Caregiver and adolescent factors associated with delayed completion of the three-dose human papillomavirus vaccination series. Issue 11 (7th March 2018)

• Record Type: Journal Article
• Authors: Widdice, Lea E.; Hoagland, Rebecca; Callahan, S. Todd; Kahn, Jessica A.; Harrison, Christopher J.; Pahud, Barbara A.; Frey, Sharon E.; Berry, Andrea A.; Kotloff, Karen L.; Edwards, Kathryn M.; Mulligan, Mark J.; Sudman, Jon; Nakamura, Aya; Bernstein, David I.
• Is Part Of: Vaccine. Volume 36:Issue 11(2018)
• Page Start: 1491
• Page End: 1499
• Publication Date: 2018-03-07
• Subjects: Human papillomavirus -- Vaccine -- Completion -- Adherence; CI confidence interval -- HPV human papillomavirus -- 4vHPV quadrivalent human papillomavirus vaccine -- OR odds ratio -- REALM Rapid Estimate of Adult Literacy in Medicine -- U.S. United States -- VTEU vaccine and treatment evaluation unit -- WIC The Special Supplemental Nutrition Program for Women, Infants, and Children; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2017.12.060
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Delays in completion of the human papillomavirus vaccine (4vHPV) are commonplace. Predictors of delayed completion included caregiver race, level of education, and vaccine access. Attitudes and beliefs about HPV vaccination were not associated with delayed completion. Abstract: Background: Delayed completion of human papillomavirus vaccination (4vHPV) series is common. We sought to identify factors associated with delay. Methods: This substudy was part of a large prospective, multi-site study recruiting 9–17 year old girls at the time of their third 4vHPV dose to assess immunogenicity associated with prolonged dosing intervals. At participating sites, parents/legal guardians (caregivers) of all enrolled girls (9–17 years old) and enrolled girls aged 14–17 years were approached for participation. Caregivers completed a questionnaire measuring adolescent and caregiver sociodemographic characteristics, caregiver attitudes and beliefs about on-schedule HPV vaccination and HPV vaccine safety, adolescent's health behaviors, barriers to accessing health care, provider office vaccination practices and a Rapid Estimate of Adult Literacy in Medicine (REALM). Participating girls completed a separate questionnaire measuring their attitudes and beliefs about on-schedule HPV vaccination and HPV vaccine safety. Delay was defined as receiving the third 4vHPV dose >12 months after the first. Bivariate, multinomial logistic regression and multivariate logistic regression analyses were used to identify factors predicting delayed completion. Results: Questionnaires were completed by 482 caregivers and 386 adolescents; 422 caregivers completed a REALM. Delayed 4vHPV dosing occurred in most adolescents (67%). In multivariate analyses, predictors of delayed completion included caregiver demographic factors (self-reported black vs. white race and high school or less education vs. college or more) and an interaction between caregiver's inability to get an immunization appointment as soon as needed and adolescent's type of insurance. Conclusions: Caregiver's race and educational level, accessibility of immunization appointments, and adolescent's insurance type were found to be related to delays in completion of 4vHPV, but caregiver or adolescent attitudes and beliefs about on-schedule HPV vaccination or HPV vaccine safety were not. Therefore, interventions to improve adherence to recommended vaccination schedules could benefit from a focus on improving access to immunizations. ClinicalTrials.gov (NCT01030562).