# Beyond the check-up: how well-child exams, pediatric specialists, and provider recommendations can close HPV vaccine gaps for Chinese American Teens

## TL;DR

This study explores how healthcare providers and practices can improve HPV vaccination rates among Chinese American teens by focusing on provider recommendations and well-child exams.

## Contribution

The study identifies provider and practice-level factors influencing HPV vaccine uptake in Chinese American adolescents, a population with suboptimal vaccination rates.

## Key findings

- Provider recommendations strongly predict HPV vaccine initiation and completion among Chinese American teens.
- Adolescents in the Northeast and West have higher HPV vaccine completion rates compared to those in the South.
- Pediatric care and well-child exams at ages 11–12 are significant predictors of vaccine uptake.

## Abstract

This study aimed to identify provider- and practice-level factors influencing human papillomavirus (HPV) vaccine uptake among Chinese American (CA) adolescents. Despite increasing public health efforts, HPV vaccination rates in this population remain suboptimal, and knowledge on the link between provider/practice characteristics and vaccine uptake is limited.

We analyzed data from 1,272 CA adolescents (aged 13–17) using the National Immunization Survey-Teen (2015–2019) datasets. Key measures included HPV vaccine initiation and completion (based on proxy reporting and verification), accompanied by various multilevel factors: provider-level (recommendation, specialty), practice-level (facility type, vaccine acquisition, well-child exam), parent-level (mother’s education, marital status), and adolescent-level characteristics. Weighted descriptive statistics and stepwise multivariate logistic regression were used to examine associations.

Overall, 71.22% of CA adolescents initiated at least one HPV vaccine dose, while 48.14% completed the regimen. Provider's recommendation (initiation OR = 21.50, completion OR = 8.12), having a pediatrician (initiation OR = 5.37, completion OR = 3.20), and receiving the 11–12-year-old well-child exams significantly predict both initiation and completion. Regional disparities were observed, with adolescents in the Northeast and West showing higher completion rates than those in the South. Unexpectedly, adolescents not enrolled in school and those with mothers who had less than 12 years of education or were unmarried showed higher completion rates.

Provider recommendations and pediatric care are crucial for improving HPV vaccination rates among CA adolescents. Addressing regional disparities and implementing targeted interventions, including enhanced provider training focused on culturally sensitive communication, are essential to dismantle systemic barriers and improve comprehensive vaccination coverage in this underserved population.