Many Adolescents Still Not Receiving HPV Vaccine.
Recommendations by medical providers are the most consistent factor influencing teenagers to get the HPV (human papillomavirus) vaccine—but even then, many adolescents do not start or complete the vaccine series, according to a new study led by School of Public Health researchers.
In the study in the Journal of Community Health, a research team used national immunization data for youths 13 to 17 years old to explore vaccination coverage for both girls and boys. HPV is responsible for 70 percent of all cervical cancers in the US and 90 percent of genital warts. A three-dose vaccine sequence is recommended for teenagers, but vaccination rates have remained relatively low in the decade since the vaccine became available.
The study found that in 2013, the vaccination completion rate for 13- to 17-year-olds was just 26 percent. Another 19 percent of teens initiated the sequence, but did not complete it. Completion rates were higher for girls than boys—38 percent, versus 14 percent.
Vaccination rates were measurably higher among teenagers who received a recommendation by a medical provider, as well as among girls living in the Midwest and boys from low-income families eligible for the “Vaccines for Children” program. But while provider recommendation was “the strongest predictor” of vaccine completion, the research team found it was “insufficient to achieve high coverage rates, especially among boys.”
In addition, provider recommendation did not lead to a higher rate of vaccine acceptance among girls with “highly educated” mothers, the authors found.
“Highly educated mothers were immune to provider recommendations, suggesting that they may arrive at clinic visits with preconceived notions of what is appropriate for their child,” the study says. “This paradox suggests some caregivers may perceive messages conveyed by clinicians as an option, rather than a direct recommendation.
“Failure to address the skepticism of caregivers about HPV vaccines may significantly weaken the effectiveness of provider recommendations,” the authors said.
The research team found that the most common reasons for refusal were that the vaccine was not recommended (21.3 percent); belief that the vaccine was unnecessary (16.8 percent); lack of knowledge (16.3 percent); safety concerns (9.7 percent); and that the teen was not sexually active (8.7 percent). Caregivers of boys were more likely to report that the vaccine was not recommended by a provider or that the vaccine was not needed, while parents and guardian of girls were more likely to decline vaccination because of safety concerns.
The findings “suggest that healthcare providers need to be attentive to potential gender bias with regard to HPV vaccination,” the authors said. In addition, the findings emphasize “a need for enhanced efforts to educate caregivers about the safety and efficacy” of the vaccine.
“Tailoring and targeting the recommendations to address the unique concerns of caregivers of male and female teens may improve acceptability and uptake of the HPV vaccine,” they concluded.
The World Health Organization recommends HPV vaccines as part of routine vaccinations in countries that can afford them, along with other prevention measures.
The first HPV vaccine became available in 2006. As of 2014, 58 countries had included it in their routine vaccinations, at least for girls.
In the US, the Centers for Disease Control and Prevention recommends the vaccine for preteen boys and girls at ages 11 or 12, so they are protected before ever being exposed to the virus. Young women can get the vaccine through age 26, and young men can get vaccinated through age 21.
The study was co-led by Kristin Johnson, a doctor of public health candidate at SPH and public health consultant with John Snow, Inc., and Meng-Yun Lin, a PhD candidate in health law, policy, and management. SPH co-authors were: Howard Cabral, professor of biostatistics, and Lewis Kazis, professor of health law, policy, and management. Ingrid Katz, associate physician at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, also contributed.
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