Human Papillomavirus Vaccine Initiation Research Articles

The Effects of Motivational Interviewing on Promoting Human Papillomavirus Vaccination Initiation and Completion Among South Asian Mother/Daughter Dyads: A Pilot Randomised Controlled Trial.

Vaccination against HPV is an effective strategy for the prevention of HPV infection and cervical cancer. Nevertheless, the HPV vaccine uptake rate is low among ethnic minorities in Hong Kong. This study sought to assess the feasibility and acceptability of motivational interviewing among South Asian mother-daughter dyads and to preliminarily examine its effects on knowledge of HPV infection and vaccination, health beliefs, intention to have the daughters vaccinated, and initiation and completion of HPV vaccine series. This was a pilot randomised controlled trial. Forty South Asian mothers with at least one daughter aged 9 to 17years were recruited. The intervention group received a motivational interviewing intervention whereas the control group received usual care. Structured questionnaires were used to collect data on the participants' characteristics and selected outcome variables. Bias-corrected Hedges' g and rate difference together with their 95% confidence intervals were calculated to estimate the effect sizes of the intervention on the outcomes The acceptability was assessed via semi-structured interviews. A larger proportion of the daughters of the intervention group participants had received the first dose of HPV vaccine (95% [19 out of 20]) vs 0% [0 out of 20]). The intervention group showed greater improvement in knowledge at 3months after the intervention (Hedges' g = 0.77 (95%CI:0.13-1.41)). Most interviewees were satisfied with the intervention. The intervention was feasible and acceptable. The intervention can help to increase South Asian mothers' knowledge and to increase the initiation of HPV vaccine series by their daughters. This study was registered at the Chinese Clinical Trial Registry (ChiCTR2100052751) on 5 November 2021.

Socioeconomic/health-related factors associated with HPV vaccination initiation/completion among females of paediatric age: A systematic review with meta-analysis.

To systematically identify, appraise, and summarise published evidence on individual socioeconomic and health-related factors associated with human papillomavirus (HPV) vaccination initiation and completion among females of paediatric age. A global systematic review with meta-analysis (PROSPERO: CRD42023445721). We performed a literature search in December 2022 and supplemented the search on August 1, 2023. Appropriate data were pooled using an inverse variance, random-effects model and the results were expressed as odds ratios, with 95% confidence intervals. A statistically significant point pooled increased/decreased odds of 30-69% was regarded to be strongly associated, and ≥70% was very strongly associated. We included 83 cross-sectional studies. Among several significantly associated factors, being an older girl: 1.67 (1.44-1.93), having health insurance: 1.41 (1.16-1.72), and being in a public school: 1.54 (1.05-2.26) strongly increased the odds of vaccination initiation, and nativity in the country of study: 1.82 (1.33-2.50), use of contraception: 2.00 (1.16-3.46), receipt of influenza vaccination: 1.75 (1.54-2.00) and having visited a healthcare provider: 1.85 (1.51-2.28) in the preceding year very strongly increased the odds of vaccination initiation. Likewise, being an older girl: 1.36 (1.23-1.49) and having visited a healthcare provider in the preceding year: 1.46 (1.05-2.04) strongly increased the odds of vaccination series completion, and school-based vaccination: 3.08 (1.05-9.07), having health insurance: 1.72 (1.27-2.33), and receipt of influenza vaccination in the preceding year: 1.72 (1.62-1.83) very strongly increased the odds of vaccination series completion. We made similar observations when the studies were limited to the United States. Several individual socioeconomic/health-related factors may determine initiating and completing the HPV vaccination series among paediatric females. These factors provide insights that may be key to identifying girls at increased risk of not being vaccinated and may aid targeted public health messaging.

HPV Vaccination Stages and Associated Factors Among Children of Immigrant Women.

This study aimed to identify key determinants by stage of implementation of human papillomavirus (HPV) vaccination among children of immigrant women in South Korea. Cross-sectional descriptive study. The sample comprised 262 Chinese, Vietnamese, and Korean-Chinese women with children living in South Korea. The survey was conducted using self-report questionnaires. The HPV vaccination levels in children were classified into four transition stages. Sequential logistic regression analysis was conducted to identify the factors affecting the transition of HPV vaccination status. Social norms had the greatest influence on the intention to vaccinate. Perceived barriers were a significant factor associated with intention or initiation of vaccination, whereas perceived severity and susceptibility were associated with the intention and initiation stages, respectively. Upon the initiation of HPV vaccination, low perception of discrimination in healthcare was associated with continued vaccination. Given the importance of completing multiple doses of the HPV vaccine within a given timeframe, it is important to provide culturally appropriate interventions in stages to prevent dropouts.

