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Hatch BA, Valenzuela S, Darden PM, Fagnan LJ, Dickinson C, Marino M, Robison SG, Larsen R, Carney PA. Clinic-level differences in human papillomavirus vaccination rates among rural and urban Oregon primary care clinics. J Rural Health 2023; 39:499-507. [PMID: 36396353 DOI: 10.1111/jrh.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Human papillomavirus (HPV) infection contributes to vaccine-preventable malignancies. Rural populations experience lower HPV vaccination rates despite similar rates of other childhood vaccinations. Individual- and clinic-level characteristics likely contribute to this disparity, but little is known about the separate roles of each. We compared clinic-level HPV vaccination rates among rural versus urban primary care clinics, identified factors associated with HPV vaccination, and separately assessed the impact of individual- and clinic-level characteristics on rural disparities in HPV vaccination. METHODS This cross-sectional study included 537 Oregon primary care clinics participating in the Vaccines for Children (VFC) program during 2019. Vaccination status was assessed using Oregon's ALERT Immunization Information System and included HPV vaccine ≥ 1 dose for ages 11 and 12; HPV vaccination up to date (UTD) for ages 13-17, and coadministration with tetanus, diphtheria, and acellular pertussis (Tdap). Rural versus urban clinic-level outcomes were assessed using negative binomial regression. FINDINGS Participating clinics were 24.5% rural and 75.6% urban. Family medicine clinics comprised 71.1%; pediatrics, 16.9%; and mixed, 12.1%. Across clinics, the average proportion of patients qualifying for VFC was 43%, and non-White patients were 14.1%. The mean rate of HPV vaccine ≥1 dose was lower among rural clinics (46.9% vs 51.1%, P = .039), as was vaccination UTD (40.5% vs 49.9%, P < .001). Adjusting for differences in individual- and clinic-level characteristics, rural disparities were no longer statistically significant. CONCLUSIONS Both individual- and clinic-level characteristics play a role in rural disparities in HPV vaccination, and modifiable clinic-level differences may be opportune targets to address these disparities.
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Affiliation(s)
- Brigit A Hatch
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Steele Valenzuela
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Paul M Darden
- Population Health Research, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Lyle J Fagnan
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Caitlin Dickinson
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Miguel Marino
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Rex Larsen
- Oregon Immunization Program, Portland, Oregon, USA
| | - Patricia A Carney
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
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Groene EA, Horvath KJ, Yared N, Mohammed I, Muscoplat M, Kuramoto S, Richter T, Kulasingam S. Missed Opportunities for Human Papillomavirus Vaccination by Parental Nativity, Minnesota, 2015-2018. Public Health Rep 2022; 137:867-877. [PMID: 34252324 PMCID: PMC9379833 DOI: 10.1177/00333549211027244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) vaccination coverage in the United States is far below coverage for other routine adolescent vaccines. We examined whether missed opportunities for HPV vaccination among adolescents differ by parental nativity (country of origin) in Minnesota. METHODS We retrospectively analyzed birth record and immunization information data for adolescents in Minnesota born during 2004-2007 using data from January 1, 2015, through December 31, 2018. Using logistic regression, we assessed the association between parental nativity and missed opportunities for HPV vaccine initiation, or receipt of other vaccines without receipt of the HPV vaccine. We adjusted for parent/child demographic and vaccination characteristics. We defined nativity as the number of non-US-born parents and maternal region of birth. RESULTS Adolescents with mothers born in Eastern Europe (adjusted odds ratio [aOR] = 2.33; 95% CI, 2.01-2.73) and Africa (aOR = 1.36; 95% CI, 1.28-1.43) had greater adjusted odds of missed opportunities for HPV vaccination than adolescents with US-born mothers. However, adolescents with mothers from Latin America and the Caribbean had lower odds of missed opportunities than adolescents with US-born mothers (aOR = 0.61; 95% CI, 0.58-0.65). Adolescents with 1 or 2 non-US-born parents had lower odds of missed opportunities for HPV vaccination than adolescents with 2 US-born parents (1 parent: aOR = 0.92; 95% CI, 0.88-0.96; 2 parents: aOR = 0.90; 95% CI, 0.87-0.94). CONCLUSIONS Future studies should evaluate outreach to groups with HPV vaccination disparities and identify other drivers of missed opportunities among adolescents with US-born parents, such as multiparity.
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Affiliation(s)
- Emily A. Groene
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Keith J. Horvath
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Nicholas Yared
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Inari Mohammed
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Miriam Muscoplat
- Minnesota Immunization Information Connection, Minnesota
Department of Health, St. Paul, MN, USA
| | - Sydney Kuramoto
- Minnesota Immunization Information Connection, Minnesota
Department of Health, St. Paul, MN, USA
| | - Tyler Richter
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
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3
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Daniel CL, Lawson F, Vickers M, Green C, Wright A, Coyne-Beasley T, Lee HY, Turberville S. Enrolling a rural community pharmacy as a Vaccines for Children provider to increase HPV vaccination: a feasibility study. BMC Public Health 2021; 21:1266. [PMID: 34187438 PMCID: PMC8240772 DOI: 10.1186/s12889-021-11304-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. with over 80 million infected individuals. High-risk strains are associated with 6 different cancers. Although infection is preventable, U.S. vaccination rates remain suboptimal and there are noted disparities between urban and rural communities due to economic barriers, lack of access, and low awareness and education. Methods The current pilot study sought to overcome these barriers through an interprofessional collaborative enrolling a community pharmacy in a rural, medically underserved Alabama county as a Vaccines for Children (VFC) provider to provide free vaccines to eligible adolescents. Program evaluation was conducted to determine the intervention’s feasibility. Potential efficacy was assessed by analyzing county-level HPV vaccination uptake and completion rates using state immunization registry data. Results Over the 8-month study, 166 total vaccines were administered to 89 adolescents ages 10–18, including 55 doses of HPV vaccine, 53 doses of Tdap vaccine, 45 doses of meningococcal vaccine, and 13 doses of influenza vaccine. Among these adolescents, mean age was 12.6 years old, and 64 (71.9%) were VFC patients. The pharmacy recorded an increase in total vaccine administration of 158.8%, an increase in prescription revenue of 34.8%, and an increase in total revenue by 24.4% during the course of the study, compared to the previous year. Conclusions Findings from the current work demonstrate the potential of this strategy and can serve as a blueprint for statewide and national dissemination and implementation to ultimately increase access to vaccination services, increase vaccination rates, and reduce urban-rural vaccine disparities.
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Affiliation(s)
- Casey L Daniel
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA.
| | - Frances Lawson
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Macy Vickers
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Chelsea Green
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Anna Wright
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hee Y Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Stacie Turberville
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
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Mohammadpour F, Mansouri A, Hadjibabaie M. Utilization Evaluation of Human Papilloma Virus Vaccine (GARDASIL®) in Iran; A Cross-Sectional Study. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 19:68-76. [PMID: 32922470 DOI: 10.22037/ijpr.2020.1100923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vaccination against HPV seems to be a good approach for prevention of cervical cancer and genital warts. But in Iran we are confronted with lack of evidence for its cost-effectiveness whereas its consumption is dramatically increasing. This was a cross- sectional study. We used a questionnaire including 5 sections as follows; Patients demographic information, Patients medical history, Pregnancy and lactation considerations, Gardasil prescription characteristics and HPV infection characteristics. Prescriber with adherence to guideline were defined as those prescribing Gardasil for correct age range and indication with accurate dosage and administration. Descriptive statistics for variables was shown by frequency (percent) or mean (± SD) and evaluation of relation between categorical variables was performed by using Chi-square test. Total 566 Gardasil recipients participated in the study. There were mostly female with mean age of 28.1 (± 6.68). For 128 (22.6%) participants Gardasil prescribed correctly considering both age range (9-26 years) and indication (prophylactic). From this group, 80 participants (14.1%/566) have received accurate Gardasil dosage and interval (prescriber had adherence to guideline). Patients' out of pocket payment in guidelines adherent prescriptions was a seventh of total costs obtained from 566 consumers. Gynecologists significantly prescribed for prophylaxis higher than other specialties (p-value = 0.01). Prescribers' practice in administrating Gardasil is obviously not appropriate and it is imposing burdensome cost to community and government. On the other hand, we have encountered with increasing rate of its use in Iran in past years. Therefore, we are in urgent need for appropriate interventions in national level and prompt supervision to regulate Gardasil consumption.
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Affiliation(s)
- Fateme Mohammadpour
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Ava Mansouri
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.,Faculty of Pharmacy, Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Srivastava A, Dempsey A, Galitsky A, Fahimi M, Huang L. Parental awareness and utilization of meningococcal serogroup B vaccines in the United States. BMC Public Health 2020; 20:1109. [PMID: 32664872 PMCID: PMC7362432 DOI: 10.1186/s12889-020-09181-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Meningococcal serogroup B (MenB) is the most common cause of invasive meningococcal disease (IMD) in the United States. The US Advisory Committee on Immunization Practices (ACIP) recommends vaccination of healthy adolescents against MenB based on shared clinical decision-making (Category B recommendation). This survey assessed factors associated with MenB vaccine awareness, utilization, and interest among parents/guardians of US adolescents. Methods Survey participants were identified in 2016 through KnowledgePanel®, an online random sample of US households; population-based weighting methodology was used to ensure data reflected a demographically representative population sample. Adults with ≥1 dependent aged 16–19 years were eligible and completed an online questionnaire. Respondents were grouped in terms of MenB vaccination of their child as: 1) vaccinated, 2) intending to vaccinate, 3) MenB vaccine-unaware, or 4) vaccine-aware but not intending to vaccinate. Univariate and multivariate analyses were used to identify factors influencing MenB vaccine awareness and utilization; univariate analyses used the weighted proportion of each group or weighted means, and multivariate analyses used logistic regression models based on the weighted study sample of each group. Results Six hundred nineteen parents/guardians participated, corresponding to 26,266,700 members of the US population after weighting. MenB vaccine awareness was significantly associated with parent race and sex. Specifically, 57% of parents were unaware of MenB vaccines, and there was significantly higher lack of awareness among males and those of Hispanic or non-White ethnicity. In addition, 36% of unaware parents/guardians were interested in and seeking MenB vaccine information from their healthcare provider (HCP), and there was higher interest among parents of Hispanic ethnicity. ‘Vaccinated/intending to vaccinate’ versus ‘not intending to vaccinate’ and ‘vaccinated’ versus ‘intending to vaccinate’ were both strongly associated with whether an HCP had recommended vaccination (odds ratios, 4.81 [95% CI 2.46, 9.35] and 5.66 [95% CI 2.46, 12.87], respectively). Conclusions Racial and socioeconomic disparities exist in the awareness and utilization of MenB vaccines among parents/guardians of US adolescents. HCP discussion and recommendation are critical catalysts for MenB vaccination and underscore the need to accurately interpret and implement the shared clinical decision-making (Category B) recommendation.
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Affiliation(s)
- Amit Srivastava
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc, 300 Technology Square, 3rd Floor, Cambridge, MA, 02139, USA.
| | | | | | | | - Liping Huang
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc,, Collegeville, PA, USA
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Isabirye A, Mbonye M, Asiimwe JB, Kwagala B. Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis. BMC Womens Health 2020; 20:145. [PMID: 32660461 PMCID: PMC7359563 DOI: 10.1186/s12905-020-01014-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination. METHODS Based on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10-14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey. RESULTS Majority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1-8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile. CONCLUSIONS Both individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.
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Affiliation(s)
- Alone Isabirye
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda.
| | - Martin Mbonye
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - John Bosco Asiimwe
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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7
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Isabirye A, Mbonye M, Asiimwe JB, Kwagala B. Factors associated with HPV vaccination uptake in Uganda: a multi-level analysis. BMC Womens Health 2020. [PMID: 32660461 DOI: 10.1186/s12905‐020‐01014‐5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The cervical cancer burden in Uganda is high amidst low uptake of HPV vaccination. Identification of individual and community factors associated with HPV vaccination are imperative for directed interventions. Conversely, in most Low and Middle Income Countries (LMICs) including Uganda this problem has not been sufficiently studied as the influence of individual and contextual determinants remains undetermined in spite of their substantial effect on HPV vaccine uptake. The aim of the study was to identify individual (school attendance status, age of girls, ethnicity, and amount of media exposure) and community (socioeconomic disadvantages) factors associated with HPV vaccination. METHODS Based on a modified conceptual framework for health care utilization, hierarchical modelling was used to study 6093 girls, aged 10-14 years (level 1), nested within 686 communities (level 2) in Uganda by analyzing data from the 2016 Uganda Demographic and Health Survey. RESULTS Majority (78%) of the girls had not been vaccinated. A number of both individual and community factors were significantly associated with HPV vaccination. The Odds of HPV vaccination were higher among girls age; 11, 13, and 14 compared to girls age 10 years, attending school compared to girls not attending school, who were; foreigners, Iteso, Karamajong, Banyoro, Basoga, and other tribe compared to Baganda, living in families with 1-8 members compared to those living in families with 9 or more members and middle social economic status compared to poor wealth quintile. CONCLUSIONS Both individual and community factors show a noticeable effect on HPV vaccination. If higher vaccination rates are to be achieved in Uganda, these factors should be addressed. Strategies aimed at reaching younger girls, street children, out of school girls, and girls with lower SES should be embraced in order to achieve high vaccination uptake.
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Affiliation(s)
- Alone Isabirye
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda.
| | - Martin Mbonye
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - John Bosco Asiimwe
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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Agawu A, Hanlon AL, Buttenheim AM, Song L, Fiks AG, Feemster KA. Disparities in Human Papillomavirus Vaccine Series Completion by Adolescent Males: A Retrospective Cohort Study. Acad Pediatr 2020; 20:364-373. [PMID: 31108236 DOI: 10.1016/j.acap.2019.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 04/18/2019] [Accepted: 05/04/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccine has been recommended for male patients for the prevention of genital warts and precancerous anal lesions since 2009. Our objective was to characterize race and insurance-based disparities in HPV vaccine completion among male patients who initiated the HPV vaccine series. METHODS This was a retrospective cohort study of adolescent male patients in a primary care network who initiated the HPV vaccine series from October 2009 to December 2013. We measured vaccine series completion as the primary outcome. We evaluated associations between outcomes and race and insurance status, controlling for potential confounders and effect modification with multivariable logistic regression. Analyses were stratified by vaccine recommendation era (permissive vs routine). RESULTS In total, 42% of males in the cohort (16,691) completed the vaccine series. In the permissive vaccine era (2009-2011), non-black patients (53%) were more likely to complete than black patients (32%) and non-Medicaid patients (49%) were more likely to complete than Medicaid patients (33%). These differences persisted in the routine recommendation era (2012-2013). In both the permissive and routine eras, Medicaid insurance was associated with a larger reduction in the predicted probability of vaccine series completion for non-black patients. Adherence to the recommended vaccination schedule was low, with a median time to completion of 8.9 months. Using the updated completion schedule (2016), we found that completion rates were greater (54.1%) with continued differences based on race (60% vs 45.7% for non-black vs black patients) and insurance (57.4% vs 46.4% completion for non-Medicaid vs Medicaid patients). CONCLUSIONS We found significant disparities in HPV vaccine series completion rates among male patients based on race and insurance, unchanged based on era of initiation or visit frequency.
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Affiliation(s)
- Atu Agawu
- Division of General Pediatrics (A Agawu, AG Fiks).
| | - Alexandra L Hanlon
- School of Nursing, University of Pennsylvania (AL Hanlon, AM Buttenheim)
| | | | - Lihai Song
- Healthcare Analytics Unit, PolicyLab (L Song), Children's Hospital of Philadelphia
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Feder MA, Kulasingam SL, Kiviat NB, Mao C, Nelson EJ, Winer RL, Whitham HK, Lin J, Hawes SE. Correlates of Human Papillomavirus Vaccination and Association with HPV-16 and HPV-18 DNA Detection in Young Women. J Womens Health (Larchmt) 2019; 28:1428-1435. [PMID: 31264912 DOI: 10.1089/jwh.2018.7340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Despite a reduction in the prevalence of vaccine-preventable types of human papillomavirus (HPV), attributed to increased HPV vaccine uptake, HPV continues to be a major cause of cancer in the United States. Methods: We assessed factors associated with self-reported HPV vaccine uptake, HPV vaccination effectiveness, using DNA testing to assess HPV types 16 and/or 18 (HPV 16/18) positivity, and patterns of HPV vaccination in 375 women aged 21-29 years who were eligible to receive catch-up vaccination, using baseline data collected from March 2012 to December 2014 from a randomized controlled trial evaluating a novel approach to cervical cancer screening. Results: More than half (n = 228, 60.8%) of participants reported receipt of at least one HPV vaccine dose and 16 (4.3%) tested positive for HPV 16/18 at baseline. College-educated participants were four times more likely to have been vaccinated than those reporting high school education or less. 56.5% of HPV-vaccinated participants reported first dose after age 18 and 68.4% after first vaginal intercourse. Women vaccinated after age 18 and women vaccinated after first vaginal intercourse were somewhat more likely to be infected with HPV 16/18 infection compared with women vaccinated earlier, but these associations did not reach statistical significance. Conclusions: HPV vaccination is common among college-educated women in the catch-up population but less common among those without college education. Contrary to current guidelines, catch-up females frequently obtain HPV vaccination after age 18 and first vaginal intercourse. Women without a college education represent an ideal population for targeted HPV vaccination efforts that emphasize vaccination before sexual debut.
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Affiliation(s)
- Molly A Feder
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Shalini L Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Nancy B Kiviat
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Constance Mao
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Erik J Nelson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Hilary K Whitham
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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Lake PW, Kasting ML, Christy SM, Vadaparampil ST. Provider perspectives on multilevel barriers to HPV vaccination. Hum Vaccin Immunother 2019; 15:1784-1793. [PMID: 30779687 DOI: 10.1080/21645515.2019.1581554] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Understanding physician recommendation practices for HPV vaccination is a crucial step to developing interventions that can increase high quality recommendations and improve vaccination acceptance. Florida physicians (n = 340) completed a survey assessing recommendation strategies, specifically strength, consistency, and presentation. Physicians were also asked to provide suggestions for improving HPV vaccination in Florida. Responses were dichotomized for each outcome: strength (i.e., strongly recommend vs. other), consistently recommend (i.e., always recommend vs. other), and recommendation presentation (i.e., presented in the same manner as mandatory vaccines for adolescents vs. other). Bivariate logistic regression was conducted to determine the association between physician/practice characteristics and each outcome. Variables significant (p < .05) in bivariate analyses were included in multivariable logistic regression analyses. Vaccines for Children (VFC) provider status (OR = 2.62, 95% CI = 1.23-5.59 [strong]; OR = 2.84, 95% CI = 1.26-6.39 [consistent]) and not limiting the number of vaccines during a visit (OR = .283, 95% = CI .111-.722 [strong]; OR = .210, 95% = CI .066-.673 [consistent]) were significantly associated with strong and consistent recommendation. Reminders from the healthcare team were associated with consistency (OR = 2.26, 95% CI = 1.23-4.16) and EMR-based reminders were associated with presentation (OR = 2.00, 95% CI = 1.11-3.61). Multinomial logistic regression analysis examined factors associated with level of engagement in recommendation strategies. Multinomial regression indicated VFC providers (OR = 12.61, 95% CI = 1.89-82.20), and those receiving EMR-based reminders (OR = 4.02, 95% = CI 1.28-12.63), among others, were more likely to engage in all 3 types of recommendation practices. Physician suggestions for improving HPV vaccination rates included improving parent/patient/provider education and reducing vaccine costs. Future interventions should emphasize key components of delivering effective HPV vaccine recommendations, include information about insurance coverage, and improve provider awareness of VFC benefits.
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Affiliation(s)
- Paige W Lake
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA
| | - Monica L Kasting
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,b Center for Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,c Department of Health and Kinesiology, Purdue University , West Lafayette , IN , USA
| | - Shannon M Christy
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,d Morsani College of Medicine, University of South Florida , Tampa , FL , USA
| | - Susan T Vadaparampil
- a Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,b Center for Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA.,d Morsani College of Medicine, University of South Florida , Tampa , FL , USA
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11
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Hopfer S, Wright ME, Pellman H, Wasserman R, Fiks AG. HPV vaccine recommendation profiles among a national network of pediatric practitioners: understanding contributors to parental vaccine hesitancy and acceptance. Hum Vaccin Immunother 2019; 15:1776-1783. [PMID: 30570419 PMCID: PMC6746469 DOI: 10.1080/21645515.2018.1560771] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Practitioner communication is one of the most important influences and predictors of HPV vaccination uptake. The objective of this study was to conduct a latent class analysis characterizing pediatric practitioner HPV recommendation patterns. Methods: Pediatric practitioners of the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) national network completed an online survey where they were presented with 5 hypothetical vignettes of well child visits and responded to questions. Questions asked about their use of communication strategies, assessments about the adolescent patient becoming sexually active in the next 2 years for decision-making about HPV vaccine recommendation, and peer norms. Latent class analysis characterized practitioner subgroups based on their response patterns to 10 survey questions. Multinomial logistic regression examined practitioner characteristics associated with each profile. Results: Among 470 respondents, we identified three distinct practitioner HPV vaccine recommendation profiles: (1) Engagers (52%) followed national age-based guidelines, strongly recommended HPV vaccination, and perceived peers as strongly recommending; (2) Protocol Followers (20%) also strongly recommended HPV vaccination, but were less likely to engage families in a discussion about benefits; and (3) Ambivalent HPV Vaccine Recommenders (28%) delayed or did not recommend HPV vaccination and were more likely to use judgment about whether adolescents will become sexually active in the next two years. Practicing in a suburban setting was associated with twice the odds of being an Ambivalent Recommender relative to being an Engager (OR = 2.2; 95% CI:1.1-4.1). Conclusions: Findings underscore the importance of continued efforts to bolster practitioner adoption of evidence-based approaches to HPV vaccine recommendation especially among Ambivalent Recommenders.
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Affiliation(s)
- Suellen Hopfer
- Department of Population Health and Disease Prevention, Irvine, CA, USA
- Institute for Clinical & Translational Science, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Margaret E. Wright
- Pediatric Research in Office Settings (PROS), Itasca, IL, USA
- American Academy of Pediatrics (AAP), Itasca, IL, USA
| | - Harry Pellman
- University of California, Irvine, CA, USA
- Edinger Medical Group, University of California, Fountain Valley, CA, USA
| | - Richard Wasserman
- Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Alexander G. Fiks
- Pediatric Research in Office Settings (PROS), Itasca, IL, USA
- The Center for Clinical Effectiveness, USA
- Policy Lab, USA
- Pediatric Research Consortium, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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12
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MacDonald SE, Russell ML, Liu XC, Simmonds KA, Lorenzetti DL, Sharpe H, Svenson J, Svenson LW. Are we speaking the same language? an argument for the consistent use of terminology and definitions for childhood vaccination indicators. Hum Vaccin Immunother 2018; 15:740-747. [PMID: 30457475 PMCID: PMC6605715 DOI: 10.1080/21645515.2018.1546526] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/30/2018] [Indexed: 11/23/2022] Open
Abstract
Vaccination indicators are used to measure the health status of individuals or populations and to evaluate the effectiveness of vaccination programs or policies. Ensuring that vaccination indicators are clearly and consistently defined is important for effective communication of outcomes, accurate program evaluation, and comparison between different populations, times, and contexts. The purpose of this commentary is to describe commonly used vaccination indicators and to highlight inconsistencies in how childhood vaccine researchers use and define these terms. The indicators we describe are vaccine coverage, uptake, and rate; vaccination status, initiation, and completion; and up-to-date, timely, partial, and incomplete vaccination. We conclude that many vaccination indicators are not explicitly defined within published research studies and/or are used quite differently across studies. We also note that the choice of indicator in a given study is often driven by program or vaccine specific factors, may be constrained by data availability, and should be chosen to best reflect the outcome of interest. We conclude that the use of consistent language and definitions would promote more effective communication of research findings. We also propose some standardized definitions for common indicators, with the goal of provoking discussion and debate on the issue.
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Affiliation(s)
- Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L. Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xianfang C. Liu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberley A. Simmonds
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Diane L. Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Heather Sharpe
- Respiratory Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada, USA
- Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Svenson
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Lawrence W. Svenson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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13
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Rosen BL, Bishop JM, McDonald S, Wilson KL, Smith ML. Factors Associated with College Women's Personal and Parental Decisions to be Vaccinated Against HPV. J Community Health 2018; 43:1228-1234. [PMID: 29961186 DOI: 10.1007/s10900-018-0543-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The human papillomavirus (HPV) is a public health concern because of its association with cancer. HPV vaccine rates among college students remains low. This is a critical catch-up age for individuals to receive the HPV vaccine and research shows parents still play a role in college students' medical decision-making. Therefore, the purpose of this study was to examine factors related to college women making a solo decision to initiate the HPV vaccination in comparison to making a joint parent-daughter decision. Data collected using an internet-delivered questionnaire were analyzed from 799 college women who had initiated or completed the HPV vaccination. Multinomial logistic regression was performed to compare study variables on who decided the participant should be vaccinated (self-decision, parent-only decision, joint parent-daughter decision). Participants who were older (OR 1.68, p < 0.001) and sexually active (OR 4.97, p < 0.001) were significantly more likely to have made a solo decision to be vaccinated. Participants who completed the HPV vaccination (OR 0.33, p < 0.001) and those who talked with a parent about the HPV vaccine (OR 0.12, p < 0.001) were significantly less likely to have made a solo decision to be vaccinated. Findings indicate joint parent-daughter decisions may improve HPV vaccination cycle completion.
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Affiliation(s)
- Brittany L Rosen
- School of Human Services, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | - James M Bishop
- School of Human Services, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Skye McDonald
- School of Human Services, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Kelly L Wilson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, 77030, USA
| | - Matthew Lee Smith
- School of Public Health, Center for Population Health and Aging, Texas A&M University, College Station, TX, 77030, USA
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14
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Dempsey AF, Pyrznawoski J, Lockhart S, Barnard J, Campagna EJ, Garrett K, Fisher A, Dickinson LM, O’Leary ST. Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination: A Cluster Randomized Clinical Trial. JAMA Pediatr 2018; 172:e180016. [PMID: 29507952 PMCID: PMC5875329 DOI: 10.1001/jamapediatrics.2018.0016] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE The incidence of human papillomavirus (HPV)-related cancers is more than 35 000 cases in the United States each year. Effective HPV vaccines have been available in the United States for several years but are underused among adolescents, the target population for vaccination. Interventions to increase uptake are needed. OBJECTIVE To evaluate the effect of a 5-component health care professional HPV vaccine communication intervention on adolescent HPV vaccination. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial using covariate-constrained randomization to assign study arms and an intent-to-treat protocol was conducted in 16 primary care practices in the Denver, Colorado, metropolitan area. Participants included 188 medical professionals and 43 132 adolescents. INTERVENTIONS The 5 components of the intervention were an HPV fact sheet library to create customized information sheets relevant to each practice's patient population, a tailored parent education website, a set of HPV-related disease images, an HPV vaccine decision aid, and 2½ hours of communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination. Each practice participated in a series of 2 intervention development meetings over a 6-month period (August 1, 2014, to January 31, 2015) before the intervention. MAIN OUTCOMES AND MEASURES Differences between control and intervention changes over time (ie, difference in differences between the baseline and intervention period cohorts of patients) in HPV vaccine series initiation (≥1 dose) and completion (≥3 doses) among patients aged 11 to 17 years seen at the practices between February 1, 2015, and January 31, 2016. Vaccination data were obtained from the practices' records and augmented with state immunization information system data. RESULTS Sixteen practices and 43 132 patients (50.3% female; median age, 12.6 years [interquartile range, 10.8-14.7 years] at the beginning of the study period) participated in this trial. Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.62) and completion (aOR, 1.56; 95% CI, 1.27-1.92) than those in the control practices (a 9.5-absolute percentage point increase in HPV vaccine series initiation and a 4.4-absolute percentage point increase in HPV vaccine series completion in intervention practices). The intervention had a greater effect in pediatric practices compared with family medicine practices and in private practices compared with public ones. Health care professionals reported that communication training and the fact sheets were the most used and useful intervention components. CONCLUSIONS AND RELEVANCE A health care professional communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02456077.
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Affiliation(s)
- Amanda F. Dempsey
- Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora,Division of General Pediatrics, Department of Pediatrics, University of Colorado Denver, Aurora
| | - Jennifer Pyrznawoski
- Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora
| | - Steven Lockhart
- Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora
| | - Juliana Barnard
- Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora
| | - Elizabeth J. Campagna
- Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora
| | - Kathleen Garrett
- Center for Public Health Practice, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Allison Fisher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - L. Miriam Dickinson
- Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora,Department of Biostatistics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Sean T. O’Leary
- Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora,Division of Infectious Diseases, Department of Pediatrics, University of Colorado Denver, Aurora
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15
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The Relationship of Health Beliefs with Information Sources and HPV Vaccine Acceptance among Young Adults in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040673. [PMID: 29617313 PMCID: PMC5923715 DOI: 10.3390/ijerph15040673] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 01/01/2023]
Abstract
Despite the HPV vaccine’s efficacy in preventing cervical cancer, its coverage rates among Asians are very low. To increase immunization coverage among these populations, understanding the psychological factors that affect HPV acceptability is critical. To this end, this study examined the relationships between multidimensional health beliefs and HPV vaccine acceptance, and what information sources effectively foster HPV vaccination-related health beliefs. Data were collected using a survey of 323 undergraduate students in Korea. Results showed that perceived susceptibility, perceived severity, perceived benefits, and perceived vaccine safety concerns predicted vaccine acceptance. Multiple dimensions of perceived barriers showed differing impacts on vaccine acceptance. In addition, interpersonal information sources were effective in boosting various health beliefs for HPV vaccination. The Internet also was effective in reducing social barriers, but the effects were opposite to those of social media. Theoretical and practical implications are discussed.
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16
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Rand CM, Goldstein NPN. Patterns of Primary Care Physician Visits for US Adolescents in 2014: Implications for Vaccination. Acad Pediatr 2018; 18:S72-S78. [PMID: 29502641 DOI: 10.1016/j.acap.2018.01.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/01/2018] [Accepted: 01/02/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Because most adolescent vaccinations are delivered in primary care, opportunities to vaccinate depend on the presence of visits and types of visits. We evaluated: 1) national visit patterns (having an annual preventive visit with a physician, provider type seen, visit types) for adolescents across the United States, and 2) the type of physician visits at which vaccines are administered for this age group. METHODS We performed a secondary data set analysis of the 2014 Medical Expenditure Panel Survey. Data are collected through interviews of caregivers of a nationally representative sample of the noninstitutionalized US population. We used descriptive analyses to examine use of health care according to age and gender, and visit types at which vaccines were given according to age. RESULTS During a 12-month period, almost half of participants had no primary care physician (PCP) visits, and one-third had a preventive visit to a PCP. An additional 19% had only nonpreventive care visits to a PCP. Uninsured participants had the highest rate of no care, and the lowest rate of preventive care. Most preventive care visits by adolescents 11 to 17 years of age were to pediatricians, and most visits among those 18 to 21 years of age were to family/general practitioners. Overall, 67% of non-check-up PCP visits were for acute care, 10% were for follow-up, and 7% for immunization only. Nationally, 61%, 26%, and 12% of vaccines were given at preventive, immunization-only, and acute/follow-up visits, respectively. CONCLUSIONS Fewer than half of adolescents receive preventive care, and many have no PCP visits. This reinforces the need to offer outreach to adolescents to improve rates of preventive visits, and to take advantage of all primary care visits for vaccinations. Because pediatricians and family practice/general practice physicians vaccinate most adolescents, these providers should remain the target audience for vaccine education and quality improvement activities.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Nicolas P N Goldstein
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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17
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Rahman M, Hirth JM, Berenson AB. Adherence to ACIP Recommendation for Human Papillomavirus Vaccine Among US Adolescent Girls. J Community Health 2018; 42:385-389. [PMID: 27704304 DOI: 10.1007/s10900-016-0267-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to examine correlates of human papillomavirus (HPV) vaccine use according to Advisory Committee on Immunization Practices (ACIP)'s recommendations among US adolescent girls. We used National Immunization Survey of Teens 2013 data. Based on provider-verified (n = 9403) information, 57.3, 39.1 and 19.0 % of adolescent girls, initiated, completed and completed the HPV vaccine according to ACIP's recommendation (by age 12), respectively. Hispanic race/ethnicity, a physician recommendation for HPV vaccine and ≥1 influenza vaccine in the past 3 years were all associated with a higher likelihood of compliance with ACIP's recommendation. Girls from a larger family and those whose immunization provider was a STD/school/teen clinic were less likely to receive the vaccine at the recommended age compared to a girl raised in a smaller sized family and received immunization from a hospital facility, respectively. Only one-fifth of 13-17 yo girls receive the HPV vaccine by age 12 as recommended by ACIP. Physician visits and influenza vaccination settings are opportunities to improve vaccine series completion at the recommended age.
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Affiliation(s)
- Mahbubur Rahman
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA. .,Center for Clinical Epidemiology, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Jacqueline M Hirth
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA
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18
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Oltean HN, Lofy KH, Goldoft MJ, DeBolt CA. Human Papillomavirus Vaccination in Washington State: Estimated Coverage and Missed Opportunities, 2006-2013. Public Health Rep 2017; 131:474-82. [PMID: 27252567 DOI: 10.1177/003335491613100313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Human papillomavirus (HPV) causes almost all cervical cancer in women and contributes to vaginal, anal, oropharyngeal, and penile cancer morbidity and mortality. Although vaccines effective in preventing up to nine types of HPV are available, vaccination rates are low nationally. We assessed HPV vaccination coverage by age, sex, and county using Washington State Immunization Information System data. METHODS We calculated on-time dose coverage by county and statewide among adolescents aged 11-12 years and assessed coverage by age 18 years. We calculated missed opportunities as the number of visits at which doses of other adolescent vaccines were administered without administration of the first dose of HPV vaccine (HPV1). RESULTS In 2013, HPV vaccination coverage estimates with one, two, and three doses (HPV1-3) for adolescents aged 11-12 years were 48.5%, 32.4%, and 18.3% among girls and 31.2%, 17.1%, and 8.1% among boys. The three-dose HPV vaccine coverage estimate increased to 40.1% among girls by age 18 but was unchanged for boys. Coverage estimates varied by age, sex, and county. One-third of eligible unvaccinated girls and two of five eligible boys aged 11-17 years had at least one missed opportunity to receive HPV1. CONCLUSION Despite a recommendation to vaccinate adolescents aged 11-12 years, HPV vaccination is often delayed and coverage levels among all age groups are below national target levels. Improved understanding of the variability of HPV vaccination coverage rates by age, sex, and county can inform targeted interventions statewide.
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Affiliation(s)
- Hanna N Oltean
- Washington State Department of Health, Office of Communicable Disease Epidemiology, Shoreline, WA
| | - Kathryn H Lofy
- Washington State Department of Health, Office of Communicable Disease Epidemiology, Shoreline, WA
| | - Marcia J Goldoft
- Washington State Department of Health, Office of Communicable Disease Epidemiology, Shoreline, WA
| | - Charla A DeBolt
- Washington State Department of Health, Office of Communicable Disease Epidemiology, Shoreline, WA
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19
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Baldwin AS, Denman DC, Sala M, Marks EG, Shay LA, Fuller S, Persaud D, Lee SC, Skinner CS, Wiebe DJ, Tiro JA. Translating self-persuasion into an adolescent HPV vaccine promotion intervention for parents attending safety-net clinics. PATIENT EDUCATION AND COUNSELING 2017; 100:736-741. [PMID: 27912928 PMCID: PMC5385267 DOI: 10.1016/j.pec.2016.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/04/2016] [Accepted: 11/19/2016] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Self-persuasion is an effective behavior change strategy, but has not been translated for low-income, less educated, uninsured populations attending safety-net clinics or to promote human papillomavirus (HPV) vaccination. We developed a tablet-based application (in English and Spanish) to elicit parental self-persuasion for adolescent HPV vaccination and evaluated its feasibility in a safety-net population. METHODS Parents (N=45) of age-eligible adolescents used the self-persuasion application. Then, during cognitive interviews, staff gathered quantitative and qualitative feedback on the self-persuasion tasks including parental decision stage. RESULTS The self-persuasion tasks were rated as easy to complete and helpful. We identified six question prompts rated as uniformly helpful, not difficult to answer, and generated non-redundant responses from participants. Among the 33 parents with unvaccinated adolescents, 27 (81.8%) reported deciding to get their adolescent vaccinated after completing the self-persuasion tasks. CONCLUSIONS The self-persuasion application was feasible and resulted in a change in parents' decision stage. Future studies can now test the efficacy of the tablet-based application on HPV vaccination. PRACTICE IMPLICATIONS The self-persuasion application facilitates verbalization of reasons for HPV vaccination in low literacy, safety-net settings. This self-administered application has the potential to be more easily incorporated into clinical practice than other patient education approaches.
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Affiliation(s)
| | | | | | - Emily G Marks
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, USA
| | | | | | | | - Simon Craddock Lee
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, USA
| | - Celette Sugg Skinner
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, USA
| | | | - Jasmin A Tiro
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, USA
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20
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Kempe A, O’Leary ST, Shoup JA, Stokley S, Lockhart S, Furniss A, Dickinson LM, Barnard J, Daley MF. Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial. Pediatrics 2016; 137:e20152857. [PMID: 26921286 PMCID: PMC5884084 DOI: 10.1542/peds.2015-2857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. METHODS All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. RESULTS At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). CONCLUSIONS Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.
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Affiliation(s)
- Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Departments of Pediatrics, and
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Shannon Stokley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Lockhart
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - L. Miriam Dickinson
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Juliana Barnard
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado, Aurora, Colorado,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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21
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Clarke MA, Coutinho F, Phelan-Emrick DF, Wilbur M, Chou B, Joshu CE. Predictors of Human Papillomavirus Vaccination in a Large Clinical Population of Males Aged 11 to 26 years in Maryland, 2012-2013. Cancer Epidemiol Biomarkers Prev 2015; 25:351-8. [PMID: 26698909 DOI: 10.1158/1055-9965.epi-15-0983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite the recommendation for routine human papillomavirus (HPV) vaccination in males, coverage estimates remain low. We sought to identify predictors of receiving each HPV vaccine dose among a large clinical population of males. METHODS We conducted a cross-sectional analysis of electronic medical records for 14,688 males ages 11 to 26 years attending 26 outpatient clinics (January 2012-April 2013) in Maryland to identify predictors of each HPV vaccine dose using multivariate logistic regression models with generalized estimating equations. All analyses were stratified in accordance with vaccine age recommendations: 11 to 12 years, 13 to 21 years, and 22 to 26 years. Analyses of predictors of receipt of subsequent HPV doses were also stratified by the number of clinic visits (≤3 and >3). RESULTS Approximately 15% of males initiated the HPV vaccine. Less than half of males eligible received the second and third doses, 49% and 47%, respectively. Non-Hispanic black males (vs. non-Hispanic white) ages 11 to 12 and 13 to 21 years and males with public insurance (vs. private) ages 13 to 21 years had significantly greater odds of vaccine initiation, but significantly decreased odds of receiving subsequent doses, respectively. Attendance to >3 clinic visits attenuated the inverse association between public insurance and receipt of subsequent doses. CONCLUSION Overall, rates of HPV vaccine initiation and of subsequent doses were low. While non-Hispanic black and publicly insured males were more likely to initiate the HPV vaccine, they were less likely to receive subsequent doses. IMPACT Tailoring different intervention strategies for increasing HPV vaccine initiation versus increasing rates of subsequent doses among males may be warranted.
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Affiliation(s)
- Megan A Clarke
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Francesca Coutinho
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Darcy F Phelan-Emrick
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - MaryAnn Wilbur
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Betty Chou
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
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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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Dempsey AF, Brewer SE, Pyrzanowski J, Sevick C, O’leary ST. Acceptability of human papillomavirus vaccines among women older than 26 years. Vaccine 2015; 33:1556-61. [DOI: 10.1016/j.vaccine.2015.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 01/16/2023]
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Donahue KL, Hendrix KS, Sturm LA, Zimet GD. Human papillomavirus vaccine initiation among 9–13-year-olds in the United States. Prev Med Rep 2015; 2:892-898. [PMID: 26594616 PMCID: PMC4652326 DOI: 10.1016/j.pmedr.2015.10.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9–26-year-old males and females, with routine vaccination recommended for 11–12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13–17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9–13-year-olds in the United States. A national sample of mothers of 9–13-year-olds in the United States (N = 2446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child's HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child's initiation of the HPV vaccine (i.e., receipt of one or more doses). Approximately 35% of the full sample and 27.5% of the 9–10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers' communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage. Approximately 35% of 9–13-year-olds had initiated the HPV vaccine series. A quarter of 9–10-year-olds had initiated the HPV vaccine series. At age 13, females were more likely than males to have initiated HPV vaccination. No gender difference in HPV vaccine initiation was found prior to age 13. Provider recommendation was a particularly salient predictor of HPV vaccination
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Taylor JL, Zimet GD, Donahue KL, Alexander AB, Shew ML, Stupiansky NW. Vaccinating sons against HPV: results from a U.S. national survey of parents. PLoS One 2014; 9:e115154. [PMID: 25541726 PMCID: PMC4277268 DOI: 10.1371/journal.pone.0115154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose The quadrivalent HPV vaccination was approved for use in males ages 9 to 26 in 2009 and recommended for routine administration in 2011. The purpose of this study was to uncover predictable commonalities amongst parents who chose to vaccinate their 11–17 year old sons against HPV. Methods We compiled data from a U.S. national sample of 779 parents with sons 11–17 years old using a web-based survey to gather information about behavioral and sociodemographic factors which predicted receipt of 1 or more HPV vaccine doses based on parental report. Predictors were first modeled individually for univariable associations. Significant predictors (p<0.10) were combined in a multivariable model. Results In the adjusted model, independent predictors included receipt of flu vaccination, health insurance coverage and sexual health topic discussions with sons. Sons who had received a flu shot in the last two years more frequently received at least one dose of the vaccine (OR 1.82; 95% CI 1.45–2.26). Sons covered by private health insurance had decreased odds of HPV vaccination (OR 0.56 95% CI 0.37–0.83). Lastly, parents who had discussed sexual health topics with their sons were more likely to vaccinate (OR 1.61; 95% CI 1.37–1.89). Conclusions Male vaccination rates in the U.S. have increased, but males continue to be under-immunized. Utilization of health care is an important factor in HPV vaccine uptake; therefore, health care providers should use every contact as an opportunity to vaccinate. Communication about sexual health topics may provide a forum for parents and health care providers to have conversations about HPV vaccination as those more comfortable discussing these topics may also be more comfortable discussing HPV vaccination.
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Affiliation(s)
- Jaime L. Taylor
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Greg D. Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kelly L. Donahue
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Andreia B. Alexander
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcia L. Shew
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Nathan W. Stupiansky
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Rahman M, McGrath CJ, Hirth JM, Berenson AB. Age at HPV vaccine initiation and completion among US adolescent girls: trend from 2008 to 2012. Vaccine 2014; 33:585-7. [PMID: 25529289 DOI: 10.1016/j.vaccine.2014.12.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/25/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the trend of provider-verified HPV vaccine initiation (≥1 dose) and completion (≥3 doses) among adolescent girls at the Advisory Committee on Immunization Practices (ACIP) recommended age (11-12 years). METHODS We analyzed National Immunization Survey of Teens 2008-2012 data and examined the trend of provider-verified HPV vaccine initiation and completion among <13 year old girls. RESULTS Data on age at HPV vaccine initiation and completion were available for 24,466 and 15,972 girls, respectively. The weighted proportion of girls who initiated the vaccine at <13 years of age was 14.1%, 24.1%, 35.9%, 47.7% and 55.9% in 2008, 2009, 2010, 2011 and 2012, respectively (p for trend <.001). The similar trend was also observed for mean age at HPV vaccine initiation and completion (p<.001). CONCLUSIONS Additional efforts are needed to increase HPV vaccine uptake among adolescent girls as only half of them receive this vaccine at ACIP recommended age.
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Affiliation(s)
- Mahbubur Rahman
- Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, United States.
| | - Christine J McGrath
- Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Jacqueline M Hirth
- Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, United States
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Jeudin P, Liveright E, Del Carmen MG, Perkins RB. Race, ethnicity, and income factors impacting human papillomavirus vaccination rates. Clin Ther 2014; 36:24-37. [PMID: 24417783 DOI: 10.1016/j.clinthera.2013.11.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection and cervical cancer disproportionately affect low-income and minority women. HPV vaccines have the potential to either reduce or exacerbate racial disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake. OBJECTIVES This review aims to identify barriers and facilitators of equitable uptake of HPV vaccination among low-income and minority girls. This review discusses factors related to race, ethnicity, and income that are associated with initiation and completion rates of the 3-dose HPV vaccine series and presents targets for intervention. METHODS We reviewed relevant English-language literature to identify current vaccination rates and factors associated with vaccine uptake. Study findings related to race (black, Latino, Asian), and incomes were summarized. RESULTS Current trends in the United States indicate low uptake among all adolescents, and that rates stagnated between 2011 and 2012. Low-income and minority adolescents are equally or more likely to start the HPV vaccination series than are white and higher-income adolescents, but are less likely to complete all 3 shots. Provider recommendation is a key factor in HPV vaccination, and minorities are less likely to report receiving recommendations for HPV vaccination. CONCLUSIONS As black, Hispanic, and Asian populations continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent an increase in cervical cancer disparities.
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Affiliation(s)
- Patricia Jeudin
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Elizabeth Liveright
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca B Perkins
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts.
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Feemster KA, Middleton M, Fiks AG, Winters S, Kinsman SB, Kahn JA. Does intention to recommend HPV vaccines impact HPV vaccination rates? Hum Vaccin Immunother 2014; 10:2519-26. [PMID: 25483470 DOI: 10.4161/21645515.2014.969613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Despite recommendations for routine vaccination, HPV vaccination rates among adolescent females have remained low. The objective of this prospective cohort study was to determine whether clinician intention to recommend HPV vaccines predicts HPV vaccine series initiation among previously unvaccinated 11 to 18 year-old girls (N=18,083) who were seen by a pediatric clinician (N=105) from a large primary care network within 3 years of vaccine introduction. We used multivariable logistic regression with generalized estimating equations, Cox Regression and standardized survival curves to measure the association between clinician intention and time to and rate of first HPV vaccine receipt among eligible females. All models adjusted for patient age, race/ethnicity, payor category, visit type, and practice location. Eighty-5 percent of eligible 11 to 12 year-old and 95% of 13 to 18 year-old girls were seen by a provider reporting high intention to recommend HPV vaccines. However, only 30% of the cohort initiated the HPV vaccine series and the mean number of days from first eligible visit to series initiation was 190 (95% C.I. 184.2, 195.4). After adjusting for covariates, high clinician intention was modestly associated with girls' likelihood of HPV vaccine series initiation (OR 1.36; 95 % C.I. 1.07, 1.71) and time to first HPV vaccination (HR 1.22; 95% 1.06, 1.40). Despite high intention to vaccinate among this cohort of pediatric clinicians, overall vaccination rates for adolescent girls remained low. These findings support ongoing efforts to develop effective strategies to translate clinician intention into timely HPV vaccine receipt.
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Affiliation(s)
- Kristen A Feemster
- a Division of Infectious Diseases ; The Children's Hospital of Philadelphia ; Philadelphia , PA USA
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Cowburn S, Carlson M, Lapidus J, Heintzman J, Bailey S, DeVoe J. Insurance continuity and human papillomavirus vaccine uptake in Oregon and California federally qualified health centers. Am J Public Health 2014; 104:e71-9. [PMID: 25033154 PMCID: PMC4151916 DOI: 10.2105/ajph.2014.302007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between insurance continuity and human papillomavirus (HPV) vaccine uptake in a network of federally qualified health clinics (FQHCs). METHODS We analyzed retrospective electronic health record data for females, aged 9-26 years in 2008 through 2010. Based on electronic health record insurance coverage information, patients were categorized by percent of time insured during the study period (0%, 1%-32%, 33%-65%, 66%-99%, or 100%). We used bilevel multivariable Poisson regression to compare vaccine-initiation prevalence between insurance groups, stratified by race/ethnicity and age. We also examined vaccine series completion among initiators who had at least 12 months to complete all 3 doses. RESULTS Significant interactions were observed between insurance category, age, and race/ethnicity. Juxtaposed with their continuously insured peers, patients were less likely to initiate the HPV vaccine if they were insured for less than 66% of the study period, aged 13 years or older, and identified as a racial/ethnic minority. Insurance coverage was not associated with vaccine series completion. CONCLUSIONS Disparities in vaccine uptake by insurance status were present in the FQHCs studied here, despite the fact that HPV vaccines are available to many patients regardless of ability to pay.
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Affiliation(s)
- Stuart Cowburn
- Stuart Cowburn is with OCHIN, Inc., Portland, OR. Matthew Carlson is with the Department of Sociology, Portland State University, Portland. Jodi Lapidus is with the Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland. John Heintzman, Steffani Bailey, and Jennifer DeVoe are with the Department of Family Medicine, Oregon Health & Science University, Portland
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Navarro-Illana P, Diez-Domingo J, Navarro-Illana E, Tuells J, Alemán S, Puig-Barberá J. "Knowledge and attitudes of Spanish adolescent girls towards human papillomavirus infection: where to intervene to improve vaccination coverage". BMC Public Health 2014; 14:490. [PMID: 24885391 PMCID: PMC4061915 DOI: 10.1186/1471-2458-14-490] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/24/2014] [Indexed: 11/12/2022] Open
Abstract
Background HPV vaccine coverage is far from ideal in Valencia, Spain, and this could be partially related to the low knowledge about the disease and the vaccine, therefore we assessed these, as well as the attitude towards vaccination in adolescent girls, and tried to identify independently associated factors that could potentially be modified by an intervention in order to increase vaccine coverage. Methods A cross sectional study was conducted in a random selection of schools of the Spanish region of Valencia. We asked mothers of 1278 girls, who should have been vaccinated in the 2011 campaign, for informed consent. Those that accepted their daughters’ participation, a questionnaire regarding the Knowledge of HPV infection and vaccine was passed to the girls in the school. Results 833 mothers (65.1%) accepted participation. All their daughters’ responded the questionnaire. Of those, 89.9% had heard about HPV and they associated it to cervical cancer. Only 14% related it to other problems like genital warts. The knowledge score of the girls who had heard about HPV was 6.1/10. Knowledge was unrelated to the number of contacts with the health system (Pediatrician or nurse), and positively correlated with the discussions with classmates about the vaccine. Adolescents Spanish in origin or with an older sister vaccinated, had higher punctuation. 67% of the girls thought that the vaccine prevented cancer, and 22.6% felt that although prevented cancer the vaccine had important safety problems. 6.4% of the girls rejected the vaccine for safety problems or for not considering themselves at risk of infection. 71.5% of the girls had received at least one vaccine dose. Vaccinated girls scored higher knowledge (p = 0.05). Conclusion Knowledge about HPV infection and vaccine was fair in adolescents of Valencia, and is independent to the number of contacts with the health system, it is however correlated to the conversations about the vaccine with their peers and the vaccination status. An action to improve HPV knowledge through health providers might increase vaccine coverage in the adolescents.
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Affiliation(s)
- Pedro Navarro-Illana
- Facultad de Enfermería, Universidad Católica de Valencia "San Vicente Mártir", C/Jesús, 10, 46007 Valencia, Spain.
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Joseph NP, Clark JA, Mercilus G, Wilbur MB, Figaro J, Perkins R. Racial and ethnic differences in HPV knowledge, attitudes, and vaccination rates among low-income African-American, Haitian, Latina, and Caucasian young adult women. J Pediatr Adolesc Gynecol 2014; 27:83-92. [PMID: 24602302 PMCID: PMC3950833 DOI: 10.1016/j.jpag.2013.08.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine facilitators and barriers to HPV vaccine uptake in African-American, Haitian, Latina, and White women aged 18-22 and to determine vaccination completion rates among participants over 5 years. DESIGN Using semi-structured interviews and medical record review, we assessed HPV knowledge and attitudes towards HPV vaccination among young women. We then determined their subsequent HPV vaccination initiation and completion rates. We used constructs from the Health Belief Model and methods based in grounded theory and content analysis to identify attitudes towards HPV vaccination cues to initiate vaccination, perception of HPV, and how communication about issues of sexuality may impact vaccine uptake. PARTICIPANTS We enrolled 132 African-American, Haitian, Latina, and White women aged 18-22 years who visited an urban academic medical center and 2 affiliated community health centers between the years 2007 and 2012. MAIN OUTCOME MEASURES Intent to vaccinate and actual vaccination rates. RESULTS Of 132 participants, 116 (90%) stated that they were somewhat or very likely to accept HPV vaccination if offered by their physician, but only 51% initiated the vaccination over the next 5 years. Seventy-eight percent of those who initiated vaccination completed the 3 doses of the HPV vaccine series. Forty-five percent (45%, n = 50) of the adolescents who started the series completed 3 doses over a 5-year period: 42% of African-American (n = 16), 33% of Haitian (n = 13), 63% of Latina (n = 10), and 65% of White young women (n = 11) completed the 3-dose series. Despite low knowledge, they reported high levels of trust in physicians and were willing to vaccinate if recommended by their physicians. CONCLUSION Desire for HPV vaccination is high among older adolescents, physician recommendation, and use of every clinic visit opportunity may improve vaccine uptake in young women. More White young women completed the HPV vaccine series compared with other race and ethnic young women.
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Affiliation(s)
- Natalie Pierre Joseph
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Jack A. Clark
- Boston University School of Public Health, Boston MA
| | - Glory Mercilus
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - MaryAnn B. Wilbur
- Department of Gynecology & Obstetrics, Johns Hopkins Hospital, 600 North Wolfe Street, Phipps 279, Baltimore, MD 21287, work phone: 410-997-0040
| | - Jean Figaro
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Rebecca Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine
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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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Hoque ME, Monokoane S, Van Hal G. Knowledge of and attitude towards human papillomavirus infection and vaccines among nurses at a tertiary hospital in South Africa. J OBSTET GYNAECOL 2014; 34:182-6. [DOI: 10.3109/01443615.2013.861395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brabin L, Kitchener HC, Stern PL. Implementation of prophylactic HPV vaccination: progress and future challenges. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cullen KA, Stokley S, Markowitz LE. Uptake of human papillomavirus vaccine among adolescent males and females: Immunization Information System sentinel sites, 2009-2012. Acad Pediatr 2014; 14:497-504. [PMID: 24954170 PMCID: PMC4593413 DOI: 10.1016/j.acap.2014.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 03/04/2014] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Advisory Committee on Immunization Practices (ACIP) has recommended routine human papillomavirus (HPV) vaccination at age 11 or 12 years for girls since 2006 and for boys since 2011. We sought to describe adolescent HPV vaccination coverage, doses administered from 2009 to 2012, and age at first vaccination by sex. METHODS Aggregate data were analyzed from 8 Immunization Information System sentinel sites on HPV vaccinations in children and adolescents aged 11 to 12 years, 13 to 15 years, and 16 to 18 years. Vaccination coverage by age group was reported for 2009 to 2012, and weekly doses administered were determined. Age at first HPV vaccination was calculated for girls in 2007 and 2011 and for boys in 2011. RESULTS This analysis included data on 2.9 million adolescents aged 11 to 18 years. There were small increases in coverage for girls, with receipt of ≥1 dose of HPV vaccine reaching 27.1% of ages 11 to 12, 47.9% of ages 13 to 15, and 57.1% of ages 16 to 18 by December 31, 2012. Uptake of ≥1 dose in boys reached ∼18% for all age groups. Doses administered showed seasonal variation, with highest uptake before back to school among girls and steady increases in boys after the 2009 ACIP recommendation for permissive use. Doses administered to boys surpassed those administered to girls by September 2012. Among vaccinated girls, more received vaccine at the recommended age of 11 to 12 years in 2011 (74.2%) compared to 2007 (9.9%). In 2011, 27.3% of vaccinated boys received their first dose at age 11 to 12 years. CONCLUSIONS HPV vaccination coverage increased among adolescents between 2009 and 2012. However, increases among girls were small, and coverage for boys and girls remained below target levels.
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Affiliation(s)
- Karen A Cullen
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Lauri E Markowitz
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga
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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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Fisher WA, Kohut T, Salisbury CM, Salvadori MI. Understanding Human Papillomavirus Vaccination Intentions: Comparative Utility of the Theory of Reasoned Action and the Theory of Planned Behavior in Vaccine Target Age Women and Men. J Sex Med 2013; 10:2455-64. [DOI: 10.1111/jsm.12211] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lutringer-Magnin D, Cropet C, Barone G, Canat G, Kalecinski J, Leocmach Y, Vanhems P, Chauvin F, Lasset C. HPV vaccination among French girls and women aged 14–23 years and the relationship with their mothers’ uptake of Pap smear screening: A study in general practice. Vaccine 2013; 31:5243-9. [DOI: 10.1016/j.vaccine.2013.08.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/18/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
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A population-level assessment of factors associated with uptake of adolescent-targeted vaccines in Michigan. J Adolesc Health 2013; 53:498-505. [PMID: 24054080 DOI: 10.1016/j.jadohealth.2013.07.022] [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: 02/28/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Increases in adolescent vaccine coverage are needed. The aim of this study was to identify population-level clinical and demographic factors associated with adolescent vaccination. METHODS A retrospective analysis of data from the Michigan Care Improvement Registry (MCIR), a statewide immunization registry, was performed for 2006-2010. The sample included 1,252,655 adolescents aged 11-18 years. Vaccine coverage levels were calculated for tetanus-diphtheria-acellular pertussis (Tdap), meningococcal conjugate (MCV4), flu (seasonal influenza), and human papillomavirus, females only (HPV) vaccines. For the subset of adolescents enrolled in Medicaid, claims data were used to obtain information about the type of visits in which vaccines were administered. RESULTS As of 2010, statewide coverage levels for Tdap and MCV4 vaccines were 46.0% and 46.5%, respectively whereas only 15% of females had completed the HPV vaccine series. Only one in four female adolescents were up to date for all three of these vaccines. Statewide coverage among adolescents for flu vaccine during the 2009-2010 season was 8%. Age was the most significant predictor of HPV vaccination, whereas health care-associated factors (provider type and childhood immunization history) were the strongest predictors for the other three vaccines. Older adolescents were less likely to have received the flu vaccine but more likely to have receive HPV vaccine doses than younger adolescents. Among Medicaid-enrolled adolescents, most Tdap, MCV, and first-dose HPV vaccines, but only 29% of flu doses, were administered during preventive visits. CONCLUSIONS Noted variability in adolescent vaccine coverage by age, vaccine type, and health care-associated factors provides a framework for developing future outreach activities to increase adolescent vaccine use.
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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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Eberth JM, Hossain MM, Tiro JA, Zhang X, Holt JB, Vernon SW. Human papillomavirus vaccine coverage among females aged 11 to 17 in Texas counties: an application of multilevel, small area estimation. Womens Health Issues 2013; 23:e131-41. [PMID: 23481692 DOI: 10.1016/j.whi.2012.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 11/13/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Local data are often used to plan and evaluate public health interventions and policy. With increasingly fewer public resources to collect sufficient data to support direct estimation of local outcomes, methods for deriving small area estimates are vital. The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among adolescent females in Texas using multilevel small area estimation. METHODS Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (≥1 dose Gardasil) from the 2008 Behavioral Risk Factor Surveillance System. Using the parameter estimates from the final model, we simulated 10,000 data sets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county. RESULTS County-level coverage estimates ranged from 7% to 29%, compared with the state average of 18% (95% confidence interval [CI], 13.59-21.88). Many Southwestern border and metropolitan counties exhibited high coverage estimates. Low coverage estimates were noted in the Panhandle, Southeastern border region, and Northeast. Significant correlations were observed between HPV vaccination and Hispanic ethnicity, county poverty, and public health region poverty. CONCLUSION Harnessing the flexibility of multilevel small area models to estimate HPV vaccine coverage at the county level, we have provided data that may inform the development of health education programs/policies, the provision of health services, and the planning of new research studies. Additionally, we have provided a framework for modeling other health outcomes at the county level using national survey data.
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Affiliation(s)
- Jan M Eberth
- Division of Quantitative Sciences, Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA.
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Baldwin AS, Bruce CM, Tiro JA. Understanding how mothers of adolescent girls obtain information about the human papillomavirus vaccine: associations between mothers' health beliefs, information seeking, and vaccination intentions in an ethnically diverse sample. J Health Psychol 2013; 18:926-38. [PMID: 22992585 PMCID: PMC4005804 DOI: 10.1177/1359105312445078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined factors associated with information seeking about the human papillomavirus vaccine among mothers of adolescent girls by testing whether information seeking and vaccination intentions for their daughters are associated with perceived vulnerability, severity, and vaccine benefits in an ethnically diverse sample. Mothers (N = 256) of unvaccinated girls living in Dallas, Texas, were surveyed (49% Black, 29% Hispanic, and 18% White). Perceived vulnerability to human papillomavirus was associated with talking with others (odds ratio = 1.71, 95% confidence interval = 1.09, 2.66) and talking with a doctor about the vaccine (odds ratio = 1.42, 95% confidence interval = 1.01, 1.99), and perceived vaccine benefits were associated with vaccination intentions (odds ratio = 2.96, 95% confidence interval = 1.98, 4.42), but the perceived severity was not associated with any dependent measure. Beliefs about human papillomavirus risk are associated with seeking information from a doctor and interpersonal sources, but ethnic minorities are less likely to talk with others about the vaccine.
