Examining the Integrative Effects of Adolescent, Parent, Provider, and Practice Level Factors on Adolescents' HPV Vaccine Uptake across Six Asian American Subgroups

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PROJECT SUMMARY Human papillomavirus (HPV) is the most common form of sexually transmitted infection in the US, with approximately 79 million US individuals infected with HPV. The Advisory Committee on Immunization Practices (ACIP) recommends vaccine initiation between 11–12 years old, and it can be initiated as young as 9 years old. However, less than half of 13- to 17-year-old girls and less than one-third boys were fully vaccinated against HPV, much lower than the80% goal of Healthy People 2030. Significant barriers to HPV vaccination have been identified in 1) missed clinical opportunities due to provider and practice-related barriers, 2) low parental awareness, and 3) limited access to HPV vaccination services due to sociocultural and financial barriers. Asian Americans are disproportionally affected by HPV and HPV related conditions. Despite public health efforts, HPV vaccination rates were suboptimal in Asian American adolescents. Regional data showed low awareness of HPV vaccine and low vaccination rates in Chinese, Filipino, Japanese, Asian Indian, Korean, and Vietnamese subgroups. However, literature of the multilevel social determinants of HPV vaccine in Asian Americans is limited. Identifying high-risk groups and the multilevel mechanisms of HPV vaccine uptake are crucial in reducing disparities and increasing HPV vaccination rates in Asian American adolescents. This study will be the first study to use a nationally representative sample to examine the integrative effects of adolescent, parent, provider, and practice level factors in six Asian American subgroups. The proposed study will leverage the existing data from the 2010–2019 National Immunization Survey-Teen (NIS- Teen), the gold standard of US vaccination data. The study sample will include 6,019 boys and girls aged 13– 17 of Chinese (1,613), Filipino (1,383), Japanese (834), Indian (800), Korean (786), and Vietnamese (603) ethnicity. The specific aims are, Aim 1: to examine the integrative effects of adolescent, parent, provider, and practice level factors in their association with adolescent's HPV vaccine initiation and completion among six Asian American subgroups. Aim 2: to investigate the parent-reported reasons for delay or refusal of HPV vaccine for adolescents across six Asian American subgroups. Each specific aim addresses a unique research question that links practice/provider characteristics with adolescents/parent level factors, and together provide a comprehensive understanding of the social mechanisms of HPV vaccine uptake in Asian adolescents. Findings of this proposed study will provide subgroup-specific epidemiological data, guide the improvement of clinical practices, and inform the development of evidence-based strategies to reduce missed opportunities and improve adolescent vaccination in Asian American adolescents.