Abstract IA08: Provider recommendation of HPV vaccination for adolescent males: A widening health disparity
Authors: Vadaparampil Susan T. 
Published: October 2015

Abstract
HPV-related cancers provide an example of how health disparities extend beyond race/ethnicity to include gender, sexual identity, or socioeconomic status. HPV is linked to anal, penile, and oropharyngeal cancers, the last of which disproportionately affects males compared to females (6.2 vs. 1.4 cases per 100,000 population, respectively). In addition to gender disparities, certain subgroups of men are also at greater risk for experiencing disparities in HPV-related cancers. A recent analysis of SEER data documents that men from racial/ethnic, sexual minority, and low socioeconomic groups are disproportionately affected by HPV-related cancers. Significantly higher rates of HPV-associated anal cancer are observed among Black men compared to White men (1.6 vs. 1.1 cases per 100,000). Despite a recent Institute of Medicine report focusing on improving the health of sexual minorities, rates of anal cancer are more than six times higher among men who have sex with men compared to those who have intercourse only with women. Disparities have also been noted for men living in low versus high socioeconomic status areas for HPV-associated cancers of the anus and penis.
HPV vaccine in males has demonstrated high levels of immunogenicity, as well as reductions in genital lesions and precancerous anogenital lesions. In 2011, the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices recommended routine HPV vaccination of all males ages 11-12 years; catch-up vaccination for males ages 13-21; and men who have sex with men ages 22-26. Florida has among the nation's highest rates of male HPV-related diseases including the 5th highest rate of anal cancer and the highest rate of oropharyngeal cancer. Vaccination has tremendous potential primary prevention benefits for males, particularly those from racial/ethnic and sexual minority groups disproportionately affected by HPV-related diseases.
The 2011 National Immunization Survey-Teen data showed adolescent males were 19 times more likely to be vaccinated if parents reported receiving an HPV vaccine recommendation from their son's health care provider, compared to those not receiving a recommendation. The CDC and the President's Cancer Panel strongly advocate increasing physician recommendations as a primary approach to improving HPV vaccine uptake. While early studies suggest physicians support the concept of male vaccination, little is known about actual practice behaviors. Understanding recommendation practices and factors associated with those practices are essential to designing and conducting interventions to increase physicians' HPV vaccine recommendations to males. We are currently conducting a study of a representative sample of Florida-based primary care physicians most directly involved with adolescent/young adult vaccinations to explore this issue. We will present preliminary findings from the first 167 respondents that describe: the prevalence of physician recommendation of HPV vaccination to early (11-12), middle (13-17), and late (18-21) adolescent and young adult (22-26) males as well as barriers and practice patterns related to vaccine recommendation for adolescent and young adult males.
Citation Format: Susan T. Vadaparampil. Provider recommendation of HPV vaccination for adolescent males: A widening health disparity. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA08.