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Affiliation(s)
- Austin S Baldwin
- Department of Psychology, Southern Methodist University, Dallas, TX 75275- 0442, USA.
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Factors associated with human papillomavirus vaccination among young adult women in the United States. Vaccine 2013; 31:2937-46. [PMID: 23643629 DOI: 10.1016/j.vaccine.2013.04.041] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/11/2013] [Accepted: 04/17/2013] [Indexed: 11/22/2022]
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Gattoc L, Nair N, Ault K. Human papillomavirus vaccination: current indications and future directions. Obstet Gynecol Clin North Am 2013; 40:177-97. [PMID: 23732024 PMCID: PMC4416057 DOI: 10.1016/j.ogc.2013.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections affecting both men and women worldwide. The development of the prophylactic HPV vaccines is a significant pharmaceutical innovation with potential to reduce HPV-related morbidity. However, barriers to the universal use and acceptability of the HPV vaccines continue to exist in both economically privileged and disadvantaged countries. It may be decades before the impact of preventive vaccines on HPV-related diseases caused by the considerable burden of HPV infections will be seen. Collaborative efforts must continue to promote vaccine implementation.
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Affiliation(s)
- Leda Gattoc
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Navya Nair
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Kevin Ault
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
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Abstract
The current chapter reviews research on correlates of human papillomavirus (HPV) vaccine uptake. Findings are organized within an Information-Motivation-Behavioral Skills (IMB) model framework, which specifies that HPV vaccination information, motivation to act on this information, and behavioral skills for acting on it effectively, are fundamental determinants of HPV vaccine uptake. Empirical support for the hypothesized relationships of HPV vaccine information, HPV vaccine motivation, HPV vaccine behavioral skills, and HPV vaccine uptake is reported, and support for conceptual models that move beyond purely motivational accounts of HPV vaccine uptake is adduced. An IMB model approach to promotion of HPV vaccine uptake is proposed, and directions for future research in this area are discussed. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Fisher H, Trotter CL, Audrey S, MacDonald-Wallis K, Hickman M. Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis. Int J Epidemiol 2013; 42:896-908. [PMID: 23620381 PMCID: PMC3733698 DOI: 10.1093/ije/dyt049] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The human papillomavirus (HPV) vaccine offers an opportunity to reduce health inequalities associated with cervical cancer provided the vaccine is delivered equitably at population level. Method We reviewed evidence of inequalities in HPV vaccine uptake in young women after undertaking a comprehensive search of databases from inception to March 2012. Studies that compared HPV vaccination initiation and/or completion by at least one ethnicity or socioeconomic-related variable in adolescent young women were included. There were no language restrictions. Data were extracted by two reviewers and pooled in a meta-analysis using a random-effects model; sub-analyses and meta-regression were undertaken to investigate sources of heterogeneity. Results In all, 29 publications related to 27 studies were included in the review. Black young women were less likely to initiate HPV vaccination compared with White young women (combined OR: 0.89, 95% CI: 0.82–0.97). In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40–0.78). There was no strong evidence that lower family income (combined OR: 1.16, 95% CI: 1.00–1.34) or lower parental education (combined OR 1.06, 95% CI: 0.92–1.22) influenced HPV vaccination initiation. Conclusions We found strong evidence for differences in HPV vaccination initiation by ethnicity and healthcare coverage, but did not find a strong association with parental education or family income variables. The majority of studies originated from the USA. Population-based studies reporting both initiation and completion of the HPV vaccination programme are required to establish patterns of uptake in different healthcare contexts.
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Affiliation(s)
- Harriet Fisher
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Factors influencing the willingness of US women to vaccinate their daughters against the human papillomavirus to prevent cervical cancer. Med Oncol 2013; 30:582. [PMID: 23609191 DOI: 10.1007/s12032-013-0582-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
The human papillomavirus (HPV) vaccine helps to prevent cervical cancer. However, research indicates that public acceptance of the vaccine is suboptimal. Our aims were to evaluate the willingness of US women to use the HPV vaccine in their daughters, examine their current understanding of HPV, and determine the impact of HPV knowledge and other socio-demographic factors on their willingness to get their daughters vaccinated. Women aged ≥ 18 years were identified from the US Health Information National Trends Survey. We developed a 6-point composite scoring system based on individual responses to HPV-related questions to characterize personal understanding about HPV. Logistic regression models were constructed to explore the influence of the women's HPV knowledge level and additional socio-demographic factors on the willingness to use HPV in their daughters. There were 804 female respondents: mean age was 44.9 (SD = 2.53) years and 73 % were White. In total, 75 % of women indicated they would vaccinate their daughters against HPV. Mean knowledge score was 4.6 (SD = 0.80). While White race was associated with higher willingness to use the vaccine in their daughters (OR = 1.86, p = 0.04), HPV knowledge level was not (OR = 0.47, p = 0.22). Among US women, HPV knowledge level was high, but it was not associated with the willingness to vaccinate their daughters against HPV. Interventions focused on alleviating racial disparities might better modify the use of the HPV vaccine.
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Al-Naggar RA, Bobryshev YV, Al-Jashamy K, Al-Musli M. Practice of HPV vaccine and associated factors among school girls in Melaka, Malaysia. Asian Pac J Cancer Prev 2013; 13:3835-40. [PMID: 23098480 DOI: 10.7314/apjcp.2012.13.8.3835] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study is to determine the practice and associated factors of HPV vaccine among school girls in Melaka, Malaysia. METHODOLOGY A total number of 612 secondary school girls participated in this study. The questionnaire consists of 38 questions which included 3 sections. The first section is about socio- demography. The Second section is about knowledge and awareness of HPV vaccines. The third section is about practices with associated barriers of HPV vaccination. Verbal consent was obtained from all participants, and data were analyzed using SPSS 13. RESULTS A total number of 612 secondary school girl students participated in this study. The mean age was 13.93 ± SD (1.09); minimum age was 13 years old and maximum was 17 years old. The majority of them was Malay, from rural areas and had a family monthly income of RM 3000 or less (91.8%, 53.1%, 69.6%; respectively). The majority of the parents of the school girls were with secondary education level (56.4%). The majority of the participants did not have a family history of cervical cancer (99.0%). The prevalence of HPV vaccination was 77.9% among school girls in Melaka. The majority of the participants were vaccinated in their schools (77.0%). About 69% knew about cervical cancer and 77.6% had ever heard about HPV vaccine. Regarding the factors that influence the practice of uptake HPV vaccine, they were age, race, income, parents' education, knowledge about cervical cancer, heard about HPV vaccine and place of getting the vaccine (p<0.001). CONCLUSION The prevalence of HPV vaccine among school girls is high. Age, race, income, parents' education, knowledge about cervical cancer, heard about HPV vaccine and place of getting the vaccine were the significant factors that influence the practice of uptake HPV vaccine among school girls.
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Affiliation(s)
- Redhwan Ahmed Al-Naggar
- Community Medicine Department, International Medical School, Management and Science University, Malaysia.
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Hopkins TG, Wood N. Female human papillomavirus (HPV) vaccination: global uptake and the impact of attitudes. Vaccine 2013; 31:1673-9. [PMID: 23375978 DOI: 10.1016/j.vaccine.2013.01.028] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/09/2013] [Accepted: 01/15/2013] [Indexed: 01/27/2023]
Abstract
Human papillomavirus (HPV) is the causative agent in cervical cancer and has been implicated in a range of other malignancies. Preventative vaccines are now internationally available and provide high levels of protection from common viral strains. The introduction of a comprehensive vaccination programme (except 'program' in computers) could prevent over 60% of current cervical cancer cases, but this is dependent on such programmes achieving a high level of coverage. In this review, we summarise the current trends in female HPV vaccination coverage throughout the world, and place it in the context of available research on attitudes towards vaccination amongst the public and health professionals. Where countries have the resources for mass vaccination programmes, uptake has varied. School-based opt-out programmes consistently achieve highest coverage, whilst countries and regions without systematic vaccination schemes have low coverage. In all countries, the success of vaccination programmes is dependent on the support of the public and healthcare professionals. Whilst public acceptance is dependent on multiple factors, it has repeatedly been shown that recommendation by a health professional, particularly clinicians, is key to vaccine uptake. Worryingly, it appears that a proportion of clinicians still have significant reservations about promoting vaccination, particularly for younger age groups. A commitment now, to fully educating both the public and clinicians, has the potential to make a dramatic future impact.
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Affiliation(s)
- Tom Glass Hopkins
- Institute of Reproductive and Developmental Biology, Imperial College, London, UK.
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