title: In a safety net population HPV4 vaccine adherence worsens as BMI increases.
abstract: OBJECTIVE
  Obesity adversely inhibits antibody response to vaccination. Three doses of HPV4 may or may not provide adequate long term protection against HPV 16/18 in obese females. The aim of this study was to determine whether adherence to HPV4 vaccination in a safety net population was reduced with increasing body mass index (BMI).
  
  
  METHODS
  We designed a historical prospective study evaluating the number and dates of HPV4 dosing that occurred from July 1, 2006 through October 1, 2009 by the demographic characteristics of the 10-26 year old recipient females. The defined dosing intervals were adapted from the literature and obesity categories were defined by the WHO.
  
  
  RESULTS
  1240 females with BMI measurements received at least one dose of HPV4; 38% were obese (class I, II and III) and 25% were overweight. Females with normal BMI received on-time triplet dosing significantly more often than did the obese class II and III females (30% vs. 18%, p<0.001). Obese class II/III females have a significant 45% less chance of completing the on-time triplet HPV4 series than normal women (OR = 0.55, 95% CI: 0.37, 0.83). Pregnancy history has a significant influence on BMI and HPV4 dosing compliance in this safety net population where 71% had been gravid. Hispanic females were less likely to complete HPV4 dosing regardless of BMI (aOR = 0.39, 95% CI: 0.16, 0.95).
  
  
  CONCLUSIONS
  Obesity, as well as gravidity and Hispanic race, are risk factors for lack of HPV4 vaccine adherence among young females in a safety net population.
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America; Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America; Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Diane M
authors: DM
authors: Harper
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Britney M
authors: BM
authors: Else
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Mitchell J
authors: MJ
authors: Bartley
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Anne M
authors: AM
authors: Arey
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Angela L
authors: AL
authors: Barnett
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Beth E
authors: BE
authors: Rosemergey
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Christopher A
authors: CA
authors: Paynter
authors: Department of Obstetrics and Gynecology, Radboud University, Nijmegen, the Netherlands.
authors: Inge
authors: I
authors: Verdenius
authors: Hampshire College, Amherst, Massachusetts, United States of America.
authors: Sean M
authors: SM
authors: Harper
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: George D
authors: GD
authors: Harris
authors: Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Jennifer A
authors: JA
authors: Groner
authors: Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Gerard J
authors: GJ
authors: Malnar
authors: Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Jeffrey
authors: J
authors: Wall
authors: Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America.
authors: Aaron J
authors: AJ
authors: Bonham
mesh_terms: D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000276:immunology*; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D009765:Obesity; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D010349:Patient Compliance; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines