P9 Missed Opportunities for HPV Vaccination Among Adolescents in a High-Risk Community

Tuesday, March 13, 2012
Hyatt Exhibit Hall
Marjan Javanbakht, PhD1, Susan Walker, MPH, CHES2, Sami L. Gottlieb, MD, MSPH3, Lauri Markowitz, MD4 and Sarah Guerry, MD2, 1School of Public Health, Department of Epidemiology, UCLA, Los Angeles, CA, 2Sexually Transmitted Disease Program, Division of HIV/STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, 3Division of STD Prevention, CDC, Atlanta, GA, 4Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA

Background: Maximizing HPV vaccine uptake is critical for those at highest risk for cervical cancer.

Objectives: To evaluate missed opportunities for HPV vaccination and explore provider messaging associated with successful HPV vaccination of adolescent girls in a high-risk community.

Methods: During October 2008-September 2009, 107 parents of 11-17 year-old girls were interviewed immediately after completing a clinical visit at two urban clinics in Los Angeles serving populations with high cervical cancer rates.

Results: The majority of parent respondents were Hispanic women (89%); daughters’ mean age was 13.9 years.  At the time of their visit, 73 (68%) daughters were eligible to receive HPV vaccine: 50 (68%) had never initiated the vaccine series and 23 (32%) were due for their second or third dose.  Nearly 60% (43/73) of those eligible did not receive HPV vaccine, with the majority having never initiated vaccination (n=33).  Among girls eligible for vaccination, those vaccinated during their visit were older (mean age=14.8 vs. 13.2 years; p=.01); no other demographic differences were noted. A large proportion of parents who vaccinated their daughters noted that the doctor recommended the vaccine (60% vs. 26%; p<.01). Receiving specific vaccine information from the staff was also associated with receipt of vaccine, including information that HPV vaccine works best if received before sex (57% vs. 9%; p<.01), that the vaccine prevents cervical cancer (70% vs. 33%; p<.01) and genital warts (50% vs. 9%; p<.01), and that HPV is a sexually transmitted infection (53% vs. 23%; p<.01). 

Conclusions: A substantial proportion of adolescents eligible for HPV vaccine did not receive it during a clinical visit. Provider recommendation appears to be an influential vaccination motivator as does receiving specific HPV vaccine information. 

Implications for Programs, Policy, and Research: Providers are critical in increasing HPV vaccine uptake and need to limit missed opportunities for vaccination.