Factors associated With Medicaid providers' recommendation of the HPV vaccine to low-income adolescent girls.
OBJECTIVE
Human papillomavirus (HPV) vaccination in the United States remains a public health challenge with vaccine rates of 50%. Although health care providers can facilitate HPV vaccination, several factors may impede their ability to universally recommend the vaccine. To maximize the potential of HPV vaccines, it is important to understand challenges providers face in the clinical environment. The study sought to identify factors associated with recommendation of the HPV vaccine for low-income adolescents in the early (9-10), target (11-12), early adolescent catch-up (13-14), and late adolescent catch-up (15-17) vaccination groups.


METHODS
Surveys were mailed between October 2009 and April 2010 to a random sample of Florida-based physicians serving Medicaid-enrolled adolescents. Data were analyzed in 2013.


RESULTS
Among early adolescents, discomfort discussing sexually transmitted infections (STIs) with teens (odds ratio [OR] = 1.75), difficulty ensuring vaccine completion (OR = .73), and discomfort discussing STIs with parents (OR = .44) were associated with recommendation. For target adolescents, discomfort discussing STIs with teens (OR = 2.45), time constraints (OR = .70), vaccine efficacy concerns (OR = .65), discomfort discussing STIs with parents (OR = .33), obstetrics/gynecology (OR = .25) and family medicine (OR = .24) specialty, and non-Hispanic black patient (OR = .15) were associated with recommendation. In early catch-up adolescents, concerns that teens will practice riskier behaviors (OR = .57), discomfort discussing STIs with parents (OR = .47), and family medicine specialty (OR = .20) were associated with recommendation. For late catch-up adolescents, family medicine specialty (OR = .13) was associated with recommendation.


CONCLUSIONS
Modifiable factors that impede or influence provider recommendations of HPV vaccines can be addressed through intervention. Overall, findings suggest that efforts should focus on sexuality communication and family medicine specialty.
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Shalanda A
SA
Bynum
Department of Health Outcomes and Policy, College of Medicine; and the Institute for Child Health Policy, University of Florida, Gainesville, Florida.
Stephanie A S
SA
Staras
Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida.
Teri L
TL
Malo
Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, Florida.
Anna R
AR
Giuliano
Department of Health Outcomes and Policy, College of Medicine; and the Institute for Child Health Policy, University of Florida, Gainesville, Florida.
Elizabeth
E
Shenkman
Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida; Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, Florida. Electronic address: Susan.Vadaparampil@moffitt.org.
Susan T
ST
Vadaparampil
D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008484:Medicaid; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000523:psychology; D053918:Papillomavirus Vaccines; D011203:Poverty; D011369:Professional-Patient Relations; D000297:Psychology, Adolescent; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data
D053918:Papillomavirus Vaccines
Adolescent; Barriers; Human papillomavirus vaccines; Low-income population; Physicians