Regional variations in human papillomavirus prevalence across time in NHANES (2003-2014).

INTRODUCTION: The consequences of low human papillomavirus (HPV) vaccination in Census regions with higher incidence of cervical cancer may contribute to continued disparities. Our purpose was to evaluate regional variations in HPV prevalence across time. METHODS: Repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 2003-2014 were examined. Participants included females 14 to 34 years old who provided adequate vaginal samples for HPV DNA typing (N = 6387). Region of residence and HPV vaccination status associations with HPV prevalence were examined using chi-square and multivariable logistic regression. HPV types were grouped according to vaccine-type HPV (types 6, 11, 16, 18) and risk (high or low-risk). Time and vaccination status were included in subsequent models for post-licensure survey cycles (2007-2014) to assess their effects on observed associations. RESULTS: No decreases in vaccine-type HPV prevalence were found between the prevaccine cycles (2003-2006) and early post-licensure cycles (2007-2010, p > 0.05). Vaccine-type HPV prevalence decreased in late post-licensure years (2011-2014) compared to prevaccine years (2003-2006, p = 0.001). The highest prevalence of vaccine-type HPV occurred in the South (8.6%) and Midwest (8.6%), followed by the West (4.8%), and the Northeast (3.5%) in late post-licensure years. Lower odds of vaccine-type HPV across time in post-licensure survey cycles were found to be attributable to time, and more strongly to HPV vaccination. CONCLUSIONS: There were regional variations in vaccine-type HPV prevalence between prevaccine and post-licensure years. These decreases appeared to be at least partially attributable to HPV vaccination. Programs are needed to address geographical disparities in HPV vaccination.

Prevalence of Food Addiction Among Low-Income Reproductive-Aged Women.

BACKGROUND: Hyperpalatable foods (i.e., high in salt, sugar, or fat) have been shown to have addictive properties that may contribute to overeating. Prior studies conducted on food addiction behaviors are mostly based on white and middle-aged women. Data are not available, however, on reproductive-aged women from other races/ethnicities or low-income women. The purpose of this study was to examine the prevalence and correlates of food addiction among multiethnic women of low socioeconomic status. METHODS: We conducted a cross-sectional survey of health behaviors, including food addiction according to the Yale Food Addiction Scale (YFAS) between July 2010 and February 2011 among 18- to 40-year-old low-income women attending reproductive-health clinics (N = 1,067). RESULTS: Overall, 2.8% of women surveyed met the diagnosis of food addiction. The prevalence of food addiction did not differ by age group, race/ethnicity, education, income, or body mass index categories, tobacco and alcohol use, or physical activity. However, it did differ by level of depression (p < 0.01). The YFAS symptom count score significantly differed by race/ethnicity (p < 0.01) with black women having higher scores than Hispanic women. Racial differences were also observed among some of the YFAS symptoms. CONCLUSION: These findings demonstrated a low prevalence of food addiction among low-income, reproductive-aged women. Racial differences were observed in the YFAS symptom count score, but not in the overall prevalence of food addition. Additionally, women with food addiction had higher levels of depression than women without food addiction.

Correlates of Human Papillomavirus Vaccine Completion Among Adolescent Girl Initiators.

OBJECTIVE: To examine correlates of vaccine series completion among young adolescent US girls who initiated the human papillomavirus (HPV) vaccine. METHODS: We analyzed National Immunization Survey-Teens 2012 provider-verified data to examine correlates of HPV vaccine completion among 13- to 17-year-old girls who initiated HPV vaccine in 2012 (N = 4548). RESULTS: The weighted vaccine series completion rate among 13- to 17-year-old girl initiators was 66.7% (95% confidence interval [CI], 64.0-69.3). Adolescent girls who were older, residents of the Northeast (adjusted prevalence ratio [aPR], 1.36; 95% CI, 1.07-1.73), and had provider-verified seasonal influenza vaccination in the past year (aPR, 1.67; 95% CI, 1.32-2.11) and provider recommendation (aPR, 1.40; 95% CI, 1.10-1.77) were more likely to complete the 3-dose vaccine series. CONCLUSIONS: Parents of younger adolescent girls need to be educated about the importance of completing the 3-dose HPV vaccine series. Provider recommendation for the vaccine would also facilitate series completion.

Association between mother-child sexual communication and HPV vaccine uptake.

