Lavanya Vasudevan1, Jan Ostermann2, Yunfei Wang3, Sayward E Harrison4, Valerie Yelverton5, Jodi-Ann McDonald3, Laura J Fish6, Charnetta Williams7, Emmanuel B Walter8. 1. Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA. Electronic address: lavanya.vasudevan@duke.edu. 2. Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA; South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA. 3. Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA. 4. South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC 29208, USA. 5. Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA. 6. Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Cancer Institute, 2424 Erwin Rd, Suite 602, Durham, NC 27710, USA. 7. Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30329, USA. 8. Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA; Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA.
Abstract
BACKGROUND AND OBJECTIVES: Despite a high burden of human papillomavirus (HPV)-attributable cancers, the southern US lags other regions in HPV vaccination coverage. This study sought to characterize and contextualize predictors of HPV vaccination in the southern US. METHODS: From December 2019 - January 2020, parents of adolescents (ages 9-17 years) living in thirteen southern US states were recruited from a nationally-representative online survey panel and completed a cross-sectional survey. The primary study outcome was initiation of HPV vaccination. RESULTS: Of 1105 parents who responded to the survey, most were ≥35 years of age and of female gender. HPV vaccination initiation was reported only among 37.3% of adolescents and was highest at age 12. Cumulative HPV vaccination coverage was highest at age 15 (60%) but lower than coverage for tetanus-diphtheria-acellular pertussis (Tdap, 79.3%) and Meningococcal vaccines (MenACWY, 67.3%). Provider recommendation was strongly associated with higher odds of HPV vaccination (aOR: 49.9, 95 %CI: 23.1-107.5). In alternative predictive models, home/online (vs. public) schooling and parents' working status were associated with lower odds of vaccination; health care visits in the past 12 months and shorter travel times to adolescents' usual health care provider were associated with greater odds of vaccination. CONCLUSIONS: Our findings suggest missed opportunities for HPV vaccination in the southern US and support strengthening provider recommendation for on-time initiation of HPV vaccination among adolescents. Other strategies to increase HPV vaccinations may include encouraging co-administration with other adolescent vaccines, increasing vaccine access, and promoting vaccinations for home/online-school students.
BACKGROUND AND OBJECTIVES: Despite a high burden of human papillomavirus (HPV)-attributable cancers, the southern US lags other regions in HPV vaccination coverage. This study sought to characterize and contextualize predictors of HPV vaccination in the southern US. METHODS: From December 2019 - January 2020, parents of adolescents (ages 9-17 years) living in thirteen southern US states were recruited from a nationally-representative online survey panel and completed a cross-sectional survey. The primary study outcome was initiation of HPV vaccination. RESULTS: Of 1105 parents who responded to the survey, most were ≥35 years of age and of female gender. HPV vaccination initiation was reported only among 37.3% of adolescents and was highest at age 12. Cumulative HPV vaccination coverage was highest at age 15 (60%) but lower than coverage for tetanus-diphtheria-acellular pertussis (Tdap, 79.3%) and Meningococcal vaccines (MenACWY, 67.3%). Provider recommendation was strongly associated with higher odds of HPV vaccination (aOR: 49.9, 95 %CI: 23.1-107.5). In alternative predictive models, home/online (vs. public) schooling and parents' working status were associated with lower odds of vaccination; health care visits in the past 12 months and shorter travel times to adolescents' usual health care provider were associated with greater odds of vaccination. CONCLUSIONS: Our findings suggest missed opportunities for HPV vaccination in the southern US and support strengthening provider recommendation for on-time initiation of HPV vaccination among adolescents. Other strategies to increase HPV vaccinations may include encouraging co-administration with other adolescent vaccines, increasing vaccine access, and promoting vaccinations for home/online-school students.
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