A Comparison of HPV Vaccination Coverage Estimates Among U.S. Adolescents and Adults using Birth Cohorts for Long-Term Evaluation Restricted; Files Only

Lewis, Rachael (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/q237ht38m?locale=en


To our knowledge, this is the first analysis which utilizes a birth cohort approach to directly compare projections of HPV vaccination coverage from adolescent vaccination assessments to actual coverage estimates from adult vaccination assessments. Our analysis identifies discrepancies between adolescent and adult HPV vaccination estimates using two national immunization surveillance systems, NIS-Teen and NHIS. To achieve our research aims, we constructed each birth cohort using data from the NHIS (2013-2018) and the NIS-Teen (2008-2017) datasets. Coverage projections were generated using a survey-weighted Poisson regression analysis of adolescent data from NIS-Teen. Survey-weighted point estimates of adult vaccination coverage were calculated from NHIS data. Birth cohorts were selected if they had HPV vaccination data for all adolescent years (13-17) and at least one year of adult data (19+). HPV vaccination coverage was measured through either parental-report or self-report of having received at least one dose of the HPV vaccine.   


Our analysis found that the projected HPV vaccination coverage estimates for young adults are higher than the actual coverage estimates, thereby indicating a plateau in the rate of vaccine uptake after mid-adolescence (13-17 years). Our findings also draw attention to potential reporting issues between NIS-Teen and NHIS, as the estimated vaccination coverage in young adults is lower than the estimated coverage of the same birth cohort in adolescence. Our project highlights the need for further investigation into the impact of the HPV vaccine uptake plateau seen in young adult populations in the United States.  


Table of Contents

Chapter 1: Introduction  1

Chapter 2: Literature Review 6

References  18

Chapter 3: Manuscript  22

Abstract  23

Introduction   24

Methods  25

Results   31

Discussion  33

References  40

Tables and Figures  43

Chapter 4: Public Health Implications  47

Appendix  49

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