Reasons for non-vaccination against HPV and future vaccination intentions among 19-26 year-old women

Gregory D Zimet, Thomas W Weiss, Susan L Rosenthal, Margaret B Good, Michelle D Vichnin, Gregory D Zimet, Thomas W Weiss, Susan L Rosenthal, Margaret B Good, Michelle D Vichnin

Abstract

Background: Despite CDC recommendations regarding universal catch-up vaccination against human papillomavirus (HPV), only about ten percent of young adult women in the United States have been vaccinated. The purpose of this study was to better understand reasons for non-vaccination among insured 19-26 year-old women and to evaluate future vaccination intentions.

Methods: We used an administrative claims database from a large US managed care plan to identify women aged 19-26 for receipt of a mailed survey. From a sample of 1,375 women with no evidence of HPV vaccination from June 1, 2006 through April 30, 2007, 222 completed surveys were received, of which 185 were eligible for this analysis. The main outcome measures were unvaccinated women's attitudes and vaccine awareness, likelihood of future action regarding the vaccine, and reasons for inaction.

Results: Among the 185 non-vaccinees, 25.4% were married, 83.2% were white, and 89.2% had a college or higher level education. The vaccine was described as very important by 32.4% of subjects, and 30.1% had discussed the vaccine with a doctor and received a doctor's recommendation. Half or fewer of respondents were "very" or "extremely" likely to discuss the vaccine with their doctor (50.0%), do additional research on the vaccine (42.6%), ask a doctor to get the vaccine (37.5%), or make an appointment to get the vaccine (27.8%), while 48.0% were "somewhat", "very", or "extremely" likely to do nothing to get the vaccine. Among the latter, reasons for taking no action included being married or in a monogamous relationship (54.9%), belief that the vaccine is too new (35.4%), not having enough information about the vaccine (31.7%), concerns about side effects (24.4%), and uncertainty about insurance coverage (24.4%).

Conclusions: Educational interventions may be needed to enhance HPV vaccination rates among 19-26 year-old women, particularly regarding information about vaccine safety, vaccine efficacy, insurance coverage, and the value of vaccination to women in monogamous relationships.

