Patient-Level Factors Associated With Lack of Health Care Provider Recommendation for the Human Papillomavirus Vaccine Among Young Cancer Survivors

PURPOSE Young cancer survivors are at increased risk for morbidities related to infection with the human papillomavirus (HPV), yet their HPV vaccine initiation rates remain low. Patient-/parent-reported lack of health care provider recommendation for HPV vaccination is strongly associated with vaccine noninitiation. We aimed to identify patient-level factors associated with survivor-/parent-reported lack of provider recommendation for HPV vaccination among young cancer survivors. METHODS Cancer survivors ages 9-26 years and 1-5 years off therapy completed a cross-sectional survey (parent-completed for survivors 9-17 years of age). Lack of health care provider HPV vaccine recommendation was the outcome of interest in a multivariable logistic regression model that included relevant patient-level sociodemographic, clinical, and vaccine-related variables. RESULTS Of 955 survivors, 54% were male, 66% were non-Hispanic White, and 36% had leukemia. At survey participation, survivors were an average age (± standard deviation) of 16.3 ± 4.7 years and 32.8 ± 14.7 months off therapy. Lack of provider HPV vaccine recommendation was reported by 73% (95% CI, 70% to 75%) of survivors. For the entire cohort, patient-level factors associated with lack of reported provider recommendation included perceived lack of insurance coverage for the HPV vaccine (odds ratio [OR], 4.0; 95% CI, 2.7 to 5.9; P < .001), male sex (OR, 2.8; 95% CI, 1.9 to 4.0; P < .001), and decreased parent-survivor communication regarding HPV vaccination (OR, 1.7 per unit decrease in score; 95% CI, 1.3 to 2.2; P < .001). In the sex- and age-stratified models, perceived lack of insurance coverage (all models) and male sex (age-stratified models) were also significantly associated with lack of reported provider recommendation. CONCLUSION We identified factors characterizing survivors at risk for not reporting receipt of a health care provider HPV vaccine recommendation. Future research is needed to develop interventions that facilitate effective provider recommendations for HPV vaccination among all young cancer survivors.

Human papillomavirus vaccination among diverse college students in the state of Georgia: who receives recommendation, who initiates and what are the reasons?

Young adulthood is a critical time for catch-up HPV vaccination. We assessed predictors of vaccine recommendation and initiation among college students. We analysed cross-sectional surveys from 2397 students using multivariable logistic regressions. Guided by the Socio-ecological and Health Belief Models, measures included socio-demographic characteristics, intrapersonal measures (e.g. vaccine beliefs), interpersonal measures (e.g. doctor’s recommendation) and institutional-level measures (e.g. college settings). The sample included students from private, public, technical and historically black colleges/universities. Of the sample, 64.5% were White; additionally, 48.3% of women (n = 750/1552) and 18.8% of men (n = 159/845) received a doctor’s recommendation. Among women, predictors included older age, US-born, higher parental education and attending private schools. Among men, predictors included younger age, being homosexual and attending private schools. HPV vaccine series initiation was low—43.3% of women (n = 672) and 16.7% of men (n = 141). Doctor’s recommendation predicted initiation for both sexes. Younger women, women attending technical colleges and men of ‘multiple/other’ race had lower odds of initiation. Common initiation barriers for both sexes included a lack of doctor recommendation and sexual inactivity. These barriers and the associations between nativity, race and socio-economic status with vaccine recommendation and initiation should be further investigated. Interventions should improve patient–provider communication around HPV vaccine.