Health Care Provider Recommendation, Human Papillomavirus Vaccination, and Race/Ethnicity in the US National Immunization Survey.
ABSTRACT Objectives. Human papillomavirus (HPV) is a common sexually transmitted infection in the United States, yet HPV vaccination rates remain relatively low. We examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and the association between recommendation and vaccination. Methods. We used the 2009 National Immunization Survey-Teen, a nationally representative cross-section of female adolescents aged 13 to 17 years, to assess provider-verified HPV vaccination (≥ 1 dose) and participant-reported health care provider recommendation for the HPV vaccine. Results. More than half (56.9%) of female adolescents received a recommendation for the HPV vaccine, and adolescents with a recommendation were almost 5 times as likely to receive a vaccine (odds ratio = 4.81; 95% confidence interval = 4.01, 5.77) as those without a recommendation. Racial/ethnic minorities were less likely to receive a recommendation, but the association between recommendation and vaccination appeared strong for all racial/ethnic groups. Conclusions. Provider recommendations were strongly associated with HPV vaccination. Racial/ethnic minorities and non-Hispanic Whites were equally likely to obtain an HPV vaccine after receiving a recommendation. Vaccine education efforts should target health care providers to increase recommendations, particularly among racial/ethnic minority populations. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e6. doi:10.2105/AJPH.2011.300600).
SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: The human papillomavirus (HPV) vaccine is safe and efficacious in patients with systemic inflammatory diseases (SID) who have higher rates of persistent HPV infection. We compared HPV vaccine uptake among SID and non-SID patients. Using a U.S. insurance claims database (2006-2012), we identified individuals 9-26 years with ≥2 SID diagnosis codes ≥7 days apart with ≥12 months of continuous enrollment prior to the second code (index date). We matched SID patients by age, sex and index date to randomly selected non-SID subjects and selected those with ≥24 months of post-index date continuous follow-up. We also identified a non-SID subcohort with ≥1 diagnosis code for asthma. We defined initiation as ≥1 HPV vaccination claim after 2007, and completion as 3 claims. We used multivariable logistic regression to assess uptake in females 11-26 years comparing SID, non-SID and asthma cohorts, adjusting for demographics, region, comorbidities, and healthcare utilization. We identified 5,642 patients 9-26 years with SID and 20,643 without. The mean age was 18.1 years (SD 4.9). We identified 1,083 patients with asthma; the mean age was 17.2 (SD 5.1). Among females, 20.6% with SID, 23.1% without SID and 22.9% with asthma, received ≥1 HPV vaccine. In our adjusted models, the odds of receipt of ≥1 vaccine was 0.87 times lower in SID (95% CI 0.77-0.98) compared to non-SID and did not differ for 3 vaccines (OR 1.03, 95% CI 0.83-1.26). The odds of initiation and completion were not statistically different between SID and non-SID asthma cohorts. In this nationwide cohort, HPV vaccine uptake was extremely low. Despite the heightened risk of persistent HPV infection among those with SID, no increase in HPV vaccine uptake was observed. Public health efforts to promote HPV vaccination overall are needed, and may be particularly beneficial for those at higher risk.PLoS ONE 02/2015; 10(2):e0117620. DOI:10.1371/journal.pone.0117620 · 3.53 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Objective The aim of this study is to determine the association between racial/ethnic status and uptake and completion of the HPV vaccine series in college women. Methods Participants were recruited from a large university in North Central Florida. Young women between 18 and 26 years of age who were currently enrolled in a college course comprised the study sample. Participants completed an anonymous online survey that assessed sociodemographic characteristics, sexual behaviors, gynecological healthcare utilization, and perception of risk to HPV-associated diseases. Multivariable analysis was conducted to determine the relationship between racial/ethnic status and HPV vaccination status. Results Of the 835 with complete data (51.0 % white, 16.5 % black, 13.8 % Hispanic, 8.3 % Asian, and 9.9 % other), 53 % had initiated (receipt of at least one dose) the three-dose HPV vaccine series. Of those who initiated, 70 % indicated that they had completed all three doses. In adjusted analysis, blacks were significantly less likely to report initiation [adjusted prevalence ratio (aPR) = 0.78; 95 % confidence interval (CI), 0.63, 0.97] and completion (aPR = 0.64; 95 % CI: 0.48, 0.84) of the three dose HPV vaccine as compared to whites. Although completion rates were lower in all other racial/ethnic groups as compared to whites, these rates did not reach statistical significance. Conclusions These findings are consistent with research from other types of settings and demonstrate lower initiation and completion rates of HPV vaccine among black women attending college as compared to their white counterparts. Additional research is needed to understand why black college women have low initiation and completion rates.12/2014; DOI:10.1007/s40615-014-0074-7
[Show abstract] [Hide abstract]
ABSTRACT: We evaluated the feasibility of a multilevel intervention to increase the human papillomavirus (HPV) vaccine initiation among adolescents. We used a four-arm factorial, quasi-experimental trial to assess feasibility and short-term, preliminary effectiveness of a health system-level, gender-specific postcard campaign and an in-clinic health information technology (HIT) system. Between August and November 2013, we tested the intervention among 11- to 17-year-olds without prior HPV vaccine claims in the Florida Medicaid or Children's Health Insurance Program encounters (2,773 girls and 3,350 boys) who attended or were assigned to primary care clinics in North Central Florida. At least one postcard was deliverable to 95% of the parents. Most parents (91% boys' and 80% girls') who participated in the process evaluation survey (n = 162) reported seeking additional information about the vaccine after receiving the postcard. Only 8% (57 of 1,062) of the adolescents assigned to a HIT provider with an office visit during the study used the HIT system. When compared with arms not containing that component, HPV vaccine initiation increased with the postcard campaign (girls, odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1-2.3 and boys, not significant), the HIT system (girls, OR = 1.5; 95% CI = 1.0-2.3 and boys, OR = 1.4; 95% CI = 1.0-2.0), and the combined HIT and postcard intervention (girls, OR = 2.4; 95% CI = 1.4-4.3 and boys, OR = 1.6; 95% CI = 1.0-2.5). A system-level postcard campaign was feasible. Despite low recruitment to the in-clinic HIT system, the intervention demonstrated short-term, preliminary effectiveness similar to prior HPV vaccine interventions. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.Journal of Adolescent Health 05/2015; 56(5S):S40-S46. DOI:10.1016/j.jadohealth.2014.11.024 · 2.75 Impact Factor