HPV Vaccine Completion Research Articles

Two Web-Based and Theory-Based Interventions With and Without Brief Motivational Interviewing in the Promotion of Human Papillomavirus Vaccination Among Chinese Men Who Have Sex With Men: Randomized Controlled Trial.

BackgroundHuman papillomavirus (HPV) vaccination is effective in the prevention of vaccine-type genital warts and cancers among men who have sex with men (MSM).ObjectiveThe primary objective of this randomized controlled trial (RCT) is to evaluate the efficacies of 2 web- and theory–based interventions with and without brief motivational interviewing (MI) over the phone to increase the completion of HPV vaccination among unvaccinated participants within a 24-month follow-up period compared with the control group.MethodsA 3-arm parallel-group RCT was conducted between July 2017 and December 2019. Five telephone surveys were conducted at baseline and at 3, 6, 9, and 24 months by blinded interviewers. Participants were Hong Kong Chinese–speaking MSM aged between 18 and 45 years with regular internet access who were recruited from outreaching at venues, web-based recruitment, and peer referral. Those who had ever received HPV vaccination were excluded. A total of 624 participants were randomized into either the online tutorial (OT) only group (n=208), the OT plus MI group (OT-MI; n=208), or the control group (n=208). In total, 459 (459/624, 73.6%) completed the follow-up evaluation at 24 months. Participants in the OT group received a fully automated OT developed based on the health belief model. On top of the same OT, the OT-MI group received brief MI over the phone. Reminders were sent to the participants of the OT and OT-MI groups after 1, 2, 4, 6, and 8 months. Participants in the control group received web-based health communication messages unrelated to HPV or HPV vaccination. The research team validated the self-reported HPV vaccination uptake. Intention-to-treat analysis was used for outcome analyses. Logistic regression models and multivariable linear regression models were used to test the between-group differences in primary and secondary outcomes. Baron and Kenny’s methods were used to test the mediation hypothesis.ResultsThe participants in the OT-MI group reported a significantly higher validated completion of HPV vaccination at 24 months than the control group (36/208, 17.3% vs 15/208, 7.2%; P=.006). However, the difference in HPV vaccination completion between the OT and the control groups (24/208, 11.5% vs 15/208, 7.2%; P=.17), or between OT-MI and OT groups (P=.13), was not statistically significant. The association between randomization status (OT-MI group vs control group) and HPV vaccination completion became statistically nonsignificant after controlling for changes in the perceived susceptibility to HPV (24 months vs baseline), whereas perceived susceptibility remained strongly associated with HPV vaccination uptake in the model (P<.001). Changes in perceived susceptibility fully mediated the intervention effect.ConclusionsTheory-based OT with brief MI over the phone was effective in increasing HPV vaccination completion among Chinese MSM. Perceived susceptibility is an active theoretical component that causes behavioral changes.Trial RegistrationClinicalTrials.gov NCT03286907; https://clinicaltrials.gov/ct2/show/NCT03286907

HPV vaccine coverage across Hispanic/Latinx subgroups in the United States.

Research on HPV vaccine coverage in the United States has typically aggregated Hispanic/Latinx individuals into a single group for analyses, an approach that has potentially masked variation between Hispanic/Latinx subgroups. To address this limitation, we examined HPV vaccine coverage across Hispanic/Latinx subgroups. We analyzed data on Hispanic/Latinx adolescents ages 13-17 (n = 16,335) from the 2012-2016 National Immunization Survey-Teen. Each adolescent was categorized into a subgroup: Mexican, Cuban, Puerto Rican, Central American, South American, other Spanish origin, or multi-subgroup. We examined HPV vaccine initiation (receipt of one or more doses) and completion (receipt of three doses) for males and females separately. Analyses used weighted logistic regression. Vaccine coverage among males was highest among Central Americans (initiation: 57.5%; completion: 31.1%) and lowest among multi-subgroup males (initiation: 46.3%; completion: 19.9%). Among females, initiation ranged from 63.4% among Cubans to 71.2% among Puerto Ricans, and completion ranged from 33.6% among multi-subgroup females to 48.7% among South Americans. Hispanic/Latinx subgroups were similar on these outcomes in regression models. However, within several subgroups, vaccine coverage was higher among adolescents whose parents' preferred language was Spanish (i.e., potentially less acculturated) compared to those whose parents' preferred language was English. Modest variation in HPV vaccine coverage exists across Hispanic/Latinx subgroups, with differences found by preferred language within several subgroups. Findings provide insight into HPV vaccine coverage among Hispanic/Latinx subgroups and can help guide future surveillance efforts and vaccination interventions.

