Abstract
Since introduction of the human papillomavirus (HPV) vaccine, there remains low uptake compared to other adolescent vaccines. There is limited information postapproval about parental attitudes and barriers when presenting for routine care. This study evaluates HPV vaccine uptake and assesses demographics and attitudes correlating with vaccination for girls aged 11–12 years. A prospective cohort study was performed utilizing the University of Virginia (UVA) Clinical Data Repository (CDR). The CDR was used to identify girls aged 11–12 presenting to any UVA practice for a well-child visit between May 2008 and April 2009. Billing data were searched to determine rates of HPV vaccine uptake. The parents of all identified girls were contacted four to seven months after the visit to complete a telephone questionnaire including insurance information, child’s vaccination status, HPV vaccine attitudes, and demographics. Five hundred and fifty girls were identified, 48.2% of whom received at least one HPV vaccine dose. White race and private insurance were negatively associated with HPV vaccine initiation (RR 0.72, 95% CI 0.61–0.85 and RR 0.85, 95% CI 0.72–1.01, respectively). In the follow-up questionnaire, 242 interviews were conducted and included in the final cohort. In the sample, 183 (75.6%) parents reported white race, 38 (15.7%) black race, and 27 (11.2%) reported other race. Overall 85% of parents understood that the HPV vaccine was recommended and 58.9% of parents believed the HPV vaccine was safe. In multivariate logistic regression, patients of black and other minority races were 4.9 and 4.2 times more likely to receive the HPV vaccine compared to their white counterparts. Safety concerns were the strongest barrier to vaccination. To conclude, HPV vaccine uptake was higher among minority girls and girls with public insurance in this cohort.
Highlights
Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States and is associated with 99% of all cervical cancers [1,2]
In Virginia, black women have a higher risk of cervical cancer than white women and are twice as likely to die of the disease [6]
This quadrivalent HPV vaccine protects against viral types 6, 11, 16, and 18, which are known to cause approximately 90% of genital warts and 70% of cervical cancer [7,8]
Summary
Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States and is associated with 99% of all cervical cancers [1,2]. A vaccine to protect against human papillomavirus was first introduced in 2006 in the United States (Gardasil®, Merck & Co, Inc., Whitehouse Station, NJ, USA) This quadrivalent HPV vaccine protects against viral types 6, 11, 16, and 18, which are known to cause approximately 90% of genital warts and 70% of cervical cancer [7,8]. The National Immunization Survey for Adolescents (NIS-Teen) documents adolescent immunization for ages 13–17 These data show national HPV vaccination rates fall below recommended levels and are significantly lower than other adolescent vaccinations [10]. A recent in depth analysis of the NIS 2008 regarding HPV vaccination, the first year of HPV vaccination reporting, demonstrated differential rates of vaccination completion by race with minority girls less likely to complete the series [12]. This study documents baseline vaccination rates for the year prior to enactment of the Virginia school mandate
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