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Warren BR, Gillette-Walch H, Adler J, Arias R, Klausner JD, Ashing KT, Villa A. Assessment of human papillomavirus vaccination rates of adolescents in California, 2018-2019. Prev Med Rep 2023; 32:102144. [PMID: 36852308 PMCID: PMC9958035 DOI: 10.1016/j.pmedr.2023.102144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/20/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Accurate documentation of state-level human papillomavirus (HPV) vaccination is required for public health planning and to inform corrective actions. To examine the representativeness of the California Immunization Registry, we compared the National Immunization Survey (NIS)-Teen, commercial HMOs in California, Medi-Cal, and California Immunization Registry data for HPV vaccine series completion. Our objectives were to evaluate the vaccine registries, compare and report their completeness, and make recommendations on how to improve and use these studies. Vaccination values were extrapolated for all adolescents aged 13 to 17 years from 2018 to 2019 from NIS-Teen, adolescents aged 13 years from 2018 to 2019 reported in the California Immunization Registry, and adolescents aged 13 years for 2018 for commercial HMOs and Medi-Cal. HPV series completion among 13-year-olds in 2018 for commercial HMOs was 50 %, Medi-Cal was 45 %, and the California Immunization Registry was 28 %, with NIS-Teen rates for 13 to 17-year-olds at 50 % in 2018 and 54 % in 2019. Both rural and urban geographic regions were found to have low completion rates of the HPV series, with trends ranging from 13 % to 45 %. The California Immunization Registry's lower HPV vaccine series completion among 13-year-olds compared to the other reporting sources is most likely due differences in reporting and data collection. Importantly, this data will serve as a comparator for future, similar studies of various sources of HPV vaccination rates following the passing of Bill-1797, which will mandate immunization reporting starting in January 2023.
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Affiliation(s)
- Brooke R. Warren
- School of Medicine, University of California, San Francisco. San Francisco, CA, United States
| | | | - Jaime Adler
- Academy Health. Washington, DC, United States
| | - Raquel Arias
- American Cancer Society. Burbank, CA, United States
| | - Jeffrey D. Klausner
- Division of Disease Prevention, Policy and Global Health, Department of Preventive Medicine, University of Southern California Keck School of Medicine. Los Angeles, CA, United States
| | - Kimlin T. Ashing
- Division of Health Equity, City of Hope Comprehensive Cancer Center. Duarte, CA, United States
| | - Alessandro Villa
- Oral Medicine, Oral Oncology and Dentistry, Miami Cancer Institute. Miami, FL, United States,Herbert Wertheim College of Medicine, Florida International University. Miami, FL, United States,Corresponding author at: 8900 N. Kendall Drive Miami, FL 33176, United States.
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2
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Chido-Amajuoyi OG, Talluri R, Jackson I, Shete SS, Fokom Domgue J, Shete S. The influence of parent-child gender on intentions to refuse HPV vaccination due to safety concerns/side effects, National Immunization Survey - Teen, 2010-2019. Hum Vaccin Immunother 2022; 18:2086762. [PMID: 35797721 PMCID: PMC9621054 DOI: 10.1080/21645515.2022.2086762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/01/2022] [Indexed: 12/20/2022] Open
Abstract
Amid subpar uptake of HPV vaccination in the United States, gender-generated disparities in HPV vaccination uptake have the potential to perpetuate existing disparities in HPV-associated cancers. Yet few studies have investigated the influence of parent-child gender on intentions to refuse HPV vaccination due to safety concerns/side effects. This study used nationally representative data, spanning 2010-2019, from the National Immunization Survey-Teen (NIS-Teen). NIS-Teen respondents are parents/guardians or primary caregivers of adolescents 13-17 years old living in the United States. Over the study period, intentions to refuse HPV vaccination due to safety concerns rose among all parent-child gender pairings but were highest among respondent mothers regarding their unvaccinated daughters. The results revealed a statistically significant increased likelihood of having intentions to refuse HPV vaccination due to safety concerns among all parent-child combinations compared with father-son pairs. These odds were consistently highest among mother-daughter pairs. In 2019, compared with father-son pairs, fathers were 1.94 (95% CI: 1.21-3.12) times more likely to report the intention to not vaccinate against HPV for their daughters, while mothers were 2.23 (95% CI: 1.57-3.17) and 2.87 (95% CI: 2.02-4.09) times more likely to report intentions to refuse HPV vaccination for their sons and daughters, respectively. These findings were persistent and constantly increased over the 10-year study period. Interventions aimed at correcting gender-based misperceptions and countering misinformation about the safety of the HPV vaccine are warranted.
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Affiliation(s)
| | - Rajesh Talluri
- Department of Data Science, The University of Mississippi Medical Center, Jackson, MS, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Inimfon Jackson
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Sahil S. Shete
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Joël Fokom Domgue
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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3
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Chido-Amajuoyi OG, Talluri R, Wonodi C, Shete S. Trends in HPV Vaccination Initiation and Completion Within Ages 9-12 Years: 2008-2018. Pediatrics 2021; 147:peds.2020-012765. [PMID: 33941585 PMCID: PMC8785751 DOI: 10.1542/peds.2020-012765] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Routine human papillomavirus (HPV) vaccination is recommended at ages 11 to 12 years and may be initiated as early as 9 years of age. METHODS Data were derived from the National Immunization Survey-Teen, spanning 2008-2018. Using health care provider-verified vaccination histories, we examined trends in human papillomavirus vaccination up-to-date (HPV-UTD) rates within ages 9 to 12 years. Furthermore, we assessed vaccination status by sociodemographic factors and US state of residence. RESULTS Overall, amid evidence of recent stagnation, HPV vaccination between ages 9 to 12 increased over the years. Initiation rates rose from 17.3% in 2008 to 62.8% in 2018, and HPV-UTD rates rose from 13.5% in 2011 to 32.8% in 2018. After the inception of gender-neutral HPV vaccination, HPV-UTD rates between 2011 and 2018 rose by 31.9% among boys and only 6.6% among girls. For most of the study period, non-Hispanic Black and Hispanic individuals had higher rates of initiation and HPV-UTD than non-Hispanic white individuals. In 2018, vaccination initiation rates exceeded 70% in several states; however, HPV-UTD rates in most US states were <50%, excluding Rhode Island (61.6%), Colorado (58.7%), Hawaii (53.5%), District of Columbia (53.2%), and Ohio (50%). CONCLUSIONS HPV vaccination within ages 9 to 12 years is suboptimal. To leverage the substantial benefits of HPV vaccination within this age range, it is imperative that conscious efforts are taken at the national and state levels to promote HPV vaccination for this age group.
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Affiliation(s)
| | - Rajesh Talluri
- Department of Data Science, University of Mississippi
Medical Center, Jackson, Mississippi; and,Contributed equally as co-first authors
| | - Chizoba Wonodi
- Department of International Health, Bloomberg School
of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sanjay Shete
- Departments of Epidemiology and .,Biostatistics and.,Division of Cancer Prevention and Population Sciences, The University of Texas and Maryland Anderson Cancer Center, Houston, Texas
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Caldwell AC, Madden CA, Thompson DM, Garbe MC, Roberts JR, Jacobson RM, Darden PM. The impact of provider recommendation on human papillomavirus vaccine and other adolescent vaccines. Hum Vaccin Immunother 2021; 17:1059-1067. [PMID: 33074774 DOI: 10.1080/21645515.2020.1817713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This study explored the association between provider recommendation and adolescent vaccine coverage. We analyzed data from the 2008 to 2018 National Immunization Survey-Teen including coverage with one dose of quadrivalent meningococcal conjugate vaccine (MenACWY), Tetanus-diphtheria-acellular pertussis vaccine (Tdap), and one and three doses of Human papillomavirus (HPV) vaccine. We compared vaccine coverage between those who recalled a provider recommendation and those who did not. Among those who received a provider recommendation for MenACWY, coverage trended from 67.8% (2008) to 88.1% (2013), contrasted to those who did not, trending from 30.9% to 73.1%. Among those with a provider recommendation for Tdap, coverage trended from 47.6% to 89.7%, contrasted to those who did not, trending from 35.6% to 82.2%. Among females with a provider recommendation for HPV vaccine, receipt of initial dose of HPV vaccine trended from 57.5% (2008) to 74.3% (2018), contrasted to those who did not, trending from 18.1% to 49.8%, and among males, trended from 17.2% (2010) to 75.1% (2018) for those with a provider recommendation, compared to 0.5% to 44.7% for those without. In 2013, coverage difference by provider recommendation was 26.0% among females for one dose of HPV vaccine and 21.9% for three doses, and among males was 44.8% and 20.8%, respectively, while it was lower at 15% for MenACWY and 7.6% for Tdap. For each vaccine, coverage was higher with a provider recommendation; the largest difference was noted for HPV vaccine. This finding verifies for providers the importance of their recommendation, especially for the HPV vaccine.
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Affiliation(s)
- Alexandria C Caldwell
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christi A Madden
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - David M Thompson
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Connor Garbe
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - James R Roberts
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Robert M Jacobson
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Rochester, MN, USA
| | - Paul M Darden
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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5
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Reiter PL, Pennell ML, Martinez GA, Katz ML. Provider recommendation for HPV vaccination across Hispanic/Latinx subgroups in the United States. Hum Vaccin Immunother 2021; 17:1083-1088. [PMID: 33326347 PMCID: PMC8018483 DOI: 10.1080/21645515.2020.1846399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/02/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022] Open
Abstract
Healthcare provider recommendation is a key predictor of HPV vaccination among adolescents, yet little is known about how parents' receipt of a provider recommendation differs across Hispanic/Latinx subgroups in the United States. We analyzed data from the 2012-2016 National Immunization Survey - Teen on Hispanic/Latinx adolescent ages 13-17 (n = 16,335). Analyses used weighted logistic regression models. Overall, 62.6% of parents of Hispanic/Latinx females and 46.4% of parents of Hispanic/Latinx males reported that they had received a provider recommendation for HPV vaccination. Among parents of females, receipt of a provider recommendation ranged from 55.0% among Central Americans to 73.3% among parents of Puerto Ricans. Among parents of males, the range was from 44.5% among Mexicans and multi-subgroup males to 53.4% among Cubans. There were no differences across Hispanic/Latinx subgroups in adjusted models among either males or females (all p > .05). Among parents of females, provider recommendation was less common among those whose preferred language was Spanish for Central Americans and South Americans (both p < .05). Efforts are needed to improve provider communication about and recommendations for HPV vaccination among the Hispanic/Latinx population and to ensure the availability of language assistance services for individuals with limited English proficiency.
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Affiliation(s)
- Paul L. Reiter
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Michael L. Pennell
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Glenn A. Martinez
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Department of Spanish and Portuguese, The Ohio State University, Columbus, OH, USA
| | - Mira L. Katz
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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6
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Atkinson KM, Mithani SS, Bell C, Rubens-Augustson T, Wilson K. The digital immunization system of the future: imagining a patient-centric, interoperable immunization information system. Ther Adv Vaccines Immunother 2020; 8:2515135520967203. [PMID: 33681700 PMCID: PMC7900792 DOI: 10.1177/2515135520967203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 09/16/2020] [Indexed: 12/31/2022] Open
Abstract
To ensure the effectiveness of increasingly complex immunization programs in upper-middle and high-income settings, comprehensive information systems are needed to track immunization uptake at individual and population levels. The maturity of cloud systems and mobile technologies has created new possibilities for immunization information systems. In this paper, we describe a vision for the next generation of digital immunization information systems for upper-middle and high-income settings based on our experience in Canada. These systems center on the premise that the public is engaged and informed about the immunization process beyond their interaction with primary care, and that they will be a contributor and auditor of immunization data. The digital immunization system of the future will facilitate reporting of adverse events following immunization, issue digital immunization receipts, permit identification of areas of need and allow for delivery of interventions targeting these areas. Through features like immunization reminders and targeted immunization promotion campaigns, the system will reduce many of the known barriers that influence immunization rates. In light of the global COVID-19 pandemic, adaptive digital public health information systems will be required to guide the rollout and post-market surveillance of the SARS-CoV-2 vaccine.
