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Anandarajah A, Shato T, Humble S, Barnette AR, Brandt HM, Klesges LM, Sanders Thompson VL, Silver MI. The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents. Hum Vaccin Immunother 2024; 20:2300879. [PMID: 38174998 PMCID: PMC10773709 DOI: 10.1080/21645515.2023.2300879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9-17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers' attitudes, information sources, and trust in those sources were associated with their adolescent's HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.
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Affiliation(s)
- Akila Anandarajah
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Thembekile Shato
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Sarah Humble
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Alan R. Barnette
- Department of Neonatology, Saint Francis Medical Center, Cape Girardeau, MO, USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Lisa M. Klesges
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Michelle I. Silver
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Hirth J, Ostovar-Kermani T, Gutierrez JA, Thompson EL, Barnett TE, Zoorob R. Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series. Vaccine 2024; 42:2827-2836. [PMID: 38519345 DOI: 10.1016/j.vaccine.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Up-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD. METHODS A secondary analysis of The National Immunization Survey - Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators. RESULTS The final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9-10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78-8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65-0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46-0.96). CONCLUSION Strong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.
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Affiliation(s)
- Jacqueline Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, United States.
| | | | - Judith A Gutierrez
- Department of Family and Community Medicine, Baylor College of Medicine, United States
| | - Erika L Thompson
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, United States
| | - Tracey E Barnett
- Department of Quantitative & Qualitative Health Sciences, School of Public Health, University of Texas at San Antonio, United States
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, United States
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Xiong S, Humble S, Barnette A, Brandt H, Thompson V, Klesges LM, Silver MI. Associations of geographic-based socioeconomic factors and HPV vaccination among male and female children in five US states. BMC Public Health 2024; 24:702. [PMID: 38443823 PMCID: PMC10916280 DOI: 10.1186/s12889-024-18206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND We assessed whether five geographic-based socioeconomic factors (medically underserved area (MUA); healthcare provider shortage area (HPSA); persistent poverty; persistent child poverty; and social vulnerability index (SVI)) were associated with the odds of HPV vaccination initiation, series completion, and parental vaccine hesitancy, and whether the observed relationships varied by gender of the child. METHODS An online panel service, administered through Qualtrics®, was used to recruit parents of adolescents 9-17 years of age to complete a one-time survey in 2021. Coverage of the panel included five US states: Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois. Generalized estimating equation (GEE) models were used to assess population-level associations between five geographic-based socioeconomic factors (MUA; HPSA; persistent poverty; persistent child poverty; and SVI) and three HPV vaccination outcomes (initiation, series completion, and hesitancy). All GEE models were adjusted for age of child and clustering at the state level. RESULTS Analyses were conducted using responses from 926 parents about their oldest child in the target age range (9-17 years). The analytic sample consisted of 471 male children and 438 female children across the five states. In adjusted GEE models, persistent child poverty and HPSA were negatively associated with HPV vaccination initiation and series completion among female children, respectively. Among male children, high social vulnerability was negatively associated with HPV vaccine series completion. Additionally, persistent poverty and high social vulnerability were negatively associated with HPV vaccine hesitancy in male children. CONCLUSIONS The results of this cross-sectional study suggest that geographic-based socioeconomic factors, particularly, HPSA, persistent poverty, and SVI, should be considered when implementing efforts to increase HPV vaccine coverage for adolescents. The approaches to targeting these geographic factors should also be evaluated in future studies to determine if they need to be tailored for male and female children.
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Affiliation(s)
- Serena Xiong
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Suite 166, 55414, Minneapolis, MN, USA.
| | - Sarah Humble
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
| | - Alan Barnette
- Saint Francis Medical Center, 211 St. Francis Drive, 63703, Cape Girardeau, MO, USA
| | - Heather Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, 38105-3678, Memphis, TN, USA
| | - Vetta Thompson
- Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University School of Medicine, 63110, St. Louis, MO, USA
- Department of Medicine and Pediatrics, Washington University School of Medicine, Washington University in St. Louis, 63110, St. Louis, MO, USA
| | - Lisa M Klesges
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
| | - Michelle I Silver
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
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McNeil CJ, Barr B, Munawar I, DeWitt ME, Myers JS, Shetty AK. Assessing Barriers to Human Papillomavirus (HPV) Vaccination in At-Risk Rural Communities of Western North Carolina, United States. Vaccines (Basel) 2023; 11:1785. [PMID: 38140189 PMCID: PMC10747883 DOI: 10.3390/vaccines11121785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Human papillomavirus (HPV) vaccination among adolescents in rural, western North Carolina (NC) remains suboptimal. Data are needed to understand the barriers to HPV vaccination in these communities. We conducted a cross-sectional pilot study of parental attitudes and provider practices regarding HPV vaccination in rural western NC counties with lower HPV vaccination rates. Eight health department clinics were enrolled in the study. Further, 29 provider and 32 parent surveys were analyzed along with environmental scans. Median provider comfort regarding knowledge of HPV-associated diseases was 85% (IQR = 75-95), on a scale of 0-100% (100% representing complete comfort). Median parental comfort level regarding knowledge of HPV-associated diseases and the HPV vaccine was 75% (IQR = 50-89) and 75% (IQR = 49-96), respectively. Less than 25% of parents rated the HPV vaccine as 'extremely effective' against genital (16.7%) and anal cancers (17.9%). Parents were more likely to rate the vaccine as 'extremely effective' to 'very effective' if their child was female. There was no significant difference between parental- and provider-reported comfort with knowledge about HPV-associated diseases (p = 0.0725) and the HPV vaccine (p = 0.167). This study identified multiple opportunities to increase HPV vaccine coverage among unvaccinated adolescents at parental, provider, and clinic levels. Health education of rural NC residents and providers in public health settings may identify future interventions to increase HPV vaccine uptake.
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Affiliation(s)
- Candice J. McNeil
- Office of Global Health, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (B.B.); (A.K.S.)
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
| | - Breona Barr
- Office of Global Health, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (B.B.); (A.K.S.)
- Department of Family Medicine, West Virginia University, Ranson, WV 26506, USA
| | - Iqra Munawar
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
| | - Michael E. DeWitt
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
- Department of Biology, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Jenny Snow Myers
- Immunization Branch, Division of Public Health, Carolina Department of Health and Human Services, Raleigh, NC 27609, USA;
| | - Avinash K. Shetty
- Office of Global Health, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (B.B.); (A.K.S.)
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
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