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Lewis RM, Markowitz LE. Disparities in human papillomavirus vaccination coverage in the United States, National Health and Nutrition Examination Survey, January 2017-March 2020. Vaccine 2022; 40:2828-2832. [PMID: 35393147 DOI: 10.1016/j.vaccine.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND We assessed disparities in HPV vaccination coverage by sociodemographic characteristics in the United States. METHODS Using 2017-March 2020 National Health and Nutrition Examination Survey data, we estimated vaccination coverage of ≥ 1 dose of HPV vaccine by race/ethnicity and poverty, insurance, and nativity status for females and males aged 9-14, 15-19, and 20-29 years. RESULTS Among those aged 9-14 years, coverage among non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) females (40.0%, 33.6%, 34.0%) and males (27.1%, 35.3%, 30.9%) was higher than non-Hispanic White (NHW) females (26.5%) and males (25.2%). Among those aged 15-19 and 20-29 years, coverage varied among NHB, Hispanic, and NHA compared to NHW females and was lower among NHB, Hispanic, and NHA than NHW males. Coverage was lower among uninsured than insured in most comparisons. CONCLUSIONS HPV vaccination coverage varied by race/ethnicity and other characteristics. Efforts are needed to increase HPV vaccination coverage in all populations.
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Affiliation(s)
- Rayleen M Lewis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA; Synergy America, Inc., 6340 Sugarloaf Parkway, Suite 200, Duluth, GA 30097, USA.
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA
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Comparison of Social Inequality in Human Papillomavirus (HPV) Vaccination among Teenagers with Parental Reports and Healthcare Providers’ Records in the 2019 National Immunization Survey-Teen. Vaccines (Basel) 2022; 10:vaccines10020178. [PMID: 35214637 PMCID: PMC8874670 DOI: 10.3390/vaccines10020178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Relatively little is known about social inequality in human papillomavirus (HPV) vaccination among teenagers in the United States. This study aims to investigate whether there is a social disparity in HPV vaccination among teenagers and if so, whether it can differ according to the source of teen vaccination information (parental reports and provider records). Methods: We used the data from the 2019 National Immunization Survey-Teen (NIS-Teen; 42,668 teenagers, aged 13–17) including parent-reported vaccination status. Among them, 18,877 teenagers had adequate provider-reported vaccination records. Two socioeconomic status (SES) measures were used: mother’s education and annual family income. Multivariate logistic analyses were conducted. Results: False negatives of parental reports against provider records were more than two times higher (p < 0.001) in low-SES teens than in high-SES teens. In both SES measures, the proportion of HPV-unvaccinated teenagers was lowest at the highest SES level in analyses with parental reports. However, it was the opposite in analyses with provider records. Interestingly, regardless of the vaccination information source, the HPV unvaccinated rate was highest in the middle-SES teens (>12 years, non-college graduates; above poverty level, but not >USD 75 K). Conclusions: Significant social inequality in HPV vaccination among teenagers exists in the United States. The pattern of social inequality in HPV vaccination can be distorted when only parent-reported vaccination information is used.
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The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study. LANCET REGIONAL HEALTH. AMERICAS 2021; 8:100128. [PMID: 36778727 PMCID: PMC9904075 DOI: 10.1016/j.lana.2021.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Reaching and maintaining high global human papillomavirus (HPV) vaccine uptake has been challenging. The impact of publicly funded HPV immunization programs and the interplay of sociodemographic, psychosocial and policy factors in maximizing vaccination is poorly understood. This observational study examined the impact of introducing publicly funded school-based HPV vaccination programs for boys directly on uptake in boys and indirectly on uptake in girls, while concurrently examining other important sociodemographic and psychosocial factors. Methods Data were collected from a national, longitudinal sample of Canadian parents of children aged 9-16 years during August-September 2016 (T1) and June-July 2017 (T2). Participants completed an online questionnaire measuring sociodemographic characteristics, vaccine knowledge and attitudes, health care provider recommendation, and HPV vaccine uptake. Analyses were conducted separately for parents of boys and girls using logistic regression analyses at T1 and T2. Jurisdictions with HPV vaccine funding for boys at both time-points were compared to those with funding at neither time-points and those that introduced funding between time-points. Findings The sample included parents of boys (n = 716) and girls (n = 843). In multivariable analyses, jurisdictions with funding for boys at both time-points had higher odds of vaccination (adjusted odds ratio, T1 = 10.18, T2 = 11.42; 95% confidence interval, T1 = 3.08-33.58, T2 = 5.61-23.23) than jurisdictions without funding at both time-points; however, funded jurisdictions did not have higher odds of vaccination compared to jurisdictions that newly introduced funding for boys. Vaccination was associated with consistent determinants in boys and girls including child's age, health care provider recommendation, perceived vaccine harms, and perceived vaccine affordability. Interpretation This gender-sensitive analysis highlights the interplay of sociodemographic, psychosocial, and policy factors that can improve HPV vaccination. Publicly funded school-based programs are an impactful strategy to increase vaccine uptake. Funding This work was supported by the Canadian Cancer Society Research Institute (#704,036). GKS was supported by the Vanier Canada Graduate Scholarship and Queen Elizabeth II Diamond Jubilee Scholarship programs. The funders of this work had no role in the data collection, analysis, or interpretation, or any aspect pertinent to the study.
