New Tools to Improve the HPV Vaccine Rates Among Adolescent Males

By Laura Brey, Vice President for Strategy and Knowledge Management, School-Based Health Alliance

You might expect us to be celebrating the tenth anniversary the HPV vaccine, which immunizes preteens and adolescents against deadly cancers. Sadly, the milestone was marked not with jubilation but head-scratching among public health leaders who wondered why the vaccine wasn’t an overwhelming success. Some of the blame was placed with pediatricians and family practitioners who failed to promote it.

Dismal vaccine results

According to the CDC, only 22 percent of 11-12 year-old males and 40 percent of females received the HPV vaccine in 2014. And that’s despite its effectiveness in preventing sexually transmitted infections (STIs), which cause 90 percent of anal and cervical cancer, 70 percent of vaginal, vulvar, and throat cancers, and 60 percent of penile cancers.

The HPV immunization rate pales in comparison to the immunization rates for other diseases: 80-90 percent of teens are immunized for tetanus, diphtheria, pertussis, and meningitis. What’s causing this disparity? A Washington Post article recently pointed out that pediatricians don’t understand their responsibility for promoting the vaccine and its impact on preventing cancer, since the disease strikes the patient decades later when he or she is no longer under a pediatrician’s care.

Making sure it’s not the same story 10 years from now

During the 2015-16 school year, the School-Based Health Alliance—along with the American Sexual Health Association, Healthy Teen Network, and Partnership for Male Youth—launched our Young Adolescent Male Health Project. Our goal was to find school-centered strategies to boost the HPV vaccine immunization rate of male adolescents. We conducted a literature review, and interviewed dozens of young people and school-based health care providers to get to the root causes of why adolescents don’t receive this crucial vaccine.

What adolescents say

Adolescents want a provider who doesn’t judge them, who they can trust and talk to, who listens to their needs, and with whom they’ve established rapport and continuity. They need their provider to be honest with them about the risks of STIs and use simple language to clearly explain how they’ll perform a male reproductive health exam and diagnose and treat different STIs. Adolescents don’t know what HPV is, they don’t know that it’s contagious, and they don’t know that it can cause cancer in adulthood. Once they learn about HPV and its connection to cancer, they want to get the vaccine.

What providers say

Providers fear that parents buy in to the myth that the vaccine increases adolescent promiscuity, and may resist consenting for their adolescents to receive it—despite studies published over the last four years that show no such link. (In fact, reduced sexual activity following HPV education is reported in some cases). Providers not accustomed to working with adolescents also tend to feel uncomfortable discussing HPV and other STIs with their young patients. They need strategies and talking points to help them chat more candidly about those issues.

School-based health centers increase access to HPV vaccine

To help school-based health centers (SBHCs) deliver HPV vaccines to their student patients, we created an adolescent and young adult male (AYAM) provider checklist and an AYAM self-assessment questionnaire. The self-assessment tool helps young males get ready for the well child visit, explains what to expect at the visit and on their exam, and prompts their thinking about how they feel physically and mentally—and what they want to talk to the provider about. The provider checklist, a companion to the self-assessment tool, offers tips on how to build trust and rapport, have a frank conversation, and explain confidentiality to young males. It also includes probes specific to young males: gender identity, LGBTQ, sexual health and relationships, birth control, HPV and other vaccines, mental health, substance use, and resiliency. There is no other male-specific self-assessment questionnaire or provider checklist that systematically addresses these issues.

Both tools were tested in SBHCs in California, Georgia, and Maryland during 180 male adolescent well-child visits. At each visit, providers and young males discussed HPV, its risks, and the benefits of the vaccine. The providers suggested going ahead and starting the vaccine series at that visit. Reports back to us from the providers confirmed that young males were receptive to the vaccine after being counseled. We believe that a similar approach with preteen and adolescent females could work to increase their HPV vaccine rates.

The two instruments are available free of charge for public use. Downloadable PDFs are available below or on the American Sexual Health Association website.

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Download Provider Checklist

Download Self-Assessment Questionnaire

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