Accountable care organizations and HPV vaccine uptake: a multilevel analysis.

To examine associations between accountable care organization (ACO) membership and human papillomavirus (HPV) vaccination and to evaluate variation in HPV vaccination across ACO providers. Retrospective cohort study. We analyzed the records of commercially insured children and adolescents aged 11 to 14 years using Connecticut's All-Payer Claims Database from January 2012 to December 2017. A total of 23,911 adolescents receiving care from 933 ACO-attributable providers and 923 non-ACO-attributable providers were included. The mean rate of HPV vaccine initiation was 53% overall (51% among boys, 55% among girls). Among those who initiated the vaccine, the mean rate of HPV vaccine completion was 69% (67% among boys, 70% among girls). Adolescents receiving care at ACOs vs non-ACOs were significantly more likely to receive initial HPV vaccination (OR, 1.80; 95% CI, 1.69-1.91) and to complete the HPV vaccine series (OR, 1.12; 95% CI, 1.01-1.23). Among adolescents receiving care in ACOs, providers were responsible for 14% of variability in HPV vaccine initiation and 10% of variability in HPV vaccine completion and ACOs were responsible for less than 1% of variability in HPV vaccine initiation and completion. Adolescents receiving care from ACOs were significantly more likely to initiate and complete HPV vaccination than were adolescents receiving care in non-ACO settings. Variation in HPV vaccine uptake attributable to providers within ACOs dwarfed variation attributable to ACOs, indicating that vaccine uptake was more dependent on the provider irrespective of the ACO with which they were affiliated. Efforts to improve HPV vaccination rates may require provider-focused interventions regardless of the overall performance of their health care system orproviderorganization.

Abstract A065: How accurate are parents' recalls? Factors affecting the concordance of parental and provider reports of HPV vaccination among African American adolescents

Abstract Objectives. Since the introduction of the human papillomavirus (HPV) vaccine in 2006, substantial efforts have been made at the national and state levels to monitor its uptake and understand the factors influencing vaccination. Most studies have focused on the acceptability and intent to vaccinate among adolescents and their parents, providing limited insights into how this understanding affects actual vaccine uptake and completion. A common method for measuring adolescents' vaccination status is parental recall. While some research has assessed the accuracy of parental recall, its implications have not been thoroughly explored. African Americans are disproportionately affected by HPV-related cancers, with higher mortality rates for cervical and oropharyngeal cancers compared to non-Hispanic whites. This study examined the accuracy of parents' reports of their adolescent children's HPV vaccination status and how this accuracy varied by socio-demographic characteristics within the Black/African American community. Methods. Data were taken from the 2015–2019 National Immunization Survey (NIS)-Teen, which includes a household interview and a provider-completed immunization history. We evaluated concordance between parents’ and providers’ reports of teens’ HPV vaccine initiation (at least 1 dose) and completion (3 doses) among Black/African American adolescents between the age of 13 to 17. We assessed bivariate associations of sociodemographic characteristics with having a concordant, false-positive (overreporting) or false-negative (underreporting) report, and used multinomial logistic regression to estimate the independent impact of each characteristic. Results: In a cohort of 68,205 adolescents (51.2% male, 95% CI: 50.4%-51.8%; 48.8% female, 95% CI: 48.2%-49.5%), parental reporting discrepancies in vaccination status were observed. Girls' parents were more likely to underreport (β=0.10, p=0.03) and overreport (β=0.10, p=0.03) vaccination status compared to boys' parents. Mothers with higher education levels were less likely to underreport, while single mothers were more likely to underreport (β=0.15, p=0.02) and overreport (β=0.17, p=0.008) vaccination status. Conclusions: Discrepancies between physician-reported and parental-reported HPV vaccination records among African American teenagers were observed, with parental reporting accuracy varying based on the child's gender and the mother's education level and marital status. Strategies to improve parental reporting accuracy and address disparities are needed to increase HPV vaccination rates and reduce HPV-related diseases in the African American community. Citation Format: Elaine Z. Liu, Philip Siu, Chun Pan, Grace X. Ma, Lin Zhu. How accurate are parents' recalls? Factors affecting the concordance of parental and provider reports of HPV vaccination among African American adolescents [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A065.

