Working to close the gap: identifying predictors of HPV vaccine uptake among young African American women

Factors associated with greater likelihood of human papillomavirus (HPV) vaccination among women who experience excess cervical cancer incidence and mortality requires further study. The purpose of this study was to assess factors associated with HPV vaccine uptake among young African American women. Three hundred sixty-three African American women aged 18-26 were recruited from Historically Black Colleges/Universities to complete a questionnaire to assess health beliefs associated with HPV vaccination. One quarter of participants reported uptake of the HPV vaccine. Women who reported uptake had significantly higher HPV knowledge, lower perceived barriers to vaccination, and were younger (all p<.05). Factors significantly associated with HPV vaccine uptake included HPV knowledge (OR=1.22), perceived severity of health outcomes (OR=0.48), perceived barriers to vaccination (OR=0.49), cues to action (OR=1.94), and age (OR=0.68). Findings can be used to inform the development of targeted HPV vaccine promotion programs for African American women to prevent continued cervical cancer disparities.     

Knowledge and Acceptability of the HPV Vaccine Among Ethnically Diverse Black Women

The purpose of the study was to examine HPV vaccine knowledge and acceptability among ethnically diverse Black women. Forty-four women were interviewed in 6 focus groups (2 African American, 2 English-speaking Caribbean, 1 Haitian, and 1 African). Thematic content analysis was used to generate common concepts and themes and to compare findings across groups. There was varied but limited knowledge and confusion across ethnic groups about the HPV infection and vaccine. African and Haitian women had the least knowledge. Overall, women were generally receptive toward the HPV vaccine for girls but unclear about the need to vaccinate boys. Concerns about the HPV vaccine were mainly related to side effects/safety and vaccinating children at a young age. Healthcare provider’s recommendation of the vaccination was important for decision making. Educational interventions with Black women about HPV vaccination should recognize cultural beliefs that vary by ethnic group.     

Knowledge,Attitudes, and Beliefs Regarding HPV Vaccination: Ethnic and Cultural Differences Between African-American and Haitian Immigrant Women

BackgroundBlack women have higher rates of cervical cancer and lower rates of HPV vaccination than White women in the United States, and Haitians may be an especially vulnerable subgroup of Black women. To reduce these disparities, understanding differences among subgroups of Black women is crucial.MethodsThe objective of our study was to assess similarities and differences in the knowledge, attitudes, beliefs, and practices toward HPV vaccination and actual vaccination rates among African-American and Haitian immigrant women and their daughters. We used validated surveys of HPV knowledge, trust in physicians, acculturation, and constructs of the health belief model: Perceived susceptibility, severity, and barriers. We probed women's thought processes about vaccination using open-ended questions. We then reviewed medical records to determine vaccination rates.ResultsNineteen African Americans and 51 Haitians participated. Although 75% of Haitians and 63% of African Americans intended to vaccinate their daughters, only 47% of African-American and 31% of Haitian daughters were vaccinated. African Americans were more knowledgeable than Haitians and had more prior experience with HPV disease. Most African Americans felt that vaccination fell within the parental role, whereas many Haitians felt uncomfortable vaccinating against sexually transmitted infections because they felt children should not be having sex. Both ethnic groups wanted more information about HPV vaccines.ConclusionCultural differences between African-American and Haitian immigrant mothers revealed distinct barriers for vaccine acceptance. Improving HPV vaccine rates in Black women may require culturally competent and sensitive approaches that address ethnic-specific barriers.     

HPV Vaccination and Sexual Behavior in a Community College Sample

Many US parents are concerned that vaccinating daughters against human papillomavirus (HPV) will communicate implicit approval for sexual activity and be associated with early or risky sexual behavior (Scarinci et al. in J Womens Health 16(8):1224–1233, 2007; Schuler et al. in Sex Transm Infect 87:349–353, 2011) [7, 8]. The aims of this study were to understand (a) whether the HPV vaccine was associated with risky sexual behavior among a diverse sample of female adolescents and young adults, and (b) to better understand the chronology of HPV vaccination and sexual behavior. An anonymous web-based survey was used to collect data from 114 female community college students. T test and Chi square analyses were used to compare vaccinated and unvaccinated groups on age at first intercourse and proportion who had ever had sexual intercourse. Linear multiple regression was used to predict frequency of condom use and number of sexual partners in the past year, using vaccination status and demographic factors as predictors. About 38 % reported receiving at least one dose of the HPV vaccine. Many of those vaccinated (45 %) received the vaccine after having initiated sexual activity. The proportion of women who were sexually experienced did not differ by HPV vaccine status, nor did age at first intercourse, number of partners in the past year, or frequency of condom use. Current findings suggest that HPV vaccination is not associated with riskier sexual activity for the young women in this sample. Adolescents and their parents may benefit from education about the need to receive the HPV vaccine before onset of sexual activity.     

Predictors of HPV vaccine acceptability: a theory-informed, systematic review

OBJECTIVE: To inform future human papillomavirus (HPV) vaccination programs, we systematically reviewed studies of HPV-related beliefs and HPV vaccine acceptability, organizing the findings using health behavior theory and cervical cancer risk factors. METHODS: We searched Medline, CINAHL, and PsycINFO from 1995 to January, 2007 for studies of HPV beliefs and HPV vaccine acceptability among adolescents, young adults, and parents of adolescents in the United States. RESULTS: We identified 28 studies. Most were small, cross-sectional studies of parents and adults. Most parents reacted positively to the possibility of vaccinating their daughters against HPV. Vaccination acceptability was higher when people believed the vaccine was effective, a physician would recommend it, and HPV infection was likely. Cost and, for 6% to 12% of parents, concerns that vaccination would promote adolescent sexual behavior were barriers to vaccination. African American, Hispanic, and white respondents were equally accepting of the HPV vaccine. Parents with lower levels of education reported higher vaccine acceptability. Many studies inadequately reported on other variables associated with cervical cancer mortality. CONCLUSIONS: HPV vaccine programs in the United States should emphasize high vaccine effectiveness, the high likelihood of HPV infection, and physicians' recommendations, and address barriers to vaccination.     

Pap Testing, Awareness, and Acceptability of a Human Papillomavirus (HPV) Vaccine Among Chinese American Women

Little is known about the knowledge and opinions of human papillomavirus (HPV) vaccine among Chinese immigrants, nor the impact of framing HPV as a sexually transmitted infection in this population. A cross-sectional survey was conducted focusing on knowledge and experience with HPV, HPV vaccine, cervical cancer and Pap testing, and attitudes toward HPV vaccine in response to different message frames. Chinese American women were recruited in a community setting (n?=?162). Only 19?% had heard of HPV and 38?% had had a Pap test in the last 3?years. Multivariate logistic regression showed that English proficiency was associated with vaccination acceptance and insurance status was associated with HPV awareness; there was no observed correlation with message framing. Chinese American women with limited English proficiency have low HPV awareness. Community-based, culturally appropriate education about cervical cancer and HPV vaccine should be directed toward limited-English proficient Chinese American women.     

Health Care Provider Recommendation,Human Papillomavirus Vaccination,and Race/Ethnicity in the US National Immunization Survey

Objectives. Human papillomavirus (HPV) is a common sexually transmitted infection in the United States, yet HPV vaccination rates remain relatively low. We examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and the association between recommendation and vaccination.Methods. We used the 2009 National Immunization Survey–Teen, a nationally representative cross-section of female adolescents aged 13 to 17 years, to assess provider-verified HPV vaccination (≥ 1 dose) and participant-reported health care provider recommendation for the HPV vaccine.Results. More than half (56.9%) of female adolescents received a recommendation for the HPV vaccine, and adolescents with a recommendation were almost 5 times as likely to receive a vaccine (odds ratio = 4.81; 95% confidence interval = 4.01, 5.77) as those without a recommendation. Racial/ethnic minorities were less likely to receive a recommendation, but the association between recommendation and vaccination appeared strong for all racial/ethnic groups.Conclusions. Provider recommendations were strongly associated with HPV vaccination. Racial/ethnic minorities and non-Hispanic Whites were equally likely to obtain an HPV vaccine after receiving a recommendation. Vaccine education efforts should target health care providers to increase recommendations, particularly among racial/ethnic minority populations.Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States.1,2 In 2006, the Food and Drug Administration (FDA) licensed the first HPV vaccine for use in females aged 9 to 26 years. Subsequently, the Advisory Committee on Immunization Practices (ACIP) recommended routine HPV vaccination of 11- and 12-year-old girls, with ensuing catch-up vaccinations recommended for older female adolescents and young adults.3 However, HPV vaccine coverage of adolescents remains less than 50%,4 and Healthy People 2020 recognizes the facilitation of HPV vaccination as an emerging issue in sexually transmitted diseases.5Health care provider recommendation has been shown to be a strong predictor of vaccination for a wide range of vaccines in older age groups.6–8 Therefore, one potential explanation for the low levels of HPV vaccine coverage is that parents and adolescents are not receiving HPV vaccine recommendations from their health care providers. A previous study indicated that less than 40% of adolescents discussed the HPV vaccine with their health care provider.9African Americans and other minority groups are disproportionately affected by HPV infection and subsequent cervical cancer compared with non-Hispanic Whites.10,11 A better understanding of how to prevent HPV infection among racial/ethnic minorities will have important implications for reducing these health disparities. At the national level, little is known about racial/ethnic differences in the likelihood of receiving an HPV vaccine recommendation by a health care provider. In addition, little is known about the association between receiving a provider recommendation and actual HPV vaccine receipt and whether this association differs by race/ethnicity.Using the National Immunization Survey (NIS), a nationally representative sample of female adolescents aged 13 to 17 years in the United States, we examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and in the association between provider recommendation and provider-verified HPV vaccine initiation. In addition, we examined the roles of parental socioeconomic status and health insurance status in influencing the likelihood of provider recommendation and vaccine initiation.     

