Rates and Predictors of Human Papillomavirus Vaccination among Young Men Recruited from Urban Clinical and Community Settings

Background and Objective: Human papillomavirus (HPV) vaccination rates are suboptimal in young men, representing a missed opportunity to prevent cancers caused by HPV. Data about factors associated with vaccination over time are important to design interventions that improve vaccination rates. The aims of this study were to determine HPV vaccine initiation and completion rates in young men 13-26 years of age recruited from clinical and community settings from 2013-2014 and 2016-2017, and to determine factors associated with vaccination. Material and Methods: Men (N=747) were recruited from a hospital-based teen health center (THC), health department sexually transmitted disease clinic (HDSTD) and the general community. Participants completed a self-administered survey assessing demographic and behavioral factors. Vaccination status was determined using the electronic medical record and a statewide immunization registry. We determined vaccine initiation and completion rates, by recruitment site and year. We determined factors independently associated with vaccine initiation and completion, overall and stratified by recruitment year, using multivariable logistic regression. Results: Mean age was 21.2 years, 258 (34.5%) had initiated the vaccine series and 154 (20.8%) had completed it. Those recruited from the THC (vs. community and HDSTD) were more likely to initiate (71.3%, 23.2%, and 19.5%, respectively, p<.0001) and complete (50.7%, 11.7%, and 8.3%, p<.0001) the series. In multivariable analysis, variables associated with vaccine initiation were younger age (13-17 vs. 22-26 years: AOR 5.31), insurance plan (Private vs. Medicaid: OR 0.39; Medicaid vs. others: AOR 2.22), no cigarette smoking (no vs. yes: AOR 1.78) and recruitment site (THC vs. HDSTD: AOR 3.74; THC vs. community: AOR 3.01). Variables associated with vaccine completion were younger age (13-17 vs. 22-26 years: AOR 3.55; 18-21 vs. 22-26 years: AOR 4.26), insurance plan (Private vs. Medicaid: AOR 0.51; Medicaid vs. others: AOR 2.62), fewer lifetime female partners (1 vs. 2-10: AOR 2.55; 1 vs. 11+: AOR 2.23) and recruitment site (THC vs. HDSTD: AOR 4.99; THC vs. community: AOR 3.95). Conclusion: HPV vaccine initiation and completion rates were low among young men over the six years after vaccine recommendations for men. Men who reported behaviors that have been associated with a higher risk for HPV were less likely to be vaccinated. Interventions that improve access to a primary care medical home and insurance programs that cover vaccination costs may increase HPV vaccination rates in young men