Human Papillomavirus Vaccine Completion Rates Research Articles

Optimizing Protection Against HPV-Related Cancer: Unveiling the Benefits and Overcoming Challenges of HPV Vaccination.

Human papillomavirus (HPV) vaccine is an underutilized tool in cancer prevention. HPV vaccine completion rates in adolescents age 13 to 15 years remain low at 59%. The HPV vaccine can prevent more than 90% of cases of cancer caused by HPV, including cervical, oropharyngeal, anal, penile, vulvar, and vaginal. HPV vaccine is very safe and effective, as demonstrated by numerous large-scale studies. Practice-based strategies can improve vaccination rates, such as having providers give a strong presumptive recommendation for the vaccine, using motivational interviewing for hesitant families, and using electronic health record reminders to prompt providers to offer it, among other interventions. Offering HPV vaccine starting at age 9 years is another evidence-based strategy to improve HPV vaccine completion rates, which has been shown to be acceptable to both providers and parents. [Pediatr Ann. 2024;53(10):e372-e377.].

Effect of an HPV Vaccination Multi-Level, Multi-Component Program on HPV Vaccination Initiation and Completion in a Pediatric Clinic Network.

Despite clear evidence of the public health benefits of the human papillomavirus (HPV) vaccine in preventing HPV-related cancers and genital warts, underutilization of HPV vaccination in the United States persists. Interventions targeting multi-level determinants of vaccination behavior are crucial for improving HPV vaccination rates. The study's purpose was to implement and evaluate the adapted Adolescent Vaccination Program (AVP), a clinic-based, multi-level, multi-component intervention aimed at increasing HPV vaccine initiation and completion rates in a five-clinic pediatric network in Bexar County, Texas. The adaptation process was guided by established frameworks and involved formative work with clinic stakeholders. The study utilized a quasi-experimental single group pre- and post- study design, with an external comparison data using the National Immunization Survey-Teen (NIS-Teen) datasets for the same time period to examine the AVP's effect on HPV vaccination initiation and completion. A series of interrupted time series analyses (ITSA) compared the clinic system patient outcomes (HPV vaccination initiation and completion rates) in the post-intervention to the general adolescent population (NIS-Teen). Of the 6438 patients (11-17 years) with clinic visits during the 3-year study period, HPV vaccination initiation rates increased from 64.7% to 80.2% (p < 0.05) and completion rates increased from 43.2% to 60.2% (p < 0.05). The AVP was effective across various demographic and economic subgroups, demonstrating its generalizability. ITSA findings indicated the AVP improved HPV vaccination initiation and completion rates in clinic settings and that AVP strategies facilitated resilience during the pandemic. The minimal adaptation required for implementation in a new clinic system underscores its feasibility and potential for widespread adoption.

HPV Multilevel Intervention Strategies Targeting Immunization in Community Settings (HPV MISTICS): Study protocol for a hybrid 1 stepped-wedge cluster randomized trial

BackgroundThis protocol paper describes the overall design for HPV MISTICS, a multilevel intervention to increase human papillomavirus (HPV) vaccination initiation and completion rates among adolescents aged 11–17. MethodsWe will conduct a hybrid type 1 implementation-effectiveness trial using a stepped-wedge cluster randomized trial in eight federally qualified health centers (FQHCs) in Florida. Intervention components target three levels: system, providers, and parents. Outcomes will be assessed using quantitative (e.g., vaccination data, survey data) and qualitative methods (e.g., staff and parent interviews). We expect to quantify changes in HPV vaccine series initiation and completion rates for adolescents ages 11–17 in the eight FQHCs. We have hypothesized a 20-percentage point increase in HPV vaccine series initiation and a 10-percentage point increase in series completion. We also anticipate being able to explore factors at the system, provider, and patient levels as potential covariates. Implementation outcomes, barriers, and facilitators identified in the study will help characterize the implementation process and inform potential future intervention scale-up. ResultsThe project is ongoing; effectiveness and implementation outcomes will be determined following project completion. ConclusionsFindings will provide evidence of an equity-informed research design and implementation procedures that could help improve HPV vaccination rates in similar health systems.Clinical trials identifier:NCT05677360 (date registered: 2022-12-22); https://clinicaltrials.gov/study/NCT05677360?lead=Moffitt%20Cancer%20Center%20&aggFilters=status:rec&page=2&rank=17

Assessing the long-term implications of age 9 initiation of HPV vaccination on series completion by age 13-15 in the US: projections from an age-structured vaccination model.

