Page 27 - Delaware Medical Journal - January/February 2019

ORIGINAL RESEARCH
INTRODUCTION: The purpose of this study was to describe human papillomavirus (HPV) vaccine coverage in the age group 18-29 years by state and to identify disparities in HPV vaccine coverage by gender in the U.S.
METHODS: Using Behavioral Risk Factor Surveillance System data (2011 to 2016), analysis was conducted by year on adult respondents in the 18-29-year age group. Combined data (2013-2016) was analyzed to generate a sufficient sample for males and females in the 18-29-year age group. Descriptive estimates were calculated for subgroups and two-tailed significance tests were used to test for differences in prevalence between selected subgroups (P < .05).
RESULTS: For the combined data, 44.7% (95% C1= 42.9, 46.5) of women (n= 4199) and 15.4% (95% CI =14.1, 16.7) of men (n=1107) in the 18-29-year age group had ≥1 HPV vaccination shot. 60.1% of females and 30.6% of males completed the HPV vaccination shot series. Significant differences in HPV coverage were found by race, education, income, insurance, and Metropolitan Statistical Area (MSA) status.
CONCLUSIONS: Each year in the United States, an estimated 39,000 cancers are attributed to HPV infection.1 The majority of these cancers could be prevented by receipt of the HPV vaccine. HPV vaccine coverage in the U.S. remains below the Healthy People 2020 objective of 80% for both males and females. This study provides baseline data for implementing strategies and targeting interventions to improve HPV vaccination practices.
INTRODUCTION
Human papillomavirus (HPV) infection has health consequences for both men
and women. HPV causes cancers of the cervix, vagina, and vulva in women; cancers of the penis in men; and genital warts, oropharyngeal, and anal cancers in both men and women.1 show that nearly 39,000 cancers each year in the United States are caused by HPV infection.1, 2 The majority of these cancers are caused by types 16 or 18 of HPV.1, 2 Effective HPV vaccines are available to protect against most of these cancers.2 The Advisory Committee on Immunization Practices (ACIP) has recommended HPV vaccination at age 11 or 12 years for females (since 2006) and males (since 2011).3
Currently, 9-valent HPV (9Vhpv) vaccines are being distributed in the United States.3 9vHPV protects not only against HPV
and is approved for administration in
a three-dose series at intervals of zero, one or two, and six months.1, 2, 3 The three-dose series recommendation was changed to a two-dose schedule for HPV vaccination in early adolescence (9-14 years) by ACIP in October 2016.4, 5 The importance of getting an HPV vaccine
cannot be emphasized enough, especially considering the fact that while there is
a routine screening for cervical cancer, there is none for the other 20,000 or so cancers caused by HPV infections. For example, cancers of the back of the throat (oropharynx) and cancers of the anus/ rectum are likely to be diagnosed at a later stage, with a poorer prognosis.1, 2
Healthy People 2020 (HP2020) targets 80% HPV vaccine coverage (three doses) for males and females by age 13 to 15 years.6 Previous research indicates current HPV vaccine coverage among U.S. adolescents is well below that objective.7 Ongoing research to identify trends in HPV vaccine coverage and characteristics associated with low vaccine uptake in the United States is of utmost importance in reaching the HP2020 objective.
The purpose of this study is to: 1) describe and compare HPV vaccine coverage in
the age group 18-29 years by state from 2011 to 2016 and 2) to identify disparities in HPV vaccine coverage by gender in
the selected age group. Data for this study is provided by the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) for the years 2011 to 2016.8
METHODS
Data source
BRFSS is the largest population-based telephone survey to collect behavioral information from a random sample of individuals aged 18 years or older and living in the U.S. In the optional module, following are the questions regarding HPV vaccination: “A vaccine to prevent the human papillomavirus or HPV infection is available and is called the cervical cancer or genital warts vaccine, HPV shot [if female ‘GARDASIL or CERVARIX’; if male ‘GARDASIL’]. Have you ever had the HPV vaccination?” and “How many HPV shots did you receive?” HPV questions are an optional module for states administering BRFSS and available data was limited to states opting for the module each year.
The HPV module was completed by
year as follows: in 2011, three states (Connecticut, Tennessee, and Wisconsin); in 2012, eight states (Alabama, Arizona, Connecticut, Delaware, Maine, Massachusetts, Texas, and West Virginia);
Hawaii, Massachusetts, Mississippi,
and Rhode Island); in 2014, eight states (Alabama, Delaware, Georgia, Indiana, Massachusetts, Minnesota, Rhode Island,
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Abstract