HPV vaccination coverage and willingness to be vaccinated among 18–30 year-old students in Italy

ObjectivesIn Italy, free HPV vaccination has been offered to 12 years-old girls since 2007, while for males only since 2015. The aims of our study were: to measure HPV vaccination coverage among young women; to assess willingness to receive HPV vaccination among unvaccinated males and females; to evaluate the association of coverage and attitudes with knowledge regarding HPV and with sexual behavior.MethodsA cross-sectional survey was conducted in an Italian region among 18–30 year-old students attending medical and healthcare professions schools. Participants completed a self-administered questionnaire exploring knowledge, attitudes and behaviors related to HPV infections, sexually transmitted diseases and their prevention. Information on vaccination status was also verified for each student through the immunization records provided by the participants during the occupational medical visit.Results517 students were enrolled, with a 97% response rate. Of female participants, 40.5% had received at least one dose of HPV vaccine, while among unvaccinated participants, 60.5% stated their willingness to be vaccinated. A negative attitude towards HPV vaccination was associated with an older age, whereas a correct knowledge that both sexes are at risk of HPV infection, and the knowledge that vaccine protects against cervical cancer were confirmed to be associated to a willingness to receive HPV vaccination.ConclusionsOur results showed low HPV vaccination coverage among young women and high reported willingness to receive vaccination among both sexes. More active education on the link between HPV and all related cancers could be beneficial to help prevent significant burden of the HPV-related diseases.     

Accuracy of self-reported human papillomavirus vaccine receipt among adolescent girls and their mothers

PurposeThe use of self-report of human papillomavirus (HPV) vaccination status has several implications for clinical care and research. Reports of HPV vaccination history of adolescent girls (ages: 14–17 years) and their mothers were compared with medical chart data to assess the accuracy of HPV vaccine recall.MethodsAdolescent girls (N = 74) and their mothers independently completed questionnaires regarding HPV vaccination history, which were compared with medical chart data to assess the accuracy of HPV vaccine recall.ResultsThere were high levels of inaccuracy between actual HPV vaccination and self-report of vaccine receipt. Both mothers and daughters had poor recall of HPV vaccination, and were more likely to underestimate than overestimate the coverage. Girls who accurately reported their vaccination status were not more likely to have been sexually active in the past 2 months (p = .75).ConclusionsThese findings have clinical and research implications, as self-report is relied on to assess young women's vaccination status in research settings or in the absence of medical records. These data address the still prevalent concern that HPV vaccination encourages adolescent sexual behavior. It is unlikely that sexual behaviors will change as a result of vaccination in the large percentage of girls who cannot recall being vaccinated.     

Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood

PurposeYoung adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university.MethodsWe conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination.ResultsMany young adults cited their parents’ views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine’s benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers’ vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure.ConclusionsAlthough college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.     

“We've Been Together. We Don't Have It. We're Fine.” How Relationship Status Impacts Human Papillomavirus Vaccine Behavior among Young Adult Women

BackgroundVaccination against the human papillomavirus (HPV) has the potential to significantly reduce morbidity and mortality associated with genital warts and HPV-related cancers. However, HPV vaccination rates continue to be suboptimal among the “catch-up” population of 18- to 26-year-old women. One consistent risk factor for nonvaccination is being in a relationship. This study aimed to understand how relationship status and vaccination status impact risk perceptions and perceived need for the HPV vaccine among young adult women.MethodsIn-depth interviews were conducted with a sample (n = 50) of recently HPV vaccinated and unvaccinated college women, and stratified by four relationship categories. Comparative thematic analysis was used to assess relationship status and HPV risk perceptions.ResultsWomen in relationships perceived their risk of HPV to be low, which they attributed to monogamy and few sexual partners. Women in dating relationships reported higher HPV risk, which was linked to unprotected sex and sexual activity. In contrast, single women stated that their low risk for HPV was due to sexual inactivity.ConclusionsThis study builds on the epidemiological literature, by understanding how relationship status impacts HPV vaccination among young adult women. Relationship status contributed to HPV risk perceptions and vaccination decisions among these women. Perceptions were framed based on sexual behavior, such as monogamy or number of sexual partners. Future efforts should tailor health messages to young adult women's specific risk misperceptions about HPV.     

Low HPV Vaccine Coverage Among Female Community College Students

This study assessed HPV vaccination and its correlates among culturally diverse 18–26?year-old community college women in Los Angeles. Specific research questions were: (1) What proportion of respondents have initiated the HPV vaccine, and what proportion have completed the three-dose series? (2) What demographic (e.g., age, ethnicity), psychosocial (e.g., vaccine-related beliefs, perceived social norms), and health care-related variables (e.g., health insurance status, provider recommendation, health care trust and satisfaction) are associated with vaccine initiation for this sample? Participants were recruited from the campus of a community college in central Los Angeles. All female students between 18 and 26 were eligible to participate. An anonymous web-based survey assessed number of HPV vaccine doses received as well as demographic information, HPV- and HPV vaccine-related knowledge, attitudes, and behavior, perceived social norms, provider & health care system factors, sexual behavior, cervical health, and mother-daughter communication about sex. Analyses were conducted using 178 surveys. Multivariate logistic regression tested the relationships of statistically significant bivariate predictors to vaccine initiation. Those who initiated the vaccine were younger, more often had a health-related academic major, thought the vaccine to be safer, perceived HPV severity lower, and perceived higher social approval for HPV vaccination than those unvaccinated. All who had initiated the vaccine had a doctor’s recommendation. To increase uptake among 18–26-year-old women, research should explore provider interventions to increase vaccine recommendation, and also identify individuals and groups who may have negative beliefs about vaccine safety and efficacy to provide support in vaccine decision-making.     

Awareness, knowledge, and beliefs about human papillomavirus in a racially diverse sample of young adults.

PURPOSE: To assess current levels and correlates of awareness, knowledge, and beliefs about human papillomavirus (HPV) in a racially diverse sample of young adults. Correlates of interest in HPV education and the HPV vaccine were also examined. METHODS: A total of 124 students 18-26 years of age from two southeastern universities (including a historically black university) completed a survey assessing demographic characteristics, sexual history, awareness and knowledge of HPV, HPV-related beliefs (perceived risk of HPV infection, perceived shame associated with HPV infection), interest in learning more about HPV, and interest in the HPV vaccine (women only). RESULTS: More than 75% of the sample had heard of HPV. Although some misunderstandings were observed, HPV knowledge was relatively high. Women reported greater awareness and knowledge of HPV than did men. Higher perceptions of risk were observed among sexually active participants and those with multiple sexual partners. Younger participants, men, and those with less HPV knowledge indicated they would feel more ashamed if diagnosed with HPV. Black/African-American and sexually active participants reported greater interest in HPV education. Greater interest in the HPV vaccine was observed among women who were sexually active, had multiple sexual partners, and felt vulnerable to HPV infection. CONCLUSIONS: This study is one of the first to assess awareness, knowledge, and beliefs about HPV since the HPV vaccine was approved. Findings suggest that awareness of HPV may be increasing, yet many misconceptions remain. Continued efforts are needed to promote further understanding of HPV infection, the HPV vaccine, and the importance of routine cervical screening.     

No association between HPV vaccination and infertility in U.S. females 18–33 years old

BackgroundHuman papillomavirus (HPV) vaccines have been recommended as primary prevention of HPV-related cancers for over 10 years in the United States, and evidence reveals decreased incidence of HPV infections following vaccination. However, concerns have been raised that HPV vaccines could decrease fertility. This study examined the relationship between HPV immunization and self-reported infertility in a nationally representative sample.MethodsData from the 2013–2016 National Health and Nutrition Examination Survey were analyzed to assess likelihood of self-reported infertility among women aged 20 to 33, who were young enough to have been offered HPV vaccines and old enough to have been queried about infertility (n = 1114). Two logistic regression models, stratified by marital history, examined potential associations between HPV vaccination and infertility. Model 1 assessed the likelihood of infertility among women who had never been pregnant or whose pregnancies occurred prior to HPV vaccination. Model 2 accounted for the possibility of latent and/or non-permanent post-vaccine infertility by including all women 20–33 years old who reported any 12-month period of infertility.Results8.1% reported any infertility. Neither model revealed any association between HPV vaccination at any age and self-reported infertility, regardless of marital status.ConclusionThere was no evidence of increased infertility among women who received the HPV vaccine. These results provide further evidence of HPV vaccine safety and should give providers confidence in recommending HPV vaccination. Further research should explore protective effects of HPV vaccines on female and male fertility.     

Human papillomavirus knowledge,attitudes, and vaccination among Chinese college students in the United States

Human papilloma virus (HPV) is the most common sexually transmitted infection in the USA with some strains increasing the risk of certain cancers. The HPV vaccine, introduced in 2006, has reduced the infection rate, although racial/ethnic disparities in vaccination exist. Asian college students are among those with the lowest vaccination rates, however there has been little exploration as to why. The purposes of this study were to assess (a) knowledge and attitudes regarding HPV and its vaccine, (b) HPV vaccination practices, and (c) factors associated with HPV-related knowledge and attitudes, and vaccination among Chinese college students in the USA. This cross-sectional quantitative survey collected data face-to-face and online from 449 participants. The mean scores for HPV knowledge and attitudes were 40.87 and 2.36 indicating a low-to-moderate level of knowledge but a moderately positive attitude regrading HPV transmission and vaccination. Only half (50.8%) knew that the vaccination could be received after the age of 18 years. Only 38.3% reported having receiving at least one dose of the vaccine, with 92.4% receiving their first HPV vaccines in the USA. Multiple logistic regression showed that men and non-health sciences majors had lower knowledge about HPV. Older students, those without a primary care provider, and those who completed the survey in English had more negative attitudes about the HPV and vaccine. Participants who were younger, female, had a higher level of knowledge, had more positive attitudes, and completed the survey online were associated with better vaccination status. Findings from this study provide insight into Chinese college students’ knowledge and attitudes about HPV and HPV vaccination and may be used to develop culturally sensitive programs that address the risk of HPV and the benefits of HPV vaccine.     

Using risk factors to predict human papillomavirus infection: implications for targeted vaccination strategies in young adult women

Targeting human papillomavirus (HPV) vaccines to sub-populations most likely to benefit could be necessary if sufficient financing is not available for comprehensive immunization. Using data from 3276 sexually active young adult women in Wave III of the National Longitudinal Study of Adolescent Health, we investigated the feasibility of using behavioral risk factors to target sub-populations for HPV vaccination. We found associations between specific risk factors and vaccine-type-specific HPV infection (OR 1.7-2.1), and the likelihood of having HPV increased with increasing numbers of risk factors. However, no threshold number of risk factors predicted HPV infection with adequate specificity and sensitivity. Furthermore, at a population level, our analyses indicated that targeted approaches to HPV vaccination using specific risk factors were a poor strategy for vaccine implementation as they would exclude up to 80% of the otherwise eligible population from vaccination. Our results support implementation of comprehensive HPV vaccination strategies.     

Vaccination Interest and Trends in Human Papillomavirus Vaccine Uptake in Young Adult Women Aged 18 to 26 Years in the United States: An Analysis Using the 2008–2012 National Health Interview Survey

