Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs

• Published in: Journal of community health 2024-10, Vol.49 (5), p.857-868
• Main Authors: Tsegaye, Adino Tesfahun, Lin, John, Cole, Allison, Szpiro, Adam A, Rao, Darcy W., Walson, Judd, Winer, Rachel L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Adult; Cancer; Cancer screening; Cancer vaccines; Cervical cancer; Child; Community and Environmental Psychology; Early Detection of Cancer - statistics & numerical data; Electronic health records; Electronic medical records; Ethics; Family Practice (Medicine); Female; Health care; Health Promotion and Disease Prevention; Human papillomavirus; Humans; Immunization; Male; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Mothers; Mothers - psychology; Mothers - statistics & numerical data; Original Paper; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - administration & dosage; Patient Compliance - statistics & numerical data; Pediatrics; Preventive medicine; Primary care; Teenagers; Uterine Cervical Neoplasms - prevention & control; Vaccination - statistics & numerical data; Washington
• ISSN: 0094-5145; 1573-3610; 1573-3610
• DOI: 10.1007/s10900-024-01333-w

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11–17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06–1.13) and completion (APR:1.16, 95%CI:1.08–1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01–1.07) and completion (APR:1.12, 95%CI:1.05–1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.