Routine human papillomavirus (HPV) vaccination in the US is recommended at ages 11 or 12 years and can be given at age 9. Vaccination completion rates among adolescents 13-15 years in the US remain below the 80% goal. This study evaluated the long-term effects of increasing proactive HPV vaccination initiation rates at age 9 years in completion rates of adolescents. An age-structured vaccination model was developed and parametrized based on the National Immunization Survey-Teen (NIS-Teen) survey data. The model projected vaccination coverage (by vaccination status and age group), for 20 years, for a routine initiation scenario (no increase in initiation rates of 9-year-olds) and different proactive initiation (increased age 9 initiation) scenarios. The time to reach a completion rate of 80% for 13-15-year-olds was estimated. The model also generated projections stratified for subgroups of interest. Results indicated that vaccine completion rates of 80% in 13-15-year-olds may not be achieved by 2040 under current trends of routine initiation at ages 11 or 12 years. However, increasing initiation rates in 9-year-olds by 1% and 3% annually could shorten the time to achieve 80% completion by 4 and 8 years, respectively. Stratification analyses showed that increasing initiation rates in 9-year-olds can also reduce disparities across subgroups in the time to achieve vaccination completion targets. Increasing HPV vaccination initiation rates in 9-year-olds by as little as 1%-3% annually may be an effective strategy to improve HPV vaccination completion rates in adolescents by age 15 and reach the Healthy People goal of 80% completion much earlier.

The roles of Human Papillomavirus (HPV) test awareness and knowledge in HPV vaccination initiation and completion among college students in the Deep South of the United States: applying the Andersen’s Behavioral Model

ABSTRACT Human papillomavirus (HPV) has the highest prevalence of all sexually transmitted infections in the United States (U.S.). Despite the effectiveness in preventing HPV-related cancers, HPV vaccination rates were still low among young adults. Thus, this study aimed to (1) investigate HPV vaccination initiation and completion rates among college students, (2) examine relevant factors associated with HPV vaccine initiation and completion. A convenient sample of 327 college students was recruited from universities in the Deep South of the U.S. via online surveys. Logistic regressions were conducted to examine factors associated with HPV vaccination initiation and completion. About 54% of participants in the current study initiated HPV vaccination, and most of the participants who initiated the vaccination completed the series (52%). Participants who were female (odds ratio [OR] = 3.01, confidence interval [CI] = 1.38 to 6.58; OR = 2.28, CI = 1.07 to 4.85), aware of the HPV tests (OR = 16.53, CI = 5.60 to 48.83; OR = 7.36, CI = 2.99 to 18.13), and aware that ‘men should have HPV vaccination’ (OR = 2.33, CI = 1.07 to 5.09; OR = 3.27, CI = 1.50 to 7.12) were more likely to initiate the HPV vaccination and complete the vaccine series. The finding that only half of the students initiated and completed the HPV vaccine series indicates that further studies and intervention strategies are needed. Particular attention should be focused on college student populations who are male and with little HPV health knowledge.

Human papillomavirus vaccination uptake in the Rio Grande Valley of Texas: Results from a pilot community‐based educational and school‐based vaccination program

