title: HPV vaccination coverage of teen girls: the influence of health care providers.
abstract: BACKGROUND
  Between 2010 and 2014, the percentage of 13-17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine ("fully vaccinated") increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine ("not immunized") decreased by 11.3 percentage points to 40.0%.
  
  
  OBJECTIVE
  To evaluate the complex interactions between parents' vaccine-related beliefs, demographic factors, and HPV immunization status.
  
  
  METHODS
  Vaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n=8490) were analyzed. HPV vaccination status was determined from teens' health care provider (HCP) records.
  
  
  RESULTS
  Among teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p<0.05). Among teen girls administered 1-2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration.
  
  
  CONCLUSIONS
  Results suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses.
authors: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, MS A-19, 1600 Clifton Road, NE, Atlanta, GA 30333, United States. Electronic address: pzs6@cdc.gov.
authors: Philip J
authors: PJ
authors: Smith
authors: Centers for Disease Control and Prevention, Atlanta, GA 30333, United States. Electronic address: zma2@cdc.gov.
authors: Shannon
authors: S
authors: Stokley
authors: Emory University, Atlanta, GA 30322, United States. Electronic address: robert.a.bednarczyk@emory.edu.
authors: Robert A
authors: RA
authors: Bednarczyk
authors: Emory University, Atlanta, GA 30322, United States. Electronic address: worenst@emory.edu.
authors: Walter A
authors: WA
authors: Orenstein
authors: Emory University, Atlanta, GA 30322, United States. Electronic address: somer@emory.edu.
authors: Saad B
authors: SB
authors: Omer
mesh_terms: D000293:Adolescent; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D010290:Parents / Q000523:psychology; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Attributable risk; HPV; Parental concerns; Provider influence