Human papillomavirus vaccine coverage in the United States, National Health and Nutrition Examination Survey, 2007-2008

Development and psychometric properties of the human papillomavirus-quality of life (HPV-QoL) questionnaire to assess the impact of HPV on women health-related-quality-of-life

Purpose

The HPV-Quality-of-Life (HPV-QoL) questionnaire was developed to determine the impact of Human-Papillomavirus (HPV) infection and related interventions on women health-related quality-of-life. This study provides the development and preliminary psychometric properties of a novel HPV-QoL questionnaire for adult women with HPV.

Methods

After reviewing literature and cognitive debriefing interviews in women who had experienced HPV-related conditions, instrument items and domains were developed. A draft questionnaire was pilot tested for comprehension and ease of completion. Psychometric evaluation of the final HPV-QoL scale was conducted in a psychometric study including 252 adult women derived to our centre by a positive HPV test in the cervical cancer screening program and/or presenting genital warts.

Results

The present study reveals that the HPV-QoL questionnaire, structured in four domains: general well-being [including psychological well-being and social well-being subdomains], health, contagiousness and sexuality, showed good metric properties of feasibility irrespective of age or educational level, and time to administer was less than 5 min. Internal consistency and temporal stability (reliability) showed values above the acceptable standards. The instrument showed its concurrent validity by means of a significant correlation with mental and sexual existing instruments; GHQ-12 and FSFI questionnaires, respectively, and also known groups validity showing significant differences among the subgroups regarding either sexual dysfunction or mental deterioration.

Conclusion

This study provides an HPV-QoL questionnaire with an innovative patient-reported outcomes specific measurement tool to assess HRQoL in women with HPV infection. The present study suggests this questionnaire has satisfactory psychometric properties, including validity and reliability. Results support the use of the HPV-QoL questionnaire as a HRQoL measurement instrument for daily medical practice and clinical research.

Vaccination coverage rates and predictors of HPV vaccination among eligible and non-eligible female adolescents at the Brazilian HPV vaccination public program

Background

Since March 2014, the quadrivalent HPV vaccine has been incorporated into the Brazilian Unified Health Care System and began to be offered, without direct costs, for girls from 9 to 13 years of age. Older female adolescents would have the option to be vaccinated at private health care system being responsible for the payment of HPV vaccine. The present study aimed to evaluate the coverage rates and predictors of HPV vaccination in Brazil among two groups of female adolescents: eligible and non-eligible for the HPV vaccination public program.

Methods

We used data from the 2015 Brazilian National Adolescent School-Based Health Survey, which involved a probabilistic sample of 5404 female adolescents students at public and private schools. Using a questionnaire, we gathered information on sociodemographic characteristics, sexual behavior, and respondent perception of parental supervision and have been vaccinated for HPV. Age-specific vaccination rates were analyzed in girls aged 9 to 13 at the time of public vaccination (eligible for public policy), as well among those 14 to 17 years old not eligible by the Ministry of Health for vaccination. We used Poisson regression models to investigate associated factors.

Results

HPV vaccine coverage was 83.5 and 21.8% among eligible and non-eligible populations, respectively. In both populations, the chance of being vaccinated decreased with older age. In the eligible population there is a greater chance of being vaccinated among ethnic group “pardas” but not with other indicators of socioeconomic status. In the non-eligible population, there was a clear association between higher vaccine coverage and greater maternal education and living with the mother.

Conclusion

Our findings highlight the importance of public policies to minimize inequities in access to cancer prevention measures in vulnerable adolescents. A public policy of HPV vaccination for older female adolescents would increase coverage with possible reduction of HPV-related diseases in this group of women.

Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study

Background

This study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18-60 years in the Philippines.

Methods

Prevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups.

Results

Overall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58-4.98%) for men and women aged 18-60 years. Genital warts prevalence was 3.39% (95% CI: 3.13-3.65%) and 8.0% (95% CI: 7.69-8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66-18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively).

Conclusions

Genital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.

Are we speaking the same language? an argument for the consistent use of terminology and definitions for childhood vaccination indicators

Vaccination indicators are used to measure the health status of individuals or populations and to evaluate the effectiveness of vaccination programs or policies. Ensuring that vaccination indicators are clearly and consistently defined is important for effective communication of outcomes, accurate program evaluation, and comparison between different populations, times, and contexts. The purpose of this commentary is to describe commonly used vaccination indicators and to highlight inconsistencies in how childhood vaccine researchers use and define these terms. The indicators we describe are vaccine coverage, uptake, and rate; vaccination status, initiation, and completion; and up-to-date, timely, partial, and incomplete vaccination. We conclude that many vaccination indicators are not explicitly defined within published research studies and/or are used quite differently across studies. We also note that the choice of indicator in a given study is often driven by program or vaccine specific factors, may be constrained by data availability, and should be chosen to best reflect the outcome of interest. We conclude that the use of consistent language and definitions would promote more effective communication of research findings. We also propose some standardized definitions for common indicators, with the goal of provoking discussion and debate on the issue.

Correlates of Human Papillomavirus Infection Among a National Sample of Sexual Minority Women

BACKGROUND

Many sexual minority women are infected with human papillomavirus (HPV), yet little is known about correlates of HPV infection among this population.

MATERIALS AND METHODS

We analyzed data from a national sample of sexual minority women (i.e., women who either reported a history of female sexual partners or identified as nonheterosexual) aged 20-59 from the 2003 to 2012 National Health and Nutrition Examination Survey (n = 830). Weighted logistic regression identified correlates of infection with any HPV type and infection with a high-risk HPV type.

RESULTS

About 53% of women were infected with any HPV type, and about 37% were infected with a high-risk HPV type. Women who reported five or more sexual partners during their lifetime (adjusted odds ratio [aOR] = 5.07, 95% confidence interval [CI]: 2.26-11.42) were more likely to be infected with a high-risk HPV type. Compared to women aged 20-29, women aged 40-49 (aOR = 0.51, 95% CI: 0.32-0.81) or 50-59 (aOR = 0.27, 95% CI: 0.14-0.53) were less likely to be infected with a high-risk HPV type, as were women who were married or living with a partner (aOR = 0.62, 95% CI: 0.44-0.89). Mostly similar correlates were identified for infection with any HPV type, although infection with any HPV type was also less common among women who identified as lesbian compared to those who identified as heterosexual (aOR = 0.38, 95% CI: 0.21-0.68).

CONCLUSIONS

Demographic and health-related characteristics were associated with HPV infection outcomes. Findings can inform HPV prevention efforts for sexual minority women by providing information about risk factors and subgroups at particular risk for infection.

Human Papillomavirus Vaccination Among Adults and Children in 5 US States

CONTEXT

The Centers for Disease Control and Prevention Advisory Committee for Immunization Practices has recommended human papillomavirus (HPV) vaccines for use in children and young adults for preventing HPV-related diseases, but HPV vaccine coverage is low in the United States.

OBJECTIVE

To assess HPV vaccination among US adults and children and to identify characteristics associated with HPV vaccination.

METHODS

We used the 2010 Behavioral Risk Factors Surveillance System data to examine HPV vaccine initiation and completion among adults aged 18 to 26 years and children aged 9 to 17 years in 5 US states. We performed a multivariate logistic regression to evaluate factors associated with HPV vaccination.

