Disparities in Human Papillomavirus Vaccine Series Initiation Among Adolescent Girls Enrolled in Florida Medicaid Programs, 2006–2008

Abstract

Purpose To better understand the human papillomavirus (HPV) vaccine series initiation among 9–17-year-old female Medicaid beneficiaries in Florida programs between June 2006 and December 2008 (n = 237,015). Methods Among the Florida Medicaid enrollees with itemized claims collected (non-managed care organization enrollees), we assessed the association between HPV vaccine series initiation (≥1 vaccine claim) and important demographic characteristics (age, race/ethnicity, program enrollment, area of residence, and length of enrollment). Results Among 11-17-year-olds, vaccine initiation increased over time from <1% by December 2006 to nearly 19% by December 2008. By December 2008, HPV vaccine initiation increased with respect to age from 9 (1.6%) to 13 years (22.9%), remained relatively stable from ages 13 to 15 years (between 21% and 22%), and decreased among 16- (18.6%) and 17-year-olds (15.7%). Compared with girls in Pilot or Fee for Service programs, the girls in MediPass or Children's Medical Service Network programs were more likely to have initiated the vaccine series. Within three of the four programs, Hispanics were more likely than non-Hispanic white and black girls to have initiated the vaccine series. Conclusions This study expands the understanding of HPV vaccine initiation to low-income adolescents eligible for free vaccine through the Federal Vaccine for Children program. Increased understanding of reasons for the observed differences, especially by program and race/ethnicity, will aid in developing interventions to improve HPV vaccine initiation.

HPV Vaccination Completion and Compliance with Recommended Dosing Intervals Among Female and Male Adolescents in an Inner-City Community Health Center

“…The rate of HPV vaccine completion in this study is dramatically lower for females than the rate reported in NIS-Teen data for the same year (2011) nationally (24 % in our study vs. 71 % nationally) [15]. However, HPV vaccine completion rates for the whole sample and among female, Black, and Hispanic adolescents are closer to those reported in studies in underserved and low-income areas [12,13,17,20,21,23,25,35]. Further, the rate of HPV vaccine completion among males in this study (28 %) is similar to the rate reported in NIS-Teen data nationally [15].…”

“…For male adolescents who initiated the HPV vaccine nationally in 2013, the 3-dose completion rates were lower for Black and Hispanic adolescents (45 % and 47 %, respectively) and those below poverty (44 %) compared to White adolescents (51 %) and those above poverty (50 %) [16]. Further, several site-based studies in the US have demonstrated a significant and continuing trend of lower HPV vaccination among Black and Hispanic adolescents [17][18][19][20][21][22][23][24], as well as in low-income and urban areas [21,[25][26][27]. In addition to race/ethnicity and poverty status, completion for females appears significantly lower among older adolescents [17,28,29].…”

Insurance Continuity and Human Papillomavirus Vaccine Uptake in Oregon and California Federally Qualified Health Centers

“…primary language was excluded because of correlation with race/ ethnicity). As effect measure modification of HPV vaccine series initiation by age, race/ ethnicity, and insurance program type has been previously reported, 18 we also assessed pairwise and 3-way interactions between independent variables in the multivariable model. We used backward stepwise selection with an exclusion level of P < .05 to specify the final model.…”

“…Among Medicaid enrolled patients, who constitute almost 40% of FQHC patients nationally, 8 duration of insurance enrollment has been associated with HPV vaccine initiation, with longer enrollment being a predictor for initiating the vaccine series. 17,18 Other researchers have demonstrated that, compared with being uninsured or sporadically insured, having continuous insurance coverage is positively associated with the receipt of preventive services in FQHCs, despite the fact that patients can receive care regardless of insurance coverage in these settings. 16,19,20 Existing studies of HPV vaccination in FQHCs have also been limited to patients younger than 19 years, 9---11 precluding examination of insurance effects across the full age range for which the vaccine is recommended (9---26 years).…”

Three Doses to Finish: A Review on Completion of Human Papillomavirus (HPV) Vaccination among Adolescent Females Aged 12-17 years

“…California also shows low rate of HPV vaccination among adolescent females when compared to US average [32]. In Florida, HPV vaccine initiation and completion among Medicaid population was found to be 19.8%, which is much lower than 37.2%, the rate of vaccination in general population of the country [28,33]. Disparities also exist in the Appalachian area of the US [34].…”