Improving HPV Vaccination Rates in a Racially and Ethnically Diverse Pediatric Population

Abstract

BACKGROUND AND OBJECTIVES: Nationally, 54.2% of youth are fully vaccinated for human papilloma virus (HPV) with persistent gender and racial/ethnic disparities. We used a quality improvement approach to improve completion of the HPV vaccine series by age 13 years. As a secondary aim, we examined racial/ethnic and gender differences in vaccine uptake. METHODS: The study setting included 2 pediatric, academic, primary care practices in Massachusetts. We designed a multilevel patient-, provider-, and systems-level intervention addressing parental hesitancy, provider communication, and clinical operations. Rates of HPV series completion by age 13 were monitored using a control p chart. Bivariate and multivariate analyses evaluated vaccine completion differences on the basis of clinic size, gender, and race/ethnicity. RESULTS: Between July 1, 2014, and September 30, 2021, control p charts showed special cause variation with HPV vaccine initiation by age 9 years, increasing from 1% to 52%, and vaccine completion by 13 years, increasing from 37% to 77%. Compared with White and Black children, Hispanic children were more likely to initiate the HPV vaccine at age 9 (adjusted odds ratio [95% confidence interval] = (1.4–2.6)] and complete the series by age 13 (adjusted odds ratio [95% confidence interval] = 2.3 (1.7–3.0). CONCLUSIONS: A multilevel intervention was associated with sustained HPV vaccine series completion by age 13 years. Hispanic children were more likely to be vaccinated. Qualitative family input was critical to intervention design. Provider communication training addressed vaccine hesitancy. Initiation of the vaccine at age 9 and clinicwide vaccine protocols were key to sustaining improvements.

Spatiotemporal analysis of HPV vaccination and associated neighborhood-level disparities in Texas—an ecological study

“…In New York, higher HPV vaccination rates have been reported among Hispanic and Black adolescents, aligning with our findings in Texas ( 23 ). However, these states did not exhibit the same extent of reverse disparity for male adolescents, suggesting that local cultural, socioeconomic, and policy factors might influence these patterns ( 23 , 24 ). For instance, the study “Improving HPV Vaccination Rates in a Racially and Ethnically Diverse Pediatric Population” highlighted successful interventions that increased vaccination rates in a diverse population yet did not report significant gender disparities like those found in Texas ( 24 ).…”

“…However, these states did not exhibit the same extent of reverse disparity for male adolescents, suggesting that local cultural, socioeconomic, and policy factors might influence these patterns ( 23 , 24 ). For instance, the study “Improving HPV Vaccination Rates in a Racially and Ethnically Diverse Pediatric Population” highlighted successful interventions that increased vaccination rates in a diverse population yet did not report significant gender disparities like those found in Texas ( 24 ). These differences underscore the importance of considering local context and tailored interventions when addressing HPV vaccination disparities across different regions.…”

“…For instance, research has shown that Hispanic adolescents have higher HPV vaccination rates compared to their non-Hispanic white counterparts, likely due to targeted public health initiatives and community outreach programs ( 25 ). Similarly, in many states, Hispanic women constitute a significant proportion of the clients served by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), indicating effective outreach and utilization of services within this community ( 24 ). Studies have also reported higher cervical cancer screening rates among Hispanic women, attributed to culturally tailored interventions and community health programs that address language barriers and provide patient navigation ( 26 ).…”

Human papillomavirus vaccination at the first opportunity: An overview

“… 22 Another study, started in 2014, conducted in a different population but using a similar intervention, documented increases in HPV vaccine uptake that were sustained through 2021. 23 These two studies, taken together, provide preliminary evidence that this type of multi-level intervention may be generalizable for use in a variety of populations to achieve high and sustained HPV vaccine uptake.…”

The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents

“… 19 While it is important to address disparities in healthcare, it is also crucial to understand health behaviors across all racial and ethnic groups to improve overall statewide public health outcomes. Additionally, compared to African American and Hispanic adolescents, HPV vaccination coverage is lower among non-Hispanic White adolescents, 20 suggesting a need for further research investigating trust and HPV vaccination among this population.…”