Objectives: To examine knowledge of and financial barriers to early adoption of human papillomavirus (HPV) vaccination, specifically the role played by insurance, income, and affordability (measured by forgoing or delaying needed medical care due to cost/no insurance).
Study design: We used the 2007 California Health Interview Survey. Females aged 18 to 26 years (n = 1840) and parents with daughters aged 8 to 17 years (n = 5765) were analyzed separately.
Methods: Logistic regression models were used with the following dependent variables: (1) heard of the HPV vaccine, (2) received 1 dose only, (3) completed the series, (4) have not previously heard of HPV vaccine but interested in receiving it, and (5) interested and willing to pay $360 for it.
Results: Individuals enrolled in private health maintenance organizations (HMOs) were more likely to have heard of the vaccine compared with the uninsured and those enrolled in public HMOs. Young adults enrolled in private HMOs were also more likely to have initiated HPV vaccination or completed the series compared with uninsured young adults or those insured in non-HMO plans. Higher income parents were more willing to pay the cost of the vaccine. Forgoing needed care due to costs led to lower odds of initiating HPV vaccination among parents and completing the series among young adults.
Conclusions: Strategies to increase HPV vaccination rates should consider insurance or cost barriers for adults and those with high medical care expenditures. Disparities in receipt of the HPV vaccine are likely to continue without targeted outreach to more vulnerable populations.