Vaccine Initiation Rates Research Articles

Abstract A066: Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019)

Abstract Introduction: The HPV vaccination rates among Asian American adolescents were found to be below optimal levels. Understanding the high-risk demographics and the various factors influencing HPV vaccine acceptance is essential for addressing disparities and enhancing vaccination rates in this population. This study aimed to investigate HPV vaccine uptake in adolescents aged 13 to 17 across six major Asian American ethnic groups using nationally representative data. Methods: The study analyzed data from the National Immunization Survey- Teen (2015-2019), comprising 3,968 Asian American adolescents from Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese backgrounds. Provider and practice characteristics were examined alongside HPV vaccine initiation and completion rates within each subgroup. Results: Findings revealed that while the overall initiation rate among Asian American adolescents was 66.65%, significant variations existed among subgroups, ranging from 57.3% in Asian Indians to 71.22% in Chinese adolescents. Similarly, completion rates ranged from 30.89% in Asian Indians to 48.14% in Chinese adolescents, with an aggregated completion rate of 40.37% for the total Asian American sample. Household survey data generally showed lower initiation and completion rates compared to provider-reported data but still reflected subgroup disparities. Conclusion: Across all ethnic groups, a common barrier to HPV vaccination was the lack of physician recommendation. However, slight variations in this barrier were observed among subgroups. These findings underscore the importance of considering socioeconomic, cultural, and acculturation-related factors in designing effective public health and clinical interventions to promote HPV vaccination among Asian American adolescents. Citation Format: Lin Zhu, Elaine Z. Liu, Philip Siu, Chun Pan, Grace X. Ma. Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019) [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 A066.

COVID-19 vaccination initiation and completion in a multicenter cohort study of insured US transgender and cisgender adults

PurposeTransgender and gender-diverse (TGD) people may have been disproportionately impacted by the COVID-19 pandemic, yet little is known about vaccination status in this population. This multicenter cohort study of insured adults examined the rates of COVID-19 vaccine initiation and completion in TGD persons compared to matched cisgender persons. MethodsA cohort of TGD persons and matched cisgender persons enrolled in Kaiser Permanente health plans in Northern and Southern California between 12/1/2020 and 7/31/2021 were analyzed. COVID-19 vaccination initiation and completion rates were compared across groups using Cox regression models. ResultsAmong transmasculine persons, the HR (95 % CI) estimates for COVID-19 vaccination initiation and completion were, respectively, 1.35 (1.30–1.40) and 1.78 (1.71–1.85) compared with cisgender women and 1.34 (1.29–1.40) and 1.81 (1.73–1.88) compared with cisgender men. Among transfeminine persons, the corresponding HRs (95 % CIs) for vaccination initiation and completion were 1.35 (1.30–1.40) and 1.78 (1.71–1.85) compared with cisgender women and 1.34 (1.29–1.40) and 1.81 (1.73–1.88) compared with cisgender men. ConclusionFindings from this cohort of insured adults demonstrated that TGD persons initiated and completed COVID-19 vaccination at higher rates compared to matched cisgender persons. Further work is needed to understand vaccination rates and determinants in the broader TGD populations.

A multilevel intervention to promote HPV vaccination among young adults in Texas: protocol for a randomized controlled trial

BackgroundHuman papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol.MethodsThe study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18–26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4–6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention.DiscussionRecruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden.Trial RegistrationNCT05057312.

