title: Factors related to vaccine uptake by young adult women in the catch-up phase of the National HPV Vaccination Program in Australia: Results from an observational study.
abstract: BACKGROUND
  Australia commenced a publically-funded, National Human Papillomavirus (HPV) Vaccination Program in 2007 with a two year catch-up phase for females aged 12-26 years.
  
  
  OBJECTIVE
  To identify the factors associated with the uptake of the HPV vaccine (which has a recommended 3-dose schedule in Australia) by young adult women vaccinated by general practitioners and community-based programs within the catch-up phase.
  
  
  METHODS
  1139 women who were eligible to receive the free HPV vaccine during the catch-up period were recruited in 2008-2009 (age 20-29 years at recruitment), in New South Wales, after having a normal (negative) cervical smear result recorded on the NSW Pap Test Register. Participants completed a self-administered questionnaire providing information on vaccination status, and sociodemographic and other factors.
  
  
  RESULTS
  Overall, 880 (77%) women reported receiving ≥ 1 dose of the vaccine and 777 women (68%) reported receiving ≥ 2 doses. In multivariable analysis (adjusting for the period for which each woman was eligible for free HPV vaccination), uptake of ≥ 1 dose of the vaccine was significantly associated with being born in Australia (p < 0.01), being single (p = 0.02), being nulliparous (p < 0.01), living in a higher socioeconomic status area (p-trend = 0.03), living in more remote areas (p = 0.03), drinking alcohol (p < 0.01) and using hormonal contraceptives (p < 0.01). Although vaccinated women were more likely to have fewer sexual partners than unvaccinated women (p-trend = 0.02), they were also more likely to report a prior sexually transmitted infection (STI) (p = 0.03). Similar factors were associated with receiving ≥ 2 doses.
  
  
  CONCLUSIONS
  In this group, women living in higher socioeconomic status areas were more likely to be vaccinated against HPV in the catch-up phase of the national program. Although vaccinated women tended to have fewer sexual partners, they also reported prior STIs, which may be a marker of increased risk of prior exposure to HPV. The findings of this study reinforce the continuing need to prioritise equitable delivery of vaccination to various population subgroups.
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: k.canfell@unsw.edu.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.
authors.forename: Sam
authors.initials: S
authors.lastname: Egger
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.
authors.forename: Louiza S
authors.initials: LS
authors.lastname: Velentzis
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Jessica Darlington
authors.initials: JD
authors.lastname: Brown
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
authors.affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Banks
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Freddy
authors.initials: F
authors.lastname: Sitas
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D032541:Mass Vaccination; D009313:National Health Programs / Q000706:statistics & numerical data*; D009517:New South Wales; D065006:Papanicolaou Test; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical smears; HPV vaccine; Inequality; Sexual behaviour; Socioeconomic status