Bynum Shalanda A, Staras Stephanie A S, Malo Teri L, Giuliano Anna R, Shenkman Elizabeth, Vadaparampil Susan T
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Department of Health Outcomes and Policy, College of Medicine; and the Institute for Child Health Policy, University of Florida, Gainesville, Florida.
J Adolesc Health. 2014 Feb;54(2):190-6. doi: 10.1016/j.jadohealth.2013.08.006. Epub 2013 Sep 21.
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.
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.
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.
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.
在美国，人乳头瘤病毒（HPV）疫苗接种率仅为50%，仍是一项公共卫生挑战。尽管医疗服务提供者能够推动HPV疫苗接种，但仍有几个因素可能阻碍他们普遍推荐该疫苗。为了最大限度发挥HPV疫苗的潜力，了解医疗服务提供者在临床环境中面临的挑战很重要。该研究旨在确定与低收入青少年在早期（9 - 10岁）、目标年龄段（11 - 12岁）、青少年早期补种（13 - 14岁）和青少年晚期补种（15 - 17岁）疫苗接种组中HPV疫苗推荐相关的因素。
2009年10月至2010年4月期间，向佛罗里达州为参加医疗补助计划的青少年提供服务的医生随机样本邮寄调查问卷。2013年对数据进行了分析。
在青少年早期，与疫苗推荐相关的因素包括：与青少年讨论性传播感染（STIs）时感到不适（比值比[OR]=1.75）、难以确保疫苗接种完成（OR=.73）以及与家长讨论性传播感染时感到不适（OR=.44）。对于目标年龄段的青少年，与疫苗推荐相关的因素有：与青少年讨论性传播感染时感到不适（OR=2.45）、时间限制（OR=.70）、对疫苗效力的担忧（OR=.65）、与家长讨论性传播感染时感到不适（OR=.33）、妇产科（OR=.25）和家庭医学（OR=.24）专业，以及非西班牙裔黑人患者（OR=.15）。在早期补种的青少年中，担心青少年会采取更危险行为（OR=.57）、与家长讨论性传播感染时感到不适（OR=.47）以及家庭医学专业（OR=.20）与疫苗推荐相关。对于晚期补种的青少年，家庭医学专业（OR=.13）与疫苗推荐相关。
阻碍或影响医疗服务提供者推荐HPV疫苗的可改变因素可通过干预加以解决。总体而言，研究结果表明应将努力重点放在性方面的沟通和家庭医学专业上。
