Reasons for Limited Uptake of HPV Vaccine among Women Ages 19-26

Background:
Despite CDC recommendations regarding vaccination against HPV, uptake of the quadrivalent HPV vaccine has been less than optimal among women ages 19-26.

Objectives:
To better understand reasons for non-vaccination among insured women ages 19-26 that have yet to be vaccinated against HPV.

Methods:
We used an administrative claims database from a large U.S. managed care plan to identify women ages 19-26 for mailed survey administration. Pregnancy and cervical cancer were exclusionary criteria. We selected a sample of 1,375 females with no evidence of HPV vaccination from 1/1/07 through 4/30/07. We received 221 completed surveys (16.1% response). For analysis purposes, we removed 36 individuals who subsequently received the HPV vaccine through 4/30/08.

Results:
Among the 185 non-vaccinees, 25.4% were married, 86.5% were white, and 44.9% had a college degree or higher; 32.4% stated that the HPV vaccine was very important to them, and 38.1% had discussed the vaccine with a doctor. With respect to future plans, 37.5% were likely to ask a doctor to get the vaccine, 42.7% planned to do additional research on the vaccine, 50% planned to discuss the vaccine with their doctor, and 27.9% planned to make an appointment to get the vaccine. About half of respondents (52.0%) were not likely to do anything regarding HPV vaccination. Reasons for taking no action were: married or in a monogamous relationship (54.9%), vaccine was too new (35.4%), not having enough information about the vaccine (31.7%), unsure about insurance coverage (24.4%), and concerned about side effects (24.4%).

Conclusions:
These findings suggest key areas for informational efforts to enhance HPV vaccination rates among 19-26 year old women. One-half of the non-vaccinated women had some interest in the HPV vaccine, suggesting patient or provider factors may be impacting uptake. Health information regarding vaccine safety and the value of vaccination to women in monogamous relationships may be needed.