Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
JNCI Cancer Spectr. 2023 Aug 31;7(5). doi: 10.1093/jncics/pkad068.
Despite the known benefits of preventing human papillomavirus (HPV)-related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro-level (state) and meso-level (organization) factors associated with HPV vaccine initiation and up-to-date.
Data from 2020 National Immunization Survey-Teen were used to study a sample of 20 163 US adolescents (aged 13-17 years). The data were collected from each teen's parents or guardians and health-care professionals. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted.
The prevalence of HPV vaccine initiation was 75.1% and of remaining up-to-date was 58.6%. At the macro level, teens living in states with high and moderate religiosity had lower odds of HPV vaccine initiation (high religiosity adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.50 to 0.78; moderate religiosity AOR = 0.68, 95% CI = 0.55 to 0.85) and up-to-date (high religiosity AOR = 0.69, 95% CI = 0.56 to 0.85; moderate religiosity AOR = 0.74, 95% CI = 0.61 to 0.91) than states with low religiosity. At the meso level, when none of their healthcare professionals ordered vaccine from the state, teens had lower odds of initiation (AOR = 0.68, 95% CI = 0.53 to 0.87) and up-to-date (AOR = 0.76, 95% CI = 0.60 to 0.95) than teens whose healthcare professionals ordered vaccine from the state. In addition, race and ethnicity, age, mother's education level, household income, well-child examination status, and doctor's recommendation were significantly associated with HPV vaccine uptake.
A multiprong approach is needed to address religious and systemic barriers to HPV vaccination and expand healthcare professionals' access and enrollment in state vaccine initiatives, such as the Vaccine for Children program.
尽管预防人乳头瘤病毒（HPV）相关癌症的好处已被广泛认知，但 HPV 疫苗在美国的接种率仍然很低。本研究基于社会生态学理论，评估了与 HPV 疫苗接种启动和及时接种相关的宏观（州）和中观（组织）因素。
本研究使用了 2020 年全国免疫调查-青少年的数据，对 20163 名美国青少年（年龄 13-17 岁）进行了研究。数据来自每个青少年的父母或监护人以及卫生保健专业人员。计算了加权患病率估计值，并进行了多变量回归分析。
HPV 疫苗接种启动的流行率为 75.1%，及时接种的流行率为 58.6%。在宏观层面上，生活在宗教信仰程度较高和中等的州的青少年接种 HPV 疫苗的可能性较低（宗教信仰程度较高的调整后优势比 [AOR]分别为 0.63（95%置信区间 [CI]：0.50-0.78）和 0.68（95%CI：0.55-0.85）；宗教信仰程度中等的 AOR 分别为 0.68（95%CI：0.56-0.85）和 0.74（95%CI：0.61-0.91）），及时接种的可能性也较低（宗教信仰程度较高的 AOR 分别为 0.69（95%CI：0.56-0.85）和 0.74（95%CI：0.61-0.91）；宗教信仰程度中等的 AOR 分别为 0.74（95%CI：0.61-0.91））。在中观层面上，当他们的卫生保健专业人员没有从州订购疫苗时，青少年接种疫苗的可能性较低（AOR 分别为 0.68（95%CI：0.53-0.87）和 0.76（95%CI：0.60-0.95））。此外，种族和民族、年龄、母亲的教育水平、家庭收入、儿童健康检查状况和医生的推荐与 HPV 疫苗接种率显著相关。
需要采取多管齐下的方法来解决 HPV 疫苗接种的宗教和系统障碍，并扩大卫生保健专业人员获得和参与州疫苗计划（如儿童疫苗计划）的机会。
