Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists

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• 作者：Annika M. Hofstetter ; MD ; PhD ; MPH¹ ; ² ; ³ ; ^{annika.hofstetter@seattlechildrens.org} ; Lauren Lappetito¹ ; Melissa S. Stockwell ; MD ; MPH¹ ; ⁴ ; ⁵ ; Susan L. Rosenthal ; PhD¹ ; ⁴ ; ⁶
• 关键词：Adolescents ; Chronic medical conditions ; HPV vaccination ; Pediatric subspecialist
• 刊名：Journal of Pediatric and Adolescent Gynecology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：30
• 期：1
• 页码：88-95
• 全文大小：268 K
• 卷排序：30

文摘

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.Design and SettingNational cross-sectional study.ParticipantsPediatric endocrinologists, hematologist/oncologists, pulmonologists, and rheumatologists identified using the American Medical Association Physician Masterfile (n = 418).InterventionsSubspecialists 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.Main Outcome MeasuresHPV vaccination recommendation.ResultsOver 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.ConclusionThis study revealed that many subspecialists fail to recommend HPV vaccination to adolescents with CMCs and highlights potential targets for future interventions.