title: Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics.
abstract: BACKGROUND
  Adolescent HPV vaccination in minority and low income populations with high cervical cancer incidence and mortality could reduce disparities. Safety-net primary care clinics are a key delivery site for improving vaccination rates in these populations.
  
  
  OBJECTIVE
  To examine prevalence of HPV initiation (≥ 1 dose), completion (receipt of dose 3 within 12 months of initiation), and receipt of 3 doses in four safety-net clinics as well as individual-, household-, and clinic-level correlates of initiation.
  
  
  METHODS
  We used multilevel modeling to investigate HPV initiation among 700 adolescent females who sought primary care in four safety-net clinics in Dallas, Texas from March 2007 to December 2009. Data were abstracted from patients' paper and electronic medical records.
  
  
  RESULTS
  HPV vaccine uptake varied significantly by clinic. Across clinics, initiation was 36.6% and completion was 39.7% among those who initiated. In the total study population, only 15.7% received all three doses. In multivariate, two-level logistic regression analyses, initiation was associated with receipt of other adolescent vaccines, influenza vaccination in the year prior to data abstraction, being sexually active, and having more chart documentation (presence of health maintenance questionnaire and/or immunization record). There was no association between initiation and age, race/ethnicity, or insurance status.
  
  
  CONCLUSIONS
  In four urban safety-net clinics, HPV initiation rates paralleled 2008 national rates. The correlation of HPV initiation with other adolescent vaccines underscores the importance of reviewing vaccination status at every health care visit. HPV vaccine uptake in safety-net clinics should continue to be monitored to understand impact on cervical cancer disparities.
authors: Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390-9066, United States. jasmin.tiro@utsouthwestern.edu
authors: Jasmin A
authors: JA
authors: Tiro
authors: Sandi L
authors: SL
authors: Pruitt
authors: Corinne M
authors: CM
authors: Bruce
authors: Donna
authors: D
authors: Persaud
authors: May
authors: M
authors: Lau
authors: Sally W
authors: SW
authors: Vernon
authors: Jay
authors: J
authors: Morrow
authors: Celette Sugg
authors: CS
authors: Skinner
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D005191:Family Characteristics; D005260:Female; D052689:Gammapapillomavirus / Q000276:immunology; D054625:Healthcare Disparities; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology; D011320:Primary Health Care; D013781:Texas; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines