Assessing Influencing Factors of HPV Vaccine Series Uptake in the United States Using the 2020 National Immunization Survey-Teen (NIS-Teen) Open Access
Fudge, Kelsey (Spring 2023)
Abstract
Background/Intro: Human papillomavirus (HPV)-related cancers can be prevented through vaccination. HPV vaccination is recommended for all males and females from 9 to 26 years of age, with catch-up vaccination available to adults 27 to 45 years of age through a shared clinical decision-making recommendation. The vaccine series consists of two or three doses, depending on age of initiation. Little is known about sociodemographic influences on HPV vaccine series completion, incompletion, and non-initiation.
Methods: We conducted a secondary analysis of HPV vaccination data from the 2020 NIS-Teen using SAS (version 9.4, The SAS Institute, Cary, NC) procedures appropriate for complex survey data analysis, weighted according to the NIS-Teen Data User’s Guide specifications, restricted to provider-verified immunization history data. Adolescents were classified into three categories of vaccination status—not initiated, initiated but not complete (partial), and complete. These classifications were compared by key sociodemographic characteristics using weighted proportions, prevalence ratios, and 95% confidence intervals for all estimates. Multivariable Poisson regression using methods for subset analysis of NIS-Teen data was used to estimate adjusted prevalence ratios and associated 95% confidence intervals.
Main Results: Overall, 58.6% of adolescents had completed the HPV vaccine series, with 16.5% partially vaccinated, and 24.9% unvaccinated. Only 45.6% of 13-year-olds completed the HPV vaccine series, in contrast with 17-year-olds (64.5%). Among each race/ethnicity category, the majority had completed the HPV vaccine series, ranging from 55.4% completion among White adolescents to 62.8% completion among Hispanic adolescents. There were relatively small differences in vaccine uptake among males versus females. With regard to poverty status, previously identified patterns in HPV vaccination for 13- to 17-year-olds remained consistent, as there were higher vaccination rates among adolescents living below the poverty line compared to adolescents living at or above the poverty line.
Conclusions/Public Health Recommendations: This study suggests that adolescents of racial and ethnic minorities living below poverty are significantly more likely to be either partially or completely vaccinated against HPV when compared to their less disparate counterparts. Utilizing the findings presented here, targeted interventions and policies can begin to be constructed towards specific groups whose vaccine coverage is lacking.
Table of Contents
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION...............................................................................................1
Current Issue.......................................................................................................................1
Current Breadth of Knowledge...............................................................................................1
Current Knowledge Gap........................................................................................................2
Importance of Addressing Knowledge Gap..............................................................................3
List of Abbreviations.............................................................................................................3
CHAPTER 2: REVIEW OF THE LITERATURE...........................................................................4
Overview..............................................................................................................................4
Nature of the Problem...........................................................................................................5
HPV-Associated Diseases.......................................................................................................5
Agencies Involved in Vaccine Research and Uptake..................................................................6
HPV Epidemiology................................................................................................................7
The HPV Vaccine Over Time...................................................................................................8
Current HPV Vaccine Coverage and Factors of Uptake..............................................................10
Summary/Conclusion............................................................................................................12
CHAPTER 3: RESULTS/MANUSCRIPT.....................................................................................13
Title Page.............................................................................................................................13
Abstract...............................................................................................................................14
Introduction.........................................................................................................................15
Methods...............................................................................................................................16
Results.................................................................................................................................17
Table 1.................................................................................................................................21
Table 2.................................................................................................................................23
Discussion............................................................................................................................25
CHAPTER 4: CONCLUSIONS & PUBLIC HEALTH RECOMMENDATIONS....................................30
REFERENCES.........................................................................................................................31
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