Health Disparities in Human Papillomavirus Vaccine Coverage: Trends Analysis From the National Immunization Survey-Teen, 2008-2011

Rollins School of Public Health, Emory University, Atlanta GA.
Clinical Infectious Diseases (Impact Factor: 8.89). 10/2013; 58(2). DOI: 10.1093/cid/cit707
Source: PubMed


Adolescent uptake of human papillomavirus (HPV) vaccine remains low. We evaluated HPV vaccine uptake patterns over 2008–2011
by race/ethnicity, poverty status, and the combination of race/ethnicity and poverty status, utilizing National Immunization
Survey–Teen data. Minority and below-poverty adolescents consistently had higher series initiation than white and above-poverty

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Available from: Saad B Omer, Jan 13, 2016
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    • "This coupled with our observation that later meningococcal/Tdap initiation is strongly associated with later HPV vaccine initiation suggests that there are some females delaying initiation of multiple vaccines while others may just be delaying initiation of the HPV vaccine. This study also found that the age of HPV vaccine initiation is comparable across race/ethnicity, which mirrors the finding that HPV vaccine uptake is fairly similar by race/ethnicity[7], although uptake may be modestly higher among Hispanic females[7,9]. There were some differences between factors for HPV vaccine uptake and age of vaccine initiation. "
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    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.
    Full-text · Article · Dec 2016
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    • "A trend analysis of NIS-Teen data for 2008 through 2011 reported that minority and below-poverty adolescents had consistently higher HPV vaccine series initiation than white and above-poverty adolescents. In this analysis, all race/ethnicity groups had completion percentages ranging from 32% to 40% [6]. Overall, these current HPV vaccination rates are well below the Healthy People 2020 goal of an 80% coverage level of 3 doses of HPV vaccine by age 13–15 years [7]. "
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    ABSTRACT: Objective: Minority populations in the United States are disproportionally affected by human papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer. Study design: Cross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates. Results: Of 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine. Conclusions: Our study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers' failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed.
    Full-text · Article · May 2014 · Vaccine
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    ABSTRACT: Introduction: Human papillomavirus (HPV) infection remains one of the most commonly sexually transmitted infections in both females and males. HPV viruses are associated with several manifestations including genital warts, but more importantly for urology practitioners, cervical and penile carcinomas and recurrent genital condylomata in both sexes. The incidence of HPV-related carcinomas has increased in cervical, oropharyngeal, vulvar, penile, and anal cancers. Effective vaccines have been available for almost a decade, but widespread adoption of vaccine administration has been problematic for multiple reasons. Many countries (over 100) have adopted vaccine programs for females and an increasing number of countries are extending the indications to include males between the ages of 9-26. There still seems to be controversy surrounding these universal vaccination programs as well as some ethical and practical concerns regarding the administration of a vaccine for diseases that are associated with sexual contact in both sexes, especially during the early adolescent years. Objective: The objective was to provide a review of the available literature so pediatric and adult urologists may be more aware of the issues related to HPV vaccination in order to more effectively counsel patients and parents regarding the risks, benefits, and public health issues regarding HPV vaccination. This topic is especially relevant to pediatric urologists who see patients in the target age group for the HPV vaccine. There has been an explosion of literature regarding HPV vaccination programs and the relative difficulty in adopting the vaccine series with a completion rate of under 50% of patients in the recommended age ranges for vaccination. Methods: Articles were obtained from an extensive Medline literature search (1998-present) to evaluate the current HPV vaccination regimens for teenagers with special emphasis on the urologically focused disease burden. Results: The adoption of universal HPV vaccination has been difficult, but appears to be increasing over time as public education improves and governmentally- mandated vaccine programs increase. Despite the ethical concerns raised, the benefits of vaccination with regard to cancer prevention outweigh the risks and potential side effects related to the quadrivalent vaccine administration. Clearly, more follow-up over time is required to document these improvements in public health. Urologists need to remain aware of the prevention strategies for HPV infection and should help with counseling parents and patients in the appropriate age groups for HPV vaccination. Urology providers need to help engage and educate the parents and teenage patients to help promote broader adoption of the HPV vaccine regimen.
    No preview · Article · Jan 2014 · Translational Andrology and Urology
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