Factors Associated With Medicaid Providers’ Recommendation of the HPV Vaccine to Low-Income Adolescent Girls

Authors

Susan T. Vadaparampil, Department of Cancer Epidemiology, Moffitt Cancer Center, University of South FloridaFollow
Shalanda Bynum, Uniformed Services University of the Health Sciences
Stephanie Staras, University of Florida
Teri Malo, Health Outcomes and Behavior Program, Moffitt Cancer Center,
Anna Giuliano, Department of Cancer Epidemiology, Moffitt Cancer Center, University of South Florida
Elizabeth Shenkman, University of Florida

Date of this Version

2014

Citation

Journal of Adolescent Health 54 (2014) 190-196

Comments

This article is a U.S. government work, and is not subject to copyright in the United States.

Abstract

Purpose: 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.