AbstractObjectiveTo pilot and evaluate a combined community‐based education and middle school‐based human papillomavirus (HPV) vaccination program in a rural, medically underserved Texas area.MethodsThe study included 2276 students enrolled at three Rio Grande City Grulla Independent School District, (RGCGISD, formerly Rio Grande City Consolidated Independent School District) middle schools (08/2016–02/2020). The intervention took place in a middle school setting with the community‐based, physician‐led HPV education campaign starting in 08/2016, and a school‐based vaccination program (Phase 1: 08/2017; Phase 2: 08/2018). Pre‐ and postintervention HPV vaccination rates were tracked against 2016 National Immunization Survey‐Teen rates (target: initiation 49.3%; completion 32.9%). Summary statistics were stratified by middle school.ResultsIn 2016, HPV vaccine initiation and completion rates for RGCGISD were lower than the national average (39.7% and 17.9%, respectively). In 2020, the overall HPV vaccine initiation rate increased by 58.0% (from 39.7% to 68.5%) and completion rates doubled (from 17.9% to 42.1%). The median age at HPV vaccine initiation and HPV vaccine completion (range) were 11.2 years (9–15) and 12 years (9–15). The median interval between HPV vaccine doses (range) was 287 days (36–1576). There were different between males and females among the three middle schools.ConclusionsMiddle schools serve as a feasible, effective interventional setting for delivering and increasing HPV education and vaccine uptake among adolescents, which offers substantial long‐term health benefits.

The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study

The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age. Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population. We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015. We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001). Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates.

Quality Improvement Project to Increase Human Papillomavirus Two-Dose Vaccine Series Completion by 13 Years in Pediatric Primary Care Clinics

PurposeThe human papillomavirus (HPV) causes genitourinary and oropharyngeal cancers. The HPV vaccine is safe and effective in preventing those diseases; however, vaccine series completion rates remain low in the United States. Our quality improvement (QI) project aimed to increase HPV-vaccination series completion rates to 70% from 2017 to 2020 for the 13-year patient population in an extensive academic pediatric primary care network that serves predominantly minority and Medicaid-insured children in Columbus, OH. MethodsThe outcome measure was the percentage of 13-years Nationwide Children's Hospital Primary Care Network patients who completed the two-dose vaccine series by their 13th birthday. Four QI implemented interventions were utilized. Electronic medical records alert informed providers when the HPV vaccines are due. We studied monthly data for the network and for individual clinics using statistical process control, displaying data on a control chart. We followed two process measures, captured opportunity rate, and the number of HPV vaccines given. ResultsWe substantially increased HPV-vaccination series completion rates overall in the 13-year teen population from 27% to 65%, and three clinics reached the 70% goal for at least one quarter. Latino children had the highest completion rate of 80% and White children had the lowest completion rate at 64%. DiscussionOur QI project used four measures to improve HPV-vaccination series completion rates in the 13-year patient population that serves minority and low-income teens predominantly. Further QI studies are needed to improve HPV vaccine completion rates in teens.

Factors Affecting Completion of Human Papillomavirus Vaccination Series by Gender in a Predominantly Hispanic Border Town Community.

The human papillomavirus (HPV) vaccine is recommended for females and males aged 9 to 45. Nationally, the HPV vaccination rates are lower for males than females; however, this has not been studied in a US-Mexico border community. Our study aims to report the HPV vaccination completion by gender and determine which sociodemographic factors influence vaccination. This cross-sectional study was conducted among uninsured and underinsured individuals aged between 9 and 26 years served through a community-based HPV vaccine program in El Paso, TX. Data collected included demographic information, psychosocial variables, and vaccine administration data. Descriptive statistics were used to summarize demographic data. Unadjusted t test/Fisher exact test and multivariable relative risk regression were run on significant variables to determine the association with vaccine completion by gender. Most participants were female (63.4%), and an overall vaccine series completion was 30.67%. We found no significant difference in HPV vaccine completion rates by gender. Males who resided in the United States for more than a decade were 31% more likely to complete the vaccine series, and females who had 9 to 13 years of education had lower odds of vaccine completion. Knowledge significantly increased after the intervention for both genders (p = .002). There was no significant change in psychosocial variables from the preintervention to the immediate postintervention survey. Our multicomponent, culturally tailored intervention may equally impact male and female participants and encourages all genders to complete their HPV vaccine series. Additional studies with a larger male sample are needed.

Integrated Health Maintenance Reminders for Improved HPV Vaccine Administration: TowardImprovements in Completion Disparities.

