Abstract
BackgroundThe Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The vaccine is provided in two different service delivery models depending upon the acceptance of the program by the local school board. Vaccinations may be provided “in-school” or in “community” through appointments at Public Health Clinics. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, “in-school” and “community”, and to examine if socioeconomic status (SES) was a contributing factor.MethodsIndividual data from the Calgary Zone Public Health vaccination database for all grade 5 and 9 girls in Calgary for school years 2008–2011 were analyzed using descriptive statistics. These data included vaccination records for 35,592 girls. Logistic regression was used to examine the effect of delivery system and SES status on being vaccinated, controlling for school type.ResultsHPV vaccination completion rates were 75% (95% confidence interval = 74.7%, 75.8%) for girls with an “in-school” compared to 36% (95% confidence interval = 35.3%, 37.2%) for girls in schools with a “community” service delivery model. A girl’s neighbourhood SES was related to the likelihood of being HPV vaccinated depending on the service delivery model available to her. For girls attending a Public school with an “in-school” delivery model, the proportion completing vaccination increased as SES decreased (high SES = 79%; medium SES = 79%; low SES = 83%; p-value<0.001). For girls attending Calgary Catholic School District schools with the “community” delivery model there was a decrease in immunization rates from high and mid to low SES (high SES = 41%; medium SES = 42%; low SES = 34%; p-value<0.001). These results show that those with lower SES were differentially disadvantaged by not having access to an “in-school” vaccination delivery model.ConclusionService delivery models make a difference in HPV vaccination completion rates and create inequities for health protection and disease prevention based on socioeconomic status.
Highlights
The Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9
Consistent with the recommendation of the Canadian Immunization Committee, the Program in Alberta was intended to be delivered, like other school-age vaccinations, on school sites [1]. Given that this public health program is delivered in collaboration with the local school districts this means that the policies should be consistent, and not create barriers for any group
For example more than half the girls attending the Catholic schools with the “inschool” model lived in neighbourhoods classified as having high socioeconomic status (SES), compared to less than a third of the girls attending Public schools (Table 1)
Summary
The Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, “in-school” and “community”, and to examine if socioeconomic status (SES) was a contributing factor. Consistent with the recommendation of the Canadian Immunization Committee, the Program in Alberta was intended to be delivered, like other school-age vaccinations, on school sites [1]. Given that this public health program is delivered in collaboration with the local school districts this means that the policies should be consistent, and not create barriers for any group
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