For whatever reasons, uptake of the human papillomavirus (HPV) vaccine in the teenaged years is mediocre, but do the college years offer new opportunities for healthcare providers to encourage the vaccine? Maybe not, according to a new study.
The study attempted to gauge whether young adults left to make healthcare decisions on their own—maybe for the first time—might present healthcare providers with an opportunity to make up for missed opportunities in HPV vaccination.
Despite recommendations from numerous health organizations, HPV vaccination rates remain low across the country. Physician recommendation and parental approval are both strong indicators of vaccine compliance, yet coverage remains around 63% for females and 50% for males compared with percentages in the 1970s and 1980s in other countries. Entry into college has been seen as a time that physicians may help young adults catch up on missed HPV vaccines, considering a general increase in sexual activity during this period as well as increased independence in medical decision making.
However, whereas parental approval already plays a huge role in vaccine uptake during the teenaged years, the report reveals that this influence often continues into early adulthood.
A total of 527 students at 2 universities were polled for the study, 55.8% of whom had at least initiated the HPV vaccination series. Those students cited encouragement from physicians and/or parents as an influential factor in their vaccination. Among undergraduates in the study who were encouraged to receive the vaccine by both a doctor and a parent, 95.8% decided to receive the vaccine. However, just 29.6% of students who were encouraged to get the vaccine by their doctor but discouraged by a parent ended up receiving it. A third of the students polled weren’t aware of where to even get the HPV vaccine, and female (26.7%) undergraduates were more likely than males (2.3%) to report that a parent had not allowed them to be vaccinated against HPV.
The report also revealed that 80% of students who had started the HPV series had completed it. Of those that had not received the vaccine, 4.5% planned to get it within the next year, 50% had not plans to receive the vaccine, and 45.5% were uncertain.
Female students and younger students across both genders were most likely to have received the vaccine, and initiation of sexual intercourse had little impact on vaccine uptake.
In terms of medical decision making, most students reported that they were still on their parents’ health insurance plans and depended on them for financial support. It’s not surprising, then, that 77.3% report that their parents were sometimes to mostly involved with their decision making, with just 20.6% stating that they make their own medical decisions. However, students were more likely to exercise their own medical decision-making power when it came to flu vaccination, according to the report.
Top reasons among students undecided about or against vaccination were the belief that they didn’t need it because they weren’t sexually active; because their parents had not allowed them to receive the vaccine; or because they had heard that the vaccine had too many adverse effects.
Kathleen R Ragan, of the Department of Epidemiology at the Rollins School of Public Health at Emory University, Atlanta, Georgia, and lead author of the study, says parents still have a lot of influence over the medical decisions of their children in college, and that more research is needed to figure out exactly how and why college students defer to their parents on medical decisions and what providers can do to provide more effective interventions.
“Our study found that (parental) influence extends throughout the college years for young adult men and women,” Ragan says. “Interventions addressing parental barriers can increase adolescent and young adult HPV vaccine uptake.”
Provider recommendations also can increase vaccine uptake, so Ragan says it’s crucial to monitor a patients’ vaccine history and regularly encourage parents to protect their children from cancers caused by HPV.
“Pediatricians can increase vaccine uptake and help parents protect children from cancers caused by HPV by avoiding missed opportunities for vaccination and implementing catch-up vaccination strategies for teenagers and young adults who have not yet received the vaccine or completed the series,” Ragan says. “While we acknowledge that it is imperative for physicians to focus on emphasizing the primary schedule and recommending vaccination at 11 to 12 years old instead of relying on catch-up vaccination to occur, our study found that there is great potential for targeted catch-up campaigns for 18- to 26-year-olds given their increased risk for HPV transmission and low vaccination coverage.”
Even in college-aged adults, vaccine decisions are heavily influenced by parents, so it’s key that pediatricians start their education there before patients transition out of their practices.
“Our study found that college students’ healthcare decision making is still greatly influenced by their parents and that encouragement by parents and doctors is associated with HPV vaccine initiation through adolescence into early adulthood for both men and women,” Ragan says. “This highlights implications for clinical practice regarding the importance of recognizing the strong influence of parental acceptance and continuously working to address parental barriers and increase timely vaccination to prevent HPV cancers.”
Providers can avoid missed opportunities for vaccination by establishing effective ways to increase compliance, such as monitoring patient vaccination history and checking vaccination status at every sick and well visit; using patient reminders; being more proactive about initiating vaccine conversations; and continuing to encourage parents to protect children against HPV cancers.
Educating the patients themselves also has a lot of benefit, Ragan says, even if it seems too late.
“In our study, over 40% of students who were undecided about getting the vaccine indicated their doctor did not discuss it with them. Therefore, there is potential for greatly increasing uptake via clinical practice standards that emphasize more routine physician discussion and recommendation about HPV vaccination,” she says.
Education campaigns on cancer prevention are particularly useful, Ragan adds, and often are more effective than approaching the vaccine in terms of prevention of other sexually transmitted disease risks.
“Campaigns about cancer prevention are more influential than those that focus on preventing genital warts,” Ragan says. “The HPV vaccine should be packaged with other adolescent vaccines to reinforce messaging that HPV vaccination is a normal part of adolescent healthcare and conversations should focus on the importance of protecting patients against HPV cancers among both men and women.”
On the other hand, talking to someone who had an adverse effect from the vaccine was the primary negative influential factor that prevented study participants from receiving the vaccine. Education of both parents and patients, it seems, is key to improving uptake, but more research is needed to find the best methods.
“We discovered that although there are some modifiable barriers that can be addressed, students’ healthcare decision making is not independent, and parental factors that influenced them in their teenaged years are still highly impactful,” the report notes. “More research is needed to understand the determinants of students’ decision-making process across healthcare factors in order to effectively incorporate interventions during the transition to college. Research is also needed regarding parents’ awareness of the influence they may have and why students’ sense of independence decreases when healthcare is involved.”