Browsing by Subject "Papillomavirus Vaccines"
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Item Association between patient characteristics and HPV vaccination recommendation for postpartum patients: A national survey of Obstetrician/Gynecologists(Elsevier Inc., 2022-04-20) Lake, Paige W.; Head, Katharine J.; Christy, Shannon M.; DeMaria, Andrea L.; Thompson, Erika L.; Vadaparampil, Susan T.; Zimet, Gregory D.; Kasting, Monica L.Human papillomavirus (HPV) vaccination rates in the U.S. are relatively low. Provider recommendation rates for HPV vaccination often vary by patient age and relationship status. Obstetrician/gynecologists (OB/GYNs) represent a key provider group that can recommend the HPV vaccine. This study examined differences in OB/GYN recommendation of HPV vaccination for inpatient postpartum patients by age, parity, and marital status. Data were collected from OB/GYNs nationally via a cross-sectional survey. Participants were randomized to two vignette groups (23-year-old patient or 33-year-old patient). Within each group, participants received 4 vignettes that were identical except for patient marital status (married/not in a committed relationship) and number of children (first/third child), and were asked to indicate HPV vaccination recommendation likelihood on a scale of 0 (definitely would not) to 100 (definitely would). A 2 x 2 2 general linear model with repeated measures was used to examine main and interaction effects of patient age, relationship status, and parity. 207 OB/GYNs were included in the final analyses. Recommendation was high for 23-year-old patients (range: 64.5-84.6 out of 100). When marital status and parity were held constant, recommendation likelihood was higher for the younger vs. older patient and was also higher for patients not in a committed relationship, compared to married patients (all p-values < 0.001). Differences in recommendation exist when considering age and relationship status, which provides insight into OB/GYN clinical decision-making. Findings highlight the need to address barriers to HPV vaccination recommendation, including awareness of risk factors to consider when recommending the vaccine.Item Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system(Elsevier Inc., 2024-03-01) Meadows, Rachel J.; Gehr, Aaron W.; Lu, Yan; Maynard, Grace; Akpan, Idara N.; Taskin, Tanjila; Fulda, Kimberly G.; Patel, Divya; Matches, Sarah; Ojha, Rohit P.; Thompson, Erika L.BACKGROUND: Strong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). METHODS: We used a quasi-experimental design, where the eligible population included people aged 9-26 years with at least one encounter in June 2020-February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. RESULTS: Our study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13-21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9-12 and 13-17 years. CONCLUSION: Our provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.Item Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents(Elsevier Inc., 2021-09-17) Francis, Jenny K.R.; Rodriguez, Serena A.; Dorsey, Olivia; Blackwell, James-Michael; Balasubramanian, Bijal A.; Kale, Neelima; Day, Philip; Preston, Sharice M.; Thompson, Erika L.; Pruitt, Sandi L.; Tiro, Jasmin A.Parental vaccine hesitancy is a growing concern. Less is known about provider or practice characteristics that encounter HPV-specific vaccine-hesitant parents, the providers' confidence in responding to HPV vaccine concerns, and the attitudes and use of vaccine dismissal policies (i.e., removing patients from the practice). North Texas providers completed an online survey. Dependent variables assessed: (1) percentage of HPV vaccine-hesitant parents encountered in practice defined as substantive, or high (≥11%, or among more than one out of ten adolescent patient encounters) versus low (≤10%) levels; (2) confidence in responding to 11 HPV vaccine concerns; (3) attitudes and use of vaccine dismissal policies. Chi-square and Fisher's exact tests were conducted. Among 156 providers, 29% reported high HPV vaccine hesitancy (≥11% of patient population). Overall, providers reported being "very confident" in addressing vaccine concerns (mean: 3.37 out of 4, SD: 0.57). Mean confidence scores were significantly higher for white (vs. non-white) providers and for pediatricians (vs. family practitioners). Providers were least confident in responding to parents' religious/personal beliefs (69%). Some providers (25%) agreed with policies that dismissed vaccine-hesitant parents after repeated counseling attempts. More providers used dismissal policies for childhood (19%) than adolescent (10%) immunizations. Provider communication training should include parental religious/personal beliefs to effectively address HPV vaccine hesitancy. Other regions should examine their HPV-specific vaccine hesitancy levels to understand how the use of dismissal policies might vary between adolescent and childhood immunizations.Item The influence of race/ethnicity and social determinants of health and HPV vaccination in vaccine-eligible adults in the U.S.