How providers are key to increasing male HPV vaccination rates

Kathryn Landis, MSPH

Provider recommendations go a long way in improving vaccination rates for human papillomavirus (HPV) vaccine in teenaged boys, but there is still room for improvement, according to a new report.

The study, published in the June 2018 issue of Vaccine, took a close look at racial and ethnic differences in recommendations for HPV vaccination and vaccination rates among teenaged boys, questioning whether providers were recommending the vaccine less frequently to minorities.¹

Kathryn Landis, MSPH, of the Department of Health Policy and Management at Rollins School of Public Health, Emory University, Atlanta, Georgia, and lead author of the report, says provider recommendations were consistent in all demographics, but could be improved across the board.

“Provider recommendations are a very strong ‘cue to action’ for vaccine initiation regardless of race/ethnicity, and recommendation rates can be improved for the male population to reduce spread of HPV infection and HPV-related cancers,” Landis says. “Previous research has identified interesting HPV vaccination patterns for initiation and completion. As a result, we were interested in learning more about how provider recommendation might differentially impact racial/ethnic groups in the vaccination process.”

The HPV vaccine has been recommended as a routine vaccine by the Advisory Committee on Immunization Practices (ACIP) since 2011, yet uptake remains low among male adolescents, according to the investigators. Specifically, they found that providers aren’t making recommendations for the vaccine often enough in this population.

The researchers analyzed the 2014 National Immunization Survey-Teen (NIS-Teen), which reviewed provider-verified vaccination data from 10,743 male teenagers across 50 states. The data revealed a 41.3% vaccination rate across the cohort, and HPV vaccine initiation rates that were 76% higher in Hispanic teenagers and 43% higher in non-Hispanic other and multiple race minority adolescents compared with white teenagers.

Other demographic information revealed in the study included the fact that 90.4% of the teenagers in the study had a well-child visit at age 11 to 12 years; 57.1% had insurance coverage through a caregiver employer or union; and 75.3% were up-to-date on Tdap or meningococcal vaccines. Just a third-36.4%-of the teenagers in the study for whom HPV vaccination was initiated came from families with incomes greater than $75,000 per year; 37.1% had mothers with college degrees; and 67.5% came from households with married parents. Overall, the study noted that two-thirds of teenaged boys with access to private insurance did not have the HPV vaccine initiated, but 47.3% of boys with public insurance did.

“We found that adolescent race/ethnicity did not significantly predict likelihood of provider recommendation,” the study authors note. “Hispanic and non-Hispanic black adolescents had 16% and 22% higher odds of receiving a recommendation compared to white counterparts, respectively. Non-Hispanic other and multiple race adolescents had 2% lower odds of receiving a recommendation in comparison to whites.” 

Hispanic teenagers had by far the highest odds of initiating HPV vaccines compared with whites, and-for those who did not receive a recommendation-Hispanics, non-Hispanic blacks, and non-Hispanic other/multiple race adolescents had odds of initiation twice as high compared with whites, the report notes.

The researchers also point out that non-Hispanic white teenagers had nearly 11-times higher odds of initiation of the vaccine when a provider recommendation was made. The odds of Hispanic teenagers starting the series after a provider recommendation was nearly 9 times higher, and the odds of non-Hispanic black and other/multiple race adolescents were nearly 5 times higher and 7 times higher, respectively, according to the report.

Although less than half-41.3%-of teenaged boys received the vaccine overall, the numbers are up from a 2013 report, which placed vaccination rates in this group at 34.6%.

References:

1. Landis K, Bednarczyk RA, Gaydos LM. Correlates of HPV vaccine initiation and provider recommendation among male adolescents, 2014 NIS-Teen. Vaccine. 2018;36(24):3498-3504.