HPV vaccine rates, race, and income

Findings of a recent study looking at the influence of community-level geographic features on human papilloma virus (HPV) vaccination rates among teen girls may be helpful for developing strategies to increase vaccine uptake.

Published online January 14, 2016, in Cancer Epidemiology, Biomarkers, and Prevention, the research examined associations between geographic factors and HPV vaccine initiation rates in a nationally representative sample of females aged 13 to 17 years using data from the CDC National Immunization Survey-Teen. Results of logistic regression analyses controlling for individual factors showed vaccine initiation rates were highest in the poorest communities (61% in high-poverty communities vs 52.4% in low-poverty communities) and among Hispanics living in communities where the racial and ethnic composition was predominantly Hispanic (69.0%) or mixed race (60.4%) compared with majority non-Hispanic white communities (49.9%).  Regardless of the girls’ own race/ethnicity, however, those living in predominantly non-Hispanic white and non-Hispanic black communities had the lowest initiation rates.

“The HPV vaccine is an effective cancer prevention vaccine that is severely underutilized in the United States. Our study identifies groups with the lowest uptake that may be targeted for vaccine promotion,” said Kevin Henry, PhD, lead author and Assistant Professor of Geography at Temple University in Philadelphia, Pennsylvania, and member of Fox Chase Cancer Center’s Cancer Prevention and Control program.  “While we need to explore strategies to improve public health messaging for sociodemographic groups that are least likely to be vaccinated, perhaps we can draw from some of the successful community outreach programs that are in place in predominantly Hispanic communities.”

Although a number of previous studies examined individual factors associated with HPV vaccination uptake, Dr Henry noted that this investigation is the first to consider a role for neighborhood or community factors, such as the racial/ethnic composition and poverty levels.

“We know where one lives matters for many health events, outcomes, and services, and from this study, we know that geography matters for HPV vaccine initiation independent of individual-level variables or factors."

Dr. Henry and coauthors note that the finding of higher HPV vaccination initiation among girls living in the poorest communities may seem contrary to prevailing beliefs equating socioeconomic disadvantage with barriers to care and underutilization of health services. The explanation may relate in part to the availability of “safety-net” immunization services, such as the State Children’s Health Insurance Program (SCHIP) or Medicaid, along with the federally funded Vaccine for Children program for individuals living at the poverty level.

“In our study, rates of HPV vaccination were highest among girls with SCHIP or Medicaid health insurance compared with girls who had private insurance,” noted Dr Henry.

Other possible contributors include healthcare practice and community-based interventions and related strategies supporting HPV vaccination that have focused on poor communities where rates of cervical cancer are highest. Furthermore, there may be positive or protective factors related to living in communities that have a high concentration of ethnic minorities sharing the same health-related values that provide critical social and instrumental support to promote HPV vaccination, said Dr Henry.

The study also confirmed some previously reported associations between individual factors and HPV vaccination, including age (highest in older girls), mother’s age and education level (highest among girls with younger and less educated mothers) and race/ethnicity (highest among Hispanics vs other groups). The strongest predictor for vaccination, however, was provider recommendation-the vaccination rate was nearly two-fold higher in the cohort where the girls or their parents received a recommendation for vaccine than in those who did not (64% vs 34.8%).

“Given this information and that HPV vaccination rates in the United States remain substantially below the US Department of Health and Human Service target of 80% at 8 years after the vaccine was first recommended, healthcare providers need to continue talking about HPV vaccination to teens and their parents, regardless of race/ethnicity or where they live,” Dr Henry said.