(2022-08) Garg, Ashvita; Thompson, Erika; Nguyen, Uyen-Sa D.T.; Luningham, Justin M.Background: Human Papillomavirus (HPV) vaccination is an essential primary prevention measure against HPV-related cancers, currently approved for catch-up for inadequately vaccinated adults by age 26 and for mid-adults aged 27-45 with shared clinical decision-making. Although HPV vaccination rates have been gradually increasing, racial/ethnic disparities and low catch-up among adults persist. Examining the Social Determinants of Health (SDOH) associated with HPV vaccination in different racial groups may help explain these disparities in lower vaccine uptake. Previous studies using national datasets have found differences in estimated prevalence of HPV vaccine uptake across datasets for racial/ethnic minorities, especially for Asian Americans, when compared to non-Hispanic White, with results varying from lower to higher uptakes. Despite Asian Americans being a very diverse racial group, most studies either combine them in one category or with other races, resulting in an incomplete picture of HPV vaccine uptake among different Asian American subgroups. Purpose: Using the SDOH framework, this study aimed to examine the racial/ethnic differences for HPV vaccination across three U.S. national databases among vaccine-eligible adults and examine the association between HPV vaccination and Asian racial subgroups. Methods: For the first aim, the study utilized 2017-2019 NHIS (n=30,788), 2017-2020 pre-pandemic NHANES (n=3,685), and 2017-2019 BRFSS (n=30,324) data, ages 18-45 years. Asian racial subgroup disparities for the second aim were assessed with 2014-2018 NHIS data (n=34,839, ages 18-38). Survey-weighted multivariable logistic regression models identified the association between HPV vaccination status (outcome) and explanatory variables: SDOH indicators, race/ethnicity, sex, nativity, and age. Results: The racial/ethnic differences in HPV vaccine uptake were not similar between the three datasets. In the NHIS dataset, compared to Non-Hispanic White, Non-Hispanic Asian and Non-Hispanic Asian males were more likely to be vaccinated. With NHANES data, Non-Hispanic Asian males were less likely to be vaccinated. While BRFSS data did not show statistically significant differences in HPV vaccination for difference races/ethnicity. However, inverse variance weighted averages indicated that compared to Non-Hispanic White, Non-Hispanic Asian individuals had higher odds of receiving HPV vaccination. Males compared to females and foreign-born compared to U.S.-born individuals were less likely to be vaccinated. Among SDOH factors, education level, time since last healthcare visit, health insurance status, and having a usual place of healthcare were significantly associated with HPV vaccination. Compared to White individuals, Asian Indian were less likely to be vaccinated while Filipino and individuals from other Asian subgroups were more likely to be vaccinated. Additionally, foreign-born Asian Indian compared to foreign-born White individuals and Asian Indian females compared to White females were less likely to be vaccinated. Regarding SDOH factors, education level, insurance status, and time since last healthcare were significantly associated with HPV vaccination. Conclusion: This study identified racial/ethnic differences in HPV vaccine uptake and SDOH indicators associated with HPV vaccination. Findings indicate that more studies are needed to assess the differences in these three surveillance systems that led to the conflicting findings and to explore the reasons for lower vaccination uptake among the Asian Indian population. Finally, tailoring HPV vaccine awareness campaigns and improving vaccination access for males, foreign-born, individuals lacking health insurance, or those failing to have regular healthcare visits could help promote HPV vaccination and reduce HPV-associated cancers.