<p><strong>OBJECTIVE: </strong>Human papillomavirus (HPV) vaccine has been recommended for males for prevention of genital warts and precancerous anal lesions since 2009. Our objective was to characterize race and insurance-based disparities in HPV vaccine completion among males who initiated the HPV vaccine series.</p>

<p><strong>METHODS: </strong>Retrospective cohort study of adolescent males in a primary care network who initiated the HPV vaccine series 10/09-12/13. We measured vaccine series completion as the primary outcome. We evaluated associations between outcomes and race and insurance status, controlling for potential confounders and effect modification with multivariable logistic regression. Analyses were stratified by vaccine recommendation era (permissive vs. routine).</p>

<p><strong>RESULTS: </strong>42% of males in the cohort (16,691) completed the vaccine series. In the permissive vaccine era (2009 - 2011), non-black patients (53%) were more likely to complete than Black patients (32%), and non-Medicaid were more likely to complete than Medicaid patients (33%). These differences persisted in the routine recommendation era (2012 - 2013). In both the permissive and routine eras Medicaid insurance was associated with a larger reduction in the predicted probability of vaccine series completion for non-black patients. Adherence to the recommended vaccination schedule was low with a median time to completion of 8.9 months. Using the updated completion schedule (2016), completion rates were higher (54.1%) with continued differences based on race (60% vs. 45.7% for non-black vs. black patients) and insurance (57.4% vs. 46.4% completion for non-Medicaid vs. Medicaid patients).</p>

<p><strong>CONCLUSIONS: </strong>There are significant disparities in HPV vaccine series completion rates among males based on race and insurance, unchanged based on era of initiation or visit frequency.</p>

<p><strong>BACKGROUND: </strong>Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources.</p>

<p><strong>OBJECTIVE: </strong>This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness.</p>

<p><strong>METHODS: </strong>A convenience sample of youth aged 18 to 21 years was recruited from a youth-specific homeless shelter. All participants completed a 47-item survey, with 10 individuals completing a semistructured interview. Descriptive statistics, exact testing, logistic regression, and generalized estimating equation modeling was performed for quantitative data analysis. Interviews were transcribed verbatim, and NVivo 10 (QSR International) was employed to facilitate double coding and thematic analysis.</p>

<p><strong>RESULTS: </strong>A total of 87 participants completed the survey with a mean age of 19.4 (SD 1.1) years. While experiencing homelessness, 56% (49/87) accessed the internet at least once a day, with 86% (75/87) accessing once a week. Access to a smartphone was associated with a 3.03 greater odds of accessing the internet and was the most frequently used device (66% of participants, 57/87). While experiencing homelessness, subjects reported a 68% decreased odds in internet access frequency (odds ratio [OR] 0.32, P&lt;.001), 75% decreased odds in spending greater amounts of time on the internet (OR 0.25, P&lt;.001), and an 87% decreased odds of social media use (OR 0.13, P=.01). Ten participants completed the semistructured interview. Several themes were identified, including (1) changes in internet behaviors while experiencing homelessness, (2) health status as a major concern and reason for Internet use, and (3) interest in a website dedicated to youth experiencing homelessness. While experiencing homelessness, participants indicated their behaviors were more goal-oriented and less focused on leisure or entertainment activities.</p>

<p><strong>CONCLUSIONS: </strong>While homeless youth experience changes in the frequency, amount of time, and specific uses of the internet and social media, study participants were able to access the internet regularly. The internet was used to search health-related topics. Given the importance of smartphones in accessing the internet, mobile-optimized websites may be an effective method for reaching this group.</p>