Physician Attitudes and Receptiveness to STD Vaccines

MVD Business Research Merck & Company, Inc.

2

Objectives

• To determine physicians’ perceptions of adolescent sexual activity

• To assess the comfort-level, timing, and content of sexual risk discussions among physicians and their female adolescent patients

• To examine any behavioral differences between pediatricians and family practitioners regarding sexual risk discussions

• To describe physicians’ knowledge of STDs and to assess their perceived need for STD vaccines

3

Methodology

• 642 physicians were selected at random from the AMA master file and contacted by mail, e-mail and telephone to participate in an internet-based study

– 309 pediatricians

– 333 family practitioners

4

Methodology

Selection Criteria:• Physician

– Has been in practice between 2-50 years

– Has not participated in vaccine-related research in the past three months

– Spends 70% of time seeing/treating patients

– Involved in vaccine decision-making in practice

– Does not work for a manufacturer of pharmaceutical products (nor has family that does)

• Practice

– At least 20% of patients are between the ages of 9-18

– No more than 75% of patients 19 years of age or older

5

Methodology

• Quotas were set for the following physician characteristics to obtain a balanced sample:

– Specialty (Pediatrician 50%, GP-FPs 50%)

– Gender (Male 50%, Female 50%) within specialty

– Region (evenly distributed across 6 regions)*

• All results were tested at the 95% confidence level, two-tailed

*Northeast (CT, DE, MA, ME, NH, NY, NJ, RI, VT), Mid Atlantic (DC, KY, MD, OH, PA, VA, WV), Southeast (AL, FL, GA, MS, NC, SC, TN), North Central (CO, IL, IN, MI, MN, ND, NE, SD, WI, WY) , South Central (AR, IA, KS, LA, MO, NM, OK, TX), West (AK, AZ, CA, HI, ID, MT, NV, OR, UT, WA)

Results

7

Sample Characteristics

GP/FPs Pedsn=309 n=333

Average % time seeing patients 98% 98%

Average number of years in practice 16.9 16.8

Number of patients per week 136 122

Solo practice 24% 14%

Single specialty practice 69% 78%

Staff Model HMO 4% 8%

8

3%7%

23%

55%

0%

10%

20%

30%

40%

50%

60%

2%6%

22%

51%

0%

10%

20%

30%

40%

50%

60%

Perception of Patient Sexual Activity

9-10 11-12 13-15 16-18 9-10 11-12 13-15 16-18

% o

f P

ati

en

tsS

ex

ua

lly

Ac

tiv

e

% o

f P

ati

en

tsS

ex

ua

lly

Ac

tiv

e

Patient Age Patient Age

GP/FPsn=309

Pediatriciansn=333

Physicians believe that sexual activity is highest at age 16-18 compared with younger age groups.

What percent of your adolescent/teenage (age 9-18) patients in the following age groups do you believe are sexually active?

9

Perceptions of Specific Female Sexual Activity

n = 642 Average Age Youngest Age

Masturbation 635 12.9 9.9

Mutual Masturbation 633 15.4 12.7

Oral Sex 636 15.8 12.6

Vaginal Intercourse 638 16.1 12.7

Anal Intercourse 589 17.4 15.2

Thinking about your female adolescent/teenage (age 9-18) patients, what is the average age they engage in the following types of behavior? What is the youngest age?

10

Comfort Level with Discussions

10% 16%36% 39%

11% 18%

43% 38%6%

9%

22%

50%

11%12%

28%52%

Very comfortable Extremely comfortable

9-10 11-12 13-15 16-18 9-10 11-12 13-15 16-18Among Patients Aged: Among Patients Aged:

GP/FPs (n=309) Pediatricians (n=333)

GP/FPs and pediatricians report increasing levels of comfort with sexual risk discussions as patients get older

Using the scale below, please indicate how comfortable you feel discussing sex with your adolescent/teenage patients?

11

Timing of Sexual Risk Discussions

GP/FPsn=309

Peds n=333

Before patient is sexually active 22% 34%

When I suspect a patient is sexually active 51% 27%

Only when patient/parent asks me 4% 2%

When do you most commonly speak to your teenage/adolescent patients (age 9-18) about sexually transmitted diseases?

