Background and Purpose: Despite Food and Drug Administration approval and clinical practice guidelines for universal adolescent vaccination with currently available human papillomavirus (HPV) vaccines, dissemination in the U.S. has lagged behind other countries. Physician recommendation is a key predictor of HPV vaccine uptake. Understanding factors associated with recommendation is important for efforts to increase current suboptimal rates of vaccine uptake. This study aimed to examine physician recommendations to vaccinate female patients aged 11-26 years, in 2009 and 2011, at 3 and 5 years post-vaccine licensure, respectively. A second aim was to identify trends in factors associated with vaccine recommendation for ages 11-12.

Methods: Nationally representative samples of physicians practicing Family Medicine, Pediatrics, and Obstetrics and Gynecology were randomly selected from the American Medical Association Physician Masterfile (n=1,538 in 2009, n=1,541 in 2011). A mailed survey asked physicians about patient and clinical practice characteristics; immunization support; and frequency of HPV vaccine recommendation (“always” = >75% of the time vs. other).

Results: Completed surveys were received from 1,013 (68% response rate) eligible physicians in 2009 and 928 (63%) in 2011. The proportion of physicians who reported “always” recommending HPV vaccine increased significantly from 2009 to 2011 for patients aged 11-12 (35% vs. 40% respectively; p=.03), but not for patients aged 13-17 (53% vs. 55%; p=.28) or 18-26 (50% vs. 52%; p=.52). Physician specialty, age, and perceived issues/barriers to vaccination were associated with vaccine recommendation for patients aged 11-12 in both years. Pediatricians (versus FPs) were more likely to “always” recommend vaccination. OBGYNs also were more likely to recommend vaccination in 2011. In 2009, physicians aged 40-49 years (versus 50-65 years) had greater odds of vaccine recommendation, whereas those aged 25-39 years had greater odds of recommendation in 2011. Physicians reporting low (versus high) overall HPV vaccination-related issues/barriers had greater odds of recommendation in both years. A medium issue/barrier score also was associated with greater odds of recommendation in 2011. Physician ethnicity and Vaccines for Children enrollment status also were significantly associated with recommendation in 2009, whereas practice type and number of strategies used to ensure vaccine series completion were linked to recommendation in 2011.

Conclusions: Results suggest a modest increase in recommendations for HPV vaccination of females ages 11-12 over a two-year period; however, recommendations remain suboptimal for all age groups despite national recommendations for universal immunization. Consistent intervention targets include clinical specialty, physician age, and reducing barriers to immunizing patients.

Citation Format: Susan T. Vadaparampil, Teri L. Malo, Anna R. Giuliano. Dissemination of human papillomavirus vaccination in the U.S.: The role of physician recommendation. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr FO01-02.