Adolescent U.S. women of all racial and ethnic groups who have received a recommendation from a health care provider to get vaccinated against the human papillomavirus (HPV) are more likely than others to initiate the vaccine, according to an analysis of 2009 data from a nationally representative sample.[1] Fifty-seven percent of the young women had had a provider recommend that they be vaccinated against HPV, and 44% had received at least one dose of the three-part vaccination series. Adolescents who had had a provider recommend the HPV vaccine to them were more likely than others to have received at least one dose (odds ratio, 4.8); the association was positive and strong among all racial and ethnic groups studied (3.6–7.5).

To assess racial and ethnic differences in provider recommendation for HPV vaccination and in the association between receiving a recommendation and receiving at least one dose of the vaccine, researchers conducted bivariate and multivariate analyses on data from the 2009 National Immunization Survey–Teen. They limited the analytic sample to the 9,274 females aged 13–17 with provider-verified vaccination records and complete information on age; race and ethnicity; mother's age, education and marital status; type of insurance; and receipt of HPV vaccine recommendation.

Among the sample of adolescent females, 60% were white, 18% were Hispanic, 15% were black and 7% were members of other racial and ethnic groups; the mean age of young women was 15 years. Sixty-five percent had health insurance coverage through an employer or union plan, 22% were covered by Medicaid or the State Children's Health Insurance Program (SCHIP), 6% had other insurance and 6% were uninsured. About one-third were eligible for the federally funded Vaccines for Children (VFC) program, which provides no-cost vaccinations to those who cannot afford them otherwise. Overall, 57% of young women had had a provider recommend that they get vaccinated against HPV, and 44% had received at least one dose of the vaccine.

Receipt of a vaccination recommendation from a provider differed by race and ethnicity in bivariate analyses: Sixty-one percent of whites had received a recommendation, compared with 50% of blacks, 51% of Hispanics and 55% of other adolescents. Vaccine initiation, however, did not differ by race and ethnicity. Greater proportions of nonwhites than of whites were covered by Medicaid or SCHIP and were eligible for VFC.

In multivariate analyses, blacks were less likely than whites to have received a recommendation for HPV vaccination (odds ratio, 0.7); compared with young women who had health insurance through an employer or union plan, those who were uninsured had lower odds of having received a vaccine recommendation (0.4). Race and ethnicity was not associated with having received at least one dose of the HPV vaccine. However, young women who had had a provider recommend the HPV vaccine were more likely than others to have received at least one dose (4.8); vaccine initiation was also positively associated with being covered by Medicaid or SCHIP (1.5). The association between HPV vaccine recommendation and initiation was positive and strong for each racial and ethnic group (3.6 for Hispanics, 5.3 for whites, 7.0 for blacks and 7.5 for others).

The researchers mention several limitations of their study, including that their results may have been affected by recall bias and that their data were cross-sectional. In addition, they note, because their vaccination history measure was dichotomized into at least one dose or none, their results address only vaccine initiation, not completion. They conclude that "future longitudinal studies, including possible oversamples of racial/ethnic minority respondents, are needed to assess the predictors of series completion."—J. Rosenberg

Reference

1. Ylitalo KR, Lee H and Mehta NK, Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey, American Journal of Public Health, 2013, 103(1):164–169.