To evaluate the effect of a health maintenance reminder (HMR) on human papillomavirus (HPV) vaccine administration and completion across different age, insurance, and race cohorts. Retrospective pre-post analysis. Academic primary care. Patients aged 9 to 26 who had initiated the HPV vaccine series from 2016 to 2021 were analyzed, based on current age-based standards. The cohort was divided based on vaccine uptake before and after the implementation of the HMR program in February 2020. The multivariate analysis estimated the odds of vaccine completion based on sociodemographic factors, and variable interactions were investigated to determine independent associations between sociodemographic factors and HMR implementation. There were 7654 individual patients (mean age was 15.8 years; 46.7 were males; and 50.7% were white). HPV vaccine completion rates increased post-HMR implementation by 59.2% (37% pre-, and 58.9% post-HMR; p < .001) in the entire cohort. Overall, black patients (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.60, 0.70) and patients ≥18 years (aOR = 0.13; 95% CI: 0.11, 0.15) were significantly less likely to complete their vaccine series; however, this improved significantly following HMR in these groups (p < .001). Post-HMR, race, and insurance status were not independently associated with disparate vaccine completion rates, however,age was, and patients ≤14 or younger had higher odds of vaccine completion (aOR = 3.54; 95% CI: 2.91, 4.32). The implementation of an HMR was associated with increased HPV vaccine uptake across age and race groups in this single-institution study. Future research should explore barriers to implementing HMRs in different health care settings.

Impact of a Multi-Level, Multi-Component, System Intervention on HPV Vaccination in a Federally Qualified Health Center.

Human papillomavirus (HPV) vaccines can significantly reduce the burden of HPV-associated cancers, but remain underutilized. We evaluated a multi-component, system-level intervention to improve HPV vaccination in a large Federally Qualified Health Center (FQHC) that serves a primarily low income Latino population. From January 2015 through March 2017, we evaluated the effectiveness of a multi-component, system-level intervention to improve HPV vaccination rates in eight clinics randomly assigned to study condition (four intervention, four usual care). The intervention included parent reminders for HPV vaccine series completion, provider training, clinic-level audit and feedback, and workflow modifications to reduce missed opportunities for vaccination. Using a difference-in-differences approach, we compared HPV vaccination rates among patients, ages 11 to 17 during a 12-month preintervention period and a 15-month intervention period. Linear mixed models were used to estimate intervention effects on vaccine initiation and completion. The sample included approximately 15,000 adolescents each quarter (range 14,773-15,571; mean age 14 years; 51% female, 88% Latino). A significantly greater quarterly increase in HPV vaccine initiation was observed for intervention compared with usual care clinics (0.75 percentage point greater increase, P &lt; 0.001), corresponding to 114 additional adolescents vaccinated per quarter. The intervention led to a greater increase in HPV vaccine completion rates among boys (0.65 percentage point greater increase, P &lt; 0.001), but not girls. Our system-level intervention was associated with modest improvements in HPV vaccine initiation overall and completion among boys. Study findings have implications for reducing HPV-related cancers in safety net populations.

