Abstract B14: Factors associated with adolescent HPV vaccine uptake in safety-net clinics
Authors: Tiro Jasmin A. , Bruce Corinne , Bishop Wendy P. , Goodell Katharine , Skinner Celette Sugg 
Published: May 2012

Abstract
Background: Cervical cancer disproportionately affects minority and low socioeconomic status (SES) populations and could be nearly eliminated if prevention and screening were universally available and used. Uptake of the human papillomavirus (HPV) vaccine could reduce disparites. Clinic, provider, and patient factors determining vaccine use in the US are not well understood. Most studies of correlates have relied on patient self-report.
Aim: Use behavioral model of health services utilization to examine patient, provider, and clinic characteristics associated with HPV vaccine use among females ages 11–18 receiving care in safety-net clinics.
Methods: Retrospective medical record review of a random sample of 353 female patients ages 11–18 who had an index visit between March 2007 and February 2008 at one of two safety net clinics which provide primary care to underserved populations. Dependent variables abstracted included: physician recommendation; HPV vaccine acceptance; number of doses delivered (0–3); and timeliness (e.g., on-schedule delivery of doses). Independent variables included patient sociodemographics, health care access, vaccine and sexual behavior, and clinic documentation. Chi-square tests (p&lt;0.05) identified significant factors.
Results: The sample was diverse (N = 353; 38.5%African American, 53.5% Hispanic, 52.7% age &lt;15, 93.2% publicly insured, 39.1% with a clinic visit in the past year, 34.6% sexually active). Only 140 out of 353 eligible female patients (39.7%) received a recommendation from a health care provider. Patient factors associated with provider recommendation were younger age (&lt;15), being Caucasian, having some type of insurance, visiting the clinic in the past year, receipt of other recommended adolescent vaccines (TDAP and MCV4), receipt of flu shot in past year, and not being sexually active. Clinic documentation of Vaccine for Childrens program eligibility, vaccine record, and completion of health maintenance form in past year was also associated with provider recommendation. Of those who received a recommendation, only 24.3% refused the vaccine, most initiated the series (59.3% received 1–2 doses), and 16.4% completed all three doses. Only 1 patient completed the series according to CDC guidelines for timely delivery. The only factor associated with vaccine refusal among those who received a recommendation was lack of receipt of other adolescent vaccines.
Conclusions: Even in a safety-net clinic population where female adolescents have access to care, HPV vaccine delivery is suboptimal. Delivery breaks down at two points: physician recommendation and dose completion. Our data show that most patients do not receive a physician recommendation. Of those who get a recommendation, most patients initiate the series, but do not complete all three doses. Chart reminders that improve provider recommendation and patient-directed reminders to address delivery of second and third doses are urgently needed.
Citation Information: Cancer Prev Res 2010;3(1 Suppl):B14.