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Recommending Human Papillomavirus Vaccination at Age 9: A National Survey of Primary Care Professionals

  • Wei Yi Kong
    Affiliations
    Department of Health Behavior, Gillings School of Global Public Health (WY Kong, Q Huang, BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC
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  • Qian Huang
    Affiliations
    Department of Health Behavior, Gillings School of Global Public Health (WY Kong, Q Huang, BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC
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  • Peyton Thompson
    Affiliations
    Division of Infectious Diseases, Department of Pediatrics (P Thompson), University of North Carolina, Chapel Hill, NC
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  • Brigid K. Grabert
    Affiliations
    Department of Health Behavior, Gillings School of Global Public Health (WY Kong, Q Huang, BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC

    Lineberger Comprehensive Cancer Center (BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC
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  • Noel T. Brewer
    Affiliations
    Department of Health Behavior, Gillings School of Global Public Health (WY Kong, Q Huang, BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC

    Lineberger Comprehensive Cancer Center (BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC
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  • Melissa B. Gilkey
    Correspondence
    Address correspondence to Melissa B. Gilkey, PhD, Associate Professor of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box 7440; Chapel Hill, NC 27516
    Affiliations
    Department of Health Behavior, Gillings School of Global Public Health (WY Kong, Q Huang, BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC

    Lineberger Comprehensive Cancer Center (BK Grabert, NT Brewer, MB Gilkey), University of North Carolina, Chapel Hill, NC
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Published:January 22, 2022DOI:https://doi.org/10.1016/j.acap.2022.01.008

      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.

