Factors Associated With Initiation and Completion of Human Papillomavirus Vaccine Series Among Young Women Enrolled in Medicaid

doi:10.1016/j.jadohealth.2010.09.015

Journal of Adolescent Health

Volume 47, Issue 6, December 2010, Pages 596-599

https://doi.org/10.1016/j.jadohealth.2010.09.015 Get rights and content

Abstract

Purpose

To determine age- and race-specific uptake rates of human papillomavirus (HPV) vaccine among females aged 9–20 years who participated in the Florida Medicaid during the first 2 years after approval by the Food and Drug Administration, and to identify factors associated with HPV vaccine initiation and series completion.

Methods

Medicaid administrative data were used to identify claims for HPV vaccination together with individual, provider, and practice characteristics linked to each vaccination.

Results

As of June 2008, 9.4% of females aged 11–18 years had ever received an HPV vaccination, and 1.8% had completed the three-vaccine series. In multivariate analysis, receipt of an HPV vaccination was found to be associated with age and race/ethnicity. In comparison with their white counterparts, black females were approximately half as likely to complete the three-vaccine series after initiation.

Conclusions

The data obtained suggest relatively slow initial uptake and completion of the HPV vaccine series in this population who are at an increased risk for cervical cancer, with racial disparities in vaccine uptake and vaccine series completion.

Section snippets

Methods

Medicaid administrative data were obtained from the Florida Agency for Health Care Administration. The study population included all females aged 9–20 who were enrolled in the Florida Medicaid between July 2006 and June 2008 (n = 718,660). The study was approved by the University of Florida Institutional Review Board; with funding support from Merck, Inc, without any restrictions pertaining to either analyses or publication.

HPV vaccination was identified using the Current Procedural Terminology

Results

Nearly 2 years after approval by the Food and Drug administration (June 2008), 9.4% of the 11–18-year-old Medicaid-enrolled females had ever received an HPV vaccination and 1.8% had received the three-vaccine series. The majority of initial HPV vaccinations were given by pediatricians (85%), with fewer being provided by family practitioners and/or general practitioners (12%), and the least by obstetricians and/or gynecologists (1%) or internal medicine providers (1%).

As of June 2008, the

Discussion

These rates of early uptake of HPV vaccination are lower than the 25%–30% rate reported for adolescent females in other studies conducted around the same period as our study [3], [4], [7], [8], including studies on adolescents with private insurance [3]. Black females were significantly less likely as compared with either Hispanic or white females to initiate HPV vaccination or to complete the three-vaccine series, whereas Hispanic females were more likely to initiate vaccination as compared

Acknowledgments

Robert Cook conceived the study, oversaw the analysis, and wrote the manuscript; Jianyi Zhang provided data programming, data analysis, and contributed to writing; Jocelyn Mullins contributed to data analysis and writing of this manuscript; Teresa Kauf helped plan the study design, interpreted data, and edited the manuscript; Babette Brumback and Chris Mallison helped plan the study design and provided assistance with data analysis; Heather Steingraber helped plan the study design and edited

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There are more references available in the full text version of this article.

Cited by (73)