152. Factors Impacting HPV Vaccination Rates Among Minority Adolescents and Young Adults (AYA)

In 2018, there were 43 million Human papillomavirus (HPV) infections, majority were among adolescent and young adults (AYA). To decrease risk of HPV, individuals aged 9-26 years old should get vaccinated. However, vaccination rates have remained stagnant in the last several years. There are racial/ethnic and gender disparities in knowledge, awareness, and overall vaccine uptake. Cost of the vaccine is a barrier to vaccine uptake among uninsured AYA. The purpose of this is to examine factors impacting HPV vaccination uptake and completion rates among AYA utilizing a clinic-system located in Southeast Texas. The setting was a nine-clinic system that, through state funds, provides free preventive primary and reproductive health services to >10,000 Medicaid, low-income, and uninsured AYA ages 13 – 24 years old annually. Services include free immunizations including the HPV vaccine. Majority (97.9%) of patients fall below the 250% Federal Poverty Level threshold and 96% belong to racial/ethnic minority groups. We retrospectively collected demographic information, immunization status, and billed services data among clinic AYAs from March 2018 to December 2020. We set statistical significance at p < 0.05. A total of 19,045 AYAs were seen between March 2018 and December 2020 with 2,258 HPV vaccines administered and 3,119 having completed their HPV vaccination series. There were statistically significant differences in HPV vaccine uptake between females and males (6.7% vs. 3.2%, respectively), minors and adults (6.9% vs. 3.1%, respectively), and between school-based and community-based clinic locations (7.8% vs. 2.1%, respectively). Around 49% of AYAs who received an HPV vaccine also received additional vaccines during their visit versus 51% who only got the HPV vaccine. Additionally, those who had any sexually transmitted infection screening during the visit had a lower HPV administration rate than those who did not have an STI screening (2.3% vs. 5.6%, respectively). A logistical regression model found age, income, sex, clinic location type and having additional vaccines given during the visit were significantly correlated with receiving an HPV vaccine (R2=0.28). There were statistically significant differences in series completion between females and males (17.7% vs. 12.7%, respectively), minors and adults (19.3% vs. 15.3%), and clinic location type (27.0% vs. 10.9%). A logistical regression model found age, income, sex, and clinic location type were significantly correlated with series completion (R2=0.06). However, both logistical regression models had negligible to weak correlation meaning there are additional factors impacting HPV vaccination uptake and series completion. Clinic HPV completion rates were lower than state and national averages. Some barriers may be the lack of vaccine records for AYAs that access primary care elsewhere, and health seeking behavior specifically for sexual health. The findings support policies such as removing cost barriers, and creative strategies including gender-neutral and school-based sexual health messaging that includes HPV vaccine promotion as it may provide a critical time window for AYA to get vaccinated earlier. Targeting AYA who only utilize reproductive health care may be another tactic to reach unvaccinated AYA. Future studies should explore other factors such as systems-related factors impacting HPV vaccination uptake and series completion.

HPV vaccination and factors influencing vaccine uptake among people of Indian ancestry living in the United States.

Approximately one-quarter of annual global cervical cancer deaths occur in India, possibly due to cultural norms promoting vaccine hesitancy. We sought to determine whether people of Indian ancestry (POIA) in the USA exhibit disproportionately lower human papilloma virus (HPV) vaccination rates than the rest of the US population. We utilised the 2018 National Health Interview Survey to compare HPV vaccine initiation and completion rates between POIA and the general US population and determined factors correlating with HPV vaccine uptake among POIA. Compared to other racial groups, POIA had a significantly lower rate of HPV vaccination (8.18% vs. 12.16%, 14.70%, 16.07% and 12.41%, in White, Black, Other Asian and those of other/mixed ancestry, respectively, P = 0.003), but no statistically significant difference in vaccine series completion among those who received at least one injection (3.17% vs. 4.27%, 3.51%, 4.31% and 5.04%, P = 0.465). Among POIA, younger individuals (vs. older), single individuals (vs. married), those with high English proficiency (vs. low English proficiency), those with health insurance and those born in the USA (vs. those born outside the USA) were more likely to obtain HPV vaccination (P = 0.018, P = 0.006, P = 0.029, P = 0.020 and P = 0.019, respectively). Public health measures promoting HPV vaccination among POIA immigrants may substantially improve vaccination rates among this population.

Human papillomavirus vaccination uptake among Native Hawaiian and Pacific Islander adults in the United States

PurposeTo examined human papillomavirus (HPV) vaccination rates and identified factors that are associated with HPV vaccination among Native Hawaiian and Pacific Islander (NHPI) young adults aged 18–34. MethodsData from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey were analyzed. The outcome variables were HPV vaccination initiation (receipt of ≥1 dose) and completion (receipt of ≥3 doses). Multivariable logistic regressions were used to identify socio-demographic, healthcare access and utilization factors that were associated with HPV vaccination. ResultsA total of 663 adults were included in the study. The overall HPV vaccination initiation and completion rates were 17.6% and 7.9%, respectively. Most of the respondents who had initiated and completed the vaccine were women, of multiple race, un-married, had some college or associate degree, insured, and had a usual place of getting care. In the weighted multivariable models, men were less likely to initiate (AOR = 0.21, 95% CI = 0.12, 0.34) and complete (AOR = 0.16, 95% CI = 0.07, 0.34) the HPV vaccination compared with women. ConclusionsThe low HPV vaccination coverage found in this study signals the need for more evidence-based, culturally relevant immunization and cancer prevention interventions for NHPIs. Failure to improve HPV vaccination rates may increase the burden of HPV associated preventable cancers among NHPIs and broaden disparities.

