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Hirth J, Ostovar-Kermani T, Gutierrez JA, Thompson EL, Barnett TE, Zoorob R. Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series. Vaccine 2024; 42:2827-2836. [PMID: 38519345 DOI: 10.1016/j.vaccine.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Up-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD. METHODS A secondary analysis of The National Immunization Survey - Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators. RESULTS The final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9-10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78-8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65-0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46-0.96). CONCLUSION Strong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.
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Affiliation(s)
- Jacqueline Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, United States.
| | | | - Judith A Gutierrez
- Department of Family and Community Medicine, Baylor College of Medicine, United States
| | - Erika L Thompson
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, United States
| | - Tracey E Barnett
- Department of Quantitative & Qualitative Health Sciences, School of Public Health, University of Texas at San Antonio, United States
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, United States
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Schelbar N, Ward CN, Phillips E, Herr MJ, Acevedo S, Conner H, Greiner A, Corriveau E. Impact of COVID-19 pandemic and vaccine perceptions on HPV vaccine hesitancy. Am J Otolaryngol 2024; 45:104172. [PMID: 38103489 DOI: 10.1016/j.amjoto.2023.104172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This study evaluated the impact of the COVID-19 pandemic and vaccine perceptions on Human Papillomavirus (HPV) vaccine hesitancy. Secondary endpoints included comparing COVID-19 and HPV vaccination trends regarding time, community of residence, and unmet social needs. METHODS This was a survey-based, cross-sectional study that included 101 participants who were recruited through the Wyandotte County Public Health Department. Participants were eligible for inclusion in this study if they were a parent/guardian of one or more children aged 13 to 17; English- or Spanish-speaking. This study took place in Wyandotte County, Kansas. Descriptive statistics and chi-square analyses were utilized. RESULTS There was no difference in completion of COVID-19 and HPV vaccines (p = 0.0975). Significantly more individuals started and did not finish the HPV vaccine series compared to the COVID-19 vaccine series (p = 0.0004). Most participants indicated their opinion on the HPV vaccine had not changed due to the pandemic (71.3 %). Participants who felt familiar with HPV had higher rates of HPV vaccine completion. While 77 % of participants felt extremely or moderately familiar with HPV, 61.4 % were unaware of its association with oropharyngeal cancer. CONCLUSION There was minimal change in parents' perception of the HPV vaccine due to the COVID-19 pandemic despite decreased rates of vaccination during this time. HPV vaccine series completion was significantly lower than COVID-19 vaccine series completion, highlighting a need to improve HPV vaccine completion counseling. Additionally, patient education should address the knowledge gap discovered regarding the link between HPV infection and oropharyngeal cancer.
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Affiliation(s)
- Natalie Schelbar
- University of Kansas School of Medicine, Kansas City, KS, United States of America.
| | - Christina N Ward
- University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States of America
| | - Elaine Phillips
- University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Michael J Herr
- University of Alabama at Birmingham Heersink School of Medicine, Department of Cell, Developmental, and Integrative Biology, United States of America
| | - Sarah Acevedo
- University of Virginia, Department of Medicine, Charlottesville, VA, United States of America
| | - Hannah Conner
- Wyandotte County Unified Government Public Health Department, Kansas City, KS, United States of America
| | - Allen Greiner
- Wyandotte County Unified Government Public Health Department, Kansas City, KS, United States of America; University of Kansas Medical Center Department of Family Medicine & Community Health, Kansas City, KS, United States of America
| | - Erin Corriveau
- Wyandotte County Unified Government Public Health Department, Kansas City, KS, United States of America; University of Kansas Medical Center Department of Family Medicine & Community Health, Kansas City, KS, United States of America
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Minihan AK, Bandi P, Star J, Fisher-Borne M, Saslow D, Jemal A. The association of initiating HPV vaccination at ages 9-10 years and up-to-date status among adolescents ages 13-17 years, 2016-2020. Hum Vaccin Immunother 2023; 19:2175555. [PMID: 36748322 PMCID: PMC10026883 DOI: 10.1080/21645515.2023.2175555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Recent guidelines from the American Cancer Society stress HPV vaccination series initiation at the youngest opportunity, i.e., age 9 years. There are limited data on the association between initiating HPV vaccination at ages 9-10 years and up-to-date (UTD) status. In this study, we compare nationally representative UTD HPV vaccination rates between adolescents who initiated the series younger (ages 9-10 years) vs. older (≥ age 11 years). Five years of pooled data (2016-2020) from National Immunization Survey-Teen were used to estimate the UTD HPV vaccination prevalence among younger vs. older initiating 13-17-year-olds. Adjusted logistic regression models estimated prevalence ratios (aPRs), differences (aDs), and difference in differences (aDDs) in prevalence of being UTD to assess the overall association of age at initiation with being UTD and differences in sociodemographic predictors of being UTD among younger vs. older initiators. UTD prevalence for younger initiators was 93% compared with 72% among older initiators (aPR: 1.27,95%CI: 1.24,1.31). Among older initiators, UTD prevalence was significantly different by sex, insurance status, and current age; no such differences were observed among younger initiators. Results indicate that younger initiation is associated with a 27% higher UTD prevalence, highlighting the importance of promoting younger initiation, particularly among those with health-care barriers.
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Affiliation(s)
- Adair K Minihan
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
| | - Priti Bandi
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
| | - Jessica Star
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
| | | | - Debbie Saslow
- Prevention and Early Detection, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
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O'Leary ST. Why the American Academy of Pediatrics recommends initiating HPV vaccine at age 9. Hum Vaccin Immunother 2022; 18:2146434. [PMID: 36404635 DOI: 10.1080/21645515.2022.2146434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American Academy of Pediatrics (AAP) recommends starting the human papillomavirus (HPV) vaccine series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series. This recommendation differs from the Advisory Committee on Immunization Practices (ACIP), which recommends HPV vaccination be initiated at age 11 or 12 years, stating the series can be started at age 9 years. This commentary discusses the reasoning behind AAP's decision to differ from ACIP, as the AAP and ACIP schedules are essentially harmonized for all other vaccines. Reasons include recognition that (1) vaccination uptake is suboptimal; (2) offering vaccination earlier offers provider's flexibility in introducing the vaccine; (3) initiating the vaccine at age 9 or 10 may be preferable for parents or adolescents who do not want to receive ≥3 concomitant vaccines at age 11 or 12; (4) earlier initiation may disentangle HPV recommendations from discussions of sexuality; (5) earlier recommendation might alleviate HPV vaccine hesitancy "fatigue;" (6) the immune response is robust at younger ages with no evidence of waning protection; and (7) there is a dearth of evidence supporting starting the recommendation at age 11 or 12 within the "adolescent immunization platform."
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO, USA
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Kim J, Dove MS, Dang JHT. Sociodemographic factors associated with HPV awareness/knowledge and cervical cancer screening behaviors among caregivers in the U.S. BMC Womens Health 2022; 22:335. [PMID: 35941594 PMCID: PMC9358833 DOI: 10.1186/s12905-022-01918-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 08/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Family caregivers may be at a higher risk for several chronic diseases, including cancer. Cervical cancer is one of the most common causes of cancer death among women. Despite family caregivers' vulnerability, the status of their HPV awareness, knowledge, and preventive health behaviors, including cervical cancer screening, has been understudied. Thus, this study aimed to examine the sociodemographic factors associated with HPV awareness and knowledge and adherence to the cervical cancer screening guidelines among caregivers in the U.S. METHODS Nationally representative cross-sectional survey data were obtained from the Health Information National Trends Survey (HINTS 5, 2017-2020). Female caregivers aged 21-65 were included (N = 1190). Weighted multivariable logistic regression was performed to identify factors associated with HPV awareness (heard of HPV), knowledge (HPV can cause cervical cancer), and adherence to the United States Preventive Service Task Force 2018 cervical cancer screening guidelines by sociodemographic factors (age, race/ethnicity, education, household income, marital status,) and the intensity of caregiving. RESULTS An estimated 79% of female caregivers were aware of HPV and 84% adhered to the cervical cancer screening guidelines. Caregivers who were older than 50 (OR = 3.62, 1.91-6.85, adherence of aged 21-50 vs. 51-65), Hispanics of race/ethnicity compared with Black/African Americans (OR = 3.14, 1.31-7.52, adherence of Black/African Americans vs. Hispanics), with a high school education or less (OR = 2.34, 1.14-4.82, adherence of Some college or more vs. High school education or less), and with intense caregiving duty (spending 35 h/week or more on caregiving) compared with light-duty (OR = 2.34, 1.10-5.00, adherence of 5-14 h vs. 35 h or more, weekly) had poor adherence to the cervical cancer screening guidelines. Caregivers who were older, racial minorities (Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Multiple races), and less educated showed lower HPV awareness (Heard of HPV) than their counterparts. CONCLUSIONS There are caregiving populations whose HPV awareness and cervical cancer screening adherence are low. To improve their awareness and knowledge of HPV and support their cervical cancer screening behaviors, we need to consider interventions that target those specific populations.
