Finally, it should be noted that HPV vaccine was approved for administration to males after data collection for the current study commenced.38 Physicians' recommendation and administration practices for HPV vaccine may differ for male patients compared with female patients. Some research regarding attitudes and perceptions of vaccinating males against HPV was conducted prior to US Food and Drug Administration approval.39 A sample of family physicians and pediatricians was surveyed about recommending HPV vaccination to their female patients, and if they would recommend the vaccine to males if recommended by the ACIP and covered by insurance. More physicians reported they would see more
��often�� or ��always�� recommend the vaccine for males (24.1%) compared with females (18.1%) aged 9 to 10 years (P < .001); however, more physicians would recommend the vaccine to females than males for the 11 to 12 and 13 to 18 age groups (P < .001). Following the completion of this study, the ACIP issued a permissive recommendation for quadrivalent HPV vaccine administration to boys in 2009, which was replaced in 2011 with recommendation for routine use of HPV vaccine in males aged 11 to 12 years.40 Additional research is needed to examine physicians' administration of HPV vaccine to their male patients. There are several limitations of this study. First, the use of self-reported data may introduce social desirability effects. Second, selection bias may be present (eg, providers may have self-selected to participate based on strong HPV vaccination opinions). Epacadostat molecular weight
Third, Medicaid claims data do not include vaccinations received outside of the Medicaid system (eg, state health department), and, therefore, the number of girls deemed eligible for vaccine doses may be an overestimate. Eligibility overestimates may subsequently underestimate the provider's clinic population vaccination rate, especially among those regularly referring out for vaccination. Yet, the influence of outside vaccination is likely small, because most providers (77%) in our study reported they did not refer out for JQ1
vaccinations. These limitations should be viewed in light of this study's strengths. This study accessed claims data to ascertain physician administration of HPV vaccination. These data may yield more precise identifiers compared with that of self-reported data. In addition, a response rate of nearly 70% from a random sample of Medicaid providers enhances generalizability to all Florida Medicaid providers. Finally, this study complemented claims data with a survey to gain a more in-depth understanding of issues surrounding HPV vaccine administration. Taken together, study findings suggest HPV vaccination disparities in low-income females, even in the absence of vaccine cost to the patient.