Abstract A066: Inaccuracy in parental reports of adolescent human papillomavirus vaccination: A multilevel analysis of the influences of state-level and individual-level factors
Authors: Vu Milkie H. N. , Luu Minh , Haardörfer Regine , Berg Carla J. , Escoffery Cam , Bednarczyk Robert A. 
Published: August 2020

Abstract
Background: Accurate reporting of human papillomavirus (HPV) vaccination status is necessary for monitoring coverage and identifying under-vaccinated populations. While parental recall or reports are commonly used to identify adolescent HPV vaccination status, these self-reports may be subjected to bias. The Socioecological Framework suggests that factors at the individual (e.g., education), interpersonal (e.g., interactions with health care provider), community (e.g., state median income), and policy levels (e.g., state-level HPV vaccine policy) can influence the accuracy of parental reports.
Objective: We explored potential multilevel correlates of the accuracy of parental reports of adolescent HPV vaccination status.
Methods: Data from parents of 19,751 adolescents (2016 National Immunization Survey-Teen) were analyzed using multilevel modeling. We examined the adolescent's age, sex, race/ethnicity, maternal education, and household poverty status (individual-level); the number of health care providers seen (interpersonal-level); state-level median income (community-level); and state policy regarding HPV vaccine (i.e., whether a state has a policy mandating HPV vaccine for school entry or educating residents about HPV vaccine) (policy level). Outcomes included: 1) inaccuracy in reporting vaccine initiation (≥1 dose) and 2) inaccuracy in reporting completion (3 doses).
Results: In the sample, 20.6% and 22.2% inaccurately reported initiation and completion, respectively. Compared to parents of White adolescents, parents of those who were Black (OR=1.6 and 1.5), Hispanic (OR=1.4 and 1.7), or of multiple races or other race (OR=1.8 and 1.8) were more likely to inaccurately report initiation and completion, respectively. Households with higher maternal education (OR=0.7 and 0.9) and nonpoverty status (OR=0.5 and 0.6) were less likely to inaccurately report. Compared to those who had seen 0 or 1 provider, those who had seen more providers were less likely to inaccurately report (OR=0.9 and 0.9 for seeing 2 providers, OR=0.8 and 0.9 for 3+ providers). Neither state-level median income nor state HPV vaccine policy was associated with either outcome.
Discussion: Parents of racial/ethnic minority adolescents and households with more socioeconomic disadvantages were more likely to inaccurately report HPV vaccine initiation and completion. These results have implications for vaccine estimates drawn from self-reports. Future research can examine and target sources of inaccuracies in these groups, for example, uncertainty in provider communication, low health literacy, or social desirability in reporting. Having seen more providers was associated with higher accuracy, suggesting the importance of increased access to vaccine records. State vaccine policy does not appear to have an impact on the accuracy of parental reports, pointing to a need to further examine differential policy implementation or enforcement.
Citation Format: Milkie H. N. Vu, Minh Luu, Regine Haardörfer, Carla J. Berg, Cam Escoffery, Robert A. Bednarczyk. Inaccuracy in parental reports of adolescent human papillomavirus vaccination: A multilevel analysis of the influences of state-level and individual-level factors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A066.