Racial/Ethnic Differences in Adolescent Male HPV Vaccine Initiation and Provider Recommendation Público
Landis, Kathryn Elizabeth (2016)
Published
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
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