Human papillomavirus (HPV) infection, the most common sexually transmitted virus in the United States, is a known risk factor for several cancers, including cervical and anal cancers. Getting vaccinated is one way to reduce the transmission of HPV. Two HPV vaccines have been approved by the Food and Drug Administration to protect against HPV. These vaccines are given as a series of three injections over six months, starting at age 11 through age 26 for females and age 21 for males. Disparities exist in HPV vaccination among Black, Hispanic, and low-income adolescent populations. The purpose of this study was to examine the correlates of HPV vaccine initiation in a sample of predominantly Black and Hispanic adolescents at inner-city community health centers.
[Photo (from left): Dr. Dennis Carmody, Dr. Rula Btoush and Dr. Brown]
Rutgers researchers obtained study data from electronic health records from the Newark Community Health Centers (NCHC) in Newark, New Jersey. The NCHC is a federally qualified health care organization composed of seven health centers in four communities of the Greater Newark area. Annually, the NCHC serves approximately 19,000 ethnically diverse patients, most of whom are from low-income and uninsured families. Five of their health centers were included in this study; the two excluded centers do not provide pediatric services.
The study sample included 3,180 adolescents who were seen at NCHC in 2011. In the study sample, 61 percent were female, 85 percent were Black or Hispanic, 25 percent were non-English speakers, 33 percent were uninsured, and 67 percent were seen by a pediatric health care professional. The outcome variable was HPV vaccine initiation by comparing adolescents who had received at least one dose of the HPV vaccine with those who did not receive any HPV vaccination.
Only 27.4 percent of the adolescents in the study sample initiated HPV vaccination. HPV vaccination was lower among older adolescents and those seen by non-pediatric health care providers, and higher among non-English speakers and those seen at two site locations. Insurance status was significant only among female and Hispanic adolescents. Language was not a predictor among Hispanic adolescents. Across all analyses, HPV vaccination was greatly impacted by the interaction of age and health care provider specialty. Dramatically lower HPV vaccination rates were found among older adolescents seen by non-pediatric HCPs (3 percent –5 percent) compared to other adolescents (ranging between 23 percent and 45 percent).
According to Dr. Diane Brown, a co-author and professor of health education and behavioral science at the Rutgers School of Public Health, “By understanding who does and does not initiate the HPV vaccine and when and where, public health professionals can better develop programs to improve the use of the vaccine which can reduce cancer rates and disparities.”
The study has been published online in May in the American Journal of Public Health (14:e1-e9) and will soon be coming in print. The study also examined completion and compliance with recommended dosing intervals, which appears in the June issue of the Journal of Community Health. Co-authors of the study also include Ms. Sushanna Fogarty, alumna of the department of urban health administration at the Rutgers School of Public Health, as well as Dr. Rula Btoush (principal investigator) and Dr. Dennis Carmody at the Rutgers School of Nursing.