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Measuring school level attributable risk to support school-based HPV vaccination programs

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journal contribution
posted on 2023-05-21, 09:10 authored by Vujovich-Dunn, C, Wand, H, Brotherton, JML, Gidding, H, Sisnowski, J, Lorch, R, Veitch, M, Sheppeard, V, Effler, P, Skinner, SR, Alison VennAlison Venn, Davies, C, Hocking, J, Whop, L, Leask, J, Canfell, K, Sanci, L, Smith, M, Kang, M, Temple-Smith, M, Kidd, M, Burns, S, Selvey, L, Meijer, D, Ennis, S, Thomson, C, Lane, N, Kaldor, J, Guy, R

Background: In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation.

Methods: A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence).

Results: The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1-14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7-8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9-3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7-3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6-4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3-2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76-82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31-44) and lower attendance rate (PAR = 37%, 95%CI: 29-46).

Conclusion: This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs.


Publication title

BMC Public Health



Article number









Menzies Institute for Medical Research


BioMed Central Ltd.

Place of publication

United Kingdom

Rights statement

© 2022. The Authors. This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, (, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Repository Status

  • Open

Socio-economic Objectives

Adolescent health