Article

Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination

Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, Missouri 63108, USA.
American journal of preventive medicine (Impact Factor: 4.53). 05/2010; 38(5):525-33. DOI: 10.1016/j.amepre.2010.01.018
Source: PubMed

ABSTRACT

A human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration for use among women/girls in 2006. Since that time, limited research has examined HPV vaccine uptake among adolescent girls and no studies have examined the role of geographic disparities in HPV vaccination.
The purpose of this study is to examine geographic disparity in the prevalence of human papillomavirus (HPV) vaccination and to examine individual-, county-, and state-level correlates of vaccination.
Three-level random intercept multilevel logistic regression models were fitted to data from girls aged 13-17 years living in six U.S. states using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) and the 2000 U.S. census.
Data from 1709 girls nested within 274 counties and six states were included. Girls were predominantly white (70.6%) and insured (74.5%). Overall, 34.4% of girls were vaccinated. Significant geographic disparity across states (variance=0.134, SE=0.065) and counties (variance=0.146, SE=0.063) was present, which was partially explained by state and county poverty levels. Independent of individual-level factors, poverty had differing effects at the state and county level: girls in states with higher levels of poverty were less likely whereas girls in counties with higher poverty levels were more likely to be vaccinated. Household income demonstrated a similar pattern to that of county-level poverty: Compared to girls in the highest-income families, girls in the lowest-income families were more likely to be vaccinated.
The results of this study suggest geographic disparity in HPV vaccination. Although higher state-level poverty is associated with a lower likelihood of vaccination, higher county-level poverty and lower income at the family level is associated with a higher likelihood of vaccination. Research is needed to better understand these disparities and to inform interventions to increase vaccination among all eligible girls.

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    • "The lack of significant differences between physicians' discussion of the HPV vaccine with young adults in the study period may also explain report in a previous study that knowledge of HPV and its association with cancer is low in the general population, and more individuals obtain their HPV information from media and internet sources than at a physician's office [32]. It is important to understand barriers to HPV vaccine discussion and recommendation by physicians in order to ensure that more physicians are discussing the vaccine with their patients, especially with racial minorities who are at a higher risk of developing most HPV infections [28] [29] [30] [31]. "
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    ABSTRACT: Background The human papillomavirus (HPV) vaccine was approved for preventing some oncogenic strains of the HPV in 2006. Predictors of HPV vaccine uptake include physicians’ conversations with patients and the patients’ race; particularly among racial minorities, African-Americans are less likely to complete required doses. Purpose To analyze whether there were differences in the percentage of participants who reported they ever had a discussion with a provider about the HPV vaccine in 2007 and 2013; and to analyze physicians’ discussions based on patients’ race. Methods Adults within the vaccination age of 18–26 years were identified from the Health Information National Trends Survey (HINTS) 2007 (n = 687) and 2013 (n = 496) databases. A logistic regression generated odds ratios between races for each of the two years and a z-test compared the two odds ratios on the natural log scale. Results There was only a 3% increase in conversations about the HPV vaccine between 2007 and 2013, but no significant differences based on race in 2007 (p = 0.16) or 2013 (p = 0.64). In 2007, physicians had more than 2.5 greater odds of having discussed the HPV vaccine with their African-American patients than Caucasian patients while being 1.24 times more likely to do so in 2013. These ratios were not significantly different from each other (z = 0.97; p = 0.17). Conclusions After almost a decade since the HPV vaccine was approved, there have been no significant changes in the amount of conversations physicians have with patients about the vaccine. It is important that physicians’ encounter with patients be seen as an opportunity to encourage HPV vaccine uptake, particularly among racial minorities.
    Full-text · Article · Jun 2015 · Journal of Cancer Policy
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    • "In contrast several studies reported that no significant correlation between parental income and vaccine initiation (Rosenthal et al., 2008; Caskey et al., 2009; Gerend et al., 2009; Allen et al., 2010; Pruitt and Schootman, 2010; Reiter et al., 2010; Yeganeh et al., 2010). Knowledge about HPV vaccine significantly influences the practice of HPV vaccine among secondary school girls. "

    Full-text · Dataset · Mar 2014
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    • "In contrast several studies reported that no significant correlation between parental income and vaccine initiation (Rosenthal et al., 2008; Caskey et al., 2009; Gerend et al., 2009; Allen et al., 2010; Pruitt and Schootman, 2010; Reiter et al., 2010; Yeganeh et al., 2010). Knowledge about HPV vaccine significantly influences the practice of HPV vaccine among secondary school girls. "
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    ABSTRACT: Objective: The objective of this study is to determine the practice and associated factors of HPV vaccine among school girls in Melaka, Malaysia. Methodology: A total number of 612 secondary school girls participated in this study. The questionnaire consists of 38 questions which included 3 sections. The first section is about socio- demography. The Second section is about knowledge and awareness of HPV vaccines. The third section is about practices with associated barriers of HPV vaccination. Verbal consent was obtained from all participants, and data were analyzed using SPSS 13. Results: A total number of 612 secondary school girl students participated in this study. The mean age was 13.93 ± SD (1.09); minimum age was 13 years old and maximum was 17 years old. The majority of them was Malay, from rural areas and had a family monthly income of RM 3000 or less (91.8%, 53.1%, 69.6%; respectively). The majority of the parents of the school girls were with secondary education level (56.4%). The majority of the participants did not have a family history of cervical cancer (99.0%). The prevalence of HPV vaccination was 77.9% among school girls in Melaka. The majority of the participants were vaccinated in their schools (77.0%). About 69% knew about cervical cancer and 77.6% had ever heard about HPV vaccine. Regarding the factors that influence the practice of uptake HPV vaccine, they were age, race, income, parents' education, knowledge about cervical cancer, heard about HPV vaccine and place of getting the vaccine (p<0.001). Conclusion: The prevalence of HPV vaccine among school girls is high. Age, race, income, parents' education, knowledge about cervical cancer, heard about HPV vaccine and place of getting the vaccine were the significant factors that influence the practice of uptake HPV vaccine among school girls.
    Full-text · Dataset · Mar 2014
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