An innovative housing-related measure for individual socioeconomic status and human papillomavirus vaccination coverage: A population-based cross-sectional study

BackgroundHuman papillomavirus (HPV) is a known cause of anogenital (eg, cervical) and oropharyngeal cancers. Despite availability of effective HPV vaccines, US vaccination-completion rates remain low. Evidence is conflicting regarding the association of socioeconomic status (SES) and HPV vaccination rates. We assessed the association between SES, defined by an individual validated Housing-based Index of Socioeconomic Status (HOUSES), and HPV vaccination status. MethodsWe conducted a cross-sectional study of children/adolescents 9–17 years as of December 31, 2016, living in southeastern Minnesota by using a health-record linkage system to identify study-eligible children/adolescents, vaccination dates, and home addresses matched to HOUSES data. We analyzed the relationship between HPV vaccination status and HOUSES using multivariable Poisson regression models stratifying by age, sex, race, ethnicity, and county. ResultsOf 20,087 study-eligible children/adolescents, 19,363 (96.4%) were geocoded and HOUSES measures determined. In this cohort, 57.9% did not receive HPV vaccination, 15.8% initiated (only), and 26.3% completed the series. HPV vaccination-initiation and completion rates increased over higher SES HOUSES quartiles (P < .001). Rates of HPV vaccination initiation versus unvaccinated increased across HOUSES quartiles in multivariable analysis adjusted for age, sex, race, ethnicity, and county (1st quartile, referent; 2nd quartile, 0.97 [0.87–1.09]; 3rd quartile, 1.05 [0.94–1.17]; 4th quartile, 1.15 [1.03–1.28]; test for trend, P = .002). HOUSES was a stronger predictor of HPV vaccination completion versus unvaccinated (1st quartile referent; 2nd quartile, 1.06 [0.96–1.16]; 3rd quartile, 1.12 [1.03–1.23]; 4th quartile, 1.32 [1.21–1.44]; test for trend, P < .001). Significant interactions were shown for HPV vaccination initiation by HOUSES for sex (P = .009) and age (P = .006). ConclusionThe study showed disparities in HPV vaccination by SES, with the highest HOUSES quartiles associated with increased rates of initiating and even greater likelihood of completing the series. HOUSES data may be used to target and tailor HPV vaccination interventions to undervaccinated populations.

Barriers and facilitators to HPV vaccine uptake among US rural populations: a scoping review.

Compared to US urban populations, rural residents have a higher incidence of HPV-related cancer and lower HPV vaccine coverage. This study determined what is known about barriers and facilitators to vaccine uptake in US rural settings. A scoping review was conducted to describe individual, interpersonal, organizational, and community/societal barriers and facilitators to HPV vaccine initiation and completion among US rural populations and to identify gaps in the current research. A systematic search was conducted using PubMed/MEDLINE and CINAHL databases. A total of 1,083 abstracts were reviewed and 13 articles met the inclusion criteria. Major themes at the individual-level included caregiver and vaccine-recipient demographics, other immunizations received, pap test history, awareness/knowledge of cervical cancer, HPV vaccine, or HPV infection, attitudes and motivation to vaccinate, STD diagnosis, sexual behavior, cervical cancer history, contraceptive use, and cancer fatalism. Interpersonal themes focused on provider influence and communication, caregiver and peer influence, and social support for the caregiver. At the organizational-level, themes included health insurance, provider characteristics, school-based interventions, and provider/practice-based interventions. The only community/societal factor examined related to a social marketing campaign. Additional research is needed on interpersonal, organizational, and community/societal factors, as well as an expanded focus on rural males. Future studies should account for rural heterogeneity by expanding the geographic areas studied. Our findings detailing factors found to be associated with HPV vaccine uptake will help inform future clinical, health services, and communityresearch, as well as interventions and policy efforts.

HPV vaccine uptake among daughters of Latinx immigrant mothers: Findings from a cluster randomized controlled trial of a community-based, culturally relevant intervention