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Chow EP, Fairley CK, Wigan R, Hocking JS, Garland SM, Cornall AM, Tabrizi SN, Chen MY. Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study. JMIR Public Health Surveill 2021; 7:e32407. [PMID: 34874884 PMCID: PMC8691408 DOI: 10.2196/32407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Men who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied. OBJECTIVE We aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males. METHODS We included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status. RESULTS The median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7% (95% CI 38.8%-56.7%; 61/128), a specificity of 85.9% (95% CI 75.0%-93.4%; 55/64), a positive predictive value of 87.1% (95% CI 77.0%-93.9%; 61/70), and a negative predictive value of 45.1% (95% CI 36.1%-54.3%; 55/122). CONCLUSIONS Self-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes.
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Affiliation(s)
- Eric Pf Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia
| | - Alyssa M Cornall
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Buller DB, Pagoto S, Henry K, Berteletti J, Walkosz BJ, Bibeau J, Baker K, Hillhouse J, Arroyo KM. Human Papillomavirus Vaccination and Social Media: Results in a Trial With Mothers of Daughters Aged 14-17. Front Digit Health 2021; 3:683034. [PMID: 34713152 PMCID: PMC8521953 DOI: 10.3389/fdgth.2021.683034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake. Secondary analysis in a randomized trial of a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination was undertaken with the aims of (a) determining whether the pre–post-change occurred in self-reports of the mothers on HPV vaccination of their adolescent daughters; (b) describing the comments and reactions to vaccine posts; (c) exploring the relationship of campaign engagement of the mothers assessed by their comments and reactions to posts to change in the self-reports of the mothers of HPV vaccination. Materials and Methods: Mothers of daughters aged 14–17 were recruited from 34 states of the US (n = 869). A social media campaign was delivered in two Facebook private groups that differed in that 16% of posts in one were focused on indoor tanning (IT) and 16% in the other, on prescription drug misuse, assigned by randomization. In both groups, posts promoted HPV vaccination (n = 38 posts; no randomization) and vaccination for other disease (e.g., influenza, n = 49). HPV and other vaccination posts covered the need for a vaccine, the number of adolescents vaccinated, how vaccines are decreasing the infection rates, and stories of positive benefits of being vaccinated or harms from not vaccinating. Guided by social cognitive theory and diffusion of innovations theory, posts were intended to increase knowledge, perceived risk, response efficacy (i.e., a relative advantage over not vaccinated daughters), and norms for vaccination. Some vaccination posts linked to stories to capitalize on identification effects in narratives, as explained in transportation theory. All mothers received the posts on vaccination (i.e., there was no randomization). Mothers completed surveys at baseline and 12- and 18-month follow-up to assess HPV vaccine uptake by self-report measures. Reactions (such as sad, angry) and comments to each HPV-related post were counted and coded. Results: Initiation of HPV vaccination (1 dose) was reported by 63.4% of mothers at baseline, 71.3% at 12-month posttest (pre/post p < 0.001), and 73.3% at 18-month posttest (pre/post p < 0.001). Completion of HPV vaccination (two or three doses) was conveyed by 50.2% of mothers at baseline, 62.5% at 12-month posttest (pre/post p < 0.001), and 65.9% at 18-month posttest (pre/post p < 0.001). For posts on HPV vaccines, 8.1% of mothers reacted (n = 162 total), and 68.4% of posts received a reaction (63.2% like; 13.2% love, 7.9% sad). In addition, 7.6% of mothers commented (n = 122; 51 unfavorable, 68 favorable, 1 neutral), and 50.0% of these posts received a comment. There were no differences in pre–post change in vaccine status by the count of reactions or comments to HPV vaccine posts (Ps > 0.05). Baseline vaccination was associated with the valence of comments to HPV vaccine posts (7.2% of mothers whose daughters had completed the HPV series at baseline made a favorable comment but 7.6% of mothers whose daughters were unvaccinated made an unfavorable comment). Conclusion: Effective strategies are needed in social media to promote HPV vaccines and counter misinformation about and resistance to them. Mothers whose daughters complete the HPV vaccine course might be recruited as influencers on HPV vaccines, as they may be predisposed to talk favorably about the vaccine. Comments from mothers who have not been vaccinated should be monitored to ensure that they do not spread vaccine-critical misinformation. Study limitations included lack of randomization and control group, relatively small number of messages on HPV vaccines, long measurement intervals, inability to measure views of vaccination posts, reduced generalizability related to ethnicity and social media use, and use of self-reported vaccine status. Clinical Trial Registration:www.clinicaltrials.gov, identifier NCT02835807.