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

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 qualitative study of ethnic Korean women and men's experiences of HPV and HPV vaccination in the United States

ABSTRACT Introduction Approximately 42.5% of adults aged 18–59 in the United States is estimated to be affected by human papillomavirus (HPV) infection. However, Asian Americans have the lowest HPV vaccination initiation rate compared to other racial groups. This study aims to explore the experiences of HPV and the HPV vaccination among ethnic Korean women and men in the United States. Methods A total of 33 ethnic Korean and Korean Americans aged 27–45 years living in the U.S. were recruited via word-of-mouth and social media using a purposive sampling strategy. They participated in an online survey. Of the 33 participants, 29 (14 females and 15 males) participated in in-depth interviews via password-protected Zoom. A content analysis approach was used to analyze the interviews. Results Only 32% of participants had received the HPV vaccine at least once (female: 35.3%, male: 12.5%). Six major themes emerged from data analysis: (1) awareness of HPV, HPV vaccine, and HPV-associated cancers; (2) attitudes toward the HPV vaccine; (3) barriers to HPV vaccination; (4) women's experiences and preferences for pap smear testing; (5) experiences with HPV diagnosis; and (6) HPV and HPV vaccination education preferences. Conclusion The findings highlight cultural factors that may impede the discussion about and uptake of HPV vaccination and HPV-associated cancer screening, which emphasize the need for culturally appropriate interventions to overcome stigma around HPV and enhance vaccination rates. Healthcare providers should consider ethnic and cross-cultural differences perceptions to effectively HPV-related health information. This study provides insight into the experiences and understanding of HPV and vaccination among ethnic Korean men and women, laying the groundwork for developing culturally-tailored programs that sim to increase HPV vaccination rates and mitigate the stigma and impact of HPV-related disease in this community.

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.

Are Interventions Efficacious at Increasing Human Papillomavirus Vaccinations Among Adults? A Meta-Analysis.

A variety of intervention strategies to improve Human Papillomavirus (HPV) vaccination rates in adults exist; however, they have shown varying efficacy and inconsistent outcomes. This meta-analysis tested the efficacy of HPV vaccination interventions for adults in increasing vaccine intentions, rates of initiation of the vaccine series, and completion rates. The study also tested potential moderators (intervention strategy, theory-based versus nontheory-based interventions, race/ethnicity, gender, study quality) of relationships between intervention receipt and vaccine intentions. Electronic databases (PsychINFO, Web of Science, Scopus, EBSCO, JSTOR, PubMed) were searched for English-language articles published up to September 2021. Eligible studies included outcomes of vaccine intentions, receipt of the first dose, or vaccine series completion and included intervention and comparison conditions. The search yielded 38 eligible studies reporting 78 effect sizes. Random effects, multilevel, meta-analytic models revealed a significant, small effect of interventions on vaccine intentions (OR = 0.36, 95% CI [0.07, 0.65]); a nonsignificant effect on vaccine initiation rates (OR = 1.29; 95% CI [0.87, 1.91]); and significant effects on vaccine completion rates (OR = 1.58, 95% CI [1.18, 2.11]). Race/ethnicity, gender, intervention strategy, theory-based interventions, and study quality did not moderate the intervention effects on vaccine intentions. Evidence supports the efficacy of interventions to increase intentions to receive the HPV vaccine and completion of the HPV vaccine series in adults. However, evidence did not support the efficacy of interventions to increase HPV vaccine initiation. Findings highlight directions for developing more efficacious HPV vaccine interventions for adults.

The Trump vote and Covid-19 vaccination across US states, US counties, and Connecticut towns

ABSTRACT In the United States over the past 40 years national issues and allegiances have increasingly displaced state and local concerns and identities in shaping the preferences of voters and the internal processes of political parties. This study finds that such nationalization has also manifested itself in health-related behaviour, specifically in the takeup of Covid-19 vaccines. Despite the heterogeneities of US states, counties, and towns, the share of the vote that Trump received in the 2020 US presidential election is found at each level to be a strong and robust predictor of a lower June 2022 Covid-19 vaccination initiation rate, even after adjusting for sociodemographic composition, spatial effects, and diverse provisioning- and takeup-related factors. At each of the three subnational levels, the Trump 2020 vote share was also correlated more closely than the Trump 2016 vote share or the Romney 2012 vote share with the June 2022 Covid-19 vaccination initiation rate.

When the market got the first dose: Stock volatility and vaccination campaign in COVID-19 period

During the COVID-19 pandemic, the news of clinical trials for vaccines and mass vaccinations have brought renewed optimism for stabilizing the economy and financial markets. However, the mental stress of investors or doubt about the effectiveness of government policies to cope with economic disruptions has caused stock market volatility. We investigate the significance of the vaccination rate in alleviating the global stock market volatility which is measured by the GJR–GARCH model. We discover that a higher vaccine initiation rate has a positive effect on global stock markets, especially in developed countries and areas with higher rates than their average. Our findings remain reliable even when using different projected volatility models and other estimates of the main independent variables. Mass immunization also implies that governments will not have to take extreme measures to handle the pandemic, which alleviates investor worries about compliance and the prolonged effects of COVID-19. Our research indicates that global stock markets are providing insight into the economic value of the development of COVID-19 vaccines, even before public vaccinations start.

Cluster analysis of adults unvaccinated for COVID-19 based on behavioral and social factors, National Immunization Survey-Adult COVID Module, United States

By the end of 2021, approximately 15% of U.S. adults remained unvaccinated against COVID-19, and vaccination initiation rates had stagnated. We used unsupervised machine learning (K-means clustering) to identify clusters of unvaccinated respondents based on Behavioral and Social Drivers (BeSD) of COVID-19 vaccination and compared these clusters to vaccinated participants to better understand social/behavioral factors of non-vaccination. The National Immunization Survey Adult COVID Module collects data on U.S. adults from September 26–December 31,2021 (n = 187,756). Among all participants, 51.6% were male, with a mean age of 61 years, and the majority were non-Hispanic White (62.2%), followed by Hispanic (17.2%), Black (11.9%), and others (8.7%). K-means clustering procedure was used to classify unvaccinated participants into three clusters based on 9 survey BeSD items, including items assessing COVID-19 risk perception, social norms, vaccine confidence, and practical issues. Among unvaccinated adults (N = 23,397), 3 clusters were identified: the “Reachable” (23%), “Less reachable” (27%), and the “Least reachable” (50%). The least reachable cluster reported the lowest concern about COVID-19, mask-wearing behavior, perceived vaccine confidence, and were more likely to be male, non-Hispanic White, with no health conditions, from rural counties, have previously had COVID-19, and have not received a COVID-19 vaccine recommendation from a healthcare provider. This study identified, described, and compared the characteristics of the three unvaccinated subgroups. Public health practitioners, healthcare providers and community leaders can use these characteristics to better tailor messaging for each sub-population. Our findings may also help inform decisionmakers exploring possible policy interventions.

Human papillomavirus vaccine uptake among teens before and during the COVID-19 pandemic in the United States

ABSTRACT It is unclear how the COVID-19 pandemic impacted human papillomavirus (HPV) vaccine uptake and which sociodemographic groups may have been most impacted. We aimed to assess differences in HPV vaccine uptake (initiation and completion) before and during the pandemic in the United States. We conducted a cross-sectional study using data from the 2019 to 2020 National Immunization Surveys – Teen (NIS-Teen), comparing vaccine initiation and completion rates in 2019 vs. 2020, based on confirmed reports by a healthcare provider. Weighted logistic regression analysis estimated odds of vaccine initiation and completion for both adolescent and parental characteristics. There were 18,788 adolescents in 2019 and 20,162 in 2020. There was 3.6% increase in HPV vaccine initiation (71.5% vs. 75.1%) and a 4.4% in completion (54.2% vs. 58.6%) rates from 2019 to 2020. In 2020, Non-Hispanic White teens were significantly less likely to initiate (aOR = 0.62, 95% CI: 0.49, 0.79) and complete (aOR = 0.71, 95% CI: 0.58, 0.86) vaccine uptake compared with non-Hispanic Black teens. Additionally, teens who lived above the poverty line were also less likely to initiate HPV vaccination (aOR = 0.63, 95% CI: 0.49, 0.80) or complete them (aOR = 0.73, 95% CI: 0.60, 0.90), compared to those who lived below the poverty line. During the COVID-19 pandemic in 2020, some historically advantaged socioeconomic groups such as those living above the poverty line were less likely to receive HPV vaccine. The impact of the pandemic on HPV vaccine uptake may transcend traditional access to care factors.

