Predictors of HPV Vaccine Uptake among Women Ages 19-26

Background:
Despite ACIP recommendations recent CDC data suggest that HPV vaccine uptake among young adult women is low (approximately 10%).

Objectives:
To identify attitudinal, behavioral, and demographic variables associated with HPV vaccine uptake among insured 19-26 year old women.

Methods:
Surveys were mailed to women ages 19-26 identified via an administrative claims database from a large U.S. managed care plan. Pregnancy and cervical cancer were exclusionary criteria. Using an observation window of 1/1/2007 – 4/30/2007, we selected 1) a random sample of 1375 females who had their first HPV vaccination during the time window and 2) a random sample of 1375 females with a medical claim during the time window, but no prior claim for HPV vaccination. The vaccinated cohort returned 345 surveys (25.1% response). The non-vaccinated cohort returned 221 surveys (16.1% response). We removed 36 individuals from the non-HPV vaccine cohort who subsequently received the HPV vaccine through 4/30/2008. Multivariate logistic regression determined predictors of receiving HPV vaccination.

Results:
HPV vaccinees and non-HPV vaccinees did not differ with respect to their general health beliefs, their willingness to follow reproductive health guidelines, or their fear of shots. Significant independent predictors of HPV vaccine receipt were: being single (OR 4.3, 95% CI: 2.1, 8.7), in school (OR 2.4, 95% CI: 1.5, 3.9), having more positive attitudes and beliefs regarding the value of vaccines in general (OR 1.4 for a 1 unit of change, 95% CI: 1.0, 2.0) and highly valuing HPV vaccination to protect themselves from cervical cancer (OR 10.2, 95% CI: 6.1, 17.0).

Conclusions:
Among these women, factors associated with being immunized against HPV include stage of life (single; in school) and positive vaccine attitudes (general and HPV-specific). Efforts to enhance uptake among women ages 19-26 should focus on explaining the value to women in stable relationships, and to address attitudes regarding vaccines.