The mediating role of vaccine hesitancy between maternal engagement with anti- and pro-vaccine social media posts and adolescent HPV-vaccine uptake rates in the US: The perspective of loss aversion in emotion-laden decision circumstances

While Human Papillomavirus (HPV) is a prominent cause of cervical cancer and mortality among underserved women, HPV vaccine completion rates remain stagnant (54%) among US adolescents. Our objective is to identify how adolescents' mothers' engagement with anti-vaccine versus pro-vaccine social media content is associated with their children's HPV vaccination rates via increased vaccine hesitancy. We employ the notion of loss aversion escalated in an emotion-laden circumstance in consumer behavior literature given that HPV vaccination decisions directly affect children's well-being. Based on this escalated loss aversion tendency for an emotion-laden decision, we explain why anti-vaccine content disproportionately increases mothers' overarching vaccine hesitancy, while pro-vaccine content does not decrease vaccine hesitancy. We conducted a population-based survey among 426 mothers of US adolescents aged 13–18. Our sample closely mimics the socioeconomic and demographic factors of the population group of mothers of adolescents in the US census. Our results show that anti-vaccine social media posts are associated with increases in mothers' overarching vaccine hesitancy and with decreases in their children's HPV vaccination rates, while pro-vaccine content has no significant association with either.

Cervical Cancer Screening and Human Papillomavirus Vaccination among Korean Sexual Minority Women by Sex of Their Sexual Partners.

Cervical cancer-preventive behaviors in Korean sexual minority women (SMW) are underexplored. We aimed to assess the differences in cervical cancer screening uptake and completion of human papillomavirus (HPV) vaccination among Korean SMW by sex of their sexual partners. This cross-sectional study used data from the 2017 Korean Sexual Minority Women’s Health Study; we included Korean lesbian and bisexual women aged ≥20 years. They were divided into three groups: SMW with more than one male sexual partner (male only/both), SMW with only female sexual partners (female-only), or no sexual partner (no partner). Among the 671 participants, 266 (39.6%), 294 (43.8%), and 111 (16.5%) belonged to the male-only/both, female-only, and no partner groups, respectively. Compared to the male-only/both group, the female-only group was significantly less likely to have undergone cervical cancer screening (Adjusted odds ratio (AOR) = 0.24, 95% confidence interval (CI) = 0.15–0.37) and to have completed HPV vaccinations (AOR = 0.58, 95% CI = 0.37–0.91). In conclusion, Korean SMW with only female sexual partners had lower cervical cancer screening and HPV vaccination completion rates than SMW who had male sexual partners. More extensive efforts are needed to improve cervical cancer-preventive behaviors among Korean SMW.

Abstract PO-273: Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy

Abstract Background: The human papillomavirus (HPV) virus is a known pathogen and carcinogen causing deadly cancers of the genitalia and head and neck. The HPV vaccine is a safe, effective cancer-preventing vaccine recommended for girls and boys at ages 11-12. Full HPV vaccine coverage is available through health insurance plans and the state of California, yet no data were readily available to describe California state-wide coverage of HPV vaccination. The Data Workgroup of the California HPV Vaccination Roundtable aimed to map State-level HPV vaccine coverage. Methods: Workgroup collected, analyzed, and mapped 2018 HPV vaccination data from the NIS-T survey, quality performance metrics from public and private health plans, and the statewide CAIR. NIS-T provides state-level estimates of routine adolescent vaccines, including HPV. Performance data were obtained from Medi-Cal and commercial health plans, administrative claims, and medical records. CAIR contains individual-level, provider-reported immunizations. HPV vaccination coverage for adolescents were estimated at the state and county level. Maps of county-level HPV vaccination and HPV-related cancer rates were built. Results: Rates of HPV-related cancers ranged from 6-12 per 100,000. Regarding HPV vaccination, there were considerable variation in the metrics and limitations of each data source, therefore estimates are not easily comparable. CAIR estimates of HPV vaccination coverage (28%) are lower than those for Medi-Cal managed care (45%) and commercial HMO members (50%). In 2018, aggregated results showed that overall 50% of 13 year old were vaccinated. We observed in the CAIR data that boys and girls are vaccinated at similar rates. However, significant county/regional HPV vaccination rates exist ranging from 9% (rural, northern) to 55% (urban, western). Northern, rural country have both the lowest HPV vaccination completion rates for 13-year-olds (9%), and the highest HPV-attributable cancer rates in the state (12 cases per 100,000 persons. Race/ethnic variations exist for HPV vaccination and HPV- related cancers–especially cervical cancer. Conclusions: This state-level data report approach may facilitate practice and policy action and help other states in developing their own reports for HPV vaccine improvements. Stakeholders are encouraged to utilize this Report when planning HPV vaccination interventions. We recommend that health systems: 1) assess HPV vaccination rates for 13-year-olds, 2) establish data exchange with CAIR, 3) implement recommended strategies to improve coverage, 4) collaborate with health plans and clinicians and 5) partner with community advocacy groups and clinic/hospital parent/patient advisory groups to improve data accuracy, as well as reduce HPV vaccine hesitance and promote at least 80% HPV vaccination completion by 2026. Citation Format: Jaime Adler, Raquel Arias, Kimlin Tam Ashing, Shauntay Davis-Patterson, Hilary Gillette-Walch, Jeffrey Klausner, Jim Knox, Beverly Mitchell, Autumn Ogden-Smith, Jane Pezua, Rita Singhal, Hoa Su. Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-273.

Barriers to Human Papillomavirus Vaccine Uptake Among Racial/Ethnic Minorities: a Systematic Review.

Human papillomavirus (HPV) is associated with poor health outcomes, including cervical cancer. Racial/ethnic minority populations experience poor health outcomes associated with HPV at higher rates. A vaccine is available to protect against HPV infections and prevent HPV-related sequelae; however, vaccination rates have remained low in the United States (U.S.) population. Thus, there is an urgent need to increase the HPV vaccination rate. Moreover, little is known about barriers to HPV vaccination in racial/ethnic minority groups. This paper highlights the most recent findings on barriers experienced by these groups. The PubMed database was searched on July 30, 2020, for peer-reviewed articles and abstracts that had been published in English from July 2010 to July 2020 and covered racial/ethnic disparities in HPV vaccination. Similar findings were observed among the articles reviewed. The low HPV vaccination initiation and completion rates among racial/ethnic minority populations were found to be associated with lack of provider recommendations, inadequate knowledge and awareness of HPV and HPV vaccination, medical mistrust, and safety concerns. Provider recommendations and accurate distribution of information must be increased and targeted to racial/ethnic minority populations in order to bolster the rate of vaccine uptake. To effectively target these communities, multi-level interventions need to be established. Further, research to understand the barriers that may affect unvaccinated adults in the catch-up age range, including males, may be beneficial, as majority of the previous studies focused on either parents of adolescents or women.

Abstract A123: Legislation by states and its impact on factors causing divergence in HPV vaccination coverage: Analysis of 2013-2017 National Immunization Survey - Teens (NIS-TEENS)