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Affiliation(s)
- Jiyeong Kim
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, USA.
| | - Melanie S. Dove
- grid.27860.3b0000 0004 1936 9684Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, USA
| | - Julie H. T. Dang
- grid.27860.3b0000 0004 1936 9684Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, USA
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Larsen A, Cedergren A. Records request response rate and vaccination status of first-time college students at a mid-sized Midwestern university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1874-1881. [PMID: 33151827 DOI: 10.1080/07448481.2020.1841209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/19/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
Objective: The purpose of this study was to establish the response rate of first-time college students to a vaccination records request, and to obtain student vaccination rates for selected vaccines. Participants: Student health records for the fall 2018 cohort of first-time college students were reviewed. Methods: Vaccination and response rates were compared based on sex, race/ethnicity, and home state. Results: There was a 66% response rate to the vaccination records request with no difference in response rate based on student demographics. Students exceeded most of the Healthy Campus 2020 vaccination targets. The human papillomavirus (HPV) and meningitis ACWY vaccines had the greatest room for improvement. Female students were significantly more likely to have a completed HPV vaccine series. Conclusions: Records response rates may be improved by students accessing and reporting state vaccination information during a required orientation. Following (CDC) guidelines for vaccination success may improve vaccination rates for HPV and menACWY.
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Affiliation(s)
- Alexandra Larsen
- Student Health Center, University of Wisconsin-La Crosse, La Crosse, Wisconsin, USA
| | - Anders Cedergren
- Department of Health Education and Health Promotion, University of Wisconsin-La Crosse, La Crosse, Wisconsin, USA
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Social determinants of human papillomavirus vaccine series completion among U.S. adolescents: A mixed-methods study. SSM Popul Health 2022; 18:101082. [PMID: 35493405 PMCID: PMC9038569 DOI: 10.1016/j.ssmph.2022.101082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/16/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Human papillomavirus (HPV) vaccination can significantly reduce HPV-associated cancers. In the US, two doses are recommended for vaccine completion for younger adolescents. However, series completion rates remain below the nation's goal of 80% coverage. Multi-faceted factors may influence adolescent series completion. The purpose of this study was to identify individual-level, relationship-level, and community-level factors of timely series completion among adolescents, ages 11–14, initiating the HPV vaccine series in 2017. Methods A convergent, mixed-methods design was used combining adolescent electronic health record data (n = 803) and qualitative interviews with adolescents and their parents (n = 32) to assess timely series completion within 14-months (e.g., January 2018 to February 2019). Multivariable logistic regression analysis examined individual-level and community-level factors influencing timely series completion. Directed content analysis was used to identify relevant themes and subthemes. We provided an integrative summary to assess patterns of convergence or divergence between quantitative and qualitative data. Results In the quantitative phase, 61.0% of adolescents completed the vaccine series and 47.3% completed it on-time. Higher odds of timely series completion were among younger adolescents at vaccine initiation (aOR = 1.82, 95%CI = 1.07, 3.11) and lower among adolescents who were Black (aOR = 0.57, 95%CI = 0.37, 0.89) and Hispanic (aOR = 0.54, 95%CI = 0.30, 0.95) compared to Non-Hispanic White adolescents and those without private insurance (aOR = 0.56, 95%CI = 0.37, 0.85). Qualitative findings revealed increased risk for HPV at sexual debut as a motivator for timely series completion. Family/peers and healthcare providers influenced timely series completion among minority adolescents. Community-level factors were not significantly associated with timely series completion, however, qualitative findings revealed lack of transportation as a barrier to timely series completion. Conclusion Multi-level factors continue to influence timely series completion, despite fewer doses needed for series completion. Innovative strategies are needed to improve care coordination for receiving vaccine doses, patient-provider communication about series completion and increase access to HPV vaccine. Access barriers create challenges for teens to complete the HPV vaccine series. Racial/ethnic disparities in adolescent HPV vaccine series completion exist. Family and healthcare providers influence parents' decisions for series completion. Parents and adolescents continue to misunderstand the HPV vaccine schedule. Despite barriers, parents and teens are motivated to finish the HPV vaccine series.
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031|] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Hubbard D, Shrestha S, Levitan EB, Yun H. Human Papillomavirus Vaccination Schedule: Adherence Among Commercially Insured Adolescents and Young Adults in the United States, 2011–2017. Am J Public Health 2020; 110:385-390. [DOI: 10.2105/ajph.2019.305485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To determine rates of human papillomavirus (HPV) vaccine adherence to the 2011 and 2016 Advisory Committee for Immunization Practices (ACIP) recommendations in the United States. Methods. We conducted a retrospective cohort study by using the 2011 to 2017 Marketscan data for beneficiaries aged 9 to 26 years who had at least 1 claim for HPV vaccination between January 1, 2011, and January 1, 2017. According to the 2011 ACIP recommendation, adherence is defined as 30 to 90 days between the first and second vaccination and 168 to 212 days between the first and third vaccination. According to the 2016 recommendation, preadolescents are classified as adherent if they had 2 claims of vaccination within 168 to 212 days. We calculated proportions of completion and adherence by recommendation. Results. Among patients classified under the 2011 ACIP recommendation (n = 2 164 096), 8.3% completed all 3 doses of the vaccine series. Of those who completed, 69.6% were considered adherent to the recommended schedule. Completion and adherence increased to 9.6% and 70.8%, respectively, among patients who were classified under the 2016 ACIP recommendation. Conclusions. Simpler recommendations lead to better adherence to the HPV vaccination schedule.
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Affiliation(s)
- Demetria Hubbard
- All authors are affiliated with the Department of Epidemiology, University of Alabama at Birmingham
| | - Sadeep Shrestha
- All authors are affiliated with the Department of Epidemiology, University of Alabama at Birmingham
| | - Emily B. Levitan
- All authors are affiliated with the Department of Epidemiology, University of Alabama at Birmingham
| | - Huifeng Yun
- All authors are affiliated with the Department of Epidemiology, University of Alabama at Birmingham
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Factors influencing Human papillomavirus (HPV) vaccination series completion in Mississippi Medicaid. Vaccine 2020; 38:2051-2057. [DOI: 10.1016/j.vaccine.2019.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/08/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022]
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Spencer JC, Brewer NT, Trogdon JG, Wheeler SB, Dusetzina SB. Predictors of Human Papillomavirus Vaccine Follow-Through Among Privately Insured US Patients. Am J Public Health 2018; 108:946-950. [PMID: 29771616 DOI: 10.2105/ajph.2018.304408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess predictors of timely human papillomavirus (HPV) vaccine follow-through among privately insured individuals initiating the 3-dose series. METHODS Using MarketScan Commercial claims data, we identified 1 332 217 privately insured US individuals aged 9 to 26 years who initiated the bivalent or quadrivalent HPV vaccine series from 2006 to 2014, with follow-up data extending through 2015. The study outcome was receipt of third HPV dose within 12 months of the first, compared by year of initiation. Control variables were age, region, insurance plan type, provider type, and seasonal influenza vaccination. RESULTS Timely HPV vaccine follow-through fell over time. The trend was especially pronounced for females (from 67% in 2006 to 38% in 2014), but was also present for males (from 36% in 2011 to 33% in 2014). Similar patterns were present when we controlled for patient and provider characteristics or used alternative definitions of follow-through. Other positive predictors of timely follow-through included receipt of flu vaccine in the prior year and receipt of first HPV vaccine dose from an obstetrician/gynecologist. CONCLUSIONS HPV vaccine follow-through is low and has declined over time.
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Affiliation(s)
- Jennifer C Spencer
- At the time of the study, Jennifer C. Spencer, Stephanie B. Wheeler, Justin G. Trogdon, and Stacie B. Dusetzina were with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Noel T. Brewer was with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Stacie B. Dusetzina was also with the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Noel T Brewer
- At the time of the study, Jennifer C. Spencer, Stephanie B. Wheeler, Justin G. Trogdon, and Stacie B. Dusetzina were with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Noel T. Brewer was with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Stacie B. Dusetzina was also with the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Justin G Trogdon
- At the time of the study, Jennifer C. Spencer, Stephanie B. Wheeler, Justin G. Trogdon, and Stacie B. Dusetzina were with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Noel T. Brewer was with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Stacie B. Dusetzina was also with the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Stephanie B Wheeler
- At the time of the study, Jennifer C. Spencer, Stephanie B. Wheeler, Justin G. Trogdon, and Stacie B. Dusetzina were with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Noel T. Brewer was with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Stacie B. Dusetzina was also with the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Stacie B Dusetzina
- At the time of the study, Jennifer C. Spencer, Stephanie B. Wheeler, Justin G. Trogdon, and Stacie B. Dusetzina were with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Noel T. Brewer was with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Stacie B. Dusetzina was also with the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
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Widdice LE, Hoagland R, Callahan ST, Kahn JA, Harrison CJ, Pahud BA, Frey SE, Berry AA, Kotloff KL, Edwards KM, Mulligan MJ, Sudman J, Nakamura A, Bernstein DI. Caregiver and adolescent factors associated with delayed completion of the three-dose human papillomavirus vaccination series. Vaccine 2018; 36:1491-1499. [PMID: 29428177 PMCID: PMC6055999 DOI: 10.1016/j.vaccine.2017.12.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Delayed completion of human papillomavirus vaccination (4vHPV) series is common. We sought to identify factors associated with delay. METHODS This substudy was part of a large prospective, multi-site study recruiting 9-17 year old girls at the time of their third 4vHPV dose to assess immunogenicity associated with prolonged dosing intervals. At participating sites, parents/legal guardians (caregivers) of all enrolled girls (9-17 years old) and enrolled girls aged 14-17 years were approached for participation. Caregivers completed a questionnaire measuring adolescent and caregiver sociodemographic characteristics, caregiver attitudes and beliefs about on-schedule HPV vaccination and HPV vaccine safety, adolescent's health behaviors, barriers to accessing health care, provider office vaccination practices and a Rapid Estimate of Adult Literacy in Medicine (REALM). Participating girls completed a separate questionnaire measuring their attitudes and beliefs about on-schedule HPV vaccination and HPV vaccine safety. Delay was defined as receiving the third 4vHPV dose >12 months after the first. Bivariate, multinomial logistic regression and multivariate logistic regression analyses were used to identify factors predicting delayed completion. RESULTS Questionnaires were completed by 482 caregivers and 386 adolescents; 422 caregivers completed a REALM. Delayed 4vHPV dosing occurred in most adolescents (67%). In multivariate analyses, predictors of delayed completion included caregiver demographic factors (self-reported black vs. white race and high school or less education vs. college or more) and an interaction between caregiver's inability to get an immunization appointment as soon as needed and adolescent's type of insurance. CONCLUSIONS Caregiver's race and educational level, accessibility of immunization appointments, and adolescent's insurance type were found to be related to delays in completion of 4vHPV, but caregiver or adolescent attitudes and beliefs about on-schedule HPV vaccination or HPV vaccine safety were not. Therefore, interventions to improve adherence to recommended vaccination schedules could benefit from a focus on improving access to immunizations. ClinicalTrials.gov (NCT01030562).
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Affiliation(s)
- Lea E Widdice
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
| | - Rebecca Hoagland
- Cota Enterprises, Inc., 16570 46th Street, McLouth, KS, 66054 , United States.
| | - S Todd Callahan
- Division of Adolescent and Young Adult Health, Vanderbilt University, 719 Thompson Lane Suite 36300, Nashville, TN 37204, United States.
| | - Jessica A Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
| | - Christopher J Harrison
- Division of Pediatric Infectious Diseases, Children's Mercy Hospital Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Barbara A Pahud
- Division of Pediatric Infectious Diseases, Children's Mercy Hospital Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Sharon E Frey
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States.
| | - Andrea A Berry
- Division of Infectious Diseases and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Karen L Kotloff
- Division of Infectious Diseases and Tropical Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Kathryn M Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt Vaccine Research Program, D7227 Medical Center North, Vanderbilt University School of Medicine, Nashville, TN, United States.
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court, Suite 200, Decatur, GA 30030, United States.
| | - Jon Sudman
- Kaiser Permanente Georgia, 200 Crescent Centre Parkway, Tucker, GA 30084, United States.
| | - Aya Nakamura
- The Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, United States.
| | - David I Bernstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
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Widdice LE, Unger ER, Panicker G, Hoagland R, Callahan ST, Jackson LA, Berry AA, Kotloff K, Frey SE, Harrison CJ, Pahud BA, Edwards KM, Mulligan MJ, Sudman J, Bernstein DI. Antibody responses among adolescent females receiving two or three quadrivalent human papillomavirus vaccine doses at standard and prolonged intervals. Vaccine 2018; 36:881-889. [PMID: 29306506 PMCID: PMC6055998 DOI: 10.1016/j.vaccine.2017.12.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/21/2017] [Accepted: 12/07/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The originally recommended dosing schedule, 0, 2, 6 months, for the 3-dose quadrivalent human papillomavirus vaccine (4vHPV) was often not followed, resulting in longer than recommended intervals between doses and interest in the effect of prolonged intervals. Recent two-dose recommendations require investigations into the effect of delaying dose 2. METHODS This multi-site, prospective study enrolled healthy 9-17 year old girls (n = 1321) on the day of or within 28 days following a third dose of 4vHPV vaccination. Antibody titers to 4vHPV types were measured at one and six months post-dose 3 from all participants and post-dose 2 from participants who were on time for dose 3. To compare antibody responses, participants were categorized into groups: second and third doses on time (control group); on-time dose 2, substantially late dose 3 (group 2); substantially late dose 2, on-time dose 3 (group 3); both doses substantially late (group 4). Analyses compared age-adjusted geometric mean titers (GMTs) at one-month and six-months post-dose 3, effect of delaying the second dose, and two versus three doses as well as post-dose 2 GMTs, stratified by age. RESULTS Compared to on-time dosing, one-month post-dose 3 GMTs were non-inferior in groups 2, 3, and 4 and were superior in group 2. Six month post-dose 3 GMTs were superior in groups 2, 3, and 4 for each genotype, except HPV 18 in group 3. Age-adjusted post does 2 titers were significantly lower than post-dose 3 titers when dose 2 was on time but were significantly higher when dose 2 was substantially late. Participants ≥15 years old had no difference in post-dose 2 titers compared to <15 year olds when dose 2 was substantially delayed. CONCLUSIONS Prolonged intervals between doses do not appear to diminish and may enhance antibody response to 4vHPV. ClinicalTrials.gov (NCT00524745).
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Affiliation(s)
- Lea E Widdice
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Rebecca Hoagland
- Cota Enterprises, Inc., 16570 46th Street, McLouth, KS 66054, United States.
| | - S Todd Callahan
- Division of Adolescent and Young Adult Health, Vanderbilt University, 719 Thompson Lane, Suite 36300, Nashville, TN 37204, United States.
| | - Lisa A Jackson
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, United States.
| | - Andrea A Berry
- Division of Infectious Disease and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Sharon E Frey
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States.
| | - Christopher J Harrison
- Division of Pediatric Infectious Diseases, Children's Mercy - Kansas City, 2401 Gillham Road, MO 64108, United States.
| | - Barbara A Pahud
- Division of Pediatric Infectious Diseases, Children's Mercy - Kansas City, 2401 Gillham Road, MO 64108, United States.
| | - Kathryn M Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt Vaccine Research Program, D7227 Medical Center North, Vanderbilt University School of Medicine, Nashville, TN 37232, United States.
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court, Suite 200, Decatur, GA 30030, United States.
| | - Jon Sudman
- Kaiser Permanente Georgia, 200 Crescent Centre Parkway, Lower Level, Tucker, GA 30084, United States.
| | - David I Bernstein
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 6014, Cincinnati, OH 45229, United States.
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Corriero R, Gay JL, Robb SW, Stowe EW. Human Papillomavirus Vaccination Uptake before and after the Affordable Care Act: Variation According to Insurance Status, Race, and Education (NHANES 2006-2014). J Pediatr Adolesc Gynecol 2018; 31:23-27. [PMID: 28756028 DOI: 10.1016/j.jpag.2017.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE The purpose of the study was to compare human papillomavirus (HPV) vaccination rates before and after Affordable Care Act (ACA) implementation among women, and examine differences according to insurance status and other sociodemographic variables. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional analysis of the National Health and Nutrition Examination Survey questionnaire data. Participants (n = 4599) were from a random sample of the United States population. INTERVENTIONS AND MAIN OUTCOME MEASURES HPV vaccination status and number of doses received according to age, income, education, race, and insurance coverage. RESULTS Over time, the proportion of women reporting HPV vaccination increased from 16.4% to 27.6%, and reporting vaccination completion (3 doses) increased from 56.8% to 67.2%. After ACA implementation, respondents were 3.3 times more likely to be vaccinated compared with before ACA implementation (95% confidence interval [CI], 2.0-5.5) adjusting for age, race, and insurance coverage. Similarly, respondents were more likely to have received 2 (odds ratio, 2.8; 95% CI, 1.5-5.3) or 3 doses (odds ratio, 5.8; 95% CI, 2.5-13.6). CONCLUSION Vaccination uptake increased in a comparison of waves of data from before and after ACA implementation. This increase in vaccination coverage could be related to the increased preventative service coverage, which includes vaccines, required by the ACA. Future studies might focus on the role insurance has on vaccination uptake, and meeting Healthy People 2020 objectives for vaccination coverage.
