{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:37:32Z","timestamp":1790804252267,"version":"4.1.0"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"\n BACKGROUND AND OBJECTIVES<\/jats:title>\n Although HPV vaccine initiation as early as aged 9\u00a0years has been recommended, most clinicians initiate at ages 11 to 12\u00a0years. We assessed clinician-reported impact of early initiation on parental responses and vaccine discussions.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n As part of an ongoing cluster randomized pragmatic trial across 31 Colorado and California pediatric practices, we allocated practices to switch HPV vaccine initiation to ages 9 to 10\u00a0years or to enhanced usual care (initiation at ages 11 to 12\u00a0years). All clinicians received online training on improving HPV vaccination; intervention arm clinicians also received training on initiating at ages 9 to 10\u00a0years. We surveyed all clinicians in both arms at 1, 6, 12, 18, 24, 30, and 36 months (all &gt;80% response rates), and queried clinicians in the ages 9 to 10\u00a0years arm about vaccination at ages 9 to 10 vs 11 to 12\u00a0years.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Almost all intervention arm clinicians switched rapidly to the ages 9 to 10\u00a0years initiation; most control clinicians remained at ages 11 to 12\u00a0years. Parental concerns\/questions, pushback, hesitancy, and adherence to recommendations did not differ significantly between study arms and were similar at ages 9 to 10 vs 11 to 12\u00a0years among intervention arm clinicians. Only about one-tenth of clinicians in both arms brought up sexual activity during HPV vaccine discussions; two-thirds in both arms indicated parents sometimes\/often did. Intervention arm clinicians were more likely than controls to state discussions were shorter by a lot\/little (55% vs 37%, P\u2009=\u2009.005) since study initiation.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Initiating HPV vaccination at ages 9 to 10\u00a0years instead of ages 11 to 12\u00a0years had little impact on parental questions\/concerns, pushback, hesitancy, or clinicians\u2019 ability to convince hesitant parents. Initiation at ages 9 to 10\u00a0years was perceived by clinicians to shorten HPV vaccine discussions.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2025-074674","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:02:53Z","timestamp":1775520173000},"source":"Crossref","is-referenced-by-count":1,"title":["Clinician Perceptions of the Impact of Switching HPV Vaccine Initiation to 9\u201310\u00a0Years"],"prefix":"10.1542","volume":"157","author":[{"given":"Peter G.","family":"Szilagyi","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Gurfinkel","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"},{"name":"2Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado and Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Clark","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Albertin","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Saville","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"},{"name":"3Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean T.","family":"O\u2019Leary","sequence":"additional","affiliation":[{"name":"2Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado and Children\u2019s Hospital Colorado, Aurora, Colorado"},{"name":"3Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Beaty","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sitaram","family":"Vangala","sequence":"additional","affiliation":[{"name":"4David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heide","family":"Woo","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Golden","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, University of California, Irvine, California"},{"name":"6Rady Children\u2019s Health, Orange County, Orange, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasjit","family":"Singh","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, University of California, Irvine, California"},{"name":"6Rady Children\u2019s Health, Orange County, Orange, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Kempe","sequence":"additional","affiliation":[{"name":"2Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado and Children\u2019s Hospital Colorado, Aurora, Colorado"},{"name":"3Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"issue":"19","key":"2026090101171070400_r1","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1056\/NEJMcp2108502","article-title":"Human papillomavirus vaccination","volume":"388","author":"Markowitz","year":"2023","journal-title":"N Engl J Med."},{"key":"2026090101171070400_r2","volume-title":"Increase the proportion of adolescents who get recommended doses of the HPV vaccine \u2014 IID\u201308","author":"Office of Disease Prevention and Health Promotion","year":"2030"},{"issue":"30","key":"2026090101171070400_r3","doi-asserted-by":"crossref","first-page":"466","DOI":"10.15585\/mmwr.mm7430a1","article-title":"Vaccination coverage among adolescents aged 13\u201317\u00a0years - National Immunization Survey-Teen, United States, 2024","volume":"74","author":"Pingali","year":"2025","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"2026090101171070400_r4","volume-title":"Immunizations for Adolescents (IMA)","author":"National Committee for Quality Assurance"},{"issue":"5","key":"2026090101171070400_r5","doi-asserted-by":"crossref","first-page":"e154","DOI":"10.3928\/19382359-20250307-01","article-title":"Vaccine hesitancy: where are we now?","volume":"54","author":"Gilliland","year":"2025","journal-title":"Pediatr Ann."},{"issue":"2","key":"2026090101171070400_r6","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/MOP.0000000000001441","article-title":"HPV vaccine hesitancy in the United States","volume":"37","author":"Joshi","year":"2025","journal-title":"Curr Opin Pediatr."},{"issue":"49","key":"2026090101171070400_r7","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.15585\/mmwr.mm6549a5","article-title":"Use of a 2-dose schedule for human papillomavirus vaccination - updated recommendations of the Advisory Committee on Immunization Practices","volume":"65","author":"Meites","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"6","key":"2026090101171070400_r8","doi-asserted-by":"crossref","first-page":"2146434","DOI":"10.1080\/21645515.2022.2146434","article-title":"Why the American Academy of Pediatrics recommends initiating HPV vaccine at age 9","volume":"18","author":"O\u2019Leary","year":"2022","journal-title":"Hum Vaccin Immunother."},{"key":"2026090101171070400_r9","first-page":"582","volume-title":"Red Book: 2018 Report of the Committee on Infectious Diseases","author":"American Academy of Pediatrics","year":"2018","edition":"31st ed"},{"key":"2026090101171070400_r10","doi-asserted-by":"crossref","first-page":"100401","DOI":"10.1016\/j.eclinm.2020.100401","article-title":"Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four Nordic countries","volume":"23","author":"Kjaer","year":"2020","journal-title":"EClinicalMedicine."},{"issue":"9","key":"2026090101171070400_r11","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1001\/jamapediatrics.2021.0766","article-title":"Effect of training pediatric clinicians in human papillomavirus communication strategies on human papillomavirus vaccination rates: a cluster randomized clinical trial","volume":"175","author":"Szilagyi","year":"2021","journal-title":"JAMA Pediatr."},{"issue":"2","key":"2026090101171070400_r12","doi-asserted-by":"crossref","first-page":"e2024068145","DOI":"10.1542\/peds.2024-068145","article-title":"A bundled, practice-based intervention to increase HPV vaccination","volume":"155","author":"Szilagyi","year":"2025","journal-title":"Pediatrics."},{"issue":"1","key":"2026090101171070400_r13","doi-asserted-by":"crossref","first-page":"2480870","DOI":"10.1080\/21645515.2025.2480870","article-title":"Human papillomavirus vaccination at age 9 or 10\u00a0years to increase coverage - a narrative review of the literature, United States 2014\u20132024","volume":"21","author":"Brewer","year":"2025","journal-title":"Hum Vaccin Immunother."},{"issue":"3","key":"2026090101171070400_r14","doi-asserted-by":"crossref","first-page":"2269026","DOI":"10.1080\/21645515.2023.2269026","article-title":"Evidence supporting the initiation of HPV vaccination starting at age 9: collection overview","volume":"19","author":"Perkins","year":"2023","journal-title":"Hum Vaccin Immunother."},{"issue":"4","key":"2026090101171070400_r15","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.acap.2022.01.008","article-title":"Recommending human papillomavirus vaccination at age 9: a national survey of primary care professionals","volume":"22","author":"Kong","year":"2022","journal-title":"Acad Pediatr."},{"key":"2026090101171070400_r16","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.ypmed.2017.07.016","article-title":"Association of physicians perceived barriers with human papillomavirus vaccination initiation","volume":"105","author":"Farias","year":"2017","journal-title":"Prev Med."},{"issue":"4","key":"2026090101171070400_r17","doi-asserted-by":"crossref","first-page":"e20191475","DOI":"10.1542\/peds.2019-1475","article-title":"HPV vaccine delivery practices by primary care physicians","volume":"144","author":"Kempe","year":"2019","journal-title":"Pediatrics."},{"key":"2026090101171070400_r18","first-page":"149","article-title":"Changes in strength of recommendation and perceived barriers to human papillomavirus vaccination: longitudinal analysis of primary care physicians, 2008\u20132018","volume-title":"J Pediatr.","author":"Cataldi","year":"2021"},{"issue":"1","key":"2026090101171070400_r19","doi-asserted-by":"crossref","first-page":"e20193852","DOI":"10.1542\/peds.2019-3852","article-title":"Parental hesitancy about routine childhood and influenza vaccinations: a national survey","volume":"146","author":"Kempe","year":"2020","journal-title":"Pediatrics."},{"issue":"38","key":"2026090101171070400_r20","doi-asserted-by":"crossref","first-page":"6027","DOI":"10.1016\/j.vaccine.2020.06.074","article-title":"Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US","volume":"38","author":"Szilagyi","year":"2020","journal-title":"Vaccine."},{"issue":"8","key":"2026090101171070400_r21","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1093\/jpids\/piac049","article-title":"COVID-19 vaccine acceptance among US parents: a nationally representative survey","volume":"11","author":"Hammershaimb","year":"2022","journal-title":"J Pediatric Infect Dis Soc."},{"key":"2026090101171070400_r22","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform."},{"issue":"1","key":"2026090101171070400_r23","doi-asserted-by":"crossref","first-page":"e2024069625","DOI":"10.1542\/peds.2024-069625","article-title":"Feasibility and acceptability of recommending HPV vaccine at ages 9\u201310\u00a0years","volume":"156","author":"Tietbohl","year":"2025","journal-title":"Pediatrics."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-074674\/1923983\/pediatrics.2025074674.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-074674\/1923983\/pediatrics.2025074674.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:17:19Z","timestamp":1788239839000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/157\/5\/e2025074674\/207113\/Clinician-Perceptions-of-the-Impact-of-Switching"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,4,7]]},"published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2025-074674","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]},"article-number":"e2025074674"}}