TY - JOUR
T1 - Measuring school level attributable risk to support school-based HPV vaccination programs
AU - Vujovich-Dunn, C.
AU - Wand, H.
AU - Brotherton, J. M.L.
AU - Gidding, H.
AU - Sisnowski, J.
AU - Lorch, R.
AU - Veitch, M.
AU - Sheppeard, V.
AU - Effler, P.
AU - Skinner, S. R.
AU - Venn, A.
AU - Davies, C.
AU - Hocking, J.
AU - Whop, L.
AU - Leask, J.
AU - Canfell, K.
AU - Sanci, L.
AU - Smith, M.
AU - Kang, M.
AU - Temple-Smith, M.
AU - Kidd, M.
AU - Burns, S.
AU - Selvey, L.
AU - Meijer, D.
AU - Ennis, S.
AU - Thomson, C.
AU - Lane, N.
AU - Kaldor, J.
AU - Guy, R.
N1 - Funding Information:
All methods were performed in accordance with the Declaration of Helsinki and approved by the following ethical committees. Ethical approval was provided by the Human Research Ethics Committees of the University of New South Wales (HC17632), the Australian National University (2017/516), the University of Tasmania (1320/17), the Aboriginal Health and Medical Research Council of New South Wales (1320/17), the Aboriginal Health Council of Western Australia (818), and the Department of Health of Western Australia (RGS0000000456). The project performed secondary analyses of existing administrative datasets that are held by states and national statutory bodies. Individual consent was not required based on Sect. 2.3.10 of the NHMRC’s National Statement on Ethical Conduct in Human Research (2007).
Funding Information:
Ethical approval was provided by the Human Research Ethics Committees of the University of New South Wales (HC17632), the Australian National University (2017/516), the University of Tasmania (1320/17), the Aboriginal Health and Medical Research Council of New South Wales (1320/17), the Aboriginal Health Council of Western Australia (818), and the Department of Health of Western Australia (RGS0000000456).
Funding Information:
JS was funded by an Australian Government Research Training Program Scholarship, LW was funded by the NHMRC Early Career Fellowship (#1142035), and MS was funded by NHRMC grant (APP1159491) Cancer Institute NSW. RG was funded by an NHMRC fellowship (GNT1124647) and is a co-investigator on a project which received funding from Seqirus [unrelated to this project]. KC reports she is co-PI of an investigator-initiated trial of cervical screening, "Compass", run by the VCS Foundation Australia, which is a government-funded not-for-profit charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Diagnostics. She is also co-PI on a major implementation program "Elimination of Cervical Cancer in the Western Pacific" which will receive support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. However, neither KC nor her institution has received direct funding from industry for these or any other research project. All other authors have no competing interest to declare.
Funding Information:
The study was conducted as part of the HPV Partnership Project (NHMRC grant number APP1132344), which was formed between researchers, the National HPV Vaccination Program Register, and the health departments of three states, New South Wales, Tasmania, and Western Australia to understand why gaps persist in the HPV vaccination school-based program.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/4
Y1 - 2022/4
N2 - Background: In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. Methods: A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). Results: The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1–14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). Conclusion: This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs.
AB - Background: In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. Methods: A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). Results: The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1–14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). Conclusion: This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs.
KW - Cervical cancer
KW - Health equity
KW - HPV vaccines
KW - Immunisation programs
KW - Primary prevention
KW - School-based
UR - http://www.scopus.com/inward/record.url?scp=85128804750&partnerID=8YFLogxK
U2 - 10.1186/s12889-022-13088-x
DO - 10.1186/s12889-022-13088-x
M3 - Article
C2 - 35468743
AN - SCOPUS:85128804750
VL - 22
SP - 1
EP - 10
JO - BMC Public Health
JF - BMC Public Health
SN - 1471-2458
IS - 1
M1 - 822
ER -