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Affiliation(s)
- Rosemary Corriero
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Jennifer L Gay
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia.
| | - Sara Wagner Robb
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Ellen W Stowe
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
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16
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Liu G, Kong L, Du P. HPV vaccine completion and dose adherence among commercially insured females aged 9 through 26 years in the US. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2016; 2:1-8. [PMID: 26623444 PMCID: PMC4662446 DOI: 10.1016/j.pvr.2015.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although HPV vaccination has been recommended for use in girls and young women since 2007, HPV vaccine uptake is low in the US. METHODS We conducted a retrospective cohort study using the 2008-2011 MarketScan data to examine HPV vaccine completion and dose adherence among commercially insured females aged 9-26 years. We performed multivariable logistic regression models to examine factors related to HPV vaccine completion and HPV vaccine dose adherence. RESULTS Among 378,484 females aged 9-26 years who initiated HPV vaccination, only 29.4% completed HPV vaccination. Compared with females receiving vaccines from primary care providers, those receiving vaccines from OB/GYN providers were more likely to complete the vaccine series. Age at HPV vaccine initiation, health insurance plan, seasonal pattern, and flu vaccination were also significantly associated with vaccine completion. Among 111,286 females who completed HPV vaccination, 62.4% received all doses within 30 days of the recommended schedules. Similar factors relating to HPV vaccine completion were consistently associated with HPV vaccine dose adherence. However, younger age (<22 years) and receipt of flu vaccine were negatively related to HPV vaccine dose adherence. CONCLUSIONS Intervention programs to improve HPV vaccine reminding system and reduce logistic barriers for both physicians and patients are warranted.
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Affiliation(s)
- Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Ping Du
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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17
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Hirth J, Kuo YF, Laz TH, Starkey JM, Rupp RE, Rahman M, Berenson AB. Concordance of adolescent human papillomavirus vaccination parental report with provider report in the National Immunization Survey-Teen (2008-2013). Vaccine 2016; 34:4415-21. [PMID: 27435385 PMCID: PMC4979581 DOI: 10.1016/j.vaccine.2016.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/08/2016] [Accepted: 07/10/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the accuracy of parental report of HPV vaccination through examination of concordance, with healthcare provider vaccination report as the comparison. METHODS The 2008-2013 National Immunization Survey (NIS)-Teen was used to examine accuracy of parent reports of HPV vaccination for their female daughters aged 13-17years, as compared with provider report of initiation and number of doses. Multivariable logistic regression models were used to examine associations related to concordance of parent and provider report. RESULTS Of 51,746 adolescents, 84% concordance for HPV vaccine initiation and 70% concordance for number of doses was observed. Accuracy varied by race/ethnicity, region, time, and income. The parent report of number of doses was more likely to be accurate among parents of 13 and 14year old females than 17year olds. Accuracy of initiation and number of doses were lower among Hispanic and black adolescents compared to white parents. The odds of over-report was higher among minorities compared to whites, but the odds of underreport was also markedly higher in these groups compared to parents of white teens. Accuracy of parental vaccine report decreased across time. CONCLUSIONS These findings are important for healthcare providers who need to ascertain the vaccination status of young adults. Strengthening existing immunization registries to improve data sharing capabilities and record completeness could improve vaccination rates, while avoiding costs associated with over-vaccination.
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Affiliation(s)
- Jacqueline Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States.
| | - Yong-Fang Kuo
- Division of Epidemiology and Biostatistics, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Tabassum Haque Laz
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States; Health Research and Consulting Services, Dhaka, Bangladesh(1)
| | - Jonathan M Starkey
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Richard E Rupp
- Department of Pediatrics, School of Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Mahbubur Rahman
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States; Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan(1)
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
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18
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St Sauver JL, Rutten LJF, Ebbert JO, Jacobson DJ, McGree ME, Jacobson RM. Younger age at initiation of the human papillomavirus (HPV) vaccination series is associated with higher rates of on-time completion. Prev Med 2016; 89:327-333. [PMID: 26930513 PMCID: PMC4969174 DOI: 10.1016/j.ypmed.2016.02.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/11/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
Vaccination rates for human papillomavirus (HPV) have remained disappointingly low. It is critical to identify methods to increase on-time vaccine series completion rates (before 13 or 15years). To determine whether younger age (9 to 10years of age) at HPV vaccine series initiation was associated with improved on-time completion rates compared to initiation at 11 to 12years, we examined the prevalence of on-time HPV vaccine series completion rates from August 2006 through December 2012 in a large, population-based cohort of children and adolescents (aged 9.5 to 27years) residing in Olmsted County, MN on December 31, 2012 (n=36,223). We compared age at vaccine initiation between individuals who successfully completed both 2 and 3 doses of the vaccination series on-time (before age 13.5 or 15.0years) using multivariate logistic regression. On-time completion of both 2 and 3 doses of the vaccine series by age 13.5 or 15.0years was significantly associated with initiation at 9 to 10years as compared to 11 to 12years after adjusting for sex, race, insurance status, frequent health care visits, and year of first vaccination (all p<.01). Interventions focused on beginning the vaccination series at 9 to 10years of age may result in higher rates of timely series completion.
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Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA; Robert D and Patricia E Kern Center for the Science of Health Care Delivery, College of Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
| | - Lila J Finney Rutten
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA; Robert D and Patricia E Kern Center for the Science of Health Care Delivery, College of Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - Jon O Ebbert
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, College of Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA; Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA; Robert D and Patricia E Kern Center for the Science of Health Care Delivery, College of Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA; Robert D and Patricia E Kern Center for the Science of Health Care Delivery, College of Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - Robert M Jacobson
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, College of Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA; Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
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Howard DL, Soulli B, Johnson N, Cooper S. Women's Understanding of the Term 'Pap smear': A Comparison of Spanish-Speaking Versus English-Speaking Women. Matern Child Health J 2016; 20:2336-2347. [PMID: 27451859 DOI: 10.1007/s10995-016-2057-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective To compare the understanding of the term 'Pap smear' among Spanish-speaking women, as compared to their English-speaking counterparts. Methods Surveys were distributed to English and Spanish speaking female patients in an urban Obstetrics and Gynecology clinic. Patients were at least 18 years old or they were less than 18 years old and pregnant. Results A majority of participants (77.3 % English-speaking vs. 74.1 % Spanish-speaking, respectively) were able to identify at least one correct descriptor for the term Pap smear. However, Spanish-speaking women were significantly less likely to choose incorrect descriptors. Spanish-speaking women were much less likely to say that a Pap smear was the same as a Pelvic exam (45.7 vs. 78.8 %; p = 0.001), or a test for a sexually transmitted disease (25 vs. 60.6 %; p = 0.001). Conclusions for Practice Compared to English-speaking women, Spanish-speaking women are much less likely to conflate a pelvic exam with a Pap smear. Overall understanding was suboptimal, regardless of primary language, indicating that major efforts are still needed to improve functional health literacy with respect to cervical cancer screening.
