title: Identifying human papillomavirus vaccination practices among primary care providers of minority, low-income and immigrant patient populations.
abstract: OBJECTIVE
  Minority populations in the United States are disproportionally affected by human papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer.
  
  
  METHODS
  Cross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates.
  
  
  RESULTS
  Of 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine.
  
  
  CONCLUSIONS
  Our study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers' failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed.
authors.affiliation: Department of Community Health Sciences, State University of New York, Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, USA. Electronic address: denise.bruno@downstate.edu.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Bruno
authors.affiliation: Department of Community Health Sciences, State University of New York, Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, USA. Electronic address: tracey.wilson@downstate.edu.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Wilson
authors.affiliation: Immigrant Health and Cancer Disparities, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA. Electronic address: ganyf@mskcc.org.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gany
authors.affiliation: Immigrant Health and Cancer Disparities, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA. Electronic address: aragonea@mskcc.org.
authors.forename: Abraham
authors.initials: A
authors.lastname: Aragones
mesh_terms: D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008913:Minority Groups; D009519:New York City; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D058007:Physicians, Primary Care; D011203:Poverty; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV vaccine and primary care providers; HPV vaccine barriers; Human papillomavirus vaccine