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Affiliation(s)
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Kimberly Henry
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | | | | | - Jessica Bibeau
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Katie Baker
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, United States
| | - Joel Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, United States
| | - Kelsey M Arroyo
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
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A validated modification of the vaccine hesitancy scale for childhood, influenza and HPV vaccines. Vaccine 2021; 39:1831-1839. [PMID: 33676784 DOI: 10.1016/j.vaccine.2021.02.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Vaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood vaccines; some psychometric properties were suboptimal. METHODS We collected data using large, nationally-representative samples of parents in the U.S. We adapted the VHS items, and additional hesitancy items, to assess hesitancy towards influenza and HPV vaccines in addition to routine childhood vaccines. We then used exploratory and confirmatory factor analysis to identify latent constructs and create modified scales for childhood (VHS-child), influenza (VHS-flu) and HPV (VHS-HPV) vaccines with improved psychometric properties. Finally, we compared hesitancy scores on the VHS-child, VHS-flu, and VHS-HPV, to self-reported receipt of each vaccine category, and compared subscale scores to assess whether drivers of hesitancy differed by vaccine category. RESULTS 2052 parents of children <18 years old completed the VHS-child and VHS-flu while 2020 parents of adolescents completed the VHS-HPV. A two-factor structure of 'risks' and a 'lack of confidence' was found for each vaccine category. Slight modifications to the VHS improved psychometric properties. Hesitancy was strongly associated with vaccine receipt: e.g., 76% of parents not hesitant towards influenza vaccine had vaccinated their child the past season, versus 9% of hesitant parents (p < 0.0001). Subscale scores also differed significantly between vaccines: lack of confidence was greater towards influenza (Median (IQR): 2.0 (1.2, 3.3)) and HPV (2.0 (1.3, 3.0)) vaccines than childhood (1.2 (1.0, 1.8), p < 0.0001 for both) vaccines; perceived risks of HPV vaccines (2.7 (1.7, 3.7)) were greater than for childhood vaccines (2.0 (1.3, 3.0), p < 0.0001). CONCLUSIONS Our modified VHS scales perform well psychometrically and allow for consistent measurement of the extent and reasons for hesitancy between vaccine categories. We suggest that future work use these scales to examine hesitancy towards other vaccines and to monitor hesitancy over time.
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Szilagyi PG, Albertin CS, Gurfinkel D, Saville AW, Vangala S, Rice JD, Helmkamp L, Zimet GD, Valderrama R, Breck A, Rand CM, Humiston SG, Kempe A. Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine 2020; 38:6027-6037. [PMID: 32758380 PMCID: PMC9495911 DOI: 10.1016/j.vaccine.2020.06.074] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND While many clinicians encounter parents or adolescents who refuse HPV vaccine, little is known about the prevalence of hesitancy for HPV vaccine nationally or its association with vaccination. METHODS In April 2019, we surveyed families with adolescents 11-17 years using a national online panel (Knowledge Panel®) as the sampling frame. We assessed the prevalence of HPV vaccine hesitancy with the validated 9-item Vaccine Hesitancy Scale (VHS). We used multivariate analyses to assess demographic factors associated with HPV vaccine hesitancy. We also assessed practical barriers to receipt of HPV vaccine and the relationship between barriers and hesitancy. Finally, we evaluated the association between both HPV vaccine hesitancy and practical barriers on HPV vaccine receipt or refusal. RESULTS 2,177 parents out of 4,185 sampled (52%) completed the survey, 2,020 qualified (lived with adolescent). Using a VHS cut-off score > 3 out of 5 points, 23% of US parents were hesitant about HPV vaccine. Hesitancy was lower among those with Hispanic ethnicity. At least one out of five parents disagreed that the HPV vaccine is beneficial for their adolescent, that the vaccine is effective, protects against HPV-related cancers, or that they followed their adolescent's health-care provider's recommendation about the vaccine. Many were concerned about vaccine side effects and the novelty of the vaccine. Adolescents living with vaccine-hesitant parents were less than one-third as likely to have received the vaccine (RR = 0.29, 95% CI 0.24, 0.35) or completed the vaccine series (RR = 0.29, 95% CI 0.23, 0.36), and were 6-fold more likely to have refused the vaccine because of parental vaccine-related concerns (RR = 6.09, 95% CI = 5.26, 7.04). Most practical barriers were independently associated with vaccine receipt but not with vaccine refusal. CONCLUSIONS HPV vaccine hesitancy is common nationally and strongly related to both under-vaccination and vaccine refusal.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Christina S Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Sitaram Vangala
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - John D Rice
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Cynthia M Rand
- Department of Pediatrics, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| | | | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
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Oliveira CR, Avni-Singer L, Badaro G, Sullivan EL, Sheth SS, Shapiro ED, Niccolai LM. Feasibility and Accuracy of a Computer-Assisted Self-Interviewing Instrument to Ascertain Prior Immunization With Human Papillomavirus Vaccine by Self-Report: Cross-Sectional Analysis. JMIR Med Inform 2020; 8:e16487. [PMID: 32012073 PMCID: PMC7003116 DOI: 10.2196/16487] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background Ascertaining history of prior immunization with human papillomavirus (HPV) vaccine can be challenging and resource-intensive. Computer-assisted self-interviewing instruments have the potential to address some of the challenges of self-reporting, and may also reduce the time, costs, and efforts associated with ascertaining immunization status. Objective This study assesses both the feasibility and the accuracy of a computer-assisted self-interviewing instrument to ascertain a patient’s history of immunization with the HPV vaccine. Methods We developed both a survey and a Web-based data collection system using computer-assisted self-interviewing to ascertain self-reported HPV vaccine immunization history. We implemented the instrument in a sample of adult women enrolled in an ongoing study of the HPV vaccine. Vaccine records from prior sources of care were reviewed to verify reported immunization history. Results Among the 312 participants who provided HPV vaccine immunization history by self-report, almost all (99%) were able to do so using the computer-assisted self-interviewing instrument. The median survey completion time was 10 minutes (IQR 7-17). The accuracy of self-report was 84%, sensitivity was 89%, specificity was 80%, and the negative predictive value was 92%. Conclusions We found that it is feasible to collect a history of immunization with the HPV vaccine using a computer-assisted self-interviewing instrument. This approach is likely to be acceptable to adult women and is reasonably accurate in a clinical research setting.
