Vaccination Interest and Trends in Human Papillomavirus Vaccine Uptake in Young Adult Women Aged 18 to 26 Years in the United States: An Analysis Using the 2008–2012 National Health Interview Survey

摘要

Objectives. Human papillomavirus (HPV) vaccines have been approved since 2006, yet vaccination rates remain low. We investigated HPV vaccination trends, interest, and reasons for nonvaccination in young adult women. Methods. We used data from the 2008–2012 National Health Interview Survey to analyze HPV vaccine uptake trends (≥?1 dose) in women aged 18 to 26 years. We used data from the 2008 and 2010 National Health Interview Survey to examine HPV vaccination interest and reasons for nonvaccination among unvaccinated women. Results. We saw significant increases in HPV vaccination for all young women from 2008 to 2012 (11.6% to 34.1%); however, Hispanics and women with limited access to care continued to have lower vaccination rates. Logistic regression demonstrated lower vaccination interest among unvaccinated women in 2010 than 2008. Respondents in 2010 were significantly less likely to give lack of knowledge as a primary reason for nonvaccination. Conclusions. Uptake of HPV vaccine has increased from 2008 to 2012 in young women. Yet vaccination rates remain low, especially among women with limited access to care. However, unvaccinated women with limited health care access were more likely to be interested in receiving the vaccine. Human papillomavirus (HPV) is widespread among young females in the United States, with an estimated prevalence of 59.8% in women aged 20 to 24 years in 2007 to 2010. 1 Persistent infection with high-risk strains of HPV has been linked to development of certain cancers, including cervical, oropharyngeal, and anal cancers, with an estimated 13.2 per 100?000 women diagnosed annually with HPV-associated cancers between 2004 and 2008. 2 Since 2006, 2 HPV vaccines have been approved by the Food and Drug Administration that safely 3 and effectively 1 prevent infection with several high-risk HPV strains. 2 Since 2006, the Advisory Committee on Immunization Practices has recommended that 3 doses of the HPV vaccine be administered to young females aged 11 to 26 years, with a focus on early vaccination. 4,5 Data for 18- to 26-year-old women from the adult version of the 2007 National Immunization Survey estimated that 10% of young women had initiated the HPV vaccination series. 6 For the same year, vaccine initiation among California women aged 18 to 27 years was estimated to be 11.0%. 7 In 2011, vaccination rates (≥?1 dose) among young women aged 19 to 26 years had increased to 29.5%. 8 Vaccination rates for adolescents were more favorable (53.8% for ≥?1 dose, 33.4% for ≥?3 doses for 13- to 17-year-old adolescents in 20123), but are far from the national goal of 80% vaccination completion for 13- to 15-year-old adolescents by 2020. 9 Despite these low vaccine initiation and even lower completion rates, few studies have examined reasons for nonvaccination of young adult women, and no study has specifically studied how these reasons may have changed over time. 6,10–13 A recent study focusing on parental attitudes showed an increase in parents not intending to vaccinate adolescent daughters and citing safety concerns as one of the main reasons for nonvaccination. 14 Furthermore, previous studies of trends in HPV vaccination have focused primarily on adolescents. 3,15,16 However, with high levels of nonvaccination continuing in 2011 for both the main target group and young adults, it is critical to understand trends in vaccination and risk factors for nonvaccination in this age group, as these young women can still benefit from receiving the HPV vaccine and promote greater herd immunity. Therefore, using nationally representative data from the National Health Interview Survey (NHIS) for young women, our aim was to (1) estimate trends in HPV vaccination uptake (≥?1 dose) in women aged 18 to 26 years from 2008 to 2012, (2) examine HPV vaccination interest among young unvaccinated women in 2008 and 2010, and (3) investigate reasons for nonvaccination among women who were not interested in receiving the vaccine in 2008 and 2010. Both vaccination interest, defined as whether an unvaccinated woman was interested in receiving the HPV vaccine in the survey, and reasons for nonvaccination for unvaccinated women, who were not interested or undecided, were only assessed in the 2008 and 2010 NHIS.