Sociodemographic Predictors of Human Papillomavirus Vaccine Uptake Among Young Adults in the United States: A Cross-sectional Analysis and Implications for Cancer Prevention in Nursing Practice.

Background: More than 36,000 new cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the United States, with racial/ethnic differences observed in incidence and mortality. HPV vaccination is a means of primary prevention against HPV-associated cancers, and in 2018, the Food and Drug Administration expanded age of eligibility for the HPV vaccine to 27-45 years. However, no study has examined differences in vaccine uptake based on race/ethnicity since the expansion of age of eligibility. Objective: To characterize racial/ethnic differences in HPV vaccine uptake among eligible adults aged 27-45 years in the United States, and identify socioeconomic factors associated with differential vaccine uptake. Methods: We analyzed nationally representative, cross-sectional data from the 2019 National Health Interview Survey (n = 9,440). Outcome of interest was HPV vaccine uptake, defined as receipt of at ≥ 1 dose of the vaccine. Main independent variable was race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic other). Other covariates included age, sex, marital status, highest level of education, annual income, insurance status, having a usual place of care, and geographic region of residence. Weighted, multivariable logistic regression model estimated odds of HPV vaccine uptake based on race/ethnicity, while adjusting for other covariates. Results: Majority of respondents were non-Hispanic whites (60.7%). Vaccine uptake rate was only 15.5%. In the unadjusted analysis, there were associations between HPV vaccine uptake and race/ethnicity, sex, marital status, education, income, insurance, place of care, and geography (p < 0.001). After adjusting for covariates, significant racial/ethnic differences in HPV vaccine uptake persisted. Compared to non-Hispanic whites, non-Hispanic blacks were 36% (aOR = 1.36; 95% CI 1.09, 1.70) more likely to receive the HPV vaccine. However, Hispanics were 27% less likely than non-Hispanic whites to receive the HPV vaccine (aOR = 0.73; 95% CI 0.58, 0.92). Additionally, individuals who did not have a usual place of care had lower odds of vaccine uptake (aOR = 0.72; 95% CI 0.57, 0.93), as were those with lower educational levels (high school aOR = 0.62; 95% CI 0.50, 0.78; some college aOR = 0.83; 95% CI 0.70, 0.98), compared to college graduates or more. Compared to participants residing in the South, those in the West were more likely to receive the vaccine (aOR = 1.49; 95% CI 1.24, 1.80); and females had over three times the odds of receiving the vaccine (aOR = 3.58; 95% CI 3.03, 4.23) than males. Conclusions: Only 1-in-6 adults between 27 and 45 years in the United States have received at least one dose of the HPV vaccine, and Hispanics are significantly less likely to do so, as are individuals without a usual place of care. Given the importance of the vaccine in cancer prevention, it is critical that these disparities be mitigated. Citation Format: Nosayaba Osazuwa-Peters, Natalie Rincon, Kelsey Rae McDowell, Tiarney Ritchwood, Eric Adjei Boakye. Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among adults aged 27-45 years in the United States [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-271.

Factors associated with human papillomavirus (HPV) patient-clinician communication and HPV vaccine uptake among adults in the United States.

BackgroundEnsuring vaccine access is a prerequisite for promoting human papilloma virus (HPV) vaccination. Although HPV vaccination efforts in China have primarily focused on young females, little research has examined the difficulties they face in accessing the HPV vaccine and its impact on vaccine uptake and intention. This study analyzed the overall perception of access difficulties to HPV vaccines, as well as three specific vaccine access difficulties, and examined their influencing factors among female university students in China. We also examined the associations between overall and specific vaccine access difficulties and HPV vaccination intention and uptake.MethodsA cross-sectional study was conducted among female university students from eight universities or colleges in Zhejiang Province, China, from December 2020 to January 2021. Logistic regressions were used to identify factors associated with both overall and specific perceptions of vaccine access difficulties. A multivariable logistic regression model and a multiple linear regression model were used to explore factors influencing HPV vaccine uptake and vaccine intention by controlling for potential confounding factors, respectively.ResultsA total of 3176 female university students were included in this study. The proportion of female students perceiving overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information, were 60.6%, 57.7%, 60.7%, and 54.0%, respectively. Perceived overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information were associated with HPV vaccine uptake and intention.ConclusionsChinese female university students generally perceived various difficulties in accessing HPV vaccine. It is crucial to improve access to HPV vaccine, optimize the layout and service quality of HPV vaccination centers, and enhance the dissemination and transparency of HPV vaccine information. More efforts are needed to provide a strong guarantee for HPV vaccination uptake among female university students.