23 Identifying HPV vaccination initiation hot and cold spots and associated disparities in Texas

Over 90% of HPV-associated cancers are preventable through HPV vaccination. Only 43.5% of Texas adolescents, however, have completed the vaccine series, and the state ranks 47th in vaccination rates across the country. The goal of this study was to examine the geospatial uptake of the HPV vaccine in Texas and the associated disparities. HPV vaccine data from 2017–2021 was obtained from the Texas Department of State Health Services. Zip code-level estimates of individuals 9 years and older who received at least one HPV vaccine since 2017 in the Texas Immunization Information System (ImmTrac2) database were used to create a choropleth map. Through the Environmental Science Research Institute's (ESRI) ArcGIS Pro Version 2.2.0 software, the Cluster and Outlier Analysis Tool was used to determine a “neighborhood” around each zip code. Zip codes were subsequently demarcated as hot or cold spots (or neither) based off Local Moran's I score calculations, meaning they had a statistically significant greater or lesser concentration of vaccinations than would be expected from a random distribution. After identifying hot spots and cold spots of vaccine initiation, we explored the demographic neighborhood characteristics. 346 statistically significant hot and 374 cold spot zip codes of HPV vaccine initiation were identified (Fig. 1). The remainder of the zip codes (1115) were outliers or not part of statistically significant clusters. Hot spot zip codes, or areas of high vaccine initiation, were found along the Gulf coast, in large cities, and in less developed areas near the Texas panhandle. Cold spot zip codes were in the northern Texas panhandle, along the Texas–Louisiana border, and on the periphery of major cities. Compared to cold spot zips, hot spots had significantly higher percentages of children on public insurance, had higher poverty rates, and had higher percentages of African American and Hispanic residents.Download : Download high-res image (217KB)Download : Download full-size image In Texas, areas with higher poverty rates, increased use of public insurance, and higher percentages of minority populations had significantly higher rates of HPV vaccine initiation. This may be due to differences in patient interest in the vaccine, to vaccine access through government insurance, or to outreach efforts that have promoted the vaccine in especially vulnerable populations.

EPH109 Impact of COVID-19 Pandemic on HPV Vaccine Initiation Rates in Adolescent Girls: Projected Time to Reverse Dose Deficits in France

EPH109 Impact of COVID-19 Pandemic on HPV Vaccine Initiation Rates in Adolescent Girls: Projected Time to Reverse Dose Deficits in France

HPV vaccination initiation among white, black and Middle East North African (MENA) males

ObjectivesUS males initiate HPV vaccination at older ages than females and currently have low population coverage. We aim to describe the prevalence and predictors of HPV vaccination initiation among males of White, Black, and Middle-Eastern/North-African (MENA) descent in southeast Michigan. MethodsWe conducted three community-based surveys in 2019 that provided primary data via self report. Using population weights and multivariate modeling, we measured the prevalence and predictors of HPV vaccine initiation in each race/ethnicity of men (age 18–34 years) analyzed. ResultsThe vaccine initiation rates were 44.5 % (95 % CI: 44.4, 44.6) for White men, 46.2 % (46.0, 46.4) for Black men, and 23.2 % (22.8, 23.6) for MENA men, (p < 0.001). Being a student, compared to unemployed or disabled, was significantly associated with HPV vaccine initiation across all three races/ethnicities. Married men of any race/ethnicity were unlikely to be vaccinated. MENA men born in the US and having some college education were also more likely to initiate HPV vaccination. ConclusionsWhite, Black, and MENA men are not vaccinated in accord with Healthy (Healthy People 2030, 2022) goals. Each race/ethnicity has different predictors of vaccination.

