HPV vaccination among adolescent males: Results from the National Immunization Survey-Teen

US guidelines provided a permissive recommendation for HPV vaccine for males in 2009, with an updated recommendation for routine vaccination in 2011. Data on vaccine uptake among males, however, remain sparse. We analyzed 2010–2011 data (collected mostly prior to the recommendation for routine vaccination) from the National Immunization Survey-Teen for a nationally representative sample of adolescent males ages 13–17 (n = 22,365). We examined HPV vaccine initiation (receipt of at least one dose based on healthcare provider records) as the primary outcome. Analyses used weighted logistic regression. HPV vaccine initiation increased from 1.4% in 2010 to 8.3% in 2011. Parents who reported receiving a healthcare provider recommendation to get their sons HPV vaccine were much more likely to have vaccinated sons (OR = 19.02, 95% CI: 14.36–25.19). Initiation was also higher among sons who were Hispanic (OR = 1.83, 95% CI: 1.24–2.71) or who were eligible for the Vaccines for Children program (OR = 1.53, 95% CI: 1.01–2.31). Only 31.0% of parents with unvaccinated sons indicated their sons were “somewhat likely” or “very likely” to receive HPV vaccine in the next year. The most common main reasons for parents not intending to vaccinate were believing vaccination is not needed or not necessary (24.5%), not having received a provider recommendation (22.1%), and lack of knowledge (15.9%). HPV vaccination is low among adolescent males in the US, and provider recommendation for vaccination is likely key to improving vaccine uptake. Given the updated recommendation for routine vaccination and the changes in health insurance coverage that are likely to follow, continued efforts are needed to monitor HPV vaccination among males.     

Factors associated with human papillomavirus vaccination among young adult women in the United States

Background

Human papillomavirus (HPV) vaccination is recommended to protect against HPV-related diseases.

Objective

To estimate HPV vaccine coverage and assess factors associated with vaccine awareness, initiation and receipt of 3 doses among women age 18–30 years.

Methods

Data from the 2010 National Health Interview Survey were analyzed to assess associations of HPV vaccination among women age 18–26 (n = 1866) and 27–30 years (n = 1028) with previous HPV exposure, cervical cancer screening and selected demographic, health care and behavioral characteristics using bivariate analysis and multivariable logistic regression.

Results

Overall, 23.2% of women age 18–26 and 6.7% of women age 27–30 years reported receiving at least 1 dose of HPV vaccine. In multivariable analyses among women age 18–26 years, not being married, having a regular physician, seeing a physician or obstetrician/gynecologist in the past year, influenza vaccination in the past year, and receipt of other recommended vaccines were associated with HPV vaccination. One-third of unvaccinated women age 18–26 years (n = 490) were interested in receiving HPV vaccine. Among women who were not interested in receiving HPV vaccine (n = 920), the main reasons reported included: not needing the vaccine (41.3%); concerns about safety of the vaccine (12.5%); not knowing enough about the vaccine (11.9%); not being sexually active (8.2%); a doctor not recommending the vaccine (7.6%); and already having HPV (2.7%). Among women with health insurance, 10 or more physician contacts within the past year and no contraindications, 74.5% reported not receiving HPV vaccine.

Conclusions

HPV vaccination coverage among women age 18–26 years remains low. Opportunities to vaccinate are missed. Healthcare providers can play an important role in educating young women about HPV and encouraging vaccination. Successful public health and educational interventions will need to address physician attitudes and practice patterns and other factors that influence vaccination behaviors.     

Considerations for human papillomavirus (HPV) vaccination of mid-adult women in the United States

In the United States, human papillomavirus (HPV) vaccination is recommended for 11 or 12 year old girls, with catch-up vaccination through age 26 years. Data are available for women over the age of 26 years on immunogenicity for both quadrivalent and bivalent HPV vaccines and on efficacy for the quadrivalent HPV vaccine. If HPV vaccines are licensed for use in women over 26 years of age (mid-adult women), recommendations for this age group will need to be considered. This review summarizes vaccine efficacy and immunogenicity data in mid-adult women, and addresses epidemiologic data related to key questions for consideration of vaccine recommendations for women over age 26 years.     

Impact of reduced human papillomavirus vaccination coverage rates due to COVID-19 in the United States: A model based analysis

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected utilization of preventative health care, including vaccines. We aimed to assess HPV vaccination rates during the pandemic, and conduct a simulation model-based analysis to estimate the impact of current coverage and future pandemic recovery scenarios on disease outcomes. The model population included females and males of all ages in the US. The model compares pre-COVID vaccine uptake to 3 reduced coverage scenarios with varying recovery speed. Vaccine coverage was obtained from Truven Marketscan™. Substantially reduced coverage between March-August 2020 was observed compared to 2018–2019. The model predicted that 130,853 to 213,926 additional cases of genital warts; 22,503 to 48,157 cases of CIN1; 48,682 to 110,192 cases of CIN2/3; and 2,882 to 6,487 cases of cervical cancer will occur over the next 100 years, compared to status quo. Providers should plan efforts to recover HPV vaccination and minimize potential long-term consequences.     

Disparities in human papillomavirus vaccination coverage in the United States,National Health and Nutrition Examination Survey,January 2017–March 2020

BackgroundWe assessed disparities in HPV vaccination coverage by sociodemographic characteristics in the United States.MethodsUsing 2017-March 2020 National Health and Nutrition Examination Survey data, we estimated vaccination coverage of ≥ 1 dose of HPV vaccine by race/ethnicity and poverty, insurance, and nativity status for females and males aged 9–14, 15–19, and 20–29 years.ResultsAmong those aged 9–14 years, coverage among non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) females (40.0%, 33.6%, 34.0%) and males (27.1%, 35.3%, 30.9%) was higher than non-Hispanic White (NHW) females (26.5%) and males (25.2%). Among those aged 15–19 and 20–29 years, coverage varied among NHB, Hispanic, and NHA compared to NHW females and was lower among NHB, Hispanic, and NHA than NHW males. Coverage was lower among uninsured than insured in most comparisons.ConclusionsHPV vaccination coverage varied by race/ethnicity and other characteristics. Efforts are needed to increase HPV vaccination coverage in all populations.     

The clinical benefit and cost-effectiveness of human papillomavirus vaccination for adult women in the Netherlands

Background

The use of human papillomavirus (HPV) vaccines has been universally approved for women from age 12 to 25 years, but those older than 16 years receive no reimbursement for the cost of the vaccine in the Netherlands. Reductions in the vaccine price as well as new insights in the efficacy of HPV vaccines offer renewed arguments to consider HPV vaccination in adult women. We calculated the clinical benefit and cost-effectiveness of vaccinating women aged 17-25 years in 2010.

Methods

The calculations were based on an individual-based simulation model for cervical carcinogenesis, with HPV infection risks obtained from a type-specific HPV transmission model. The indirect protective effect from vaccinating 12 to 16 year-old girls was adjusted for. Cervical screening in the model was incorporated according Dutch screening guidelines, i.e. 7 cytology-based rounds at 5-year intervals from the age of 30. As base-case, we assumed the vaccine to offer full protection against HPV16/18 only if no prior exposure to that type had occurred before vaccination. In sensitivity analyses, we considered partial cross-protection against types 31/33/45/58 and efficacy against all future infections, irrespective of previous or current infection status.

Results

In base-case analyses, vaccinating 17 year-olds reduced their lifetime risk of treatment for precancerous lesions from 7.77% to 3.48% and their lifetime cervical cancer risk from 0.52% to 0.24%. These risks were 6.12% and 0.45%, respectively, for a 25 year-old vaccinee. The incremental cost-effectiveness ratio (ICER) for vaccinating 17-25 year-olds was €22,526 per quality-adjusted life-year (QALY) at a vaccine price of €65 per dose, a 50% reduction of the 2010 pharmacy price in the Netherlands. If cross-protection against types 31/33/45/58 was included, the ICER decreased to €14,734 per QALY. Results were robust to efficacy assumptions with respect to previous or current infection status.

Conclusion

The clinical benefit of HPV vaccination of women up to 25 years moderately depends on cross-protection to non-vaccine types. Refunding the cost of the vaccine to 17-25 year-old women in the Netherlands can be considered cost-effective at anticipated price reductions.     

Comparison of the implementation of human papillomavirus and hepatitis B vaccination programs in the United States: Implications for future vaccines

Vaccines for two viruses which cause cancer, human papillomavirus (HPV) and hepatitis B virus (HBV), are recommended for all children in the United States. Numerous parallels exist between the two vaccines in addition to their roles in cancer prevention, including transmission through sexual contact, multiple doses needed for series completion, and vaccine administration in adolescence for HPV and in the initial phase of the HBV vaccination program. All of these factors were viewed as potential barriers to achieving high rates of coverage, yet the ultimate success of the HBV vaccination program led to predictions that similarly high rates of coverage could be achieved for the HPV vaccine. However, currently, only the recommendation for HBV vaccination is supported by mandates for school entry in most states. Uptake of the HPV vaccine has lagged far behind U.S. goals for public health promotion. The aim of this paper is to examine factors which may account for the divergent pathways of the two vaccines. Four main factors are identified: logistical challenges of vaccine administration, attitudes of parents and healthcare providers, safety concerns, and cost. For each factor examined, recommendations are offered to confront similar barriers likely to arise for future vaccines. The authors conclude that gender-neutral state mandates coupled with school-located vaccination programs, stronger gender-neutral messaging from pharmaceutical companies and healthcare providers, and younger age of vaccine administration, if approved, present the most promising approaches to improving uptake of the HPV vaccine, and similar vaccines down the road.     

Changes in childhood immunization decisions in the United States: Results from 2012 & 2014 National Parental Surveys

ObjectiveUnderstanding the current status of parents’ vaccine decision making is crucial to inform public policy. We sought to assess changes in vaccine decisions among parents of young children.MethodsWe conducted a web-based national poll of parents of children <7 years in 2012 and 2014. Participants reported vaccine decisions for their youngest child. We calculated survey-weighted population estimates of overall immunizations decisions, and delay/refusal rates for specific vaccines.ResultsIn 2012, 89.2% (95% CI, 87.3–90.8%) reported accepting or planning to accept all recommended non-influenza childhood vaccines, 5.5% (4.5–6.6%) reported intentionally delaying one or more, and 5.4% (4.1–6.9%) reported refusing one or more vaccines. In 2014, the acceptance, delay, and refusal rates were 90.8% (89.3–92.1%), 5.6% (4.6–6.9%), and 3.6% (2.8–4.5%), respectively. Between 2012 and 2014, intentional vaccine refusal decreased slightly among parents of older children (2–6 years) but not younger children (0–1 years). The proportion of parents working to catch up on all vaccines increased while those refusing some but not all vaccines decreased. The South experienced a significant increase in estimated acceptance (90.1–94.1%) and a significant decrease in intentional ongoing refusal (5.0–2.1%). Vaccine delay increased in the Northeast (3.2–8.8%).ConclusionsNationally, acceptance and ongoing intentional delay of recommended non-influenza childhood vaccines were stable. These findings suggest that more effort is warranted to counter persistent vaccine hesitancy, particularly at the local level. Longitudinal monitoring of immunization attitudes is also warranted to evaluate temporal shifts over time and geographically.     

Awareness of and attitude towards human papillomavirus infection and vaccination for cervical cancer prevention among adult males and females in Korea: A nationwide interview survey

We assessed adult male and female awareness and acceptance of human papillomavirus (HPV) infection and vaccination for cervical cancer prevention, as well as factors associated with willingness to be administered the HPV vaccine. A nationwide population-based interview survey was conducted in Korea. One thousand male and female adults were included with random sampling. Despite the fact that awareness of HPV infection (13.3%) and the preventive effect of HPV vaccination (8.6%) were low, willingness to vaccinate against HPV (55.0%) was relatively high, especially with regard to participants’ daughters (77.0%). Those who were informed about HPV infection (adjusted odds ratio, aOR = 2.5 and 95% confidence interval, CI = 1.1–5.3 in males; aOR = 2.5 and 95% CI = 1.5–4.2 in females) or vaccination (aOR = 2.9 and 95% CI = 1.1–7.6 in males; aOR = 2.9 and 95% CI = 1.6–5.4 in females), or who perceived a susceptibility to HPV infection (aOR = 3.6 and 95% CI = 1.9–6.8 in males; aOR = 2.8 and 95% CI = 1.6–5.0 in females) were more accepting of vaccination than those who did not.     

The adult vaccination landscape in the United States during the Affordable Care Act era: Results from a large retrospective database analysis

BackgroundEarly provisions of the Affordable Care Act (ACA) reduced financial barriers to preventive care, including routinely recommended vaccines; however, vaccination coverage remains suboptimal. This study examined characteristics of routine adult vaccinations and potential missed opportunities for vaccinations through the lens of healthcare resource utilization among adults in the ACA era.MethodsThis was a retrospective analysis of healthcare claims from the Truven Health MarketScan Commercial Claims and Encounters (CCAE), Medicare Supplemental (MS), and Multi-State Medicaid databases among adults aged 19 years or older. Influenza, Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis), herpes zoster (HZ), and pneumococcal vaccinations were identified between 2011 and 2016. Potential missed opportunities were defined as well-visits at which individuals were age-eligible for vaccination but did not receive it, assessed during recommended windows for each vaccine. Missed encounters were defined as having no well-visits. Multivariable logistic regression was used to identify factors associated with vaccination and potential missed opportunities.ResultsFamily/internal medicine and unknown/other providers administered most influenza, Tdap, and pneumococcal vaccinations, for the CCAE/MS and Medicaid cohorts, respectively. HZ vaccinations were primarily administered through pharmacies. The proportion of vaccination events increased in the pharmacy setting between 2011 and 2016. Having preventive care visits, non-well-visits, and receiving most care from a family/internal medicine practitioner were associated with increased odds of vaccination. Missed encounters were common in Medicaid enrollees. Potential missed opportunities were more prevalent in the CCAE/MS cohort than among Medicaid enrollees. Having non-well-visits was associated with a reduced likelihood of having a missed opportunity.ConclusionSince the ACA implementation, preventive care among adults was sporadic. Many adults had limited opportunities for vaccination. The large prevalence of missed opportunities suggests vaccination uptake could be improved. Better support for vaccination or referrals for providers who may not traditionally vaccinate could improve vaccine uptake.     

Association between human papillomavirus vaccine status and sexually transmitted infection outcomes among females aged 18-35 with a history of sexual activity in the United States: A population survey-based cross-sectional analysis

BackgroundCurrent human papillomavirus (HPV) vaccine coverage in the United States (in 2019, 66–70%), remains below the Healthy People 2020 coverage goal of 80%. HPV vaccine misinformation, including parental concerns of sexual risk-compensation influence vaccine uptake. We examined the association between HPV vaccination and sexually transmitted infection (STI) outcomes.MethodsOf the 20,146 participants from 2013 to 2014 and 2015–2016 cycles of the National Health and Nutrition Examination Survey, 1050 females aged 18–35 with a history of sexual activity had complete case data. Roa-Scott Chi-squared and F-tests assessed survey-weighted socio-demographic differences between vaccinated and unvaccinated participants. Weighted logistic regression assessed crude and adjusted associations between self-reported HPV vaccination (none vs. ≥ 1dose) and lab-confirmed STIs (trichomonas and chlamydia) and vaccine-type HPV (6/11/16/18). As a sensitivity analysis, we conducted weighted-propensity score (PS) models and inverse probability weighting by vaccination status. PS and logistic regression were estimated through survey-weighted logistic regression on variables including race, education, income, marital status, US citizenship, cycle year and age.ResultsOverall, 325 (31.8%) females with a history of sexual activity were HPV vaccinated, of which 22 (6.1%) received the vaccine at the routine-recommended ages of 11–12, 65.7% were vaccinated after their self-reported sexual debut, 3.8% had a lab-confirmed STI and 3.5% had vaccine-type HPV. There was no association between HPV vaccination and any STIs (adjusted odds ratio [aOR] 0.67, 95%CI:0.38–1.20), and vaccinated participants had 61% reduced odds of vaccine-type HPV (vs. unvaccinated; aOR 0.39, 95%CI:0.19–0.83). Results from the PS sensitivity analysis were similar to the main findings.ConclusionAmong females who reported a history of sexual activity, HPV vaccination status was protective against vaccine-type HPV and not associated with lab-based STI outcomes. Although findings may be susceptible to reporting bias, results indicating low vaccine uptake at routine-recommended ages requires additional efforts promoting HPV vaccination before sexual-debut.     

Hepatitis A virus infection in the United States: serologic results from the Third National Health and Nutrition Examination Survey

To determine the prevalence of hepatitis A virus (HAV) infection in the general U.S. population, sera from participants in the Third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988–1994 were tested for antibody to HAV (anti-HAV). Among 21,260 participants aged ≥6 years tested, the overall prevalence of infection was 31.3%, and increased markedly with age. The age-adjusted prevalence was significantly higher among foreign- compared to U.S.-born participants, and was highest among Mexican-Americans and lowest among non-Hispanic whites. Among U.S.-born children, only Mexican-American ethnicity and income below the poverty level were associated with HAV infection in a multivariate model. During this period before hepatitis A vaccination, age, ethnicity and birthplace were the most important determinants of HAV infection in the United States.     

Serum alpha-tocopherol status in the United States population: findings from the Third National Health and Nutrition Examination Survey.

Despite the role vitamin E may have in protecting against various chronic conditions, little is known about vitamin E status in the US population. Using data from the Third National Health and Nutrition Examination Survey (1988-1994), the authors examined the distribution and correlates of serum alpha-tocopherol among 16,295 US adults aged 18 or more years. The mean concentration of alpha-tocopherol was 26.8 micromol/liter (geometric mean, 25.0 micromol/liter).The 25th, 50th, and 75th percentiles were 19.6, 24.1, and 30.4 micromol/liter, respectively.The mean alpha-tocopherol/cholesterol ratio was 5.1 (geometric mean, 4.9); the 25th, 50th, and 75th percentiles were 4.1, 4.7, and 5.5 (10(-3)), respectively. About 27% of the US population had a low alpha-tocopherol concentration (<20 micromol/liter). After age standardization, 29% of the men, 28% of the women, 26% of the Whites (men, 27%, and women, 26%), 41% of the African Americans (men, 42%, and women, 40%), 28% of the Mexican Americans (men, 29%, and women, 27%), and 32% of the other participants (men, 36%, and women, 29%) had this low concentration. For all participants, age, educational attainment, serum cholesterol, and several serum vitamins and carotenoids were directly related to and high density lipoprotein cholesterol was inversely related to serum alpha-tocopherol concentration in multiple linear regression analysis. Men had a higher concentration than did women, and African Americans had the lowest concentration of any racial or ethnic group. These results show that important proportions of US adults have a low serum alpha-tocopherol concentration, which may increase their risk for chronic diseases in which low dietary intake or blood concentration of alpha-tocopherol have been implicated.     

Serum total homocysteine concentrations in adolescent and adult Americans: results from the third National Health and Nutrition Examination Survey

BACKGROUND: The elevation of circulating total homocysteine concentrations in a fasting state is associated with an increased risk of occlusive vascular disease. OBJECTIVE: The primary goals of this study were to describe the distribution of serum total homocysteine concentrations in the United States and to test for differences in homocysteine concentrations among sex, age, and race-ethnicity categories. DESIGN: Using surplus sera from phase 2 of the third National Health and Nutrition Examination Survey, we measured serum total homocysteine concentrations for a nationally representative sample of 3766 males and 4819 females aged > or = 12 y. RESULTS: Age-adjusted geometric mean total homocysteine concentrations were 9.6 and 7.9 mmol/L in non-Hispanic white males and females, 9.8 and 8.2 mmol/L in non-Hispanic black males and females, and 9.4 and 7.4 mmol/L in Mexican American males and females, respectively. Age-adjusted geometric mean total homocysteine concentrations were significantly lower in females than in males in each race-ethnicity group (P < 0.01) and were significantly lower in Mexican American females than in non-Hispanic white and non-Hispanic black females (P < 0.01). There was a significant age-sex interaction (P < 0.01), reflecting the fact that homocysteine concentrations in females tended to diverge from those in males at younger ages and converge with those in males at older ages. CONCLUSIONS: The first data on homocysteine concentrations in a nationally representative sample of Americans confirm the age and sex differences reported previously in nonrepresentative samples. These data also indicate that differences between Mexican American and non-Hispanic females may influence circulating homocysteine concentrations.     

Social support, social selection and self-assessed health status: results from the veterans health study in the United States

This study provided a comprehensive assessment of the association between social support and health using longitudinal data from the Veterans Health Study. Unlike previous studies which examined the relationship between one single domain of social support with either mental or physical health, the present study assessed the effects of three different domains of social support on multiple measures of health. The findings of the study indicated that social support tended to mediate the deleterious effects of non-military traumatic events; whereas the adverse consequences of traumatic events experienced in the military were not affected by social support, suggesting that stressors associated with combat had a long lasting effect on the health status of veterans. The study results revealed that compared with those with better health, respondents with poor health were more likely to have lower levels of social support, suggesting that poor health might be a barrier to a person's ability to participate and/or maintain social relationships. The study also showed that different types of social support had varying beneficial effects on different measures of health. While perceived support had a strong effect on all the measures of health (except alcoholism) included in the study, living arrangement had a significant effect on post-traumatic stress disorder or physical health and participation in group activities had a strong effect only on physical functioning. The results of the study highlight the need for future research to determine whether particular types of social support affect various aspects of health differently. This simultaneous focus on multiple support functions and health outcomes is important because it provides insight into the mechanisms linking social support to health.     