RESULTS

We assessed the HPV vaccination status of 706 women and 560 men and 2201 girls and 2292 boys. In 2010, a total of 258 (41.6%) women and 21 (4.3%) men had initiated HPV vaccination. Of those vaccinated women, 182 (75%) completed the 3-dose vaccine series. Rural residence (adjusted odds ratio [aOR] = 0.37) and not having a Papanicolaou test (aOR = 0.44) were negatively associated with HPV vaccine initiation among women. Women who were aged 18 to 20 years (aOR = 2.93) were more likely to complete HPV vaccination. A total of 612 (24.6%) girls and 86 (5.2%) boys received 1 or more doses of HPV vaccines; 308 (50.3%) vaccinated girls and 14 (10.8%) vaccinated boys completed the vaccine series. Younger age (9-12 years: aOR = 0.09) and not receiving a seasonal influenza vaccine (aOR = 0.44) were negatively related to HPV vaccine initiation in girls. Girls were less likely to initiate and complete HPV vaccination if their parents did not have a routine checkup within 1 year.

CONCLUSION

HPV vaccination in the United States remains below the Healthy People 2020 objective (80%). To increase HPV vaccination, strategies still need to focus on improving access to HPV vaccines and utilization of health services.

Ecological Association of Human Papillomavirus Vaccination with Cervical Dysplasia Prevalence in the United States, 2007-2014

OBJECTIVES

To examine prevalence of low- and high-grade cervical lesions over time in a large cohort of US female adolescents and women.

METHODS

We used health care claims data from 9 million privately insured female patients aged 15 to 39 years to estimate annual prevalence of cytologically detected cervical low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and high-grade histologically detected cervical intraepithelial neoplasia grades 2 and 3 (CIN2+) during 2007 through 2014. We restricted analyses to those who received cervical cancer screening in a given calendar year.

RESULTS

Prevalence of HSIL and CIN2+ decreased significantly for those aged 15 to 19 years. Average annual percent change in prevalence in this group during 2007 through 2014 for HSIL and CIN2+ was -8.3% and -14.4%, respectively (P < .001 for both estimates). Prevalence of HSIL and CIN2+ also decreased significantly for women aged 20 to 24 years. No decreases were seen in women aged 25 to 39 years.

CONCLUSIONS

Decreases in high-grade lesions reflected their greater association with human papillomavirus types 16 and 18, compared with low-grade lesions, providing ecological evidence of population effectiveness of human papillomavirus vaccination among young, privately insured women.

Effect of Educational Intervention on Cervical Cancer Prevention and Screening in Hispanic Women

To evaluate the effect of an educational intervention on four domains of health care utilization and cervical cancer prevention and screening in a Hispanic population. Data collected from a survey were used to design education strategies focused on four domains of interest. A second survey was conducted to measure the impact of the intervention. Following the intervention, respondents were more likely to have any knowledge of human papillomavirus (HPV). Respondents living in the United States (US) for <5 years were more likely to have had a Papanicolaou smear in the preceding 3 years (p = 0.0314), to report knowledge of HPV vaccination (p = 0.0258), and to be willing to vaccinate themselves (p = 0.0124) and their children (p = 0.0341) after the intervention. Educational interventions designed to meet the needs identified by the sample group led to an increase in HPV awareness throughout the entire population surveyed and an increase in health care service utilization and HPV vaccine acceptance for women living in the US for <5 years. These tools should be promoted to reduce the cervical cancer burden on vulnerable populations.

Rate and predictors of human papillomavirus vaccine uptake among women who have sex with women in the United States, the National Health and Nutrition Examination Survey, 2009-2012

AIMS AND OBJECTIVES

To examine rates and associated correlates of human papilloma virus vaccine uptake in women who have sex with women in the United States, and to determine whether they differ from those in women who do not have sex with women.

BACKGROUND

Women who have sex with women are at risk for human papilloma virus infection but are less likely to receive preventive gynaecological services. Little research has been carried out to evaluate human papilloma virus vaccination rates and associated predictors of vaccination uptake in this population.

DESIGN

Cross-sectional descriptive study.

METHODS

Data from two consecutive cohorts of the National Health and Nutrition Examination Survey conducted by the United States' Centers for Disease Control were analysed.

RESULTS

The sample (N = 1105) consisted of women aged 18-26 years. There was no difference in human papilloma virus vaccine uptake between women who have sex with women and women who do not have sex with women. Overall, the vaccination rate was low (32·5%). Having health insurance and more education were significant predictors of vaccine uptake in women who have sex with women. Higher education and younger age were predictors in women who do not have sex with women.

CONCLUSIONS

Vaccination rates of women are far lower than the national target of 80%. The predictors of vaccine uptake were different in women who have sex with women than for women who do not have sex with women.

RELEVANCE TO CLINICAL PRACTICE

Women in their 20s (regardless of their sexual orientation) should be recognised as an undervaccinated population and require targeted interventions to improve vaccination uptake.

Oral sex and oropharyngeal cancer: The role of the primary care physicians

BACKGROUND

We aimed to study the prevalence of oral sex and its possible association with human papillomavirus (HPV) 16 infection in the development of oropharyngeal cancer in the US population for possible prevention.

METHODS

We conduct a systemic review on the prevalence of oral sex among Americans among different age groups, the prevalence of HPV 16 infection reported in oropharyngeal cancer, and correlation between oral sex and oropharyngeal cancer.

RESULTS

Oral sex is prevalent among adolescents and sexually active adults. Sixty percent of oropharyngeal cancer reported in the United States is associated with HPV 16 infections. Individuals who practiced oral sex with multiple partners are at risk for developing oropharyngeal cancer and need to be informed about practicing safe sex or getting vaccination.

CONCLUSION

Family physicians will play a key role in prevention and educating the public about the risk of oral sex.

Disparities in collaborative patient-provider communication about human papillomavirus (HPV) vaccination

BACKGROUND

Healthcare providers may vary their communications with different patients, which could give rise to differences in vaccination coverage. We examined demographic disparities in parental report of collaborative provider communication and implications for human papillomavirus (HPV) vaccination.

METHODS

Participants were 4,124 parents who completed the National Immunization Survey-Teen about daughters ages 13-17. We analyzed disparities in collaborative communication (mutual information exchange, deliberation, and decision) and whether they mediated the relationship between demographic characteristics and HPV vaccine initiation.

RESULTS

Half of parents (53%) in the survey reported collaborative communication. Poor, less educated, Spanish-speaking, Southern, and rural parents, and parents of non-privately insured and Hispanic adolescents, were least likely to report collaborative communication (all p<.05). These disparities in communication accounted for geographic variation in HPV vaccination, specifically, the higher rates of uptake in the Northeast versus the South (mediation z=2.31, p<.01) and in urban/suburban vs. rural areas (mediation z=2.87, p<.01). These disparities were also associated with vaccination among subgroups with relatively high coverage, minimizing what could have been even higher uptake among Hispanic compared to non-Hispanic white adolescents (mediation z=-3.04, p<.01) and non-privately versus privately insured adolescents (mediation z=-3.67, p<.001). Controlling for provider recommendation attenuated some of these associations (but all p<.10).

CONCLUSIONS

Collaborative communication showed widespread disparities, being least common among underserved groups. Collaborative communication helped account for differences-and lack of differences-in HPV vaccination among some subgroups of adolescent girls. Leveraging patient-provider communication, especially for underserved demographic groups, could improve HPV vaccination coverage.

HPV infection among a population-based sample of sexual minority women from USA

OBJECTIVES

Sexual minority women are at risk for infection with human papillomavirus (HPV); yet, relatively little is known about the prevalence of HPV infection among this population.

