Since introduction of the human papillomavirus (HPV) vaccine, there remains low uptake compared to other adolescent vaccines. There is limited information postapproval about parental attitudes and barriers when presenting for routine care. This study evaluates HPV vaccine uptake and assesses demographics and attitudes correlating with vaccination for girls aged 11–12 years. A prospective cohort study was performed utilizing the University of Virginia (UVA) Clinical Data Repository (CDR). The CDR was used to identify girls aged 11–12 presenting to any UVA practice for a well-child visit between May 2008 and April 2009. Billing data were searched to determine rates of HPV vaccine uptake. The parents of all identified girls were contacted four to seven months after the visit to complete a telephone questionnaire including insurance information, child’s vaccination status, HPV vaccine attitudes, and demographics. Five hundred and fifty girls were identified, 48.2% of whom received at least one HPV vaccine dose. White race and private insurance were negatively associated with HPV vaccine initiation (RR 0.72, 95% CI 0.61–0.85 and RR 0.85, 95% CI 0.72–1.01, respectively). In the follow-up questionnaire, 242 interviews were conducted and included in the final cohort. In the sample, 183 (75.6%) parents reported white race, 38 (15.7%) black race, and 27 (11.2%) reported other race. Overall 85% of parents understood that the HPV vaccine was recommended and 58.9% of parents believed the HPV vaccine was safe. In multivariate logistic regression, patients of black and other minority races were 4.9 and 4.2 times more likely to receive the HPV vaccine compared to their white counterparts. Safety concerns were the strongest barrier to vaccination. To conclude, HPV vaccine uptake was higher among minority girls and girls with public insurance in this cohort.
References
[1]
Bosch, F.X.; Manos, M.M.; Munoz, N.; Sherman, M.; Jansen, A.M.; Peto, J.; Schiffman, M.H.; Moreno, V.; Kurman, R.; Shah, K.V. Prevalence of human papillomavirus in cervical cancer: A worldwide perspective. International biological study on cervical cancer (ibscc) study group. J. Natl. Cancer Inst. 1995, 87, 796–802, doi:10.1093/jnci/87.11.796.
[2]
Weinstock, H.; Berman, S.; Cates, W., Jr. Sexually transmitted diseases among american youth: Incidence and prevalence estimates, 2000. Perspect. Sex. Reprod. Health 2004, 36, 6–10, doi:10.1363/3600604.
[3]
Siegel, R.; Naishadham, D.; Jemal, A. Cancer statistics, 2012. CA Cancer J. Clin. 2012, 62, 10–29, doi:10.3322/caac.20138.
[4]
Kulasingam, S.L.; Hughes, J.P.; Kiviat, N.B.; Mao, C.; Weiss, N.S.; Kuypers, J.M.; Koutsky, L.A. Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: Comparison of sensitivity, specificity, and frequency of referral. JAMA 2002, 288, 1749–1757, doi:10.1001/jama.288.14.1749.
[5]
Ho, G.Y.; Bierman, R.; Beardsley, L.; Chang, C.J.; Burk, R.D. Natural history of cervicovaginal papillomavirus infection in young women. N. Engl. J. Med. 1998, 338, 423–428, doi:10.1056/NEJM199802123380703.
[6]
Virginia Department of Health. Virginia cancer registry. Available online: http://www.vahealth.org/cdpc/CancerRegistry/02data.htm/ (accessed on 30 October 2012).
[7]
Munoz, N.; Bosch, F.X.; de Sanjose, S.; Herrero, R.; Castellsague, X.; Shah, K.V.; Snijders, P.J.F.; Meijer, C.J.L.M.; International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N. Engl. J. Med. 2003, 348, 518–527, doi:10.1056/NEJMoa021641.
[8]
The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N. Engl. J. Med. 2007, 356, 1915–1927, doi:10.1056/NEJMoa061741.
[9]
Markowitz, L.E.; Dunne, E.F.; Saraiya, M.; Lawson, H.W.; Chesson, H.; Unger, E.R. Quadrivalent human papillomavirus vaccine: Recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm. Rep. 2007, 56, 1–24.
[10]
Centers for Disease Control and Prevention (CDC). National and state vaccination coverage among adolescents aged 13–17 years—United States, 2011. MMWR Morb. Mortal. Wkly. Rep. 2012, 61, 671–677.
[11]
Garcini, L.; Galvan, T.; Barnack-Tavlaris, J. The study of human papillomavirus (hpv) vaccine uptake from a parental perspective: A systematic review of observational studies in the united states. Vaccine 2012, 30, 4588–4595, doi:10.1016/j.vaccine.2012.04.096.
[12]
Dorell, C.; Yankey, D.; Santibanez, T.; Markowitz, L. Human papillomavirus vaccination series initiation and completion, 2008–2009. Pediatrics 2011, 128, 830–839, doi:10.1542/peds.2011-0950.
[13]
Gowda, C.; Carlos, R.; Butchart, A.; Singer, D.; Davis, M.; Clark, S.; Dempsey, A. Chias: A standardized measure of parental hpv immunization attitudes and beliefs and its associations with vaccine uptake. Sex. Transm. Dis. 2012, 39, 475–481, doi:10.1097/OLQ.0b013e318248a6d5.
[14]
Young, J.; Bernheim, R.; Korte, J.; Stoler, M.; Guterbock, T.; Rice, L. Human papillomavirus vaccination recommendation may be linked to reimbursement: A survey of virginia family practitioners and gynecologists. J. Pediatr. Adolesc. Gynecol. 2011, 24, 380–385, doi:10.1016/j.jpag.2011.06.016.
[15]
HPV vaccine. Available online: http://www.ncsl.org/issues-research/health/hpv-vaccine-state-legislation-and-statutes.aspx/ (accessed on 30 October 2012).
[16]
Morita, J.Y.; Ramirez, E.; Trick, W.E. Effect of a school-entry vaccination requirement on racial and ethnic disparities in hepatitis b immunization coverage levels among public school students. Pediatrics 2008, 121, e547–e552, doi:10.1542/peds.2007-0799.
[17]
Dempsey, A.; Mendez, D. Examining future adolescent human papillomavirus vaccine uptake, with and without a school mandate. J. Adolesc. Health 2010, 47, 242–248, doi:10.1016/j.jadohealth.2009.12.009.
[18]
Janz, N.K.; Champion, V.L.; Strecher, V.J. The Health Belief Model. In Health Behavior and Health Education: Theory, Research, and Practice, 3rd ed.; Glanz, K., Rimer, B.K., Lewis, F.M., Eds.; John Wiley & Sons, Inc.: San Francisco, CA, USA, 2002; pp. 45–66.
[19]
Centers for Disease Control and Prevention (CDC). National, state, and local area vaccination coverage among adolescents aged 13–17 years—United States, 2008. MMWR Morb. Mortal. Wkly. Rep. 2008, 58, 997–1001.
[20]
Ylitalo, K.; Lee, H.; Mehta, N. Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the us national immunization survey. Am. J. Public Health 2013, 103, 164–169, doi:10.2105/AJPH.2011.300600.
[21]
Vadaparampil, S.; Staras, S.; Malo, T.; Eddleton, K.; Christie, J.; Rodriguez, M.; Giuliano, A.; Shenkman, E. Provider factors associated with disparities in human papillomavirus vaccination among low-income 9- to 17-year-old girls. Cancer 2013, 119, 621–628, doi:10.1002/cncr.27735.
