Framing of national HPV vaccine recommendations and willingness to recommend at ages 9-10

Figures & data

Table 1. Participant and clinic characteristics (n = 2,527).

Characteristics	n (%)
Participant
Gender
Woman	1810 (72)
Man	637 (25)
Nonbinary, another gender, or prefer not to say	80 (3)
Race/ethnicity
Asian	356 (14)
Black	123 (5)
Hispanic	100 (4)
White	1664 (66)
Multiple races or ethnicities	94 (4)
Another race/ethnicity or prefer not to say	190 (8)
Training
Physician	1223 (48)
Physician assistant	198 (8)
Advanced practice nurse	405 (16)
Nurse^a	606 (24)
Medical assistant or certified nursing assistant	95 (4)
Specialty
Pediatrics	1253 (50)
Family medicine or general practice	1274 (50)
Years in practice
0–9 years	950 (38)
10–19 years	740 (29)
20+ years	837 (33)
Patients ages 9–12 years seen per week
<10 children	730 (29)
10–24 children	1000 (40)
25+ children	797 (32)
Role in HPV vaccination^b
Assess vaccination status	2384 (94)
Indicate child is due for vaccine	2331 (92)
Recommend vaccine	2294 (91)
Address concerns	2352 (93)
Administer vaccine	1187 (47)
Clinic
Member of a healthcare system
No	963 (38)
Yes	1564 (62)
Clinic type
Solo practice	275 (11)
Group practice	1259 (50)
Hospital or academic institution	512 (20)
FQHC or community health center	272 (11)
State or local department of public health	37 (1)
Local, community, or nonprofit organization	116 (5)
Other	56 (2)
Providers in clinic
1	169 (7)
2–5	986 (39)
6–10	661 (26)
11+	711 (28)
Rurality
Rural primary clinic	232 (9)
Rural secondary clinic	298 (12)
Other non-rural clinic	1997 (79)
Region
Northeast	505 (23)
Midwest	576 (26)
South	841 (38)
West	296 (13)
VFC program provision of vaccines
0% of doses	207 (8)
1–49% of doses	918 (36)
50%+ of doses	750 (30)
Don’t know	652 (26)

Note. FQHC = Federally Qualified Health Center. HPV = human papillomavirus. VFC = Vaccines for Children.

^aNurses include RN, LPN, and LVN.

^bResponse scale was check all that apply.

Figure 1. Impact of recommendation frame on willingness to recommend HPV vaccination for patient ages 9–10 years.

*p < .05. Reference group = No recommendation.

Table 2. Moderators of the impact of recommendation frame on willingness to recommend HPV vaccination for patient ages 9–10 years.

		Recommendation frame
Moderator	Interaction p	No recommendation (ref)	Age 11-12	Age 9-12	Starting at age 9
Overall		54	37	58	63
By training	.66
Physician (n = 682)		57	40	62	64
Other clinical staff (n = 653)		51	34	54	63
By specialty	.06
Pediatrics (n = 623)		53	37	52	57
Non-pediatrics (n = 712)		55	36	63	69
By years in practice	.12
0–9 (n = 559)		57	47	62	70
10+ (n = 776)		52	30	55	59
By clinic healthcare system membership	.32
No (n = 462)		48	35	54	55
Yes (n = 873)		58	38	60	68
By clinic rurality	.46
Non-rural (n = 1045)		53	35	58	63
Rural (n = 290)		58	42	56	64

Note. Interaction p is for interaction of recommendation frame and moderator variable. HPV = human papillomavirus.

*p < .05, **p < .001.

Table 3. Perceived benefits of HPV vaccination at ages 9 and 12.

Benefit	Age 9 %	Age 12 %	OR (95% CI)
Sex does not come up in discussions with parents	24	10	2.78 (2.23, 3.48)
Children complete the vaccine series before age 13	56	47	1.44 (1.23, 1.68)
Children receive protection before exposure to HPV	65	63	1.10 (0.93, 1.29)
Discussions with parents are brief	13	12	1.06 (0.84, 1.34)
Children get fewer vaccines during a visit	43	42	1.05 (0.90, 1.23)
Parents agree to vaccination	14	24	0.53 (0.43, 0.64)
Parents ready to talk about HPV vaccine	12	43	0.18 (0.15, 0.22)

Note. OR = odds ratio. CI = confidence interval. HPV = human papillomavirus. Age 12 was the referent group.