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J Adolesc Health. 2015 May;56(5 Suppl):S17-20. doi: 10.1016/j.jadohealth.2014.10.273.

Effectiveness of centralized text message reminders on human papillomavirus immunization coverage for publicly insured adolescents.

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Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. Electronic address:
Monroe Plan for Medical Care, Rochester, New York.
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
Department of Research, Division of Primary Care Research, American Academy of Pediatrics, Elk Grove Village, Illinois.
Mattel Children's Hospital UCLA, Los Angeles, California.



We evaluated a managed care organization (MCO)-generated text message reminder-recall system designed to improve human papillomavirus (HPV) vaccination coverage.


We conducted a randomized controlled trial of text reminder-recall for parents of 3,812 publicly insured adolescents aged 11-16 years with no prior HPV vaccinations who were enrolled in a single MCO and were patients at one of 39 primary care practices. We determined the rate of HPV receipt for intervention versus control with the Kaplan-Meier failure function and determined hazard ratios using a clustered stratified Cox model, clustering on primary care provider and stratified on practice. We examined results for all subjects, and for those with a valid phone number, stratified by age group (11-13 years and 14-16 years) and gender. A post hoc analysis included all subjects and controlled for age and gender.


HPV dose 1 vaccination rates were not significantly different when all participants were included, but for the subset of parents (54%) able to receive messages, HPV dose 1 rates were 13% for the control group and 16% for the intervention group; hazard ratio, 1.3 (95% confidence interval, 1.0-1.6; p = .04), when controlling for age and gender. There were no significant findings in the analysis stratified by age and gender.


MCO-based text reminders are feasible and have a modest effect on HPV dose 1 vaccination rates for those parents able to receive text messages with valid phone numbers in the MCO database. Future studies should examine a similar intervention for those parents who already accepted the first HPV vaccine dose.


Adolescent health services; Human papillomavirus vaccines; Reminder systems; Text messaging

[Indexed for MEDLINE]

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