Advertisement

Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents

      Introduction

      Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S.

      Methods

      Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression.

      Results

      Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents.

      Conclusions

      Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • President's Cancer Panel
        HPV vaccination for cancer prevention: progress, opportunities, and a renewed call to action. a report to the president of the United States from the chair of the President's Cancer Panel. Bethesda, MD: President's Cancer Panel.
        Published November 2018
      1. Immunization and infectious diseases. Healthy People 2020, HHS, Office of Disease Prevention and Health promotion.https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives. Updated June 23, 2021. Accessed October 15, 2020.

      2. HPV vaccination information for health professionals. American Cancer Society.https://www.cancer.org/health-care-professionals/hpv-vaccination-information-for-health-professionals/our-hpv-vaccination-initatives.html. Accessed October 15, 2020.

      3. How many cancers are linked with HPV each year? Centers for Disease Control and Prevention. http://www.cdc.gov/cancer/hpv/statistics/cases.htm.Updated September 3, 2020. Accessed October 15, 2020.

        • Meites E
        • Kempe A
        • Markowitz LE.
        Use of a 2-dose schedule for human papillomavirus vaccination - updated recommendations of the Advisory Committee on Immunization Practices.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1405-1408https://doi.org/10.15585/mmwr.mm6549a5
        • Elam-Evans LD
        • Yankey D
        • Singleton JA
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1109-1116https://doi.org/10.15585/mmwr.mm6933a1
        • Abma JC
        • Martinez GM.
        Sexual activity and contraceptive use among teenagers in the United States, 2011-2015.
        Natl Health Stat Rep. 2017; : 1-23
        • St Sauver JL
        • Rutten LJF
        • Ebbert JO
        • Jacobson DJ
        • McGree ME
        • Jacobson RM.
        Younger age at initiation of the human papillomavirus (HPV) vaccination series is associated with higher rates of on-time completion.
        Prev Med. 2016; 89: 327-333https://doi.org/10.1016/j.ypmed.2016.02.039
        • Hirth JM
        • Tan A
        • Wilkinson GS
        • Berenson AB.
        Completion of the human papillomavirus vaccine series among insured females between 2006 and 2009.
        Cancer. 2012; 118: 5623-5629https://doi.org/10.1002/cncr.27598
        • Inguva S
        • Barnard M
        • Ward LM
        • et al.
        Factors influencing human papillomavirus (HPV) vaccination series completion in Mississippi Medicaid.
        Vaccine. 2020; 38: 2051-2057https://doi.org/10.1016/j.vaccine.2019.12.030
        • Schluterman NH
        • Terplan M
        • Lydecker AD
        • Tracy JK.
        Human papillomavirus (HPV) vaccine uptake and completion at an urban hospital.
        Vaccine. 2011; 29: 3767-3772https://doi.org/10.1016/j.vaccine.2011.03.032
        • Ackerson B
        • Hechter R
        • Sidell M
        • et al.
        Human papillomavirus vaccine series completion in boys before and after recommendation for routine immunization.
        Vaccine. 2017; 35: 897‒902https://doi.org/10.1016/j.vaccine.2017.01.007
        • Liu G
        • Kong L
        • Du P.
        HPV vaccine completion and dose adherence among commercially insured females aged 9 through 26 years in the U.S.
        Papillomavirus Res. 2016; 2: 1-8https://doi.org/10.1016/j.pvr.2015.10.001
        • Freeman AJH
        • Gamboa C
        • Darbinian JA
        • Littell RD
        • Torrente S.
        Disparities in human papillomavirus vaccine completion rates among females in an integrated health care system.
        Obstet Gynecol. 2018; 132: 717-723https://doi.org/10.1097/AOG.0000000000002802
        • Spencer JC
        • Brewer NT
        • Trogdon JG
        • Wheeler SB
        • Dusetzina SB.
        Predictors of human papillomavirus vaccine follow-through among privately insured U.S. patients.
        Am J Public Health. 2018; 108: 946-950https://doi.org/10.2105/AJPH.2018.304408
        • Dorell CG
        • Yankey D
        • Santibanez TA
        • Markowitz LE.
        Human papillomavirus vaccination series initiation and completion, 2008-2009 [published correction appears in Pediatrics. 2012;130(1):166–168].
        Pediatrics. 2011; 128: 830-839https://doi.org/10.1542/peds.2011-0950
        • Niccolai LM
        • Mehta NR
        • Hadler JL.
        Racial/Ethnic and poverty disparities in human papillomavirus vaccination completion.
        Am J Prev Med. 2011; 41: 428-433https://doi.org/10.1016/j.amepre.2011.06.032
        • Agawu A
        • Hanlon AL
        • Buttenheim AM
        • Song L
        • Fiks AG
        • Feemster KA.
        Disparities in human papillomavirus vaccine series completion by adolescent males: a retrospective cohort study.
        Acad Pediatr. 2020; 20: 364-373https://doi.org/10.1016/j.acap.2019.05.002
        • Reiter PL
        • Gupta K
        • Brewer NT
        • et al.
        Provider-verified HPV vaccine coverage among a national sample of Hispanic adolescent females.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 742-754https://doi.org/10.1158/1055-9965.EPI-13-0979
      4. The social-ecological model: a framework for prevention. Center for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Fpublichealthissue%2Fsocial-ecologicalmodel.html. Updated January 28, 2020. Accessed October 15, 2020.

