Primary Submission Category: Health care/services
Drivers of Variation in Human Papillomavirus Vaccination Rates among Adolescent Dependents within the Military Health System
Authors: Joel Segel, Mark Ramos, Nicholas Zaorsky, Eugene Lengerich, Guangqing Chi, Alison Chetlen, Patrick Luan, William Calo,
Presenting Author: Joel Segel*
Purpose
To estimate the relative importance of family and provider factors in explaining geographic variation of HPV vaccination among adolescent dependents within the Military Health System (MHS).
Methods
Using 2007-2019 MHS Data Repository Data, we identified a sample of adolescent dependents of military service members who were continuously enrolled in TRICARE from age 9 to 13, 15, or 17 depending on outcome; and who had not been vaccinated by age 11. We estimated Kaplan-Meier curves of vaccination rates and estimated the effect of parent factors (rank, service branch) and catchment area factors (average per capita spending and fraction of care purchased from the private sector). We also used the random nature of military family moves to disentangle the relative importance of family and provide factors in explaining the observation variation in HPV vaccination rates. Specifically, we estimated the likelihood of adolescents unvaccinated at age 11 who moved from catchment areas with low (or high) vaccination rates to catchment areas with high (or low) vaccination rates as well as the impact of multiple moves on subsequent HPV vaccination rates.
Results
HPV vaccination rates were lower among adolescents of parents with more senior rank. Adolescents moving from lower HPV vaccination rate catchment areas to higher HPV vaccination rate catchment areas were significantly more likely to become vaccinated emphasizing the importance of provider factors in explaining variation in HPV vaccination. Adolescents experiencing multiple moves were significantly less likely to become vaccinated.
Conclusions
Adolescents who experience the disruption from multiple moves during adolescence are significantly less likely to receive HPV vaccination. Provider factors explain much of the variation in adolescent HPV vaccination rates within the MHS. Understanding successful approaches of high HPV vaccination catchment areas; and targeting interventions to families experiencing multiple moves during adolescence is critical to improving HPV vaccination within the MHS.