Clinician knowledge,clinician barriers,and perceived parental barriers regarding human papillomavirus vaccination: Association with initiation and completion rates

PurposeWe tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level.MethodsWe conducted a survey from October 2015 through January 2016 among primary care clinicians (n = 280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination. Primary care clinicians included family medicine physicians, general pediatricians, and family and pediatric nurse-practitioners. We also used the Rochester Epidemiology Project to measure HPV vaccination delivery. Specifically we used administrative data to measure receipt of at least one valid HPV vaccine dose (initiation) and receipt of three valid HPV vaccine doses (completion) among 9–18 year old patients residing in the same 27-county geographic region. We assessed associations of clinician survey data with variation in vaccine delivery at the clinical site using administrative data on patients aged 9–18 years (n = 68,272).ResultsConsistent with our hypothesis, we found that greater knowledge of HPV and the HPV vaccination was associated with higher rates of HPV vaccination initiation (Incidence rate ratio [IRR] = 1.05) and completion of three doses (IRR = 1.28). We also found support for the hypothesis that greater perceived parental barriers to the HPV vaccination were associated with lower rates of initiation (IRR = 0.94) and completion (IRR = 0.90). These IRRs were statistically significant even after adjustment for site-level characteristics including percent white, percent female, percent ages 9–13, and percent with government insurance or self-pay at each site.ConclusionsClinician knowledge and their report of the frequency of experiencing parental barriers are associated with HPV vaccine delivery rates—initiation and completion. Higher measures of knowledge correlated with higher rates. Fewer perceived occurrences of parental barriers correlated with lower rates. These data can guide efforts to improve HPV vaccine delivery in clinical settings.     

The role of maturity in adolescent decision-making around HPV vaccination in France

Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents’ involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents’ capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls’ involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents’ lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters’ own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.     

Uptake of HPV Vaccine among young adults with disabilities, 2011 to 2018

IntroductionLittle is known about human papillomavirus (HPV) vaccine uptake among young adults with disabilities (YAWD), despite this population having a higher risk of HPV infection and related cancers compared to the general population.ObjectiveTo compare the prevalence of HPV vaccination among young adults with disabilities to young adults without disabilities. We hypothesized that YAWD would have a lower prevalence of HPV vaccination than the general population.MethodsThis cross-sectional study used data for the years 2011 to 2018 of the National Health Interview Survey. Our analysis included 14,577 people (weighted n = 34,420,024) aged 18 to 26 years. Univariate and multivariable logistic models were used to estimate the role of disability on HPV vaccination uptake among young adults and to identify potential factors associated with HPV vaccination among YAWD.ResultsThe proportion of female and male YAWD with HPV vaccination was similar to those without disabilities, regardless of sex (Female Adjusted Odds Ratio (OR): 1.16; 95% Confidence Interval (CI): 0.91 to 1.48; Male Adjusted OR: 1.05; 95% CI: 0.69 to 1.60). Among female and male YAWD, the proportion with HPV vaccination was 56.1% and 28.5%, respectively. Other factors significantly associated with HPV vaccination among YAWD included age, country of birth, healthcare utilization, and insurance status.ConclusionsHPV vaccination among YAWD did not differ significantly from those without disabilities; however, the prevalence of HPV vaccination among young adult males and females remains significantly below national goals. Connecting young adults, specifically male YAWD, to the healthcare system is of utmost importance to improve HPV vaccination uptake.     

Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations

BackgroundGenital human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection among young adults ages 15–25 years in the United States (US). Although HPV vaccines are recommended for individuals ages through 26 years, vaccine completion rates remain substantially low.MethodsAccordingly, our study utilized a comprehensive – Theoretical Domains Framework (TDF) of behavior change to systematically identify facilitators and barriers to catch-up HPV vaccinations. Five databases - Medline, Embase, CINAHL, ERIC, and PsycINFO were searched from January 2009 to July 2019 for empirical studies using quantitative and qualitative methods to assess HPV vaccine uptake among males ages 18–26 years within US college and university settings. The TDF analytic process included a content analysis using the mixed deductive-inductive approach to extract, analyze and categorize data into TDF domains/themes and sub-themes.ResultsOverall, 17 studies were selected for data extraction. We identified eleven key TDF domains that influenced HPV vaccination behavior among college male students: ‘knowledge’ (82% of included studies), ‘environmental context and resources’ (53%), ‘beliefs about consequences’ (53%), ‘unrealistic optimism’ (50%) and ‘pessimism’ (6%), ‘emotion’ (50%), ‘social influences’ (50%), ‘beliefs about capabilities’ (41%), ‘intention’ (24%), ‘reinforcement’ (18%), ‘social professional role and identity’(12%), and ‘behavioral regulation’ (12%). Barriers influencing HPV vaccine uptake included lack of knowledge and awareness regarding HPV infections, HPV vaccine safety, effectiveness, side effects, and costs; absence of health providers’ recommendations; lack of healthcare and health insurance; low levels of perceived susceptibility and severity for HPV infections; HPV vaccine misinformation; as well as social stigma and peer influences regarding HPV vaccinations. Enablers for HPV vaccine uptake included high levels of perceived benefits for HPV vaccines.DiscussionOur study theoretically identified factors influencing HPV vaccinations. This could inform the efficient planning, support, and implementation of interventions that facilitate catch-up HPV vaccination practices among high-risk males within college/university settings.     