Introduction: This study explored the influence of the Theory of Planned Behavior constructs on human papillomavirus (HPV) vaccine (HPVV) intentions and uptake among Hispanic parents in South Florida for their children aged 9-21. Method: A descriptive exploratory analysis was conducted using 39 surveys completed by Hispanic parents. These surveys encompassed demographic data and questions about HPVV uptake, intention, attitudes, subjective norms, knowledge, self-efficacy, and awareness. Results: Most participants were uninsured (77%), unemployed (59%), and had low Americanism acculturation (74%). A little over half were aware of the HPVV (54%), yet most had high positive HPVV attitudes (95%) and self-efficacy (85%). HPVV intentions within the year were also high (82%); however, HPVV uptake (45%) and HPVV knowledge (40%) were low at the time of the study. Most parents reported physicians (72%) and nurses/nurse practitioners (59%) as the most influential individuals in their decision-making. A statistically significant relationship between HPVV intention and HPVV attitude (X_Wald^2 (1) = 5.71, p = 0.02., OR = 5.11) and between HPVV uptake and HPVV awareness (X_Wald^2 (1) = 4.63, p = 0.03., OR = 12) were observed. Conclusion: This study recommends further research and targeted interventions to improve HPVV awareness among Hispanic communities. The participants' highly positive attitudes and self-efficacy provide a hopeful outlook for future vaccination efforts within this demographic.

Background: Limited English proficiency (LEP) impacts patient-provider communication and access to healthcare, both of which are also associated with human papillomavirus (HPV) vaccine uptake. We examined the association between LEP and HPV vaccine uptake among parents/guardians of adolescents and young adults eligible for the HPV vaccination in the United States. Methods: Using a cross-sectional study design, we analyzed nationally representative data from the National Health and Nutrition Examination Survey between 2017 and 2020 (n = 3,993). Outcome of interest was HPV vaccine uptake, defined as initiation (at least one dose), or completion (at least two or three doses). LEP was defined as completing the questionnaire in a language other than English and/or using an interpreter. Logistic regression models estimated odds of HPV vaccine uptake based on LEP, adjusting for covariates, including age, sex, healthcare access, income, race, and ethnicity. Analyses were stratified into groups aged 9-17 and 18-26 years. Results: LEP rate was 11.2% in the 9 to 17 age-group (n = 2,584), and 8.8% in the 18-26 age-group (n = 1,409). In the adjusted analyses, we found no association between LEP and HPV vaccination in either age groups (for 9-17 years: aORinitiation = 1.10; 95% CI 0.69, 1.77; aORcompletion = 1.04; 95% CI 0.60, 1.81; and for 18-26 years: aORinitiation = 0.70; 95% CI 0.40, 1.25; aORcompletion for 18-26 years = 1.23; 95% CI 0.56, 2.70). However, we found significant associations between HPV vaccine uptake and age, sex, race/ethnicity, and healthcare access variables in both age groups. Conclusions: While language proficiency status was not significantly associated with HPV vaccine uptake in our study, we found that age, sex, race/ethnicity, and access to care are associated with HPV vaccination. This indicates the need for continued interventions targeting factors to increase access to HPV vaccine. Citation Format: Marian F. Talip, Trinity Casimir, Jillian H. Hurst, Daniel J. Rocke, Tammara L. Watts, Trinitia Y. Cannon, Eric Adjei Boakye, Nosayaba Osazuwa-Peters. The impact of limited English proficiency and healthcare access on HPV vaccine uptake in the United States. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P023.

