Racial/Ethnic Differences in Adolescent Male HPV Vaccine Initiation and Provider Recommendation Open Access

Abstract

Over the past decade, vaccination has emerged as a safe, effective way to prevent Human Papillomavirus (HPV) infection and subsequent HPV-related cancers; however, HPV vaccine uptake remains low in the US. Provider recommendations are strongly tied to vaccine uptake, and consistent provision of recommendations is an essential tool for decreasing disparities. After the 2011 Advisory Committee on Immunization Practices (ACIP) recommendation for routine vaccination of males to prevent HPV infection, little is known about specific predictors for initiation. The purpose of this study is to examine racial and ethnic differences for HPV vaccine initiation and provider recommendation in male adolescents. Based on prior National Immunization Survey-Teen (NIS-Teen) publications for males and females, it was hypothesized that minority adolescents would be more likely to initiate HPV vaccines, but less likely to receive a provider recommendation compared to whites. The present study used the 2014 NIS-Teen, which included 10,753 male adolescents with provider verified vaccination data in 50 US states. Multivariate logistic regression models evaluated racial/ethnic differences in initiation, provider recommendation, and if recommendation moderates the relationship between race/ethnicity and initiation. Hispanic adolescents had 76 percent higher odds and non-Hispanic other/multiple race adolescents had 43 percent higher odds of initiation compared to their white counterparts. Rates of provider recommendation were consistent across all racial/ethnic groups, with approximately one-half of parents reporting they received a provider recommendation. There was no significant difference in the odds of receiving a provider recommendation across racial/ethnic groups. These findings suggest that provider recommendations for all males can be improved, and future research should focus on developing culturally appropriate interventions to increase HPV vaccine uptake among all racial/ethnic groups. Future research should also examine HPV vaccine completion patterns in male adolescents.

Table of Contents

INTRODUCTION 1

LITERATURE REVIEW 3

HUMAN PAPILLOMAVIRUS BACKGROUND 3

HPV VACCINE HISTORY 3

POLITICS OF THE HPV VACCINE 5

RACIAL AND ETHNIC DIFFERENCES IN VACCINE UPTAKE 6

THE ROLE OF PROVIDER RECOMMENDATION 8

RACIAL AND ETHNIC DIFFERENCES IN PROVIDER RECOMMENDATION 9

THE IMPORTANCE OF VACCINATING MALES 11

SUMMARY 13

METHODOLOGY 14

THEORETICAL FRAMEWORK 14

FIGURE 1. CONCEPTUAL FRAMEWORK: HPV VACCINE INITIATION PROCESS FOR MALE RACIAL/ETHNIC MINORITY ADOLESCENTS 15

FOCAL RELATIONSHIP 16

CONFOUNDERS 17

RESEARCH QUESTIONS AND HYPOTHESES 24

DATA SOURCE 25

ANALYTIC SAMPLE 27

FIGURE 5. ANALYTIC SAMPLE FLOWCHART FOR NIS-TEEN 2014 27

TABLE 1. KEY CONSTRUCTS AND MEASUREMENT PLANS, NIS-TEEN 2014 28

STATISTICAL METHODS 31

ANALYSES 31 TABLE 2. LOGISTIC REGRESSION MODELS 32

RESULTS 33 DESCRIPTIVE STATISTICS 33

TABLE 3. WEIGHTED ADOLESCENT MALE AND PARENT CHARACTERISTICS BY HPV VACCINE INITIATION STATUS, NIS TEEN 2014 34

MAIN ANALYSIS 36

TABLE 4. WEIGHTED LOGISTIC REGRESSIONS FOR RACIAL/ETHNIC DIFFERENCES IN ADOLESCENT MALE HPV VACCINE INITIATION AND PROVIDER RECOMMENDATION, NIS TEEN 2014 39

INTERACTION EFFECTS 41

FIGURE 6. INTERACTION BETWEEN RACE/ETHNICITY AND PROVIDER RECOMMENDATION ON MALE HPV VACCINE INITIATION, NIS-TEEN 2014 42

FIGURE 7. INTERACTION BETWEEN RACE/ETHNICITY AND PROVIDER RECOMMENDATION ON MALE HPV VACCINE INITIATION, NIS-TEEN 2014 42

DISCUSSION 43

SUMMARY 43

PREDICTORS OF INITIATION 43

PROVIDER RECOMMENDATION IS A STRONG PREDICTOR OF INITIATION 45

POLICY IMPLICATIONS FOR IMPROVING HPV VACCINE UPTAKE 47

STRENGTHS AND LIMITATIONS 48

RECOMMENDATIONS FOR FUTURE RESEARCH 49

CONCLUSION 52

REFERENCES 53

APPENDIX A. RACE AND ETHNICITY SENSITIVITY ANALYSIS 61

TABLE 5. LOGISTIC REGRESSION MODELS (SENSITIVITY ANALYSIS) 62

TABLE 6. ADOLESCENT MALE RACE AND ETHNICITY FREQUENCIES, NIS-TEEN 2014 62

TABLE 7. WEIGHTED ADOLESCENT MALE RACE AND ETHNICITY FREQUENCIES, NIS TEEN 2014 63

TABLE 8. WEIGHTED LOGISTIC REGRESSIONS FOR RACIAL AND ETHNIC SENSITIVITY ANALYSIS IN ADOLESCENT MALE HPV VACCINE INITIATION AND PROVIDER RECOMMENDATION, NIS TEEN 2014 64

APPENDIX B. SUPPLEMENTAL TABLES 66

TABLE 9. WEIGHTED ADOLESCENT MALE AND PARENT CHARACTERISTICS BY HPV VACCINE INITIATION STATUS, NIS TEEN 2014 66

TABLE 10. WEIGHTED ADOLESCENT MALE AND PARENT CHARACTERISTICS BY RACE/ETHNICITY, NIS TEEN 2014 68

TABLE 11. INTERACTION COMPARISONS BETWEEN RACE/ETHNICITY AND PROVIDER RECOMMENDATION ON HPV VACCINE INITIATION STATUS, NIS TEEN 2014 70

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HPV vaccines vaccination adolescent provider recommendation
Committee Chair / Thesis Advisor	Gaydos, Laurie, Emory University
Committee Members	Bednarczyk, Robert A, Emory University Von Esenwein, Silke, Emory University Joski, Peter J, Emory University

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