Vibrator use among heterosexual men varies by partnership status: results from a nationally representative study in the United States

This nationally representative study documents that vibrator use among heterosexually identified men in the United States is common, with 43.8% reporting use of a vibrator at some point in their lives, with most vibrator use by heterosexual men occurring within the context of sexual interactions with a female partner. Approximately 94% of male vibrator users reported that they had used a vibrator during sexual play with a partner, and 82% reported that they had used a vibrator during sexual intercourse. These data support the work of therapists and educators who often make recommendations for the incorporation of vibrators into partnered relationships.     

The need for prenatal care in the United States: evidence from the 1980 National Natality Survey

Seventy-eight percent of U.S. mothers begin prenatal care during the first three months of pregnancy; 18 percent wait until the second three months; and five percent wait until the third trimester or receive no care at all. Patterns of prenatal care vary widely among population subgroups: Mothers younger than 18 and unmarried mothers are the least likely to obtain first-trimester care (49 percent and 56 percent, respectively), and the most likely to obtain care only in the third trimester or none at all (about 12 percent of each group). Women aged 18-19, blacks, Hispanics, poor women and women with little education also have disproportionately high levels of very late or no care (7-9 percent). Married, white, nonpoor women, in contrast, obtain the most timely prenatal care: In 1980, only two percent initiated care in the third trimester or received no care. Compared with this subgroup of women, the population as a whole has two times the risk of obtaining inadequate care. Unmarried women run the highest relative risk (five times the risk for married, white, nonpoor women), followed by teenagers, Hispanic women, women with little education, poor women and blacks (who have from three to more than four times the risk of the comparison group).     

An update on human papillomavirus vaccine uptake among 11-17 year old girls in the United States: National Health Interview Survey, 2010

Purpose

A 3-dose human papillomavirus (HPV) vaccine is recommended for adolescents to protect against HPV-related cervical and other cancers. The purpose of this study was to provide an update on HPV vaccine uptake among 11–17 year old girls residing in the US.

Methods

Data from the 2010 National Health Interview Survey (NHIS) were obtained to assess HPV vaccination status and its correlates. Multivariate logistic regression analyses were performed to examine HPV vaccine uptake of ≥1 dose and ≥3 doses among all girls, and completion of the 3-dose series among those who initiated (received ≥1 dose) the vaccine.

Results

Overall, 28.9% and 14.2% received ≥1 dose and ≥3 doses of vaccine: 14.5% and 3.0% among 11–12 year old girls, and 34.8% and 18.7% among 13–17 year olds, respectively. Hispanics had higher uptake of ≥1 dose (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.22–2.17) than whites. Having received an influenza shot in the past year and parents’ awareness of the vaccine were significantly associated with receiving ≥1 dose (OR 1.88, 95% CI 1.51–2.33 and OR 16.57, 95% CI 10.95–25.06) and ≥3 doses (OR 1.48, 95% CI 1.13–1.92 and OR 10.60, 95% CI 5.95–18.88). A separate multivariate model based on girls who initiated the vaccine did not identify any significant correlates of 3-dose series completion. Among parents of unvaccinated girls, 60% were not interested in vaccinating their daughters and mentioned three main reasons: “does not need vaccine” (25.5%), “worried about safety” (19.3%) and “does not know enough about vaccine” (16.6%). Of those who were interested, 53.7% would pay $360–$500 for the vaccination, while 41.7% preferred to receive it at a much lower cost or free.

Conclusions

Only 1 out of 3 girls (11–17 years) have received ≥1 dose of HPV vaccine and much less have completed all 3 doses. Strategies should be taken to improve this vaccine uptake among girls, especially those 11–12 year olds, and to educate parents about the importance of vaccination.     

Food insufficiency exists in the United States: results from the third National Health and Nutrition Examination Survey (NHANES III).

OBJECTIVES: The purpose of this study was to estimate the prevalence of food insufficiency in the United States and to examine sociodemographic characteristics related to food insufficiency. METHODS: Data were analyzed from the third National Health and Nutrition Examination Survey, a cross-sectional representative sample of the civilian noninstitutionalized population living in households. Individuals were classified as "food insufficient" if a family respondent reported that the family sometimes or often did not get enough food to eat. RESULTS: From 1988 through 1994, the overall prevalence of food insufficiency was 4.1% and was primarily related to poverty status. In the low-income population, food insufficiency was positively associated with being Mexican American, being under the age of 60, having a family head who had not completed high school, participating in the Food Stamp Program, and not having health insurance. It was not related to family type or employment status of the family head. Over half of food-insufficient individuals lived in employed families. CONCLUSIONS: Food insufficiency is not limited to very low-income persons, specific racial/ethnic groups, family types, or the unemployed. Understanding food insufficiency is critical to formulating nutrition programs and policies.