Abstract Background: Human papilloma virus (HPV) is strongly associated with multiple cancer types, affecting women, men and children of all races, ethnicities and backgrounds. HPV causes more than 30,000 cases of cancer every year and more than 70% of U.S population will experience at-least one HPV infection at some point. School-entry mandates and public health education campaigns though being separate entities, have significantly increased vaccine uptake, reduced disease prevalence and decreased racial disparities in disease rates. Furthermore, improvements in immunization against HPV are not equally distributed across gender, age, demographic and socioeconomic divisions within the recommended group of vaccine recipients. Objectives: To analyze and report the association between state-level policies and HPV vaccination uptake. We further explore predictors of HPV vaccination uptake using Aday &amp; Anderson’s behavioral theory of healthcare utilization. Methods: A repeated cross-sectional survey of NIS-Teens data from 2013-2017 was used for the analysis. Bivariable associations and multivariable ordered logistic regression models were statistically performed using STATA 15/IC &amp; SAS v9.4. Results: HPV vaccination completion rates were 17% higher in teens who lived in states with a legislative mandate irrespective of policy enactment. Relative to males, females had 72% higher odds of uptake. Compared to whites, Non-Hispanic blacks had a 21% lower odds of vaccination uptake. Compared to western region of the US, the north-east region reported 1.47 times higher odds of HPV vaccination. Provider recommendation was also significantly associated with HPV vaccination coverage rates. Conclusion: State legislative mandates had a profound impact of vaccination uptake. Additionally, racial minorities were significantly less likely to receive vaccination. Analysis of statewide adaptation of policy related bills and federal funding on VFC (Vaccine For Children) program could further inform those policy initiatives with the greatest uptake of vaccination. Citation Format: Radhika Ranganathan, Peyin Hung, Swann Arp Adams, Nicole L Hair, Shiba Simon Bailey. Legislation by states and its impact on factors causing divergence in HPV vaccination coverage: Analysis of 2013-2017 National Immunization Survey - Teens (NIS-TEENS) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A123.

Abstract C084: Geographic variation in human papillomavirus (HPV) vaccination initiation and completion among adults in the United States

Abstract Background: Approximately 43,000 human papillomavirus (HPV)-associated cancers and 350,000 genital warts are diagnosed annually in the United States. The HPV vaccine can prevent HPV-associated cancers and genital warts. The Advisory Committee on Immunization Practices recommends routine HPV vaccination for adolescents between 11 and 12 years of age, and catch-up vaccination up to 45 years recently. Despite the availability, safety, and efficacy of HPV vaccines, uptake has been suboptimal compared to other routine vaccinations in adolescents, and even worse for adults in the catch-up group. As little is known about geographic variation in HPV vaccine uptake among adults, we explored how HPV vaccine initiation and completion rates among 18–34 year olds (both men and women) varies by geographic region. Methods: We analyzed data from 16 states (Alabama, Arkansas, Connecticut, Georgia, Hawaii, Massachusetts, Mississippi, Missouri, New Hampshire, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Texas, and West Virginia) which conducted the adult HPV module survey during 2015–2017 Behavioral Risk Factor Surveillance System. Two variables were used to define geographic region: census region (South, Northeast and Midwest/west) and residential area (urban and rural). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of three doses. Weighted, multivariable binary logistic regression models were used to assess the association between geographic region and HPV vaccine uptake, adjusting for demographic, socioeconomic, and healthcare utilization factors. Results: A total of 18,078 adults were included in the study, of whom 80% resided in the South. The overall HPV initiation and completion rates were 23.4% and 11.0%, respectively. Vaccine initiation was higher among those who resided in the Northeast (38.6%) followed by Midwest/west (23.8%) and lowest for those in the South (21.8%). But initiation rates was similar between those who reside in urban (24.1%) and rural (21.0%) areas. Completion rates followed the same trend as initiation for both census region and residential area. In the adjusted models, compared to adults residing in the South, those living in the Northeast were more likely to initiate (adjusted odds ratio: 2.14; 95 % CI: 1.81–2.53) and complete (1.80; 1.47–2.20) the HPV vaccine. There were no significant differences observed for initiation or completion by residential area. Conclusions: Both the South and the Northeast have low HPV vaccination initiation and completion rates compare to the Healthy People 2020 goal of 80%, but vaccine uptake were significantly lower in the South region. No difference in HPV vaccine uptake was observed between the rural and urban areas. This demonstrates the need to develop and implement interventions programs to reduce geographical disparities in HPV vaccine uptake and ultimately to improve HPV vaccine uptake, especially in the South region. Citation Format: Eric Adjei Boakye, Maggie Wang, Wiley D Jenkins, Nosayaba Osazuwa-Peters, Oluwole Babatunde, Min Jee Lee, Minjin Kim. Geographic variation in human papillomavirus (HPV) vaccination initiation and completion among adults in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C084.