Objectives. Human papillomavirus (HPV) vaccines have been approved since 2006, yet vaccination rates remain low. We investigated HPV vaccination trends, interest, and reasons for nonvaccination in young adult women.Methods. We used data from the 2008–2012 National Health Interview Survey to analyze HPV vaccine uptake trends (≥ 1 dose) in women aged 18 to 26 years. We used data from the 2008 and 2010 National Health Interview Survey to examine HPV vaccination interest and reasons for nonvaccination among unvaccinated women.Results. We saw significant increases in HPV vaccination for all young women from 2008 to 2012 (11.6% to 34.1%); however, Hispanics and women with limited access to care continued to have lower vaccination rates. Logistic regression demonstrated lower vaccination interest among unvaccinated women in 2010 than 2008. Respondents in 2010 were significantly less likely to give lack of knowledge as a primary reason for nonvaccination.Conclusions. Uptake of HPV vaccine has increased from 2008 to 2012 in young women. Yet vaccination rates remain low, especially among women with limited access to care. However, unvaccinated women with limited health care access were more likely to be interested in receiving the vaccine.Human papillomavirus (HPV) is widespread among young females in the United States, with an estimated prevalence of 59.8% in women aged 20 to 24 years in 2007 to 2010.1 Persistent infection with high-risk strains of HPV has been linked to development of certain cancers, including cervical, oropharyngeal, and anal cancers, with an estimated 13.2 per 100 000 women diagnosed annually with HPV-associated cancers between 2004 and 2008.2 Since 2006, 2 HPV vaccines have been approved by the Food and Drug Administration that safely3 and effectively1 prevent infection with several high-risk HPV strains.2Since 2006, the Advisory Committee on Immunization Practices has recommended that 3 doses of the HPV vaccine be administered to young females aged 11 to 26 years, with a focus on early vaccination.4,5 Data for 18- to 26-year-old women from the adult version of the 2007 National Immunization Survey estimated that 10% of young women had initiated the HPV vaccination series.6 For the same year, vaccine initiation among California women aged 18 to 27 years was estimated to be 11.0%.7 In 2011, vaccination rates (≥ 1 dose) among young women aged 19 to 26 years had increased to 29.5%.8 Vaccination rates for adolescents were more favorable (53.8% for ≥ 1 dose, 33.4% for ≥ 3 doses for 13- to 17-year-old adolescents in 2012³), but are far from the national goal of 80% vaccination completion for 13- to 15-year-old adolescents by 2020.9Despite these low vaccine initiation and even lower completion rates, few studies have examined reasons for nonvaccination of young adult women, and no study has specifically studied how these reasons may have changed over time.6,10–13 A recent study focusing on parental attitudes showed an increase in parents not intending to vaccinate adolescent daughters and citing safety concerns as one of the main reasons for nonvaccination.14 Furthermore, previous studies of trends in HPV vaccination have focused primarily on adolescents.3,15,16 However, with high levels of nonvaccination continuing in 2011 for both the main target group and young adults, it is critical to understand trends in vaccination and risk factors for nonvaccination in this age group, as these young women can still benefit from receiving the HPV vaccine and promote greater herd immunity.Therefore, using nationally representative data from the National Health Interview Survey (NHIS) for young women, our aim was to (1) estimate trends in HPV vaccination uptake (≥ 1 dose) in women aged 18 to 26 years from 2008 to 2012, (2) examine HPV vaccination interest among young unvaccinated women in 2008 and 2010, and (3) investigate reasons for nonvaccination among women who were not interested in receiving the vaccine in 2008 and 2010. Both vaccination interest, defined as whether an unvaccinated woman was interested in receiving the HPV vaccine in the survey, and reasons for nonvaccination for unvaccinated women, who were not interested or undecided, were only assessed in the 2008 and 2010 NHIS.     

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.     

Assessing genital human papillomavirus genoprevalence in young Australian women following the introduction of a national vaccination program

ObjectivesFollowing the implementation of Australia's National HPV Vaccination Program in April 2007, this study evaluated the prevalence of vaccine-targeted human papillomavirus (HPV) genotypes (HPV 6, 11, 16, 18) amongst vaccine-eligible young women.MethodsBetween September 2011 and August 2013, women from Victoria, Australia aged 18–25 were recruited through targeted advertising on the social networking website Facebook. Participants completed an online questionnaire, and sexually active women were asked to provide a self-collected vaginal swab for HPV deoxyribonucleic acid (DNA) detection and genotyping. Samples positive for HPV were genotyped using the Linear Array HPV genotyping test (Roche Diagnostics). Self-reported HPV vaccination details were verified with the National HPV Vaccination Program Register (NHVPR).ResultsOf 431 vaginal swabs, 24.8% were positive for HPV DNA. Vaccine-targeted HPV genotypes were detected in only seven (1.6%) samples; all HPV 16 (of the six HPV 16 positive vaccinated women, all had received the vaccine after sexual debut). There were no cases of HPV 6, 11 or 18 identified. HPV types 51, 59, 73, 84, and 89 were the most prevalent genotypes. Vaccination rates were high, with 77.3% of participants having received all three doses of the vaccine, and there was an 89.8% concordance between self-reported and registry-reported HPV vaccination status. Strong associations were observed between vaccination status, age, language spoken at home and country of birth, as well as between HPV detection and the number of male sexual partners.ConclusionPreliminary data from this study demonstrate a very low prevalence of vaccine-related HPV genotypes amongst vaccine-eligible women from Victoria, Australia. We were able to use Facebook to effectively reach and recruit young women to participate in the assessment of the impact of Australia's HPV vaccination program.