Disparities in HPV vaccine uptake and provider recommendation by provider facility type

Document Type

Conference Proceeding

Publication Date


Publication Title

Cancer Epidemiol Biomarkers Prev


Background: Approximately 46,000 cases of human papillomavirus (HPV) attributable cancers are diagnosed annually in the United States. The HPV vaccine can prevent over 90% of HPV-attributable cancers, yet national uptake remains lower than the Healthy People 2030 target goal of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings. We examined the association between provider facility type and provider recommendation and HPV vaccine uptake among adolescents in the US.

Methods: We conducted secondary data analysis of the 2020 National Immunization Survey-Teen data (n=20,162), which provides current, population-based estimates of vaccination coverage among adolescents. Provider facility type was classified as public facilities (i.e., public health department-operated clinic, community health center, rural health clinic, tribal/Indian health facility), hospital-based facilities, private facilities, and mixed facilities (i.e., vaccination provided in more than one of the above-mentioned locations). Self-reported provider recommendation was dichotomized as yes/no. HPV vaccine initiation was defined as the receipt of ≥1 dose of the HPV vaccine, and completion was defined as the receipt of ≥2 doses (if the adolescent received first dose before age 15) or ≥3 doses (if the adolescent was at least 15 years old). Weighted, multivariable logistic regression models estimated the odds of receiving provider recommendation and initiating and completing the HPV vaccine by provider facility type, adjusting for adolescents age, gender, race, poverty level, number of doctor visits per year, and mother's age, marital status, and education.

Results: Approximately 81% of adolescents received a provider recommendation for the HPV vaccine and 47.5% received their vaccination at providers based in private facilities. The prevalence of HPV vaccine initiation was 75.1% and completion was 58.6%. In the adjusted analyses, adolescents who received their vaccination from public facilities (aOR=0.63; 95% CI: 0.51-0.78) were less likely to receive provider recommendation for the vaccine compared to those who received their vaccination at private facilities. Similarly, adolescents who received their vaccination from public facilities were less likely to initiate (aOR=0.73; 95% CI: 0.59-0.90) and complete (aOR=0.62; 95% CI: 0.52-0.77) the HPV vaccination compared to those who received their vaccination at private facilities. There was no difference between hospital and mixed vs. private facilities for both provider recommendation and vaccination.

Conclusions: Both the recommendation for and uptake of the vaccine regimen were less common in public facilities than private facilities. Given the populations served in public facilities and the health disparities that exist in these populations, a greater focus is needed on recommendation for vaccination and follow through.





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