OBJECTIVE: To examine the association between mother-child communication about sex, sexually transmitted diseases (STDs), and contraception/condoms and HPV vaccine uptake by gender. METHODS: Women (n = 1372) with ≥ 1 child aged 9-17 years receiving care in reproductive health clinics in Southeast Texas were asked to complete a self-administered questionnaire between September 2011 and October 2013. RESULTS: The majority of mothers with ≥ 1 eligible daughter (n = 886) reported having talked about 'sex' (77.7%), 'STDs' (76.6%) and 'contraception' (73.2%) with their daughters. The respective figures for mothers with ≥ 1 son (n = 836) were 68.8%, 69.0% and 65.3%. Mothers who discussed sex, STDs, or contraception with their daughters compared to those who did not were more likely to report that their daughter initiated (≥ 1 dose) HPV vaccination after adjusting for confounders (all p < .05). Similarly, mother-son discussions about STDs or condoms, but not sex, were associated with HPV vaccine initiation for their sons compared to those who did not discuss these topics. These associations were not significant with regard to HPV vaccine completion (3 doses) for neither daughters nor sons. CONCLUSION: Mother-child communication on STDs and contraception/condoms is associated with HPV vaccine initiation, but not completion, among both daughters and sons.

Provider recommendation mediates the relationship between parental human papillomavirus (HPV) vaccine awareness and HPV vaccine initiation and completion among 13- to 17-year-old U.S. adolescent children.

OBJECTIVES: To examine the association between parental human papillomavirus (HPV) awareness and HPV vaccine initiation/completion based on 13- to 17-year-old US adolescent children and to explore whether these associations were mediated by provider recommendation. METHODS: We used publicly available National Immunization Survey-Teen 2011 data (11 236 adolescent girls and 12 328 boys). RESULTS: Weighted logistic regression analysis showed that parental HPV awareness and provider recommendation predicted HPV vaccine initiation and completion separately among both girls and boys, after adjusting for demographic and health care use variables. When provider recommendation and parental HPV awareness were entered in the model simultaneously, only provider recommendation was independently associated with HPV vaccine initiation and completion, demonstrating a mediation effect of provider recommendation. CONCLUSIONS: Future studies are needed to better understand why physicians may not provide a recommendation for the HPV vaccine as well as to identify strategies to improve providers' ability to effectively communicate their recommendations.

Level of nutrition knowledge and its association with weight loss behaviors among low-income reproductive-age women.

To examine influence of nutrition knowledge on weight loss behaviors among low-income reproductive-age women. We conducted a self-administered cross-sectional survey of health behaviors including socio-demographic characteristics, nutrition knowledge, and weight loss behaviors of 16-40 year old women (n = 1,057) attending reproductive health clinics located in Southeast Texas between July 2010 and February 2011. Multiple linear regression and multivariable logistic regression analyses were performed to identify correlates of nutrition knowledge and examine its association with various weight loss behaviors after adjusting for confounders. The mean nutrition knowledge score was low (5.7 ± 2.8) (possible score 0-15). It was significantly lower among African American women than whites (P < .001). Obese women (P = .002), women with high school enrollment/diploma (P = .030), and some college hours/degree (P < .001) had higher nutrition knowledge scores than their counterparts. The higher score of nutrition knowledge was significantly associated with higher odds of engaging in healthy weight loss behaviors: eating less food [odds ratio (OR) 1.12, 95% confidence interval (CI) 1.06-1.18], switching to foods with fewer calories (OR 1.10, 95% CI 1.04-1.16), exercising (OR 1.10, 95% CI 1.04-1.16), eating more fruits/vegetables/salads (OR 1.11, 95% CI 1.06-1.17) and less sugar/candy/sweets (OR 1.09, 95% CI 1.04-1.15). However, it was not associated with unhealthy weight loss behaviors, such as using laxatives/diuretics or inducing vomiting. Nutrition knowledge is low among reproductive-age women. An increase in nutrition knowledge may promote healthy weight loss behaviors.

Effect of the decision-making process in the family on HPV vaccination rates among adolescents 9-17 years of age.