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Affiliation(s)
- Carlos R Oliveira
- Section of Infectious Diseases and Global Health, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Lital Avni-Singer
- Section of Infectious Diseases and Global Health, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Geovanna Badaro
- Section of Infectious Diseases and Global Health, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Erin L Sullivan
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, United States
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Eugene D Shapiro
- Section of Infectious Diseases and Global Health, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Linda M Niccolai
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, United States
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Spencer JC, Calo WA, Brewer NT. Disparities and reverse disparities in HPV vaccination: A systematic review and meta-analysis. Prev Med 2019; 123:197-203. [PMID: 30930259 PMCID: PMC6724708 DOI: 10.1016/j.ypmed.2019.03.037] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 01/20/2023]
Abstract
Studies disagree about whether racial and ethnic groups have lower or higher human papillomavirus (HPV) vaccination uptake, an important issue given large disparities in some HPV cancers. We sought to characterize and explain racial and ethnic differences in HPV vaccination. We systematically searched PubMed, CINAHL, Embase, and Web of Science to identify US studies through mid-2017 reporting associations of race and ethnicity with HPV vaccination. We identified 118 studies (n = 3,095,486) published in English that reported HPV vaccine initiation or follow-through in the US from which we could calculate effect sizes. We used random effects meta-analysis to synthesize effect sizes for comparisons of Whites or non-Hispanics to Blacks, Hispanics, Asians, or all minority groups combined. Studies showed no racial or ethnic differences in HPV vaccine initiation overall. However, when restricting to studies using provider-verified vaccination data, minorities were 6.1% [3.3%-8.8%] more likely than Whites to initiate HPV vaccination. Advantages were larger for Hispanics, males, and younger samples (age < 18). In contrast, minorities were 8.6% [5.6%, 11.7%], less likely than Whites to follow-through with the full HPV vaccine series, a disparity present across all participant and study characteristics. More recent studies found larger advantages for racial and ethnic minorities in HPV vaccine initiation and smaller disparities in follow-through. In summary, high-quality studies found racial and ethnic minorities are more likely to initiate but less likely to follow-through with HPV vaccination, a clear finding that self-report studies obscure. Higher HPV vaccine initiation among minorities suggests potential reductions in HPV cancer disparities.
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Affiliation(s)
- Jennifer C Spencer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America.
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America
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10
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Rodriguez SA, Savas LS, Loomba P, Vernon SW, Fernandez ME. Low-income Hispanic parent recall of daughters' HPV vaccination status: Correlates of accurate reporting of daughters' HPV-vaccine naïve status compared with electronic health records. Vaccine 2019; 37:2998-3001. [PMID: 31036458 PMCID: PMC6719552 DOI: 10.1016/j.vaccine.2019.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/12/2019] [Accepted: 04/22/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to (1) assess the accuracy of parental recall of adolescent (11-17 years) daughters' HPV vaccine initiation in a low-income, urban Hispanic population, and (2) describe the correlates of accurate recall. METHODS We compared parental recall of HPV vaccine naivety to daughter's electronic medical records to calculate the proportion of parents accurately reporting HPV naïve status. We used mixed effects logistic regression to identify correlates of accurate recall. RESULTS We verified vaccination status for 1103 daughters of participants who reported their daughters were HPV vaccine-naïve; 69.3% of parents accurately reported their daughters as HPV vaccine-naïve. Parents of older daughters (13-17 years) compared to younger daughters (11-12 years) had significantly lower odds of accurately reporting daughters as unvaccinated (AOR = 0.60; 95% CI 0.42-0.83). DISCUSSION Underreporting of vaccination status among our study population corresponds with national data that suggest lower income and minority populations underreport HPV vaccination initiation and completion.
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Affiliation(s)
- Serena A Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25(th) Floor, Houston, TX 77030, United States.
| | - Preena Loomba
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25(th) Floor, Houston, TX 77030, United States.
| | - Sally W Vernon
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25(th) Floor, Houston, TX 77030, United States.
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25(th) Floor, Houston, TX 77030, United States.