METHODS

We analysed data from the 2003-2012 National Health and Nutrition Examination Survey among women aged 20-59 (n=7132). We examined two dimensions of sexual orientation (sexual identity and sexual behaviour) and used weighted logistic regression to determine how HPV infection outcomes (any HPV type, high-risk HPV type and vaccine HPV type) vary by dimension.

RESULTS

Similar patterns emerged for sexual identity and sexual behaviour. In bivariate analyses, HPV infection outcomes were more common among non-heterosexual women compared with heterosexual women (any type: 49.7% vs 41.1%; high-risk type: 37.0% vs 27.9%), as well as among women who reported any same-sex partners compared with women who reported only opposite-sex partners (any type: 55.9% vs 41.0%; high-risk type: 37.7% vs 28.2%; vaccine type: 19.1% vs 14.0%) (p<0.05). When we disaggregated measures of sexual orientation into subgroups, bisexual women and women who reported partners of both sexes had greater odds of HPV infection outcomes (p<0.05 in bivariate analyses). Multivariate models attenuated several of these differences, though lesbian women and women who reported only same-sex partners had lower odds of most HPV infection outcomes in multivariate analyses (p<0.05).

CONCLUSIONS

HPV infection is common among sexual minority women, though estimates vary depending on how sexual orientation is operationalised. Results can help inform targeted HPV and cervical cancer prevention efforts for sexual minority women.

Differences in HPV Immunization Levels Among Young Adults in Various Regions of the United States

HPV vaccine uptake in young adult women in the Southern US has been previously found to be the lowest in the country. In addition, geographic variation with regard to HPV vaccination among young adult men has not been investigated yet. The objective of this study was to use the most recent data to determine if inequality still exists. We used Behavioral Risk Factor Surveillance System 2012 data from 8 states (no data available from Midwest) to examine the geographic variations in weighted proportion of adults who initiated (≥ 1 dose) and completed (3 doses) the HPV vaccine among 3727 young adults (2014 women and 1713 men) 18-26 years old based on self-reported HPV vaccination and socio-demographic characteristics. The weighted vaccine initiation and completion rates among men were: 6.3 and 1.7% overall, 8.5 and 2.2% in the Northeast, 6.7 and 1.6% in the West, and 4.9 and 1.4% in the South (p = 0.184 and 0.774). The rates among women were: 40.4% and 27.4, 58.7 and 45.6%, 39.0 and 24.8%, and 30.4 and 17.7% in the respective regions (p < 0.001 for both). Adjusted multivariable logistic regression showed that women living in the South and West were less likely to initiate and complete the 3-dose HPV vaccine series when compared to those in the Northeast. Despite an increase in HPV vaccine uptake among young adult women in all regions, geographic disparity still exists. Moreover, young adult men had very low HPV vaccine initiation and completion rates throughout the US.

Human papillomavirus vaccine trials and tribulations: Clinical perspectives

Human papillomavirus (HPV) affects hundreds of millions of people worldwide and is associated with both benign and malignant neoplasms in men and women. It is a double-stranded DNA virus with an icosahedral capsid. Forty HPV types are known to infect mucosal keratinocytes. If not cured by the immune system, the infection can lead to genital warts, mucosal dysplasia, or cancer. The most common oncogenic types are 16 and 18. The vaccine to prevent HPV and its associated morbidity and mortality has existed since 2006. Several variations protect against an increasing number of HPV types. The recommended vaccination age is before sexual exposure; administration of the vaccine to children has been controversial. This continuing medical education review evaluates the current HPV vaccines available to clinicians. Part I focuses on the debate over who should be vaccinated, at what age, and in which populations.

Correlates of human papillomavirus vaccine series completion among young adult female initiators

Incomplete human papillomavirus (HPV) vaccination is a public health concern. The objective of this study was to examine the correlates of vaccine series completion among 18-26 year old US women using the Behavioral Risk Factor Surveillance System (BRFSS) data. Using BRFSS data collected during 2008-2010, we conducted multivariable logistic regression analysis to examine the correlates of HPV vaccine completion among HPV vaccine initiators. Among 656 women (18-26 years old) who initiated the HPV vaccine, the overall weighted vaccine series completion rate was 60.7%. It was 32.9%, 65.3%, and 69.9% in 2008, 2009, and 2010, respectively. Black and Hispanic women were less likely to complete the series compared with white women. Higher income, having a college degree and completion of the study in a more recent year were associated with higher completion rates. Thus, the reasons for HPV series non-completion may be multifactorial. Interventions targeting 18-26 year old female vaccine initiators with low income and education, and minority backgrounds may improve HPV vaccine series completion.

Human papillomavirus vaccine uptake among males 11-26 years in United States: findings from the National Health and Nutrition Examination Survey, 2011-2012

Anogenital human papillomavirus (HPV) infection is the leading sexually transmitted infection in the United States. In October 2011, the quadrivalent HPV vaccine (HPV4) was recommended for males in the U.S. We analyzed a subsample of 11–26 year old (N = 1012) males, from the National Health and Nutritional Examination Survey 2011–2012 dataset, to examine HPV vaccine uptake. The initiation rates in the 11–17 years and the 18–26 years age-groups were 10.7% (95% confidence interval (CI): 8.09–16.6%) and 5.5% (95%CI: 3.1–9.5%) respectively. The corresponding HPV vaccine completion rates were 39.3% (16.7–67.7%) for the 11–17 year old males and 59.1% (37.2–77.6) for the 18–26-year-old males. Despite a slight increase, HPV vaccine uptake remained low among males. These findings can help in HPV vaccination policy in the United States, with a focus on informational messages directed toward young males and their parents in order to increase uptake of HPV vaccine.

The potential of plants for the production and delivery of human papillomavirus vaccines

The available vaccines against human papillomavirus have some limitations such as low coverage due to their high cost, reduced immune coverage and the lack of therapeutic effects. Recombinant vaccines produced in plants (genetically engineered using stable or transient expression systems) offer the possibility to obtain low cost, efficacious and easy to administer vaccines. The status on the development of plant-based vaccines against human papillomavirus is analyzed and placed in perspective in this review. Some candidates have been characterized at a preclinical level with interesting outcomes. However, there is a need to perform the immunological characterization of several vaccine prototypes, especially through the oral administration route, as well as develop new candidates based on new chimeric designs intended to provide broader immunoprotection and therapeutic activity.

Human papillomavirus vaccination of females in a large health claims database in the United States, 2006-2012

PURPOSE

Information on vaccine utilization from a variety of sources is useful to give a status of the vaccine program and define opportunities to improve uptake. We evaluated MarketScan Commercial Claims and Encounters database on human papillomavirus (HPV) vaccine initiation and completion of all three doses among girls/women from 2006 to 2012.

METHODS

Data were obtained from the 2006-2012 MarketScan Commercial Claims and Encounters database. The study population included female enrollees aged 11-26 years who were continuously enrolled in the same private insurance plan from 2006 to 2012 (n = 407,371). We evaluated overall and yearly vaccine initiation and completion, demographic characteristics associated with vaccine initiation, clinical visits in which vaccine was given, and missed opportunities for vaccination.

RESULTS

By the end of 2012, 36.9% of females aged 11-26 years had received at least one HPV vaccine dose. Vaccination coverage was highest among females aged 17-18 years (49.3%) and aged 15-16 years (43.1%) and lowest among females aged 11-12 years (16.8%). Between 2007 and 2012, 96.1% of the 246,192 unvaccinated females had at least one missed opportunity (a heath care visit without HPV vaccine administered).

CONCLUSIONS

Over a 6 year period, HPV vaccine initiation was lowest in the girls aged 11-12 years. Importantly, most (96.1%) unvaccinated females had at least one missed vaccination opportunity, and providers and health systems should focus efforts on using existing visits for vaccination.

