Multivariate Analysis of Female HPV Vaccination Rates in the Intermountain West

Friday, April 24, 2015
Djin L. Lai, BSN, RN , College of Nursing, University of Utah, Salt Lake City, UT
Qian Ding, MS , Department of Internal Medicine, University of Utah, Salt Lake City, UT
Echo Warner, MPH , Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
Julia Bodson , Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
Deanna L. Kepka, PhD, MPH , Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
Purposes/ Aims: The purpose of this study is to investigate sociodemographic factors associated with HPV vaccination rates among females aged 13-17 in the Intermountain West.

Background: The HPV vaccine protects against cervical, anogenital, and oropharyngeal cancers as well as genital and oropharyngeal warts. Yet, rates of vaccination in the US remain poor compared to other developed nations such as parts of Canada, the United Kingdom, and Australia. To date, few studies have investigated factors of HPV vaccination in the Intermountain West. Understanding the influence of various sociodemographic characteristics on HPV vaccination rates will inform future studies and intervention planning in the region.

Methods: Multivariable analysis of the 2012 National Immunization Survey-Teen (NIS-Teen) dataset was conducted in Stata 13.1. Sociodemographic factors included maternal age, adolescent grade in school, and adolescent vaccination history (receipt of influenza, meningococcal, and TDAP immunizations). Survey weighted Pearson chi-square tests and multivariable weight Poisson regression were conducted. Adjusted prevalence ratios (PR) with 95% confidence intervals (CI) were reported.

Results: Older maternal age (> 45 years) was associated with lower rates of HPV initiation (PR=0.71, 95% CI=0.58-0.87, p=0.001) and completion (PR=0.67, 95% CI=0.46-0.97, p=0.032) compared to mothers < 35 years of age. Additionally, female 9th to 12th graders were more likely to initiate (PR=1.51, 95% CI=1.25-1.83, p<0.001) and complete  (PR=2.42, 95% CI=1.72-3.40, p<0.001) the HPV vaccination series than those in 6th to 8th grade, the targeted age group for the HPV vaccine. Recipients of an influenza immunization were more likely to also begin the 3-dose HPV vaccine series (PR=1.51, 95% CI=1.29-1.77, p<0.001) and complete it (PR=1.73, 95% CI=1.37-2.18, p<0.001). Likewise, receipt of a meningococcal immunization was positively associated with HPV vaccination initiation (PR=1.97, 95% CI=1.53-2.54, p=<0.001) and completion (PR=2.56, 95% CI=1.66-3.96, p=<0.001) while TDAP immunization was not associated with HPV vaccination.

Implications: The CDC recommends that adolescents receive the HPV vaccine at 11 or 12 years of age; however, our results indicate that fewer female adolescents are receiving the vaccine at the recommended ages. These findings suggest that recommending the HPV vaccine in visits where other adolescent vaccines are administered may be fruitful in increasing HPV vaccination rates. Younger maternal age is associated with HPV vaccination in nation-wide analyses of the NIS-Teen dataset, however, racial and income demographics were not shown to be significant in this region. Interventions are needed to increase low HPV vaccine initiation and completion in the Intermountain West.

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