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Vu M, Luu M, Haardörfer R, Berg CJ, Escoffery C, Bednarczyk RA. A multilevel analysis of factors influencing the inaccuracy of parental reports of adolescent HPV vaccination status. Vaccine 2019; 37:869-876. [PMID: 30626532 DOI: 10.1016/j.vaccine.2018.12.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Parental reports are commonly used for adolescent HPV vaccination status but may be subjected to bias. Guided by the Socioecological Framework, our study explores potential multilevel factors influencing the inaccuracy of parental reports of adolescent HPV vaccination status. METHODS Data from parents of 19,683 adolescents with provider-verified data were analyzed using multilevel modeling. Correlates included adolescent characteristics, parent/household factors, number of providers seen, state-level median income, and state-level HPV vaccine policy. Outcomes included inaccuracy in reporting: vaccine initiation (≥1 dose), completion (3 doses), and number of doses. RESULTS 24% and 25% of parents reported initiation and completion inaccurately; 28% under-reported and 11% over-reported number of doses. All adolescent characteristics, parent/household factors, and number of healthcare providers seen were associated with the outcomes. Of note, compared to parents of White adolescents, parents of racial/ethnic minority adolescents were more likely to inaccurately report all outcomes (aOR ranges from 1.43 to 1.76 for initiation, 1.45-1.75 for completion, 1.98-2.05 for under-reporting, and 1.17-1.41 for over-reporting). Households with higher maternal education (aOR = 0.70, 0.92, 0.79, and 0.80) and income (aOR = 0.54, 0.62, 0.50, and 0.70) were less likely to inaccurately report initiation, report completion, under-report, and over-report, respectively. Those having seen more providers were less likely to inaccurately report initiation and completion but more likely to over-report number of vaccine doses. DISCUSSION Being parents of females, older adolescents, and racial/ethnic minority adolescents, having lower material education, and poverty status were associated with higher odds of inaccurately reporting HPV vaccination status. These results have implications for estimates drawn from self-reports. Future research can examine sources of inaccuracies (e.g., social desirability or health literacy); they could also explore solutions (e.g., access to vaccine records) that can help parents accurately report vaccination status. State policy does not appear to have an impact on report accuracy.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Minh Luu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Robert A Bednarczyk
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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12
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Schurink-van 't Klooster TM, Donken R, Schepp RM, van der Klis FRM, de Melker HE. Persistence of immune response following bivalent HPV vaccination: A follow-up study among girls routinely vaccinated with a two-dose schedule. Vaccine 2018; 36:7580-7587. [PMID: 30377068 DOI: 10.1016/j.vaccine.2018.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 09/06/2018] [Accepted: 10/04/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND In this cohort study, we examined antibody levels and avidity after a two-dose schedule (0, 6 months) of the bivalent HPV-vaccine in girls routinely vaccinated in the Dutch HPV-vaccination program, up to 2 years following vaccination. METHODS A blood sample at 7, 12 and 24 months after the first dose and questionnaire data were collected (n = 56). HPV type-specific antibody concentrations (lU/ml) against seven types (HPV16/18/31/33/45/52/58) were assessed using a validated virus-like particles (VLP) multiplex immunoassay. Avidity was tested using a modification of this assay. RESULTS Seropositivity for vaccine types HPV 16 and 18 was 100% up to month 24, but declined for HPV-types 31/33/45/52/58, although not statistically significant for HPV45. All Geometric Mean Concentrations (GMCs) declined by months 12 and 24, but remained high for HPV16/18. Between month 7 and 12, GMCs declined more for other types. High avidity antibodies were induced up to 24 months for vaccine types (75%, 76-78% and 81-82% at months 7, 12 and 24, respectively), but for other types antibody avidity was 16-29% at month 7, 20-32% at month 12 and 19-32% at month 24. CONCLUSIONS GMCs declined over time for HPV-types 16/18/31/33/45/52/58, but remained high for vaccine-types HPV16/18 up to 24 months of follow-up. Antibody avidity was >75% for vaccine types but <35% for other HPV-types. Further follow-up of this cohort will provide insight into antibody and avidity kinetics over time.
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Affiliation(s)
| | - Robine Donken
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.; Women's Health Research Institute, BC Women's Hospital + Health Centre, University of British Colombia, Vancouver, BC, Canada
| | - Rutger M Schepp
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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13
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Rodriguez SA, Savas LS, Baumler E, Nyitray AG, Mullen PD, Vernon SW, Fernandez ME. Parental predictors of HPV vaccine initiation among low-income Hispanic females aged 11-17 years. Vaccine 2018; 36:5084-5090. [PMID: 29980388 DOI: 10.1016/j.vaccine.2018.06.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Hispanic women experience a disproportionate burden of cervical cancer morbidity and mortality compared to non-Hispanic women. Increasing HPV vaccination among Hispanic adolescents can help alleviate disparities. This study aimed to identify parental psychosocial predictors associated with HPV vaccine initiation and correlates of parental intentions to obtain the vaccine for their Hispanic adolescent daughters aged 11-17 years. METHODS This study is part of a larger three-arm randomized controlled trial testing the effectiveness of interventions to increase HPV vaccination. Parents of adolescent females were recruited in community clinics where we conducted baseline surveys. We obtained electronic medical records six months after baseline to assess vaccination status. Multilevel logistic regression was used to identify correlates of parental intentions to vaccinate and predictors of HPV vaccine initiation. Analyses with initiation as the outcome also controlled for intervention study arm. The Integrated Behavioral Model guided selection of psychosocial and outcome variables. RESULTS Our sample (n = 765) consisted mostly of mothers with less than a high school education born outside of the U.S. Forty-one percent had a household income less than $15,000. Most daughters had public or private insurance. Twenty-one percent initiated the HPV vaccine series. Correlates of intention to vaccinate intention included subjective norms related to daughter's doctor (AOR = 1.04; 95% CI 1.01-1.07), belief that the vaccine is safe (AOR = 1.38; 95% CI 1.06-1.78), self-efficacy to obtain the vaccine for their daughter (AOR = 2.39; 95% CI 1.52-3.77), and parental concern about vaccine side effects (AOR = 0.73; 95% CI 0.60-0.89). Intentions predicted initiation (AOR = 2.01; 95% CI 1.10-5.26); concern about sexual disinhibition decreased the odds of having a vaccinated daughter at follow-up (AOR = 0.66; 95% CI 0.47-0.92). DISCUSSION Parental intention and concerns about sexual disinhibition predict vaccine initiation. Further research is needed to explore the role of intention as a potential mediator between psychosocial variables and vaccination status.
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Affiliation(s)
- Serena A Rodriguez
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25th Floor, Houston, TX 77030, United States; Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., E5.506S, Dallas, TX 75390, United States.
