Elsevier

Vaccine

Volume 31, Issue 28, 19 June 2013, Pages 2937-2946
Vaccine

Factors associated with human papillomavirus vaccination among young adult women in the United States

https://doi.org/10.1016/j.vaccine.2013.04.041Get rights and content

Highlights

  • We assessed characteristics associated with HPV vaccination of young women.

  • Overall, 23.2% of women age 18–26 reported receiving at least 1 dose of HPV vaccine.

  • A regular provider and receiving other vaccines were associated with HPV vaccination.

Abstract

Background

Human papillomavirus (HPV) vaccination is recommended to protect against HPV-related diseases.

Objective

To estimate HPV vaccine coverage and assess factors associated with vaccine awareness, initiation and receipt of 3 doses among women age 18–30 years.

Methods

Data from the 2010 National Health Interview Survey were analyzed to assess associations of HPV vaccination among women age 18–26 (n = 1866) and 27–30 years (n = 1028) with previous HPV exposure, cervical cancer screening and selected demographic, health care and behavioral characteristics using bivariate analysis and multivariable logistic regression.

Results

Overall, 23.2% of women age 18–26 and 6.7% of women age 27–30 years reported receiving at least 1 dose of HPV vaccine. In multivariable analyses among women age 18–26 years, not being married, having a regular physician, seeing a physician or obstetrician/gynecologist in the past year, influenza vaccination in the past year, and receipt of other recommended vaccines were associated with HPV vaccination. One-third of unvaccinated women age 18–26 years (n = 490) were interested in receiving HPV vaccine. Among women who were not interested in receiving HPV vaccine (n = 920), the main reasons reported included: not needing the vaccine (41.3%); concerns about safety of the vaccine (12.5%); not knowing enough about the vaccine (11.9%); not being sexually active (8.2%); a doctor not recommending the vaccine (7.6%); and already having HPV (2.7%). Among women with health insurance, 10 or more physician contacts within the past year and no contraindications, 74.5% reported not receiving HPV vaccine.

Conclusions

HPV vaccination coverage among women age 18–26 years remains low. Opportunities to vaccinate are missed. Healthcare providers can play an important role in educating young women about HPV and encouraging vaccination. Successful public health and educational interventions will need to address physician attitudes and practice patterns and other factors that influence vaccination behaviors.

Introduction

Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and can cause cervical cancer, genital warts and other anogenital cancers. Quadrivalent and bivalent HPV vaccines were licensed for use in the United States in 2006 and 2009, respectively, and recommended for prevention of vaccine HPV-type-related cervical cancers and cancer precursors [1], [2]. Routine HPV vaccination of females age 11 or 12 years is recommended [2] and vaccination of females age 13–26 years who have not been previously vaccinated [1], [2]. Routine cervical cancer screening is generally recommended at age 21 to age 65 years for adult women, regardless of HPV vaccination status, although guidelines may differ from one another with regards to when to start, stop, how often to screen, and use of the conventional Pap test or liquid-based cytology [1], [3], [4], [5], [6].

Since HPV vaccine was recommended for use in females, estimates of vaccine coverage among young women have been published [7], [8], [9], [10], [11], [12]. In previous reports factors associated with HPV vaccination in adult women (≥18) have included white race, higher education and income, having insurance, discussions with a healthcare provider about HPV vaccine, history of sexual activity, and receipt of other vaccines [7], [8], [9], [10], [11]. Concern about vaccine safety, doctors not recommending vaccination and cost have been barriers to HPV vaccination [8], [12].

This study at four years following first licensure of HPV vaccine uses national data to update information among age-eligible adult women on associations of initiation and receipt of the complete three dose series.

Section snippets

Methods

We analyzed data from the 2010 National Health Interview Survey (NHIS) which collected data throughout the year using a design oversampling for Hispanics, blacks, and Asians to produce nationally representative samples. The 2010 NHIS sample adult core included questions about HPV infection, Pap testing, and HPV vaccination. The NHIS protocol was approved by the National Center for Health Statistics Research Ethics Review Board (ERB # 2009-16). Additional details about the 2010 NHIS are located

Ever told had HPV, cervical cancer screening and awareness of HPV vaccine

Overall, women age 27–30 years were more likely to have been told they had HPV (12.3%) than were women age 18–26 years (8.5%) (p < 0.05). These women were more likely to have ever heard of HPV vaccine (91.4%) and to have received at least one dose of HPV vaccine (30.2%) than women who had not been told they had HPV (84.7% and 19.9%, respectively) (p < 0.05). Women age 18–26 and 27–30 years had similar likelihood of awareness of HPV vaccine (Table 1).

Among respondents age 18–20 years, 21–26 years,

Discussion

The findings of this study indicate that 4 years following the recommendation for routine vaccination at age 11 or 12 years and through age 26 for those not previously vaccinated, HPV vaccination remains low with initiation highest among women age 18–20 years. The finding of higher initiation levels at younger ages has been reported [8], [9], [11], [14] and might reflect the knowledge, attitude and practices of the healthcare providers of young adult women [9], the social norms of young women

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