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Affiliation(s)
- David L Howard
- WellHealth Quality Care/Las Vegas Minimally Invasive Surgery, 9260 West Sunset Road, Las Vegas, Nevada, 89147, USA.
| | - Beth Soulli
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA
| | - Nicole Johnson
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA
| | - Saladin Cooper
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA
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20
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Hirth JM, Lin YL, Kuo YF, Berenson AB. Effect of number of human papillomavirus vaccine doses on guideline adherent cervical cytology screening among 19-26year old females. Prev Med 2016; 88:134-9. [PMID: 27085993 PMCID: PMC4902738 DOI: 10.1016/j.ypmed.2016.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/31/2016] [Accepted: 04/12/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Little is known about how the number of HPV vaccine doses affect adherence to screening guidelines. This study compared adherence to cervical cancer screening by the number of HPV vaccine doses received by young women and assessed whether the specialty of vaccinating providers affected behavior. METHODS This retrospective cohort study using administrative insurance claims records included 24,964 19-26year old women who received at least 1 injection of the HPV vaccine between January 2006 and November 2009. Vaccinated young women continuously enrolled in a nationally-representative private insurance plan for 6months prior to and 37months after HPV vaccine administration were included. Logistic regression was used to compare the odds of Papanicolaou (Pap) testing 3years after vaccine initiation by number of vaccine doses and provider type. RESULTS In this sample, 79.3% had a Pap test 3years following vaccine initiation. Receiving 1 (aOR: 0.60, 95% CI 0.55-0.65) or 2 (aOR: 0.80, 95% CI 0.74-0.87) doses was associated with decreased odds of Pap testing compared to 3 doses. Many young women in our sample (16.5%) were diagnosed with cervical dysplasia prior to HPV vaccination. Patients vaccinated by non-obstetrician/gynecologists were less likely to get a Pap test following vaccination. CONCLUSIONS Women who received 1 or 2 doses of the HPV vaccine were less likely than those who received 3 doses to be screened for cervical cancer 3years following vaccine initiation. Pediatricians and primary care physicians should convey the importance of initiating and continuing screening to HPV vaccinated patients.
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Affiliation(s)
- Jacqueline M Hirth
- Department of Obstetrics and Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555, United States.
| | - Yu-Li Lin
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555, United States
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555, United States
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555, United States
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21
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Thompson EL, Vamos CA, Vázquez-Otero C, Logan R, Griner S, Daley EM. Trends and predictors of HPV vaccination among U.S. College women and men. Prev Med 2016; 86:92-8. [PMID: 26868093 DOI: 10.1016/j.ypmed.2016.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND HPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females. METHODS The National College Health Assessment-II (Fall 2009-2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015. RESULTS Females had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18-21 vs. 22-26years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only. CONCLUSIONS These findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.
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Affiliation(s)
- Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Coralia Vázquez-Otero
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Rachel Logan
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Stacey Griner
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
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Wilson RM, Brown DR, Carmody DP, Fogarty S. HPV Vaccination Completion and Compliance with Recommended Dosing Intervals Among Female and Male Adolescents in an Inner-City Community Health Center. J Community Health 2016; 40:395-403. [PMID: 25312867 DOI: 10.1007/s10900-014-9950-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Human papillomavirus (HPV) vaccination continues to lag behind other adolescent vaccines, especially in areas with pervasive disparities in HPV-related cancers. The purpose of this study was to examine HPV vaccine completion and dosing intervals among low-income adolescents in urban areas. The study included electronic health record data on HPV vaccination for 872 adolescents who received at least one dose of the HPV vaccine. Only 28.4% completed the 3-dose series. For the whole sample, HPV vaccine completion was higher for non-English speakers and among adolescents seen at Newark-South and East Orange sites. Completion was higher among non-English speaking female and Hispanic adolescents, females seen in Newark-South and East Orange sites, and insured Black adolescents. Completion was also dramatically lower among non-English speaking Black adolescents seen at Newark-North, Irvington, and Orange sites (12.5%) compared to other Black adolescents (22.0-44.4%). The mean dosing intervals were 5.5 months (SD = 4.6) between dose 1 and 2 and 10 months (SD = 6.1) between dose 1 and 3. Longer durations between vaccine doses were found among uninsured adolescents and those seen at Newark-North, Irvington, and Orange sites. Non-English speakers had longer duration between dose 1 and 3. Further, durations between dose 1 and 3 were dramatically longer among insured adolescents seen at Newark-North, Irvington, and Orange locations for the whole sample (M = 11.70; SD = 7.12) and among Hispanic adolescents (M = 13.45; SD = 8.54). Understanding how the study predictors facilitate or impede HPV vaccination is critical to reducing disparities in cervical and other HPV-related cancer, especially among Black, Hispanic, and low-income populations.
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Affiliation(s)
- Rula M Wilson
- Rutgers School of Nursing, 65 Bergen St., Newark, NJ, 07101, USA,
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Simons HR, Unger ZD, Lopez PM, Kohn JE. Predictors of Human Papillomavirus Vaccine Completion Among Female and Male Vaccine Initiators in Family Planning Centers. Am J Public Health 2015; 105:2541-8. [PMID: 26469660 DOI: 10.2105/ajph.2015.302834] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We estimated human papillomavirus (HPV) vaccine series completion and examined predictors of completion among adolescents and young adults in a large family planning network. METHODS Our retrospective cohort study of vaccine completion within 12 months and time to completion used electronic health record data from 119 Planned Parenthood health centers in 11 US states for 9648 patients who initiated HPV vaccination between January 2011 and January 2013. RESULTS Among vaccine initiators, 29% completed the series within 12 months. Patients who were male, younger than 22 years, or non-Hispanic Black or who had public insurance were less likely to complete within 12 months and completed more slowly than their counterparts. Gender appeared to modify the effect of public versus private insurance on completion (adjusted hazard ratio = 0.76 for women and 0.95 for men; relative excess risk due to interaction = 0.41; 95% confidence interval = 0.09, 0.73). CONCLUSIONS Completion was low yet similar to previous studies conducted in safety net settings.
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Affiliation(s)
- Hannah R Simons
- The authors are with Planned Parenthood Federation of America, New York, NY
| | - Zoe D Unger
- The authors are with Planned Parenthood Federation of America, New York, NY
| | - Priscilla M Lopez
- The authors are with Planned Parenthood Federation of America, New York, NY
| | - Julia E Kohn
- The authors are with Planned Parenthood Federation of America, New York, NY
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Hirth JM, Rahman M, Smith JS, Berenson AB. Regional variations in HPV vaccination among 9-17 year old adolescent females from the BRFSS, 2008-2010. Hum Vaccin Immunother 2015; 10:3475-83. [PMID: 25668660 DOI: 10.4161/21645515.2014.980202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Human papillomavirus (HPV) vaccine uptake among 18-26 y old women varies by geographic region in the US. However, little is known about regional variations in vaccination among girls who are in the vaccine's targeted age groups. Regional variation in HPV vaccination among female adolescents (9-17 y old) was examined using cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) between 2008 and 2010. Multivariable logistic regression estimated the association of region of residence (10 states included questions about adolescent HPV vaccination) with uptake and completion of the 3-shot HPV vaccine series. Among 7,849 adolescents, 26.9% initiated, and 55.2% of initiators completed the series. Adolescents from Northeast/Midwest/West states were 1.74 (95% CI: 1.45-2.10) times more likely to have initiated HPV vaccination compared to the South/Southwestern states. Among initiators, vaccine series completion did not vary significantly between the South/Southwestern and Northeast/Midwest/West states. Flu vaccination was associated with increased odds of initiation in both regions and completion of the HPV vaccine series in the South/Southwestern states only. Girls 9-10 and 11-12 y old were less likely to have initiated and 11-12 y olds were less likely to have completed the HPV vaccine series compared to 13-17 y olds. The observed regional variations in vaccination could cause rates of cervical cancer to remain higher in the South/Southwest and widen currently observed regional disparities in cervical cancer rates.
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Affiliation(s)
- Jacqueline M Hirth
- a Department of Obstetrics and Gynecology; Center for Interdisciplinary Research in Women's Health ; University of Texas Medical Branch ; Galveston , TX USA
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25
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McCandless B, Sharpe BR. Philanthropic support of HPV vaccination efforts. Prev Med 2015; 76:126. [PMID: 25657169 DOI: 10.1016/j.ypmed.2014.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Davlin SL, Berenson AB, Rahman M. Correlates of HPV knowledge among low-income minority mothers with a child 9-17 years of age. J Pediatr Adolesc Gynecol 2015; 28:19-23. [PMID: 25444051 PMCID: PMC4282947 DOI: 10.1016/j.jpag.2014.01.109] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/28/2014] [Accepted: 01/31/2014] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To assess the level of HPV knowledge among low income, minority mothers with a child between the ages of 9-17 y. DESIGN Women who sought care at a university-based clinic and had at least 1 child aged 9 to 17 years were approached. A total of 638 mothers were recruited. Only those who had heard of HPV were included in the correlation analyses (n = 468). MAIN OUTCOME MEASURES HPV knowledge was assessed utilizing a self-administered questionnaire consisting of 20 questions. RESULTS There were differences between those who had heard of HPV and those who had not. More of those who had not heard of HPV were Hispanic (63%), low-income (89%), and did not graduate high school (59%). Of those who had heard of HPV, the majority did not answer 50% of questions correctly. Few knew the vaccine could prevent genital warts (19.7%). Factors independently associated with HPV knowledge included age, personal history of HPV, cervical dysplasia or cervical cancer, acquiring knowledge from ≥ 2 sources, having known someone with HPV or cervical cancer, having seen a brochure on the vaccine, and having seen an advertisement for the vaccine. CONCLUSIONS Knowledge regarding HPV is low among low-income women with children in the target age range for HPV vaccination. Increased awareness should focus on genital warts and other cancers, since this population has virtually no knowledge of other health outcomes related to HPV infection. Educational programs tailored to this population need to be developed to increase vaccination.