Characteristics of a cluster-randomized phase IV human papillomavirus vaccination effectiveness trial

High-risk human papillomaviruses (hrHPV) cause anogenital and oropharyngeal cancers. HPV-16/18 virus-like particle vaccine formulated with an AS04 adjuvant is very efficacious against hrHPV associated precancers but the herd effects of different vaccination scenarios are not known. Our cluster randomized trial (NCT00534638) assesses the overall and herd effects of vaccinating girls vs. girls and boys. In two school-years (2007-2008 and 2008-2009) we invited 80,272 1992-1995 born early adolescents to a CRT in 33 communities a priori stratified by low, intermediate and high HPV-16/18 seroprevalence. In 11 Arm A communities 90% of participating girls and boys were assigned to receive HPV-16/18 vaccine, in 11 Arm B communities 90% of girls were assigned to receive HPV-16/18 vaccine - boys were assigned to receive hepatitis B-virus (HBV) vaccine, and in 11 Arm C communities all were assigned to receive HBV-vaccine. Prevalence of HPV in vaccinated and unvaccinated girls is studied at age 18.5 years. Recruitment resulted in equal enrolment of four birth cohorts (born 1992-1995) comprising altogether 32,175 (40% response) early adolescents: 20,514 girls (50.5-53.0% response by arm) and 11,661 boys (21.9-31.6%% response by arm). At the age of 15 years, 79.3% of the vaccinees completed a questionnaire. Among them >98% were living at, and during the week-ends 1.3-1.6% stayed outside, the study site communities. Smoking habit and alcohol consumption were similar in the different trial arms, also mean-age of menarche (12.4 years) and 1st ejaculation (12.6 years), and sexual behaviour (among those <25%, who had had sexual debut) did not differ by arm: mean-age at the sexual debut 14.3 and 14.4 in girls and boys, and proportions of those with multiple (≥5) life-time sexual partners (6.5-7.5%) at the age of 15 years. Uniform residential, life-style and sexual behaviour characteristics indicate successful randomization/enrolment of the CRT. Our CRT will verify modelled predictions on up to 31% herd effect of vaccinating both girls and boys with moderate vaccine coverage - quantifying overall effectiveness of different strategies which will soon guide how to implement HPV vaccination.

Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females

Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.

Insurance continuity and human papillomavirus vaccine uptake in Oregon and California federally qualified health centers

OBJECTIVES

We examined the association between insurance continuity and human papillomavirus (HPV) vaccine uptake in a network of federally qualified health clinics (FQHCs).

METHODS

We analyzed retrospective electronic health record data for females, aged 9-26 years in 2008 through 2010. Based on electronic health record insurance coverage information, patients were categorized by percent of time insured during the study period (0%, 1%-32%, 33%-65%, 66%-99%, or 100%). We used bilevel multivariable Poisson regression to compare vaccine-initiation prevalence between insurance groups, stratified by race/ethnicity and age. We also examined vaccine series completion among initiators who had at least 12 months to complete all 3 doses.

RESULTS

Significant interactions were observed between insurance category, age, and race/ethnicity. Juxtaposed with their continuously insured peers, patients were less likely to initiate the HPV vaccine if they were insured for less than 66% of the study period, aged 13 years or older, and identified as a racial/ethnic minority. Insurance coverage was not associated with vaccine series completion.

CONCLUSIONS

Disparities in vaccine uptake by insurance status were present in the FQHCs studied here, despite the fact that HPV vaccines are available to many patients regardless of ability to pay.

Accuracy of parental reports of children's HPV vaccine status: implications for estimates of disparities, 2009-2010

OBJECTIVES

Since the introduction of the human papillomavirus (HPV) vaccine in 2006, there have been considerable efforts at the national and state levels to monitor uptake and better understand the individual and system-level factors that predict who gets vaccinated. A common method of measuring the vaccination status of adolescents is through parental recall. We examined how the accuracy of parents' reports of their daughters' HPV vaccination status varied by social characteristics.

METHODS

Data were taken from the 2009-2010 National Immunization Survey (NIS)-Teen, which includes a household interview and a provider-completed immunization history. We evaluated concordance between parents' and providers' reports of teens' HPV vaccine initiation (≥1 dose) and completion (≥3 doses). We assessed bivariate associations of sociodemographic characteristics with having a concordant, false-positive (overreporting) or false-negative (underreporting) report, and used multinomial logistic regression to estimate the independent impact of each characteristic.

RESULTS

In bivariate analyses, concordance of parent-reported HPV vaccine initiation was associated with each of the sociodemographic characteristics investigated. In regression models, self-reported nonwhite race, lower household income, and lower education level of the teen's mother were associated with a higher likelihood of having a false-negative parental report than a concordant report.

CONCLUSION

Our results indicate that, while estimates of overall coverage based on parental report may be unbiased, the differences in the accuracy of parental report could result in misleading estimates of disparities in HPV vaccine coverage.

English proficiency, knowledge, and receipt of HPV vaccine in Vietnamese-American women

Cervical cancer is one of the most important disease burdens experienced by Vietnamese-American women. Human papillomavirus (HPV) is the etiological agent in almost all cases of cervical cancer. We surveyed Vietnamese-American women to determine receipt of HPV vaccine and assessed if limited English proficiency and knowledge related to HPV vaccine were associated with HPV vaccine uptake. Of the 113 Vietnamese-American women who participated in the study, 58 % (n = 68) was born in Vietnam. The mean years of residency in the United States was 12.75 years. Only 16 (14 %) reported receiving HPV vaccine and 11 (9 %) reported receiving all three shots. Thirteen women responded that they are not at all likely to receive HPV vaccine. Of the whole sample, 47 % (n = 53) reported proficiency in spoken and written English. English proficiency was significantly associated with receipt of HPV vaccine (OR = 4.4; confidence interval (95 % CI) = 1.2; 16.50; p = 0.03). Of the knowledge items, 70 % (n = 79) responded correctly that HPV increases the risk for cervical cancer. However, as many as 60 % responded incorrectly, that HPV infection can be cured with medication. The item, "People infected with HPV can be cured with medication," was the most important variable associated with receipt of HPV vaccine. Specifically, those with correct response were 3.8 times more likely to report receiving the HPV vaccine (OR = 3.8; 95 % CI = 1.1; 13.5; p = 0.04). Important public health needs are the development and evaluation of educational programs on HPV and cervical cancer that are designed for Vietnamese-American women.

Human papillomavirus vaccination and sexual behavior in young women

STUDY OBJECTIVE

To compare sexual attitudes and behaviors of young women who have received or declined the HPV vaccine.

DESIGN

Cross-sectional survey.

SETTING

Obstetrics and gynecology and pediatrics clinics at a large, Midwestern, academic health center.

PARTICIPANTS

223 young women (ages 13-24): 153 who had received HPV vaccination and 70 with no prior HPV vaccination.

MAIN OUTCOME MEASURES

Sexual behaviors; attitudes toward sexual activity.

RESULTS

Vaccinated young women were slightly but significantly younger than unvaccinated (mean age 19.2 vs 20.0). Both groups showed a large percentage of participants engaging in high-risk sexual behavior (75% vs 77%). The mean age at sexual debut was not significantly different between the groups (16.8 vs 17.0) nor was the average number of sexual partners (6.6 for both). Unvaccinated participants were more likely to have been pregnant (20% vs 8.6%, P = .016), although this difference was not significant in multivariate analysis CI [0.902-5.177]. Specific questions regarding high-risk sexual behaviors and attitudes revealed no significant differences between the groups.

