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.
Highlights
Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection affecting both males and females (Hariri et al, 2011; Forhan et al, 2009; Giuliano et al, 2008)
A significantly higher percentage of initiators had mothers who reported that their child's healthcare provider had recommended or strongly recommended HPV vaccination, while a significantly higher percentage of non-initiators had mothers who reported that their child's healthcare provider had not discussed the possibility of vaccinating their child against HPV
This study adds to literature suggesting that provider communication and/or recommendation regarding HPV vaccination is a key factor in parents' vaccination decisions, suggesting that this may be a key factor at earlier ages
Summary
Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection affecting both males and females (Hariri et al, 2011; Forhan et al, 2009; Giuliano et al, 2008). HPV is the primary cause of cervical cancer and leading cause of other anogenital and oropharyngeal cancers, in addition to causing genital warts (Schiffman et al, 2007; Munoz et al, 2004; Watson et al, 2008; Jayaprakash et al, 2011). Vaccination provides effective protection against HPV and its associated adverse health outcomes (Baandrup et al, 2013; Giuliano et al, 2011; Hariri et al, 2013; Markowitz et al, 2013). The three available HPV vaccines each protect against two “high-risk” HPV types (HPV16 and 18) associated with the majority of HPV-related cancers. The quadrivalent and 9-valent vaccines protect against two “low-risk” types (HPV6 and 11) associated with 90% of genital warts. The 9-valent vaccine protects against five additional “high-risk” types (HPV31, 33, 45, 52, and 58) responsible for 10% of HPV-related cancers (Petrosky et al, 2015). While the three-dose vaccine series may be initiated as early as age nine (Centers for Disease Control and Prevention, 2010), the Advisory
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