From bad to worse: The representation of the HPV vaccine Facebook

BackgroundAnti-HPV vaccination social media messages may increase vaccine hesitancy and avoidance. This study analyzed (1) the first decade of public, HPV-vaccine related Facebook posts’ characteristics, engagement, and health belief messages; (2) relationships between variables; (3) how those variables changed over time; and (4) identified and analyzed the posts with the most engagement.MethodsThe data sample consisted of 6,506 public HPV vaccine-related Facebook posts (n = 6,506) published within the first decade following the FDA’s first HPV vaccine approval (June 8, 2006 – June 8, 2016). Post characteristics, engagement, and health belief model (HBM) messages were coded (Krippendorf’s alpha range: 0.71–1.00).ResultsBarriers to HPV vaccination appeared more often (47.1%) than benefits (19.8%). Regarding the tone towards the vaccine, negative was dominant (45.0%) and the average sample sentiment was negative (M = -0.15, SD = 0.851). Tone positivity was negatively correlated with barriers to HPV vaccine (r = -0.631, p < 0.0001). The post with the most engagement (11,000 reactions, 6,100 comments, and 329,000 shares displayed) was anti-HPV vaccine, and negative posts received significantly greater engagement. Over time, negative tone and barriers had a greater presence. The data showed evidence for forward momentum (Durbin-Watson values) of HPV infection susceptibility (0.004), HPV infection severity (0.426), HPV vaccine benefits (0.297), and barriers to HPV vaccination (0.226) messages, tone (0.690), and the number of reactions (1.589), comments (1.389), and shares (1.340).ConclusionFacebook posts about the HPV vaccine were mostly negative with a frequent focus on barriers to vaccination. Time effects suggest that anti-HPV vaccine posts have encouraged more anti-HPV vaccine posts. Research should continue to address the influence of time. The influence of messages that are pro-HPV vaccine, but perhaps are negative in tone, address barriers, and/or presented by individual stakeholders, should be tested inside and outside of social media channels.     

Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay,bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019

IntroductionIn 2015/2016, Canada’s largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization.MethodsEngage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator.ResultsAcross the three cities, 26–35% and 14–21% of men ≤ 26 years and 7–26% and 2–9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06–4.36; ≥27: PR = 2.73, 95%CI 1.14–6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64–5.05; ≥27: PR = 2.03, 95%CI 1.07–3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance.ConclusionsSixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.     

Decision-making about HPV vaccination in parents of boys and girls: A population-based survey in England and Wales

BackgroundSchool-based HPV vaccination in the UK will soon be extended to boys. Based on other countries’ experience, uptake may initially be lower in boys than girls. We assessed HPV vaccine attitudes and decision-making in parents of boys and girls, to explore sex differences and inform public health messages.MethodsWe carried out a cross-sectional population-based survey using home-based interviews in spring 2019. Participants were adults in England and Wales, with a child in school years 5–7 (aged 9–12 and eligible for HPV vaccination within 3 years). Measures included awareness of HPV and the vaccine, demographic factors, previous vaccine refusal and (after exposure to brief information) whether participants would allow their child to have the HPV vaccine (decided to vaccinate; decided not to vaccinate; undecided). We also assessed vaccine attitudes. Data were weighted to adjust for non-response. Multinomial logistic regression was used to explore predictors of deciding to (or not to) vaccinate compared with being undecided.ResultsAmong 1049 parents (weighted n = 1156), 55% were aware of HPV and the girls’ vaccination programme, but only 23% had heard of plans to vaccinate boys. After information exposure, 62% said they would vaccinate their child, 10% would not, and 28% were undecided. Parents of girls were more willing to vaccinate than parents of boys (adjusted odds ratio: 1.80 (1.32–2.45)). Positive attitudes and HPV/vaccine awareness were significantly independently associated with deciding to vaccinate. Previous vaccine refusal for a child was the strongest predictor of not wanting the HPV vaccine.ConclusionsOur findings suggest a need for public health campaigns to raise awareness of plans to extend HPV vaccination to boys. Reassuringly only 10% of all parents were unwilling to vaccinate and our data suggest further information, including about safety and efficacy, may be important in supporting undecided parents to make the decision to vaccinate.     

