title: Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure.
abstract: OBJECTIVE
  The objectives of this study were to assess, in a nationally representative network of pediatricians and family physicians, (1) human papillomavirus (HPV) vaccination practices, (2) perceived barriers to vaccination, and (3) factors associated with whether physicians strongly recommended HPV vaccine to 11- to 12-year-old female patients.
  
  
  METHODS
  In January through March 2008, a survey was administered to 429 pediatricians and 419 family physicians.
  
  
  RESULTS
  Response rates were 81% for pediatricians and 79% for family physicians. Ninety-eight percent of pediatricians and 88% of family physicians were administering HPV vaccine in their offices (P<.001). Among those physicians, fewer strongly recommended HPV vaccination for 11- to 12-year-old female patients than for older female patients (pediatricians: 57% for 11- to 12-year-old patients and 90% for 13- to 15-year-old patients; P<.001; family physicians: 50% and 86%, respectively; P<.001). The most-frequently reported barriers to HPV vaccination were financial, including vaccine costs and insurance coverage. Factors associated with not strongly recommending HPV vaccine to 11- to 12-year-old female patients included considering it necessary to discuss sexuality before recommending HPV vaccine (risk ratio: 1.27 [95% confidence interval: 1.07-1.51]) and reporting more vaccine refusals among parents of younger versus older adolescents (risk ratio: 2.09 [95% confidence interval: 1.66-2.81]).
  
  
  CONCLUSIONS
  Eighteen months after licensure, the vast majority of pediatricians and family physicians reported offering HPV vaccine. Fewer physicians strongly recommended the vaccine for younger adolescents than for older adolescents, and physicians reported financial obstacles to vaccination.
authors.affiliation: Department of Pediatrics, University of Colorado, Aurora, CO, USA. matthew.f.daley@kp.org
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Markowitz
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Black
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barrow
authors.forename: Christine
authors.initials: C
authors.lastname: Babbel
authors.forename: Sami L
authors.initials: SL
authors.lastname: Gottlieb
authors.forename: Nicole
authors.initials: N
authors.lastname: Liddon
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008007:Licensure, Medical; D008297:Male; D053918:Papillomavirus Vaccines; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines