The accuracy of human papillomavirus vaccination status based on adult proxy recall or household immunization records for adolescent females in the United States: results from the National Immunization Survey-Teen

https://doi.org/10.1016/j.annepidem.2013.02.002Get rights and content

Abstract

Purpose

We assessed the accuracy of human papillomavirus (HPV) vaccination status based on adult proxy recall and household immunization records for adolescent females in the United States.

Methods

We used data from the 2010 National Immunization Survey—Teen for females aged 13 to 17 years. The accuracy of HPV vaccination status (≥1 dose) based on adult proxy recall (unweighted n = 6868) and household immunization records (unweighted n = 2216) was assessed by estimating the sensitivity, specificity, and corresponding 95% confidence limits (CL) of these measures with provider-reported HPV vaccination status as the reference standard. Our analyses accounted for the complex survey design and population weights.

Results

The sensitivity and specificity of adult proxy recall were 83.9% (95% CL: 81.2%, 86.6%) and 90.4% (95% CL: 88.9%, 92.0%), respectively. Conversely, the sensitivity and specificity of household immunization records were 74.2% (95% CL: 69.1%, 79.2%) and 98.0% (95% CL: 96.8%, 99.1%), respectively. The accuracy of both measures varied by race/ethnicity, proxy respondent, and maternal education.

Conclusions

Our results suggest that adult proxy recall and household immunization records have reasonable accuracy for classifying HPV vaccination status for females aged 13 to 17 years in the United States, but these measures present a trade-off between sensitivity and specificity.

Introduction

The prominent etiologic role of human papillomavirus (HPV) infection in cervical cancer prompted the development and public dissemination of bivalent and quadrivalent HPV vaccines in 2006 to immunize against HPV-16 and -18, which account for 70% of cervical cancer cases [1], [2]. The quadrivalent version also includes HPV-6 and -11 to immunize against genital warts [1], [2]. The United States Advisory Committee on Immunization Practices currently recommends routine HPV vaccination with three doses (administered over 6 months) of either bivalent or quadrivalent vaccine for females aged 11 to 12 years (ie, before sexual debut), with “catch-up” vaccination recommended for females aged 13 to 26 years [3], [4]. These recommendations were recently updated to promote routine use of the quadrivalent vaccine for males aged 11 to 12 years, and “catch-up” vaccination for males aged 13 to 21 years [5].

Many studies have assessed the prevalence of [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23] and factors associated with HPV vaccine uptake among adolescents in the post-vaccination era [24], [25], [26]; adult proxy recall (largely maternal) has been the primary method of measuring vaccine uptake. Similar to any study design that uses proxy-reported measures [27], the validity of inferences from study results partially depends on the accuracy with which HPV vaccine uptake is measured. Misclassification of HPV vaccination status may bias not only prevalence estimates, but also measures of association, which might compromise the public health utility of study findings. Therefore, our aim for this study was to assess the accuracy of HPV vaccination status based on adult proxy recall and household immunization records, relative to health provider report, for adolescent females in the United States.

Section snippets

Data source

We used data from the 2010 National Immunization Survey-Teen (NIS-Teen) [28], a nationally representative survey of adolescent vaccination coverage rates, to assess the accuracy of adult proxy recall and household immunization records of HPV vaccination status. The 2010 NIS-Teen survey design and methodology have been described in detail elsewhere [29]. Briefly, the NIS-Teen is a supplement to the National Immunization Survey (NIS) designed to estimate vaccination coverage rates among children

Results

Our unweighted study population comprised 6868 females for whom adult proxy recall with adequate provider data were available and 2216 females for whom household immunization records with adequate provider data were available. Table 1 describes the characteristics of the study population. Briefly, racial/ethnic minorities comprised approximately 26% and 33% of the adult proxy recall group and household immunization records group, respectively. Mothers were the main proxy respondents for both

Discussion

Our results suggest that adult proxy recall and household immunization records have reasonable accuracy for classifying HPV vaccination status of at least one dose for females aged 13 to 17 years in the United States. We observed that these measures more accurately classified HPV vaccination status among non-Hispanic whites, when the adolescent’s mother is the proxy respondent, and when the mother is at least a high school graduate. Notably, these two measures present a trade-off between

Acknowledgments

Supported by the American Lebanese Syrian Associated Charities (ALSAC). The funding sources were not involved in the study design, data collection, analysis, interpretation, writing, or decision to submit this report.

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