References

    1. Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6–10. doi: 10.1363/3600604.
    1. Huang CM. Human papillomavirus and vaccination. Mayo Clinic Proc. 2008;83:701–707. doi: 10.4065/83.6.701.
    1. Castellsague X. Natural history and epidemiology of HPV infection and cervical cancer. Gynecol Oncol. 2008;110(3 Suppl 2):S4–7. doi: 10.1016/j.ygyno.2008.07.045.
    1. Harper DM. Impact of vaccination with Cervarix (Trade Mark) on subsequent HPV-16/18 infection and cervical disease in women 15-25 years of age. Gynecol Oncol. 2008;110(3 Suppl 1):S11–17. doi: 10.1016/j.ygyno.2008.06.029.
    1. US Food and Drug Administration. Cervarix Approval Letter. 2009. Accessed 10/26/09.
    1. Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, Tang GWK, Ferris DG, Steben M, Bryan J, Taddeo FJ, Railkar R, Esser MT, Sings HL, Nelsom M, Boslego J, Sattler C, Barr E, Koutsky LA. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007;356:1928–1943. doi: 10.1056/NEJMoa061760.
    1. FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:1915–1927. doi: 10.1056/NEJMoa061741.
    1. US Food and Drug Administration. Gardasil Approval Letter. 2006. Accessed 04/15/2009.
    1. US Food and Drug Administration. Gardasil Approval Letter. 2009. Accessed 10/19/2009.
    1. Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER. Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep. 2007;56(RR-2):1–24.
    1. Centers for Disease Control and Prevention. FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP) & FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP) MMWR. 2010;59:626–32.
    1. Kahn JA, Rosenthal SL, Jin Y, Huang B, Namakydoust A, Zimet GD. Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women. Obstet Gynecol. 2008;111:1103–1110.
    1. Conroy K, Rosenthal SL, Zimet GD, Jin Y, Bernstein DI, Glynn S, Kahn JA. Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination. J Women's Health. 2009;18:1679–1686. doi: 10.1089/jwh.2008.1329.
    1. Grant D, Kravitz-Wirtz N, Breen N, Tiro JA, Tsui J. One in four California adolescent girls have had human papillomavirus vaccination. Policy Brief UCLA Cent Health Policy Res. 2009. pp. 1–6.
    1. Jain N, Euler GL, Shefer A, Lu P, Yankey D, Markowitz L. Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007. Prev Med. 2009;48:426–431. doi: 10.1016/j.ypmed.2008.11.010.
    1. Adams M, Jasani B, Fiander A. Prophylactic HPV vaccination for women over 18 years of age. Vaccine. 2009;27:3391–3394. doi: 10.1016/j.vaccine.2009.01.067.
    1. Rosenthal SL, Weiss TW, Zimet GD, Ma L, Good MB, Vichnin MD. Predictors of HPV Vaccine Uptake among Women Ages 19-26: Importance of a Physician's Recommendation. Vaccine. 2010. ed2010.
    1. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: A meta-analytic review. Br J Soc Psychol. 2001;40:471–500. doi: 10.1348/014466601164939.
    1. Allen JD, Mohllajee AP, Shelton RC, Othus MK, Fontenot HB, Hanna R. Stage of adoption of the human papillomavirus vaccine among college women. Prev Med. 2009;48:420–425. doi: 10.1016/j.ypmed.2008.12.005.
    1. Zimet GD. Understanding and overcoming barriers to human papillomavirus vaccine acceptance. Curr Opin Obstet Gynecol. 2006;18(Suppl 1):s23–28. doi: 10.1097/01.gco.0000216317.10690.8f.
    1. Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: a theory-informed, systematic review. Prev Med. 2007;45:107–114. doi: 10.1016/j.ypmed.2007.05.013.
    1. Kahn JA, Rosenthal SL, Hamann T, Bernstein DI. Attitudes about human papillomavirus vaccine in young women. Int J STD AIDS. 2003;14:300–306. doi: 10.1258/095646203321605486.
    1. Boehner CW, Howe SR, Bernstein DI, Rosenthal SL. Viral sexually transmitted disease vaccine acceptability among college students. Sex Transm Dis. 2003;30:774–778. doi: 10.1097/01.OLQ.0000078823.05041.9E.
    1. Walsh CD, Gera A, Shah M, Sharma A, Powell JE, Wilson S. Public knowledge and attitudes towards human papilloma virus (HPV) vaccination. BMC Public Health. 2008;8:368. doi: 10.1186/1471-2458-8-368.
    1. Brabin L, Roberts SA, Stretch R, Baxter D, Chambers G, Kitchener H, McCann R. Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: Prospective cohort study. BMJ. 2008;336:1056–1058. doi: 10.1136/.
    1. Crosbie EJ, Brabin L. Cervical cancer: Problem solved? Vaccinating girls against human papillomavirus. BJOG. 2010;117:137–142. doi: 10.1111/j.1471-0528.2009.02369.x.
    1. Marshall H, Ryan P, Roberton D, Baghurst P. A cross-sectional survey to assess community attitudes to introduction of Human papillomavirus vaccine. Aust N Z J Public Health. 2007;31:235–242. doi: 10.1111/j.1467-842X.2007.00054.x.
    1. Reeve C, De La Rue S, Pashen D, Culpan M, Cheffins T. School-based vaccinations delivered by general practice in rural north Queensland: An evaluation of a new human papilloma virus vaccination program. Commun Dis Intell. 2008;32:94–98.
    1. Dempsey AF. Human papillomavirus: The usefulness of risk factors in determining who should get vaccinated. Rev Obstet Gynecol. 2008;1:122–128.

Source: PubMed

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