Predictors of HPV vaccine uptake among women aged 19–26: Importance of a physician's recommendation
Introduction
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States [1]. Low-risk viral types (e.g., HPV types 6 and 11) can cause genital warts and respiratory papillomatosis [2]. High-risk types (e.g., HPV types 16 and 18) can cause precancerous lesions and genital cancers, and have been found in 99% of cervical cancers [3].
The incidence of HPV infection in the United States is estimated at 6.2 million cases per year among females and males, with 74% of new infections occurring in those aged 15–24 [4]. As of 2004, the prevalence of HPV infection was 26.8% among US women aged 14–59, with the highest prevalence (44.8%) in those aged 20–24 [2].
Two vaccines have been developed for the prevention of HPV infection—one that targets HPV types 16 and 18 [5], and another that targets HPV types 6, 11, 16, and 18 [6], [7]. The bivalent vaccine was approved by the FDA in October 2009 for the prevention of cervical cancer and certain precancerous lesions caused by HPV infection [8]. The quadrivalent vaccine was approved by the FDA in 2006 for the prevention of cervical cancer, certain precancerous lesions, and genital warts in females and, in 2009, for the prevention of genital warts in males [9], [10]. The CDC/s Advisory Committee on Immunization Practices (ACIP) has recommended quadrivalent vaccination of 11–12-year-old females and catch-up of 13–26 and now expanded that to provisionally recommend vaccination of females with the bivalent vaccine and vaccination of males with quadrivalent HPV vaccine [11].
There was a considerable amount of literature on parents’ and women's attitudes toward HPV vaccination prior to the availability of the vaccines [12], [13], [14], [15]; recent efforts have focused on factors associated with vaccine uptake [16], [17], [18], [19], [20], [21], [22]. Although the ACIP recommendation prioritizes pre-adolescents, there is demonstrated benefit to immunizing young adults, even if they are already sexually active [23]. There is a need to better understand the patient factors that are predictive of vaccination among young adult women, who have a low rate of HPV vaccination (10–12%) [19], [20]. Thus, we sought to assess the demographic and attitudinal characteristics that are predictive of HPV vaccination among insured 19–26-year-old women in the United States.
Section snippets
Study sample
Women with and without HPV vaccination were identified using medical and pharmacy claims from a large US managed care plan affiliated with i3 Innovus. The health plan provides fully insured coverage of physician, hospital, and prescription drug services to more than 15 million patients across the United States. Women were identified in the health plan database if they: (1) received a new claim for the HPV vaccine or any outpatient medical claim on an index date occurring during an
Patient sample
Of the 2750 surveys sent out (1375 to each group), vaccinees returned 345 and non-vaccinees returned 222, for statistically different response rates of 25.1% and 16.2%, respectively (chi-square test, p < 0.01). Thirty-seven patients originally classified as non-vaccinees from the health plan database were subsequently removed from the analysis because they reported in the survey that they had been vaccinated against HPV, leaving 185 surveys eligible for analysis. Respondents and non-respondents
Discussion
Although CDC has recommended catch-up HPV vaccination for women from 19–26 years of age, this is an age group about which there are many concerns about reaching high rates of uptake. Within this cohort of 19–26-year-old women for whom insurance was not a barrier and who were surveyed in April–May 2008, those who had discussed the HPV vaccine with their physician and received a recommendation were overwhelmingly more likely to have been vaccinated. In addition, the strength of the physician's
Acknowledgment
We thank Melissa Stauffer, PhD, in collaboration with SCRIBCO, for providing medical writing assistance.
References (49)
Impact of vaccination with Cervarix (trade mark) on subsequent HPV-16/18 infection and cervical disease in women 15–25 years of age
Gynecol Oncol
(2008)- et al.
Predictors of HPV vaccine acceptability: a theory-informed, systematic review
Prev Med
(2007) - et al.
Literature review of human papillomavirus vaccine acceptability among women over 26 years
Vaccine
(2009) - et al.
Stage of adoption of the human papillomavirus vaccine among college women
Prev Med
(2009) - et al.
Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007
Prev Med
(2009) - et al.
Parents’ health beliefs and HPV vaccination of their adolescent daughters
Soc Sci Med
(2009) - et al.
Uptake of HPV vaccine: demographics, sexual history and values, parenting style, and vaccine attitudes
J Adolesc Health
(2008) - et al.
Prophylactic HPV vaccination for women over 18 years of age
Vaccine
(2009) - et al.
Parental perspectives on vaccinating children against sexually transmitted infections
Soc Sci Med
(2004) - et al.
Women's knowledge, attitudes, and intentions concerning human papillomavirus vaccination: findings of a waiting room survey of obstetrics-gynaecology outpatients
J Obstet Gynaecol Can
(2008)
Knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines among women living in metropolitan and rural regions of China
Vaccine
Awareness, knowledge, and beliefs about human papillomavirus in a racially diverse sample of young adults
J Adolesc Health
Young adults and acceptance of the human papillomavirus vaccine
Public Health
Predictors of interest in HPV vaccination: a study of British adolescents
Vaccine
Parental attitudes to pre-pubertal HPV vaccination
Vaccine
Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000
Perspect Sex Reprod Health
Prevalence of HPV infection among females in the United States
JAMA
Relationships of human papillomavirus type, qualitative viral load, and age with cytologic abnormality
Cancer Res
Human papillomavirus and vaccination
Mayo Clin Proc
Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases
N Engl J Med
Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions
N Engl J Med
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