B15

Background

High risk types of HPV are necessary though not sufficient causes of the vast majority of cervical cancers. With the approval by FDA of the HPV vaccine among women age 9-26, dissemination is critical. Fewer than one-third of the US population has heard of HPV. Few know about its association with cervical cancer, and how to prevent its spread. Yet, physician recommendation is key to vaccination.

Methods

The study examines vaccination intentions and practices among a sample of 235 multi-ethnic/racial, urban primary care physicians who are enrolled in an RCT of an educational intervention. Intention was measured via self-report prior to FDA approval. Vaccination rates were assessed two years post-FDA vaccine approval, among their multi-ethnic female patients, age 18-26, using medical audit.

Results

Prior to the approval of the vaccine, findings revealed strong intention to vaccinate among physicians, at 92% extremely or somewhat likely to vaccinate. Multivariate analyses of primary care physicians revealed that those who regularly performed recto-pelvic examinations on asymptomatic women (β=0.21, p=0.03), and those who were more familiar with the ACS screening guidelines held stronger intentions to vaccinate (β=0.24, p=0.01) than did comparable others. Female primary care physicians had stronger intentions to vaccinate for HPV than male providers (β=0.21, p=0.03). Two years post-approval, 10% of multi-ethnic female patients age 18-26 have received at least one inoculation, 2% have received the entire 3-dose protocol. Major barriers are awareness, cost, and availability of the vaccine. Conclusions: The findings reveal stronger intentions to vaccinate than contemporaneous population-based surveys (80%), but similar predictors in gender and knowledge. The rate of vaccination is comparable to the 14% for the Hepatitis B vaccine among children one year post-approval, but much lower than among pediatricians in a Boston metropolitan hospital (57%) during a similar period of time. This is the first study to observe vaccination intentions among urban physicians working in under-resourced communities, and to systematically report the HPV vaccination uptake among their young adult female patients. Targeted dissemination strategies to urban primary care physicians in under-resourced areas, with tailored messages, are critical. In addition to exploring the pragmatic issues in disseminating the vaccine, we will examine the ethical, political, and social contexts for population-based HPV vaccine inoculations.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):B15.

Seventh AACR International Conference on Frontiers in Cancer Prevention Research-- Nov 16-19, 2008; Washington, DC