      Methods

      We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010.

      Results

      The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds.

      Conclusions

      Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings.

      Keywords

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      References

        • Wilkin T.
        • Lee J.Y.
        • Lensing S.Y.
        • et al.
        Safety and immunogenicity of the quadrivalent human papillomavirus vaccine in HIV-1-infected men.
        J Infect Dis. 2010; 202: 1246-1253
        • Chin-Hong P.V.
        • Palefsky J.M.
        Natural history and clinical management of anal human papillomavirus disease in men and women infected with human immunodeficiency virus.
        Clin Infect Dis. 2002; 35: 1127-1134
        • Centers for Disease Control and Prevention
        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: 1705-1708
        • Saraiya M.
        Burden of HPV-associated cancers in the United States. Presentation before the Advisory Committee on Immunization Practices (ACIP), February 24, 2011.
        US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Ga2011 (Available at:) (Accessed March 5, 2012)
        • Hu D.
        • Goldie S.
        The economic burden of noncervical human papillomavirus disease in the United States.
        Am J Obstet Gynecol. 2008; 198: 500.e501-500.e507
        • Hoy T.
        • Singhal P.K.
        • Willey V.J.
        • et al.
        Assessing incidence and economic burden of genital warts with data from a US commercially insured population.
        Curr Med Res Opin. 2009; 25: 2343-2351
        • Palefsky J.M.
        Human papillomavirus–related disease in men: not just a women's issue.
        J Adolesc Health. 2010; 46: S12-S19
        • Jin F.
        • Prestage G.P.
        • Kippax S.C.
        • et al.
        Risk factors for genital and anal warts in a prospective cohort of HIV-negative homosexual men: the HIM study.
        Sex Transm Dis. 2007; 34: 488-493
        • US Food and Drug Administration
        Approval letter—Gardasil (human papillomavirus quadrivalent [types 6, 11, 16, and 18]).
        Food and Drug Administration, Silver Spring, Md2011 (Available at:) (Accessed March 5, 2012)
        • Centers for Disease Control and Prevention
        FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP).
        MMWR Morb Mortal Wkly Rep. 2010; 59: 630-632
        • Kahn J.A.
        • Rosenthal S.L.
        • Tissot A.M.
        • et al.
        Factors influencing pediatricians' intention to recommend human papillomavirus vaccines.
        Ambul Pediatr. 2007; 7: 367-373
        • Kahn J.A.
        • Zimet G.D.
        • Bernstein D.I.
        • et al.
        Pediatricians' intention to administer human papillomavirus vaccine: the role of practice characteristics, knowledge, and attitudes.
        J Adolesc Health. 2005; 37: 502-510
        • Riedesel J.M.
        • Rosenthal S.L.
        • Zimet G.D.
        • et al.
        Attitudes about human papillomavirus vaccine among family physicians.
        J Pediatr Adolesc Gynecol. 2005; 18: 391-398
        • Daley M.F.
        • Liddon N.
        • Crane L.A.
        • et al.
        A national survey of pediatrician knowledge and attitudes regarding human papillomavirus vaccination.
        Pediatrics. 2006; 118: 2280-2289
        • Weiss T.W.
        • Zimet G.D.
        • Rosenthal S.L.
        • et al.
        Human papillomavirus vaccination of males: attitudes and perceptions of physicians who vaccinate females.
        J Adolesc Health. 2010; 47: 3-11
        • Centers for Disease Control and Prevention
        National and state vaccination coverage among adolescents aged 13 through 17 years—United States, 2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1117-1123
        • Crane L.A.
        • Daley M.F.
        • Barrow J.
        • et al.
        Sentinel physician networks as a technique for rapid immunization policy surveys.
        Eval Health Prof. 2008; 31: 43-64
        • Babbie E.
        The Practice of Social Research.
        4th ed. Wadsworth, Belmont, Calif1986
        • Janz N.
        • Champion V.
        • Strecher V.
        The Health Belief Model.
        in: Glanz K. Rimer B. Lewis F. Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. Wiley, San Francisco, Calif2002: 45-66
        • Daley M.F.
        • Crane L.A.
        • Markowitz L.E.
        • et al.
        Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure.
        Pediatrics. 2010; 126: 425-433
        • Sussman A.L.
        • Helitzer D.
        • Sanders M.
        • et al.
        HPV and cervical cancer prevention counseling with younger adolescents: implications for primary care.
        Ann Fam Med. 2007; 5: 298-304
        • McMahon S.R.
        • Iwamoto M.
        • Massoudi M.S.
        • et al.
        Comparison of e-mail, fax, and postal surveys of pediatricians.
        Pediatrics. 2003; 111: e299-e303
      1. US Food and Drug Administration. Statistical review and evaluation, anal cancer—Gardasil, August 30, 2010. Available at: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm094042.htm. Accessed March 5, 2012.

        • Giuliano A.R.
        • Palefsky J.M.
        • Goldstone S.
        • et al.
        Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males.
        N Engl J Med. 2011; 364: 401-411
      2. Centers for Disease Control and Prevention. Child and adolescent immunization schedules, 2012. Available at: http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm. Accessed March 5, 2012.

        • Perkins R.B.
        • Clark J.A.
        Providers' attitudes toward human papillomavirus vaccination in young men: challenges for implementation of 2011 recommendations.
        Am J Mens Health. 2012; 6: 320-323
        • Zimet G.D.
        • Rosenthal S.L.
        HPV vaccine and males: issues and challenges.
        Gynecol Oncol. 2010; 117: S26-S31
        • Broder K.R.
        • Cohn A.C.
        • Schwartz B.
        • et al.
        Adolescent immunizations and other clinical preventive services: a needle and a hook?.
        Pediatrics. 2008; 121: S25-S34
        • Rupp R.
        • Rosenthal S.L.
        • Middleman A.B.
        Vaccination: an opportunity to enhance early adolescent preventative services.
        J Adolesc Health. 2006; 39: 461-464
        • Rand C.M.
        • Humiston S.G.
        • Schaffer S.J.
        • et al.
        Parent and adolescent perspectives about adolescent vaccine delivery: practical considerations for vaccine communication.
        Vaccine. 2011; 29: 7651-7658
        • Hughes C.C.
        • Jones A.L.
        • Feemster K.A.
        • et al.
        HPV vaccine decision making in pediatric primary care: a semi-structured interview study.
        BMC Pediatr. 2011; 11: 74
        • Alexander A.B.
        • Stupiansky N.W.
        • Ott M.A.
        • et al.
        Parent–son decision-making about human papillomavirus vaccination: a qualitative analysis.
        BMC Pediatr. 2012; 12: 192
        • Rosenthal S.L.
        • Weiss T.W.
        • Zimet G.D.
        • et al.
        Predictors of HPV vaccine uptake among women aged 19–26: importance of a physician's recommendation.
        Vaccine. 2011; 29: 890-895
        • Brewer N.T.
        • Fazekas K.I.
        Predictors of HPV vaccine acceptability: a theory-informed, systematic review.
        Prev Med. 2007; 45: 107-114
        • Gilkey M.B.
        • Moss J.L.
        • McRee A.L.
        • et al.
        Do correlates of HPV vaccine initiation differ between adolescent boys and girls?.
        Vaccine. 2012; 30: 5928-5934
        • Centers for Disease Control and Prevention
        National and state vaccination coverage among adolescents aged 13–17 years—United States, 2011.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 671-677
        • Palefsky J.M.
        • Giuliano A.R.
        • Goldstone S.
        • et al.
        HPV vaccine against anal HPV infection and anal intraepithelial neoplasia.
        N Engl J Med. 2011; 365: 1576-1585
        • Zandberg D.P.
        • Bhargava R.
        • Badin S.
        • et al.
        The role of human papillomavirus in nongenital cancers.
        CA Cancer J Clin. 2013; 63: 57-81
        • Centers for Disease Control and Prevention
        Updated recommendations for use of meningococcal conjugate vaccines—Advisory Committee on Immunization Practices (ACIP), 2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 72-76
        • Dempsey A.
        • Cohn L.
        • Dalton V.
        • et al.
        Patient and clinic factors associated with adolescent human papillomavirus vaccine utilization within a university-based health system.
        Vaccine. 2010; 28: 989-995
        • Dempsey A.F.
        • Davis M.M.
        Overcoming barriers to adherence to HPV vaccination recommendations.
        Am J Manag Care. 2006; 12: S484-S491
        • Ford C.A.
        • English A.
        • Davenport A.F.
        • et al.
        Increasing adolescent vaccination: barriers and strategies in the context of policy, legal, and financial issues.
        J Adolesc Health. 2009; 44: 568-574
        • Humiston S.G.
        • Albertin C.
        • Schaffer S.
        • et al.
        Health care provider attitudes and practices regarding adolescent immunizations: a qualitative study.
        Patient Educ Couns. 2009; 75: 121-127
        • Oster N.V.
        • McPhillips-Tangum C.A.
        • Averhoff F.
        • et al.
        Barriers to adolescent immunization: a survey of family physicians and pediatricians.
        J Am Board Fam Pract. 2005; 18: 13-19
        • Ko E.M.
        • Missmer S.
        • Johnson N.R.
        Physician attitudes and practice toward human papillomavirus vaccination.
        J Low Genit Tract Dis. 2010; 14: 339-345
        • Rand C.M.
        • Shone L.P.
        • Albertin C.
        • et al.
        National health care visit patterns of adolescents: implications for delivery of new adolescent vaccines.
        Arch Pediatr Adolesc Med. 2007; 161: 252-259
        • Nordin J.D.
        • Solberg L.I.
        • Parker E.D.
        Adolescent primary care visit patterns.
        Ann Fam Med. 2010; 8: 511-516
        • Dempsey A.F.
        • Freed G.L.
        Health care utilization by adolescents on Medicaid: implications for delivering vaccines.
        Pediatrics. 2010; 125: 43-49
        • Freed G.L.
        • Clark S.J.
        • Butchart A.T.
        • et al.
        Sources and perceived credibility of vaccine-safety information for parents.
        Pediatrics. 2011; 127: S107-S112
        • Suh C.A.
        • Saville A.
        • Daley M.F.
        • et al.
        Effectiveness and net cost of reminder/recall for adolescent immunizations.
        Pediatrics. 2012; 129: e1437-e1445
        • Jacobson V.J.
        • Szilagyi P.
        Patient reminder and patient recall systems to improve immunization rates.
        Cochrane Database Syst Rev. 2005; : CD003941