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  • br H uman papillomavirus HPV vaccination rates remain


    H uman papillomavirus (HPV) Staurosporine rates remain suboptimal despite the universal recommendation that all ado-lescents be immunized. In the US, it is estimated that 79 million people are currently infected with HPV and that each year, approximately 40 000 new HPV-associated cancers are diagnosed.1 The 9-valent HPV vaccine is highly effective
    at preventing infections caused by the most common oncogenic HPV types, yet adolescent HPV vaccine series completion rates remain low. Despite the availability and universal recommendation for the use of HPV vaccine starting at age 11 or 12 years, 2016 data for series completion among 13- to 17-year-olds is only 43.4% nationally.1,2 Adolescent HPV vaccine uptake is influenced by patient, parent, and provider factors. Among both parents and providers, HPV nonvaccination is associated with the belief that immunized adolescents are more likely to have unprotected sex and with the conviction that HPV vaccination needs to include a discussion about sexual activity.3-5 On the other hand, 2 patient factors that are consistently associated with HPV vaccine acceptance include receiving a strong vaccine recommendation from one’s provider and a general understanding that HPV vaccine has the potential to prevent some forms of cancer.6-10 Despite the well-established, positive impact of a provider’s stated recommendation on improving vaccine uptake, many providers continue to give weak, unclear, or inaccurate vaccine recommendations.11-13 Others report or convey incomplete or inaccurate knowledge regarding HPV-associated cancers, particularly related to malignancies other than cervical cancer.14 Published reports suggest that educational programs for providers that focus on delivering strong vaccine recommendations together with consumer mes-sages that focus on cancer prevention benefits of vaccine improve adolescent HPV vaccine completion rates.13-15 Here, we de-scribe an educational program for providers, their office staff, adolescents, and their parents designed to raise awareness that HPV vaccine is an important cancer-prevention tool. We hypothesized that raising such awareness would be associated with an increase in HPV vaccination rates.
    In 2015, we secured funding from the American Academy of Pediatrics (AAP) Ado-lescent Vaccinations and Wellness Grant Program, to develop and implement a cancer prevention educational program designed to target all stakeholders in the immunization delivery system at the practice level. This program included on-site education for providers and staff as well as the development and distribution
    AAP American Academy of Pediatrics
    HPV Human papillomavirus 
    From the 1Department of Pediatrics; and 2Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
    Supported by the American Academy of Pediatrics Adolescent Vaccinations and Wellness Grant Program. The authors declare no conflicts interest.
    Portions of this study were presented as a poster at the Pediatric Academic Societies annual meeting, May 6-9, 2017, San Francisco, California.
    of a cancer prevention booklet for the adolescents and their families in the practice. The color monograph presents basic life-long cancer prevention advice related to exercise, tobacco use, sun exposure, and HPV- and hepatitis B-associated dis-eases and vaccines. The booklet was designed by the study team by combining resources available from both the US Centers for Disease Control and Prevention and the American Cancer Society with the goal of bundling HPV vaccine information with other generally well-accepted anticipatory guidance for cancer prevention.16-20
    To test the effects of our novel cancer prevention educa-tion platform, we recruited 6 large pediatric offices in upstate New York to participate in a pilot effort. Each practice desig-nated a project champion, all of whom were AAP National and District 2, Chapter I member pediatricians. The project champions acted as site contacts with the study team, facili-tated practice follow-through with the program, and at-tended an end-of-study meeting to discuss the study results.
    Phase 1
    Phase 1 of the program was designed to engage and educate the providers, their nurses, and office staff about practice-specific immunization concerns, challenges, and successes. This component included an on-site education session with each participating practice led by the 2 senior study investigators starting in the fall of 2015. All office staff members were asked to attend. First, an anonymous survey was administered to the providers to assess their baseline knowledge and beliefs about HPV vaccine and cancer prevention, and to ascertain the fre-quency with which verbal and written counseling regarding cancer prevention guidance is administered to the adolescent patients in their practice (Table I; available at The educational component of the session (Table II; avail-able at included topics of vaccine hesitancy, information about HPV disease and HPV vaccine, and the role of HPV vaccine in cancer prevention. Although HPV vaccine was the primary focus of the sessions, general advice regard-ing common vaccine hesitancy issues was provided. Other common reasons for suboptimal adolescent vaccine coverage rates unrelated to vaccine hesitancy also were discussed, such as missed opportunities and failure to bundle recommended vaccines together. The discussion included reminders of the importance of a consistent positive vaccine messaging through-out the practice and that the same strength of vaccine recom-mendation should be conveyed for all category A Advisory Committee on Immunization Practices recommended ado-lescent immunizations (tetanus diphtheria acellular pertus-sis, quadrivalent conjugate meningococcal vaccine, HPV, and influenza). Practice members also shared their prior suc-cesses with quality improvement efforts to boost vaccine cov-erage rates. We answered individual provider vaccine questions, reviewed the content of the study-specific cancer prevention educational booklet, and explained the objective and details for phase 2 to each group.