Using the Theory of Planned behavior to identify correlates of HPV vaccination uptake among college students attending a rural university in Alabama

IntroductionHumanpapillomavirus (HPV) has infected nearly 80 million people in the U.S., and is associated with most cervical cancer cases. Alabama ranks first in the country for cervical cancer mortality and third for incidence. Although the HPV vaccine can prevent HPV and reduce cancer rates, Alabama is well-below the national average for HPV vaccination. Using the Theory of Planned Behavior (TPB), this Alabama-based study aimed to examine college students’ intentions to get the HPV vaccine; to examine the relationship between the relationship between religious beliefs and HPV vaccination uptake status among college students.MethodsStudents (n = 257) from a university in rural Alabama completed the survey. Multiple regression analysis, Mann-Whitney U tests, and moderation analysis were used to examine associations among the variables of interest.FindingsConsistent with TPB, results showed that attitudes and subjective norms were significant predictors of intention to get vaccinated. Knowledge that both sexes can experience HPV-related health problems, that HPV can cause genital warts, and that the vaccine protects against HPV were each associated with higher attitude scores. The results indicated that the odds of getting at least one HPV shot were higher for females than for males for non-Caucasians than for Caucasians. Students who were not vaccinated were more likely to report that religion influenced their health beliefs. *Abstract.ConclusionTPB was helpful in understanding HPV-related intentions. Communication and education efforts are needed to increase understanding of HPV illnesses and HPV vaccination benefits among peers, parents, and other loved ones of students. in the rural areas of Alabama.     

School-based vaccination of young US males: Impact of health beliefs on intent and first dose acceptance

Little is known about adolescent males and their parents with respect to intent and first dose uptake of the human papillomavirus (HPV) vaccine outside of primay care settings. The purpose of this study was to evaluate potential predictors of parental intent to vaccinate (study was conducted in November 2010–December 2012) and of first dose uptake of HPV vaccine among a sample of young adolescent males, 11–15 years of age, who received care at a school-based health center (SBHC). We also examined intent as a potential mediator of the relationships between predictors (health beliefs and perceived spousal agreement) and vaccination. Slightly more than half (n = 135 of 249) of parents reported an intention to vaccinate and 28% (n = 69) of males received their first dose of the HPV vaccine. Two of three health beliefs were significantly associated with both intention and uptake as was perceived spousal agreement. We found intention to vaccinate was a partial mediatator between the perceived benefits of HPV vaccine and first dose acceptance. We also determined that intent was a strong mediator between both general immunization benefits and perceived spousal agreement and first dose uptake. While vaccine uptake was lower than expected, particularly considering that many barriers to vaccine initiation were eliminated because of the SBHC setting, this rate is higher than in traditional settings. After controlling for intent, only perceived benefits of the HPV vaccine remained a significant predictor of first dose acceptance.     

Predictors of pneumococcal vaccination among Australian adults at high risk of pneumococcal disease

BackgroundAlthough nearly all Australian children are vaccinated against pneumococcal disease, pneumococcal vaccine uptake is low among high-risk adults. This study aimed to identify perceived barriers to pneumococcal vaccination among high-risk adults.MethodsThis paper reports combined data on pneumococcal vaccination collected from three different online, cross-sectional surveys that were administered in Australia between August 2019 and September 2020. Using Poisson regression, we identified characteristics and beliefs associated with self-reported pneumococcal vaccination among adults aged 65 and over or with chronic health conditions.ResultsThe weighted estimate for pneumococcal vaccine coverage was 24% for high-risk adults under 65 and 53% for adults aged 65 and over. Nearly half of those under 65 reported they had never heard of the pneumococcal vaccine, while 26% of those aged 65 and over had never heard of the vaccine. Among those under 65, pneumococcal vaccination was associated with high perceived disease susceptibility (PR = 1.97, 95% CI: 1.23, 3.18), not having heard of the pneumococcal vaccine (PR = 0.44, 95% CI: 0.28–0.69), awareness that their chronic health condition puts them at increased risk of pneumonia (PR = 2.44, 95% CI: 1.51–3.98), and having a doctor recommend the vaccine (PR = 3.02, 95% CI: 2.05–4.44). Among adults aged 65 and over, self-reported pneumococcal vaccination was associated with influenza vaccination in the previous 12 months (PR = 4.28, 95% CI: 2.85–6.44) and awareness that they are eligible for free pneumococcal vaccination (PR = 5.02, 95% CI: 2.34–10.77).ConclusionAwareness of pneumococcal vaccines was low among adults at high risk of pneumococcal disease, which appears to be contributing to low vaccine uptake. A doctor’s recommendation was associated with increased uptake of pneumococcal vaccine, so interventions should be developed to promote pneumococcal vaccine uptake in GP practices.     

Acceptability of vaccination against human papillomavirus among women aged 20 to 45 in rural Hunan Province,China: A cross-sectional study

ObjectiveThis study aimed to examine the intentions of and barriers to vaccination against human papillomavirus (HPV) among women aged 20 to 45 in rural areas, and to determine the popular sources to getting information about HPV vaccine and vaccination.MethodsThis cross-sectional study was conducted in 2018 with a sample of women aged 20 to 45 from rural areas of Hunan Province in China. Anonymous self-administered questionnaires were used to collect sociodemographic information and characteristics related to reproductive health of participants, and intentions of and barriers to HPV vaccination. All statistical analysis methods were performed with SPSS 18.0.ResultsA total of 2101 women participated in the study, with 58.55% intended to vaccinate against HPV. Increased intention of HPV vaccination was associated with higher age (adjusted odds ratio [AOR] = 1.35 and 1.50, respectively) and education level (AOR = 1.13 and 1.47, respectively). Women who have heard of HPV vaccine (AOR = 2.67, 95% confidence interval [CI]: 1.20–5.98) and have been aware of that cervical cancer could be prevented (AOR = 2.01, 95%CI: 1.44–2.82) were more willing to vaccinate. Having never heard of HPV vaccine and worry about efficacy and safety of vaccines were the most commonly cited reasons to refuse vaccination. The preferred source to get the knowledge was medical personnel (58.45%), followed by WeChat or Microblog, TV programs, and Internet.ConclusionWe found the intention of HPV vaccination among women aged 20 to 45 in rural China is low. Findings highlighted the importance of knowledge and trust in HPV vaccine, and suggested strengthening educational interventions on HPV vaccine and vaccination through multiple sources, including HPV vaccine coverage in health insurance to increase access.     

Messaging of Different Disease Outcomes for Human Papillomavirus Vaccination: A Systematic Review

PurposeThe purpose of this systematic review was to assess how messaging for human papillomavirus (HPV) vaccination to prevent different health outcomes (sexually transmitted infection, anogenital warts ([AGW], and/or cancer) influences intentions or initiation for the vaccine series.MethodsWe searched PubMed, MEDLINE, and Embase databases for all previously published articles with an evaluation, discussion, or comparison of messages containing content about HPV infections, AGW, precancers, or cancer through June 3, 2021. Results about messages were summarized by study population and design.ResultsWe identified 25 studies evaluating or comparing messages containing content about HPV-associated outcomes. Study designs included randomized trials (n = 12), cross-sectional surveys (n = 8), and qualitative approaches (n = 5). Few studies directly compared different messages using randomized designs or included vaccination uptake as the outcome. While many studies found support for cancer prevention messages, some studies also found equal or greater support for messages focusing on prevention of sexually transmitted infection/AGW. Variability was observed within and between studied populations (parents/adults, adolescents, young adults, healthcare providers, and adult males) and gender (male and female adolescents).DiscussionA greater understanding and deeper attention to myriad health outcomes of HPV infections could increase vaccination uptake in a variety of populations for health promotion across the lifespan.     

Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review

BackgroundPneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries.ObjectivesWe sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research.MethodsWe conducted a scoping review employing the Arksey and O’Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately.ResultsWe included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers’ perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults.ConclusionsWe identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.     