      Keywords

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      References

        • Meites E
        • Kempe A
        • Markowitz LE.
        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: 1405-1408https://doi.org/10.15585/mmwr.mm6549a5
        • Markowitz LE
        • Dunne EF
        • Saraiya M
        • et al.
        Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2007; 56 (Available at:): 1-24
        • Dunne EF
        • Markowitz LE
        • Chesson HW
        • et al.
        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 (Available at:): 1705-1708
        • O'Leary ST
        • Nyquist A-C
        Why AAP recommends initiating HPV vaccination as early as age 9.
        AAP News. 2019; (Available at:) (Published 2019. Accessed July 26, 2021)
        • Saslow D
        • Andrews KS
        • Manassaram-Baptiste D
        • et al.
        Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation.
        CA Cancer J Clin. 2020; 70: 274-280https://doi.org/10.3322/CAAC.21616
        • Elam-Evans LD
        • Yankey D
        • Singleton JA
        • et al.
        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: 1109-1116https://doi.org/10.15585/mmwr.mm6933a1
        • Senkomago V
        • Henley SJ
        • Thomas CC
        • et al.
        Human papillomavirus–attributable cancers — United States, 2012–2016.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 724-728https://doi.org/10.15585/mmwr.mm6833a3
        • Biancarelli DL
        • Drainoni ML
        • Perkins RB.
        Provider experience recommending HPV vaccination before age 11 years.
        J Pediatr. 2020; 217: 92-97https://doi.org/10.1016/j.jpeds.2019.10.025
        • Goleman MJ
        • Dolce M
        • Morack J.
        Quality improvement initiative to improve human papillomavirus vaccine initiation at 9 years of age.
        Acad Pediatr. 2018; 18: 769-775https://doi.org/10.1016/j.acap.2018.05.005
        • St. Sauver JL
        • Rutten LJF
        • Ebbert JO
        • et al.
        Younger age at initiation of the human papillomavirus (HPV) vaccination series is associated with higher rates of on-time completion.
        Prev Med. 2016; 89: 327-333https://doi.org/10.1016/j.ypmed.2016.02.039
        • Perkins RB
        • Legler A
        • Jansen E
        • et al.
        Improving HPV vaccination rates: a stepped-wedge randomized trial.
        Pediatrics. 2020; 146e20192737https://doi.org/10.1542/peds.2019-2737
        • The American Association for Public Opinion Research
        Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys.
        9th ed. AAPOR, 2016
        • Gilkey MB
        • Malo TL
        • Shah PD
        • et al.
        Quality of physician communication about human papillomavirus vaccine: findings from a national survey.
        Cancer Epidemiol Biomarkers Prev. 2015; 24: 1673-1679https://doi.org/10.1158/1055-9965.EPI-15-0326
        • Perkins RB
        • Clark JA
        • Apte G
        • et al.
        Missed opportunities for HPV vaccination in adolescent girls: a qualitative study.
        Pediatrics. 2014; 134: e666-e674https://doi.org/10.1542/peds.2014-0442
        • Henrikson NB
        • Tuzzio L
        • Gilkey MB
        • et al.
        “You're never really off time”: Healthcare providers’ interpretations of optimal timing for HPV vaccination.
        Prev Med Rep. 2016; 4: 94-97https://doi.org/10.1016/j.pmedr.2016.05.002
        • Gilkey MB
        • McRee A-L.
        Provider communication about HPV vaccination: a systematic review.
        Hum Vaccin Immunother. 2016; 12: 1454-1468https://doi.org/10.1080/21645515.2015.1129090
        • Allison MA
        • Hurley LP
        • Markowitz L
        • et al.
        Primary care physicians’ perspectives about HPV vaccine.
        Pediatrics. 2016; 137e20152488https://doi.org/10.1542/peds.2015-2488
        • Daley MF
        • Crane LA
        • Markowitz LE
        • et al.
        Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure.
        Pediatrics. 2010; 126: 425-433https://doi.org/10.1542/peds.2009-3500
        • Vadaparampil ST
        • Kahn JA
        • Salmon D
        • et al.
        Missed clinical opportunities: provider recommendations for HPV vaccination for 11-12 year old girls are limited.
        Vaccine. 2011; 29: 8634-8641https://doi.org/10.1016/j.vaccine.2011.09.006
        • Bynum SA
        • Staras SA
        • Malo TL
        • et al.
        Factors associated with Medicaid providers’ recommendation of the HPV vaccine to low-income adolescent girls.
        J Adolesc Heal. 2014; 54: 190-196https://doi.org/10.1016/j.jadohealth.2013.08.006
        • Fiks AG
        • Grundmeier RW
        • Mayne S
        • et al.
        Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt.
        Pediatrics. 2013; 131: 1114-1124https://doi.org/10.1542/peds.2012-3122
        • Brewer NT
        • Hall ME
        • Malo TL
        • et al.
        Announcements versus conversations to improve HPV vaccination coverage: a randomized trial.
        Pediatrics. 2017; 139e20161764https://doi.org/10.1542/peds.2016-1764
        • Dempsey AF
        • Pyrznawoski J
        • Lockhart S
        • et al.
        Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: a cluster randomized clinical trial.
        JAMA Pediatr. 2018; 172e180016https://doi.org/10.1001/jamapediatrics.2018.0016
        • Szilagyi PG
        • Humiston SG
        • Stephens-Shields AJ
        • et al.
        Effect of training pediatric clinicians in human papillomavirus communication strategies on human papillomavirus vaccination rates: a cluster randomized clinical trial.
        JAMA Pediatr. 2021; https://doi.org/10.1001/jamapediatrics.2021.0766
        • Rodriguez SA
        • Mullen PD
        • Lopez DM
        • et al.
        Factors associated with adolescent HPV vaccination in the U.S.: a systematic review of reviews and multilevel framework to inform intervention development.
        Prev Med (Baltim). 2020; 131105968https://doi.org/10.1016/j.ypmed.2019.105968
        • Oh NL
        • Biddell CB
        • Rhodes BE
        • et al.
        Provider communication and HPV vaccine uptake: a meta-analysis and systematic review.
        Prev Med. 2021; 148106554https://doi.org/10.1016/j.ypmed.2021.106554