Descriptors by number of appropriately timed doses.

<p>Singleton means only one dose was administered; doublet means that two doses were appropriately timed; triplet means that three doses were appropriately timed.</p><p>Bold font signifies significant differences among singleton, doublet and/or triplet doses at p<0.001.</p>*<p>Doses administered at visits at which counseling for smoking cessation, depression, or contraceptive use; and procedures including IUD placement occurred.</p>†<p>Doses administered to Other races than White, Black and Hispanic make up 4% of singleton and doublet doses and were not included in this table.</p

Predictors of Mistimed Doses.

<p>N = 124 mistimed second doses among all doses delivered; N = 153 mistimed third doses among all doses delivered.</p>*<p>Counseling for smoking cessation, depression, or contraceptive use; and Procedures including IUD placement.</p><p>‡adjusted for significant variables in univariate model.</p><p>§Not included in multivariate model due to lack of significance or co-linearity.</p><p>Bold font indicates a significant predictor.</p

Predictors of Appropriately Timed Doublet Dosing.

<p>N = 785 second on-time doses administered.</p>†<p>Adjusted for significant univariate characteristics: visit type and age.</p>*<p>Counseling for smoking cessation, depression, or contraceptive use; and Procedures including IUD placement.</p><p>Bold font values indicate significance.</p

Mistimed HPV4 Doses.

§<p>among those receiving three doses regardless of timing.</p><p>^*among those receiving only two doses regardless of timing.</p><p>Early dosing, overall, occurs significantly more frequently among females receiving HPV4 at urban locations vs. rural locations (p = 0.03).</p

Descriptors of females receiving care at the Inner City/Urban Core vs. Rural Safety Net Health Care Locations.

<p>^*There are significantly more white females in the rural location than urban, p = 0.026.</p>§<p>There are significantly more black females in the urban location than rural, p = 0.021.</p><p>There are no significant age or pregnancy history differences between the urban core population and the rural population.</p

Females receiving HPV4 by number of doses and Safety Net Health Center Location.

<p>There are no significant differences between the urban core population and the rural population for any dosing scheme.</p><p>Among those at the urban core, significantly more completed two doses on time than three doses on time, 82% vs. 67%, p<0.001.</p

In a Safety Net Population HPV4 Vaccine Adherence Worsens as BMI Increases

<div><p>Objectives</p><p>Obesity adversely inhibits antibody response to vaccination. Three doses of HPV4 may or may not provide adequate long term protection against HPV 16/18 in obese females. The aim of this study was to determine whether adherence to HPV4 vaccination in a safety net population was reduced with increasing body mass index (BMI).</p><p>Methods</p><p>We designed a historical prospective study evaluating the number and dates of HPV4 dosing that occurred from July 1, 2006 through October 1, 2009 by the demographic characteristics of the 10–26 year old recipient females. The defined dosing intervals were adapted from the literature and obesity categories were defined by the WHO.</p><p>Results</p><p>1240 females with BMI measurements received at least one dose of HPV4; 38% were obese (class I, II and III) and 25% were overweight. Females with normal BMI received on-time triplet dosing significantly more often than did the obese class II and III females (30% vs. 18%, p<0.001). Obese class II/III females have a significant 45% less chance of completing the on-time triplet HPV4 series than normal women (OR = 0.55, 95% CI: 0.37, 0.83). Pregnancy history has a significant influence on BMI and HPV4 dosing compliance in this safety net population where 71% had been gravid. Hispanic females were less likely to complete HPV4 dosing regardless of BMI (aOR = 0.39, 95% CI: 0.16, 0.95).</p><p>Conclusions</p><p>Obesity, as well as gravidity and Hispanic race, are risk factors for lack of HPV4 vaccine adherence among young females in a safety net population.</p></div

Distribution of receipt of HPV4 on time dosing by BMI categories.

<p>Women of normal and overweight BMI categories received a singleton dose of HPV4 significantly less often than women of obese class II/III (≥35 kg/m²) BMI categories (44% vs. 63%, p<0.001). Women of normal and overweight BMI categories received two on time doses of HPV4 significantly more often than women of obese II/III BMI categories (26% vs. 20%, p<0.05). Women of normal and overweight BMI categories received three on time doses of HPV4 significantly more often than women of obese II/III BMI categories (30% vs. 18%, p<0.001). Women of obese II/III BMI categories received a singleton HPV4 dose significantly more often than three on time doses (63% vs. 18%, p<0.001).</p

Distribution of mistimed triplet HPV4 dosing by BMI category.

<p>Among women receiving three doses of HPV4, obese III women received at least one early dose among the triplet series significantly more often than normal women (25% vs. 13%, p<0.001); and at least one late dose among the triplet series significantly less often than normal women (23% vs. 17%, p<0.001).</p

Safety Net Study Population by Body Mass Index category.

a<p>Differences in age, gravidity and parity are significant between underweight BMI females and each BMI category; and differences in age, gravidity and parity are significant between normal BMI females and all other BMI categories by one-way ANOVA.</p>b<p>The proportion of white and black women significantly decreases as the BMI category increases from normal, p for trend<0.001. Hispanic women are evenly distributed among the BMI categories from normal through obese class II.</p>c<p>Percentages by BMI category are per race category; percentage of total for each race is per total population.</p