Provider Recommendation Key to Boosting Teen HPV Vaccines

Diana Swift

June 23, 2022

Human papillomavirus (HPV) vaccination coverage of at least one dose significantly increased in U.S. adolescents from 56.1% in 2015 to 75.4% in 2020, according to the National Immunization Survey–Teen (NIS-Teen).

The telephone survey, conducted among the parents or guardians of children ages 13-17, found a faster increase in coverage among males than females: 4.7 percentage points annually versus 2.7 percentage points annually. With yearly overall survey samples ranging from 21,875 to 17,970, these coverage differences between males and females narrowed over the 5 years of the survey period.

The difference between coverage among males and females decreased from 13 to 3 percentage points. Traditionally, parents of boys have been less likely to vaccinate their sons against HPV.

Despite the increase in uptake, however, in 2020 about 25% of adolescents had not received at least one dose of HPV vaccine. "Targeted strategies are needed to increase coverage and narrow down inequalities," Peng-jun Lu, MD, PhD, of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in Atlanta, and colleagues wrote in Pediatrics.

In other NIS-Teen findings:

  • Coverage in 2020 was 73.7% for males and 76.8% for females (P < .05).

  • Coverage rose to 80.7% for those with a provider recommendation but was only 51.7% for those without one (P < .05).

  • The rate was 80.3% for those with a well-child visit at age 11-12 years and 64.8% for those without (P < .05).

  • In multivariable logistic regression, the main characteristics independently associated with a higher likelihood of vaccination included a provider recommendation, age 16-17 years, and being non-Hispanic Black, Hispanic, American Indian, or Alaskan Native.

  • Other predictors of vaccination included having Medicaid insurance and having a mother who was widowed, divorced, or separated, or had no more than a high school education.

  • Also predictive was having two or more provider contacts in the past 12 months, a well-child visit at age 11-12 years, and one or two vaccine providers (P < .05).

  • Coverage among adolescents living in non-metropolitan statistical areas was significantly lower than those living in MSA principal cities in all years assessed (P < .05).

Provider recommendation remains significant and has historically been highly associated with HPV vaccination. In the 2012 NIS-Teen, for example, 15% of parents not intending to have their daughters vaccinated in the next 12 months cited the lack of a provider recommendation.

"To increase HPV vaccination coverage and further reduce HPV-related morbidity and mortality, providers, parents, and adolescents should use every health care visit as a chance to review vaccination histories and ensure that every adolescent receives the HPV vaccine and other needed vaccines," Lu and associates wrote. But 18.5% of parents in the survey received no provider recommendation.

"Of note, we found that teenagers who had mothers with more education or who live in more rural communities had a lower likelihood of receiving vaccination against HPV," Lu told this news organization. "Further research should be conducted to better understand these findings."

According to Margaret E. Thew, DNP, FNP-BC, director of adolescent medicine at the Medical College of Wisconsin in Milwaukee, several studies have highlighted resistance to the vaccine among better-educated parents. "Parents with higher education associate the HPV vaccine with sexual activity and consequently refuse," said Thew, who was not involved in the NIS-Teen study. "They mistakenly assume that their children are not sexually active and they lack the understanding that HPV is one of the biggest causes of oral cancer."

The increased uptake among males was encouraging, said Thew.

Sharing her perspective on the survey-based study but not involved in it, Melissa B. Gilkey, PhD, associate professor of health behavior at the University of North Carolina in Chapel Hill, said the study is important for characterizing national trends in HPV vaccination coverage using high-quality data. "The almost 20-percentage-point jump in HPV vaccination coverage from 2015 to 2020 speaks to the hard work of primary care doctors and nurses, health departments, the CDC, and other government agencies, and public health researchers," she told this news organization. "We've long understood how critical primary care is, but these data are a powerful reminder that if we want to increase HPV vaccination rates, we need to be supporting primary care doctors and nurses."

Gilkey added that effective interventions are available to help primary care teams recommend the HPV vaccine and address parents' vaccination concerns effectively. "However, there remains an urgent need to roll out these interventions nationally."

This is especially true in the context of the COVID-19 pandemic, which has disrupted well-child visits and led to a decline in HPV vaccination coverage, she said. "We can't afford to lose our hard-won gains in HPV vaccination coverage, so supporting provider recommendations and well-child visits is more important now than ever."

According to Lu, providers should routinely recommend the vaccine and highlight the importance of vaccination in preventing HPV-related cancers. "Additionally, health care providers, parents, and adolescents should use every health care visit as a chance to review vaccination histories and ensure that every adolescent receives HPV vaccine and other needed vaccines."

This study had no external funding. The authors had no potential conflicts of interest to disclose. Gilkey is co-principal investigator of a CDC-funded study evaluating a model for improving HPV vaccine coverage in primary care settings. Thew disclosed no potential conflicts of interest.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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