OBJECTIVES: We sought to identify trends in the main reasons United States parents of unvaccinated children gave for not intending to vaccinate their adolescent children against HPV from 2010 to 2020. As interventions designed to increase vaccine uptake have been implemented across the United States, we predicted that reasons for hesitancy have changed over this period. METHODS: We analyzed data from the 2010 to 2020 National Immunization Survey-Teen, which included 119 695 adolescents aged 13 to 17 years. Joinpoint regression estimated yearly changes in the top five cited reasons for not intending to vaccinate using annual percentage changes. RESULTS: The five most frequently cited reasons for not intending to vaccinate included “not necessary,” “safety concerns,” “lack of recommendation,” “lack of knowledge,” and “not sexually active.” Overall, parental HPV vaccine hesitancy decreased by 5.5% annually between 2010 and 2012 and then remained stable for the 9-year period of 2012 through 2020. The proportion of parents citing “safety or side effects” as a reason for vaccine hesitancy increased significantly by 15.6% annually from 2010 to 2018. The proportion of parents citing “not recommended,” “lack of knowledge,” or “child not sexually active” as reasons for vaccine hesitancy decreased significantly by 6.8%, 9.9%, and 5.9% respectively per year between 2013 and 2020. No significant changes were observed for parents citing “not necessary.” CONCLUSIONS: Parents who cited vaccine safety as a reason for not intending to vaccinate their adolescent children against HPV increased over time. Findings support efforts to address parental safety concerns surrounding HPV vaccination.

It is unclear how the COVID-19 pandemic impacted human papillomavirus (HPV) vaccine uptake and which sociodemographic groups may have been most impacted. We aimed to assess differences in HPV vaccine uptake (initiation and completion) before and during the pandemic in the United States. We conducted a cross-sectional study using data from the 2019 to 2020 National Immunization Surveys – Teen (NIS-Teen), comparing vaccine initiation and completion rates in 2019 vs. 2020, based on confirmed reports by a healthcare provider. Weighted logistic regression analysis estimated odds of vaccine initiation and completion for both adolescent and parental characteristics. There were 18,788 adolescents in 2019 and 20,162 in 2020. There was 3.6% increase in HPV vaccine initiation (71.5% vs. 75.1%) and a 4.4% in completion (54.2% vs. 58.6%) rates from 2019 to 2020. In 2020, Non-Hispanic White teens were significantly less likely to initiate (aOR = 0.62, 95% CI: 0.49, 0.79) and complete (aOR = 0.71, 95% CI: 0.58, 0.86) vaccine uptake compared with non-Hispanic Black teens. Additionally, teens who lived above the poverty line were also less likely to initiate HPV vaccination (aOR = 0.63, 95% CI: 0.49, 0.80) or complete them (aOR = 0.73, 95% CI: 0.60, 0.90), compared to those who lived below the poverty line. During the COVID-19 pandemic in 2020, some historically advantaged socioeconomic groups such as those living above the poverty line were less likely to receive HPV vaccine. The impact of the pandemic on HPV vaccine uptake may transcend traditional access to care factors.

Background: While there has been increase in the uptake of the human papillomavirus (HPV) vaccine, current vaccine rate fell short of the Healthy People 2020 target. The Centers for Disease Control and Prevention (CDC) recommends that the vaccine be routinely administered to children between 11 and 12 years and could begin as early as 9 years of age. However, it is unclear to what extent the CDC’s guideline-recommended age of HPV vaccine uptake is followed. Objective: To test the hypothesis that HPV vaccine uptake is more likely at an older age in the United States rather than the CDC recommended age of 11-12 years. Methods: We analyzed the 2017-2020 nationally representative, cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) for respondents between 9 and 17 years of age, grouped as 9-10 years, 11-12 years, and 13-17 years. Outcome of interest was age of HPV vaccine uptake (initiation and completion), based on the above age groups. We estimated odds of vaccine uptake by age, using logistic regression models, and adjusted for covariates, including sex, race/ethnicity, income, and healthcare access. Results: There were 2,584 participants in our study. However, while 22% were aged 9-10, only 5.7% in this age group had initiated the vaccine. In crude analysis, there was a significant difference in in age of vaccine uptake (both initiation and completion) across age groups (p < .0001). After adjusting for covariates, we found significant associations between age and HPV vaccine uptake. Compared to participants aged 11-12 years, adolescents aged 13-17 years had over double the odds of initiating (aOR = 2.57; 95% CI 1.88, 3.51) or completing (aOR = 2.67; 95% CI 1.76, 4.06) the HPV vaccine series. However, younger individuals between 9-10 years were less likely to initiate (aOR = 0.14; 95% CI 0.09, 0.22) or complete the vaccine series (aOR = 0.19; 95% CI 0.09, 0.37). Conclusions: While the CDC recommends HPV vaccine uptake between 11-12 years of age and as early as 9 years, individuals are significantly more likely to receive the vaccine as adolescents, and less likely to receive the vaccine between 9-10 years of age. Future studies will determine patients vs. provider factors driving this difference in recommended age of vaccine uptake compared to reported age of uptake. Citation Format: Trinity Casimir, Marian F. Talip, Dina K. Abouelella, Mrudula Nair, Daniel J. Rocke, Tammara L. Watts, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Differences in guideline-recommended age of human papillomavirus (HPV) vaccine initiation and completion in the United States. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P018.

