Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Abstract

Background Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the U.S. are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. Methods We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11–12, 13–17, 18–21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with of consistent and strong recommendations for 11–12 year olds. Results We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males 13–17 (39%) compared to ages 11–12 (31%) and 18–21 (31%). Consistent and strong recommendation for 11–12 year old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty remembering to discuss HPV vaccination. Conclusion Physicians’ current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians’ personal barriers to HPV vaccine delivery. Impact As one of the first studies to examine both consistency and strength of physicians’ HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians’ recommendations.

Provider-reported acceptance and use of the Centers for Disease Control and Prevention messages and materials to support HPV vaccine recommendation for adolescent males

“…Professional organizations recommended consistent and strong provider recommendation for HPV vaccine [28, 29] as a primary approach to improving HPV vaccination. However, reported elsewhere [23], only 30.6% of physicians in this study strongly and consistently recommended HPV vaccination for males ages 11–12. Yet few studies explored messages promoting HPV vaccination for physicians to use with parents.…”

“…Participant recruitment and the survey instrument are described in detail elsewhere [23, 24] and are summarized below.…”

Physicians’ current use and preferences for male HPV vaccine-related patient education materials

“…Therefore, vaccine uptake may increase if physicians are provided with other strategies or materials to use in conjunction with fact sheets, such as client and provider reminders [14]. However, as previously reported, only 31% of providers in the current study indicated using any reminders, suggesting a substantial area for improvement [10]. Furthermore, most physicians in our study (regardless of specialty) indicated a preference for CDC materials in stark contrast to the very low preferences for materials from professional organizations.…”

“…Participant recruitment and the survey are detailed elsewhere [10, 11] and briefly summarized below.…”

“…After excluding physicians who did not list (n=5) or indicated “other” for specialty (n=21), or indicated they did not provide care for males ages 9-26 (n=12), 329 surveys were included in the final analysis. There were no statistically significant differences between responding physicians compared to the population of physicians in Florida regarding age, sex, and clinical specialty (all p > .05) [10, 11]. …”