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Affiliation(s)
- S L Davlin
- Department of Obstetrics & Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - A B Berenson
- Department of Obstetrics & Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, United States.
| | - M Rahman
- Department of Obstetrics & Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, United States
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Kepka D, Ding Q, Warner EL, Spigarelli MG, Mooney K. High school females and those with other vaccinations most likely to complete the Human Papillomavirus vaccine. Prev Med Rep 2015; 2:79-83. [PMID: 26844053 PMCID: PMC4721356 DOI: 10.1016/j.pmedr.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Adolescent females' HPV vaccine completion in the U.S. is low. More recent research is needed to investigate factors that relate to HPV vaccine completion among female adolescents in the United States. METHODS Provider-validated data from the 2012 National Immunization Survey-Teen for females ages 13-17 years (N = 9058) were analyzed from February-May 2014 using survey sample weighted statistics. A multivariable Poisson regression estimated prevalence ratios (PR) for factors influencing HPV vaccine completion: mother's education, poverty status, adolescent's grade, facility type, and receipt of other adolescent vaccinations. RESULTS In multivariable models, 9-12th grade daughters were more likely to complete HPV vaccination than 6-8th grade daughters (PR = 1.81, 95% CI = 1.58-2.06). Those seen in hospital facilities completed HPV vaccination 1.3 times more (PR = 1.29, 95% CI = 1.02-1.62) and those seen in private facilities were 1.2 times more likely to complete (PR = 1.22, 95% CI = 1.01-1.48), than those seen in public facilities, respectively. Compared to those without recommended adolescent vaccinations, receipt of seasonal influenza vaccination related to HPV vaccine completion (PR = 1.71, 95% CI = 1.54-1.89), as did receipt of TDAP vaccination (PR = 1.17, 95% CI = 1.03-1.33) and Meningitis vaccination (PR = 2.74, 95% CI = 2.20-3.42). CONCLUSIONS Adolescent females in high school, seen in private/hospital facilities, and up to date on other recommended adolescent vaccinations are most likely to complete the HPV vaccine.
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Affiliation(s)
- Deanna Kepka
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Qian Ding
- Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84132, USA
| | - Echo L. Warner
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Michael G. Spigarelli
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA
- Department of Pharmacology and Toxicology, University of Utah, 30 N 1900 E, Salt Lake City, UT, USA
| | - Kathi Mooney
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
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Chao C, Preciado M, Slezak J, Xu L. A randomized intervention of reminder letter for human papillomavirus vaccine series completion. J Adolesc Health 2015; 56:85-90. [PMID: 25438965 DOI: 10.1016/j.jadohealth.2014.08.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Completion rate for the three-dose series of the human papillomavirus (HPV) vaccine has generally been low. This study evaluated the effectiveness of a reminder letter intervention on HPV vaccine three-dose series completion. METHODS Female members of Kaiser Permanente Southern California Health Plan who received at least one dose, but not more than two doses, of the HPV vaccine by February 13, 2013, and who were between ages 9 and 26 years at the time of first HPV vaccination were included. Eighty percent of these females were randomized to receive the reminder letter, and 20% were randomized to receive standard of care (control). The reminder letters were mailed quarterly to those who had not completed the series. The proportion of series completion at the end of the 12-month evaluation period was compared using chi-square test. RESULTS A total of 9,760 females were included in the intervention group and 2,445 in the control group. HPV vaccine series completion was 56.4% in the intervention group and 46.6% in the control groups (p < .001). The effect of the intervention appeared to be stronger in girls aged 9-17 years compared with young women aged 18-26 years at the first dose and in blacks compared with whites. CONCLUSIONS Reminder letters scheduled quarterly were effective to enhance HPV vaccine series completion among those who initiated the vaccine. However, a large gap in series completion remained despite the intervention. Future studies should address other barriers to series completion, including those at the providers and the health care system level.
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Affiliation(s)
- Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
| | - Melissa Preciado
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Lanfang Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Lim WT, Sears K, Smith LM, Liu G, Lévesque LE. Evidence of effective delivery of the human papillomavirus (HPV) vaccine through a publicly funded, school-based program: the Ontario Grade 8 HPV Vaccine Cohort Study. BMC Public Health 2014; 14:1029. [PMID: 25278003 PMCID: PMC4198791 DOI: 10.1186/1471-2458-14-1029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 09/11/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Proper administration of the human papillomavirus (HPV) vaccine (three doses at 0, 2, and 6 months) will likely influence the vaccine's effectiveness and the impact of vaccination programs on health outcomes. Therefore, we assessed HPV vaccine series completion and on-time dosing in Canada's largest publicly funded, school-based HPV vaccination program. METHODS Using administrative health and immunization databases, we identified a population-based cohort of girls eligible for Ontario's Grade 8 HPV vaccination program in the 2007/08-2009/10 program years who received at least one dose of the vaccine. We determined the number of doses received and calculated the percentage of girls that completed the three-dose series in Grade 8 and Grades 8-9. To assess on-time dosing, the number of days between doses 1-2, 2-3, and 1-3 was calculated and categorized (e.g., too short, on schedule, too long) based on the manufacturer's recommendations. Analyses were also stratified by program year. RESULTS We identified a cohort of 55,798 girls who initiated the vaccination series. Series completion was high in the Grade 8 window (81.8%) and increased by approximately 6% in Grade 9. Series completion was similar across the three program years. 70.8%, 98.5%, and 86.1% of girls were classified as 'on schedule' for dosing intervals 1-2, 2-3, and 1-3, respectively; 70.0% of girls received all three doses in perfect accordance with dosing recommendations. Stratification revealed that on-time dosing was highest in the first two years of the program (85.6% and 80.6%), but dropped to 42.1% in the 2009/10 year when H1N1 vaccination programs were prioritized. CONCLUSIONS Our study demonstrates that delivery of the HPV vaccine through a free, school-based program is an effective method of ensuring high completion and on-time dosing, but may not be sufficient to guarantee high coverage.
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Affiliation(s)
- W Ting Lim
- />Department of Public Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
- />Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
| | - Kim Sears
- />School of Nursing, Queen’s University, Kingston, K7L 3N6 Canada
| | - Leah M Smith
- />Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, H3A 1A2 Canada
| | - Guoyuan Liu
- />Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
| | - Linda E Lévesque
- />Department of Public Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
- />Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
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Kharbanda EO, Parker ED, Nordin JD, Hedblom BD, Rolnick SJ. Influenza and pertussis vaccination coverage among privately insured women of reproductive age. Matern Child Health J 2014; 17:1631-7. [PMID: 23108738 DOI: 10.1007/s10995-012-1176-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An increasing number of vaccines are now designated as maternal vaccines, recommended prior to, during, or immediately following pregnancy. The influenza and pertussis (Tdap) vaccines have the potential to improve the health of women and their offspring. Among privately insured women of reproductive age, goals of this study were to describe influenza and Tdap vaccination coverage and to explore variation in coverage by age and race/ethnicity. This cross-sectional, observational study included women 18-44 years of age with continuous enrollment from 1 January 2007-31 March 2011 in a single, Midwestern health insurance plan and at least one visit to a plan affiliated practice. Data on vaccine coverage came from insurance claims, supplemented by electronic medical record data. Primary outcomes were: receipt of Tdap ever, receipt of Tdap or Tetanus vaccination (Td) in the past 10 years, and receipt of influenza vaccination during the 2010-2011 influenza season. Coverage was compared by race/ethnicity. Among 12,657 women with continuous private insurance, 45.5 % had received Tdap ever, 82.5 % had received Td or Tdap in the past 10 years, and 39.8 % received the influenza vaccine in the 2010-2011 season. Marked disparities in influenza vaccination coverage by race/ethnicity were observed, only 30.0 % of African American women received influenza vaccine compared to 40.7 % of white, non-Hispanic women (p < .0001). Among insured women of reproductive age, there is a need for interventions to increase Tdap and influenza vaccination uptake. Further research is needed to understand and address disparities in influenza vaccination coverage in this population.
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Affiliation(s)
- Elyse Olshen Kharbanda
- HealthPartners Institute for Education and Research, PO Box 1524, MS 21111R, Minneapolis, MN, 55425, USA,
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Harper DM, Verdenius I, Harris GD, Barnett AL, Rosemergey BE, Arey AM, Wall J, Malnar GJ. The influence of free quadrivalent human papillomavirus vaccine (HPV4) on the timely completion of the three dose series. Prev Med 2014; 61:20-5. [PMID: 24440159 DOI: 10.1016/j.ypmed.2014.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/24/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Economic incentives can positively influence social determinants to improve the health care of the uninsured and underserved populations. The aim of this study was to determine if free HPV4 vaccine would lead to on-time series completion in our safety net health care system in the US Midwest. METHODS A nested retrospective cohort study of females receiving HPV4 vaccine between 2006 and 2009 was conducted. Patient characteristics and payor source for each of the three HPV4 doses were abstracted from electronic records. Logistic regression was used to predict on-time completion rates. RESULTS The proportion of adolescent and adult females completing three on-time HPV4 doses was equal (21% (28/136) vs. 18% (66/358), respectively) from among the 494 females receiving 927 HPV4 doses in this study. No adolescent receiving free HPV4 vaccine completed three doses. Grant sponsorship of at least one HPV4 dose among adults did not predict three dose on-time completion (OR=1.56, 95%CI: 0.80, 3.06). Neither was adult grant sponsorship of HPV4 significant when analyzing exclusive payor sources vs. a combination of payor sources (OR=0.72, 95%CI: 0.10, 5.17). CONCLUSIONS Free HPV4 vaccine does not influence the on-time completion rates among adults.
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Affiliation(s)
- Diane M Harper
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA; Department of Obstetrics and Gynecology, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA; Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | | | - George D Harris
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Angela L Barnett
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Beth E Rosemergey
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Anne M Arey
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Gerard J Malnar
- Department of Obstetrics and Gynecology, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
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Patel A, Stern L, Unger Z, Debevec E, Roston A, Hanover R, Morfesis J. Staying on track: a cluster randomized controlled trial of automated reminders aimed at increasing human papillomavirus vaccine completion. Vaccine 2014; 32:2428-33. [PMID: 24631099 DOI: 10.1016/j.vaccine.2014.02.095] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate whether automated reminders increase on-time completion of the three-dose human papillomavirus (HPV) vaccine series. METHODS Ten reproductive health centers enrolled 365 women aged 19-26 to receive dose one of the HPV vaccine. Health centers were matched and randomized so that participants received either routine follow-up (control) or automated reminder messages for vaccine doses two and three (intervention). Intervention participants selected their preferred method of reminders - text, e-mail, phone, private Facebook message, or standard mail. We compared vaccine completion rates between groups over a period of 32 weeks. RESULTS The reminder system did not increase completion rates, which overall were low at 17.2% in the intervention group and 18.9% in the control group (p=0.881). Exploratory analyses revealed that participants who completed the series on-time were more likely to be older (OR=1.15, 95% CI 1.01-1.31), report having completed a four-year college degree or more (age-adjusted OR=2.51, 95% CI 1.29-4.90), and report three or more lifetime sexual partners (age-adjusted OR=3.45, 95% CI 1.20-9.92). CONCLUSIONS The study intervention did not increase HPV vaccine series completion. Despite great public health interest in HPV vaccine completion and reminder technologies, completion rates remain low.
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Affiliation(s)
- Ashlesha Patel
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States; Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Lisa Stern
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Zoe Unger
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Elie Debevec
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Alicia Roston
- Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Rita Hanover
- Westport Compass, 3011 S. Plateau, Salt Lake City, UT 84109, United States.
| | - Johanna Morfesis
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
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Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr 2014; 168:76-82. [PMID: 24276343 PMCID: PMC4538997 DOI: 10.1001/jamapediatrics.2013.2752] [Citation(s) in RCA: 641] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Since licensure of the human papillomavirus (HPV) vaccine in 2006, HPV vaccine coverage among US adolescents has increased but remains low compared with other recommended vaccines. OBJECTIVE To systematically review the literature on barriers to HPV vaccination among US adolescents to inform future efforts to increase HPV vaccine coverage. EVIDENCE REVIEW We searched PubMed and previous review articles to identify original research articles describing barriers to HPV vaccine initiation and completion among US adolescents. Only articles reporting data collected in 2009 or later were included. Findings from 55 relevant articles were summarized by target populations: health care professionals, parents, underserved and disadvantaged populations, and males. FINDINGS Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine's effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents. Some parents of sons reported not vaccinating their sons because of the perceived lack of direct benefit. Parents consistently cited health care professional recommendations as one of the most important factors in their decision to vaccinate their children. CONCLUSIONS AND RELEVANCE Continued efforts are needed to ensure that health care professionals and parents understand the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on communicating HPV recommendations to patients and parents. Further efforts are also needed to reduce missed opportunities for HPV vaccination when adolescents interface with the health care system. Efforts to increase uptake should take into account the specific needs of subgroups within the population. Efforts that address system-level barriers to vaccination may help to increase overall HPV vaccine uptake.
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Affiliation(s)
- Dawn M. Holman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vicki Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katherine B. Roland
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meg Watson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Liddon
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia (Stokley)
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Harper DM, Verdenius I, Ratnaraj F, Arey AM, Rosemergey B, Malnar GJ, Wall J. Quantifying clinical HPV4 dose inefficiencies in a safety net population. PLoS One 2013; 8:e77961. [PMID: 24223131 PMCID: PMC3819328 DOI: 10.1371/journal.pone.0077961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/06/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE HPV4 is the most expensive vaccine requiring three appropriately timed doses to provide maximal efficacy against two oncogenic HPV types. The primary purpose of this study is to quantify the use of HPV4 vaccine in a safety net health care system in terms of its inefficiencies. METHODS A retrospective study of HPV4 dosing from 2006-2009, among females 10-26 years old who sought care in a safety net health care system was conducted to determine dose usage patterns among those at highest risk for cervical cancer. Dose descriptors abstracted from the electronic medical record (EMR) included timing and number in series as well as characteristics of the person to whom and visit at which the dose was given. Dose inefficiencies were separated into "less than three doses" and "mistimed doses" for analysis. RESULTS The majority (66%) of HPV4 doses administered were insufficient to induce the maximal immune response necessary for HPV infection prevention. Among on-time doses, 58% were singleton or doublet doses. Mistimed doses accounted for 19% of all doses administered with late intervals being more common than early intervals among those receiving more than one dose (9% vs. 4%, p<0.001). Third doses were mistimed twice as often as second doses (10% vs. 5%, p<0.001). Black women were more likely to have a mistimed second dose and Hispanic women more likely to have a mistimed third dose compared to white women (OR = 1.70 (95% CI: 1.11, 2.61 and 2.44 (1.19, 5.00), respectively). The HPV4-only visit type at which HPV4 was initiated was the most significant predictor of on-time doublet completion. CONCLUSIONS In a safety net health care system the large inefficiencies associated with HPV4 vaccination must be addressed in order to maximize our patient's cervical cancer prevention.
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Affiliation(s)
- Diane M. Harper
- Center of Excellence, Women’s Health, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Biomedical and Health Informatics, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- * E-mail:
| | - Inge Verdenius
- Department of Obstetrics and Gynecology, Radboud University, Nijmegen, The Netherlands
| | - Felicia Ratnaraj
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Anne M. Arey
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Beth Rosemergey
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
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Receipt of human papillomavirus vaccine among privately insured adult women in a U.S. Midwestern Health Maintenance Organization. Prev Med 2013; 57:712-4. [PMID: 23859927 DOI: 10.1016/j.ypmed.2013.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe human papillomavirus (HPV) vaccine coverage among adult privately insured women including variation in coverage by race/ethnicity. METHODS This cross-sectional, observational study included women 18-26 years of age with continuous enrollment in a U.S. Midwestern health insurance plan and at least one visit to a plan affiliated practice. Vaccination data came from insurance claims and the electronic medical record. Primary outcomes were: receipt of at least 1 HPV vaccine (HPV1) and completion of the 3-dose HPV vaccine series (HPV3). Coverage was described for the entire cohort and stratified by race/ethnicity. For a subset of women, automated data was compared to personal recall. RESULTS As of June 2010, among 2546 privately insured women 18-26 years, 72.7% had received their first HPV vaccine and 57.9% completed the 3-dose series. Compared to white women, African American and Asian women had significantly lower coverage for HPV1 and HPV3. There was 94.5% (95% CI: 88.5-100%) agreement between personal recall and claims/EMR for receiving HPV1. CONCLUSIONS In this cohort of privately insured women, a majority received HPV1 and more than half completed the 3-dose vaccine series. Marked disparities in receipt of HPV vaccine by race/ethnicity were observed.