Abstract A162: The influence of parental barriers to healthcare on adolescent HPV vaccination uptake and completion among Latinos in Los Angeles

Abstract Objective: This study aims to investigate the association between parental barriers to healthcare access and HPV vaccination uptake among Latino adolescents in Los Angeles. Background: Human papillomavirus (HPV) induced cervical cancer (CC) remains a significant public health concern. Routine HPV vaccination has been recommended in the United States for girls since 2006 and boys since 2011 yet disparities in vaccine initiation and completion persist, particularly among Latino adolescents in Los Angeles. Methods: This cross-sectional study analyzed child data provided by mothers recruited from the Es Tiempo campaign (2016-2018). A total of 353 Latino adolescents aged 9 to 26 years were included in the sample. We used crosstabs to assess vaccine initiation and completion differences by child sex and birth order, while logistic regression models were used to evaluate the association between parental barriers to healthcare, such as lack of health insurance and access to a primary care provider (PCP), and HPV vaccination initiation. Results: Among the sample, 44% initiated the HPV vaccine, and 23% completed the series, with significantly higher rates among girls and firstborn children. Regarding barriers, lack of health insurance was associated with decreased odds of HPV vaccination uptake while access to a PCP showed a slight increase in vaccination uptake odds. Conclusion: HPV vaccination uptake among Latino adolescents in Los Angeles remains suboptimal, with disparities observed by gender and birth order. To improve public health outcomes, targeted interventions are needed to increase HPV vaccination uptake among Latino adolescent boys, and further research is needed to understand vaccine adherence patterns within families and among siblings. Moreover, while parental barriers to healthcare may influence vaccination uptake, future studies should also explore how factors like parental education level and socioeconomic status influence HPV vaccination status in combination with access barriers. Citation Format: Anju F. Kane, Lourdes Baezconde-Garbanati. The influence of parental barriers to healthcare on adolescent HPV vaccination uptake and completion among Latinos in Los Angeles [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A162.

Disparities in HPV Vaccination Among Adolescents by Health Care Facility Type

Approximately 31 000 cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine can prevent more than 90% of these cancers, yet national uptake remains lower than the Healthy People 2030 target of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings. To examine the association between health care facility type and adolescent HPV vaccine uptake and clinician recommendation for the vaccine in the US. This cross-sectional study uses a complex sampling design of data from the 2020 National Immunization Survey-Teen. The study included adolescents aged 13 to 17 years. The data analysis was completed between March 1 and May 31, 2022. Health care facility type classified as public, hospital-based, private, mixed (more than 1 type), and other facilities (eg, military health care facility; Women, Infants, and Children clinic; school-based health center; pharmacy). Initiation of HPV vaccination was defined as the receipt of at least 1 dose of the HPV vaccine and completion as receipt of at least 2 or 3 doses, depending on age of initiation. Parent or guardian self-reported clinician recommendation was categorized as yes or no. Weighted, multivariable logistic regression models were used to estimate the odds of initiating and completing the HPV vaccine series and receiving clinician recommendation by health care facility type adjusted for adolescent and maternal characteristics. A total of 20 162 adolescents (mean [SD] age, 14.9 [1.4] years; 51.0% male) were included. Clinician recommendation for the HPV vaccine was received by 81.4% of adolescents, and 75.1% initiated and 58.6% completed the HPV vaccine series. In the adjusted analyses, adolescents who received recommended vaccinations at public facilities had lower odds of initiating (adjusted odds ratio [AOR], 0.71; 95% CI, 0.58-0.88) and completing (AOR, 0.62; 95% CI, 0.51-0.76) HPV vaccination compared with those who received recommended vaccinations at private facilities. Similarly, adolescents who received recommended vaccinations at public facilities (AOR, 0.62; 95% CI, 0.51-0.77) had lower odds of receiving a clinician recommendation for the HPV vaccine compared with those who received recommended vaccinations at private facilities. These findings reveal health disparities in HPV vaccination among adolescent populations served by public health care facilities, suggesting that a greater focus is needed on vaccine recommendations and uptake in public facilities.