CONCLUSION

We found that sexual behaviors, including high-risk behaviors, were similar between young women who had and had not received HPV vaccination. Our findings provide no support for suggestions that the vaccine is associated with increased sexual activity. Importantly, we found that young women in our population are sexually active at a young age and are engaged in high-risk behaviors, affirming the importance of early vaccination.

Immune response to the HPV-16/18 AS04-adjuvanted vaccine administered as a 2-dose or 3-dose schedule up to 4 years after vaccination: results from a randomized study

This randomized, partially-blind study (ClinicalTrials.gov registration number NCT00541970) evaluated the immunogenicity and safety of 2-dose (2D) schedules of the HPV-16/18 AS04-adjuvanted vaccine. Results to month (M) 24 have been reported previously and we now report data to M48 focusing on the licensed vaccine formulation (20 μg each of HPV-16 and -18 antigens) administered at M0,6 compared with the standard 3-dose (3D) schedule (M0,1,6). Healthy females (age stratified: 9–14, 15–19, 20–25 years) were randomized to receive 2D at M0,6 (n = 240) or 3D at M0,1,6 (n = 239). In the according-to-protocol immunogenicity cohort, all initially seronegative subjects seroconverted for HPV-16 and -18 antibodies and remained seropositive up to M48. For both HPV-16 and -18, geometric mean antibody titer (GMT) ratios (3D schedule in women aged 15–25 years divided by 2D schedule in girls aged 9–14 years) at M36 and M48 were close to 1, as they were at M7 when non-inferiority was demonstrated. The kinetics of HPV-16, -18, -31, and -45 antibody responses were similar for both groups and HPV-16 and -18 GMTs were substantially higher than natural infection titers. The vaccine had a clinically acceptable safety profile in both groups. In summary, antibody responses to a 2D M0,6 schedule of the licensed vaccine formulation in girls aged 9–14 years appeared comparable to the standard 3D schedule in women aged 15–25 years up to 4 years after first vaccination. A 2D schedule could facilitate implementation of HPV vaccination programs and improve vaccine coverage and series completion rates.

The effects of a brief educational intervention on human papillomavirus knowledge and intention to initiate HPV vaccination in 18-26 year old young adults

OBJECTIVES

Despite the Advisory Committee on Immunization Practices (ACIP) recommendations for young adult females and males to receive the three-dose human papillomavirus (HPV) vaccine, most recent findings show that only 30% of the U.S. females aged 19-26, 2.8% of males aged 19-21, and only 1.7% of males aged 22-26 are initiating vaccination. This study evaluates the effects of a brief (5-10 min) group HPV educational intervention on knowledge and intent to vaccinate among young adults.

METHODS

A sample of 131 18-26 year old females and males was recruited from the 2012 INShape Black and Minority Health Fair in Indiana. We randomized participants into one of two groups: (1) survey completion prior to education (control group) or (2) survey completion following education (intervention group). Written surveys assessed HPV knowledge, vaccination history, and vaccination intent (for unvaccinated participants).

RESULTS

Respondents were primarily female (70%), single (85%), and the majority self-identified as non-Hispanic Black (77%). Thirty-seven percent had initiated HPV vaccination (≥1 dose) and 19% had completed the series. The intervention group had higher HPV knowledge scores (M=9.1; SD=1.8) than the control group (M=7.0; SD=2.9; F=22.53). Among unvaccinated individuals (n=79), the intervention group had higher HPV vaccination intent (86%) compared to the control group (67%) (OR=3.09; 95%CI=1.02-9.36).

CONCLUSIONS

Despite ACIP recommendations, young adults continue to have low awareness of vaccine benefits and low vaccination rates. This study suggests that educational interventions to increase HPV awareness and vaccination may help to boost vaccination rates.

Characteristics associated with initiation of the human papillomavirus vaccine among a national sample of male and female young adults

PURPOSE

To examine rates of human papillomavirus vaccine initiation, and characteristics associated with initiation, among a national sample of male and female young adults.

METHODS

Participants (n = 3,448; 48% female) were recruited using a Web-based, respondent-driven sampling strategy and completed a Web-based survey between October and December 2010.

RESULTS

A total of 45% of females and 4% of males initiated the vaccine. Females who were younger, never married, were in school, attended religious services less than once a month, were sexually active, and reported a greater number of lifetime sex partners, and who had been tested for human immunodeficiency virus were more likely to report initiation. Males who were African-American, attended religious services less than once a month, and reported a greater number of sex partners in their lifetime, and who had been tested for human immunodeficiency virus were more likely to report initiation.

CONCLUSIONS

Factors associated with human papillomavirus vaccine initiation may differ for males and females. Further research with larger samples of males is needed to fully understand characteristics associated with male initiation. Regardless of gender, however, most young adults who have not initiated sexual activity have not received the vaccine. Further research is needed to examine how to increase vaccination rates among this population, because they may benefit most from vaccination.

Uptake, coverage, and completion of quadrivalent human papillomavirus vaccine in the vaccine safety Datalink, July 2006-June 2011

PURPOSE

The Advisory Committee on Immunization Practices recommended quadrivalent human papillomavirus vaccine (HPV4) for use in females in June 2006 and in males in October 2009. The objective of our study was to describe HPV4 uptake, single-dose coverage, and completion of the three-dose series among those 9-26 years of age, after the respective female and male vaccine licensures through June 2011.

METHODS

The study population included members of eight managed care organizations participating in the Vaccine Safety Datalink; we abstracted demographic and comprehensive vaccine information from electronic health records.

RESULTS

We found one-dose coverage increasing throughout the study period, to a high of 37.7% among females and 1.3% among males in June 2011. Among those receiving at least one HPV4 dose, three-dose series completion was 42% for females and 30.2% for males.

CONCLUSIONS

Our results demonstrate low initiation and completion of the HPV4 series among those recommended to receive the vaccine. Although consistent with previous studies, these results highlight the continued need to develop, implement, and monitor strategies to increase HPV4 vaccine initiation and completion in younger adolescents to achieve maximum impact in reducing the burden of cervical cancer and other HPV-related diseases.

Geographic variation in human papillomavirus vaccination uptake among young adult women in the United States during 2008-2010

Very little is known about geographic variation in human papillomavirus (HPV) vaccine uptake among young adult women in the US. To investigate this, we analyzed data from 12 US states collected through the Behavioral Risk Factor Surveillance System between 2008 and 2010. Among 2632 young adult women (18-26 years old) who responded to HPV vaccine uptake questions, weighted vaccine initiation and completion rates were: 28.0% and 17.0% overall, 14.0% and 6.6% in the South, 28.7% and 19.3% in the Midwest/West, and 37.2% and 23.1% in the Northeast (P<0.001), respectively. Log-binomial regression analysis showed that women living in the South were less likely to initiate (adjusted prevalence ratio (aPR) 0.71, 95% confidence interval (CI) 0.60-0.83) or complete (aPR 0.61, 95% CI, 0.53-0.71) the HPV vaccine series compared to women living in the Northeast. Interventions programs to improve HPV vaccine uptake in the Southern states are warranted.