10519 Background: High-risk strains of human papillomavirus (HPV) are associated with a variety of oral and anogenital cancers, many of which are preventable through HPV vaccination. In the US, completion of an HPV vaccination series is recommended for all individuals from age 9 through 26; however, national trends in HPV vaccination uptake across sex and racial/ethnic groups over the past decade are not well described. Methods: We analyzed data from the National Health and Nutrition Examination Survey across 4 survey cycles spanning January 2011 to March 2020. We used univariate logistic regression to evaluate temporal trends in HPV vaccination uptake across sex and racial/ethnic strata, with the midpoint of each survey cycle modeled as a continuous independent variable. Vaccination uptake was defined as self/parent-reported receipt of ≥ 1 dose of an HPV vaccine series (estimates for 2 and 3 doses were unreliable due to recall bias and missing data). All estimates incorporated appropriate survey weights to be representative of the US population. Results: We identified 10,927 participants representing 70,066,252 individuals: mean age 17.4 years, 48.8% male, 54.9% White. Between 2011-March 2020, overall HPV vaccination uptake steadily increased from 23.3% to 43.0% ( P trend < 0.001; Table). HPV vaccination rates improved from 37.7% to 49.4% among females ( P trend < 0.001) and from 7.8% to 36.4% among males ( P trend < 0.001). HPV vaccination uptake increased similarly across all racial/ethnic strata by approximately 20%, with White individuals achieving the greatest vaccination uptake (45.5%) by March 2020. Conclusions: Among US adolescents and young adults, HPV vaccination uptake rose by ~20% overall and across all racial/ethnic groups. HPV vaccination uptake accelerated the most among males but still lags behind females, perhaps because routine vaccination wasn’t recommended for males until 2011, 5 years after it had been recommended for females. [Table: see text]

Objective: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students. Participants: Females aged 18 to 26 attending a university health service gynecology clinic (n = 256). Methods: Participants were randomized to receive either HPV-specific education with a mailed reminder or standard care. Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified. Results: At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake. Conclusions: Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination.

Background: This study aimed to determine human papillomavirus (HPV) vaccine uptake and willingness to receive HPV vaccination among female college students, in China, and its associated factors. Methods: An online cross-sectional survey of female college students across the eastern, central, and western regions of China was undertaken between April and September 2019. Partial least squares structural equation modeling (PLS-SEM) was used to examine factors associated with the HPV vaccine uptake and willingness to receive the HPV vaccine. Results: Among the total 4220 students who participated in this study, 11.0% reported having been vaccinated against HPV. There are direct effects of indicators of higher socioeconomic status, older age (β = 0.084 and p = 0.006), and geographical region (residing in Eastern China, β = 0.033, and p = 0.024) on HPV vaccine uptake. Higher knowledge (β = 0.062 and p < 0.000) and perceived susceptibility (β = 0.043 and p = 0.002) were also predictors of HPV vaccine uptake. Of those who had not received the HPV vaccine, 53.5% expressed a willingness to do so. Likewise, social economic status indicators were associated with the willingness to receive the HPV vaccine. Total knowledge score (β = 0.138 and p < 0.001), both perceived susceptibility (β = 0.092 and p < 0.001) and perceived benefit (β = 0.088 and p < 0.001), and sexual experience (β = 0.041 and p = 0.007) had a positive and significant direct effect on the willingness to receive the HPV vaccine, while perceived barriers (β = −0.071 and p < 0.001) had a negative effect on the willingness to receive the HPV vaccine. Conclusions: Geographical region and socioeconomic disparities in the HPV vaccination uptake rate and willingness to receive the HPV vaccine provide valuable information for public health planning that aims to improve vaccination rates in underserved areas in China. The influence of knowledge and perceptions of HPV vaccination suggests the importance of communication for HPV immunization.

Vaccinating adolescent girls against human papillomavirus—Who decides?

Background: Cervical cancer is the fourth most common cancer in women, and it is associated with infection by the Human Papillomavirus (HPV). There are effective interventions for the prevention of cervical cancer. However, the uptake of these interventions by women in developing countries is poor. This study assessed the knowledge and practices of cervical cancer preventive measures and uptake of HPV vaccines among women in Abia State. Method: This was a descriptive cross-sectional study among women in Abia State. Multistage sampling was used to recruit 700 eligible women and an ODK interviewerbased structured questionnaire was used to collect the information. Descriptive, bivariate, and multivariate analyses were done using SPSS version 26. The level of significance was set at 5%. Results: The mean age of the respondents was 40.3 ± 9.9 years and the proportion of women with good knowledge of HPV infection and vaccine was 22.0% (95% CI: 18.9- 25.1). The uptake of Pap smear and HPV vaccine was 7% and 3%, respectively, while predictors of good knowledge for HPV infection and vaccine included higher educational status (aOR = 2.53; 95% CI: 1.73–3.71, p = 0.001), being currently married (aOR = 0.32; 95% CI: 0.18–0.54, p= 0.001) and divorced (aOR = 0.25; 95% CI: 0.13–0.49, p=0.001). Conclusion: Poor knowledge of HPV infection and vaccines, and poor uptake of Pap smear and HPV vaccine were prevalent among the respondents. We recommend policymakers design health education programmes to improve knowledge and preventive cervical cancer practices.

To date, empirical studies on HPV vaccine uptake are still limited in Chinese populations and mainly conducted in female cohorts. In order to inform health services planning and health promotion programmes for HPV vaccination, this cross-sectional study aimed to report the prevalence of self-reported HPV vaccination status and to examine gender and sexual orientation differences in the uptake of HPV vaccine in Chinese college students. The overall prevalence of HPV vaccine uptake was 27.6% (n = 242), with a significantly higher prevalence in females (39.7%) than in males (4.7%). 91.4% of subjects heard about HPV vaccination, with a significantly higher prevalence in females (93.8%) than in males (86.8%). The prevalence of HPV vaccine uptake was only 2.6% for bisexual/ homosexual males and 5.0% for heterosexual males. Only 45.8% of the overall subjects knew HPV vaccination is not for females only, with a significantly higher prevalence in females (49.7%) than in males (38.6%). The low prevalence of male HPV vaccine uptake and awareness called for the need to have more male-specific HPV campaigns to promote HPV vaccination awareness and uptake in males to reduce the overall prevalence of HPV infection.

BackgroundHuman papillomavirus (HPV) vaccination rates among adolescents are increasing in Minnesota (MN) but remain below the Healthy People 2020 goal of 80% completion of the series. The goal of this study was to identify messaging and interventions impacting HPV vaccine uptake in MN through interviews with clinicians and key stakeholders.MethodsWe conducted semi-structured key participant interviews with providers and stakeholders involved in HPV vaccination efforts in MN between 2018 and 2019. Provider interview questions focused on messaging around the HPV vaccine and clinic-based strategies to impact HPV vaccine uptake. Stakeholder interview questions focused on barriers and facilitators at the organizational or state level, as well as initiatives and collaborations to increase HPV vaccination. Responses to interviews were recorded and transcribed. Thematic content analysis was used to identify themes from interviews.Results14 clinicians and 13 stakeholders were interviewed. Identified themes were grouped into 2 major categories that dealt with messaging around the HPV vaccine, direct patient–clinician interactions and external messaging, and a third thematic category involving healthcare system-related factors and interventions. The messaging strategy identified as most useful was promoting the HPV vaccine for cancer prevention. The need for stakeholders to prioritize HPV vaccination uptake was identified as a key factor to increasing HPV vaccination rates. Multiple providers and stakeholders identified misinformation spread through social media as a barrier to HPV vaccine uptake.ConclusionEmphasizing the HPV vaccine’s cancer prevention benefits and prioritizing it among healthcare stakeholders were the most consistently cited strategies for promoting HPV vaccine uptake. Methods to combat the negative influence of misinformation about HPV vaccines in social media are an urgent priority.