Longitudinal assessment of nonavalent vaccine HPV types in a sample of sexually active African American women from ten U.S. Cities
2021, Vaccine
Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States.
This sub-study obtained meta-data for 80 of the 1,365 women (18–25 years), enrolled in the BRAVO study, a randomized, open-label trial of home screening and treatment of asymptomatic bacterial vaginosis at high-risk for sexually transmitted infections conducted between 2008 and 2013. Participants were randomized to treatment or standard-of-care, and followed every 2-months for 12 months. Stored vaginal swabs from the first three visits were tested for the nine vaccine preventable HPV types using quantitative PCR. Prevalence and associated 95% confidence intervals for the HPV types were assessed using R (version 3.6.1).
The average age of the participants was 21.5 (SD ± 2.11) years, with 60% having ever been pregnant and all were African-American. Majority (71%) reported ≥ two sex partners in the prior year with 89% having unprotected vaginal sex and 45% having a new sex partner in the prior year. About 30% had ≥ one of the nine nonavalent vaccine HPV types at all three time points over a period of four months, 15% at two of any three visits, 19% at one of the three visits and 36% were negative for all nine vaccine HPV types at all time points. The most frequently detected HPV vaccine types were 52, 58, 16, and 18. The prevalence of any vaccine HPV types, and high-risk HPV types was 63.8% and 58.8%, respectively.
Our findings suggest that HPV vaccination which is currently recommended for all unvaccinated persons through age 26 years, is likely to be more beneficial than previously thought as nonavalent HPV vaccine was not available during the time these data were collected.
Urban-Rural Disparities in Vaccination Service Use Among Low-Income Adolescents
2021, Journal of Adolescent Health
To access urban-rural disparities in vaccination service use among Medicaid-enrolled adolescents and examine its association with residence county characteristics.
We used the 2016 Medicaid T-MSIS Analytic File to estimate adolescents’ use of vaccination services, defined as the proportion of adolescents aged 11–18 years with ≥ 1 vaccination visit in a county. We used linear regression and the Oaxaca-Blinder decomposition method to examine the association between county characteristics and urban-rural disparities in vaccination service use.
The analysis included 2,473 counties located in 38 states. The mean proportion of adolescents making ≥ 1 vaccination visit at the county level was low (36.09%) and was lower in rural than in urban counties (31.99% vs. 36.85%, p < .01). The number of primary care physicians (PCPs) was positively associated with vaccination service use in rural counties; in urban counties, % of households without a vehicle was negatively associated with vaccination service use. The decomposition results showed that 66.78% (3.24 percentage points) of the urban-rural disparities in vaccination service use could be attributed to urban-rural differences in the county characteristics included in the study. Characteristics measuring access to care (number of PCPs), social and economic factors (% adults with at least a bachelor’s degree and % children in poverty), quality of care (influenza vaccination rates and preventable hospital stays), and demographics (% non-Hispanic black, % Hispanic, and % females) played a role in urban-rural disparities.
Differences in county characteristics could partly explain the observed urban-rural disparities in vaccination service use among low-income adolescents.
Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority populations: A systematic review
2020, Preventive Medicine Reports
Citation Excerpt :
In 2017, 66% of adolescents aged 13–17 years started the vaccine series and 49% completed the series in the U.S., with disparities in vaccine uptake for some populations like racial and ethnic minority groups in the U.S. and other high-income countries (Van Dyne et al., 2018; Musselwhite et al., 2016; Jeudin et al., 2014). Some studies have found that Black, Hispanic, and Asian adolescents were more likely to initiate the HPV vaccine series than their white counterparts, however, were less likely to complete the series (Spencer et al., 2019; Jeudin et al., 2014; Cook et al., 2010; Widdice et al., 2011). Documented barriers to HPV vaccination of minority youth include knowledge, attitudes, and beliefs among parents, geographic location, distance to vaccination centers, immigrant or foreign-born status, acculturation levels, socioeconomic status, insurance status, and high cost of the vaccine (Ojeaga et al., 2019; Kepka et al., 2010; Tsui et al., 2013; Perkins et al. 2013; Perkins et al. 2010; Davlin et al. 2015; Bastani et al., 2011; Schluterman et al., 2011; De and Budhwani, 2017).
Minority youth represent a unique population for public health interventions given the social, economic, and cultural barriers they often face in accessing health services. Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority youth have the potential to reduce disparities in HPV infection and HPV-related cancers. This systematic review assesses the effectiveness of interventions to increase HPV vaccine uptake, measured as vaccine series initiation and series completion, among adolescents and young adults, aged 9–26 years old, identifying as a racial and ethnic minority or sexual and gender minority (SGM) group in high-income countries.
Of the 3013 citations produced by a systematic search of three electronic databases (PubMed, Embase, and Web of Science) in November 2018, nine studies involving 9749 participants were selected for inclusion. All studies were conducted in the United States and were published from 2015 to 2018. Interventions utilized education, vaccine appointment reminders, and negotiated interviewing to increase vaccination. Participants were Black or African American (44.4%), Asian (33.3%), Hispanic or Latinx (22.2%), American Indian or Alaska Native (11.1%), and SGM (22.2%). Studies enrolled parent–child dyads (33.3%), parents alone (11.1%), and youth alone (55.6%). Vaccine series initiation ranged from 11.1% to 84% and series completion ranged from 5.6% to 74.2% post-intervention. Educational and appointment reminder interventions may improve HPV vaccine series initiation and completion in minority youth in the U.S. Given the lack of high quality, adequately powered studies, further research is warranted to identify effective strategies for improving HPV vaccine uptake for minority populations.
Disparities in Human Papillomavirus Vaccine Series Completion by Adolescent Males: A Retrospective Cohort Study
2020, Academic Pediatrics
Human papillomavirus (HPV) vaccine has been recommended for male patients for the prevention of genital warts and precancerous anal lesions since 2009. Our objective was to characterize race and insurance-based disparities in HPV vaccine completion among male patients who initiated the HPV vaccine series.
This was a retrospective cohort study of adolescent male patients in a primary care network who initiated the HPV vaccine series from October 2009 to December 2013. We measured vaccine series completion as the primary outcome. We evaluated associations between outcomes and race and insurance status, controlling for potential confounders and effect modification with multivariable logistic regression. Analyses were stratified by vaccine recommendation era (permissive vs routine).
In total, 42% of males in the cohort (16,691) completed the vaccine series. In the permissive vaccine era (2009–2011), non-black patients (53%) were more likely to complete than black patients (32%) and non-Medicaid patients (49%) were more likely to complete than Medicaid patients (33%). These differences persisted in the routine recommendation era (2012–2013). In both the permissive and routine eras, Medicaid insurance was associated with a larger reduction in the predicted probability of vaccine series completion for non-black patients. Adherence to the recommended vaccination schedule was low, with a median time to completion of 8.9 months. Using the updated completion schedule (2016), we found that completion rates were greater (54.1%) with continued differences based on race (60% vs 45.7% for non-black vs black patients) and insurance (57.4% vs 46.4% completion for non-Medicaid vs Medicaid patients).
We found significant disparities in HPV vaccine series completion rates among male patients based on race and insurance, unchanged based on era of initiation or visit frequency.
Factors influencing Human papillomavirus (HPV) vaccination series completion in Mississippi Medicaid
2020, Vaccine
To identify factors associated with Human Papillomavirus (HPV) vaccine series completion among vaccine initiators in Mississippi Medicaid.
2013–2018 Mississippi Medicaid administrative claims data were analyzed. Female and male beneficiaries aged 9 to 26 years who initiated HPV vaccination in the identification period were assessed for completion of age-appropriate number of recommended doses within a period of 12 months. Sex-stratified multivariable logistic regression was used to examine factors associated with HPV vaccine series completion in the study sample.
A total of 18,110 female and 18,186 male beneficiaries initiated HPV vaccine between January 1, 2014 and June 30, 2017. Most of the initiators belonged to ages 11 to 12 years, African American race, managed care plans and Central Mississippi public health region. The vaccine series completion rate was 34% for females and 30% for males. Younger age at initiation was a significant predictor of vaccine series completion in both sexes. Specifically, initiators in age groups 9 to 10 and 11 to 12 years, respectively, had greater odds of completion, while initiators aged 15 to 26 years had lower odds of completion compared to initiators aged 13 to 14 years. Female and male beneficiaries in managed care plans (vs. fee-for-service) and of African American race (vs. Caucasians) had lower odds of completing the vaccine series. Female and male beneficiaries who initiated HPV vaccine series with a pediatrician had the highest completion rates.
HPV vaccination series completion rate in Mississippi Medicaid was suboptimal despite the high HPV-related cancer incidence in the state. HPV vaccine series completion is influenced by various sociodemographic factors. There is a need for robust education and public health programs to encourage completion of recommended doses.
“We brought our culture here with us”: A qualitative study of perceptions of HPV vaccine and vaccine uptake among East African immigrant mothers
2019, Papillomavirus Research
HPV vaccine studies in East African communities are few and focus mainly on Somali women and girls. We examined how HPV vaccine perceptions and uptake are shaped among Somali, Ethiopian, and Eritrean mothers.
We convened three focus groups in Somali, Amharic, and Tigrinya with mothers of 11–17 year old children. The Socio-Context Framework (social, cultural, and religious factors) and Andersen's Behavioral Model (predisposing, enabling, and need for care factors) informed question development.
Negative vaccine perceptions, lack of HPV vaccine knowledge, and concerns about side effects emerged as predisposing factors. Having a provider who engages parents on HPV vaccination and takes responsibility for vaccine-related risks emerged as enabling factors. Availability of vaccine information resources (e.g., person-to-person, word of mouth education for parents) were also enabling factors. Need for care factors included having comprehensive vaccine information, strong recommendation from a doctor, and validation from a co-ethnic medical professional. Women exerted strong social influence on vaccine uptake (social), had concerns about pork gelatin in vaccines (religious), and felt discussions about sex with children were culturally unacceptable (cultural).
Strategies for vaccine uptake among East African immigrants need to address factors that shape HPV vaccine perceptions for adolescents, caregivers, and providers.

