HPV awareness not linked to vaccination in high-risk population

1. Greater awareness of the human papillomavirus (HPV), cervical cancer, HPV vaccination, and vaccine advertising among the low-income, African American population studied was not associated with increased vaccination rates.

2. Vaccination among the studied cohort was low (<20%)—analyses predicted that even among adolescents with the greatest awareness, less than 25% would get vaccinated within the year.

Evidence Rating Level: 2 (Good)

Study Rundown: High-risk HPV is capable of causing various cancers, most notably cervical cancer in females. Despite the existence of multiple HPV vaccines and current Centers for Disease Control and Prevention (CDC) recommendations, many adolescent girls in the United States are not being vaccinated. Understanding the barriers to vaccination is important, especially within high-risk groups such as African Americans and low-income adolescents. Positing that awareness of HPV, cervical cancer, and the HPV vaccine might predict HPV vaccination, authors assessed baseline awareness in 2 independent samples of low-income, African American parents/guardians and adolescents and monitored vaccination status at 3, 6, and 12 months. At the end of the study period, a minority of study participants had been vaccinated, and awareness was a poor predictor of vaccination in both samples. The association between vaccination and mean awareness level reached significance in the adolescents at 6 and 12 months; however, awareness only accounted for a small percentage of the variance between the vaccinated and unvaccinated groups. This study was limited by its short follow-up period and narrow scope—possible confounding variables such as physician recommendations, differing insurance policies, and awareness of the federal Vaccines for Children (VFC) program were not considered. Regardless, the finding that awareness was not associated with vaccination argues against the utility of “awareness” campaigns. It also highlights the need for additional research to elucidate the true predictors of HPV vaccination in order to improve primary prevention.

Click to read the study, published today in Pediatrics

Relevant Reading: Racial and ethnic differences in HPV knowledge, attitudes, and vaccination rates among low-income African-American, Haitian, Latina and Caucasian young adult women

Study Author, Jessica Fishman, PhD talks to 2 Minute Medicine: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

“Those who work in clinical practice may be able to increase immunization rates by clearly communicating that they strongly recommend this vaccine. Regardless of whether patients have low levels of awareness or knowledge, patients may be likely to vaccinate when immunization is recommended as an important way to prevent cancer, and when it is made immediately available.”

In-Depth [prospective cohort]: Participants were recruited from low-income, predominantly African American Philadelphia neighborhoods and included 149 parents/guardians of girls aged 9 to 18 years who were not vaccinated against HPV and 211 unvaccinated girls aged 13 to 18. Parent age and income in addition to adolescent age, age of sexual debut, and number of sexual partners were considered as potential confounding variables. Awareness of (1) HPV, (2) cervical cancer, (3) HPV vaccination, and (4) news/advertisements about HPV vaccination was gauged by a baseline questionnaire and percentage of awareness was calculated to obtain a composite score. The Kids Immunization Database/Tracking System was used to cumulatively assess vaccination percentage at 3, 6, and 12 months. Despite high baseline awareness (only 4% of the parents/guardians and 13.7% of the teens indicated no awareness), cumulative vaccination rates were low, ranging from 5.37% at 3 months to 13% at 12 months (adolescents of parents/guardians) and 3.32% to 15.17% (adolescents). Greater awareness was not associated with vaccination in the parent/guardian sample and barely reached significance at 6 and 12 months in the adolescent sample (6 months: p = 0.048; 12 months: p = 0.0447). The predictive value of awareness for vaccination at 12 months, as assessed by the area under the curve (AUC), was poor in both samples (parents/guardians: AUC = 0.57; adolescents: AUC = 0.61). Analysis of the individual awareness measures demonstrated that they were either not significant or poorly correlated with vaccination status (Φ correlation ≤ 0.16, r² ≤ 0.03 across all measures and time points).

Image: PD

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