Background: Population-based studies of human papillomavirus (HPV) vaccine uptake among both adolescent boys and girls are limited. The purpose of this study was to examine middle and high school student knowledge and behaviors surrounding the HPV vaccine in a rural Appalachian Ohio county. Methods: Five questions regarding the HPV vaccine were added to 2012 Youth Risk Behavior Survey (YRBS) administered in an Ohio Appalachian county. The participants were asked whether or not they had heard of the HPV vaccine; been given the vaccine and, if yes, the number of shots received; and whether their health care provider and/or their parents had discussed the vaccine with them. The voluntary and anonymous survey was completed by a total of 1,300 adolescent boys and girls. Results: Of the 596 and 704 high school students who completed the survey, 51.9% were male and 48.1% were female, and 95% were white. Regarding whether they had ever heard of the HPV vaccine, 49.1%, 29.6%, 21.2% respectively reported ‘yes’, ‘no’, and ‘don't know/not sure’. Girls were more likely to report having heard of the HPV vaccine than boys (56.7% vs. 42.19%; p &amp;lt; 0.001). In all, 19.5% and 24.5% of the participants indicated having their parents and a health care provider respectively having discussed the HPV vaccine with them. Girls were two times as likely to report having a parent discuss the HPV vaccine with them than boys (P &amp;lt; 0.01). They were also almost three times as likely than boys to report a health care provider having discussed the vaccine with them (p &amp;lt; 0.01). Overall, 11.4% boys and 21.3% girls reported having received at least one dose of the vaccine (p &amp;lt; 0.001). The HPV uptake rates among middle and high school boys and girls respectively were 9.2%, 13.2%, 14.4%, and 27.4%. Conclusion: The HPV vaccine knowledge, as well as parental and health care provider communication regarding the HPV vaccine, particularly with the boys, remains low among these rural Appalachian adolescents. The role of these two factors on the HPV vaccine uptake among this adolescent population needs to be further explored.

Objective We assessed the psychosocial influences on college males’ human papillomavirus (HPV) vaccine patient-provider communication and their uptake of one or more HPV vaccine doses. Methods We conducted a cross-sectional survey with college males attending one large southwestern university. We used logistic regressions to explore the relationships between psychosocial and demographic variables on patient-provider communication and HPV vaccine uptake. Results Patient-provider communication had the most significant influence on HPV vaccine uptake. However, most college males reported never discussing the HPV vaccine with their healthcare providers. HPV vaccine awareness, perceived subjective norms to vaccinate, and behavioral control to talk to healthcare providers about the vaccine significantly influenced college males’ patient-provider communication and vaccine uptake. Conclusion HPV vaccine awareness, perceived behavioral control to communicate about the vaccine, and subjective norms to vaccinate are all addressable factors that influence HPV vaccine communication and uptake. Future intervention work should specifically target these factors for college men.

In 2018, the Food and Drug Administration expanded the age of eligibility for the human papillomavirus (HPV) vaccine to 27 to 45 years. However, it is unclear if there are racial/ethnic disparities in HPV vaccine uptake for this age-group following this expanded recommendation. We aimed to identify any disparities in HPV vaccine in 27 to 45 year-olds based on sociodemographic factors. We analyzed nationally representative, cross-sectional data from the 2019 National Health Interview Survey (n = 9440). Logistic regression models estimated the odds of vaccine uptake (receipt of ≥1 vaccine dose) based on sociodemographic factors. Participants were mostly Non-Hispanic Whites (60.7%) and females (50.9%). In adjusted models, females had over three times greater odds of vaccine uptake compared to males (aOR = 3.58; 95% CI 3.03, 4.23). Also, compared to Non-Hispanic Whites, Non-Hispanic Blacks were 36% more likely (aOR = 1.36; 95% CI 1.09, 1.70), and Hispanics were 27% less likely (aOR = 0.73; 95% CI 0.58, 0.92) to receive the vaccine. Additionally, individuals without a usual place of care had lower odds of vaccine uptake (aOR = 0.72; 95% CI 0.57, 0.93), as were those with lower educational levels (aORhigh school = 0.62; 95% CI 0.50, 0.78; aORsome college = 0.83; 95% CI 0.70, 0.98). There are disparities in HPV vaccine uptake among 27 to 45 year-olds, and adult Hispanics have lower odds of receiving the vaccine. Given the vaccine’s importance in cancer prevention, it is critical that these disparities are addressed and mitigated.