      5. Duke health performance services. Duke University Health System. https://ps.duhs.duke.edu/performance-services-home. Accessed March 3, 2021.

        • Kind AJ
        • Jencks S
        • Brock J
        • et al.
        Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.
        Ann Intern Med. 2014; 161: 765-774https://doi.org/10.7326/M13-2946
      6. 2015 area Deprivation Index v2.0. University of Wisconsin School of Medicine and Public Health. https://www.neighborhoodatlas.medicine.wisc.edu/. Accessed October 15, 2020.

        • Tsui J
        • Singhal R
        • Rodriguez HP
        • Gee GC
        • Glenn BA
        • Bastani R.
        Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls.
        Vaccine. 2013; 31: 2028-2034https://doi.org/10.1016/j.vaccine.2013.02.046
        • Mabeya H
        • Menon S
        • Weyers S
        • et al.
        Uptake of three doses of HPV vaccine by primary school girls in Eldoret, Kenya; a prospective cohort study in a malaria endemic setting.
        BMC Cancer. 2018; 18: 557https://doi.org/10.1186/s12885-018-4382-x
        • SAS Institute Inc
        SAS/IML® 9.4 user’s guide.
        SAS Institute Inc, Cary, NCPublished January 2004
        • Gilkey MB
        • Calo WA
        • Moss JL
        • Shah PD
        • Marciniak MW
        • Brewer NT.
        Provider communication and HPV vaccination: the impact of recommendation quality.
        Vaccine. 2016; 34: 1187-1192https://doi.org/10.1016/j.vaccine.2016.01.023
        • Walker TY
        • Elam-Evans LD
        • Yankey D
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2018.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 718-723https://doi.org/10.15585/mmwr.mm6833a2
        • Rahman M
        • Hirth JM
        • Berenson AB.
        Adherence to ACIP recommendation for human papillomavirus vaccine among U.S. adolescent girls.
        J Community Health. 2017; 42: 385-389https://doi.org/10.1007/s10900-016-0267-6
        • Monnat SM
        • Rhubart DC
        • Wallington SF.
        Differences in human papillomavirus vaccination among adolescent girls in metropolitan versus non-metropolitan areas: considering the moderating roles of maternalsocioeconomic status and health care access.
        Matern Child Health J. 2016; 20: 315-325https://doi.org/10.1007/s10995-015-1831-x
        • Chuang E
        • Cabrera C
        • Mak S
        • et al.
        Primary care team- and clinic level factors affecting HPV vaccine uptake.
        Vaccine. 2017; 35: 4540-4547https://doi.org/10.1016/j.vaccine.2017.07.028
        • Roncancio AM
        • Ward KK
        • Carmack CC
        • Muñoz BT
        • Cribbs FL.
        Hispanic mothers’ beliefs regarding HPV vaccine series completion in their adolescent daughters.
        Health Educ Res. 2017; 32: 96-106https://doi.org/10.1093/her/cyw055
        • Katz IT
        • Bogart LM
        • Fu CM
        • et al.
        Barriers to HPV immunization among Blacks and Latinos: a qualitative analysis of caregivers, adolescents, and providers.
        BMC Public Health. 2016; 16: 874https://doi.org/10.1186/s12889-016-3529-4
        • Gates A
        • Ranji U
        • Snyder L.
        Coverage of preventive services for adults in Medicaid.
        Kaiser Family Foundation, San Francisco, CAPublished November 13, 2014 (Accessed October 15, 2020)