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25th Floor, Houston, TX 77030, United States.
| | - Elizabeth Baumler
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25th Floor, Houston, TX 77030, United States.
| | - Alan G Nyitray
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, United States.
| | - Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25th Floor, Houston, TX 77030, United States.
| | - Sally W Vernon
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25th Floor, Houston, TX 77030, United States.
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, The University of Health Science Center at Houston School of Public Health, 7000 Fannin, 25th Floor, Houston, TX 77030, United States.
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14
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Rafferty E, Hetherington E, Tough S, Aujla S, McNeil D, Saini V, McDonald S, MacDonald SE. The impact of time since vaccination and study design on validity in parental recall of childhood vaccination status in the All Our Families cohort. Vaccine 2018; 36:2953-2959. [PMID: 29699787 DOI: 10.1016/j.vaccine.2018.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Parental reporting of childhood vaccination status is often used for policy and program evaluation and research purposes. Many factors can bias parental reporting of childhood vaccination status, however, to our knowledge, no analysis has assessed whether time since vaccination impacts reporting accuracy. Therefore, using the Calgary electronic vaccine registry (PHANTIM) as the gold standard, we aimed to test the accuracy of parental reporting of childhood vaccination status at three different time-points since vaccination. METHODS The All Our Families (AOF) cohort study asked parents to report their child's 2, 4, 6, 12 and 18 month vaccines (vaccination time-point) on questionnaires given when the child was 1, 2 and 3 years of age (survey time-point). We linked the AOF parental reporting of vaccination status to the PHANTIM registry and calculated the percent agreement and difference in coverage estimates between PHANTIM and AOF at each vaccination and survey time-point combination. Furthermore, we measured the sensitivity and specificity, and negative (NPV) and positive predictive values (PPV) of parental vaccine recall across time. RESULTS AOF parent reports of coverage rates were consistently higher than the PHANTIM estimates. While we saw significant differences in percent agreement for certain vaccination time-points, we saw no consistent directional difference by survey time-point, suggesting that parental accuracy did not change with time. We found a uniformly high sensitivity across all vaccination and survey time-points, and no consistent patterns in the specificity, PPV and NPV results. CONCLUSION Time since vaccination may not be the most important consideration when designing and implementing a vaccination survey. Other factors that may contribute to the bias associated with parental reporting of vaccination status include the complexity of the vaccine schedule, schedule changes over time, and the wording and structure of the questionnaires.
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Affiliation(s)
- Ellen Rafferty
- University of Alberta, Faculty of Nursing, 5-308 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
| | - Erin Hetherington
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Suzanne Tough
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Shyrose Aujla
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Deborah McNeil
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Strategic Clinical Networks, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB T5J 3E4, Canada; University of Calgary, Faculty of Nursing, 2800 University Way N.W., Calgary, AB T2N 1N4, Canada
| | - Vineet Saini
- Population, Public and Indigenous Health, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB T5J 3E4, Canada
| | - Sheila McDonald
- Population, Public and Indigenous Health, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB T5J 3E4, Canada
| | - Shannon E MacDonald
- University of Alberta, Faculty of Nursing, 5-308 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada; University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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15
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Donahue K, Hendrix K, Sturm L, Zimet G. Provider Communication and Mothers' Willingness to Vaccinate Against Human Papillomavirus and Influenza: A Randomized Health Messaging Trial. Acad Pediatr 2018; 18:145-153. [PMID: 28754504 PMCID: PMC5785569 DOI: 10.1016/j.acap.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To understand the effect of a health messaging intervention focused on provider communication about vaccination on mothers' willingness to vaccinate children against human papillomavirus (HPV) and seasonal influenza. METHODS A total of 2476 mothers of 9- to 13-year-olds in the United States completed a Web-based survey in August 2014. Mothers were randomized to 1 of 2 groups targeting HPV or influenza vaccine. Mothers whose child had not received the target vaccine (ie, zero doses of HPV vaccine/no prior-year administration of influenza vaccine) were randomized to the intervention. The study used a 3 × 2 between-subjects design; illustrated vignettes depicted 1 of 3 levels of provider recommendation strength (brief mention of vaccination, strong recommendation of vaccination, or personal disclosure of vaccination of own children), and presence or absence of information comparing safety of vaccination to the safety of a common daily activity. Outcome was mothers' willingness to have their child receive the target vaccine. Perceived benefits of vaccination were assessed before viewing the intervention and were included as a covariate in analyses, along with child gender. RESULTS For HPV vaccine, there was a main effect of safety information (F(1,684) = 7.99, P = .005) and perceived benefits of vaccination (F(1,684) = 221.64, P < .001) on mothers' willingness to vaccinate. For influenza, perceived benefits of vaccination significantly related to willingness to vaccinate (F(1,462) = 105.78, P < .001). Child gender was not associated with willingness. CONCLUSIONS Provider communication about vaccination may need to be tailored to the vaccine in question. A next step to increasing coverage for both HPV and influenza vaccines may be an intervention aimed at increasing mothers' perceived benefits of vaccination.