County-Level Factors Associated With HPV Vaccine Coverage Among 11-Year-Olds to 12-Year-Olds Living in Florida in 2019

BackgroundIn the United States, human papillomavirus (HPV) vaccine initiation and up-to-date (UTD) status are associated with multiple factors at the individual level such as racial/cultural (e.g., race, immigration status), socioeconomic status (e.g., living below poverty level, education), and healthcare access (e.g., insurance status/type). HPV vaccination rates differ dramatically by US geographic areas and within states. To tailor interventions to local areas, it is important to understand county-level characteristics associated with HPV vaccination rates. MethodsUsing linear regression, we assessed the association between county-level HPV vaccination initiation and UTD rates for 11-year-olds to 12-year-olds in Florida (collected from the Florida SHOTS immunization registry) and county-level variables. Factors found significant in bivariate analysis and with a variance influence factors <4 were included in multivariable models. ResultsIn 2019, county-level HPV vaccine coverage among Florida 11-year-olds to 12-year-olds ranged from 31% to 92% initiation and 3%–36% UTD. Counties with the lowest HPV vaccine coverage were concentrated in Florida's North-Central and Panhandle regions. In multivariable models, counties with primarily rural populations had lower vaccination initiation and UTD coverage. Above and beyond the association with rurality, UTD coverage was associated with family physicians per 100,000 residents and uninsured or Medicaid-enrolled populations. DiscussionWhile Florida county-level HPV vaccine initiation rates among 11-year-olds to 12-year-olds varied by county in 2019, UTD rates remained universally low despite recommendations. Tailoring interventions toward healthcare access in rural communities may increase HPV vaccine coverage.

Differences in stakeholder-reported barriers and implementation strategies between counties with high, middle, and low HPV vaccine initiation rates: a mixed methods study

BackgroundA greater understanding of the county-level differences in human papillomavirus (HPV) vaccination rates could aid targeting of interventions to reduce HPV-related cancer disparities.MethodsWe conducted a mixed-methods study to compare the stakeholder-reported barriers and efforts to increase HPV vaccination rates between counties within the highest, middle, and lowest HPV vaccine initiation (receipt of the first dose) rates among 22 northern Florida counties. Between August 2018 and April 2019, we recruited stakeholders (n = 68) through purposeful and snowball sampling to identify potential participants who were most knowledgeable about the HPV vaccination activities within their county and would represent a variety of viewpoints to create a diverse picture of each county, and completed semi-structured interviews. County-level HPV vaccine initiation rates for 2018 were estimated from the Florida Department of Health’s immunization registry and population counts. Implementation strategies were categorized by level of importance and feasibility using the Expert Recommendations for Implementing Change (ERIC) taxonomy. We compared the barriers and implementation strategies for HPV vaccination between tercile groups of counties by HPV vaccine initiation rates: highest (18 stakeholders), middle (27 stakeholders), and lowest (23 stakeholders).ResultsThe majority of the 68 stakeholders were female (89.7%), non-Hispanic white (73.5%), and represented a variety of clinical and non-clinical occupations. The mentioned barriers represented five themes: healthcare access, clinician practices, community partnerships, targeted populations, and cultural barriers. Within themes, differences emerged between county terciles. Within healthcare access, the highest rate county stakeholders focused on transportation, lowest rate county stakeholders focused on lack of clinicians, and middle county stakeholders mentioned both. The number of ERIC quadrant I strategies, higher feasibility, and importance described decreased with the tercile for HPV vaccination: highest = 6, middle = 5, and lowest =3 strategies.ConclusionsThe differing barriers and strategies between the highest, middle, and lowest vaccination rate counties suggest that a tailored and targeted effort within the lowest and middle counties to adopt strategies of the highest rate counties may reduce disparities.