The purpose of this study was to examine the relationship between human papillomavirus (HPV) vaccine uptake among adolescents aged 9-17 years and the decision-making process used by families in determining whether to vaccinate their children against HPV. A cross-sectional sample of women with at least one child aged 9-17 years (n = 1256) was recruited from 3 reproductive health clinics in Southeast Texas during 2011-2013. Self-administered survey included questions about the HPV vaccination decision-making process, HPV vaccine uptake (initiation and 3-dose series completion), and demographics. Among mothers with at least one 9 to 17-year-old daughter (n = 783), 40% independently decided whether or not to vaccinate their daughter against HPV, 22% involved their husbands/partners, and 31% their daughters. Only 7% of respondents reported other formats in the decision-making (husband/partner alone or daughter alone). Similarly, for women with at least one eligible son (n = 759), 39% decided alone, 30% with their husbands/partners, 24% with their sons, and 7% reported other formats. Among mothers with a daughter, those who made the decision independently were more likely to report that their daughters had initiated the HPV vaccine series (30%) compared with women who included their husbands/partners (10%) or daughters (20%) in the decision process or stated other types (18%) of decision making (P < 0.001). The respective figures for the completion of the entire series among daughters were 16%, 6%, 11%, and 11% (P = 0.012). Among mothers with a son, a similar scenario was observed for vaccine initiation (17%, 4%, 10%, and 0%, respectively) (P < 0.001) and completion (7%, 1%, 4%, and 0%, respectively) (P = 0.003). These associations remained significant after adjusting for confounder variables. Awareness programs to increase HPV vaccine uptake should include both parents and children, as all have an important role in deciding whether or not children will be vaccinated.

Correlates of human papillomavirus vaccine series completion among young adult female initiators.

Incomplete human papillomavirus (HPV) vaccination is a public health concern. The objective of this study was to examine the correlates of vaccine series completion among 18-26 year old US women using the Behavioral Risk Factor Surveillance System (BRFSS) data. Using BRFSS data collected during 2008-2010, we conducted multivariable logistic regression analysis to examine the correlates of HPV vaccine completion among HPV vaccine initiators. Among 656 women (18-26 years old) who initiated the HPV vaccine, the overall weighted vaccine series completion rate was 60.7%. It was 32.9%, 65.3%, and 69.9% in 2008, 2009, and 2010, respectively. Black and Hispanic women were less likely to complete the series compared with white women. Higher income, having a college degree and completion of the study in a more recent year were associated with higher completion rates. Thus, the reasons for HPV series non-completion may be multifactorial. Interventions targeting 18-26 year old female vaccine initiators with low income and education, and minority backgrounds may improve HPV vaccine series completion.

Nutritional and weight management behaviors in low-income women trying to conceive.

OBJECTIVE: To evaluate the nutritional habits and weight management strategies of women trying to conceive as compared with women not trying to conceive. METHODS: This was a cross-sectional survey of health behaviors including nutritional habits and weight management strategies of women aged 16-40 years who were low income, racially diverse, (n=1,711), and attending reproductive health clinics. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and various health behaviors after adjusting for demographic variables, gravidity, and obesity status. RESULTS: A total of 8.9% (n=153) of the participants stated they were trying to get pregnant. Women trying to conceive were more likely than those not trying to have participated in a number of unhealthy weight loss practices in the past year. These included taking diet pills, supplements, or herbs (13.5% compared with 8.8%; adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.11-3.49), using laxatives or diuretics or inducing vomiting (7.7% compared with 3.0%; adjusted OR 2.70, CI 1.23-5.91), and fasting for 24 hours (10.7% compared with 5.5%; adjusted OR 2.15, CI 1.03-4.51). There were no significant differences between the two groups in amount of exercise, current smoking status, or current alcohol consumption Furthermore, fruit, green salad and other vegetables, and intake of soda and fast food were unrelated to pregnancy intention. CONCLUSION: This study highlights that women trying to conceive are more likely to participate in unhealthy and potentially dangerous weight loss practices than women not trying to conceive. LEVEL OF EVIDENCE: II.

Geographic variation in human papillomavirus vaccination uptake among young adult women in the United States during 2008-2010.

Very little is known about geographic variation in human papillomavirus (HPV) vaccine uptake among young adult women in the US. To investigate this, we analyzed data from 12 US states collected through the Behavioral Risk Factor Surveillance System between 2008 and 2010. Among 2632 young adult women (18-26 years old) who responded to HPV vaccine uptake questions, weighted vaccine initiation and completion rates were: 28.0% and 17.0% overall, 14.0% and 6.6% in the South, 28.7% and 19.3% in the Midwest/West, and 37.2% and 23.1% in the Northeast (P<0.001), respectively. Log-binomial regression analysis showed that women living in the South were less likely to initiate (adjusted prevalence ratio (aPR) 0.71, 95% confidence interval (CI) 0.60-0.83) or complete (aPR 0.61, 95% CI, 0.53-0.71) the HPV vaccine series compared to women living in the Northeast. Interventions programs to improve HPV vaccine uptake in the Southern states are warranted.