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Affiliation(s)
- Kelly Donahue
- Department of Pediatrics, Sections of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Ind.
| | - Kristin Hendrix
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Ind
| | - Lynne Sturm
- Department of Pediatrics, Child Development, Indiana University School of Medicine, Indianapolis, Ind
| | - Gregory Zimet
- Department of Pediatrics, Sections of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Ind
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16
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Williamson G, Ahmed B, Kumar PS, Ostrov BE, Ericson JE. Vaccine-Preventable Diseases Requiring Hospitalization. Pediatrics 2017; 140:peds.2017-0298. [PMID: 28768853 DOI: 10.1542/peds.2017-0298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Plain children often have lower immunization rates than non-Plain children. Penn State Health Children's Hospital is a tertiary medical center with large nearby Plain (Amish and Mennonite) communities. We sought to describe the characteristics of children hospitalized with vaccine-preventable diseases (VPDs). We hypothesized that Amish children would have a higher risk of VPDs than non-Amish children. METHODS International Classification of Diseases, Ninth Revision codes were used to identify patients <18 years diagnosed with a VPD from January 1, 2005, to December 31, 2015, at Penn State Children's Hospital. Demographic information, immunization status, and outcomes were obtained from medical records. By using the number of children in our primary service area, we calculated the risk of VPD requiring hospitalization for Amish and non-Amish children. We assessed the relationship between Plain affiliation and vaccination status by using the Pearson correlation coefficient. RESULTS There were 215 children with 221 VPDs. Most occurred in non-Plain children: 179 of 221 (81%). Except for pneumococcal infections, VPD occurred mostly in unvaccinated or immunocompromised children, regardless of Plain affiliation. There were 15 Haemophilus influenzae type b and 5 tetanus infections that occurred in children with an unvaccinated or unknown vaccination status. The risk of a VPD requiring hospitalization was greater for Amish than for non-Plain children (risk ratio: 2.67 [95% confidence interval: 1.87-3.82]). There was a strong correlation between Plain affiliation and lack of vaccination (r = -0.63, P < .01). CONCLUSIONS Amish children had an increased risk of a VPD requiring hospitalization than non-Plain children. With the exception of those with pneumococcal disease, most vaccinated children hospitalized with a VPD were immunocompromised.
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Affiliation(s)
- Gregory Williamson
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania; and
| | - Bilaal Ahmed
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania; and
| | - Parvathi S Kumar
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Barbara E Ostrov
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Jessica E Ericson
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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17
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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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18
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Concordance between Women's Self-Reported Reasons for Cesarean Delivery and Hospital Discharge Records. Womens Health Issues 2017; 27:329-335. [PMID: 28100403 DOI: 10.1016/j.whi.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/09/2016] [Accepted: 12/16/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women's self-reports of whether they had a cesarean delivery are nearly 100% accurate, but there is little extant research on how accurately women self-report reasons for cesarean delivery when asked to recall this information in the postpartum period. OBJECTIVE We compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources. METHODS Data are from the First Baby Study, a cohort of 3,006 women who gave birth to their first baby between 2009 and 2011. Survey data were linked to hospital discharge records. Among women who delivered by cesarean (n = 846), we assessed the probability that women's self-reported reasons for cesarean delivery were confirmed by hospital discharge records (positive predictive value [PPV]), and whether agreement differed by reason for cesarean or by women's characteristics. RESULTS Overall, 91% of women reported a reason for their cesarean that was present in the discharge data. PPV varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1%), and lower PPV for malposition (81.7%). In multivariable models, women with more education and higher family income had higher odds of concordance. CONCLUSIONS Despite some variation in the probability that women's self-reported reason for cesarean is supported by the hospital discharge record, more than 90% of women reported a reason that was found in their discharge record. Accurate recall of reasons for prior cesarean may help women and clinicians to manage future pregnancies.
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19
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Morales-Campos DY, Parra-Medina D. Predictors of Human Papillomavirus Vaccine Initiation and Completion Among Latino Mothers of 11- to 17-Year-Old Daughters Living Along the Texas-Mexico Border. FAMILY & COMMUNITY HEALTH 2017; 40:139-149. [PMID: 28207677 PMCID: PMC5402888 DOI: 10.1097/fch.0000000000000144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Few Texas Latino girls initiate and complete the human papillomavirus (HPV) vaccine series, but few studies have examined predictors of initiation and completion in this group. Mothers are crucial to vaccine uptake. Using self-reported data from mothers of unvaccinated girls (n = 317), we examined the association between predictors (HPV and HPV vaccine knowledge, vaccine self-efficacy) and outcomes (initiation and completion). Despite an increase in HPV and HPV vaccine knowledge from baseline to follow-up (n = 195), we found no association between the predictors and the outcomes. Findings showed that health insurance status and study group participation (Entre Madre e Hija program or brochure only) were associated with initiation and completion.
