Examining HPV Vaccination Practices and Differences Among Providers in Virginia

  • Héctor E. Alcalá
  • George Larry Maxwell
  • Brianna Lindsay
  • Jessica Keim-Malpass
  • Emma M. Mitchell
  • Rajesh Balkrishnan


Virginia has some of the lowest HPV vaccination rates, despite being one of the few states in the USA requiring adolescent girls receive the vaccine. Provider characteristics may be an important factor in HPV vaccination. Thus, the present study assessed provider vaccination, practices, knowledge about the vaccine, and confidence in performing behaviors related to the vaccine. We conducted a cross-sectional electronic survey in a large health care system in Northern Virginia. A total of 53 responses were received. Only respondents who reported seeing adolescent patients were included in analyses (N = 42). Differences in responses were examined by provider age, gender, and type. Respondents reported recommending the vaccine a high percent of the time to eligible patients and had overall high levels of knowledge and confidence. Male providers recommended the vaccine to boys ages 11–12, less frequently than female providers. Providers age 50 and over recommended the vaccine to boys ages 11–12 less frequently than younger providers. This study shows that there are some gaps in HPV vaccine recommendation practices among providers. These gaps may be one reason for the low uptake of the HPV vaccine among adolescents. Thus, educational and training interventions of providers could be considered.


Cancer HPV vaccine Cervical cancer Health care providers 



Merck & Co., Inc. was involved in the design of questionnaire and approved the present manuscript.

Funding Information

Merck & Co., Inc., Kenilworth, NJ, USA provided financial support for the study.


  1. 1.
    de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M Global burden of cancers attributable to infections in 2008: A review and synthetic analysis. Lancet Oncol 13(6):607–615. CrossRefPubMedGoogle Scholar
  2. 2.
    Chatterjee A (2014) The next generation of HPV vaccines: nonavalent vaccine V503 on the horizon. Expert Rev Vaccines 13(11):1279–1290. CrossRefPubMedGoogle Scholar
  3. 3.
    Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, Unger ER (2013) Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and nutrition examination surveys, 2003–2010. J Infect Dis 208(3):385–393. CrossRefPubMedGoogle Scholar
  4. 4.
    Reagan-Steiner S, Yankey D, Jeyarajah J, et al. (2016) National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2015. MMWR. Morbidity and mortality weekly report; 65Google Scholar
  5. 5.
    Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA (2013) Vaccine hesitancy: an overview. Hum Vaccin Immunother 9(8):1763–1773CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    MacDonald NE, Dubé E (2015) Unpacking vaccine hesitancy among healthcare providers. EBioMedicine 2(8):792–793. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Javanbakht M, Stahlman S, Walker S et al (2012) Provider perceptions of barriers and facilitators of HPV vaccination in a high-risk community. Vaccine 30(30):4511–4516. CrossRefPubMedGoogle Scholar
  8. 8.
    Collange F, Fressard L, Cl P, Rm S, Peretti-Watel P, Verger P (2016) General practitioners’ attitudes and behaviors toward HPV vaccination: a French national survey. Vaccine 34(6):762–768. CrossRefPubMedGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention (2016) Adolescent human papillomavirus (HPV) vaccination coverage report. Centers for Disease Control and Prevention, . 2017. Accessed October 2 2017
  10. 10.
    National Conference of State Legislators (2017) HPV Vaccine: State Legislation and Statutes. National Conference of State Legislators,, Denver. Accessed October 2 2017
  11. 11.
    Berenson AB, Rahman M, Hirth JM, Rupp RE, Sarpong KO (2015) A brief educational intervention increases providers’ human papillomavirus vaccine knowledge. Hum Vaccin Immunother 11(6):1331–1336. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Gilkey MB, Malo TL, Shah PD, Hall ME, Brewer NT (2015) Quality of physician communication about human papillomavirus vaccine: findings from a National Survey. Cancer Epidemiol Biomark Prev 24(11):1673–1679. CrossRefGoogle Scholar
  13. 13.
    Opel DJ, Robinson JD, Heritage J, Korfiatis C, Taylor JA, Mangione-Smith R (2012) Characterizing providers’ immunization communication practices during health supervision visits with vaccine-hesitant parents: a pilot study. Vaccine 30(7):1269–1275. CrossRefPubMedGoogle Scholar
  14. 14.
    Riedesel JM, Rosenthal SL, Zimet GD et al (2005) Attitudes about human papillomavirus vaccine among family physicians. J Pediatr Adolesc Gynecol 18(6):391–398. CrossRefPubMedGoogle Scholar
  15. 15.
    Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O, Raude J, Pulcini C, Peretti-Watel P (2015) Vaccine hesitancy among general practitioners and its determinants during controversies: a National Cross-sectional Survey in France. EBioMed 2(8):891–897. CrossRefGoogle Scholar
  16. 16.
    Cunningham CT, Quan H, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E, Samuel S, Ghali WA, Sykes LL, Jetté N (2015) Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol 15(1):32CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Reiter PL, Stubbs B, Panozzo CA, Whitesell D, Brewer NT (2011) HPV and HPV vaccine education intervention: effects on parents, healthcare staff, and school staff. Cancer Epidemiol Biomark Prev 20(11):2354–2361. CrossRefGoogle Scholar
  18. 18.
    McLean HQ, VanWormer JJ, Chow BDW et al (2017) Improving human papillomavirus vaccine use in an integrated health system: impact of a provider and staff intervention. J Adolesc Health 61:252–258. CrossRefPubMedGoogle Scholar
  19. 19.
    Centers for Disease Control and Prevention (2016) CDC recommends only two HPV shots for younger adolescents. Accessed September 14 2017

Copyright information

© American Association for Cancer Education 2018

Authors and Affiliations

  1. 1.Department of Family, Population and Preventive Medicine; Program in Public HealthStony Brook UniversityStony BrookUSA
  2. 2.Department of Obstetrics and Gynecology and the Inova Schar Cancer InstituteFalls ChurchUSA
  3. 3.Merck and Co., Inc.KenilworthUSA
  4. 4.University of VirginiaCharlottesvilleUSA

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