Post Approval Human Papillomavirus Vaccine Uptake Is Higher in Minorities Compared to Whites in Girls Presenting for Well-Child Care

Abstract

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.

A systematic review of human papillomavirus vaccination among US adolescents

“…Although vaccine initiation was higher among Black and Hispanic adolescents than Non-Hispanic White adolescents (Barboza & Dominguez, 2016;Choi et al, 2016;Gilkey et al, 2012;Kester et al, 2013;Landis et al, 2018;Pierce et al, 2013), vaccine completion was lower among these groups (Dorell et al, 2011;Monnat et al, 2016).…”

“…In a high-quality study, the odds of timely vaccine completion were 5% higher among adolescent boys with public insurance compared to boys with private insurance (Teplow-Phipps et al, 2016). Private insurance and being uninsured were reported as both a barrier and facilitator to vaccine initiation (Lau et al, 2012;Pierce et al, 2013;Teplow-Phipps et al, 2016;Wong et al, 2011). Being uninsured, however, decreased the odds for vaccine completion (Reiter, Gupta, et al, 2014) and timely completion (Teplow-Phipps et al, 2016).…”

Rates of human papillomavirus vaccine uptake amongst girls five years after introduction of statewide mandate in Virginia

“…6 The University of Virginia (UVA) Clinical Data Repository (CDR) was queried at 3 month intervals, capturing all girls aged 11-12 who had presented for well-child care from January through December 2014. Visits occurred at UVA-supported Family Medicine and Pediatrics practices, encompassing urban, rural, and suburban practice settings.…”

“…Furthermore, girls with private insurance were significantly less likely to have been vaccinated than girls with public insurance, regardless of race. 6 Utilizing the same protocol as the 2008 study, this study seeks to evaluate the effect that the statewide vaccination mandate has had on vaccine uptake 5 years after enactment.…”

An alert to Latin America: Current human papillomavirus vaccination trends highlight key barriers to successful implementation

“…[23][24][25] In addition, the majority of parents in an Australian study agreed that a recommendation from their general practitioner would increase acceptance of the HPV vaccine, 26 and the authors of a study from Virginia stated that "provider recommendation remains the strongest modifiable event to promote [HPV] vaccination". 27 Although these data come from HICs, Latin America could learn from the shortcomings of HPV vaccine implementation in these countries and tailor educational interventions for providers and parents to address these concerns. Increasing endorsement from trustworthy references for parents, such as physicians and schools, is an essential step toward leveraging HPV vaccination in Latin America.…”