title: Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data.
abstract: Human papillomavirus (HPV) vaccine 3-dose completion rates among adolescent females in the US are low. Missed opportunities impede HPV vaccination coverage.
  
  
  
  A population-based secondary data analysis of de-identified vaccination and demographic data from the Utah Statewide Immunization Information System (USIIS) was conducted. Records were included from 25,866 females ages 11-26 years at any time during 2008-2012 who received at least one of the following adolescent vaccinations documented in the USIIS: Tdap (Tetanus, Diphtheria, Pertussis), meningococcal, and/or influenza. A missed opportunity for HPV vaccination was defined as a clinical encounter where the patient received at least one adolescent vaccination, but not a HPV vaccine.
  
  
  
  Of 47,665 eligible visits, there were 20,911 missed opportunities (43.87%). Age group, race/ethnicity, and rurality were significantly associated with missed opportunity (p<0.0001). In a multivariable mixed-effects logistic regression model that included ethnicity, location and age, as fixed effects and subject as a random effect, Hispanics were less likely to have a missed opportunity than whites OR 0.59 (95% CI: 0.52-0.66), small rural more likely to have a missed opportunity than urban youth OR 1.8 (95% CI: 1.5-2.2), and preteens more likely than teens OR 2.4 (95% CI: 2.2-2.7).
  
  
  
  Missed clinical opportunities are a significant barrier to HPV vaccination among female adolescents. Interventions targeted at providers who serve patient groups with the highest missed opportunities are needed to achieve adequate protection from HPV-associated illnesses.
  
  
  
  This is one of the first studies to utilize state immunization information system data to assess missed opportunities for HPV vaccination.
authors.affiliation: University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT, 84112, USA; Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Kepka
authors.affiliation: University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT, 84112, USA; Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT 84112, USA; Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W Salt Lake City, UT 84116, USA; Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W Salt Lake City, UT 84116, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Spigarelli
authors.affiliation: University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT, 84112, USA; Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
authors.forename: Echo L
authors.initials: EL
authors.lastname: Warner
authors.affiliation: Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W Salt Lake City, UT 84116, USA.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Yoneoka
authors.affiliation: Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W Salt Lake City, UT 84116, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: McConnell
authors.affiliation: Utah Department of Health, Utah Statewide Immunization Information System, 288 N 1460 W Salt Lake City, UT 84116, USA.
authors.forename: Alfred
authors.initials: A
authors.lastname: Balch
mesh_terms: D000293:Adolescent; D000328:Adult; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007115:Immunization Schedule; D007252:Influenza Vaccines / Q000008:administration & dosage; D022401:Meningococcal Vaccines / Q000008:administration & dosage; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012042:Registries; D014589:Utah / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D007252:Influenza Vaccines; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines
keywords: HPV vaccine; adolescent; demographic factors; preventive medicine; registries