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Affiliation(s)
- Katherine M. Atkinson
- Department of Global Public Health,
Karolinska Institutet, Stockholm, Sweden, CANImmunize Inc,
Ottawa, ON, Canada
| | - Salima Saleem Mithani
- Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa
Hospital Research Institute, 1053 Carling Ave, Ottawa, ON
K1Y4E9, Canada
- CANImmunize Inc, Ottawa, ON,
Canada
- Department of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa,
ON, Canada
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7
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Newcomer SR, Caringi J, Jones B, Coyle E, Schehl T, Daley MF. A Mixed-Methods Analysis of Barriers to and Facilitators of Human Papillomavirus Vaccination Among Adolescents in Montana. Public Health Rep 2020; 135:842-850. [PMID: 32972304 DOI: 10.1177/0033354920954512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state. METHODS Using a mixed-methods design, we integrated quantitative analyses of Montana's National Immunization Survey-Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake. RESULTS In Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers' recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%). CONCLUSIONS HPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents' knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.
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Affiliation(s)
- Sophia R Newcomer
- 214607 School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - James Caringi
- 214607 School of Social Work, University of Montana, Missoula, MT, USA
| | - Beth Jones
- 214607 School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Emily Coyle
- 214607 School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.,American Cancer Society, Montana Chapter, Missoula, MT, USA
| | - Timothy Schehl
- 214607 School of Social Work, University of Montana, Missoula, MT, USA
| | - Matthew F Daley
- 535886 Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.,Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
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8
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Reiter PL, Pennell ML, Martinez GA, Perkins RB, Katz ML. HPV vaccine coverage across Hispanic/Latinx subgroups in the United States. Cancer Causes Control 2020; 31:905-914. [PMID: 32748100 DOI: 10.1007/s10552-020-01331-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Research on HPV vaccine coverage in the United States has typically aggregated Hispanic/Latinx individuals into a single group for analyses, an approach that has potentially masked variation between Hispanic/Latinx subgroups. To address this limitation, we examined HPV vaccine coverage across Hispanic/Latinx subgroups. METHODS We analyzed data on Hispanic/Latinx adolescents ages 13-17 (n = 16,335) from the 2012-2016 National Immunization Survey-Teen. Each adolescent was categorized into a subgroup: Mexican, Cuban, Puerto Rican, Central American, South American, other Spanish origin, or multi-subgroup. We examined HPV vaccine initiation (receipt of one or more doses) and completion (receipt of three doses) for males and females separately. Analyses used weighted logistic regression. RESULTS Vaccine coverage among males was highest among Central Americans (initiation: 57.5%; completion: 31.1%) and lowest among multi-subgroup males (initiation: 46.3%; completion: 19.9%). Among females, initiation ranged from 63.4% among Cubans to 71.2% among Puerto Ricans, and completion ranged from 33.6% among multi-subgroup females to 48.7% among South Americans. Hispanic/Latinx subgroups were similar on these outcomes in regression models. However, within several subgroups, vaccine coverage was higher among adolescents whose parents' preferred language was Spanish (i.e., potentially less acculturated) compared to those whose parents' preferred language was English. CONCLUSIONS Modest variation in HPV vaccine coverage exists across Hispanic/Latinx subgroups, with differences found by preferred language within several subgroups. Findings provide insight into HPV vaccine coverage among Hispanic/Latinx subgroups and can help guide future surveillance efforts and vaccination interventions.
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Affiliation(s)
- Paul L Reiter
- College of Public Health, The Ohio State University, Columbus, OH, USA.
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Michael L Pennell
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Glenn A Martinez
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Department of Spanish and Portuguese, The Ohio State University, Columbus, OH, USA
| | | | - Mira L Katz
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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9
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Yankey D, Elam-Evans LD, Bish CL, Stokley SK. Human Papillomavirus Vaccination Estimates Among Adolescents in the Mississippi Delta Region: National Immunization Survey‑Teen, 2015-2017. Prev Chronic Dis 2020; 17:E31. [PMID: 32298229 PMCID: PMC7207045 DOI: 10.5888/pcd17.190234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction The Delta Regional Authority (DRA) consists of 252 counties and parishes in 8 states in the US Mississippi Delta region. DRA areas have high rates of disease, including cancers related to the human papillomavirus (HPV). HPV vaccination coverage in the DRA region has not been documented. Methods We analyzed data for 63,299 adolescents aged 13 to 17 years in the National Immunization Survey-Teen, 2015–2017. We compared HPV vaccination initiation coverage estimates (≥1 dose) in the DRA region with coverage estimates in areas in the 8 Delta states outside the DRA region and non-Delta states. We examined correlates of HPV vaccination coverage initiation and reasons parents did not intend to vaccinate adolescents. Results Vaccination rates in the DRA region (n = 2,317; 54.3%) and in Delta areas outside the DRA region (n = 6,028; 56.2%) were similar, but these rates were significantly lower than rates in non-Delta states (n = 54,954; 61.4%). Inside the DRA region, reasons for parents’ vaccine hesitancy or refusal were similar to those expressed by parents in the Delta areas outside the DRA region. Some parents believed that the vaccine was not necessary or had concerns about vaccine safety. Conclusion HPV vaccination coverage in the DRA region is similar to coverage in other Delta counties and parishes, but it is significantly lower than in non-Delta states. Activities to address parental concerns and improve provider recommendations for the vaccine in the DRA region are needed to increase HPV vaccination rates.
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Affiliation(s)
- David Yankey
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mail Stop H24-4 Atlanta, GA 30329-4027.
| | - Laurie D Elam-Evans
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Connie L Bish
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon K Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Williams CL, Walker TY, Elam-Evans LD, Yankey D, Fredua B, Saraiya M, Stokley S. Factors associated with not receiving HPV vaccine among adolescents by metropolitan statistical area status, United States, National Immunization Survey-Teen, 2016-2017. Hum Vaccin Immunother 2019; 16:562-572. [PMID: 31584312 PMCID: PMC7227662 DOI: 10.1080/21645515.2019.1670036] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The 2016 and 2017 National Immunization Surveys-Teen (NIS-Teen) highlighted disparities in human papillomavirus (HPV) vaccination coverage by metropolitan statistical area (MSA) status. Coverage with ≥1 dose of HPV vaccine was significantly lower among teens in suburban and mostly rural areas than it was among those in mostly urban areas. Reasons underlying this disparity are poorly understood; this analysis sought to identify sociodemographic factors associated with not initiating the HPV vaccine series and to determine whether these factors differed by MSA status. Using NIS-Teen data for a sample of 41,424 adolescents from the 2016 and 2017 survey years, multivariate logistic regression was utilized to assess associations between various sociodemographic factors and non-initiation of the HPV vaccine series by MSA status. Adjusted prevalence ratios and 95% confidence intervals are reported. A secondary analysis assessed missed opportunities for HPV vaccination by MSA status and estimated what coverage could be if these missed opportunities had not occurred. Most factors associated with not receiving HPV vaccine were similar across all three MSAs, including living in the South, having a mother with some college education, not having an 11–12-year-old well-child visit, and not receiving a provider recommendation for vaccination. Others were associated with non-initiation of the HPV vaccine series in only specific MSAs. Teens in suburban areas (82.2%) were more likely to miss opportunities for HPV vaccination than those in mostly urban (79.3%) areas. Coverage with ≥1 dose of HPV vaccine in all three MSAs would be substantially higher if these missed opportunities had been eliminated.
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Affiliation(s)
- Charnetta L Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tanja Y Walker
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center For Chronic Disease Prevention & Health Promotion, CDC, Atlanta, GA, USA
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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11
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Kahn KE, Santibanez TA, Zhai Y, Bridges CB. Association between patient reminders and influenza vaccination status among children. Vaccine 2018; 36:8110-8118. [PMID: 30448063 PMCID: PMC6419731 DOI: 10.1016/j.vaccine.2018.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patient reminders are recommended to increase vaccination rates. The objectives of this study were to estimate the percentage of children 6 months-17 years for whom a patient reminder for influenza vaccination was received by a child's parent or guardian, estimate influenza vaccination coverage by receipt of a patient reminder, and identify factors associated with receipt of a patient reminder. METHODS National Immunization Survey-Flu (NIS-Flu) data for the 2013-14 influenza season were analyzed. Tests of association between patient reminders and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving a patient reminder. RESULTS Approximately 22% of children had a parent or guardian report receiving a patient reminder for influenza vaccination for their child, ranging from 12.9% in Idaho to 41.2% in Mississippi. Children with a patient reminder were more likely to be vaccinated compared with children without a patient reminder (73.7% versus 55.5%). In the multivariable model, reminder receipt was higher for children 6-23 months compared with children 13-17 years, black children compared with white children, and children whose parent completed the survey in English compared with children whose parent completed the survey in a language other than English or Spanish. CONCLUSIONS Although patient reminders are associated with a higher likelihood of influenza vaccination, nationally, less than one-fourth of children had a parent report receiving one. Despite being based on parental report, with its limitations, this study suggests that increasing the number of parents who receive patient reminders for their children may improve vaccination coverage among children.
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Affiliation(s)
- Katherine E Kahn
- Leidos, Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Yusheng Zhai
- Leidos, Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn B Bridges
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Berry Technology Solutions, Inc., Peachtree City, GA, USA
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12
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Hanson KE, Koch B, Bonner K, McRee AL, Basta NE. National Trends in Parental Human Papillomavirus Vaccination Intentions and Reasons for Hesitancy, 2010-2015. Clin Infect Dis 2018; 67:1018-1026. [PMID: 29596595 PMCID: PMC6137113 DOI: 10.1093/cid/ciy232] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination uptake remains lower than other recommended adolescent vaccines in the United States. Parental attitudes are important predictors of vaccine uptake, yet little is known about how they have changed over time. Methods Participants included US residents aged 13-17 years with documented vaccination status who had received <3 doses of HPV vaccine whose parents responded to the National Immunization Survey-Teen, 2010-2015. Results Of the 76971 participants, 63.0% were male, 58.8% were non-Hispanic white, and 14.4 years was the median age. The percentage of unvaccinated teens decreased from 2010 to 2015, yet, annually, parents of unvaccinated teens of both sexes most often reported that they were "not likely at all" to vaccinate their teen. The percentage decreased significantly from 41.5% to 31.2% (P < .001) for parents of unvaccinated females from 2010 to 2015 but did not change among parents of males from 2012 to 2015. Conversely, parents of undervaccinated teens of both sexes reported higher and increasing vaccination intent over time. In 2015, nearly one-third of parents of unvaccinated teens reported that the vaccine was "not needed/necessary." Concerns about vaccine safety and side effects declined among parents of unvaccinated females but increased among parents of males (7.3% to 14.8%; P < .001). Conclusions Although parental vaccination intent and knowledge improved over time, intent remains low and many parents still have significant concerns about HPV vaccination, even after series initiation. Multiple strategies are needed to improve series initiation and completion in the United States.
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Affiliation(s)
| | - Brandon Koch
- Division of Biostatistics, University of Minnesota School of Public Health
| | | | - Annie-Laurie McRee
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota Medical School, Minneapolis
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13
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Kahn KE, Santibanez TA, Zhai Y, Bridges CB. Association between provider recommendation and influenza vaccination status among children. Vaccine 2018; 36:3486-3497. [PMID: 29764679 PMCID: PMC6432907 DOI: 10.1016/j.vaccine.2018.04.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Provider recommendation is associated with influenza vaccination receipt. The objectives of this study were to estimate the percentage of children 6 months-17 years for whom a provider recommendation for influenza vaccination was received, identify factors associated with receipt of provider recommendation, and evaluate the association between provider recommendation and influenza vaccination status among children. METHODS National Immunization Survey-Flu (NIS-Flu) parentally reported data for the 2013-14, 2014-15, and 2015-16 seasons were analyzed. Tests of association between provider recommendation and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving provider recommendation and the association between provider recommendation and influenza vaccination status. RESULTS Approximately 70% of children had a parent report receiving a provider recommendation for influenza vaccination for their child. The strongest association between receipt of provider recommendation and demographic characteristics was with child's age, with younger children (6-23 months, 2-4 years, and 5-12 years) being more likely to have a provider recommendation than older children (13-17 years). In addition, children living in a household above poverty with household income >$75,000 were more likely to have a parent report receipt of a provider recommendation than children living below poverty. Children with a provider recommendation were twice as likely to be vaccinated than those without. CONCLUSIONS This study affirms the importance of provider recommendation for influenza vaccination among children. Ensuring that parents of all children receive a provider recommendation may improve vaccination coverage.
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Affiliation(s)
- Katherine E Kahn
- Leidos, Inc., Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | - Yusheng Zhai
- Leidos, Inc., Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn B Bridges
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Berry Technology Solutions, Peachtree City, GA, USA
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14
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Nelson NP, Yankey D, Singleton JA, Elam-Evans LD. Hepatitis A vaccination coverage among adolescents (13-17 years) in the United States, 2008-2016. Vaccine 2018; 36:1650-1659. [PMID: 29449100 PMCID: PMC5895091 DOI: 10.1016/j.vaccine.2018.01.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/08/2018] [Accepted: 01/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The hepatitis A (HepA) vaccine was recommended by the Advisory Committee on Immunization Practices (ACIP) incrementally from 1996 to 1999. In 2006, HepA vaccine was recommended (1) universally for children aged 12-23 months, (2) for persons who are at increased risk for infection, or (3) for any person wishing to obtain immunity. Catch-up vaccination can be considered. OBJECTIVE To assess HepA vaccine coverage among adolescents and factors independently associated with vaccination administration in the US. METHODS The 2008-2016 National Immunization Survey-Teen was utilized to determine 1 and ≥2 dose HepA vaccination coverage among adolescents aged 13-17 years. Factors associated with HepA vaccine series initiation (1 dose) were determined by bivariate and multivariable analyses. Data were stratified by state groups based on ACIP recommendation: universal child vaccination recommended since 1999 (group 1); child vaccination considered since 1999 (group 2); universal child vaccination recommendation since 2006 (group 3). RESULTS In 2016, national vaccination coverage for 1 and ≥2 doses of HepA vaccine among adolescents was 73.9% and 64.4%, respectively. Nationally, a 40 percentage point increase in vaccination coverage occurred among adolescents born in 1995 compared to adolescents born in 2003. Nationally, the independent factors associated with increased vaccine initiation was race/ethnicity (Hispanic, American Indian/Alaskan Native, Asian), military payment source and provider recommendation for HepA vaccination (2008-2013). Living in a suburban or rural region, living in poverty (level <1.33-5.03), and absence of state daycare or school HepA requirement were common factors associated with decreased likelihood of vaccine initiation. CONCLUSIONS Efforts to increase HepA vaccine coverage in adolescents in all regions of the country would strengthen population protection from hepatitis A virus (HAV).
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Affiliation(s)
- Noele P Nelson
- Division of Viral Hepatitis, Clinical Interventions Team, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, United States
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, United States
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, United States
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15
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Healy J, Rodriguez-Lainz A, Elam-Evans LD, Hill HA, Reagan-Steiner S, Yankey D. Vaccination coverage among foreign-born and U.S.-born adolescents in the United States: Successes and gaps - National Immunization Survey-Teen, 2012-2014. Vaccine 2018; 36:1743-1750. [PMID: 29483032 DOI: 10.1016/j.vaccine.2018.02.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND An overall increase has been reported in vaccination rates among adolescents during the past decade. Studies of vaccination coverage have shown disparities when comparing foreign-born and U.S.-born populations among children and adults; however, limited information is available concerning potential disparities in adolescents. METHODS The National Immunization Survey-Teen is a random-digit-dialed telephone survey of caregivers of adolescents aged 13-17 years, followed by a mail survey to vaccination providers that is used to estimate vaccination coverage among the U.S. population of adolescents. Using the National Immunization Survey-Teen data, we assessed vaccination coverage during 2012-2014 among adolescents for routinely recommended vaccines for this age group (≥1 dose tetanus and diphtheria toxoids and acellular pertussis [Tdap] vaccine, ≥1 dose quadrivalent meningococcal conjugate [MenACWY] vaccine, ≥3 doses human papillomavirus [HPV] vaccine) and for routine childhood vaccination catch-up doses (≥2 doses measles, mumps, and rubella [MMR] vaccine, ≥2 doses varicella vaccine, and ≥3 doses hepatitis B [HepB] vaccine). Vaccination coverage prevalence and vaccination prevalence ratios were estimated. RESULTS Of the 58,090 respondents included, 3.3% were foreign-born adolescents. Significant differences were observed between foreign-born and U.S.-born adolescents for insurance status, income-to-poverty ratio, education, interview language, and household size. Foreign-born adolescents had significantly lower unadjusted vaccination coverage for HepB (89% vs. 93%), and higher coverage for the recommended ≥3 doses of HPV vaccine among males, compared with U.S.-born adolescents (22% vs. 14%). Adjustment for demographic and socioeconomic factors accounted for the disparity in HPV but not HepB vaccination coverage. CONCLUSIONS We report comparable unadjusted vaccination coverage among foreign-born and U.S.-born adolescents for Tdap, MenACWY, MMR, ≥2 varicella. Although coverage was high for HepB vaccine, it was significantly lower among foreign-born adolescents, compared with U.S.-born adolescents. HPV and ≥2-dose varicella vaccination coverage were low among both groups.
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Affiliation(s)
- Jessica Healy
- Centers for Disease Control and Prevention, Division of Scientific Education and Professional Development, Epidemic Intelligence Service, USA; Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, San Diego, CA, USA; County of San Diego Health and Human Services Agency, San Diego, CA, USA.
| | - Alfonso Rodriguez-Lainz
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, San Diego, CA, USA
| | - Laurie D Elam-Evans
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Holly A Hill
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Sarah Reagan-Steiner
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA
| | - David Yankey
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
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16
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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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Warner EL, Ding Q, Pappas LM, Henry K, Kepka D. White, affluent, educated parents are least likely to choose HPV vaccination for their children: a cross-sectional study of the National Immunization Study - teen. BMC Pediatr 2017; 17:200. [PMID: 29191180 PMCID: PMC5710112 DOI: 10.1186/s12887-017-0953-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/20/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) vaccination coverage is below national goals in the United States. Research is needed to inform strategically designed interventions that target sociodemographic groups with underutilization of HPV vaccination. METHODS Secondary data analysis of the National Immunization Survey-Teen 2013 measured association of sociodemographic factors (e.g., ethnicity/race, insurance) with HPV vaccination among females and males ages 13-17 (N = 18,959). Chi-square and multivariable Poisson regressions were conducted using survey-weighted statistics. RESULTS Having a mother ≥35 years, a mother with some college, being of "Other" ethnicity/race, and having no providers who order vaccines from health departments was negatively associated with females initiating HPV vaccination. Having a mother with some college, being of Non-Hispanic White or "Other" ethnicity/race, and having some or no providers who order vaccines from health departments was negatively associated with males initiating HPV vaccination. These same factors were negatively associated with males completing HPV vaccination with the exception of "Other" ethnicity/race. In contrast, having an unmarried mother, being ages 15-17, having a hospital based provider, and receiving other adolescent vaccinations were positively associated with females initiating and completing HPV vaccination. Having an unmarried mother, health insurance that is not employer or union sponsored, and influenza and meningitis vaccinations was positively associated with male's initiating HPV vaccination. For males, being 15 or 17 years old and having other adolescent vaccinations was positively associated with vaccine completion. All findings p ≤ 0.05. CONCLUSIONS Future HPV vaccination interventions may benefit from targeting certain sociodemographic groups that were negatively associated with HPV vaccination in this study.
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Affiliation(s)
- Echo L. Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT 84112 USA
- Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84123 USA
| | - Qian Ding
- Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84123 USA
| | - Lisa M. Pappas
- Biostatistics Center, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112 USA
| | - Kevin Henry
- Department of Geography, Temple University, 1115 Polett Walk, Philadelphia, PA 19112 USA
- Fox Chase Cancer Center, Cancer Prevention and Control Program, 333 Cottman Avenue, Philadelphia, Pennsylvania, 19111 USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT 84112 USA
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112 USA
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18
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Henry KA, Swiecki-Sikora AL, Stroup AM, Warner EL, Kepka D. Area-based socioeconomic factors and Human Papillomavirus (HPV) vaccination among teen boys in the United States. BMC Public Health 2017; 18:19. [PMID: 28709420 PMCID: PMC5513319 DOI: 10.1186/s12889-017-4567-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/05/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study is the first to examine associations between several area-based socioeconomic factors and human papillomavirus (HPV) vaccine uptake among boys in the United States (U.S.). METHODS Data from the 2012-2013 National Immunization Survey-Teen restricted-use data were analyzed to examine associations of HPV vaccination initiation (receipt of ≥1 dose) and series completion (receipt of three doses) among boys aged 13-17 years (N = 19,518) with several individual-level and ZIP Code Tabulation Area (ZCTA) census measures. Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation and series completion separately. RESULTS In 2012-2013 approximately 27.9% (95% CI 26.6%-29.2%) of boys initiated and 10.38% (95% CI 9.48%-11.29%) completed the HPV vaccine series. Area-based poverty was not statistically significantly associated with HPV vaccination initiation. It was, however, associated with series completion, with boys living in high-poverty areas (≥20% of residents living below poverty) having higher odds of completing the series (AOR 1.22, 95% CI 1.01-1.48) than boys in low-poverty areas (0-4.99%). Interactions between race/ethnicity and ZIP code-level poverty indicated that Hispanic boys living in high-poverty areas had a statistically significantly higher odds of HPV vaccine initiation (AOR 1.43, 95% CI 1.03-1.97) and series completion (AOR 1.56, 95% CI 1.05-2.32) than Hispanic boys in low-poverty areas. Non-Hispanic Black boys in high poverty areas had higher odds of initiation (AOR 2.23, 95% CI 1.33-3.75) and completion (AOR 2.61, 95% CI 1.06-6.44) than non-Hispanic Black boys in low-poverty areas. Rural/urban residence and population density were also significant factors, with boys from urban or densely populated areas having higher odds of initiation and completion compared to boys living in non-urban, less densely populated areas. CONCLUSION Higher HPV vaccination coverage in urban areas and among racial/ethnic minorities in areas with high poverty may be attributable to factors such as vaccine acceptance, health-care practices, and their access to HPV vaccines through the Vaccines for Children Program, which provides free vaccines to uninsured and under-insured children. Given the low HPV vaccination rates among boys in the U.S., these results provide important evidence to inform public health interventions to increase HPV vaccination.
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Affiliation(s)
- Kevin A Henry
- Department of Geography, Temple University, 115 W. Polett Walk, 308 Gladfelter Hall, Philadelphia, PA, 19122, USA. .,Fox Chase Cancer Center, Cancer Prevention and Control Program, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - Allison L Swiecki-Sikora
- Temple University, Lewis Katz School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Antoinette M Stroup
- Department of Epidemiology, Division of Cancer Epidemiology, New Jersey State Cancer Registry, Rutgers University, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.,Cancer Institute of New Jersey, Rutgers University, Cancer Prevention and Control Program, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Echo L Warner
- Huntsman Cancer Institute, University of Utah, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.,University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA
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19
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Mohammed KA, Vivian E, Loux TM, Arnold LD. Factors Associated With Parents' Intent to Vaccinate Adolescents for Human Papillomavirus: Findings From the 2014 National Immunization Survey-Teen. Prev Chronic Dis 2017; 14:E45. [PMID: 28595031 PMCID: PMC5467465 DOI: 10.5888/pcd14.160314] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction While factors associated with receipt of human papillomavirus (HPV) vaccination have been well characterized, less is known about the characteristics associated with parents’ intent to have their adolescent children vaccinated. This study aimed to examine factors associated with parental intention toward HPV vaccination. Methods We analyzed data on 10,354 adolescents aged 13 to 17 years from the 2014 National Immunization Survey–Teen. Weighted multivariable logistic regression was used to examine associations between sociodemographic characteristics of mothers and adolescents, as well as a health care provider recommendation with parents’ intention to have their children receive HPV vaccine. Results Among unvaccinated adolescents, Hispanic ethnicity (boys adjusted odds ratio [AOR], 1.87, 95% confidence interval [CI], 1.34–2.61; and girls AOR, 1.57; 95% CI, 1.05–2.35), mothers with less than a high school diploma (boys AOR, 2.41; 95% CI, 1.58–3.67; and girls AOR, 1.86; 95% CI, 1.02–3.38), and having a health care provider recommend the vaccine (boys AOR, 1.87; 95% CI, 1.52–2.31; and girls AOR, 1.38; 95% CI, 1.05–1.82) were significantly associated with parents’ intention to have their adolescent child vaccinated within the next 12 months. In addition, non-Hispanic black race was a significant predictor of parents’ intent to vaccinate for boys (AOR, 1.89; 95% CI, 1.35–2.65). Conclusion Maternal education and Hispanic ethnicity were the strongest predictors of parental intent to vaccinate against HPV, followed by provider recommendation. As HPV vaccination rates in the United States remain below the Healthy People 2020 goal, messages may need to be targeted based on maternal education, race/ethnicity, and provider recommendation.
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Affiliation(s)
- Kahee A Mohammed
- Saint Louis University Center for Outcomes Research, St Louis, Missouri.,Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri.,Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Missouri
| | - Elaina Vivian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri.,Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri.,Methodist Dallas Medical Center, Dallas, Texas
| | - Travis M Loux
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Lauren D Arnold
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St Louis, MO 63104.
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Adjei Boakye E, Tobo BB, Osazuwa-Peters N, Mohammed KA, Geneus CJ, Schootman M. A Comparison of Parent- and Provider-Reported Human Papillomavirus Vaccination of Adolescents. Am J Prev Med 2017; 52:742-752. [PMID: 27890518 DOI: 10.1016/j.amepre.2016.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/22/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is considerable effort at the state and national levels to monitor human papillomavirus (HPV) vaccine uptake and understand the factors that influence who gets vaccinated. Accurate measurement of vaccination coverage is critical for monitoring HPV vaccination. This study aimed to determine comparability between parent- and provider-reported HPV vaccination status for a sample of adolescents in the U.S. METHODS Data from the 2014 National Immunization Survey-Teen were analyzed in 2016 for 20,827 adolescents. Information on HPV vaccine uptake (initiation [one or more dose] and completion [three or more doses]) was obtained using parental (recall) and provider reports (electronic medical records). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and κ-coefficient were computed to determine how comparable parental and provider (ref group) reports were for HPV vaccination. RESULTS Prevalence of HPV vaccine initiation was comparable between parental and provider report (51.3% vs 50.0%) and for completion (30.7% vs 27.3%). Compared with provider report, parent-reported HPV vaccine initiation had high sensitivity (86.0%), specificity (87.4%), PPV (87.5%), NPV (85.9%), and acceptable κ-coefficient (0.73). Compared with provider report, parent-reported HPV vaccine completion had a sensitivity of 71.5%, specificity of 91.1%, PPV of 78.5%, NPV of 87.6%, and κ-coefficient of 0.64. Similar characteristics-adolescent age, sex, number of doctor visits, and region-were associated with HPV vaccine uptake using parental and provider reports. CONCLUSIONS Parental recall is comparable to provider report in monitoring HPV vaccine uptake for adolescents, although parental recall is less comparable for HPV vaccine completion.
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Affiliation(s)
- Eric Adjei Boakye
- Saint Louis University Center for Outcomes Research, Saint Louis University, Saint Louis, Missouri
| | - Betelihem B Tobo
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri; Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, Missouri; Saint Louis University Cancer Center, Saint Louis, Missouri
| | - Kahee A Mohammed
- Saint Louis University Center for Outcomes Research, Saint Louis University, Saint Louis, Missouri
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Mario Schootman
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri.
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21
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Zhai Y, Santibanez TA, Kahn KE, Srivastav A. Parental-Reported Full Influenza Vaccination Coverage of Children in the U.S. Am J Prev Med 2017; 52:e103-e113. [PMID: 28012814 PMCID: PMC5810364 DOI: 10.1016/j.amepre.2016.10.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/12/2016] [Accepted: 10/25/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depending upon influenza vaccination history, children aged 6 months-8 years need one or two doses of influenza vaccine to be considered fully vaccinated. The objectives of this study were to quantify the percentage of children aged 6 months-8 years who were fully vaccinated against influenza based on parental report, overall, by state, and by sociodemographic characteristics, and to examine sociodemographic characteristics associated with being fully vaccinated. METHODS Data from the National Immunization Survey-Flu for the 2012-2013 and 2013-2014 influenza seasons were analyzed in 2015 using the Kaplan-Meier method to produce vaccination coverage estimates. Wald chi-square tests were used to test for bivariate associations, and Cox proportional hazards models were used to test for demographic characteristics independently associated with the child being fully vaccinated. RESULTS The percentages of children aged 6 months-8 years who were fully vaccinated during the 2012-2013 and 2013-2014 influenza seasons were 41.0% and 45.2%, respectively. Full vaccination varied widely by state and was more likely for children requiring only one dose. Based on the statistical models, children likely to be fully vaccinated were older, non-black, had a mother with an education >12 years, or lived in a high-income household. CONCLUSIONS Most children in the U.S. are not fully vaccinated against influenza. Reminder systems and interventions that reduce or remove barriers to children receiving their second doses of influenza vaccine may improve full influenza vaccination coverage among all children.
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Affiliation(s)
| | - Tammy A Santibanez
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Factors Associated With Provider Reporting of Child and Adolescent Vaccination History to Immunization Information Systems: Results From the National Immunization Survey, 2006-2012. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:245-54. [PMID: 26062097 DOI: 10.1097/phh.0000000000000278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Use of Immunization information systems (IISs) by providers can improve vaccination rates by identifying missed opportunities. However, provider reporting of children's vaccination histories to IISs remains suboptimal. OBJECTIVE To assess factors associated with provider reporting to an IIS. DESIGN Analysis of 2006-2012 National Immunization Survey (NIS) and NIS-Teen data. NIS and NIS-Teen are ongoing random-digit-dial telephone surveys of households with children and adolescents, respectively, followed by a mail survey to providers to obtain the patient's vaccination history. SETTING AND PARTICIPANTS A total of 115 285 children aged 19 to 35 months and 83 612 adolescents aged 13 to 17 years and their immunization providers in the United States. MAIN OUTCOME MEASURES The percentage of children and adolescents with 1 or more providers reporting to or obtaining vaccination information from their local IISs. Multivariable logistic regression was used to examine patient and provider factors associated with provider reporting to IISs and adjusted prevalence of children and adolescents with 1 or more providers reporting to IISs. RESULTS In 2012, 79.4% of children and 77.4% of adolescents had 1 or more providers report any of their vaccination data to an IIS, and 41.9% of children and 51.5% of adolescents had providers who obtained any of their vaccination histories from an IIS. During 2006-2012, children and adolescents were more likely to have any of their vaccination data reported to an IIS if they received care from all public versus all private providers (children: 84.4% vs 69.6%, P < .0001; adolescents: 84.6% vs 66.4%, P < .0001), had 1 or more providers who ordered vaccines from a state or local health department (children: 76.7% vs 59.5%, P < .0001; adolescents: 77.0% vs 55.6%, P < .0001), or had 1 or more providers obtain vaccination information from the IIS (children: 86.1% vs 71.2%, P < .0001; adolescents: 83.7% vs 64.6%, P < .0001). CONCLUSIONS Health department staff should target providers less likely to use IIS services, including private providers, and providers not ordering vaccines from health departments to ensure they use IIS services.
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Cheruvu VK, Bhatta MP, Drinkard LN. Factors associated with parental reasons for "no-intent" to vaccinate female adolescents with human papillomavirus vaccine: National Immunization Survey - Teen 2008-2012. BMC Pediatr 2017; 17:52. [PMID: 28193249 PMCID: PMC5307730 DOI: 10.1186/s12887-017-0804-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background 1) To identify socio-demographic factors associated with parental “no-intent” for their 13–17 year old unvaccinated daughter to receive the human papillomavirus (HPV) vaccine series within the next twelve months, 2) to describe patterns in “no-intent” by socio-demographic factors, and 3) to identify socio-demographic factors associated with parental reasons for “no-intent”. Methods Data from 2008–2012 National Immunization Survey - Teen (NIS - Teen) were examined in this study. Parents with “no-intent” to vaccinate their daughters were asked to identify reasons for their decision. All responses were categorized into five domains identified as barriers to receive the HPV vaccine series: 1) Safety and Effectiveness Concerns; 2) Systemic Barriers; 3) Vaccine Misinformation; 4) Lack of Knowledge about the Vaccine; and 5) Socio-cultural Barriers. Multivariable logistic regression models were performed to address the study objectives. Results Number of people in the household, household income, mother’s age, education, health insurance, recommendation of a health care provider, and the survey year were significantly associated with parental “no-intent”. Race/ethnicity, mother’s education, marital status, recommendation of a health care provider, household income, age of the unvaccinated daughter, and the survey year, were significantly associated with one or more domains identified as barriers to receive the HPV vaccine. Conclusions This study identified sub-groups of parents across different socio-demographic factors with “no-intent” for their adolescent daughters to receive the HPV vaccine. Developing strategies that target educational tools towards the identified sub-groups of parents about the purpose, safety, and efficacy of the HPV vaccine, and HPV infection, may help increase HPV vaccine acceptance, initiation and completion rates.
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Affiliation(s)
- Vinay K Cheruvu
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Hilltop Drive, 320 Lowry Hall, Kent, 44242, OH, USA.
| | - Madhav P Bhatta
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Hilltop Drive, 320 Lowry Hall, Kent, 44242, OH, USA
| | - Lauren N Drinkard
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Hilltop Drive, 320 Lowry Hall, Kent, 44242, OH, USA
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Choi Y, Eworuke E, Segal R. What explains the different rates of human papillomavirus vaccination among adolescent males and females in the United States? PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2016; 2:46-51. [PMID: 29074185 PMCID: PMC5886892 DOI: 10.1016/j.pvr.2016.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/07/2016] [Accepted: 02/19/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify factors that explain differences in HPV vaccination rates for male and female adolescents and to determine self-reported barriers by parents affecting vaccination decisions. METHODS The sample included adolescents 13-17 years old with a vaccination record documented in the 2012 and 2013 National Immunization Survey-Teen dataset. A logistic regression model was developed with 13 socio-demographic factors and survey year, along with significant interaction pairs with gender. RESULTS Subjects included 20,355 and 18,350 adolescent boys and girls, respectively. About half of the females (56%) received at least one dose of HPV vaccine, compared to 28% of males. Several factors differed between males and females, including higher vaccination rates among non-Hispanic Black males and lower vaccination rates for non-Hispanic Black females compared to Whites; and a stronger association with health care provider recommendation among males. The most common parental reasons for not vaccinating their children included 'not recommended by a health care provider' for males (24%), and 'unnecessary' for females (18%). CONCLUSION We found a significant gender interaction with several socio-demographic variables in predicting vaccination uptake. These gender differences may be partially an artifact of timing, because male vaccination became routine approximately five years after female vaccination.
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Affiliation(s)
- Yoonyoung Choi
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, P.O. Box 100496, Gainesville, FL 32610, USA.
| | - Efe Eworuke
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, P.O. Box 100496, Gainesville, FL 32610, USA; Division of Epidemiology II, Office of Surveillance and Epidemiology, Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, P.O. Box 100496, Gainesville, FL 32610, USA.
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Beachler DC, Gonzales FA, Kobrin SC, Kreimer AR. HPV vaccination initiation after the routine-recommended ages of 11-12 in the United States. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2016; 2:11-16. [PMID: 26783559 PMCID: PMC4714353 DOI: 10.1016/j.pvr.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/19/2015] [Accepted: 12/19/2015] [Indexed: 10/27/2022]
Abstract
BACKGROUND Since 2006, routine HPV vaccination has been recommended for females aged 11-12 in the US. However not much is known about the extent of and factors associated with HPV vaccination after the ages of 11-12. METHODS Provider-verified data on 8,710 females aged 13-17 were analyzed from the 2013 NIS-Teen survey. 2013 data was utilized since it was the first year one can fully evaluate the age at vaccination through age 17 for females who could receive the HPV vaccine at age 11. RESULTS Among HPV vaccinated females who were 17 in 2013, 47% (95%CI=43%-50%) received their first dose after age 12, and 24% (95%CI=21%-26%) received their first dose after age 14. The HPV vaccine was more likely to be initiated later than the meningococcal and Tdap vaccines (p<0.05), and later HPV vaccine initiation was more common among those having a more highly educated mother and those not receiving a check-up/well visit between the ages of 11 and 12 in adjusted analyses (p-values<0.05). Females initiating the HPV vaccine late were more likely to not receive three doses (RR=1.90, 95%CI=1.76-2.04). CONCLUSIONS HPV vaccination is commonly initiated after the age of 12 in the US, which could limit the vaccine's population-level effectiveness.
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Affiliation(s)
- Daniel C. Beachler
- Division of Cancer Epidemiology, and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Felisa A. Gonzales
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Sarah C. Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology, and Genetics, National Cancer Institute, Bethesda, MD, USA
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Mohammed KA, Geneus CJ, Osazuwa-Peters N, Adjei Boakye E, Tobo BB, Burroughs TE. Disparities in Provider Recommendation of Human Papillomavirus Vaccination for U.S. Adolescents. J Adolesc Health 2016; 59:592-598. [PMID: 27506278 DOI: 10.1016/j.jadohealth.2016.06.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the prevalence of and examine factors associated with provider recommendation of human papillomavirus vaccination for U.S. adolescents. METHODS Multivariable logistic regression analyses were performed using data from the National Immunization Survey-Teen 2014 on 34,478 adolescents aged 13-17 years. RESULTS Overall prevalence of vaccine recommendation was 72.6% for girls and 51.8% for boys. Lower rates were observed among girls aged 13 years, living below poverty line, adolescents of lesser educated mothers, and those residing in the South. Overall, girls had higher odds of vaccine recommendation (odds ratio [OR] = 2.57; 95% confidence interval [CI] = 2.35-2.82). Correlates of higher vaccine recommendation for girls were: older age-17 versus 13 (OR = 1.51; 95% CI = 1.20-1.89), living above versus below poverty line, and residing in Northeast (OR = 1.45; 95% CI = 1.21-1.73) and Midwest (OR = 1.29; 95% CI = 1.11-1.50) versus South. For boys, correlates of higher vaccine recommendation were: non-Hispanic black (OR = 1.30; 95% CI = 1.07-1.58) and Hispanic (OR = 1.24; 95% CI = 1.03-1.48) versus non-Hispanic white race and residing in Northeast (OR = 1.79; 95% CI = 1.54-2.08) and West (OR = 1.41; 95% CI = 1.17-1.70) versus South. Other factors associated with vaccine recommendation were having a college-educated mother and frequent doctor visits in the past 12 months. CONCLUSIONS This study highlights significant disparities in provider recommendation of human papillomavirus vaccination for U.S. adolescents. Findings suggest possible areas for tailored interventions to bridge the gap in vaccine recommendation and uptake in high-risk populations.
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Affiliation(s)
- Kahee A Mohammed
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri.
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, St Louis University, St Louis, Missouri; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, St Louis University, St Louis, Missouri; St Louis University Cancer Center, St Louis, Missouri
| | - Eric Adjei Boakye
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri
| | - Betelihem B Tobo
- Department of Epidemiology, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
| | - Thomas E Burroughs
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri
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Hirth J, Kuo YF, Laz TH, Starkey JM, Rupp RE, Rahman M, Berenson AB. Concordance of adolescent human papillomavirus vaccination parental report with provider report in the National Immunization Survey-Teen (2008-2013). Vaccine 2016; 34:4415-21. [PMID: 27435385 PMCID: PMC4979581 DOI: 10.1016/j.vaccine.2016.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/08/2016] [Accepted: 07/10/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the accuracy of parental report of HPV vaccination through examination of concordance, with healthcare provider vaccination report as the comparison. METHODS The 2008-2013 National Immunization Survey (NIS)-Teen was used to examine accuracy of parent reports of HPV vaccination for their female daughters aged 13-17years, as compared with provider report of initiation and number of doses. Multivariable logistic regression models were used to examine associations related to concordance of parent and provider report. RESULTS Of 51,746 adolescents, 84% concordance for HPV vaccine initiation and 70% concordance for number of doses was observed. Accuracy varied by race/ethnicity, region, time, and income. The parent report of number of doses was more likely to be accurate among parents of 13 and 14year old females than 17year olds. Accuracy of initiation and number of doses were lower among Hispanic and black adolescents compared to white parents. The odds of over-report was higher among minorities compared to whites, but the odds of underreport was also markedly higher in these groups compared to parents of white teens. Accuracy of parental vaccine report decreased across time. CONCLUSIONS These findings are important for healthcare providers who need to ascertain the vaccination status of young adults. Strengthening existing immunization registries to improve data sharing capabilities and record completeness could improve vaccination rates, while avoiding costs associated with over-vaccination.
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Affiliation(s)
- Jacqueline Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States.
| | - Yong-Fang Kuo
- Division of Epidemiology and Biostatistics, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Tabassum Haque Laz
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States; Health Research and Consulting Services, Dhaka, Bangladesh(1)
| | - Jonathan M Starkey
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Richard E Rupp
- Department of Pediatrics, School of Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Mahbubur Rahman
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States; Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan(1)
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
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Lindley MC, Jeyarajah J, Yankey D, Curtis CR, Markowitz LE, Stokley S. Comparing human papillomavirus vaccine knowledge and intentions among parents of boys and girls. Hum Vaccin Immunother 2016; 12:1519-27. [PMID: 27003108 DOI: 10.1080/21645515.2016.1157673] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/OBJECTIVE Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Previous research suggests some differences between male and female adolescents in correlates of vaccine receipt and reasons for non-vaccination; few studies examine both sexes together. This analysis assessed knowledge and attitudes related to HPV disease and vaccination, intention to vaccinate, and reasons for delayed vaccination or non-vaccination among parents of boys and girls 13-17 y old in 50 states, the District of Columbia, and selected local areas. METHODS National Immunization Survey-Teen 2013 data were analyzed and gender differences examined. RESULTS In this sample, adolescent boys were more likely than girls to be unvaccinated and less likely to have completed the HPV vaccination series (p < 0.005 for both). Parents of girls were more likely than parents of boys to report a provider recommendation for HPV vaccination (65.0% vs. 42.1%). Only 29% of girls' parents reported a provider recommendation to begin vaccination by 11-12 y old. Among unvaccinated teens, parental intention to vaccinate in the next 12 months did not differ by sex, but reasons for vaccination or non-vaccination did. Many parents do not know the recommended number of HPV doses. CONCLUSIONS Gender differences in provider vaccination recommendations and reasons for vaccination might partially explain differential HPV uptake by male and female adolescents. Clinicians should offer strong recommendations for HPV vaccination at 11-12 y old for both girls and boys. To reduce missed opportunities, HPV vaccination should be presented in the context of, and given concurrently with, other routinely administered vaccines.
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Affiliation(s)
- Megan C Lindley
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Jenny Jeyarajah
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - David Yankey
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - C Robinette Curtis
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Lauri E Markowitz
- b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Shannon Stokley
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
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Henry KA, Stroup AM, Warner EL, Kepka D. Geographic Factors and Human Papillomavirus (HPV) Vaccination Initiation among Adolescent Girls in the United States. Cancer Epidemiol Biomarkers Prev 2016; 25:309-17. [PMID: 26768989 PMCID: PMC4817370 DOI: 10.1158/1055-9965.epi-15-0658] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/28/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study is among the first to explore geographic factors that may be associated with human papillomavirus (HPV) vaccine uptake in the United States. METHODS Data from the 2011 and 2012 National Immunization Survey-Teen for 20,565 female adolescents aged 13 to 17 years were analyzed to examine associations of HPV vaccine initiation (receipt of at least one dose) with ZIP code-level geographic factors. Logistic regression including individual and geographic factors was used to estimate the odds of HPV vaccine initiation. RESULTS Approximately 53% of girls initiated the HPV vaccine in both years. Girls in high poverty communities had higher HPV vaccine initiation compared with those in low poverty communities [61.1% vs. 52.4%; adjusted OR (AOR), 1.18; 95% confidence intervals (CI), 1.04-1.33]. Initiation was higher among girls in communities where the majority of the population was Hispanic (69.0% vs. 49.9%; AOR, 1.64; 95% CI, 1.43-1.87) or non-Hispanic mixed race (60.4% vs. 49.9%; AOR, 1.30; 95% CI, 1.17-1.44) compared with majority non-Hispanic white communities. Interactions between individual-level race/ethnicity and community racial-ethnic composition indicated significantly higher odds of initiation among Hispanic girls living in Hispanic communities compared with Hispanic girls living in predominantly non-Hispanic White (NHW) (AOR, 2.23; 95% CI, 1.87-2.65) or non-Hispanic Black (NHB) (AOR, 1.90; 95% CI, 1.20-3.04) communities, respectively. CONCLUSION Initiation rates of HPV vaccination among teen girls were highest in the poorest communities and among Hispanics living in communities where the racial-ethnic composition was predominantly Hispanic or mixed race. IMPACT Given low HPV vaccination rates in the United States, these results provide important evidence to inform public health interventions to increase HPV vaccination.
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Affiliation(s)
- Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania. Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, Pennsylvania.
| | - Antoinette M Stroup
- Department of Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey. Cancer Prevention and Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. University of Utah College of Nursing, Salt Lake City, Utah
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Rahman M, Laz TH, McGrath CJ, Berenson AB. Correlates of Human Papillomavirus Vaccine Completion Among Adolescent Girl Initiators. Clin Pediatr (Phila) 2015; 54:1328-33. [PMID: 25848128 PMCID: PMC4872699 DOI: 10.1177/0009922815579687] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine correlates of vaccine series completion among young adolescent US girls who initiated the human papillomavirus (HPV) vaccine. METHODS We analyzed National Immunization Survey-Teens 2012 provider-verified data to examine correlates of HPV vaccine completion among 13- to 17-year-old girls who initiated HPV vaccine in 2012 (N = 4548). RESULTS The weighted vaccine series completion rate among 13- to 17-year-old girl initiators was 66.7% (95% confidence interval [CI], 64.0-69.3). Adolescent girls who were older, residents of the Northeast (adjusted prevalence ratio [aPR], 1.36; 95% CI, 1.07-1.73), and had provider-verified seasonal influenza vaccination in the past year (aPR, 1.67; 95% CI, 1.32-2.11) and provider recommendation (aPR, 1.40; 95% CI, 1.10-1.77) were more likely to complete the 3-dose vaccine series. CONCLUSIONS Parents of younger adolescent girls need to be educated about the importance of completing the 3-dose HPV vaccine series. Provider recommendation for the vaccine would also facilitate series completion.
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Affiliation(s)
- Mahbubur Rahman
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Kahn KE, Santibanez TA, Zhai Y, Singleton JA. Influenza vaccination type, live, attenuated influenza vaccine (LAIV) versus inactivated influenza vaccine (IIV), received by children, United States, 2011-12 through 2013-14 influenza seasons. Vaccine 2015; 33:5196-203. [PMID: 26238724 PMCID: PMC4597891 DOI: 10.1016/j.vaccine.2015.07.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Influenza vaccines available for children in the United States include inactivated influenza vaccine (IIV) and live, attenuated influenza vaccine (LAIV). Objectives of this study were to quantify proportions of IIV and LAIV received by vaccinated children, and examine associations between vaccine type received and demographic characteristics. METHODS National Immunization Survey-Flu (NIS-Flu) parental reported data for the 2011-12 through 2013-14 influenza seasons were used to estimate proportions of vaccinated children 2-17 years who received IIV and LAIV. Tests of association between vaccination type and demographic variables were conducted using Wald chi-square tests and pair-wise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receipt of LAIV versus IIV. RESULTS In the 2013-14 season, 33.3% of vaccinated children received LAIV, similar to the proportion in the 2011-12 (32.2%) and 2012-13 (32.1%) seasons. Across all seasons studied, the strongest observed association was between vaccination type and child's age, with children 2-8 years (Adjusted Prevalence Ratio (95% confidence interval) [APR(95% CI)] 1.41(1.27-1.56), 1.46(1.34-1.59), and 1.50(1.38-1.63) for 2011-12, 2012-13, and 2013-14) and 9-12 years (APR(95% CI) 1.37(1.23-1.54), 1.38(1.26-1.51), and 1.50(1.38-1.63) for 2011-12, 2012-13, and 2013-14) being more likely to have received LAIV than children 13-17 years. Among those vaccinated, whites were more likely to have received LAIV compared with blacks (APR(95% CI) 1.19(1.05-1.35), 1.24(1.10-1.39), and 1.22(1.11-1.34) for 2011-12, 2012-13, and 2013-14), and children living above poverty (annual income >$75,000) were more likely to have received LAIV than those living at or below poverty (APR(95% CI) 1.43(1.23-1.67), 1.13(1.02-1.26), and 1.16(1.06-1.28) for 2011-12, 2012-13, and 2013-14). CONCLUSIONS This study provides a baseline of the extent and patterns of LAIV uptake that can be used to measure the impact of relevant public health policy. Additional research is needed to investigate parental and provider preferences and barriers regarding LAIV.
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Affiliation(s)
- Katherine E Kahn
- Leidos, Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, NE; Mail Stop A-19, Atlanta, GA 30333, USA.
| | - Tammy A Santibanez
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, NE; Mail Stop A-19, Atlanta, GA 30333, USA
| | - Yusheng Zhai
- Leidos, Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, NE; Mail Stop A-19, Atlanta, GA 30333, USA
| | - James A Singleton
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, NE; Mail Stop A-19, Atlanta, GA 30333, USA
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Smith PJ, Marcuse EK, Seward JF, Zhao Z, Orenstein WA. Children and Adolescents Unvaccinated Against Measles: Geographic Clustering, Parents' Beliefs, and Missed Opportunities. Public Health Rep 2015; 130:485-504. [PMID: 26327727 PMCID: PMC4529833 DOI: 10.1177/003335491513000512] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated the extent to which children and adolescents were not vaccinated against measles ("unvaccinated"), clustering within U.S. counties, and factors associated with unvaccination, including parents' vaccine-related beliefs and missed opportunities. METHODS We analyzed data from the 2010-2013 National Immunization Survey (NIS) and NIS-Teen Survey of households with 19- to 35-month-old children and 13- to 17-year-old adolescents, respectively. We used provider-reported vaccination histories to assess measles vaccination status. RESULTS In 2013, 7.5% of children and 4.5% of adolescents were unvaccinated against measles. Four-fifths (80.0%) of unvaccinated children lived in counties containing 41.9% of the nation's children, and 80.0% of unvaccinated adolescents lived in counties containing 30.4% of the nation's adolescents. Multivariable statistical analyses found that 74.6% of children who were unvaccinated against measles missed being vaccinated for reasons other than parents' negative vaccine-related beliefs, and 89.6% could be deemed as having at least one missed opportunity for being vaccinated against measles because they were administered at least one dose of other recommended vaccines after 12 months of age. Among adolescents, multivariable analyses found that only demographic factors, not vaccine-related parental beliefs, were independently associated with being unvaccinated. CONCLUSIONS Reasons other than negative vaccine-related beliefs, including missed opportunities, accounted for the vast majority of unvaccinated children and adolescents.
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Affiliation(s)
- Philip J. Smith
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
| | - Edgar K. Marcuse
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Jane F. Seward
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
| | - Zhen Zhao
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
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Gaskin GL, Glanz JM, Binswanger IA, Anoshiravani A. Immunization Coverage Among Juvenile Justice Detainees. JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 21:265-75. [PMID: 26084948 DOI: 10.1177/0885066615587790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study sought to (1) quantify the baseline immunization coverage of adolescents entering the juvenile justice system and (2) assess the effect of detention-based care on immunization coverage in youth. A cross-sectional retrospective chart review was performed of 279 adolescents detained at a large juvenile detention facility. Only 3% of adolescents had received all study immunizations prior to detention. Before detention, immunization coverage was significantly lower than that for the general adolescent population for all vaccines except the first doses of hepatitis A and varicella-zoster virus vaccines. Subsequent to detention, most individual immunization coverage levels increased and were significantly higher than in the general adolescent population. The routine administration of immunizations in the juvenile justice setting can help detained youth achieve levels of immunization coverage similar to their nondetained peers.
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Affiliation(s)
- Gregory L Gaskin
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Ingrid A Binswanger
- Division of General Internal Medicine and Division of Substance Dependence, University of Colorado School of Medicine, Aurora, CO, USA Denver Health Medical Center, Denver, CO, USA
| | - Arash Anoshiravani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA Santa Clara County Juvenile Custody Institutions, Santa Clara Valley Medical Center, San Jose, CA, USA
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Lu PJ, Yankey D, Jeyarajah J, O'Halloran A, Elam-Evans L, Greby SM, Singleton JA, Murphy TV. Hepatitis B vaccination among adolescents 13-17 years, United States, 2006-2012. Vaccine 2015; 33:1855-64. [PMID: 25724820 PMCID: PMC5808397 DOI: 10.1016/j.vaccine.2015.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hepatitis B (HepB) vaccination is the most effective measure to prevent HBV infection. Routine HepB vaccination was recommended for infants in 1991 and catch-up vaccination has been recommended for adolescents since in 1995. The purpose of this study is to assess HepB vaccination among adolescents 13-17 years. METHODS The 2006-2012 NIS-Teen were analyzed. Vaccination trends and coverage by birth cohort among adolescents were evaluated. Multivariable logistic regression and predictive marginal models are used to identify factors independently associated with HepB vaccination. RESULTS HepB vaccination coverage increased from 81.3% in 2006 to 92.8% in 2012. Coverage varied by birth cohort and 79-83% received vaccination before 2 years of age for those who were born during 1995 and 1999. Among those who had not received vaccination by 11 years of age, for the 1993-1995 birth cohorts, 9-15% were vaccinated during ages 11-12 years, and 27-37% had been vaccinated through age 16 years. Coverage among adolescents 13-17 years in 2012 ranged by state from 84.4% in West Virginia to 98.7% in Florida (median 93.3%). Characteristics independently associated with a higher likelihood of HepB vaccination included living more than 5 times above poverty level, living in Northeastern or Southern region of the United States, and having a mixed facility as their vaccination provider. Those with a hospital listed as their vaccination provider and those who did not have a well-child visit at age 11-12 years were independently associated with a lower likelihood of HepB vaccination. CONCLUSIONS Efforts focused on groups with lower coverage may reduce disparities in coverage and prevent hepatitis B infection. Parents and providers should routinely review adolescent immunizations. Routine reminder/recall, expanded access in health care settings, and standing order programs should be incorporated into routine clinical care of adolescents.
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Affiliation(s)
- Peng-jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States.
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - Jenny Jeyarajah
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - Alissa O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - Laurie Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - Stacie M Greby
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - Trudy V Murphy
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, & TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
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Rahman M, Laz TH, McGrath CJ, Berenson AB. Provider recommendation mediates the relationship between parental human papillomavirus (HPV) vaccine awareness and HPV vaccine initiation and completion among 13- to 17-year-old U.S. adolescent children. Clin Pediatr (Phila) 2015; 54:371-5. [PMID: 25238779 PMCID: PMC4366339 DOI: 10.1177/0009922814551135] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the association between parental human papillomavirus (HPV) awareness and HPV vaccine initiation/completion based on 13- to 17-year-old US adolescent children and to explore whether these associations were mediated by provider recommendation. METHODS We used publicly available National Immunization Survey-Teen 2011 data (11 236 adolescent girls and 12 328 boys). RESULTS Weighted logistic regression analysis showed that parental HPV awareness and provider recommendation predicted HPV vaccine initiation and completion separately among both girls and boys, after adjusting for demographic and health care use variables. When provider recommendation and parental HPV awareness were entered in the model simultaneously, only provider recommendation was independently associated with HPV vaccine initiation and completion, demonstrating a mediation effect of provider recommendation. CONCLUSIONS Future studies are needed to better understand why physicians may not provide a recommendation for the HPV vaccine as well as to identify strategies to improve providers' ability to effectively communicate their recommendations.
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Affiliation(s)
- Mahbubur Rahman
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Robison SG. Addressing immunization registry population inflation in adolescent immunization rates. Public Health Rep 2015; 130:161-6. [PMID: 25729105 PMCID: PMC4315857 DOI: 10.1177/003335491513000209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE While U.S. adolescent immunization rates are available annually at national and state levels, finding pockets of need may require county or sub-county information. Immunization information systems (IISs) are one tool for assessing local immunization rates. However, the presence of IIS records dating back to early childhood and challenges in capturing mobility out of IIS areas typically leads to denominator inflation. We examined the feasibility of weighting adolescent immunization records by length of time since last report to produce more accurate county adolescent counts and immunization rates. METHODS We compared weighted and unweighted adolescent denominators from the Oregon ALERT IIS, along with county-level Census Bureau estimates, with school enrollment counts from Oregon's annual review of seventh-grade school immunization compliance for public and private schools. Adolescent immunization rates calculated using weighted data, for the state as a whole, were also checked against comparable National Immunization Survey (NIS) rates. RESULTS Weighting individual records by the length of time since last activity substantially improved the fit of IIS data to county populations for adolescents. A nonlinear logarithmic (ogive) weight produced the best fit to the school count data of all examined estimates. Overall, the ogive weighted results matched NIS adolescent rates for Oregon. CONCLUSION The problem of mobility-inflated counts of teenagers can be addressed by weighting individual records based on time since last immunization. Well-populated IISs can rely on their own data to produce adolescent immunization rates and find pockets of need.
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Kepka D, Ding Q, Warner EL, Spigarelli MG, Mooney K. High school females and those with other vaccinations most likely to complete the Human Papillomavirus vaccine. Prev Med Rep 2015; 2:79-83. [PMID: 26844053 PMCID: PMC4721356 DOI: 10.1016/j.pmedr.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Adolescent females' HPV vaccine completion in the U.S. is low. More recent research is needed to investigate factors that relate to HPV vaccine completion among female adolescents in the United States. METHODS Provider-validated data from the 2012 National Immunization Survey-Teen for females ages 13-17 years (N = 9058) were analyzed from February-May 2014 using survey sample weighted statistics. A multivariable Poisson regression estimated prevalence ratios (PR) for factors influencing HPV vaccine completion: mother's education, poverty status, adolescent's grade, facility type, and receipt of other adolescent vaccinations. RESULTS In multivariable models, 9-12th grade daughters were more likely to complete HPV vaccination than 6-8th grade daughters (PR = 1.81, 95% CI = 1.58-2.06). Those seen in hospital facilities completed HPV vaccination 1.3 times more (PR = 1.29, 95% CI = 1.02-1.62) and those seen in private facilities were 1.2 times more likely to complete (PR = 1.22, 95% CI = 1.01-1.48), than those seen in public facilities, respectively. Compared to those without recommended adolescent vaccinations, receipt of seasonal influenza vaccination related to HPV vaccine completion (PR = 1.71, 95% CI = 1.54-1.89), as did receipt of TDAP vaccination (PR = 1.17, 95% CI = 1.03-1.33) and Meningitis vaccination (PR = 2.74, 95% CI = 2.20-3.42). CONCLUSIONS Adolescent females in high school, seen in private/hospital facilities, and up to date on other recommended adolescent vaccinations are most likely to complete the HPV vaccine.
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Affiliation(s)
- Deanna Kepka
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Qian Ding
- Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84132, USA
| | - Echo L. Warner
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Michael G. Spigarelli
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA
- Department of Pharmacology and Toxicology, University of Utah, 30 N 1900 E, Salt Lake City, UT, USA
| | - Kathi Mooney
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
- Cancer Control and Population Sciences Department, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
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Attanasio L, McAlpine D. Accuracy of parental reports of children's HPV vaccine status: implications for estimates of disparities, 2009-2010. Public Health Rep 2014; 129:237-44. [PMID: 24791021 DOI: 10.1177/003335491412900305] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Since the introduction of the human papillomavirus (HPV) vaccine in 2006, there have been considerable efforts at the national and state levels to monitor uptake and better understand the individual and system-level factors that predict who gets vaccinated. A common method of measuring the vaccination status of adolescents is through parental recall. We examined how the accuracy of parents' reports of their daughters' HPV vaccination status varied by social characteristics. METHODS Data were taken from the 2009-2010 National Immunization Survey (NIS)-Teen, which includes a household interview and a provider-completed immunization history. We evaluated concordance between parents' and providers' reports of teens' HPV vaccine initiation (≥1 dose) and completion (≥3 doses). We assessed bivariate associations of sociodemographic characteristics with having a concordant, false-positive (overreporting) or false-negative (underreporting) report, and used multinomial logistic regression to estimate the independent impact of each characteristic. RESULTS In bivariate analyses, concordance of parent-reported HPV vaccine initiation was associated with each of the sociodemographic characteristics investigated. In regression models, self-reported nonwhite race, lower household income, and lower education level of the teen's mother were associated with a higher likelihood of having a false-negative parental report than a concordant report. CONCLUSION Our results indicate that, while estimates of overall coverage based on parental report may be unbiased, the differences in the accuracy of parental report could result in misleading estimates of disparities in HPV vaccine coverage.
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Affiliation(s)
- Laura Attanasio
- University of Minnesota, School of Public Health, Division of Health Policy and Management, Minneapolis, MN
| | - Donna McAlpine
- University of Minnesota, School of Public Health, Division of Health Policy and Management, Minneapolis, MN
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Reiter PL, Brewer NT, Gilkey MB, Katz ML, Paskett ED, Smith JS. Early adoption of the human papillomavirus vaccine among Hispanic adolescent males in the United States. Cancer 2014; 120:3200-7. [PMID: 24948439 DOI: 10.1002/cncr.28871] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/19/2014] [Accepted: 05/22/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is common among Hispanic males, but to the authors' knowledge little is known regarding HPV vaccination in this population. The authors examined the early adoption of the HPV vaccine among a national sample of Hispanic adolescent males. METHODS The authors analyzed provider-verified HPV vaccination data from the 2010 through 2012 National Immunization Survey-Teen (NIS-Teen) for Hispanic males aged 13 years to 17 years (n = 4238). Weighted logistic regression identified correlates of HPV vaccine initiation (receipt of ≥ 1 doses). RESULTS HPV vaccine initiation was 17.1% overall, increasing from 2.8% in 2010 to 31.7% in 2012 (P < .0001). Initiation was higher among sons whose parents had received a provider recommendation to vaccinate compared with those whose parents had not (53.3% vs 9.0%; odds ratio, 8.77 [95% confidence interval, 6.05-12.70]). Initiation was also higher among sons who had visited a health care provider within the previous year (odds ratio, 2.42; 95% confidence interval, 1.39-4.23). Among parents with unvaccinated sons, Spanish-speaking parents reported much higher intent to vaccinate compared with English-speaking parents (means: 3.52 vs 2.54; P < .0001). Spanish-speaking parents were more likely to indicate lack of knowledge (32.9% vs 19.9%) and not having received a provider recommendation (32.2% vs 17.7%) as the main reasons for not intending to vaccinate (both P < .05). CONCLUSIONS HPV vaccination among Hispanic adolescent males has increased substantially in recent years. Ensuring health care visits and provider recommendation will be key for continuing this trend. Preferred language may also be important for increasing HPV vaccination and addressing potential barriers to vaccination.
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Affiliation(s)
- Paul L Reiter
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, Ohio; Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio; College of Public Health, The Ohio State University, Columbus, Ohio
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Rahman M, McGrath CJ, Berenson AB. Geographic variation in human papillomavirus vaccination uptake among 13-17 year old adolescent girls in the United States. Vaccine 2014; 32:2394-8. [PMID: 24637175 DOI: 10.1016/j.vaccine.2014.02.097] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/11/2014] [Accepted: 02/28/2014] [Indexed: 11/19/2022]
Abstract
Geographic variation in provider-verified human papillomavirus (HPV) vaccine uptake among adolescent girls in the US has not been examined. To investigate this, we analyzed 2011 National Immunization Survey-Teen data. Among 13-17 year old girls (n=11,236), weighted vaccine initiation (48.4%) and completion rates (30.6%) were the lowest in the South when compared to the Northeast (53.4% and 39.9%), Midwest (51.1% and 33.5%) and West (61.6% and 38.7%) (P<.001, both for initiation and completion). Multivariable log-binomial regression analysis indicated that 13-17 year old girls living in the South were less likely to initiate [adjusted prevalence ratio (aPR)=0.86, 95% confidence interval (CI) 0.75-0.97] and complete (aPR=0.83, 95% CI, 0.74-0.93) the HPV vaccine series compared to girls living in the Northeast. Similar differences were observed when the uptake rates in the South were compared to other regions in the US. Intervention programs to increase HPV vaccine uptake and reduce regional disparities are warranted.
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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 77555-0587, 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 77555-0587, 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 77555-0587, United States
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Reiter PL, Gupta K, Brewer NT, Gilkey MB, Katz ML, Paskett ED, Smith JS. Provider-verified HPV vaccine coverage among a national sample of Hispanic adolescent females. Cancer Epidemiol Biomarkers Prev 2014; 23:742-54. [PMID: 24633142 DOI: 10.1158/1055-9965.epi-13-0979] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hispanic females have the highest cervical cancer incidence rate of any racial or ethnic group in the United States, yet relatively little research has examined human papillomavirus (HPV) vaccination among this fast-growing population. We examined HPV vaccination among a national sample of Hispanic adolescent females. METHODS We analyzed provider-verified vaccination data from the 2010-2011 National Immunization Survey-Teen for Hispanic females ages 13 to 17 years (n = 2,786). We used weighted logistic regression to identify correlates of HPV vaccine initiation (receipt of one or more doses), completion (receipt of three doses), and follow-through (receipt of three doses among those who initiated the series). RESULTS HPV vaccine initiation was 60.9%, completion was 36.0%, and follow-through was 59.1%. Initiation and completion were more common among older daughters and those whose parents had received a provider recommendation to vaccinate (all P < 0.05). Completion was less common among daughters who had moved from their birth state (P < 0.05). All vaccination outcomes were less common among daughters without health insurance (all P < 0.05). Vaccination did not differ by parents' preferred language (all P > 0.05), although intent to vaccinate was higher among Spanish-speaking parents (P < 0.01). Spanish-speaking parents were more likely to indicate lack of provider recommendation (20.2% vs. 5.3%) and cost (10.9% vs. 1.8%) as main reasons for not intending to vaccinate (both P < 0.05). CONCLUSIONS Many Hispanic females have not received HPV vaccine. Several factors, including provider recommendation and health insurance, are key correlates of vaccination. IMPACT HPV vaccination programs targeting Hispanics are needed and should consider how potential barriers to vaccination may differ by preferred language.
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Affiliation(s)
- Paul L Reiter
- Authors' Affiliations: Division of Cancer Prevention and Control, College of Medicine; Comprehensive Cancer Center; College of Public Health, The Ohio State University, Columbus, Ohio; UNC Gillings School of Global Public Health; and Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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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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Reiter PL, Katz ML, Paskett ED. Correlates of HPV vaccination among adolescent females from Appalachia and reasons why their parents do not intend to vaccinate. Vaccine 2013; 31:3121-5. [PMID: 23664990 DOI: 10.1016/j.vaccine.2013.04.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/12/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
Limited research has examined HPV vaccination in Appalachia, a region with cervical cancer disparities. We analyzed 2008-2010 National Immunization Survey-Teen data for adolescent females ages 13-17 from Appalachia (n=1951) to identify correlates of HPV vaccination and reasons why their parents do not intend to vaccinate. HPV vaccine initiation was 40.8%, completion was 27.7%, and follow-through was 67.8%. Vaccination outcomes tended to be higher among females who were older, had visited their healthcare provider in the last year, or whose parents reported receiving a provider recommendation to vaccinate. Only 41.0% of parents with unvaccinated daughters intended to vaccinate in the next year. The most common reasons for not intending to vaccinate were believing vaccination is not needed or not necessary (21.5%) and lack of knowledge (18.5%). Efforts to reduce missed opportunities for vaccination at healthcare visits and address reasons why parents are not vaccinating may help increase HPV vaccination in Appalachia.
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Affiliation(s)
- Paul L Reiter
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, Ohio 43201, USA.
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Kawai K, O'Brien MA, Conway JH, Marshall GS, Kuter BJ. Factors associated with receipt of two doses of varicella vaccine among adolescents in the United States. Pediatr Infect Dis J 2013. [PMID: 23190788 DOI: 10.1097/inf.0b013e31827f4c3c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2006, routine two-dose varicella vaccination for all children was recommended, including a second dose catch-up program for older children and adolescents. Recent studies have shown that a second dose of the vaccine provides incremental protection against varicella disease. METHODS This study is a cross-sectional analysis of data collected in the National Immunization Survey-Teen 2010 combined with publicly available data related to state immunization requirements. Bivariate and multivariable logistic regression analyses were performed to examine individual-level and state-level factors associated with receipt of two doses of varicella vaccine among 10,542 adolescents 13 to 17 years of age with no history of varicella. RESULTS Overall, 58.1% of adolescents without any history of varicella had received two doses of varicella vaccine. Coverage varied widely among states, ranging from 19.7% in South Dakota to 85.3% in Rhode Island. In the multivariable model, receipt of two doses of varicella vaccine was significantly associated with younger age, higher maternal education level, private health insurance, more frequent health care visits, receipt of both quadrivalent meningococcal conjugate and tetanus, diphtheria, and acellular pertussis vaccinations, and residing in a state with two-dose policies for middle school entry. Vaccines for Children program-eligible adolescents were less likely to have received two doses. CONCLUSION Two-dose varicella vaccination coverage remained low among adolescents in 2010, despite the universal recommendation. Programs that are aimed specifically at Vaccines for Children program-eligible adolescents, state policies requiring two doses for middle school entry, and broad education and implementation of the adolescent vaccination platform may help to improve varicella vaccination coverage.