ObjectiveWe examined the efficacy of a culturally relevant, community-based HPV vaccination intervention among Latinx immigrant mothers with daughters aged 9–12 in Alabama. MethodsWe conducted a cluster-randomized controlled trial with “place of residence” (e.g., apartment complexes, trailer parks) as the unit of randomization that evaluated two interventions: 1) promotion of HPV vaccination and 2) promotion of healthy eating and appropriate nutrition label interpretation. Identical baseline/post/7-month follow up questionnaires were completed by all participants and both interventions consisted of four group sessions and one individual session. A total of 40 locations were randomized with 317 mother-daughter dyads enrolled in the study between May 2013 and October 2017. ResultsA total of 278 mother-daughter dyads met full eligibility and initiated the intervention/control participation. Retention rate overall was 93.2% (92.6% for the intervention arm and 93.7% for the control arm). Daughters in the intervention arm were significantly more likely to receive one, two, and three doses of HPV vaccine than daughters in the control arm p < 0.001). In multivariate analyses, mothers in the intervention arm had a six times greater odds of vaccinating daughters with the first dose (OR = 5.96, 95% CI: 3.38, 10.49), eight times greater odds of vaccinating daughters with the second dose (OR = 8.09, 95% CI: 4.0, 16.35), and more than 16 times greater odds of completing the three-dose HPV vaccine series than mothers in the control arm after adjusting for mother’s age, time in the U.S., income, and daughter’s health insurance status (OR = 16.5, 95% CI: 5.73, 47.48). Only perceived risk of their daughters’ future HPV infection remained significant as a predictor of three-dose HPV vaccination completion (OR = 0.69, 95% CI: 0.23, 2.1). ConclusionsA theory-driven, culturally-relevant intervention developed through extensive formative assessments in collaboration with community members can effectively promote HPV vaccination among 9–12 years of age daughters of Latina immigrants.

Human Papilloma Virus Vaccination Compliance in a Military Aviation Training Community

Human Papilloma Virus (HPV) vaccination compliance as reported by the CDC in 2011 falls short of a national goal to have 80% of adolescents vaccine-complete by 2020. The Naval Aviation Schools Command, Pensacola, Florida offers a single point of contact for military aviation trainees offering near-complete capture of an HPV vaccine target population. The purpose of this study is to identify baseline HPV vaccination rates among military aviation trainees and whether or not the provision of educational materials at the start of aviation training would increase future HPV vaccination compliance. Approval to conduct this study was obtained from the Institutional Review Board of Naval Medical Center Portsmouth, Virginia. Our population of interest consisted of US Navy and Marine Corps student naval aviators, student naval flight officers (officers), and student enlisted air crew (enlisted) reporting for aviation related duty. A convenience sampling of officer and enlisted student classes checking in for training was performed over a period of 6months. The first 3months of students were assigned as the intervention group and the remaining 3months of students were assigned to the control group. This study was conducted in two parts: (1) an anonymous survey captured cross-sectional data of self-reported HPV vaccine use, and (2) prospective analysis of service members' HPV vaccine rates before and after educational intervention as documented within the military's electronic health record system, Armed Forces Health Longitudinal Technology Application (AHLTA). AHLTA immunization status was evaluated for 1,164 personnel; 114 (9.8%) were excluded for missing basic vaccination information. Of the remaining 1,050, another 199 (19%) members were excluded as already vaccine complete (evidenced by three shots documented) prior to entry into the study. Within the 199 service members with documented baseline HPV vaccination completion, 197/199 (99%) were officers and 2/199 (0.1%) were enlisted. A total of 851 personnel were included for prospective analysis. Person-time of 100 person years was used and the vaccination rate translates to 16.62/100 person years (95% CI 11.29, 23.59) within intervention vs. 2.96/100 person years (95% CI 0.80, 7.58) within control groups and are significantly different (P=0.0001). Comparing intervention and control groups, rate ratios=5.61 (95% CI 2.14, 18.64) and rate differences=13.66 (95% CI 7.13, 20.19). Among intervention group survey responders who previously reported nonvaccine use, 50.5% reported a change in opinion about obtaining the vaccination, with a higher proportion of enlisted members reporting a change in opinion (62.8% vs. 39.7%, P=0.0053). Electronic health records immunizations review noted a baseline vaccine completion rate of 19%. Our study showed a health inequity between enlisted and officers, with officers having 99% of the documented baseline completion rates per AHLTA data. Our prospective analysis noted statistically significant rate differences of 13.66% and rate ratios of 5.61 between intervention and control groups. This analysis of AHLTA data combined with survey response of 50.5% indicating a change in opinion about HPV vaccine use among those who had not yet started vaccine series suggests targeted education would be a low-cost intervention to improve HPV vaccine use rates.

School-based human papillomavirus vaccination program for increasing vaccine uptake in an underserved area in Texas

ObjectiveCompare the effectiveness of community-based HPV-related education and onsite school-based vaccination versus community-based education only for increasing HPV vaccine uptake in a rural, medically underserved area. MethodsOur cohort included 2307 Rio Grande City Consolidated Independent School District (RGCISD) middle school students from 3 schools enrolled in August 2016 and followed until April 2018. Using a quasi-experimental design, this study implemented an onsite school-based vaccination program and physician-led education on HPV and HPV vaccines for parents/guardians, school nurses/staff, and pediatric/family providers in the surrounding community (15-mile radius of RGCCISD) at 1 middle school (“intervention school”), and education-only for the remaining 2 schools (“comparison schools”). The Centers for Disease Control and Prevention's HPV-related educational materials supplemented the education. HPV vaccine status was obtained from school immunization records and the project's contracted vaccine vendor. HPV vaccine initiation and completion rates were compared pre and post intervention and between the intervention and comparison schools. Logistic regression was used to compare the odds of newly initiating/completing vaccination between the intervention and comparison schools. ResultsAt baseline, the intervention school had lower HPV vaccine initiation and completion rates than the comparison schools (20.00% and 8.70% vs 28.97% and 14.56%). Post intervention, the intervention school had higher initiation and completion rates than the comparison schools (53.67% and 28.36% vs 41.56% and 20.53%). Students from the intervention school were over 3.6-times more likely to newly initiate/complete the HPV vaccinations than students from the comparison schools. ConclusionThe school with on-site vaccination events and community-based education had a higher adolescent HPV vaccination rate compared to schools that received community-based education only.

A “Sense”-ational HPV Vaccination Quality Improvement Project in a Family Medicine Residency Practice

BackgroundHuman papillomavirus (HPV) vaccination uptake for adolescents and young adults in the United States remains far from national goals. Using a multi-component intervention aligned with community-wide efforts, we implemented a quality improvement project to increase HPV vaccinations among 9-26 year-old male and female patients in an urban, low income, minority population family medicine residency practice. MethodsThe pre-intervention year was November 2, 2014 to October 31, 2015 and the intervention year was November 1, 2015 to October 31, 2016. Based on community input and published literature, the interventions were creative, practice-specific provider-, patient-, and system-level strategies. To compare pre- and post-intervention vaccinations, HPV vaccination data were extracted from an electronic medical record request for age-eligible patients seen in the practice during the intervention year. Chi-square, McNemar’s and 2-tailed, 2-sample Z tests were used to test differences in vaccination initiation (≥1 dose) and completion (3 doses) across groups and over time. ResultsDespite high pre-intervention rates (58% and 75%), HPV vaccine initiation significantly increased 12.8 percentage points (PP) for males and 10.6 PP for females from pre- to post-intervention (P < 0.001). HPV vaccine completion also significantly increased 16 PP for males and 10.9 PP for females (P < 0.001). Young adult patients (18-26 years-old) had significant increases in completion rates (9.9 PP; P < 0.001), not observed among adolescents (20 PP; ns). ConclusionsConsistent and abundant positive HPV vaccination messaging, low-cost sensory rewards, process change, and community, clinician, and nonclinical staff engagement were associated with higher HPV vaccine initiation and completion, especially among young adults.

Abstract 3327: HPV vaccination among adults at high-risk for HIV infection: A public health priority

Abstract This study describes HPV vaccination rates among individuals who engaged in HIV infection high-risk behaviors (injection drugs and/or high-risk sexual behaviors) because HIV/HPV co-infection increases HPV-associated cancer risk. Data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey were used to describe HPV vaccination rates among HIV infection high-risk adults aged 18-36 years. We included: females aged 27-36 years for whom HPV vaccination was recommended in 2006; heterosexual males aged 23-29 years and gay/bisexual males aged 18-33 years for whom HPV vaccination was recommended in 2009. Stata/SE 15.1 was used to perform chi-square tests. Of 486,303 adults who completed the 2016 BRFSS survey, only 3.39% (n=16,507/486,303) had used injection drugs and/or engaged in high-risk sexual behaviors. Among these 16,507 HIV infection high-risk adults, only 416 (2.52%) had complete data for all variables. About one fourth of gay/bisexual males aged 18-33 years had initiated the 3-dose HPV vaccine series (25.68%). Similarly, about one fourth of heterosexual females aged 18-36 years had completed the 3-dose HPV vaccine series (25.01%). Only 10.91% of heterosexual males aged 18-29 years had initiated the 3-dose HPV vaccine series. Age, sex, and sexual orientation differences in HPV vaccination rates were statistically significant (p=0.0047). All transgender men/women and gender-nonconforming individuals were unvaccinated (p=0.4138). While racial/ethnic differences in HPV vaccination rates were not statistically significant (p=0.0630), almost all non-Hispanic Blacks (96.09%) were unvaccinated. Although both HPV vaccine initiation (11.91%) and completion (15.72%) rates were higher among high-risk adults who had been tested for HIV, these differences were not statistically significant (p=0.0750). In 2016, adult HPV vaccination recommendations included all females and gay/bisexual males aged 18-26 years, and heterosexual males aged 18-21 years. The Advisory Committee on Immunization Practices considers people living with HIV infection a special population of interest because of their increased HPV-associated cancer risk. That said, it was alarming that HPV vaccination rates were low among HIV infection high-risk adults in our study, including gay/bisexual males who have the highest HPV-associated cancer risk. For example, anal cancer risk among gay/bisexual males is exacerbated by HIV/HPV co-infection. Additionally, it was also alarming that almost all non-Hispanic Blacks in our study were unvaccinated, especially given the disproportionate burden of HIV/AIDS among this racial/ethnic minority group. Taking known HIV/AIDS and HPV-related cancer disparities among racial/ethnic and sexual/gender minority populations into account, it is essential that increasing HPV vaccination rates among unvaccinated HIV infection high-risk adults remain a public health priority. Citation Format: Lisa T. Wigfall, Shalanda A. Bynum, Jessica Wells, Jennifer K. McGee-Avila, Nikita S. Wagle. HPV vaccination among adults at high-risk for HIV infection: A public health priority [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3327.

