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Loper OR, Schultz JM, Kintigh BF, Callaghan DJ. Missed opportunities for human papillomavirus vaccination using Iowa's Immunization Registry Information System. J Rural Health 2024. [PMID: 38683043 DOI: 10.1111/jrh.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Adolescent human papillomavirus (HPV) vaccination rates continue to remain lower than other adolescent vaccines, both nationwide and in Iowa. This study examined predictors of missed opportunities for first-dose HPV vaccine administrations in Iowa in order to conduct more targeted outreach and improve adolescent HPV vaccine uptake. METHODS A retrospective study was conducted to identify predictors of missed opportunities for first-dose HPV vaccination in Iowa adolescents using Iowa's Immunization Registry Information System. The study population included 154,905 adolescents aged 11-15 years between 2019 and 2022. Missed opportunity for first-dose HPV vaccination was defined as a vaccination encounter where an adolescent received a Tdap and/or MenACWY vaccine but did not receive the first-dose HPV vaccine during the same encounter. FINDINGS Over a third of the study population experienced a missed opportunity for HPV vaccination between 2019 and 2022. Missed opportunity for vaccination was most common among individuals living in a rural county (aOR = 1.36), underinsured adolescents (aOR = 1.74), males (aOR = 1.12), teens 13-15 years of age (aOR = 1.76), and White race and non-Hispanic ethnicity. CONCLUSION This study builds on previously reported predictors of missed opportunity for HPV vaccination in adolescents. Increased understanding of provider needs and barriers to administering HPV vaccination and further analysis of how the Vaccines for Children Program can play a role in HPV vaccination uptake is necessary to improve HPV vaccination rates among adolescents in Iowa and more specifically in rural communities.
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Affiliation(s)
- Ona R Loper
- Iowa Department of Health and Human Services, Des Moines, Iowa, USA
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Enujioke SC, Shedd-Steele R, Daggy J, Burney HN, Head KJ, Kasting ML, Zimet G. County-level correlates of completed HPV vaccination in Indiana. Vaccine 2023; 41:5752-5757. [PMID: 37599142 DOI: 10.1016/j.vaccine.2023.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9-14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9-14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.
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Affiliation(s)
- Sharon C Enujioke
- CDR, MC USN, Department of Pediatrics-Division of Adolescent Medicine, Navy Medicine Readiness and Training Command, Portsmouth, VA, United States.
| | | | - Joanne Daggy
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, United States
| | - Heather N Burney
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, United States
| | - Katharine J Head
- Indiana University-Purdue University Indianapolis, Department of Communication Studies, Indianapolis, IN, United States
| | - Monica L Kasting
- Purdue University, Department of Public Health, West Lafayette, IN, United States
| | - Gregory Zimet
- Indiana University School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Indianapolis, IN, United States
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Osaghae I, Chido-Amajuoyi OG, Khalifa BAA, Shete S. Barriers and determinants of consistent offering of HPV vaccination by healthcare facilities. Hum Vaccin Immunother 2023; 19:2264596. [PMID: 37846730 PMCID: PMC10583630 DOI: 10.1080/21645515.2023.2264596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
Expanding access to HPV vaccination is critical to increasing HPV vaccine uptake. We assessed the determinants and barriers to consistent offering of HPV vaccine among healthcare facilities. This was a cross-sectional survey of healthcare providers (HCPs) in Texas. Prevalence of the reasons healthcare practices do not consistently offer HPV vaccination was estimated. Multivariable regression analyses were conducted. Of 1169 HCPs included in the study, 47.5% (95% CI: 44.6-50.3%) reported their practices do not provide HPV vaccination or do not offer it consistently. Compared to physicians, nurses had 77% lower odds (Adjusted Odds Ratio (AOR): 0.23, 95% CI: 0.16-0.32, p-value: < .001), and physician assistants had 89% lower odds (AOR: 0.11, 95% CI: 0.07-0.16, p-value: < .001) of their healthcare practices consistently offering HPV vaccination. Compared to university/teaching hospitals, the odds of healthcare practices consistently offering HPV vaccination were 44% lower (AOR: 0.56, 95% CI: 0.35-0.91, p-value: 0.019) in solo practices but 266% higher (AOR: 3.66, 95% CI: 2.04-6.58, p-value: < .001) in FQHC/public facilities. The common reasons healthcare practices do not consistently offer HPV vaccination were; HPV vaccination is not within the scope of the practice (48.1%), referrals to other clinics (27.7%), and limited personnel (11.4%). Non-physicians were more likely to report that HPV vaccination was not in their scope and to refer patients than physicians. Moreover, solo practices were more likely to report challenges with acquisition and storage of the vaccine and referral of patients as reasons for not consistently offering HPV vaccination than university/teaching hospitals, FQHC/public facilities, or group practices. System-level interventions including training of non-physicians and expansion of practice enrollment in programs that support HPV vaccine acquisition and storage are needed.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Banda A. A. Khalifa
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Freeman RE, Leary CS, Graham JM, Albers AN, Wehner BK, Daley MF, Newcomer SR. Geographic proximity to immunization providers and vaccine series completion among children ages 0-24 months. Vaccine 2023; 41:2773-2780. [PMID: 36964002 PMCID: PMC10229224 DOI: 10.1016/j.vaccine.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES In the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations. METHODS We analyzed records from Montana's immunization information system for children born 2015-2017. Using geolocated address data, we calculated distance in road miles from children's residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24 months. RESULTS Among 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24 months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median = 1.7; IQR = 3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96-0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85-0.92). CONCLUSIONS Long travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.
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Affiliation(s)
- Rain E Freeman
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States.
| | - Cindy S Leary
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
| | - Jonathan M Graham
- Center for Population Health Research, University of Montana, Missoula, MT, United States; Department of Mathematical Sciences, University of Montana, Missoula, MT, United States
| | - Alexandria N Albers
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
| | - Bekki K Wehner
- Montana Immunization Program, Department of Public Health and Human Services, Helena, MT, United States
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States; University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, United States
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
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Pilcher F, Carney JK, Stein GS. Overcoming barriers to HPV vaccination in rural Vermont through a multicomponent peer-based approach. Hum Vaccin Immunother 2022; 18:2122494. [PMID: 36130214 PMCID: PMC9746368 DOI: 10.1080/21645515.2022.2122494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Human Papillomavirus (HPV) causes almost all cervical cancers and many cancers of the anus, vagina, vulva, penis, and oropharynx. The HPV vaccine provides protection to all adolescents from a broad spectrum of cancers, yet HPV vaccination rates remain lower than those of other routine vaccines. Developing effective HPV vaccine interventions is particularly important in rural areas, whose residents have lower rates of HPV vaccination and higher cervical cancer incidence and mortality; however, interventional research in these populations is relatively limited. Furthermore, though rural areas are heterogeneous in many regards, few interventions engage stakeholders to develop community-specific solutions to overcome obstacles associated with HPV vaccination. Based on a review of existing literature, we recommend a multicomponent peer-based approach that includes school-based vaccination and awareness, parental involvement, and stakeholder engagement to increase HPV vaccination in rural areas, and we provide an example of such an intervention in rural Vermont.
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Affiliation(s)
- Finlay Pilcher
- Larner College of Medicine, University of Vermont, Burlington, VT, USA,CONTACT Finlay Pilcher Larner College of Medicine, University of Vermont, 89 Beaumont Avenue, Given C401, Burlington, Vermont05405, USA
| | - Jan Kirk Carney
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Gary S. Stein
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
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