Human papillomavirus vaccine uptake among 18- to 26-year-old women in the United States: National Health Interview Survey, 2010.

BACKGROUND: Human papillomavirus (HPV) vaccine uptake among young adult women has been reported to be very low. The authors conducted this study to provide an update on HPV vaccine uptake among 18- to 26-year-old women. METHODS: The authors used the National Health Interview Survey 2010 data to estimate HPV vaccine coverage and their correlates. RESULTS: Overall, 22.7% of women initiated (≥1 dose) and 12.7% completed the vaccine (≥3 doses). Thus, about 56% of women who initiated the vaccine completed it. Multivariate logistic regression analyses showed that younger age, unmarried status, Papanicolaou test, influenza vaccine, lifetime vaccines, and HPV vaccine awareness were positively associated with receiving ≥1 and ≥3 doses. In addition, uninsured women were less likely to receive ≥1 dose (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28-0.84), and blacks (OR, 0.48; 95% CI, 0.23-0.99) and women with a family income <100% of the federal poverty level (OR, 0.40; 95% CI, 0.21-0.73) were less likely to receive ≥3 doses. Furthermore, based on vaccine initiators, blacks were less likely than whites to complete the vaccine (OR, 0.29; 95% CI, 0.16-0.55). Two thirds of unvaccinated women were not interested in future vaccination. Among those who were interested, >76.4% preferred to receive it free or at a lower cost, whereas 20% would pay the full cost of the vaccine. CONCLUSIONS: One in 8 women completed the 3-dose HPV vaccine. Educational and vaccine financing programs are needed to improve the uptake among low-income minority women who are at increased risk for cervical cancer.

Human papillomavirus vaccine uptake among 9-17 year old males in the United States: the National Health Interview Survey, 2010.

In 2009, a quadrivalent HPV vaccine was approved and "permissively" recommended for US males aged 9 to 26 y to protect against genital warts. The purpose of this study was to examine parental awareness and HPV vaccine uptake among 9-17 y old males during the first year following this recommendation. Data from the 2010 National Health Interview Survey (NHIS) were obtained to assess vaccination status (n = 2973) of this age group. Univariate logistic regression analysis was performed to examine correlates of parental awareness and uptake of the HPV vaccine. Overall, 55% of parents with sons were aware of the HPV vaccine. The likelihood of parental awareness was lower among minorities and adolescents with low family incomes, and higher among adolescents with insurance, higher parental education, and those who had a well-child check up and dental examination in the past year than their counterparts. Only 2.0% and 0.5% of 9-17 y old males initiated (≥ 1 dose) and completed (≥ 3 doses) the vaccine series, respectively. Adolescents with a Hispanic origin (odds ratio (OR) 2.03, 95% confidence interval (CI) 1.09-3.78), low family income (OR 2.89, 95% CI 1.48 -5.57), and history of influenza vaccination in the past year (OR 1.89, 95% CI 1.11 -3.22) were more likely than their counterparts to initiate the HPV vaccine. On the other hand, adolescents with private insurance (OR 0.44, 95% CI 0.20 -0.94) and those who had college educated parents (OR 0.45, 95% CI 0.22 -0.89) were less likely to initiate the vaccine. This study showed that very few adolescent males received any doses of HPV vaccine during the first year following its recommendation for this gender. Thus, interventional programs are needed to improve vaccine uptake among adolescent males.

Racial and ethnic disparities in internet use for seeking health information among young women.