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Affiliation(s)
- Kosuke Kawai
- School of Pharmacy, Temple University, Philadelphia 19140, USA.
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HPV vaccination among adolescent males: results from the National Immunization Survey-Teen. Vaccine 2013; 31:2816-21. [PMID: 23602667 DOI: 10.1016/j.vaccine.2013.04.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/01/2013] [Accepted: 04/03/2013] [Indexed: 11/23/2022]
Abstract
US guidelines provided a permissive recommendation for HPV vaccine for males in 2009, with an updated recommendation for routine vaccination in 2011. Data on vaccine uptake among males, however, remain sparse. We analyzed 2010-2011 data (collected mostly prior to the recommendation for routine vaccination) from the National Immunization Survey-Teen for a nationally representative sample of adolescent males ages 13-17 (n=22,365). We examined HPV vaccine initiation (receipt of at least one dose based on healthcare provider records) as the primary outcome. Analyses used weighted logistic regression. HPV vaccine initiation increased from 1.4% in 2010 to 8.3% in 2011. Parents who reported receiving a healthcare provider recommendation to get their sons HPV vaccine were much more likely to have vaccinated sons (OR=19.02, 95% CI: 14.36-25.19). Initiation was also higher among sons who were Hispanic (OR=1.83, 95% CI: 1.24-2.71) or who were eligible for the Vaccines for Children program (OR=1.53, 95% CI: 1.01-2.31). Only 31.0% of parents with unvaccinated sons indicated their sons were "somewhat likely" or "very likely" to receive HPV vaccine in the next year. The most common main reasons for parents not intending to vaccinate were believing vaccination is not needed or not necessary (24.5%), not having received a provider recommendation (22.1%), and lack of knowledge (15.9%). HPV vaccination is low among adolescent males in the US, and provider recommendation for vaccination is likely key to improving vaccine uptake. Given the updated recommendation for routine vaccination and the changes in health insurance coverage that are likely to follow, continued efforts are needed to monitor HPV vaccination among males.
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Darden PM, Thompson DM, Roberts JR, Hale JJ, Pope C, Naifeh M, Jacobson RM. Reasons for not vaccinating adolescents: National Immunization Survey of Teens, 2008-2010. Pediatrics 2013; 131:645-51. [PMID: 23509163 DOI: 10.1542/peds.2012-2384] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the reasons adolescents are not vaccinated for specific vaccines and how these reasons have changed over time. METHODS We analyzed the 2008-2010 National Immunization Survey of Teens examining reasons parents do not have their teens immunized. Parents whose teens were not up to date (Not-UTD) for Tdap/Td and MCV4 were asked the main reason they were not vaccinated. Parents of female teens Not-UTD for human papillomavirus vaccine (HPV) were asked their intent to give HPV, and those unlikely to get HPV were asked the main reason why not. RESULTS The most frequent reasons for not vaccinating were the same for Tdap/Td and MCV4, including "Not recommended" and "Not needed or not necessary." For HPV, the most frequent reasons included those for the other vaccines as well as 4 others, including "Not sexually active" and "Safety concerns/Side effects." "Safety concerns/Side effects" increased from 4.5% in 2008 to 7.7% in 2009 to 16.4% in 2010 and, in 2010, approaching the most common reason "Not Needed or Not Necessary" at 17.4% (95% CI: 15.7-19.1). Although parents report that health care professionals increasingly recommend all vaccines, including HPV, the intent to not vaccinate for HPV increased from 39.8% in 2008 to 43.9% in 2010 (OR for trend 1.08, 95% CI: 1.04-1.13). CONCLUSIONS Despite doctors increasingly recommending adolescent vaccines, parents increasingly intend not to vaccinate female teens with HPV. The concern about safety of HPV grew with each year. Addressing specific and growing parental concerns about HPV will require different considerations than those for the other vaccines.
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Affiliation(s)
- Paul M Darden
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Dorell C, Yankey D, Kennedy A, Stokley S. Factors that influence parental vaccination decisions for adolescents, 13 to 17 years old: National Immunization Survey-Teen, 2010. Clin Pediatr (Phila) 2013; 52:162-70. [PMID: 23221308 DOI: 10.1177/0009922812468208] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We aim to describe factors that influence parental decisions to vaccinate their adolescents. METHODS Data from the July to December 2010 National Immunization Survey-Teen Parental Concerns Module were analyzed to determine factors that influence parental decisions to vaccinate their adolescents. RESULTS Parents reported that their adolescent's health care provider recommended tetanus toxoid/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Td/Tdap; 74.4%), meningococcal conjugate (MenACWY; 60.3%), and human papillomavirus (HPV; 71.3%). Vaccination coverage estimates were significantly higher among parents who reported receiving a provider recommendation: 85.2% versus 76.7% (Td/Tdap), 77.3% versus 49.7% (MenACWY), and 62.2% versus 21.5% (HPV). Compared with Td/Tdap and MenACWY, fewer HPV vaccination conversations included recommendations for vaccination. Other than health care providers, school requirements (46.1%), news coverage (31.2%), and family (31.0%) were most frequently reported influences on parental vaccination decisions. CONCLUSIONS Many factors influence parental decisions to vaccinate their adolescents; one of the most important factors is the provider recommendation. Missed opportunities for vaccination persist when strong vaccination recommendations are not given or are delayed.
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Affiliation(s)
- Christina Dorell
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Jemal A, Simard EP, Dorell C, Noone AM, Markowitz LE, Kohler B, Eheman C, Saraiya M, Bandi P, Saslow D, Cronin KA, Watson M, Schiffman M, Henley SJ, Schymura MJ, Anderson RN, Yankey D, Edwards BK. Annual Report to the Nation on the Status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 2013; 105:175-201. [PMID: 23297039 PMCID: PMC3565628 DOI: 10.1093/jnci/djs491] [Citation(s) in RCA: 753] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year’s report includes incidence trends for human papillomavirus (HPV)–associated cancers and HPV vaccination (recommended for adolescents aged 11–12 years). Methods Data on cancer incidence were obtained from the CDC, NCI, and NAACCR, and data on mortality were obtained from the CDC. Long- (1975/1992–2009) and short-term (2000–2009) trends in age-standardized incidence and death rates for all cancers combined and for the leading cancers among men and among women were examined by joinpoint analysis. Prevalence of HPV vaccination coverage during 2008 and 2010 and of Papanicolaou (Pap) testing during 2010 were obtained from national surveys. Results Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2000 to 2009. Overall incidence rates decreased in men but stabilized in women. Incidence rates increased for two HPV-associated cancers (oropharynx, anus) and some cancers not associated with HPV (eg, liver, kidney, thyroid). Nationally, 32.0% (95% confidence interval [CI] = 30.3% to 33.6%) of girls aged 13 to 17 years in 2010 had received three doses of the HPV vaccine, and coverage was statistically significantly lower among the uninsured (14.1%, 95% CI = 9.4% to 20.6%) and in some Southern states (eg, 20.0% in Alabama [95% CI = 13.9% to 27.9%] and Mississippi [95% CI = 13.8% to 28.2%]), where cervical cancer rates were highest and recent Pap testing prevalence was the lowest. Conclusions The overall trends in declining cancer death rates continue. However, increases in incidence rates for some HPV-associated cancers and low vaccination coverage among adolescents underscore the need for additional prevention efforts for HPV-associated cancers, including efforts to increase vaccination coverage.
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Affiliation(s)
- Ahmedin Jemal
- Surveillance Research Program, American Cancer Society, 250 Williams St NW, Atlanta, GA 30303, USA.
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Reiter PL, Katz ML, Paskett ED. HPV vaccination among adolescent females from Appalachia: implications for cervical cancer disparities. Cancer Epidemiol Biomarkers Prev 2012; 21:2220-30. [PMID: 23136141 PMCID: PMC3518634 DOI: 10.1158/1055-9965.epi-12-0850] [Citation(s) in RCA: 23] [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
BACKGROUND Appalachia is a geographic region with high cervical cancer incidence and mortality rates, yet little is known about human papillomavirus (HPV) vaccination in this region. We determined HPV vaccine coverage among adolescent females from Appalachia, made comparisons to non-Appalachian females, and examined how coverage differs across subregions within Appalachia. METHODS We analyzed data from the National Immunization Survey-Teen 2008-2010 for adolescent females ages 13-17 (n = 1,951, Appalachian females and n = 25,468, non-Appalachian females). We examined HPV vaccine initiation (receipt of at least one dose), completion (receipt of at least three doses), and follow-through (completion among initiators). Analyses used weighted logistic regression. RESULTS HPV vaccine initiation [Appalachian = 40.8% vs. non-Appalachian = 43.6%; OR, 0.92; 95% confidence interval (CI), 0.79-1.07] and completion (Appalachian = 27.7% vs. non-Appalachian = 25.3%; OR, 1.12; 95% CI, 0.95-1.32) were similar between Appalachian and non-Appalachian females. HPV vaccine follow-through was higher among Appalachian females than non-Appalachian females (67.8% vs. 58.1%; OR, 1.36; 95% CI, 1.07-1.72). Vaccination outcomes tended to be higher in the Northern (completion and follow-through) and South Central (follow-through) subregions of Appalachia compared with non-Appalachian United States. Conversely, vaccination outcomes tended to be lower in the Central (initiation and completion) and Southern (initiation and completion) subregions. CONCLUSIONS In general, HPV vaccination in Appalachia is mostly similar to the rest of the United States. However, vaccination is lagging in regions of Appalachia where cervical cancer incidence and mortality rates are highest. IMPACT Current cervical cancer disparities could potentially worsen if HPV vaccine coverage is not improved in regions of Appalachia with low HPV vaccine coverage.
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Affiliation(s)
- Paul L Reiter
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Suite 525, 1590 North High Street, Columbus, Ohio 43201, USA.
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Inter-state variation in human papilloma virus vaccine coverage among adolescent girls in the 50 US states, 2007. Matern Child Health J 2012; 16 Suppl 1:S102-10. [PMID: 22453332 DOI: 10.1007/s10995-012-0999-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Human papilloma virus (HPV) vaccination could substantially reduce the burden of cervical cancer by preventing HPV infection. This study uses the 2007 National Survey of Children's Health (NSCH) to estimate HPV vaccine coverage prevalence for US girls aged 12-17, the target group for vaccination. NSCH is a population-based telephone survey of households with children younger than 18 years. The proportion of girls aged 12-17 whose parent or guardian reported receipt of a clinician recommendation for HPV vaccination, one or more does of HPV vaccine, or a complete three-dose HPV vaccine series were estimated. Multivariable models estimated adjusted associations and marginal predicted vaccine coverage prevalence for each of the 50 US states and according to race/ethnicity, household income, insurance status, parental education, and whether the girl had a 'medical home'. The NSCH sample included 17,264 girls aged 12-17. Overall 18.2 % (SE 0.8 %) of girls reportedly received at least one HPV vaccine dose and 3.6 % (SE 0.4 %) completed the series; 31 % received clinician recommendation for HPV vaccine. Girls who received a clinician recommendation to vaccinate were 23 (95 % CI 18-29) times as likely to be vaccinated as those not counseled. There was substantial interstate variation in vaccine coverage that was largely explained by variability in clinician counseling. For 2007, there was substantial variation in HPV vaccine coverage among US girls 12-17 years that was largely explained by variability in clinician counseling. Strategies aimed at increasing clinicians' counseling for HPV vaccination could substantially reduce disparities in HPV vaccine coverage.
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