Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics

Jasmin A. Tiro, Sandi L. Pruitt, Corinne M. Bruce, Donna Persaud, May Lau, Sally W. Vernon, Jay Morrow, Celette Sugg Skinner

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Adolescent HPV vaccination in minority and low income populations with high cervical cancer incidence and mortality could reduce disparities. Safety-net primary care clinics are a key delivery site for improving vaccination rates in these populations. Purpose: To examine prevalence of HPV initiation (≥1 dose), completion (receipt of dose 3 within 12 months of initiation), and receipt of 3 doses in four safety-net clinics as well as individual-, household-, and clinic-level correlates of initiation. Methods: We used multilevel modeling to investigate HPV initiation among 700 adolescent females who sought primary care in four safety-net clinics in Dallas, Texas from March 2007 to December 2009. Data were abstracted from patients' paper and electronic medical records. Results: HPV vaccine uptake varied significantly by clinic. Across clinics, initiation was 36.6% and completion was 39.7% among those who initiated. In the total study population, only 15.7% received all three doses. In multivariate, two-level logistic regression analyses, initiation was associated with receipt of other adolescent vaccines, influenza vaccination in the year prior to data abstraction, being sexually active, and having more chart documentation (presence of health maintenance questionnaire and/or immunization record). There was no association between initiation and age, race/ethnicity, or insurance status. Conclusions: In four urban safety-net clinics, HPV initiation rates paralleled 2008 national rates. The correlation of HPV initiation with other adolescent vaccines underscores the importance of reviewing vaccination status at every health care visit. HPV vaccine uptake in safety-net clinics should continue to be monitored to understand impact on cervical cancer disparities.

Original languageEnglish (US)
Pages (from-to)2368-2375
Number of pages8
JournalVaccine
Volume30
Issue number13
DOIs
StatePublished - Mar 16 2012

Fingerprint

Safety-net Providers
Papillomaviridae
Vaccination
vaccination
vaccines
Papillomavirus Vaccines
uterine cervical neoplasms
dosage
Uterine Cervical Neoplasms
Primary Health Care
uptake mechanisms
Insurance Coverage
Influenza Vaccines
Electronic Health Records
insurance
Poverty
nationalities and ethnic groups
influenza
Documentation
health services

Keywords

  • Adolescent
  • Female
  • Healthcare disparities
  • Immunization programs
  • Papillomavirus vaccines
  • Vaccination

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • veterinary(all)
  • Molecular Medicine

Cite this

Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics. / Tiro, Jasmin A.; Pruitt, Sandi L.; Bruce, Corinne M.; Persaud, Donna; Lau, May; Vernon, Sally W.; Morrow, Jay; Skinner, Celette Sugg.

In: Vaccine, Vol. 30, No. 13, 16.03.2012, p. 2368-2375.

Research output: Contribution to journalArticle

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abstract = "Background: Adolescent HPV vaccination in minority and low income populations with high cervical cancer incidence and mortality could reduce disparities. Safety-net primary care clinics are a key delivery site for improving vaccination rates in these populations. Purpose: To examine prevalence of HPV initiation (≥1 dose), completion (receipt of dose 3 within 12 months of initiation), and receipt of 3 doses in four safety-net clinics as well as individual-, household-, and clinic-level correlates of initiation. Methods: We used multilevel modeling to investigate HPV initiation among 700 adolescent females who sought primary care in four safety-net clinics in Dallas, Texas from March 2007 to December 2009. Data were abstracted from patients' paper and electronic medical records. Results: HPV vaccine uptake varied significantly by clinic. Across clinics, initiation was 36.6{\%} and completion was 39.7{\%} among those who initiated. In the total study population, only 15.7{\%} received all three doses. In multivariate, two-level logistic regression analyses, initiation was associated with receipt of other adolescent vaccines, influenza vaccination in the year prior to data abstraction, being sexually active, and having more chart documentation (presence of health maintenance questionnaire and/or immunization record). There was no association between initiation and age, race/ethnicity, or insurance status. Conclusions: In four urban safety-net clinics, HPV initiation rates paralleled 2008 national rates. The correlation of HPV initiation with other adolescent vaccines underscores the importance of reviewing vaccination status at every health care visit. HPV vaccine uptake in safety-net clinics should continue to be monitored to understand impact on cervical cancer disparities.",
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