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20
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Berenson AB, Laz TH, Rahman M. Reduction in Vaccine-Type Human Papillomavirus Prevalence Among Women in the United States, 2009-2012. J Infect Dis 2016; 214:1961-1964. [PMID: 27821406 DOI: 10.1093/infdis/jiw515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/24/2016] [Indexed: 11/14/2022] Open
Abstract
Between 2009 and 2012, the proportion of young women in the United States completing the human papillomavirus (HPV) vaccine doubled. To understand how quickly this increased uptake is affecting women in the United States, we evaluated the prevalence of vaccine-type (VT) HPV strains among young women in national data sets from 2009-2010 and 2011-2012. Among 18-26-year-old women, the prevalence of VT HPV decreased markedly over a short interval, from 15.4% in 2009-2010 to 8.5% in 2011-2012 (prevalence ratio, 0.51; 95% confidence interval, .28-.92), and the prevalence of high-risk VT HPV decreased from 13.1% to 6.5% (0.46; .25-.86). Reductions in HPV-related diseases will probably follow.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health.,Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston
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21
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Petrosky EY, Hariri S, Markowitz LE, Panicker G, Unger ER, Dunne EF. Is vaccine type seropositivity a marker for human papillomavirus vaccination? National Health and Nutrition Examination Survey, 2003-2010. Int J Infect Dis 2015; 33:137-41. [PMID: 25596377 PMCID: PMC4659353 DOI: 10.1016/j.ijid.2015.01.010] [Citation(s) in RCA: 6] [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: 11/12/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Since 2006, human papillomavirus (HPV) vaccination has been routinely recommended for adolescent females in the USA. The quadrivalent vaccine induces long-term seropositivity to HPV 6/11/16, which may be useful as a marker for HPV vaccine coverage. METHODS We evaluated vaccine type seropositivity (i.e., seropositivity to HPV 6/11/16 with or without HPV18) among females aged 14-59 years participating in the 2003-2010 National Health and Nutrition Examination Survey (cross-sectional, nationally representative surveys). We compared pre-vaccine era (2003-2006) to vaccine era (2007-2010) seropositivity and assessed agreement between vaccine era seropositivity and reported vaccination by kappa statistic. RESULTS Seropositivity was 1.0% among 2151 females in the pre-vaccine era and 22.1% among 1420 females in the vaccine era (p < 0.001); 23.1% of vaccine era females reported receipt of one or more HPV vaccine dose. Seropositivity and reported vaccination had high agreement (kappa = 0.79; 95% confidence interval 0.74-0.84). Among seropositive females, 14.5% reported no vaccination. CONCLUSION The increase in vaccine era seropositivity likely reflects vaccination uptake. Our study suggests seropositivity to HPV 6/11/16 may be a useful marker for vaccination coverage in adolescent and young adult females. Discordance between seropositivity and reported vaccination may be explained by inaccurate reporting and/or natural exposure to HPV.
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Affiliation(s)
- Emiko Y Petrosky
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
| | - Susan Hariri
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Lauri E Markowitz
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eileen F Dunne
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
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Donahue KL, Hendrix KS, Sturm LA, Zimet GD. Human papillomavirus vaccine initiation among 9–13-year-olds in the United States. Prev Med Rep 2015; 2:892-898. [PMID: 26594616 PMCID: PMC4652326 DOI: 10.1016/j.pmedr.2015.10.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9–26-year-old males and females, with routine vaccination recommended for 11–12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13–17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9–13-year-olds in the United States. A national sample of mothers of 9–13-year-olds in the United States (N = 2446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child's HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child's initiation of the HPV vaccine (i.e., receipt of one or more doses). Approximately 35% of the full sample and 27.5% of the 9–10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers' communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage. Approximately 35% of 9–13-year-olds had initiated the HPV vaccine series. A quarter of 9–10-year-olds had initiated the HPV vaccine series. At age 13, females were more likely than males to have initiated HPV vaccination. No gender difference in HPV vaccine initiation was found prior to age 13. Provider recommendation was a particularly salient predictor of HPV vaccination
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Staras SAS, Vadaparampil ST, Patel RP, Shenkman EA. Parent perceptions important for HPV vaccine initiation among low income adolescent girls. Vaccine 2014; 32:6163-9. [PMID: 25180815 DOI: 10.1016/j.vaccine.2014.08.054] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The study aims were to assess the influence of provider recommendations on parental vaccine perceptions and identify the most potent parent vaccine perceptions for HPV vaccine series initiation considering provider recommendation strength. METHODS We administered a questionnaire and assessed HPV vaccine claims among a stratified-random sample of parents of 9-17 year old girls enrolled in Florida's Medicaid and the Children's Health Insurance Program. Using multivariate analyses, we evaluated the associations between: (1) parent vaccine perceptions and provider recommendation strength, and (2) parent vaccine perceptions and HPV vaccine series initiation (≥1 vaccine claim or positive parental report) controlling for provider recommendation strength. RESULTS The majority of the 2422 participating parents agreed that the HPV vaccine was safe (61%), would not make girls more likely to have sex (69%), and prevented cervical cancer (71%). About half (44%) reported receiving a strong provider recommendation. Compared to parents without recommendations, parents with strong recommendations had 2 to 7 times higher odds of agreeing that: vaccines are safe, the HPV vaccine is safe, not concerned about side effects, and the vaccine prevents cervical cancer. Even when considering provider recommendation strength, HPV vaccine series initiation was more likely among girls of parents who agreed rather than disagreed that the HPV vaccine was safe [odds ratio (OR)=5.8, 95% confidence interval (CI)=3.1, 11.1], does not cause sex (OR=2.0, 95% CI=1.2, 3.4), prevents cervical cancer (OR=2.0, 95% CI=1.0, 3.4), and prevents HPV infections (OR=1.8, 95% CI=1.0, 3.0). CONCLUSIONS Parent concerns about HPV vaccine are similar to their concerns about other vaccines. Providers should focus HPV vaccine discussions with parents on vaccine safety and illness prevention.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Policy, College of Medicine, and The Institute for Child Health Policy, University of Florida, Gainesville, FL, United States.
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, United States; Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States; Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, FL, United States
| | - Roshni P Patel
- Department of Health Outcomes and Policy, College of Medicine, and The Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Policy, College of Medicine, and The Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
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