title: Human papillomavirus vaccination history among women with precancerous cervical lesions: disparities and barriers.
abstract: OBJECTIVE
  To estimate racial, ethnic, and socioeconomic differences in human papillomavirus (HPV) vaccination history among women aged 18-27 years with precancerous cervical lesions diagnosed, barriers to vaccination, and timing of vaccination in relation to the abnormal cytology result that preceded the diagnosis of the cervical lesion.
  
  
  METHODS
  High-grade cervical lesions are reportable conditions in Connecticut for public health surveillance. Telephone interviews and medical record reviews were conducted during 2008-2010 for women (n=269) identified through the surveillance registry.
  
  
  RESULTS
  Overall, 43% of women reported history of one or more doses of HPV vaccine. The mean age at vaccination was 22 years. Publicly insured (77%) and uninsured (85%) women were more likely than privately insured women (48%) to report no history of vaccination (P<.05). Among unvaccinated women, being unaware of HPV vaccine was reported significantly more often among Hispanics than non-Hispanics (31% compared with 13%, P=.02) and among those with public or no insurance compared with those with private insurance (26% and 36% compared with 6%, P<.05 for both). The most commonly reported barrier was lack of provider recommendation (25%). Not having talked to a provider about vaccine was reported significantly more often among those with public compared with private insurance (41% compared with 18%, P<.001). Approximately 35% of women received vaccine after an abnormal cytology result; this occurred more frequently among African American women compared with white women (80% compared with 30%, P<.01).
  
  
  CONCLUSIONS
  Catch-up vaccination strategies should focus on provider efforts to increase timely coverage among low-income and minority women.
authors.affiliation: Yale School of Public Health and Connecticut Emerging Infections Program, New Haven, Connecticut 06520, USA.
authors.forename: Niti R
authors.initials: NR
authors.lastname: Mehta
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Julian
authors.forename: James I
authors.initials: JI
authors.lastname: Meek
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Sosa
authors.forename: Alyssa
authors.initials: A
authors.lastname: Bilinski
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Markowitz
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
chemical_list: D053918:Papillomavirus Vaccines