Disparities in Cervical Cancer Prevention in the United States: HPV Vaccine Completion in 18-30 Year Old Women

Background and Purpose: In 2011, an estimated 12,710 women in the United States suffered from cervical cancer and 4,290 died from the disease. Despite progress in screening, racial/ethnic minorities and low-income women still experience higher incidence and mortality from cervical cancer. Up to 70% of cervical cancer is caused by high-risk types of human papillomavirus (HPV). New vaccines to prevent infection with high-risk HPV were licensed in 2006 and 2009. HPV vaccines are important for primary prevention, and are included in routine vaccination for girls 11-12 years and women 13-26 years as “catch-up” vaccination. Studies indicate that HPV vaccine utilization remains low, especially for young women in the “catch-up” group. Guided by the Behavioral Model of Health Care Utilization, this study identifies barriers and facilitators of HPV vaccine completion among women aged 18-30 years in the U.S.

Methods: Research questions were answered using the 2010 National Health Interview Survey (NHIS) (N=3,129). To understand the relationship between HPV vaccine completion and barriers/facilitators, a multivariate logistic regression was conducted. The regression used “receiving all three HPV shots ever” as the outcome and these predictors: race/ethnicity, age, marital status, education, family income, any live birth, annual flu shot, insurance status, usual source of care, and region of residence. Special statistical procedures were used to control for the complex survey design. Results are presented as odds ratios (OR). The pre-determined alpha level of significance was 0.05.

Results: The 2010 NHIS had 3,129 women aged 18-30 years old, representing about 27 million persons. Significant factors associated with lower HPV vaccine completion were: Non-Hispanic Black (vs. non-Hispanic White, OR=0.42), non-citizen (vs. citizen, OR=0.40), any live birth (vs. no, OR=0.44), and no usual source of care (vs. yes, OR=0.49). Significant factors associated with higher HPV vaccine completion were: 18-22 yrs. (vs. 23-30 yrs., OR=2.0), unmarried (vs. married/partnered, OR=2.7), annual flu vaccination (vs. no, OR=2.0), and STI history (vs. no, OR=1.8).

Discussion/Implications: This study indicates that the rate of HPV vaccine completion is low (10.3%) among young adult women. Findings suggest that race/ethnicity, age, marital status, citizenship, birth history, and not having a usual source of care are barriers to HPV vaccine completion. Non-Hispanics Black women were 57% less likely to have received HPV vaccination than non-Hispanic White women. Controlling for race/ethnicity, non-citizens and women without a usual source of care were 60% and 51% less likely to complete HPV vaccination than their comparators. On the other hand, women who are younger and unmarried were 2.0 and 2.7 times more likely to complete the vaccine series than their comparators. Women with STI history or who receive an annual flu shot were 1.8 and 2.0 times more likely to have the HPV vaccine than their comparators.

Study findings can help health clinicians better understand populations not completing the three-shot HPV vaccine. Results indicate a need for targeted, culturally-appropriate educational interventions for health care providers and minority and immigrant women. Policies to increase HPV vaccine completion include the utilization of health information technology and health care quality initiatives.