Pharmacists’ impact on older adults’ access to vaccines in the United States

ObjectiveThe purpose of this systematic review was to explore pharmacists’ impact on older adults’ access to vaccines in terms of realized accessibility, financial accessibility, and vaccine availability.MethodsFive databases were searched using a search strategy developed in PubMed and translated to other databases. Included studies were English-language, United States-based primary literature published between 1994 to present day. Studies were excluded if they were incomplete studies or did not focus on at least one of three dimensions of access to immunizations: realized accessibility, availability, and financial accessibility. The following data were gathered: title, authors, year published, sub-dimension of accessibility, health care setting, intervention or data source, pharmacist role, type of immunization, duration of study, sample size, and main outcome measures.ResultsTwenty-five studies met the inclusion criteria. Of those, the majority evaluated realized accessibility (n = 22, 88%). Eleven studies evaluated vaccine availability, and one study addressed financial accessibility. Pharmacists had a variety of roles in the immunization process, including screener, educator, immunizer, or documenter, and often played more than one role (n = 10, 40%). Pharmacists participated in the vaccination process across multiple health care settings, including in community pharmacies (n = 8, 32%) and hospitals (n = 7, 28%). In the majority (n = 21, 84%) of studies, pharmacists positively impacted older adults’ access to vaccines. The most common vaccinations studied were pneumococcal and influenza vaccinations (n = 20, 80%).ConclusionVaccinations are important in protecting and maintaining the health of older adults. Pharmacists improved access to vaccinations and served many roles in the vaccination process. Future research should explore how pharmacists impact access to vaccines beyond vaccination rates, especially regarding the financial impact on patients.     

Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network

BackgroundHuman papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11–17, of a large community-based primary care network.MethodsElectronic health records and administrative data from a large primary care network from January 2017 – June 2018 for patients ages 11–17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake.ResultsMost patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1–3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6–2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 – 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3–0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7–0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 – 1.0).ConclusionHPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.     

Missed opportunities for catch-up human papillomavirus vaccination among university undergraduates: Identifying health decision-making behaviors and uptake barriers

BackgroundSuboptimal adolescent human papillomavirus (HPV) vaccine rates in the US highlight the need for catch-up vaccination. When teenagers enter college, there may be a shift in healthcare decision-making from parents and guardians to the students themselves. Little is known about factors influencing college students’ healthcare decision-making processes.Study designWe evaluated HPV vaccine decision-making among 18-to-26-year-old college students through a self-administered, anonymous, cross-sectional survey. This survey was distributed to a sample of men and women in classroom settings at two universities. Categorical data comparisons were conducted using Chi-square and Fisher’s exact tests. Multivariate Poisson regression was used to model initiation of HPV vaccine and compute prevalence ratios while controlling for key influential covariates at the 0.05 alpha level.ResultsA total of 527 students participated (response proportion = 93.1%). Overall, 55.8% of participants received the HPV vaccine. Encouraging conversations with doctors and/or parents/guardians were identified as one of the most influential factors to increase vaccine uptake. Among students who received encouragement from both a doctor and parent, 95.8% received the vaccine. Campaigns about cancer prevention were viewed as more influential than those that focus on preventing genital warts. Approximately one-third of students indicated they didn’t know where to get the HPV vaccine. Women were more likely to report that their parents would not let them get the HPV vaccine compared to men (26.7% vs. 2.3%). The majority of students (77.3%) indicated their parents were sometimes, equally, or mostly involved in making decisions about receiving vaccines (other than flu).ConclusionStudents’ decision-making is greatly influenced by their parents; therefore, interventions for this population should work to increase students’ control over decision-making while also addressing parental concerns.     

Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies

ImportanceThe success in ending the COVID-19 pandemic rests partly on the mass uptake of the COVID-19 vaccine. Little work has been done to understand vaccine willingness among older adolescents and young adults. This is important since this age group may be less likely to adhere to public health guidelines.ObjectiveTo understand willingness of getting a vaccine and reasons for vaccine hesitancy among a sample of older adolescents and young adults.DesignData were from the Well-Being and Experiences study (The WE Study), a longitudinal community-based sample of older adolescents and young adults collected from Winnipeg, Manitoba, Canada from 2017 to 2020 (n = 664).SettingThe study setting was a community-based observational longitudinal study.ParticipantsParticipants for the study were aged 14 to 17 years old at baseline in 2016–17 (n = 1000). Data were also collected on one parent/caregiver. Waves 2 (n = 747) and 3 (n = 664) were collected in 2019 and 2020, respectively.ExposuresThe main exposures were sociodemographic factors, health conditions, COVID-19 knowledge, and adversity history.Main OutcomesThe main outcomes were COVID-19 vaccine willingness, hesitancy, and reasons for hesitancy.ResultsWillingness to get a COVID-19 vaccine was 65.4%. Willingness did not differ by age, sex, or mental health conditions, but did differ for other sociodemographic characteristics, physical health conditions, COVID-19 knowledge, practicing social/physical distancing, and adversity history. The most common reasons for not wanting a vaccine were related to safety, knowledge, and effectiveness. Sex differences were noted.Conclusions and RelevanceIncreasing uptake of the COVID-19 vaccine among older adolescents and young adults may rely on targeting individuals from households with lower income, financial burden, and adversity history, and generating public health messaging specifically aimed at vaccine safety, how it works to protect against illness, and why it is important to protect oneself against a COVID-19 infection.