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Assertive statements could help boost HPV vaccination rates, study finds

Physicians should use short, direct sentences that assume parents want their child vaccinated when discussing the human papillomavirus (HPV) vaccine in order to help boost vaccination rates among adolescents, according to a study published Monday in Pediatrics, NPR's "Shots" reports (Neighmond, "Shots," NPR, 12/5).

Background

HPV infections can lead to anal, cervical, middle throat, penile, vaginal and vulvar cancers. Nearly 80 million U.S. residents currently have HPV, and about 14 million new cases are reported annually. Although the immune system will clear most HPV infections, the virus leads to about 30,700 cases of cancer each year, according to a Centers for Disease Control and Prevention (CDC) analysis.

The Food and Drug Administration in 2006 approved Merck's HPV vaccine Gardasil for use in young women. The vaccine was later approved for use in young men. Vaccination is recommended at ages 11 and 12, when the body has the most robust response. The vaccine may be administered until age 26, but research shows it becomes less effective at preventing infection as people enter their 20s.

However, the number of U.S. teenagers and preteens who have received the HPV vaccine lags behind the numbers for other adolescent vaccines. According to 2015 CDC data, 42 percent of girls and 28 percent of boys ages 13 to 17 have received all three doses of the HPV vaccine, while 63 percent of girls and 50 percent of boys have received at least one dose. The government has set a goal of having 80 percent of teenagers vaccinated by 2020.

In October, CDC lowered the recommended HPV vaccination regimen from three to two doses for adolescents ages 11 to 14, based on research showing two doses among adolescents "produced an immune response similar or higher than the response in young adults (aged 16 to 26 years) who received three doses." The agency maintained its recommended three-dose, six-month regimen for individuals ages 15 to 26.

CDC said the two-dose regimen likely will improve vaccination rates (Women's Health Policy Report, 10/21).

Study details, findings

For the latest study, researchers examined how providers could most effectively discuss the vaccine with patients.

The researchers divided 30 North Carolina pediatric and family medicine clinics into three groups. One group was trained in and instructed to use brief, direct statements that assumed that parents expected to have their kids vaccinated. For example, a physician might say, "Now that [your child] is 12 there are three vaccines we give to kids his age. Today he'll get meningitis, HPV and Tdap (tetanus, diphtheria, pertussis)."

A second group of providers was trained to have relatively long, detailed conversations with patients about the vaccine, touching on the vaccine's timing, safety and efficacy. A third control group received no training.

Key findings

The study found that vaccine rates were higher when providers used assertive statements. Specifically, statements that assumed parents wanted the vaccine for their kids increased vaccination rates by 5 percent. Rates did not increase after the longer discussions or among the control group.

Noel Brewer, study author and a health and behavior scientist at the University of North Carolina, said the direct statements normalized the HPV vaccination, framing it as just like any other vaccine recommendation. "Having a long conversation seems to communicate that there's a problem with the vaccine, and that worries parents," he said ("Shots," NPR, 12/5).