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Role of Insurance, Income, and Affordability in Human Papillomavirus Vaccination
Nadereh Pourat, PhD; and Jenna M. Jones, MPH
Quality Care Opportunities: Refining Physician Performance Measurement in Ambulatory Care
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Role of Insurance, Income, and Affordability in Human Papillomavirus Vaccination

Nadereh Pourat, PhD; and Jenna M. Jones, MPH
Compared with insured adults, uninsured adults in California had less knowledge of the human papillomavirus vaccine and were less likely to be vaccinated.
Other studies have also found racial/ethnic differences in interest in vaccination,27-30 and our findings may reflect unmeasured factors such as social/cultural responses to professional recommendations or vaccine availability at usual source of care.31 Intentions were found to correlate highly with actual vaccination among Latino and African American parents.32 The higher likelihood of vaccine initiation among Latino parents may reflect the impact of targeted vaccination programs in some communities.6,32

Improvement in HPV vaccination rates among eligible populations (eg, older age eligible women, college-educated individuals, young daughters of married parents) is most effectively accomplished by addressing differences among these groups in knowledge of the vaccine, completion of the series, and initiating the vaccine at an early age.33,34 Successful outreach should also emphasize the importance of vaccination despite religious or moral beliefs surrounding sexual activity among young females, alleviating skepticism about the effectiveness of the vaccine,33,34 changing normative beliefs about the society’s approval of the decision to vaccinate,12 and framing the importance of vaccination to different populations.35

The positive relationship of receipt of a flu shot to parental HPV knowledge, vaccine initiation by adults and parents, and interest in HPV vaccination may indicate better effectiveness of advertising or educational campaigns among those who are prevention oriented and have a higher propensity for preventive care. The state-by-state variations in population and healthcare system characteristics indicates that policy solutions to improve HPV vaccination should vary. For example, the racial/ethnic diversity of the California population indicates the need for multiple tailored and culturally competent outreach strategies that are not needed in states with lower diversity. Mandatory HPV vaccination is another strategy to increase vaccination rates and is proposed in 41 states; Virginia and District of Columbia have enacted this law.36 However, public education campaigns to instill the prevention orientation are still needed and could be further reinforced in current attempts to increase delivery of preventive and primary care under the medical home model. Also, efforts to improve HPV vaccination rates should focus on barriers not examined here, such as restrictions in availability of the vaccine in clinical settings and consent law requirements.

Author Affiliations: From University of California Los Angeles Center for Health Policy Research (NP), Department of Health Services (NP, JMJ), University of California Los Angeles, Los Angeles, CA.

Funding Source: None.

Author Disclosures: The authors (NP, JMJ) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (NP); acquisition of data (NP, JMJ); analysis and interpretation of data (NP, JMJ); drafting of the manuscript (NP, JMJ); critical revision of the manuscript for important intellectual content (NP, JMJ); statistical analysis (NP, JMJ); provision of study materials or patients (NP); obtaining funding (NP); administrative, technical, or logistic support (NP); and supervision (NP).

Address correspondence to: Nadereh Pourat, PhD, UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Ste 1550, Los Angeles, CA 90024. E-mail:
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