Pilot Randomized Controlled Trial of an Intervention to Promote HPV Uptake Among Young Women Who Attend Subsidized Clinics

ObjectiveTo evaluate the preliminary efficacy, acceptability, and feasibility of Step Up to Prevention, a technology-enhanced intervention to promote human papillomavirus (HPV) vaccination uptake among young minority and low-income women. DesignA pilot randomized controlled trial. SettingTwo federally supported outpatient clinics in a large city in the northeastern United States. ParticipantsWomen who were 18 to 26 years of age (N = 60). MethodsWe randomized participants into four groups: computer information, in-person tailored, combined, and usual care. We administered computer-assisted self-interview surveys before the intervention (baseline), immediately after the intervention (postintervention), and after their clinic visit (post–clinic visit). We conducted a descriptive analysis of participant characteristics. For preliminary efficacy, we used logistic regression–assessed HPV vaccine initiation uptake rates, and we used descriptive statistics to compare theoretical mediators. We used conventional content analysis to assess participant feedback about intervention acceptability. We assessed feasibility through recruitment and retention rates and our ability to deliver the intervention. ResultsWe observed significant differences in initial HPV vaccine uptake between the intervention groups and the usual care group. Participant feedback indicated that the intervention was acceptable, empowering, and informative. We met our recruitment target, maintained a high retention rate (98%), and delivered the complete intervention to all participants. ConclusionWe report the preliminary efficacy, acceptability, and feasibility of this intervention to promote HPV vaccine initiation among young women in federally subsided health care settings by advancing favorable views and improving knowledge about HPV vaccination.

EMR-Based Interventions on HPV Vaccination Initiation, Completion, and Receiving the Next Dose: A Meta-Analytic Review.

Despite the acknowledged importance of Human Papillomavirus (HPV) vaccination in reducing HPV-related diseases, the influence of electronic medical records (EMR) on HPV vaccination uptake (HVU) remains underexplored. This study aimed to evaluate the efficacy of EMR-based interventions on HVU. A systematic review and meta-analysis of randomized controlled trials were performed, focusing on studies that primarily used EMR-based interventions to measure initiation rates, completion rates, and receipt of the next required vaccine dose. Subgroup analyses were conducted to assess the differential effects of supplementary strategies, provider feedback, and parental education or reminders on these outcomes. The results of the comprehensive analysis provided robust evidence for the significant role of EMR interventions, demonstrating an average increase of 4.7% in vaccine initiation, 6.6% in vaccine completion, and 7.2% in receipt of the next HPV vaccine dose. Additionally, the subgroup analyses indicated that provider feedback and parental education could further enhance the effectiveness of EMR-based interventions. These findings support the broader adoption of digital health technologies in vaccination programs, offering vital insights for healthcare providers, policymakers, and researchers, and emphasizing the need for continued technological innovation to improve public health outcomes.

A stepped wedge trial of a healthcare provider–focused intervention to increase human papillomavirus (HPV) vaccine initiation among survivors of childhood cancer.

10010 Background: Childhood cancer survivors are at increased risk for human papillomavirus (HPV)-related cancers. HPV vaccination is highly protective against HPV acquisition. However, we have previously shown that initiation rates among survivors are low, primarily due to lack of healthcare provider recommendation for the vaccine. Methods: We conducted a stepped wedge trial from 2021 to 2023 to evaluate the effectiveness of an evidence-based healthcare provider-focused intervention (HPV PROTECT; NCT04469569) in increasing HPV vaccine initiation rates 1y following implementation. The intervention includes provider communication training to enhance vaccine recommendation skills, audit/feedback regarding clinic vaccination rates, and patient-directed resources in multiple languages tailored to pediatric oncology settings. We measured the effectiveness of the intervention in a racially, ethnically, and geographically diverse sample of HPV vaccine naïve childhood cancer survivors, aged 9-17y, and ≥1y post-completion of therapy returning to pediatric oncology clinics for follow-up care at 6 sites. The primary outcome of interest was HPV vaccine initiation rates (abstracted from state vaccine registries) at end of each study year. Baseline data were collected for all sites in Y1, three sites were randomly selected to receive the intervention in Y2, and the remaining three in Y3. The intervention effect was tested using a longitudinal logistic regression model for initiation with intervention as the main fixed effect, adjusting for survivor age, cancer diagnosis, time off-therapy, sex, race, ethnicity, and receipt of hematopoietic cell transplantation. The secular trend (estimated using pre-intervention data from Y1 and Y2) was included as an offset, and site was included as a random effect. The intervention effect was reported as odds ratio (OR) for initiation with 95% confidence intervals (CI). Results: A total of 1779 unique vaccine naïve survivors (47.1 % leukemia; 55.1% male; 51.5% non-Hispanic white) completed 2689 clinic visits across 6 sites. Median (range) age at diagnosis was 5.1y (0-16.5), at study entry was 12.3y (9-17.9), and median time off-therapy was 5.5y (1.0-17.3). Overall incident HPV vaccine initiation was 16.0% at baseline. The adjusted odds of vaccine initiation were 1.3-fold (95%CI, 1.03-1.6; p = 0.03) higher post-intervention vs. pre-intervention, accounting for secular trend OR of 1.1. Overall prevalence of vaccine initiation increased from 51.9% pre-intervention to 61.3% post-intervention. Conclusions: The improvement in childhood cancer survivor HPV vaccine initiation rates in a diverse sample following implementation of a healthcare provider-focused intervention underscores the potential for pediatric oncology providers to positively impact HPV vaccine uptake in this vulnerable population. Clinical trial information: NCT04469569 .

