title: Correlates of human papillomavirus vaccination rates in low-income, minority adolescents: a multicenter study.
abstract: BACKGROUND
  Low rates of human papillomavirus (HPV) vaccination in low-income, minority adolescents may exacerbate racial disparities in cervical cancer incidence.
  
  
  METHODS
  Using electronic medical record data and chart abstraction, we examined correlates of HPV vaccine series initiation and completion among 7702 low-income and minority adolescents aged 11-21 receiving primary care at one of seven medical centers between May 1, 2007, and June 30, 2009. Our population included 61% African Americans, 13% Caucasians, 15% Latinas, and 11% other races; 90% receive public insurance (e.g., Medicaid). We used logistic regression to estimate the associations between vaccine initiation and completion and age, race/ethnicity, number of contacts with the healthcare system, provider documentation, and clinical site of care.
  
  
  RESULTS
  Of the 41% of adolescent girls who initiated HPV vaccination, 20% completed the series. A higher proportion of girls aged 11-<13 (46%) and 13-<18 (47%) initiated vaccination than those aged 18-21 (28%). In adjusted analyses, receipt of other recommended adolescent vaccines was associated with vaccine initiation, and increased contact with the medical system was associated with both initiation and completion of the series. Conversely, provider failure to document risky health behaviors predicted nonvaccination. Manual review of a subset of unvaccinated patients' charts revealed no documentation of vaccine discussions in 67% of cases.
  
  
  CONCLUSIONS
  Fewer than half of low-income and minority adolescents receiving health maintenance services initiated HPV vaccination, and only 20% completed the series. Provider failure to discuss vaccination with their patients appears to be an important contributor to nonvaccination. Future research should focus on improving both initiation and completion of HPV vaccination in high-risk adolescents.
authors.affiliation: Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts 02118, USA. rebecca.perkins@bmc.org
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: Perkins
authors.forename: Susan B
authors.initials: SB
authors.lastname: Brogly
authors.forename: William G
authors.initials: WG
authors.lastname: Adams
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001900:Boston; D002648:Child; D015331:Cohort Studies; D003151:Community Health Centers; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data* / Q000639:trends; D016015:Logistic Models; D008484:Medicaid; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D030361:Papillomavirus Infections / Q000208:ethnology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010372:Pediatrics / Q000191:economics / Q000706:statistics & numerical data; D011203:Poverty / Q000208:ethnology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000517:prevention & control*; D000078329:Workforce
chemical_list: D053918:Papillomavirus Vaccines