Low-income Hispanic parent recall of daughters’ HPV vaccination status: Correlates of accurate reporting of daughters’ HPV-vaccine naïve status compared with electronic health records

PurposeThis study aimed to (1) assess the accuracy of parental recall of adolescent (11–17 years) daughters’ HPV vaccine initiation in a low-income, urban Hispanic population, and (2) describe the correlates of accurate recall. MethodsWe compared parental recall of HPV vaccine naivety to daughter’s electronic medical records to calculate the proportion of parents accurately reporting HPV naïve status. We used mixed effects logistic regression to identify correlates of accurate recall. ResultsWe verified vaccination status for 1103 daughters of participants who reported their daughters were HPV vaccine-naïve; 69.3% of parents accurately reported their daughters as HPV vaccine-naïve. Parents of older daughters (13–17 years) compared to younger daughters (11–12 years) had significantly lower odds of accurately reporting daughters as unvaccinated (AOR = 0.60; 95% CI 0.42–0.83). DiscussionUnderreporting of vaccination status among our study population corresponds with national data that suggest lower income and minority populations underreport HPV vaccination initiation and completion.

HPV Vaccination Coverage Among US Teens Across the Rural-Urban Continuum.

In this study, we used data from the National Immunization Survey-Teen (NIS-Teen) to examine HPV vaccination uptake by rural and urban residence defined by ZIP code. We used 2012-2013 NIS-Teen data to examine associations of HPV vaccination among teens aged 13-17years with ZIP code measures of rural/urban (Rural-Urban Commuting Area (RUCA) codes, population density). Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation (≥ 1 dose) and completion (≥ 3 doses). HPV vaccination was lower among girls from isolated small rural towns (≥1 dose 51.0%; ≥3 doses 30.0%) and small rural towns (≥1 dose 50.2%; ≥3 doses 26.8%) than among urban girls (≥1 dose 56.0%; ≥3 doses 35.9%). Girls from small rural towns had lower odds of completion (0.74, 95% CI: 0.60-0.91) than girls from urban areas. HPV vaccination was lower among boys from isolated small rural towns (≥1 dose 17.3%; ≥3 doses 5.31%) and small rural towns (≥1 dose 18.7%; ≥3 doses 5.50%) than those in urban areas (≥1 dose 28.7%; ≥3 doses 10.7%). Boys in isolated small rural towns had statistically significantly lower odds of initiation (0.68, 95% CI: 0.52-0.88) and completion (0.63, 95% CI: 0.41-0.97) than urban boys. Girls and boys from high-poverty rural areas had lower odds of initiation and completion than did theircounterparts from high-poverty urban areas. Rural girls had lower odds of completing the HPV vaccine than their urban counterparts. Rural boys had lower odds than urban boys for HPV vaccination initiation and completion.

Associations between population based voting trends during the 2016 US presidential election and adolescent vaccination rates

BackgroundPolitics play a role in the dissemination of public health information, including immunization-related issues. We aim to describe relationships between HPV vaccination rates and state voting patterns during the 2016 US presidential election. MethodsWe classified each of the 50 states as either “Red” or “Blue,” based on whether a higher proportion of the state’s casted votes were for the Republican or Democratic nominee during the 2016 US presidential election. State-specific HPV, Tdap, and meningococcal vaccination rates were obtained from the 2016-National Immunization Survey-Teen. State socio-demographic factors and HPV vaccine legislation were obtained from the US Census Bureau and National Conference of State Legislatures. Vaccination rates and socio-demographic variables were compared using independent t-tests. Multiple linear regression compared vaccination rates between “Red” and “Blue” states, adjusting for percentage of both uninsured children and educational attainment. ResultsCompared to “Blue” states, “Red” states had significantly lower unadjusted HPV vaccine series initiation (56% vs 66%, p < 0.05) and completion (39% vs 50%, p < 0.05) rates; yet had similar rates of Tdap (88% vs 89%, p > 0.05) and meningococcal (79% vs 83%, p > 0.05) vaccinations. After adjusting for potential confounders, the regression-adjusted mean rate for HPV vaccine initiation and completion remained significantly lower for “Red” states compared to “Blue” states (57% vs 65%, p < 0.05, and 41% vs 48%, p < 0.05, respectively). ConclusionHPV vaccination rates are associated with statewide-level voting patterns. Future interventions aimed at improving HPV vaccination rates should consider engaging local and national elected leaders to be proactive in disseminating accurate and authoritative immunization information.

Multi-level determinants to HPV vaccination among Hispanic farmworker families in Florida

ABSTRACT Background: HPV vaccination is the primary prevention method for HPV-related cancers, although among Hispanic populations, migrant farmworkers may experience exacerbated challenges to HPV vaccination due to intersecting political, social, and personal contexts. This study explored multi-level determinants of HPV vaccination among Hispanic migrant farmworker families. Methods: Using a community-engaged approach and guided by the socio-ecological model, Intervention Mapping, and PRECEDE-PROCEED constructs, we recruited parents who had a daughter and/or son age 9-15 years from a rural, faith-based, community organization in Florida. Three focus groups (n = 13) were conducted in Spanish and constant comparison methods were used to analyze qualitative data. Results: Micro-level determinants included moderate HPV vaccine knowledge, desire for more HPV vaccine information, concerns about HPV vaccine completion, health/preventive motivations, past experiences with the healthcare system, and parental gender roles related to health care. Macro-level determinants included facilitators (e.g. transportation services, clinics open after work hours, governmental programs) and barriers (e.g. supervisor/employment inflexibility, long clinic wait times) to accessing health care and vaccination in general (including HPV vaccination). Participants shared their preferences for future interventions that would meet the needs of this community, and discussed potential content and mechanisms for receiving HPV information, as well as what might facilitate their overall access, uptake, and completion of the HPV vaccine series. Discussion: Determinants to HPV vaccination emerged and underscore the importance of addressing the multi-level factors when designing and delivering an HPV vaccine intervention for this Hispanic migrant farmworker population. Improving HPV vaccination rates requires responding to situational and structural hardships that disproportionately impact this group. Thus, community-tailored and culturally appropriate multi-level interventions are needed, while emphasizing existing knowledge assets and preferences favorable towards HPV vaccination, with the ultimate goal of the decreasing HPV-related disparities. Findings suggest interventions must reach beyond the individual level to account for this unique population’s lived experiences.

Abstract C91: Exploring the role of social determinants on HPV vaccine intentions and uptake among ethnoracial minority college students

Abstract Background: HPV-related diseases and cancers disproportionately affect low-income and ethnoracial minorities. HPV vaccines have the potential to reduce ethnoracial disparities in HPV-related diseases and cancers; however, HPV vaccine uptake has remained sub optimal. To achieve the greatest impact, public health campaigns should focus on improving HPV vaccine coverage where it is weakest. They should also explore more subtle but potentially significant determinants of HPV vaccine initiation and completion. The social determinants of health approach may be useful in explaining the disparities in HPV vaccine uptake rates. Methods: Ethnoracial minority male and female college students (n=956) recruited from a large public university in the southeast US completed a 20-minute web-based survey in the fall of 2011. Survey items were adapted from previous research of psychosocial HPV studies among men and women, and were based on constructs from the Health Belief Model and Social Cognitive Theory. This analysis examined self-reported data on participants' sociodemographics, HPV knowledge, HPV vaccine status, intent to receive HPV vaccination, and the importance of health provider recommendation for the HPV vaccine. Univariate analyses examined the sample distribution; bivariate analyses were conducted to examine the relationship between sociodemographics and HPV knowledge, intent, and importance of provider recommendation; and multinomial logistic regression analysis examined associations between the importance of a provider to recommend the HPV vaccine and HPV-related variables previously listed in the bivariate analysis. Results: The mean age of the sample was 23.6 years (SD=6.629) years. The sample was mostly women (74.4%), Hispanic or Latino/a (46.3%), not married (75.4%), insured (76.9%), and completed 2 years or less of college (41.9%). Frequency distributions indicated that 88.5% reported that they were knowledgeable about HPV, 79.7% reported that they were knowledgeable about the HPV vaccine, and 62.1% had a place where they could receive the vaccination. In addition, 29.6% of the sample reported receiving at least 1 dose while 22.7% of the sample reported that they intend to get the HPV vaccine. Bivariate analyses showed that participants most likely to have previous HPV knowledge were women (91.8%; p &amp;lt; 0.001) and participants with an undergraduate or graduate degree (92.2%; p = 0.036). Participants who were most likely to have previous HPV vaccine knowledge were most likely to be women (86.8%; p &amp;lt; 0.001), possess an undergraduate or graduate degree (88.7%; p=0.001), and married (87.7%; p &amp;lt; 0.001). Participants who reported having received at least one dose were more likely to be women (37.7%; p &amp;lt;0.001), have completed 2 years of college or less (35.7%; p &amp;lt;0.001), and not married (31.8%; p=0.01). Those who had 2 years of college or less (27.9%; p&amp;lt;0.001) and not married (25.2%; p=0.01) were more likely to intend to get the HPV vaccination compared to participants with more education and married, respectively. Participants who indicated that the importance for a health care provider to recommend the HPV vaccine was very important were most likely to have 2 years of college or less (52.9%; p=0.02).Multinomial logistic regression analysis showed that participants who do not believe that the provider recommendation is important or somewhat important were less likely to have received a dose of the vaccine (p&amp;lt;0.001), and less likely to have a place to receive the vaccination (p=.008; p=.003, respectively). Conclusions: As ethnoracial minorities continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent HPV-related disparities. Taking a social determinants of health approach in HPV-related disease and cancer prevention will be necessary to achieve equity and eliminate HPV-related disparities. Citation Format: Natalie D. Hernandez, Dexter Cooper, Stephanie Kolar, Christopher Wheldon. Exploring the role of social determinants on HPV vaccine intentions and uptake among ethnoracial minority college students [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C91.

IN1 - Using Electronic Health Records to Examine HPV Vaccine Initiation and Completion Rates

IN1 - Using Electronic Health Records to Examine HPV Vaccine Initiation and Completion Rates

PHS94 - Differences in HPV Vaccine Uptake by Nativity Status Among American Men Aged 18-32

About 16,500 HPV-associated cancers occur in the United States annually among men. HPV is thought to be responsible for more than 90% of anal, 70% of oropharynx and 60% of penile cancers. HPV vaccination reduces the risk of infection from the most common HPV types that cause HPV-associated cancers. There is limited research on vaccination uptake among men based on nativity status (i.e., U.S.- versus foreign-born). We examined whether there were significant differences in HPV vaccination uptake between U.S.-born and foreign-born men. The National Health Interview Survey 2014-2016 was examined for men, aged 18–32 years (n =6598). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of the three doses. Weighted, multivariable binary logistic regression models were used to assess the association between nativity status and HPV vaccine uptake, adjusting for demographic, socioeconomic, and healthcare factors. Approximately 16% of men self-identified as foreign-born, 8% had initiated the HPV vaccine, and 3% had completed the HPV vaccine. After adjusting for covariates, compared to U.S.-born men, foreign-born men were 47% [(adjusted odds ratio) 0.53; (95 % confidence interval) 0.36–0.78] less likely to initiate the HPV vaccine but there were no difference between the two groups in terms of vaccine completion. Men were more likely to initiate and complete the HPV vaccine if they had visit the doctor’s office 6+ times (3.13; 2.16–4.53), and 1-5 times (1.84; 1.42–2.39) vs. no doctor’s office within the last 12 months. The results held for HPV vaccine completion. We found that HPV vaccine uptake among men was very low overall, and foreign-born men had lower initiation compared to US born men. Public health interventions to improve HPV vaccination need to be developed for all men irrespective of nativity status.

A Learning Collaborative Model to Improve Human Papillomavirus Vaccination Rates in Primary Care

ObjectiveHuman papillomavirus (HPV) vaccination rates remain low, in part because of missed opportunities (MOs) for vaccination. We used a learning collaborative quality improvement (QI) model to assess the effect of a multicomponent intervention on reducing MOs. MethodsStudy design: pre-post using a QI intervention in 33 community practices and 14 pediatric continuity clinics over 9 months to reduce MOs for HPV vaccination at all visit types. Measures: outcome measures comprised baseline and postproject measures of 1) MOs (primary outcome), and 2) HPV vaccine initiation and completion. Process measures comprised monthly chart audits of MOs for HPV vaccination for performance feedback, monthly Plan-Do-Study-Act surveys and pre-post surveys about office systems. Intervention: providers were trained at the start of the project on offering a strong recommendation for HPV vaccination. Practices implemented provider prompts and/or standing orders and/or reminder/recall if desired, and were provided monthly feedback on MOs to assess their progress. Analyses: chi-square tests were used to assess changes in office practices, and logistic regression used to assess changes in MOs according to visit type and overall, as well as HPV vaccine initiation and completion. ResultsMOs overall decreased (from 73% to 53% in community practices and 62% to 55% in continuity clinics; P < .01, and P = .03, respectively). HPV vaccine initiation increased for both genders in community practices (from 66% to 74% for female, 57% to 65% for male; P < .01), and for male patients in continuity clinics (from 68% to 75%; P = .05). Series completion increased overall in community practices (39% to 43%; P = .04) and for male patients in continuity clinics (from 36% to 44%; P = .03). ConclusionsOffice systems changes using a QI model and multicomponent interventions decreased rates of MO for HPV vaccination and increased initiation and completion rates among some gender subgroups. A learning collaborative model provides an effective forum for practices to improve HPV vaccine delivery.

Early Outcomes of a Multilevel Human Papillomavirus Vaccination Pilot Intervention in Federally Qualified Health Centers

ObjectiveHuman papillomavirus (HPV) vaccine coverage in the United States remains low compared with other adolescent vaccines. As the largest primary care network in the United States, safety net clinics such as federally qualified health centers (FQHCs) serve patients at a disproportionate risk of HPV-related cancers. In this pilot project, the American Cancer Society (ACS) leveraged its primary care workforce to implement quality improvement interventions in the unique context of 30 FQHC systems across the country, including 130 clinic sites reaching >20,000 adolescents in a variety of geographic settings. MethodsFQHC systems were randomly selected to receive either a $90,000 2-year grant, a $10,000 3-month grant, or training and technical assistance without funding. All 3 intervention groups conducted provider training and education, completed a capacity assessment tool, and measured HPV vaccination rates. Annual HPV vaccine series initiation and completion rates for active, 11- to 12-year-old patients were measured to evaluate project outcomes. ResultsHPV vaccine series initiation rates among 11- to 12-year-old patients increased by 14.6 percentage points from a baseline of 41.2% before the intervention (2014) to the intervention year (2015). Changes in HPV second dose and series completion rates were not statistically significant. Meningococcal and tetanus, diphtheria, and acellular pertussis vaccination rates also increased significantly, by 13.9 and 9.9 percentage points from baseline rates of 49.1% and 52.5%, respectively. ConclusionsThe first year of this pilot project showed early success, particularly with HPV vaccine series initiation. On the basis of these promising results, ACS is expanding clinical quality improvement projects to increase HPV vaccination across the country.

Improving the Hpv Vaccine Completion Rate in Children Aged 12 Years in a Pediatric Resident-staffed Patient Centered Medical Home

Improving the Hpv Vaccine Completion Rate in Children Aged 12 Years in a Pediatric Resident-staffed Patient Centered Medical Home

Abstract 4221: Factors associated with HPV vaccination initiation and completion among 18-26 year olds in the United States

Abstract Background The HPV vaccine prevents HPV-associated cancers and genital warts, which cause significant morbidity and mortality in the US. While the vaccine is targeted toward 11-12-year-old boys and girls, there is a catch-up vaccination range up to 26 years. However, vaccination rates are very low among eligible young adults, aged 18-26 years, and besides college-related studies, not a lot is known about factors associated with the HPV vaccine uptake in this population. The aim of this study was to assess sociodemographic factors associated with HPV vaccination uptake in a nationally representative sample of 18-26-year-old adults. Methods The National Health Interview Survey 2014-2015 was examined for young adults, aged 18-26 years (n = 7588). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of the three doses. Sociodemographic factors included age, gender, race, marital status, education, health insurance, regular provider, number of doctor visits, and geographic region. Survey-weighted multivariable logistic regression models were used to examine the socio-demographic factors that were associated with HPV vaccine uptake. Results Approximately 27% of respondents had initiated the HPV vaccine and 16% had completed the HPV vaccine. After adjusting for covariates, compared to females, males were 81% less likely to initiate HPV vaccine [(adjusted odds ratio) 0.19; (95 % confidence interval) 0.16-0.23]. Other factors associated with HPV vaccine initiation included having health insurance (1.70; 1.32-2.18), visiting the doctor’s office 6+ times (1.86; 1.48-2.34) and 1-5 times (2.09; 1.56-2.81) vs. no doctor’s office within the last 12 months, and having no high school diploma (0.46; 0.32-0.64) and having high school diploma (0.40; 0.31-0.52) vs. college degree or higher. The same factors were associated with HPV vaccine completion; but, being black (0.60; 0.44-0.83) vs. white and having no usual place of care (0.74; 0.57-0.96) were also associated with lower odds of completing the vaccine series. Conclusions Our study shows that there are sociodemographic factors associated with HPV vaccine uptake among young adults in the United States, and males, individuals with a lower education, and those without adequate healthcare access are less likely to initiate and complete the HPV vaccination. Our findings suggest it is necessary to develop targeted interventions to promote HPV vaccination among those in the catch-up age range. Citation Format: Eric Adjei Boakye, Betelihem B. Tobo, Daphne Lew, Meera Muthukrishnan, Vy T. Pham, Rebecca Rohde, Thomas Burroughs, Mark A. Varvares, Nosayaba Osazuwa-Peters. Factors associated with HPV vaccination initiation and completion among 18-26 year olds in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4221. doi:10.1158/1538-7445.AM2017-4221