Introduction: Hospitals and private healthcare facilities are the primary setting for administering the human papillomavirus (HPV) vaccine. A goal of the President's Cancer Panel on HPV vaccination is to maximize access to vaccination services through expansion of alternative settings for receiving the HPV vaccine, such as in public health settings, schools and pharmacies. It is unclear whether utilization of these alternative settings for HPV vaccination is increasing, and which factors are associated with accessing these alternative avenues. Methods: In a cross-sectional analysis, we utilized the National Immunization Survey-Teen data from 2014 to 2020 (n = 59,140) to describe trends and factors associated with HPV vaccine uptake in private, public, and alternative settings. We calculated average annual percent change (AAPC) between 2014 and 2020, estimating the proportion of HPV vaccine across settings. Using multinomial logistic regression, we estimated the odds of receipt of HPV vaccine in public health settings and other alternative settings compared to private healthcare settings, adjusting for sociodemographic covariates. Results: We found a non-significant decrease in proportion of individuals receiving vaccines at public health settings (17.7% in 2014 vs. 13.5% in 2020; AAPC = -3.2), and a non-significant increase in private healthcare settings (79.2% in 2014 vs. 83.9% in 2020; AAPC = 0.6). We also found a non-significant decrease in the proportion of individuals receiving vaccines in alternative settings such as schools and pharmacies (3.1% in 2014 and 2.6% in 2020; AAPC = -0.9). Adjusted multinomial logistic regression analyses found several sociodemographic/socioeconomic factors associated with receiving HPV vaccine at public health facilities versus private/hospital settings. The log odds of receiving vaccinations at a public facility vs. a private facility increases almost four times moving from above poverty (earning≥ $75,000) to below poverty (aOR = 3.74; 95% CI 3.06, 4.57). The log odds of receiving HPV vaccines at a public facility compared to a private facility decreased by 26% for White teenagers vs. Black teenagers (aOR = 0.74; 95% CI 0.64, 0.86), and by 24% (aOR = 0.76; 95% CI 0.58, 0.98) for log odds of receiving vaccine at alternative settings for White teenagers vs. Black teenagers. There was also an association between educational level and log odds of receiving vaccines at a public facility (high school or less vs. college graduate aOR = 0.38; 95% CI 0.31, 0.46), and people without physician recommendations were significantly more likely to receive vaccines at public versus private settings (aOR = 1.71, 95% CI 1.41, 2.08). Conclusions: Sociodemographic and socioeconomic factors such as race, poverty, education, and access to physician HPV recommendations are all associated with receiving the HPV vaccine at public health facilities versus private settings. This information is important in targeting increased vaccine uptake among individuals with less access to care due to these factors. Citation Format: Melissa Christina White, Oyomoare L. Osazuwa-Peters, Dina K. Abouelella, Justin M. Barnes, Eric Adjei Boakye, Trinitia Y. Cannon, Tammara L. Watts, Nosayaba Osazuwa-Peters. Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A130.

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Background: Over 90% of Human papillomavirus (HPV)-associated cancers could be prevented with the HPV vaccination; yet vaccine uptake remains suboptimal. Awareness that HPV causes several cancers has been shown to improve HPV vaccination uptake. While several efforts to increase HPV-associated diseases awareness as a way to improve vaccine uptake have been made, it is unclear if these efforts have resulted in increased HPV-associated cancers awareness over the years. We examined the awareness of the link between HPV and HPV-associated cancers between 2014 and 2020 in the US. Methods: We used the Health Information National Trends Survey (HINTS) data from 2014 (HINTS 4 cycle 4) to 2020 (HINTS 5 cycle 4). HINTS is a nationally representative survey of adults aged ≥18 in the civilian non-institutionalized US population. HPV-associated cancer awareness was assessed with the question “Do you think HPV can cause i) anal ii) cervical iii) oral and iv) penile cancers”. Responses were “yes”, “no” and “not sure”. Weighted prevalence estimates and corresponding 95% CIs were calculated for all four HPV-associated cancer awareness questions at each timepoint. Results: There were five timepoints included in the study: HINTS 4 cycle 4 (2014, n=2239), HINTS 5 cycle 1 (2017, n=2034), HINTS 5 cycle 2 (2018, n=2050), HINTS 5 cycle 3 (2019, n=2270), and HINTS 5 cycle 4 (2020, n=2340). Awareness of the link between HPV and cervical cancer was high (77.6% in 2014) but decreased by 7.4% between 2014 and 2020 (Table). However, awareness of the link between HPV and anal, oral, and penile cancers was low (around 30% for each cancer type) and remained stable between 2014 and 2020 (Table). Conclusions: Awareness of the link between HPV and HPV-associated cancers has remained steady for anal, oral and penile cancers or declined slightly for cervical cancer over time. There is a need for implementing novel and target interventions to increase awareness and counteract HPV vaccine disinformation. Awareness of the link between HPV and HPV-associated cancers Weighted percent (95% CI) H4C4 (2014) H5C1 (2017) H5C2 (2018) H5C3 (2019) H5C4 (2020) HPV cause anal cancer 27.9 (24.7, 31.1) 29.1 (25.7, 32.5) 24.4 (21.3, 27.5) 28.8 (25.5, 32.0) 27.4 (24.3, 30.6) HPV cause oral cancer 31.2 (28.0, 34.4) 30.7 (27.6, 33.9) 27.0 (23.8, 30.1) 31.1 (27.8, 34.4) 29.5 (26.3, 32.8) HPV cause penile cancer 30.3 (27.1, 33.6) 31.2 (28.1, 34.2) 29.2 (25.9, 32.5) 32.0 (28.7, 35.4) 28.4 (25.1, 31.6) HPV cause cervical cancer 77.6 (74.9, 80.3) 81.5 (78.9, 84.2) 75.0 (72.0, 78.1) 73.9 (70.4, 77.3) 70.2 (67.0, 73.5) Citation Format: Eric Adjei Boakye, Mrudula Nair, Joel Fokom Domgue, Dina K. Abouelella, Heena Y. Khan, Nosayaba Osazuwa-Peters. Over 10 years since HPV vaccine approval, awareness of the causal link between HPV and HPV-associated cancers remains low in the US [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4210.

10550 Background: Despite the human papillomavirus (HPV) vaccine being safe and effective at preventing HPV-associated cancers, vaccine update is low. Several factors have been identified as barriers to getting the HPV vaccine. However, it is unclear if these factors have changed since vaccine licensure. Thus, we assessed trends in the top five reasons for vaccine hesitancy in the last decade in the US. Methods: We analyzed the 2010–2019 National Immunization Survey–Teen data, a national survey representative of the US adolescent population. We identified adolescents (n = 16,383) who had received zero dose of the HPV vaccine (unvaccinated adolescents). Parents of unvaccinated adolescents were asked how likely they will vaccinate their child in the next 12 months. Parents who responded with “not too likely”, “not likely at all” or “not sure/don’t know” (vaccine hesitant) were asked what the reasons are for their hesitancy. The top five most cited reasons for vaccine hesitancy: “not necessary”, “safety concerns”, “lack of recommendation”, “lack of knowledge”, and “not sexually active” were included in the study. Joinpoint regression estimated yearly increases/decreases in these reasons using annual percent changes. Results: The proportion of unvaccinated adolescents whose parents cited “safety concerns”’ as a reason for HPV vaccine hesitancy decreased from 2010 to 2012 but increased significantly from 2012 to 2019 at an average of 8.6% annually. The proportion of unvaccinated adolescents whose parents cited “not sexually active” as a reason for HPV vaccine hesitancy decreased on average by 33.1% from 2010-2012 and then at an average of 11.5% in the remaining years. The proportion of unvaccinated adolescents whose parents cited “not necessary” as a reason for HPV vaccine hesitancy decreased from 2010-2012 but significantly decreased by an average of 11.0% yearly from 2012-2019. The proportion of unvaccinated adolescents whose parents cited “lack of recommendation” and “lack of knowledge” as reasons for HPV vaccine hesitancy decreased over the 10-year period though not statistically significant. Conclusions: There was a decrease in most of the reasons cited by parents for vaccine hesitancy except vaccine safety which has been increasing from 2012 to 2019. These findings suggest an urgent need to combat the rising sentiment of safety concerns among parents of unvaccinated children to increase HPV vaccine confidence.