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

Human Papillomavirus Vaccination Hesitancy, Screening Disparities, and Associated Factors Among Sexual and Gender Minority Women: A Systematic Review of Global Literature [ID 2683547

INTRODUCTION: Human papillomavirus (HPV) ranks as the most prevalent sexually transmitted infection globally, with a significant association with cervical cancer in cervix-having individuals. Understanding the epidemiological patterns of HPV vaccination rates and behaviors within the context of sexual and gender minority (SGM) women is essential in identifying factors hindering the initiation of HPV vaccination and screening. METHODS: A systematic review was conducted by searching five databases (PubMed, CINAHL, Embase, Web of Sciences, MedLine). Eligibility criteria included the following: reported HPV vaccination or screening outcomes, conducted among SGM women, data collected since 2010. All studies were independently screened and synthesized following PRISMA guidelines. Of 44 items, 13 studies met the criteria. RESULTS: Sexual and gender minority women reported substantial HPV vaccine hesitancy and decreased screening practices compared to their non-SGM peers, with the degree of vaccine hesitancy and delayed screening varying among bisexual, lesbian, and transgender individuals. Individual factors associated with HPV vaccine hesitancy and decreased screening include socioeconomic status, vaccination awareness, and SGM identity. Meanwhile, interpersonal and structural factors include community biases, family support, lack of provider LGBTQ+ health education, and structural racism. CONCLUSION: Sexual and gender minority women experience a substantial health care disparity surrounding HPV vaccination hesitancy and screening status. Results from this study substantiate the need for the standardization of health care practice, individual patient vaccine counseling, and the expansion of sexual and gender minority health training at all tiers of medical education. Furthermore, additional disaggregated research is needed to understand the unique health circumstances of bisexual, lesbian, and transgender individuals, as the current research landscape fails to capture the community’s health needs.

Human papillomavirus vaccination uptake among 27-to-45-year-olds in the United States

ObjectiveThe human papillomavirus (HPV) vaccine prevents six types of cancer. Previously, this vaccine was only approved for 9–26-year-olds. However, in October 2018 the U.S. Food and Drug Administration approved the HPV vaccine for 27- to 45-year-olds (mid-adults). The current study aimed to assess HPV vaccination among a national sample of U.S adults aged 27–45 years. This study also assessed factors associated with HPV vaccine initiation after age 26. MethodsData were analyzed using the 2019 National Health Interview Survey. The study included two samples: (1) mid-adults aged 27–45 (n = 8556), and (2) mid-adults who self-reported they had initiated HPV vaccination within the 27–45 age range and those who were unvaccinated (n = 7307). The outcome variables were HPV vaccination status and HPV vaccine initiation. The independent variables represented constructs from Andersen's Behavioral Model of Health Services Use. The odds of HPV vaccination were estimated using weighted multivariable logistic regression models. ResultsOverall, 15.6% had ever received the HPV vaccine and 13.1% initiated their first dose of the vaccine after age 26. Hispanic (aOR = 0.73; 95% CI = 0.58, 0.92) and non-Hispanic Asian persons (aOR = 0.59; 95% CI = 0.41, 0.84) had lower odds of ever receiving the vaccine than non-Hispanic White persons. Females (aOR = 2.17; 95% CI = 1.42, 3.32) had higher odds of initiating the vaccine after age 26 than males. ConclusionsThe ACIP recommendation of shared clinical decision-making emphasizes the role of clinical interactions in HPV vaccine decision-making. Study findings highlight the need to further explore contextual factors that may influence HPV vaccine behavior among mid-adults.

Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series

BackgroundUp-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD. MethodsA secondary analysis of The National Immunization Survey – Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators. ResultsThe final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9–10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78–8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65–0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46–0.96). ConclusionStrong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.

Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system

BackgroundStrong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). MethodsWe used a quasi-experimental design, where the eligible population included people aged 9–26 years with at least one encounter in June 2020–February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. ResultsOur study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13–21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9–12 and 13–17 years. ConclusionOur provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.

Relationship between religiosity and HPV vaccine initiation and intention in urban black and hispanic parents

ObjectiveReligion is believed to be an important sociocultural influence in the U.S., but little is known about how religiosity shapes the human papillomavirus (HPV) vaccine decision in racial/ethnic minorities. The purpose of this study was to examine the relationship between religiosity and HPV vaccine initiation and intention among urban, racial/ethnic minority parents of adolescents 11–14 years old.DesignThis study employed a descriptive, cross-sectional design using baseline data from Black and Hispanic parents (N = 175 and 285, respectively) recruited from medically underserved communities. Chi-square tests for independence and independent-samples t-tests were run to assess sociodemographic differences in vaccine initiation and vaccine intention. Binary logistic regression analyses were conducted to determine whether religious attendance and religious salience were associated with parents’ HPV vaccine decisions for their children.ResultsApproximately 47% of Black parents had vaccinated their youth against HPV. Of those who had not initiated the vaccine for their child, 54% did not intend to do so. 54% of Hispanic parents had initiated the HPV vaccine for their youth. Of those who had not initiated the vaccine for their child, 51% did not intend to do so. Frequency of attendance at religious services and the importance of religion in one’s life was not significantly correlated with HPV vaccine decision-making for Black nor Hispanic parents.ConclusionThis study suggests that religiosity does not influence the HPV vaccine decision for urban, Black and Hispanic parents. Future studies using measures that capture the complexity of religion as a social construct are needed to confirm the findings. In addition, studies with representative sampling will enable us to make generalizations about the influence of religion on HPV vaccine decision-making for urban, racial/ethnic minority parents.

The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents

ABSTRACT This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9–17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers’ attitudes, information sources, and trust in those sources were associated with their adolescent’s HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.

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.

A Cross-Sectional Analysis of 2017-2022 National Immunization Survey: Sociodemographic Disparities Associated With Human Papillomavirus Vaccine Initiation and Completion Series Among US Adolescents.

The introduction of the Human Papillomavirus (HPV) vaccine has led to future decline in prevalence of HPV-causing cancers; however, disparities in early HPV vaccine uptake and coverage may contribute to persistent inequalities in HPV-related cancers in the United States. We assess the current trend of sociodemographic factors significantly associated with the initiation and Up To Date (UTD) HPV vaccine series among adolescents in the U.S. The retrospective National Immunization Survey-Teen data were analyzed for a cohort of adolescents aged 13-17 years who initiated HPV vaccine and completed the series from 2017 to 2022. A multivariable logistic regression estimated the correlation of sociodemographic variables to determine the odds of HPV vaccine initiation and completion as the outcomes. There were 3.2% and 5% surge in HPV vaccine initiation and UTD, respectively, with teens' mean age of 14.98 over the years. The unvaccinated dropped by 5.6%, and those not UTD declined by 4.6% in the HPV vaccine series during this period. The proportion of teens who initiated and completed the vaccine series were mostly older female teens, non-Hispanics, regularly insured with private coverage, raised by educated older mothers, above poverty status, and living in the South. The adjusted multivariable logistic regression shows the odds of initiating and completing increases over the years, and older teens are more likely to initiate the HPV vaccine and complete the vaccine series. However, boys with non-Medicaid coverage/uninsured in the South have lower odds to initiate and complete the vaccine. Improved HPV vaccine uptake and UTD were found in older females, insured with Medicaid, and from highly educated mothers in the Northeast. Findings underscore the importance of effective strategies to address current HPV vaccination disparities among identified teens with lower uptake and UTD that may reduce future burden of HPV-related cancers in the U.S.