Research In Practice Blog
"Missed Opportunities for Human Papillomavirus Vaccination Before Sexual Debut Among Adolescents"
Brian P. Jenssen, MD, MSHP; et al.
Research Letter
What is known about HPV Vaccination rates:
HPV vaccination is both safe and effective, offering long-lasting protection against cancers caused by the human papillomavirus (HPV). To maximize its effectiveness, it is best for adolescents to get vaccinated before becoming sexually active. However, the rates of timely vaccinations are not well known. Previous studies have not included data reported by adolescents concerning their sexual activity. In response to this issue, CHOP researchers used confidential adolescent surveys linked to vaccination records in a large pediatric network to examine various factors associated with not receiving HPV vaccine before sexual debut.
How this study was performed:
The research team, which includes Clinical Futures experts Brian Jenssen, MD, MSHP; Alex Fiks, MS, MSCE; Mary Kate Kelly, MPH; Maura Powell, MPH, MBA; Priyani Sharma, MPH; and Stephanie Mayne, PhD, MHS, conducted a cross-sectional analysis of adolescents within CHOP’s primary care network. This analysis encompassed 31 practices and approximately 90,000 adolescents aged 13 to 18 years. These individuals had a primary care visit at which roughly 9,000 self-reported sexual activity at any time on their Adolescent Health Questionnaire (AHQ).
Researchers utilized data from electronic health records (EHRs) and the AHQ, which included a confidential pre-visit survey completed by adolescents to assess sexual activity and other health domains. For context, "sexual debut" was defined as answering "yes" to having had sexual contact.
Researchers categorized HPV vaccinations status as:
- Series completed before sexual debut
- Initiated but not completed before sexual debut
- Not vaccinated before sexual debut
What this research adds:
A significant number of sexually active adolescents completed the HPV vaccination series before becoming sexually active. However, a surprising 12% had not received any doses. Also, practice-level variation was substantial, with rates of adolescents not vaccinated before sexual debut ranging from 5% to 47%. These significant gaps represent a major missed opportunity for cancer prevention.
Given that all adolescents had recent primary care visits, it appears that focusing on factors such as family acceptance of vaccination, physician recommendation practices, and clinic workflows could significantly enhance vaccination rates. By addressing these areas, researchers believe they can better identify and seize opportunities for improving adolescent health outcomes.
To the researchers' knowledge, this study is the first of its kind to connect adolescent-reported sexual activity with vaccination records across a large pediatric primary care network, thereby identifying these missed opportunities for pre-exposure vaccination.
Clinical Implications
Researchers are utilizing this data to initiate a quality improvement effort aimed at increasing HPV vaccination rates starting at age 9. This initiative seeks to minimize missed opportunities and reach patients before they become sexually active.
Additional information and research related to this topic:
- A Look at Each Vaccine: Human Papillomavirus www.Prevent-HPV.org
- What Health Systems Can Do Now to Improve Human Papillomavirus Vaccination
- Performance Feedback for Human Papillomavirus Vaccination: A Randomized Trial From the American Academy of Pediatrics Pediatric Research in Office Settings Research Network
- HPV Vaccinations at Acute Visits and Subsequent Adolescent Preventive Visits
- Human Papillomavirus Vaccine Completion by 13: A Quality Improvement Initiative in a Large Primary Care Network - ScienceDirect
- A Bundled, Practice-Based Intervention to Increase HPV Vaccination | Pediatrics | American Academy of Pediatrics- Study and Video Abstract
- Cost Analysis of a Scalable Clinician Communication Intervention to Increase HPV Vaccine Initiation- Study and Video Abstract