Human Papillomavirus Vaccine Use Among Adolescent Girls and Young Adult Women: An Analysis of the 2007 California Health Interview Survey
ABSTRACT Administration of the human papillomavirus (HPV) vaccine is recommended for adolescent girls and young adult women. Little is known about the factors associated with vaccination. This study examined prevalence and correlates of HPV vaccine initiation (≥1 dose) among a statewide representative sample of adolescent and young adult females living in California.
HPV vaccination data on 3615 parents of adolescent girls aged 12-17 and 2068 young adult women aged 18-27 from the 2007 California Health Interview Survey (CHIS) were examined by sociodemographic, healthcare access, and health behavior factors using chi-square and multivariable logistic regression models.
Nineteen percent of adolescent girls and 11% of young adult women had initiated the HPV vaccine series. In both groups, lower educational attainment (parental/own) was associated with lack of vaccine initiation. For adolescents, vaccine initiation was also significantly lower among those whose parents had low incomes or no usual source of care. For young adults, initiation was lower among the older group and those who spent less time in the United States, had public insurance, had no recent provider visit, or had fewer sexual partners.
In a statewide representative sample, different correlates of early initiation of HPV vaccination emerged for Californian adolescent girls and young adult women. These different patterns may be due to differential access to programs that provide free or low-cost HPV vaccines. Because several of these factors are associated with disparities in use of Pap tests, disparities will persist or even worsen unless greater effort is placed on vaccinating populations at highest risk for cervical cancer.
SourceAvailable from: Louiza S Velentzis[Show abstract] [Hide abstract]
ABSTRACT: Australia commenced a publically-funded, National Human Papillomavirus (HPV) Vaccination Program in 2007 with a two year catch-up phase for females aged 12-26 years. To identify the factors associated with the uptake of the HPV vaccine (which has a recommended 3-dose schedule in Australia) by young adult women vaccinated by general practitioners and community-based programs within the catch-up phase. 1139 women who were eligible to receive the free HPV vaccine during the catch-up period were recruited in 2008-2009 (age 20-29 years at recruitment), in New South Wales, after having a normal (negative) cervical smear result recorded on the NSW Pap Test Register. Participants completed a self-administered questionnaire providing information on vaccination status, and sociodemographic and other factors. Overall, 880 (77%) women reported receiving ≥1 dose of the vaccine and 777 women (68%) reported receiving ≥2 doses. In multivariable analysis (adjusting for the period for which each woman was eligible for free HPV vaccination), uptake of ≥1 dose of the vaccine was significantly associated with being born in Australia (p<0.01), being single (p=0.02), being nulliparous (p<0.01), living in a higher socioeconomic status area (p-trend=0.03), living in more remote areas (p=0.03), drinking alcohol (p<0.01) and using hormonal contraceptives (p<0.01). Although vaccinated women were more likely to have fewer sexual partners than unvaccinated women (p-trend=0.02), they were also more likely to report a prior sexually transmitted infection (STI) (p=0.03). Similar factors were associated with receiving ≥2 doses. In this group, women living in higher socioeconomic status areas were more likely to be vaccinated against HPV in the catch-up phase of the national program. Although vaccinated women tended to have fewer sexual partners, they also reported prior STIs, which may be a marker of increased risk of prior exposure to HPV. The findings of this study reinforce the continuing need to prioritise equitable delivery of vaccination to various population subgroups. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.Vaccine 04/2015; 32. DOI:10.1016/j.vaccine.2015.01.024 · 3.49 Impact Factor
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ABSTRACT: Among caregivers of adolescent girls, awareness of human papillomavirus (HPV) is strongly associated with vaccine uptake. Little is known, however, about the predictors of HPV awareness among low-income ethnic minority groups in the U.S. The purpose of this study is to understand demographic factors associated with HPV awareness among low-income, ethnic minority mothers in Los Angeles County. We conducted a cross-sectional study of caregivers of adolescent girls through the Los Angeles County Department of Public Health Office of Women's Health's hotline. The majority of the participants were foreign-born (88%), one quarter lacked a usual source of care, and one quarter lacked public or private health insurance for their daughter. We found that one in three participants had never heard of HPV or the vaccine. Mothers that were unaware of HPV were significantly more likely to conduct the interview in a language other than English and to lack health insurance for their daughters. HPV vaccine awareness was much lower in our caregiver sample (61%) than in a simultaneous national survey of caregivers (85%). The associations between lack of awareness and use of a language other than English, as well as lack of health insurance for their daughter indicate the need for HPV vaccine outreach efforts tailored to ethnic minority communities in the U.S. Copyright © 2014. Published by Elsevier Ltd.Vaccine 11/2014; DOI:10.1016/j.vaccine.2014.11.032 · 3.49 Impact Factor
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ABSTRACT: Background: Inequalities in cervical cancer may be increased following mass vaccination against the human papillomavirus (HPV) if girls with low vaccine uptake also have low future participation in cervical cancer screening. We evaluated how vaccine uptake distribution affects inequalities in squamous cell carcinoma (SCC) incidence between groups with different screening participation. Methods: We used an individual-based transmission dynamic model of HPV infection and disease (HPV-ADVISE). Females were stratified by routine screening frequency. We modeled the impact of vaccination on SCC incidence rate differences (absolute inequality) and incidence rate ratios (relative inequality) between women who have routine screening intervals of <5 years (frequently screened), ≥5 years (under-screened), and who are never screened. We compared simulations with uniform vaccine uptake to scenarios with unequal vaccine uptake, where never and under-screened women have lower vaccine uptake than frequently screened women. Results: Absolute SCC inequalities between groups with different screening rates were predicted to decrease post-vaccination, even when women with the lowest screening participation had the lowest vaccine uptake. Herd effects helped reduce absolute inequalities when vaccine uptake was unequal. Conversely, relative SCC remained unchanged or increased post-vaccination. Results were robust to different overall vaccination coverages and sexual mixing scenarios. Conclusion: Though mass HPV vaccination is predicted to substantially decrease SCC incidence rates, never screened women will still have the highest disease burden post-vaccination. Impact: To reduce both absolute and relative SCC inequalities, public health initiatives will need to address inequalities in both vaccine uptake and in cervical cancer screening participation. Copyright © 2014, American Association for Cancer Research.Cancer Epidemiology Biomarkers & Prevention 11/2014; 24(1). DOI:10.1158/1055-9965.EPI-14-1052 · 4.32 Impact Factor