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Printz C. HPV vaccine uptake remains low. Why some adolescents are not receiving the vaccine, and what can be done about it. Cancer 2013; 119:2947-8. [PMID: 23913400 DOI: 10.1002/cncr.28278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Verdenius I, Harper DM, Harris GD, Griffith RS, Wall J, Hempstead LK, Malnar GJ, Bekkers RLM. Predictors of three dose on-time compliance with HPV4 vaccination in a disadvantaged, underserved, safety net population in the US Midwest. PLoS One 2013; 8:e71295. [PMID: 23951123 PMCID: PMC3738587 DOI: 10.1371/journal.pone.0071295] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/27/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND HPV4 is approved as a series of three timed doses expected to result in efficacy against specific HPV infections. Completion rates in the US are quite low at the same time the structure of health care delivery is changing. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population. METHODS This is a retrospective study in which patient-, clinic- and systems-level data are abstracted from the electronic medical record (EMR) for all females 10-26 years of age receiving at least one dose of HPV4 between July 1, 2006 and October 1, 2009. RESULTS Adults were more likely to complete the three dose series if they had at least one health care visit in addition to their HPV4 visit, (aOR = 1.54 (95% CI:1.10, 2.15). Adults were less likely to complete the three dose series if they received their second HPV4 dose at an acute health care, preventive care or postpartum visits compared to an HPV4-only visit (aOR = 0.31 (95% CI: 0.13, 0.72), 0.12 (0.04, 0.35), 0.30 (0.14, 0.62), respectively). Hispanic adults were less likely than whites to complete the series (aOR = 0.24 (95% CI:0.10, 0.59). 39% of adolescents who completed two doses completed the series. CONCLUSIONS HPV4 is more likely to be effectively administered to adults in a safety net population if multiple health care needs can be met within the health care system.
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Affiliation(s)
| | - Diane M. Harper
- Center of Excellence, Women’s Health, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Departments of Biomedical and Health Informatics, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - George D. Harris
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - R. Stephen Griffith
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Laura K. Hempstead
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynecology, Radboud University, Nijmegen, The Netherlands
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Perkins RB, Anderson BL, Gorin SS, Schulkin JA. Challenges in cervical cancer prevention: a survey of U.S. obstetrician-gynecologists. Am J Prev Med 2013; 45:175-81. [PMID: 23867024 DOI: 10.1016/j.amepre.2013.03.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 01/17/2013] [Accepted: 03/25/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Current cervical cancer prevention recommendations include human papillomavirus (HPV) vaccination, Pap and HPV co-testing, and Pap testing at 3- to 5-year intervals. PURPOSE To examine attitudes, practice patterns, and barriers related to HPV vaccination and cervical cancer screening guidelines among U.S. obstetrician-gynecologists. METHODS In 2011-2012, a national sample of members of the American Congress of Obstetricians and Gynecologists responded to a 15-item (some with multiple parts) questionnaire assessing sociodemographic characteristics, clinical practices, and perceived barriers to HPV vaccination and cervical cancer screening. Multivariate logistic regression was used to identify factors associated with guideline adherence. Analyses were conducted in 2012. RESULTS A total of 366 obstetrician-gynecologists participated. Ninety-two percent of respondents offered HPV vaccination to patients, but only 27% estimated that most eligible patients received vaccination. Parent and patient refusals were commonly cited barriers to HPV vaccination. Approximately half of respondents followed guidelines to begin cervical cancer screening at age 21 years, discontinue screening at age 70 years or after hysterectomy, and appropriately utilize Pap and HPV co-testing. Most physicians continued to recommend annual Paps (74% aged 21-29 years, 53% aged ≥30 years). Physicians felt that patients were uncomfortable with extended screening intervals and were concerned that patients would not come for annual exams without concurrent Paps. Solo practitioners were less likely to follow both vaccination and screening guidelines than those in group practices. CONCLUSIONS This survey of obstetrician-gynecologists indicates persistent barriers to the adoption of HPV vaccination and cervical cancer screening guidelines. Interventions to promote guideline adherence may help improve the quality of cervical cancer prevention.
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, School of Medicine, Boston University, Boston, MA 02118, USA.
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Pierce Campbell CM, Darwish-Yassine M, Harlow SD, Johnston CM, Curado MP, Cho KR, Soliman AS. Cervical cancer screening among Michigan women: 'The Special Cancer Behavioral Risk Factor Survey', 2004-2008. J OBSTET GYNAECOL 2013; 33:617-21. [PMID: 23919863 DOI: 10.3109/01443615.2013.783006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The burden of cervical cancer remains greater among minority women. The purpose of this study was to evaluate racial/ethnic disparities in cervical cancer screening among minority women in Michigan. Data from 8,023 women (≥ 40 years) surveyed in the 2004-2008 Michigan Special Cancer Behavioral Risk Factor Survey were used to assess racial/ethnic differences in cervical cancer screening, knowledge and beliefs. Unexpectedly, African-American and Hispanic women reported being screened for cervical cancer at rates similar to, or higher than, Whites. Women demonstrated limited knowledge of cervical cancer risk factors and its signs/symptoms. Most minority women were more likely than Whites to believe in the importance of cervical screening, with Hispanic women more likely to support HPV vaccination. Differential utilisation of screening does not explain the disproportionately high rates of cervical cancer among minorities. Future research should examine disparities in the follow-up of abnormal cervical results and receipt of treatment.
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Affiliation(s)
- C M Pierce Campbell
- Department of Epidemiology, University of Michigan School of Public Health, USA
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Pierce Campbell CM, Lin HY, Fulp W, Papenfuss MR, Salmerón JJ, Quiterio MM, Lazcano-Ponce E, Villa LL, Giuliano AR. Consistent condom use reduces the genital human papillomavirus burden among high-risk men: the HPV infection in men study. J Infect Dis 2013; 208:373-84. [PMID: 23644283 DOI: 10.1093/infdis/jit191] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Data supporting the efficacy of condoms against human papillomavirus (HPV) infection in males are limited. Therefore, we examined the effect of consistent condom use on genital HPV acquisition and duration of infection. METHODS A prospective analysis was conducted within the HPV Infection in Men Study, a multinational HPV cohort study. Men who were recently sexually active (n = 3323) were stratified on the basis of sexual risk behaviors and partnerships. Using Cox proportional hazards regression, type-specific incidence of HPV infection and clearance were modeled for each risk group to assess independent associations with condom use. RESULTS The risk of HPV acquisition was 2-fold lower among men with no steady sex partner who always used condoms, compared with those who never used condoms (hazard ratio, 0.54), after adjustment for country, age, race, education duration, smoking, alcohol, and number of recent sex partners. The probability of clearing an oncogenic HPV infection was 30% higher among nonmonogamous men who always used condoms with nonsteady sex partners, compared with men who never used condoms (hazard ratio, 1.29), after adjustment for country, age, race, education duration, marital status, smoking, alcohol, and number of recent sex partners. No protective effects of condom use were observed among monogamous men. CONCLUSIONS Condoms should be promoted in combination with HPV vaccination to prevent HPV infection in men.
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Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, Weigel JL, Farmer DB, Habinshuti A, Mugeni SD, Karasi JC, Drobac PC. Reduced premature mortality in Rwanda: lessons from success. BMJ 2013; 346:f65. [PMID: 23335479 PMCID: PMC3548616 DOI: 10.1136/bmj.f65] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rwanda’s approach to delivering healthcare in a setting of post-conflict poverty offers lessons for other poor countries, say Paul Farmer and colleagues
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Affiliation(s)
- Paul E Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Hirth JM, Tan A, Wilkinson GS, Berenson AB. Completion of the human papillomavirus (HPV) vaccine series among males with private insurance between 2006 and 2009. Vaccine 2013; 31:1138-40. [PMID: 23290834 DOI: 10.1016/j.vaccine.2012.12.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/12/2012] [Accepted: 12/18/2012] [Indexed: 11/16/2022]
Abstract
Little is known about initiation and completion among males who received the HPV vaccine on an off-label basis before 2009. This study utilized administrative claims data from a private insurance company to examine completion of the 3 dose HPV series among 514 males who initiated the vaccine between 2006 and May of 2009. Frequencies of HPV vaccination were examined and multivariate logistic regression estimated the odds of completing the entire series within 365 days of initiation. We found that only 21% of male initiators completed all 3 vaccine doses within 12 months and completion decreased over time. Series completion did not vary significantly by provider type. These findings suggest that difficulties may be encountered in fully vaccinating enough males to achieve adequate herd immunity in the future.
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Affiliation(s)
- Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, United States
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