Clinical trials of human papillomavirus vaccines and beyond

Human papillomavirus (HPV) is the most common sexually transmitted infectious agent; its 14 oncogenic types are causally associated with 5-10% of all cancers. The major structural HPV protein self-assembles into immunogenic virus-like particles. Two licensed HPV vaccines--the bivalent vaccine comprising HPV types 16 and 18, and the quadrivalent vaccine comprising HPV types 6, 11, 16 and 18--have proven to be safe and efficacious against 6-month-persistent cervical infections of HPV16 and HPV18 and associated precancerous lesions, and both have efficacies of 90-100%. Among baseline HPV-negative adolescent females, vaccine efficacies against the immediate precursor of cervical cancer (intraepithelial neoplasia grade 3) irrespective of HPV type are 93.2% and 43.0% for the bivalent and quadrivalent vaccines, respectively. The quadrivalent vaccine is efficacious (>75% vaccine efficacy) against any of the more-severe precursors of vulval, vaginal and anal cancers. A strong increase in vaccine efficacy with increasing severity of the precancerous lesion is explained by accumulation of the most-oncogenic HPV types 16 and 18 in these lesions. Therefore, prophylactic HPV vaccination will exceed the best results from screening for cancer. With the extremely efficacious prophylactic HPV vaccines, the focus of organized intervention (vaccination and screening) programmes should, however, shift from reducing the HPV disease burden to controlling the prevalence of oncogenic HPV (and nononcogenic HPV) types. Eradication of the major oncogenic HPV types should be pursued.

Prevalence of anogenital warts among participants in private health plans in the United States, 2003-2010: potential impact of human papillomavirus vaccination

OBJECTIVES

We estimated anogenital wart prevalence from 2003 to 2010 by gender and age group in a large US cohort with private insurance to detect potential decreases among people most likely to be affected by human papillomavirus (HPV) vaccination.

METHODS

We restricted health care claims to those from individuals aged 10 to 39 years with continuous insurance within a given year. We derived anogenital wart diagnoses from a diagnosis of condyloma acuminata, or either a less specific viral wart diagnosis or genital wart medication combined with either a benign anogenital neoplasm or destruction or excision of a noncervical anogenital lesion.

RESULTS

Prevalence increased slightly in 2003 to 2006, then significantly declined in 2007 to 2010 among girls aged 15 to 19 years; increased in 2003 to 2007, remained level through 2009, and declined in 2010 among women aged 20 to 24 years; and increased through 2009 but not in 2010 for women aged 25 to 39 years. For males aged 15 to 39 years, prevalence for each 5-year age group increased in 2003 to 2009, but no increases were observed for 2010.

CONCLUSIONS

These data indicate reductions in anogenital warts among US females aged 15 to 24 years, the age group most likely to be affected by introduction of the HPV vaccine.

Adolescent risk-taking, cancer risk, and life course approaches to prevention

Adolescent risk-taking may have long-term consequences for adult cancer risk. Behaviors such as smoking and sexual activity, commonly initiated during adolescence, may result--decades later--in cancer. Life course epidemiology focuses on unique vulnerabilities at specific development periods and their importance to later development of disease. A life course epidemiological perspective that integrates social and biological risk processes can help frame our understanding how specific adult cancers develop. Moreover, life course perspectives augment traditional public health approaches to prevention by emphasizing the importance of unique windows of opportunity for prevention.

Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis

Background The human papillomavirus (HPV) vaccine offers an opportunity to reduce health inequalities associated with cervical cancer provided the vaccine is delivered equitably at population level.

Method We reviewed evidence of inequalities in HPV vaccine uptake in young women after undertaking a comprehensive search of databases from inception to March 2012. Studies that compared HPV vaccination initiation and/or completion by at least one ethnicity or socioeconomic-related variable in adolescent young women were included. There were no language restrictions. Data were extracted by two reviewers and pooled in a meta-analysis using a random-effects model; sub-analyses and meta-regression were undertaken to investigate sources of heterogeneity.

Results In all, 29 publications related to 27 studies were included in the review. Black young women were less likely to initiate HPV vaccination compared with White young women (combined OR: 0.89, 95% CI: 0.82–0.97). In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40–0.78). There was no strong evidence that lower family income (combined OR: 1.16, 95% CI: 1.00–1.34) or lower parental education (combined OR 1.06, 95% CI: 0.92–1.22) influenced HPV vaccination initiation.

Conclusions We found strong evidence for differences in HPV vaccination initiation by ethnicity and healthcare coverage, but did not find a strong association with parental education or family income variables. The majority of studies originated from the USA. Population-based studies reporting both initiation and completion of the HPV vaccination programme are required to establish patterns of uptake in different healthcare contexts.

Incidence of potentially human papillomavirus-related neoplasms in the United States, 1978 to 2007

BACKGROUND

Population-based studies comprehensively describing incidence patterns of human papillomavirus (HPV)-related preinvasive and invasive neoplasms prior to widespread HPV vaccination are sparse.

METHODS

Age-adjusted incidence rates (IRs), IR ratios (IRRs), and annual percent changes (APCs) in IRs were calculated for potentially HPV-related tumors diagnosed in the Surveillance, Epidemiology and End Results (SEER) Program during 1978 through 2007.

RESULTS

Overall IRs for preinvasive tumors were significantly higher than for invasive squamous cell tumors of cervix (IRR = 3.42), vulva (IRR = 1.87), and vagina (IRR = 1.19) and significantly lower for adenomatous cervical tumors (IRR = 0.43), and squamous cell tumors of penis (IRR = 0.64), anus (males, IRR = 0.53; females, IRR = 0.14), and head and neck (H&N) (males, IRR = 0.01; females, IRR = 0.02). Incidence of preinvasive squamous tumors of cervix, vagina, and penis rose rapidly over time and decreased for invasive neoplasms. The most rapid increases occurred for preinvasive (males, APC = 16.0; females, APC = 7.3) and invasive anal tumors (males, APC = 3.6; females, APC = 2.3). IR patterns were generally similar among evaluable racial/ethnic groups, with the exception of H&N invasive tumor IRs which increased exclusively among white males.

CONCLUSIONS

Contrary to the opposing trends of preinvasive and invasive squamous tumors of cervix, vagina, and penis, preinvasive and invasive anal tumor IRs increased significantly over time by sex, age, and racial/ethnic groups. Successful HPV vaccination programs are needed to measurably reduce incidence of HPV-related neoplasms in the future, particularly for cancer sites with rising incidence rates for which effective screening modalities are limited. Cancer 2013;119:2291-2299. © 2013 American Cancer Society.

Human papillomavirus vaccine initiation and awareness: U.S. young men in the 2010 National Health Interview Survey

BACKGROUND

In 2009, the quadrivalent human papillomavirus (HPV) vaccine was licensed by the U.S. Food and Drug Administration for use in men/boys aged 9-26 years. In 2009, the Advisory Committee on Immunization Practices (ACIP) provided a permissive recommendation allowing HPV vaccine administration to this group.

PURPOSE

To assess HPV vaccination initiation and coverage, evaluate awareness of HPV and HPV vaccine, and identify factors independently associated with such awareness among men aged 18-26 years.

METHODS

Data from the 2010 National Health Interview Survey were analyzed in 2011.

RESULTS

In 2010, HPV vaccination initiation among men aged 18-26 years was 1.1%. Among the 1741 men interviewed in this age group, nearly half had heard of HPV (51.8%). Overall, about one third of these men had heard of the HPV vaccine (34.8%). Factors independently associated with a higher likelihood of awareness of both HPV and HPV vaccine among men aged 18-26 years included having non-Hispanic white race/ethnicity; a higher education level; a U.S. birthplace; more physician contacts; private health insurance; received other vaccines; and reported risk behaviors related to sexually transmitted diseases, including HIV.

