Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics
Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics
复制标题
DOI：
10.1016/j.vaccine.2011.11.031
复制
发表时间：
2012-03-16
期刊：
影响因子：
5.5
通讯作者：
Skinner, Celette Sugg
中科院分区：
文献类型：
--
作者：
Tiro, Jasmin A.;Pruitt, Sandi L.;Skinner, Celette Sugg
背景：在宫颈癌发病率和死亡率高的少数民族和低收入人群中接种青少年HPV疫苗可以减少差异。安全网初级保健诊所是提高这些人群疫苗接种率的关键交付地点。目的：检查HPV起始（>= 1剂）、完成（起始12个月内接受3剂）和在4个安全网诊所接受3剂的流行情况，以及起始的个人、家庭和临床水平的相关因素。方法：我们使用多层次模型调查2007年3月至2009年12月在德克萨斯州达拉斯市四个安全网诊所寻求初级保健的700名青春期女性的HPV发病情况。数据摘自患者的纸质和电子病历。结果：不同临床对HPV疫苗的摄取差异显著。在所有诊所中，启动率为36.6%，完成率为39.7%。在整个研究人群中，只有15.7%的人接受了所有三种剂量。在多变量、双水平逻辑回归分析中，开始接种与接受其他青少年疫苗、在数据提取前一年接种流感疫苗、性活跃和有更多图表文件（存在健康维持问卷和/或免疫记录）相关。起始与年龄、种族/民族或保险状况之间没有关联。结论：在四个城市安全网诊所中，HPV起始率与2008年全国发病率相似。HPV启动与其他青少年疫苗的相关性强调了在每次卫生保健访问时审查疫苗接种状况的重要性。应继续监测安全网诊所的HPV疫苗接种情况，以了解对宫颈癌差异的影响。(C) 2011 Elsevier Ltd.版权所有。
Background: Adolescent HPV vaccination in minority and low income populations with high cervical cancer incidence and mortality could reduce disparities. Safety-net primary care clinics are a key delivery site for improving vaccination rates in these populations.Purpose: To examine prevalence of HPV initiation (>= 1 dose), completion (receipt of dose 3 within 12 months of initiation), and receipt of 3 doses in four safety-net clinics as well as individual-, household-, and clinic-level correlates of initiation.Methods: We used multilevel modeling to investigate HPV initiation among 700 adolescent females who sought primary care in four safety-net clinics in Dallas, Texas from March 2007 to December 2009. Data were abstracted from patients' paper and electronic medical records.Results: HPV vaccine uptake varied significantly by clinic. Across clinics, initiation was 36.6% and completion was 39.7% among those who initiated. In the total study population, only 15.7% received all three doses. In multivariate, two-level logistic regression analyses, initiation was associated with receipt of other adolescent vaccines, influenza vaccination in the year prior to data abstraction, being sexually active, and having more chart documentation (presence of health maintenance questionnaire and/or immunization record). There was no association between initiation and age, race/ethnicity, or insurance status.Conclusions: In four urban safety-net clinics, HPV initiation rates paralleled 2008 national rates. The correlation of HPV initiation with other adolescent vaccines underscores the importance of reviewing vaccination status at every health care visit. HPV vaccine uptake in safety-net clinics should continue to be monitored to understand impact on cervical cancer disparities. (C) 2011 Elsevier Ltd. All rights reserved.