Associations between english proficiency and HPV vaccine uptake among foreign-born men and women in the United States: a cross-sectional study using data from the National Health Interview Survey.

BACKGROUND

Disparities in human papillomavirus (HPV) vaccination persist among foreign-born adults in the U.S., who are up to 30% less likely than their U.S.-born counterparts to have ever received the vaccine. While HPV vaccination primarily targets adolescents, the recent expansion of eligibility to adults provides an opportunity to reach individuals who missed vaccination during adolescence. However, English often serves as a second or third language for many foreign-born adults, and limited proficiency or dialect differences may create barriers to navigating the U.S. healthcare system and accessing preventive services. Using data from the National Health Interview Survey, this study examines whether self-reported English proficiency is associated with HPV vaccine uptake among foreign-born U.S adults.

METHODS

We analyzed data from the 2015-2018 National Health Interview Survey (NHIS). Participants were foreign-born adults aged 18-38 years for women, and 18-36 years for men at the time of data collection (n = 5,450). The dependent variable was self-reported ever receipt of an HPV vaccine (yes/no), and the independent variable was English proficiency, dichotomized as high vs. low English proficiency. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between English proficiency and receipt of the HPV vaccine. All estimates were weighted to account for the NHIS's complex survey design.

RESULTS

The weighted prevalence of ever receiving the HPV vaccine was 12.2% (95% CI: 11.1-13.3) among foreign-born adults in the U.S. The overall mean age was 29.4 years (95% CI: 29.2-29.6). Among those who had received the HPV vaccine, 76.7% were female and 23.3% were male, whereas among those who had not received the vaccine, 49.9% were female and 50.1% were male (p < 0.001). We found that foreign-born individuals with low English proficiency were significantly less likely to have received the HPV vaccine than those with high proficiency (OR: 0.48; 95% CI: 0.32-0.73) after adjusting for sex, age, marital status, citizenship status, education, geographical region of birth, insurance status, and having a usual source of care.

CONCLUSION

Our findings suggest that limited English proficiency negatively influences the receipt of HPV vaccination among foreign-born individuals in the U.S. Targeted interventions for populations in need of linguistically tailored education and interactions within healthcare systems are needed to address disparities in HPV vaccination.