Influence of Relationship Status in Physicians' Decision to Recommend HPV Vaccination

Background:
Coverage rates for Quadrivalent HPV vaccination among 19-26 year old women are low, leading to questions regarding how physicians make decisions about vaccination for women in this age group.

Objectives:
To determine whether physicians consider relationship status when recommending HPV vaccine to women ages 19-26.

Methods:
An administrative claims database from a large U.S. managed care plan was used to identify physicians whose medical specialty was obstetrics/gynecology or general/family practice. To be eligible, physicians had to have vaccinated at least 2 female patients ages 9-26 from 1/1/2007 to 4/30/2007 and have a valid fax number.

Results:
Out of 800 surveys faxed to physician offices, we received 271 responses (34% response rate), including 158 from obstetricians/gynecologists and 113 from general/family practitioners. 61% of respondents were female. Physicians were asked to rate the importance of HPV vaccination for women as a function of relationship status (from 0=extremely low priority to 10=extremely high priority). Physicians rated "married or living with a partner" (5.8) and "single, but in a long-term monogamous relationship" (6.8) as significantly lower priorities for vaccination than "single and dating" (9.8) and "single but not in a relationship or dating" (9.2) (p<0.0001). Of note, women with a history of HPV-related disease/infection (abnormal Pap, genital warts, cervical dysplasia/cancer) were not rated differently with respect to vaccination priorities from women with no history of HPV-related disease/infection.

Conclusions:
Although physicians, appropriately, did not differentiate among women on the basis of prior HPV-related disease/infection, they did prioritize HPV vaccination based relationship status. Epidemiological studies, however, show that women in relationships perceived to be stable remain at risk for HPV infection. These findings suggest that further education of health care providers is needed regarding the ACIP recommendation for universal vaccination.