Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings

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Conference Proceeding

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Cancer Epidemiol Biomarkers Prev


Introduction: Hospitals and private healthcare facilities are the primary setting for administering the human papillomavirus (HPV) vaccine. A goal of the President's Cancer Panel on HPV vaccination is to maximize access to vaccination services through expansion of alternative settings for receiving the HPV vaccine, such as in public health settings, schools and pharmacies. It is unclear whether utilization of these alternative settings for HPV vaccination is increasing, and which factors are associated with accessing these alternative avenues.

Methods: In a cross-sectional analysis, we utilized the National Immunization Survey-Teen data from 2014 to 2020 (n = 59,140) to describe trends and factors associated with HPV vaccine uptake in private, public, and alternative settings. We calculated average annual percent change (AAPC) between 2014 and 2020, estimating the proportion of HPV vaccine across settings. Using multinomial logistic regression, we estimated the odds of receipt of HPV vaccine in public health settings and other alternative settings compared to private healthcare settings, adjusting for sociodemographic covariates.

Results: We found a nonsignificant decrease in proportion of individuals receiving vaccines at public health settings (17.7% in 2014 vs. 13.5% in 2020; AAPC = -3.2), and a non-significant increase in private healthcare settings (79.2% in 2014 vs. 83.9% in 2020; AAPC = 0.6). We also found a non-significant decrease in the proportion of individuals receiving vaccines in alternative settings such as schools and pharmacies (3.1% in 2014 and 2.6% in 2020; AAPC = -0.9). Adjusted multinomial logistic regression analyses found several sociodemographic/socioeconomic factors associated with receiving HPV vaccine at public health facilities versus private/hospital settings. The log odds of receiving vaccinations at a public facility vs. a private facility increases almost four times moving from above poverty (earning≥ $75,000) to below poverty (aOR = 3.74; 95% CI 3.06, 4.57). The log odds of receiving HPV vaccines at a public facility compared to a private facility decreased by 26% for White teenagers vs. Black teenagers (aOR = 0.74; 95% CI 0.64, 0.86), and by 24% (aOR = 0.76; 95% CI 0.58, 0.98) for log odds of receiving vaccine at alternative settings for White teenagers vs. Black teenagers. There was also an association between educational level and log odds of receiving vaccines at a public facility (high school or less vs. college graduate aOR = 0.38; 95% CI 0.31, 0.46), and people without physician recommendations were significantly more likely to receive vaccines at public versus private settings (aOR = 1.71, 95% CI 1.41, 2.08).

Conclusions: Sociodemographic and socioeconomic factors such as race, poverty, education, and access to physician HPV recommendations are all associated with receiving the HPV vaccine at public health facilities versus private settings. This information is important in targeting increased vaccine uptake among individuals with less access to care due to these factors.





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