title: Do parental education and income matter? A nationwide register-based study on HPV vaccine uptake in the school-based immunisation programme in Norway.
abstract: OBJECTIVE
  Vaccine against human papillomavirus (HPV) has been offered free of charge to all 12-year-old girls in Norway since 2009. Nevertheless, the uptake of HPV vaccine is lower than for other childhood vaccines. The aim of this study was to examine whether parental education and income are associated with initiation and completion of HPV vaccination.
  
  
  METHODS
  Nationwide register-based study.
  
  
  METHODS
  Publicly funded childhood immunisation programme in Norway.
  
  
  METHODS
  91,405 girls born between 1997 and 1999 and registered in the Norwegian Central Population Registry were offered HPV vaccine during the first 3 programme years. Of these, 84,139 had complete information on all variables and were included in the study.
  
  
  METHODS
  Information on HPV-vaccination status was obtained from the Norwegian Immunisation Registry. Data on socioeconomic factors were extracted from Statistics Norway. Risk differences (RDs) and CIs were estimated with Poisson regression.
  
  
  RESULTS
  In the study sample, 78.3% received at least one dose of HPV vaccine and 73.6% received all three doses. High maternal education was significantly associated with lower probability of initiating HPV vaccination (multivariable RD=-5.5% (95% CI -7.0% to -4.0%) for highest compared with lowest education level). In contrast, high maternal income was significantly associated with higher probability of initiating vaccination (multivariable RD=10.1% (95% CI 9.0% to 11.3%) for highest compared with lowest quintile). Paternal education and income showed similar, but weaker, associations. The negative association between education and initiation was only seen for incomes below the median value.
  
  
  CONCLUSIONS
  In spite of the presumably equal access to HPV vaccine in Norway, we found socioeconomic disparities in vaccine uptake. More studies are needed to explain the underlying factors responsible for the observed socioeconomic differences. Insight into these factors is necessary to target information and increase vaccination coverage to ultimately reduce HPV-related disease across socioeconomic barriers.
authors.affiliation: Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Berit
authors.initials: B
authors.lastname: Feiring
authors.affiliation: Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Ida
authors.initials: I
authors.lastname: Laake
authors.affiliation: Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Tor
authors.initials: T
authors.lastname: Molden
authors.affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Inger
authors.initials: I
authors.lastname: Cappelen
authors.affiliation: Institute Management and Staff, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Siri E
authors.initials: SE
authors.lastname: Håberg
authors.affiliation: Institute Management and Staff, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Magnus
authors.affiliation: Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Ólöf Anna
authors.initials: ÓA
authors.lastname: Steingrímsdóttir
authors.affiliation: Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Bjørn Heine
authors.initials: BH
authors.lastname: Strand
authors.affiliation: Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Stålcrantz
authors.affiliation: Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Lill
authors.initials: L
authors.lastname: Trogstad
mesh_terms: D000328:Adult; D002648:Child; D004522:Educational Status; D005220:Fathers; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007182:Income; D008297:Male; D009035:Mothers; D009664:Norway; D009679:Nuclear Family; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000517:prevention & control / Q000821:virology; D053918:Papillomavirus Vaccines; D010290:Parents; D010342:Patient Acceptance of Health Care; D012042:Registries; D012574:Schools; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014611:Vaccination; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: EPIDEMIOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH