1. Physician Attitudes and Receptiveness to STD Vaccines MVD Business Research Merck & Company, Inc.

2. 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. 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. 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. 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)

6. Results

7. 7 Sample Characteristics GP/FPsPeds n=309n=333 Average % time seeing patients98%98% Average number of years in practice16.916.8 Number of patients per week136122 Solo practice24%14% Single specialty practice 69%78% Staff Model HMO4%8%

8. 8 Perception of Patient Sexual Activity 9-1011-1213-1516-18 9-1011-1213-1516-18 % of Patients Sexually Active Patient Age GP/FPs n=309 Pediatricians n=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. 9 Perceptions of Specific Female Sexual Activity n = 642Average AgeYoungest Age Masturbation63512.99.9 Mutual Masturbation63315.412.7 Oral Sex63615.812.6 Vaginal Intercourse63816.112.7 Anal Intercourse58917.415.2 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. 10 Comfort Level with Discussions 9-1011-1213-1516-189-1011-1213-1516-18 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. 11 Timing of Sexual Risk Discussions GP/FPs n=309 Peds n=333 Before patient is sexually active22%34% When I suspect a patient is sexually active51%27% Only when patient/parent asks me4%2% When do you most commonly speak to your teenage/adolescent patients (age 9-18) about sexually transmitted diseases?

12. 12 Discussions with Patients GP/FPs n=309 Peds n=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. 13 Perception of Disease Severity 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. 14 Likelihood of Infection/Diseases 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. 15 9-10 11-12 13-15 16-189-1011-1213-1516-18 GP/FPsPediatricians (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. 16 Need for Vaccines Against STDs 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. 17 9-10 11-12 13-15 16-18 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. 18 Parental Resistance Base: All physicians (n=642) – 5-point scale Looking 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. 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. 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. 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 acceptance 1 1 Lenar AJ, Parental Receptiveness to a Hypothetical HPV Vaccine

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