title: Disparities in collaborative patient-provider communication about human papillomavirus (HPV) vaccination.
abstract: Healthcare providers may vary their communications with different patients, which could give rise to differences in vaccination coverage. We examined demographic disparities in parental report of collaborative provider communication and implications for human papillomavirus (HPV) vaccination.
  
  
  
  Participants were 4,124 parents who completed the National Immunization Survey-Teen about daughters ages 13-17. We analyzed disparities in collaborative communication (mutual information exchange, deliberation, and decision) and whether they mediated the relationship between demographic characteristics and HPV vaccine initiation.
  
  
  
  Half of parents (53%) in the survey reported collaborative communication. Poor, less educated, Spanish-speaking, Southern, and rural parents, and parents of non-privately insured and Hispanic adolescents, were least likely to report collaborative communication (all p<.05). These disparities in communication accounted for geographic variation in HPV vaccination, specifically, the higher rates of uptake in the Northeast versus the South (mediation z=2.31, p<.01) and in urban/suburban vs. rural areas (mediation z=2.87, p<.01). These disparities were also associated with vaccination among subgroups with relatively high coverage, minimizing what could have been even higher uptake among Hispanic compared to non-Hispanic white adolescents (mediation z=-3.04, p<.01) and non-privately versus privately insured adolescents (mediation z=-3.67, p<.001). Controlling for provider recommendation attenuated some of these associations (but all p<.10).
  
  
  
  Collaborative communication showed widespread disparities, being least common among underserved groups. Collaborative communication helped account for differences-and lack of differences-in HPV vaccination among some subgroups of adolescent girls. Leveraging patient-provider communication, especially for underserved demographic groups, could improve HPV vaccination coverage.
authors.affiliation: a Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.|b Cancer Prevention Fellowship, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda , MD , USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.affiliation: c Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.affiliation: a Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.|d Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Rimer
authors.affiliation: a Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.|d Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D003142:Communication; D005260:Female; D058015:Health Communication; D006282:Health Personnel; D006801:Humans; D008297:Male; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Collaboration; health inequities; human papillomavirus (HPV) vaccination; patient-provider communication