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Journal of Adolescent Health

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

References (10)

Understanding sexual activity defined in the HEDIS measure of screening young women for Chlamydia trachomatis

Jt Comm J Qual Improv

Knowledge and early adoption of the HPV vaccine among girls and young women: Results of a national survey

J Adolesc Health

Uptake of HPV vaccine: Demographics, sexual history and values, parenting style, and vaccine attitudes

J Adolesc Health

Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

MMWR Recomm Rep

FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP)

MMWR Morb Mortal Wkly Rep

Cited by (73)

Longitudinal assessment of nonavalent vaccine HPV types in a sample of sexually active African American women from ten U.S. Cities

Urban-Rural Disparities in Vaccination Service Use Among Low-Income Adolescents

Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority populations: A systematic review

Disparities in Human Papillomavirus Vaccine Series Completion by Adolescent Males: A Retrospective Cohort Study

Factors influencing Human papillomavirus (HPV) vaccination series completion in Mississippi Medicaid

“We brought our culture here with us”: A qualitative study of perceptions of HPV vaccine and vaccine uptake among East African immigrant mothers

Adolescent health briefFactors Associated With Initiation and Completion of Human Papillomavirus Vaccine Series Among Young Women Enrolled in Medicaid

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

Jt Comm J Qual Improv

J Adolesc Health

J Adolesc Health

Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

MMWR Recomm Rep

FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP)

MMWR Morb Mortal Wkly Rep

Adolescent health brief
Factors Associated With Initiation and Completion of Human Papillomavirus Vaccine Series Among Young Women Enrolled in Medicaid