12

Discussions with PatientsGP/FPsn=309

Pedsn=333

I stress the importance of using protection against STDs to my patients

56% 50%

Before speaking to a patient about sex, I typically ask his/her parent’s consent

56% 43%

I take it upon myself to discuss sex with my patients. After all, I don’t know from whom they receive their information

38% 48%

I believe that my patients should not engage in any sexual activity before marriage

69% 64%

Percentage of top 2 box on a 5-point scale.Thinking about your adolescent patients age 9-12, please indicate how much you agree or disagree with the following statements

13

Perception of Disease Severity

38%

41%

38%

35%

32%

17%

6%

12%

37%

39%

41%

45%

47%

37%

11%

14%

18%

20%

56%

96%

34%

4%

0% 20% 40% 60% 80% 100%

Trichomoniasis

Genital or Anal Warts

Chlamydia

Herpes Simplex 2

HPV

Cervical dysplasia

Hepatitis B

HIV

Somewhat Serious Very Serious Extremely Serious

Base: Total respondents (642 Physicians) . Using the scale below, please rate how serious the following diseases or infections are for an adolescent/teenage (age 9-18) patient

14

Likelihood of Infection/Diseases

25%

27%

45%

47%

50%

53%

38%

40%

18%

24%

24%

27%

5%

10%

8%

2%

3%

38%

34%

1%

16%

18%

8%

4%

0% 20% 40% 60% 80% 100%

Hepatitis B

HIV

Cervical dysplasia

Trichomoniasis

Genital or Anal Warts

Herpes Simplex 2

Chlamydia

HPV

Somewhat Likely Very Likely Extremely Likely

Base: Total respondents (642 Physicians) . Using the scale below, please rate the chances of your sexually active adolescent/teenage (age 9-18) patients getting the following diseases or infections.

15

12% 16%

43% 42%30%

39%7%

8%

17%

44%

11%

30%

7%6%

6% 6%

Very Concerned Extremely Concerned

9-10 11-12 13-15 16-18 9-10 11-12 13-15 16-18

GP/FPs Pediatricians(n=309) (n=333)

Physician Concern About HPV

Percentage of top 2 box on a 5-point scale.How concerned are you about Humanpapilloma Virus (HPV) infection with regards to your adolescent/teenage (age 9-18) patients?

Years of Age

16

Need for Vaccines Against STDs

81%

39%

78%

47%

0%

20%

40%

60%

80%

100%

Girls Age 9-12 Girls Age 13-18

GP/FPs (n=309) Peds (n=333)

Physicians reported that they believe vaccines against STDs are important for their 9-18 year old patients

Percentage of top 2 box on a 5-point scale Thinking about your adolescent patients age 9-12 or 13-18 please indicate how much you agree or disagree with the following statements.

17

9-10 11-12 13-15 16-18

47%

59%

79%

90%

45%

58%

79%88%

GP/FPs (n=309) Peds (n=333)

Physician likelihood to recommend a hypothetical vaccine for HPV for teenagers is high

Vaccination Recommendation

Mean percentage.Based on the information you just read, how likely are you to recommend this vaccine to each of the age groups below?

18

Parental Resistance

40% 28% 5%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Parents WillResist Vaccine

Somewhat important Very Important Extremely important

Base: All physicians (n=642) – 5-point scaleLooking at the list below, please indicate how important each of the factors are when considering not to recommend this vaccine to your adolescent/teenage (age 9-18) patients.

Among almost all physicians (73%), parental resistance to a hypothetical vaccine for HPV was considered an extremely, very, or somewhat important barrier to vaccination

19

Summary

• Physicians (pediatricians and FP/GPs) have similar beliefs about the sexual activity of their patients

– Physicians believe female patients engage in vaginal intercourse at an average age of 16

• Physicians are more comfortable having sexual risk discussions as their patients get older

– Pediatricians are more likely to start discussions before patients are sexually active

– Over 60% of physicians believe that their patients aged 9-12 should not engage in any sexual activity before marriage

20

Summary

• While physicians perceive HPV to be serious, they do not believe it to be as serious as HIV or Hepatitis B infections

– Of the sexually transmitted diseases asked about, physicians believe that their patients are most likely to become infected with HPV or chlamydia

– Physicians are more likely to be concerned about HPV infection among their older patients

• Physicians believe vaccines for STDs are needed for their 9-18 year old patients

• Physicians are more likely to recommend a hypothetical HPV vaccine for their older patients

21

Summary

• Physicians are concerned that parents will resist vaccination

– Other data suggest that parents are receptive to vaccination and that a strong recommendation increases parental acceptance1

1Lenar AJ, Parental Receptiveness to a Hypothetical HPV Vaccine

22