Research Summary

Multilevel Intervention Increases HPV Vaccination Rates Among Children, Limited Impact in Under-resourced Settings

Miranda Manier, BA

Key Highlights

  • A multilevel intervention significantly improved human papillomavirus vaccine initiation and completion for most children aged 11-12 years.
  • The intervention was less effective among children in areas with the highest socioeconomic deprivation (ADI Q4).
  • No differences in vaccination rates were found by race/ethnicity or rurality under usual care.
  • Under the intervention, children of Black race and those in rural or highly deprived areas saw limited improvements.

A multilevel intervention incorporating parent reminders and health care professional feedback was associated with increased human papillomavirus (HPV) vaccine initiation and completion among most children aged 11 to 12 years. However, the intervention showed limited effectiveness for children living in the most socioeconomically disadvantaged areas. These findings highlight persistent disparities in vaccine uptake that are not fully addressed by current strategies.

HPV vaccination uptake is inconsistent across populations, placing some children at higher risk for HPV-related cancers. Socioeconomic and geographic disparities can hinder access and adherence to vaccination schedules. Identifying effective strategies that promote equitable vaccination coverage can mitigate future cancer burdens.

This secondary analysis was based on data from a stepped-wedge cluster randomized trial conducted from April 2018 to August 2022 across six Mayo Clinic primary care practices in Minnesota. Researchers assessed whether a multilevel intervention consisting of parent reminder and recall letters along with audit and feedback reports for health care professionals differentially affected HPV vaccine initiation and completion by race and ethnicity, rurality, and Area Deprivation Index (ADI) among children aged 11 to 12 years. Analysis was carried out from March to June 2024.

Among 6232 eligible children, 52.7% were boys and 55.9% were aged 11 years. The majority identified as White (72.2%), with smaller proportions identifying as Black (9.0%), Asian (4.9%), Hispanic (2.3%), or other/unspecified (11.6%). Most participants lived in urban areas (87.2%), and 44.8% resided in ADI Q2 regions.

Under usual care, vaccine initiation and completion rates declined significantly across increasing ADI quartiles (P < .001 for trend) but did not vary by race, ethnicity, or rurality. The intervention led to a significant increase in vaccine initiation for most subgroups (range, 9.2% to 24.0%) and vaccine completion (range, 19.4% to 31.2%). Children of Black race, those in rural settings, and those in ADI Q4 areas did not experience significant improvements in initiation. For vaccine completion, the intervention was not effective among children in ADI Q4 areas.

“In this secondary analysis of a cluster randomized trial, a multilevel intervention was associated with increased HPV vaccination for most children but had limited effect for those residing in areas of highest deprivation,” Kong et al. concluded.

Reference:
Kong WY, Finney Rutten LJ, Herrin J, et al. Multilevel intervention and human papillomavirus vaccination disparities: a secondary analysis of a cluster randomized trial. JAMA Netw Open. 2025;8(7):e2518895. doi:10.1001/jamanetworkopen.2025.18895