title: Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists.
abstract: OBJECTIVE
  Many adolescents with chronic medical conditions (CMCs) are at risk of human papillomavirus (HPV) infection, associated complications, and underimmunization and often identify a pediatric subspecialist as their main provider. This study aimed to assess the HPV-related understanding, beliefs, and practices of pediatric subspecialists, which are largely unknown.
  
  
  METHODS
  National cross-sectional study.
  
  
  METHODS
  Pediatric endocrinologists, hematologist/oncologists, pulmonologists, and rheumatologists identified using the American Medical Association Physician Masterfile (n = 418).
  
  
  METHODS
  Subspecialists who care for adolescents with CMCs in the outpatient setting were recruited to complete a Web-based survey on their HPV-related knowledge, attitudes, comfort, and practices.
  
  
  METHODS
  HPV vaccination recommendation.
  
  
  RESULTS
  Over half of respondents (50.4%; n = 196/389) reported sometimes or always recommending HPV vaccination to adolescent patients with CMCs. Factors positively associated with recommendation included hematology/oncology (adjusted odds ratio [AOR], 4.69; 95% confidence interval [CI], 1.86-11.81) or rheumatology (AOR, 6.55; 95% CI, 1.67-25.74) specialization, seeing more adolescent patients with CMCs (AOR, 1.01; 95% CI, 1.00-1.02), and sometimes or always discussing sexual health (AOR, 2.53; 95% CI, 1.05-6.08) or checking vaccine status (AOR, 3.83; 95% CI, 1.59-9.20) with these patients. Those who thought it was important, but were uncomfortable discussing sexual health when recommending HPV vaccination (AOR, 0.28; 95% CI, 0.12-0.70) or who reported insufficient HPV vaccine information (AOR, 0.45; 95% CI, 0.23-0.88) or lack of primary-subspecialty care provider communication (AOR, 0.38; 95% CI, 0.16-0.93) as barriers to HPV vaccination were less likely to recommend HPV vaccination.
  
  
  CONCLUSIONS
  This study revealed that many subspecialists fail to recommend HPV vaccination to adolescents with CMCs and highlights potential targets for future interventions.
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York; Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington. Electronic address: annika.hofstetter@seattlechildrens.org.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Hofstetter
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York.
authors.forename: Lauren
authors.initials: L
authors.lastname: Lappetito
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Stockwell
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University, New York, New York.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010372:Pediatrics; D013038:Specialization / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescents; Chronic medical conditions; HPV vaccination; Pediatric subspecialist