Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, UW Box # 351619, Seattle, WA, 98195, USA.
Department of Family Medicine, University of Washington School of Medicine, Seattle, USA.
J Community Health. 2024 Oct;49(5):857-868. doi: 10.1007/s10900-024-01333-w. Epub 2024 Mar 14.
Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.
不到三分之二的美国青少年接受了 HPV 疫苗接种。尽管参与预防保健的母亲更有可能为孩子寻求预防保健，但仍需要开展关于母亲宫颈癌筛查（CCS）与青少年 HPV 疫苗接种之间关联的现有研究。我们使用华盛顿州医疗保健系统的电子健康记录数据评估了母亲预防服务利用与青少年 HPV 疫苗接种之间的关联。我们纳入了在 2018 年至 2020 年期间至少有 1 次初级保健就诊的青少年（11-17 岁）及其母亲。结局是 HPV 疫苗接种启动和完成情况。主要暴露因素是母亲是否遵循指南推荐的 CCS。次要暴露因素是母亲乳腺癌筛查的遵循情况（对于≥52 岁的母亲）和≤2 年内≥1 次健康检查。我们使用广义估计方程来估计患病率比，并探讨青少年性别、青少年提供者特征和母亲语言翻译使用的影响修饰作用。在 4121 名青少年中，66%的母亲遵循 CCS，82%的青少年启动 HPV 疫苗接种，49%的青少年完成了系列接种。CCS 遵循情况与更高的接种启动率（调整后患病率比（APR）：1.10，95%置信区间（CI）：1.06-1.13）和完成率（APR：1.16，95%CI：1.08-1.23）相关。对于男性青少年与女性青少年、在家庭医学与儿科就诊的青少年以及与母亲有相同初级保健提供者的青少年而言，这种关联更强。最近的母亲健康检查也与更高的接种启动率（APR：1.04，95%CI：1.01-1.07）和完成率（APR：1.12，95%CI：1.05-1.20）相关。结果表明，通过以家庭为中心的方法提供医疗保健并让母亲参与广泛的预防保健，可以提高青少年 HPV 疫苗接种率。