CONCLUSIONS

HPV vaccination initiation among men aged 18-26 years in 2010 was low. HPV and HPV vaccine awareness were also low, and messages in this area directed to men are needed. Since ACIP published a recommendation for routine use of HPV4 among men/boys in December 2011, continued monitoring of HPV vaccination uptake among men aged 18-26 years is useful for evaluating the vaccination campaigns, and planning and implementing strategies to increase coverage.

Human papillomavirus vaccine in adolescent women: a 2012 update

PURPOSE OF REVIEW

Despite recommendations from the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents with the human papillomavirus (HPV) vaccine, U.S. coverage among women remains less than 50%, with that of adolescent men below 2%.

RECENT FINDINGS

Ongoing studies document the efficacy and safety of the HPV vaccine. Nevertheless, misconceptions and negative attitudes persist and serve as barriers to vaccine uptake. Additionally, other factors such as age, insurance status, poverty status, and racial or ethnic background have been associated with diminished vaccine uptake and poor completion rates. Internationally, HPV vaccination programs and school-based programs have achieved increased rates of uptake and series completion. HPV vaccination coverage may also be facilitated by improving communication between physicians, parents, and adolescents as well as by addressing common misconceptions about the vaccine.

SUMMARY

This review highlights significant findings of recent literature on HPV vaccination of adolescent women with a special focus on uptake, series completion, communication, disparities in vaccine coverage, and other health outcomes associated with HPV vaccination.

Human papillomavirus vaccine uptake among 18- to 26-year-old women in the United States: National Health Interview Survey, 2010

BACKGROUND

Human papillomavirus (HPV) vaccine uptake among young adult women has been reported to be very low. The authors conducted this study to provide an update on HPV vaccine uptake among 18- to 26-year-old women.

METHODS

The authors used the National Health Interview Survey 2010 data to estimate HPV vaccine coverage and their correlates.

RESULTS

Overall, 22.7% of women initiated (≥1 dose) and 12.7% completed the vaccine (≥3 doses). Thus, about 56% of women who initiated the vaccine completed it. Multivariate logistic regression analyses showed that younger age, unmarried status, Papanicolaou test, influenza vaccine, lifetime vaccines, and HPV vaccine awareness were positively associated with receiving ≥1 and ≥3 doses. In addition, uninsured women were less likely to receive ≥1 dose (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28-0.84), and blacks (OR, 0.48; 95% CI, 0.23-0.99) and women with a family income <100% of the federal poverty level (OR, 0.40; 95% CI, 0.21-0.73) were less likely to receive ≥3 doses. Furthermore, based on vaccine initiators, blacks were less likely than whites to complete the vaccine (OR, 0.29; 95% CI, 0.16-0.55). Two thirds of unvaccinated women were not interested in future vaccination. Among those who were interested, >76.4% preferred to receive it free or at a lower cost, whereas 20% would pay the full cost of the vaccine.

CONCLUSIONS

One in 8 women completed the 3-dose HPV vaccine. Educational and vaccine financing programs are needed to improve the uptake among low-income minority women who are at increased risk for cervical cancer.

Beliefs and attitudes regarding human papillomavirus vaccination among college-age women

Research on the human papillomavirus vaccine has largely focused on parents’ attitudes toward vaccinating their young daughters. Yet, little is known about the factors that influence human papillomavirus vaccination in college-age women who are still eligible for the vaccine. This study examined attitudes toward the human papillomavirus vaccine in 150 college-age women who had received the vaccine and 58 who had not. The Health Belief Model was used to predict vaccine intentions and to compare vaccinated and unvaccinated women. Women’s self-efficacy, social environment, and perceptions of the vaccine predicted vaccine intentions and behaviors. Interventions might include these factors to promote vaccination.

Trends in HPV vaccine initiation among adolescent females in North Carolina, 2008-2010

BACKGROUND

To better target future immunization efforts, we assessed trends and disparities in human papillomavirus (HPV) vaccine initiation among female adolescents in North Carolina over 3 years.

METHODS

We analyzed data from a stratified random sample of 1,427 parents who, between 2008 and 2010, completed two linked telephone surveys: the Behavioral Risk Factor Surveillance System and the Child Health Assessment and Monitoring Program surveys. Weighted analyses examined HPV vaccine initiation for girls ages 11 to 17 years.

RESULTS

HPV vaccine initiation increased modestly over time (2008, 34%; 2009, 41%; 2010, 44%). This upward trend was present within 11 subpopulations of girls, including those who lived in rural areas, were of minority (non-black/non-white) race, or had not recently received a preventive check-up. Looking at differences between groups, HPV vaccine initiation was less common among girls who attended private versus public school, were younger, or lacked a recent check-up. However, the latter difference narrowed over time. The low level of initiation among girls without recent check-ups increased substantially (from 11% to 41%), whereas initiation among girls with recent visits improved little (from 39% to 44%, P(interaction) = 0.007).

CONCLUSIONS

Although HPV vaccine initiation improved among several groups typically at higher risk for cervical cancer, the lack of progress among girls with recent check-ups suggests that missed opportunities for administration have hampered broader improvements.

IMPACT

Achieving widespread coverage of HPV vaccine will require redoubled efforts to vaccinate adolescents during routine care.

Prevention of invasive cervical cancer in the United States: past, present, and future

Over the past several decades, invasive cervical cancer (ICC) incidence in the United States has declined dramatically. Much of this decline has been attributed to widespread use of cytology screening followed by treatment of precancerous lesions. Despite available technologies to prevent ICC and screening programs targeting high-risk women, certain populations in the United States experience disproportionately high rates of ICC (e.g., racial/ethnic minorities and rural women). Limited access to and use of screening/follow-up services underlie this disparity. The licensure of the human papillomavirus (HPV) vaccine in 2006 introduced an additional method of ICC prevention. Unfortunately, dissemination of the vaccine to age-eligible females has been lower than expected (32% have received all 3 recommended doses). Decreasing the burden of HPV infection and HPV-related diseases in the United States will require greater dissemination of the HPV vaccine to adolescents and young adults, along with successful implementation of revised ICC screening guidelines that incorporate HPV and cytology cotesting. While a future without ICC is possible, we will need a comprehensive national health care program and innovative approaches to reduce ICC burden and disparities.

Inter-state variation in human papilloma virus vaccine coverage among adolescent girls in the 50 US states, 2007

Human papilloma virus (HPV) vaccination could substantially reduce the burden of cervical cancer by preventing HPV infection. This study uses the 2007 National Survey of Children's Health (NSCH) to estimate HPV vaccine coverage prevalence for US girls aged 12-17, the target group for vaccination. NSCH is a population-based telephone survey of households with children younger than 18 years. The proportion of girls aged 12-17 whose parent or guardian reported receipt of a clinician recommendation for HPV vaccination, one or more does of HPV vaccine, or a complete three-dose HPV vaccine series were estimated. Multivariable models estimated adjusted associations and marginal predicted vaccine coverage prevalence for each of the 50 US states and according to race/ethnicity, household income, insurance status, parental education, and whether the girl had a 'medical home'. The NSCH sample included 17,264 girls aged 12-17. Overall 18.2 % (SE 0.8 %) of girls reportedly received at least one HPV vaccine dose and 3.6 % (SE 0.4 %) completed the series; 31 % received clinician recommendation for HPV vaccine. Girls who received a clinician recommendation to vaccinate were 23 (95 % CI 18-29) times as likely to be vaccinated as those not counseled. There was substantial interstate variation in vaccine coverage that was largely explained by variability in clinician counseling. For 2007, there was substantial variation in HPV vaccine coverage among US girls 12-17 years that was largely explained by variability in clinician counseling. Strategies aimed at increasing clinicians' counseling for HPV vaccination could substantially reduce disparities in HPV vaccine coverage.

Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey

OBJECTIVES

Human papillomavirus (HPV) is a common sexually transmitted infection in the United States, yet HPV vaccination rates remain relatively low. We examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and the association between recommendation and vaccination.

METHODS

We used the 2009 National Immunization Survey-Teen, a nationally representative cross-section of female adolescents aged 13 to 17 years, to assess provider-verified HPV vaccination (≥ 1 dose) and participant-reported health care provider recommendation for the HPV vaccine.

RESULTS

More than half (56.9%) of female adolescents received a recommendation for the HPV vaccine, and adolescents with a recommendation were almost 5 times as likely to receive a vaccine (odds ratio = 4.81; 95% confidence interval = 4.01, 5.77) as those without a recommendation. Racial/ethnic minorities were less likely to receive a recommendation, but the association between recommendation and vaccination appeared strong for all racial/ethnic groups.

CONCLUSIONS

Provider recommendations were strongly associated with HPV vaccination. Racial/ethnic minorities and non-Hispanic Whites were equally likely to obtain an HPV vaccine after receiving a recommendation. Vaccine education efforts should target health care providers to increase recommendations, particularly among racial/ethnic minority populations.

An update on human papillomavirus vaccine uptake among 11-17 year old girls in the United States: National Health Interview Survey, 2010

PURPOSE

A 3-dose human papillomavirus (HPV) vaccine is recommended for adolescents to protect against HPV-related cervical and other cancers. The purpose of this study was to provide an update on HPV vaccine uptake among 11-17 year old girls residing in the US.

METHODS

Data from the 2010 National Health Interview Survey (NHIS) were obtained to assess HPV vaccination status and its correlates. Multivariate logistic regression analyses were performed to examine HPV vaccine uptake of ≥ 1 dose and ≥ 3 doses among all girls, and completion of the 3-dose series among those who initiated (received ≥ 1 dose) the vaccine.

RESULTS

Overall, 28.9% and 14.2% received ≥ 1 dose and ≥ 3 doses of vaccine: 14.5% and 3.0% among 11-12 year old girls, and 34.8% and 18.7% among 13-17 year olds, respectively. Hispanics had higher uptake of ≥ 1 dose (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.22-2.17) than whites. Having received an influenza shot in the past year and parents' awareness of the vaccine were significantly associated with receiving ≥ 1 dose (OR 1.88, 95% CI 1.51-2.33 and OR 16.57, 95% CI 10.95-25.06) and ≥ 3 doses (OR 1.48, 95% CI 1.13-1.92 and OR 10.60, 95% CI 5.95-18.88). A separate multivariate model based on girls who initiated the vaccine did not identify any significant correlates of 3-dose series completion. Among parents of unvaccinated girls, 60% were not interested in vaccinating their daughters and mentioned three main reasons: "does not need vaccine" (25.5%), "worried about safety" (19.3%) and "does not know enough about vaccine" (16.6%). Of those who were interested, 53.7% would pay $360-$500 for the vaccination, while 41.7% preferred to receive it at a much lower cost or free.

CONCLUSIONS

Only 1 out of 3 girls (11-17 years) have received ≥ 1 dose of HPV vaccine and much less have completed all 3 doses. Strategies should be taken to improve this vaccine uptake among girls, especially those 11-12 year olds, and to educate parents about the importance of vaccination.

Human papillomavirus vaccine and sexual behavior among adolescent and young women

BACKGROUND

Vaccines to prevent certain types of human papillomavirus (HPV) and associated cancers are recommended for routine use among young women. Nationally representative reports of vaccine uptake have not explored the relationship between HPV vaccine initiation and various sexual behaviors.

PURPOSE

Explore sexual behavior and demographic correlates of HPV vaccine initiation from a nationally representative survey of adolescent and young adult women.

METHODS

In 2007-2008, a total of 1243 girls/women aged 15-24 years responded to questions about receiving HPV vaccine in the National Survey of Family Growth (NSFG). In 2010, demographic and sexual behavior correlates were evaluated in bivariate and multivariate analyses by age.

RESULTS

HPV vaccine initiation was higher among those aged 15-19 years than those aged 20-24 years (30.3% vs 15.9%, p<0.001). No differences existed by race/ethnicity for those aged 15-19 years, but among women aged 20-24 years, non-Hispanic blacks were less likely than non-Hispanic whites to have received the HPV vaccine (AOR=0.15). HPV vaccine initiation was greater for those with insurance regardless of age. HPV vaccination was not associated with being sexually active or number of sex partners at either age. Among sexually active adolescents aged 15-19 years, those who received HPV vaccine were more likely to always wear a condom (AOR=3.0).

CONCLUSIONS

This study highlights disparities in HPV vaccine initiation by insurance status among girls/women aged 15-24 years and by race/ethnicity among women aged >19 years. No association was found between HPV vaccination and risky sexual behavior.

Human papillomavirus vaccine uptake among 9- to 17-year-old girls: National Health Interview Survey, 2008

BACKGROUND

Since 2006, the human papillomavirus (HPV) vaccine has been routinely recommended for preadolescent and adolescent girls in the United States. Depending on uptake patterns, HPV vaccine could reduce existing disparities in cervical cancer.

METHODS

HPV vaccination status and reasons for not vaccinating were assessed using data from the 2008 National Health Interview Survey. Households with a girl aged 9-17 years were included (N = 2205). Sociodemographic factors and health behaviors associated with vaccine uptake were assessed using multivariate logistic regression.

RESULTS

Overall, 2.8% of 9- to 10-year-olds, 14.7% of 11- to 12-year-olds, and 25.4% of 13- to 17-year-olds received at least 1 dose of HPV vaccine; 5.5% of 11- to 12-year-olds and 10.7% of 13- to 17-year-olds received all 3 doses. Factors associated with higher uptake in multivariate analysis included less than high school parental education, well-child check and influenza shot in the past year, and parental familiarity with HPV vaccine. Parents' primary reasons for not vaccinating were beliefs that their daughters did not need vaccination, that their daughters were not sexually active, or had insufficient vaccine knowledge. More parents with private insurance (58.0%) than public (39.8%) or no insurance (39.5%) would pay $360-$500 to vaccinate their daughters.

CONCLUSIONS

Less than one quarter of girls aged 9-17 years had initiated HPV vaccination by the end of 2008. Efforts to increase HPV uptake should focus on girls in the target age group, encourage providers to educate parents, and promote access to reduced-cost vaccines.

Predictors of Human Papillomavirus Vaccination in Female University Students

PURPOSE

The purpose of this study was to identify predictors of HPV (Human papillomavirus) vaccination among female university students.

METHODS

The participants in this study were 1,486 female university students. Data were collected using self-administered questionnaire from september 1, 2010 to June 30, 2011. Data were analysed using descriptive statistics, t-test, chi2-test and logistic regression.

RESULTS

The rate of HPV vaccination was 7.2%. Factors that influence HPV vaccination included residential region, smoking experience, family history of cervical cancer, experience having heard about the HPV vaccination, awareness that HPV is a sexual disease, HPV knowledge, perceived seriousness, perceived benefit and perceived barrier in health beliefs.

CONCLUSION

The results suggest a need to increase HPV vaccination campaigns to increase awareness of HPV vaccination. University and health care facilities should provide health education emphasizing perceived seriousness and perceived benefits. Also, the national health insurance corporation should consider addressing cost issues as a barrier to HPV vaccination.