title: Racial/Ethnic and poverty disparities in human papillomavirus vaccination completion.
abstract: BACKGROUND
  Two vaccines against human papillomavirus (HPV), a necessary cause of cervical cancer, are currently licensed and recommended for routine administration in the U.S. to girls in a three-dose series.
  
  
  OBJECTIVE
  This study examined effects of race/ethnicity, poverty, and year on completion of the three-dose HPV vaccine series among those who initiated vaccination.
  
  
  METHODS
  Data from the 2008-2009 National Immunization Survey-Teen for girls aged 13-17 years who received at least one dose of HPV vaccine (n=7606) were analyzed in 2010-2011 using logistic regression to adjust for covariates including measures of access to care.
  
  
  RESULTS
  During this 2-year period, 55% of adolescent girls who initiated vaccination completed the three-dose series. Completion was significantly higher in 2009 (60%) compared to 2008 (48%; p<0.001). After controlling for covariates, adolescents who were black (AOR=0.48, 95% CI=0.40, 0.57) or Hispanic (AOR=0.75, 95% CI=0.64, 0.88) were significantly less likely to complete vaccination than whites. Adolescents living below the federal poverty level were significantly less likely to complete vaccination than adolescents with household incomes >$75,000 (AOR=0.76, 95% CI=0.63, 0.92). There was no significant interaction between race/ethnicity and year (p=0.92). Although poverty was associated with lower completion rates in 2008, this association was not observed in 2009 (p<0.05 for poverty-year interaction).
  
  
  CONCLUSIONS
  HPV vaccination completion rates increased between 2008 and 2009. However, significant differences by race/ethnicity and poverty were observed, and the racial/ethnic differences persisted.
authors.affiliation: Yale School of Public Health Division of Epidemiology of Microbial Diseases, Yale University, New Haven, Connecticut 06520, USA. linda.niccolai@yale.edu
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.forename: Niti R
authors.initials: NR
authors.lastname: Mehta
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006306:Health Surveys; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs; D016015:Logistic Models; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011203:Poverty; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines