Human papillomavirus vaccine initiation among adolescent girls in high-risk communities

doi:10.1016/j.vaccine.2011.01.052

Vaccine

Volume 29, Issue 12, 9 March 2011, Pages 2235-2241

https://doi.org/10.1016/j.vaccine.2011.01.052 Get rights and content

Abstract

Background

We assessed human papillomavirus (HPV) vaccine uptake among adolescent girls, parents’ intentions to vaccinate daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer.

Methods

Between October 2007 and June 2008, telephone surveys were conducted with randomly selected parents/guardians of 11–18 year old girls attending public middle and high schools serving economically disadvantaged populations in Los Angeles County.

Results

We surveyed 509 predominantly Hispanic (81%) and African American (16%) parents; 71% responded in Spanish. Overall, 23% reported their daughter had received ≥1 dose of HPV vaccine. Although 93% of daughters had seen a doctor in the past year, only 30% reported that a provider recommended HPV vaccine. Characteristics positively associated with odds of having initiated HPV vaccine were having heard of the vaccine (adjusted odds ratio [aOR] 2.6), belief in vaccine effectiveness (aOR 2.9), and doctor recommendation (aOR 48.5). Negative attitudes toward HPV vaccine (aOR 0.2) and needing more information about it (aOR 0.1) were negatively associated with vaccine initiation. Of those with unvaccinated daughters (n = 387), 62% said they “probably/definitely will” vaccinate within the next year and 21% were undecided or didn’t know; only 11% said they definitely won’t.

Conclusions

About one-quarter of adolescent girls in this at-risk community had initiated HPV vaccine by mid-2008. Provider recommendation was the single most important factor associated with vaccination. Because a substantial proportion of parents remain undecided about HPV vaccine, health care providers can play a key role by providing needed information and offering HPV vaccine to all eligible adolescents.

Introduction

A quadrivalent vaccine against human papillomavirus (HPV) was licensed in the United States in 2006. Soon thereafter, the US Advisory Committee on Immunization Practices (ACIP) recommended routine administration of HPV vaccine to 11 or 12 year-old girls, with “catch-up” vaccination of 13 through 26 year-old females who have not been previously vaccinated [1]. The vaccine has demonstrated high efficacy for prevention of HPV type 16- and 18-related cervical cancer precursors as well as HPV type 6- and 11-related anogenital warts [2], [3]. A bivalent vaccine that is also efficacious in preventing HPV 16- and 18-related cervical cancer precursors was licensed in late 2009 [4].

HPV vaccine holds major promise for reducing the burden of cervical cancer and other HPV-related disease if uptake of the vaccine is high, particularly among populations at highest risk for cervical cancer. In the United States, Hispanic women have the highest incidence rate of cervical cancer, while African-American and Hispanic women are more likely than white women to die of cervical cancer [5], [6], [7]. Ensuring that these populations have equitable access to HPV vaccine is a public health priority.

This article reports findings from a telephone survey of parents of 11–18 year old girls attending public middle and high schools serving economically disadvantaged areas in the Los Angeles, California area of the United States. The study objectives were to determine vaccine uptake among adolescent girls, parents’ intentions to vaccinate their daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer.

Section snippets

Sample and data collection

This survey was conducted as part of a study to prevent pregnancy and sexually transmitted infections among public middle and high school students in the Los Angeles area [8]. The school district, the second largest in the nation, serves primarily economically disadvantaged students [9]. Study schools were selected based on high birth rates among 15–19 year olds or high rates of Chlamydia trachomatis infections in the high school attendance areas. During the study period, the majority of

Sample characteristics

Of the 509 study participants, almost all were parents (86% mothers; 9% fathers). The sample was predominately Hispanic (81%) or African-American (16%); >70% of respondents took the survey in Spanish (Table 1). Nearly half of parents reported attaining only an eighth grade education or less. Approximately half (52%) of respondents’ index daughters were aged 14 or younger.

Awareness of HPV and HPV vaccine

Almost three-quarters of parents had heard of HPV (Table 1). Few respondents stated they knew someone with cervical cancer

Discussion

In this at-risk population, 23% of parents reported their daughter had initiated the HPV vaccine series approximately 16 months after FDA approval of HPV vaccine and 9 months after publicly funded vaccine became available in Los Angeles County. The reported HPV vaccine initiation rate in this community was similar to that found in the nationally representative 2007 National Immunization Survey (NIS)-Teen conducted in the fourth quarter of 2007 (25%) as well as the population-based California

Limitations

These findings may not generalize to other populations as this study was conducted predominately among Hispanic and African-American parents in a large urban setting. We had no information on the characteristics of survey non-respondents to assure the representativeness of the sample; however, the racial/ethnic distribution of respondents was similar to the racial/ethnic distribution of the total student population served by the school [9]. Another potential limitation was that vaccination

Conclusions

The reported HPV vaccination coverage (23%) among our population of urban Hispanic and African-American adolescents in high risk communities appears to be lower than national and California-wide coverage during a similar time period, with no differences by adolescents’ age group or race/ethnicity. Given that a large proportion of parents of unvaccinated adolescents are still undecided as to whether to vaccinate, it is of utmost importance that providers miss no opportunities to educate parents

Acknowledgement

Conflict of interest statement: The other authors have no potential conflicts of interest to report.

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^☆: This research was supported by the Centers for Disease Control and Prevention (CDC grant #MM-1006-07/07). Dr. Guerry has participated in a Speakers’ Bureau for Merck and Co., Inc.

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Human papillomavirus vaccine initiation among adolescent girls in high-risk communities☆

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Sample and data collection

Sample characteristics

Awareness of HPV and HPV vaccine

Discussion

Limitations

Conclusions

Acknowledgement

Lancet

J Adolesc Health

Soc Sci Med

Quadrivalent human papillomavirus vaccine: recommendations of the advisory committee on immunization practices (ACIP)

MMWR Recomm Rep

Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases

N Engl J Med

FDA licensure of bivalent human papillomavirus vaccine (HPV2, cervarix) for use in females and updated HPV vaccination recommendations from the advisory committee on immunization practices (ACIP)

MMWR Morb Mortal Wkly Rep

Racial and ethnic disparities in cervical cancer incidence rates in the United States, 1992–2003

Cancer Causes Control