Measuring school level attributable risk to support school-based HPV vaccination programs

• Published in: BMC public health Vol. 22; no. 1; pp. 822 - 10
• Main Authors: Vujovich-Dunn, C., Wand, H., Brotherton, J. M. L., Gidding, H., Sisnowski, J., Lorch, R., Veitch, M., Sheppeard, V., Effler, P., Skinner, S. R., Venn, A., Davies, C., Hocking, J., Whop, L., Leask, J., Canfell, K., Sanci, L., Smith, M., Kang, M., Temple-Smith, M., Kidd, M., Burns, S., Selvey, L., Meijer, D., Ennis, S., Thomson, C., Lane, N., Kaldor, J., Guy, R.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 25.04.2022; BioMed Central Ltd; BMC
• Subjects: Adolescence; Adolescent; Adolescents; Age; Australia - epidemiology; Biostatistics; Cervical cancer; Curricula; Educational aspects; Environmental Health; Epidemiology; Female; Girls; Health equity; Health promotion; HPV vaccines; Human papillomavirus; Humans; Immunisation programs; Immunization; Male; Medical screening; Medicine; Medicine & Public Health; Methods; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines; Population; Population statistics; Primary prevention; Public Health; School-based; Schools; Special education; Students; Teenagers; Vaccination; Vaccine; Vaccines; Variation; Warts; Australia; United Kingdom; Canada; United States > US; Western Australia Australia; New South Wales Australia; Tasmania Australia; Health equity; HPV vaccines; Primary prevention; Immunisation programs; School-based; Cervical cancer
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-022-13088-x

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.