To examine the influence of race/ethnicity on seeking health information from the Internet among women aged 16-24 years, the authors conducted a self-administered survey on 3,181 women regarding their Internet use and obtaining information on reproductive health (menstruation, contraception, pregnancy, sexually transmitted infections) and general health from the Internet. The authors performed multivariate logistic regression to examine the association between race/ethnicity and online health-related information seeking after adjusting for covariates. Racial/ethnic disparities were noted in overall Internet use and its use to locate health information. Overall, more White (92.7%) and Black (92.9%) women used the Internet than did Hispanics (67.5%). More White women (79.2%) used it to find health information than did Blacks and Hispanics (70.3% and 74.3%, respectively). Compared with White women, Blacks and Hispanics were less likely to seek information on contraception [(OR 0.73, 95% CI 0.58-0.91) and (OR 0.75, 95% CI 0.61-0.92)] and more likely to seek information on pregnancy tests [(OR 1.67, 95% CI 1.28-2.18) and (OR 1.40, 95% CI 1.09-1.81] and sexually transmitted infections [(OR 1.39, 95% CI 1.11-1.73) and (OR 1.25, 95% CI 1.01-1.54)], respectively. With regard to general health issues-such as how to quit smoking, how to lose weight, alcohol/drug use, mood disorders, and skin disorders-Blacks, but not Hispanics, were significantly less likely to seek online information than were Whites. Disparities in the way that women from different backgrounds use the Internet for health-related information could be associated with overall health awareness.

An update on human papillomavirus vaccine uptake among 11-17 year old girls in the United States: National Health Interview Survey, 2010.

PURPOSE: A 3-dose human papillomavirus (HPV) vaccine is recommended for adolescents to protect against HPV-related cervical and other cancers. The purpose of this study was to provide an update on HPV vaccine uptake among 11-17 year old girls residing in the US. METHODS: Data from the 2010 National Health Interview Survey (NHIS) were obtained to assess HPV vaccination status and its correlates. Multivariate logistic regression analyses were performed to examine HPV vaccine uptake of ≥ 1 dose and ≥ 3 doses among all girls, and completion of the 3-dose series among those who initiated (received ≥ 1 dose) the vaccine. RESULTS: Overall, 28.9% and 14.2% received ≥ 1 dose and ≥ 3 doses of vaccine: 14.5% and 3.0% among 11-12 year old girls, and 34.8% and 18.7% among 13-17 year olds, respectively. Hispanics had higher uptake of ≥ 1 dose (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.22-2.17) than whites. Having received an influenza shot in the past year and parents' awareness of the vaccine were significantly associated with receiving ≥ 1 dose (OR 1.88, 95% CI 1.51-2.33 and OR 16.57, 95% CI 10.95-25.06) and ≥ 3 doses (OR 1.48, 95% CI 1.13-1.92 and OR 10.60, 95% CI 5.95-18.88). A separate multivariate model based on girls who initiated the vaccine did not identify any significant correlates of 3-dose series completion. Among parents of unvaccinated girls, 60% were not interested in vaccinating their daughters and mentioned three main reasons: "does not need vaccine" (25.5%), "worried about safety" (19.3%) and "does not know enough about vaccine" (16.6%). Of those who were interested, 53.7% would pay $360-$500 for the vaccination, while 41.7% preferred to receive it at a much lower cost or free. CONCLUSIONS: Only 1 out of 3 girls (11-17 years) have received ≥ 1 dose of HPV vaccine and much less have completed all 3 doses. Strategies should be taken to improve this vaccine uptake among girls, especially those 11-12 year olds, and to educate parents about the importance of vaccination.

Association of web-based weight loss information use with weight reduction behaviors in adolescent women.

PURPOSE: To examine the association between seeking weight loss information from the Internet and weight loss behaviors. METHODS: A self-administered survey was conducted on 3,181 women, aged 16-24 years, between August 2008 and August 2010. Questions were asked on use of the Internet to obtain weight loss information and various weight loss practices. Multivariate logistic regression analyses were performed to examine the association between seeking weight loss information online and practicing these weight loss behaviors. RESULTS: In all, 39% used the Internet to seek weight loss information. Women who obtained weight loss information from the Internet were more likely to exercise (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.07-1.60), use diet pills (OR: 4.14, 95% CI: 2.93-5.84), laxatives (OR: 2.02, 95% CI: 1.15-3.54), diuretics (OR: 7.89, 95% CI: 2.88-21.61), vomit after eating (OR: 2.56, 95% CI: 1.24-5.30), skip meals (OR: 2.77, 95% CI: 2.26-3.39), smoke more cigarettes (OR: 1.56, 95% CI: 1.14-2.14), and stop eating carbohydrates (OR: 3.09, 95% CI: 1.81-5.26) after adjusting for age, race/ethnicity, body mass index, and education. CONCLUSIONS: Many young women engage in unhealthy weight loss behaviors which they may learn online. Interventions are needed to instruct young women on safe practices to lose weight.