Table 3.

RDS-weighted multinomial logistic regression showing factors associated with being in earlier stages of the cascade compared to having initiated human papillomavirus (HPV) vaccination (received at least one dose of the vaccine) among men from the Engage Study (n = 2433)

	Stage 1 vs. Stage 4: unaware of HPV vaccine vs. vaccine initiation	Stage 2 vs. Stage 4: undecided/unwilling to get vaccinated vs. vaccine initiation	Stage 3 vs. Stage 4: willing to get vaccinated vs. vaccine initiation
Characteristics of interest	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)
Country of birth
Born in Canada	Ref	Ref	Ref
Immigrated to Canada	1.79 (1.07, 2.99)	0.58 (0.33, 1.02)	0.85 (0.55, 1.32)
Sexual Orientation
Gay	Ref	Ref	Ref
Bisexual	2.84 (1.06, 7.62)	3.09 (1.19, 8.05)	1.09 (0.41, 2.89)
Queer	0.19 (0.08, 0.45)	1.77 (0.81, 3.89)	0.82 (0.44, 1.55)
Othera	0.89 (0.29, 2.27)	1.03 (0.28, 3.76)	0.69 (0.23, 2.14)
Prefer to keep same-sex romantic relationships private
Increasing agreement	1.25 (1.05, 1.48)	1.24 (1.05, 1.46)	1.02 (0.89, 1.16)
Received information on sexual health in past 6 months
No	Ref	Ref	Ref
Yes	0.31 (0.13, 0.71)	0.27 (0.12, 0.64)	0.52 (0.21, 1.26)
Past hepatitis A or B vaccination
No	Ref	Ref	Ref
Yes	0.16 (0.09, 0.30)	0.18 (0.09, 0.35)	0.38 (0.21, 0.67)
Received poor quality of healthcareb
No	Ref	Ref	Ref
Yes	0.94 (0.47, 1.88)	1.06 (0.50, 2.27)	0.91 (0.50, 1.66)
Accessing healthcare providerc
No	Ref	Ref	Ref
Yes	0.49 (0.22, 1.09)	0.36 (0.15, 0.83)	0.55 (0.23, 1.29)
Statistically-significant effect modification by city
Age groupd
Vancouver
≤26 years old	0.40 (0.18, 0.88)	1.09 (0.43, 2.74)	0.62 (0.26, 1.46)
≥27 years old	Ref	Ref	Ref
Toronto
≤26 years old	0.86 (0.30, 2.49)	1.97 (0.57, 6.78)	0.46 (0.17, 1.25)
≥27 years old	Ref	Ref	Ref
Montreal
≤26 years old	0.08 (0.04, 0.18)	0.20 (0.09, 0.47)	0.13 (0.06, 0.28)
≥27 years old	Ref	Ref	Ref
Increasing Financial Strain Index scored,e
Vancouver	1.22 (1.07, 1.40)	1.40 (1.16, 1.69)	1.10 (0.96, 1.27)
Toronto	0.90 (0.72, 1.12)	0.98 (0.79, 1.22)	0.89 (0.75, 1.06)
Montreal	1.05 (0.88, 1.25)	0.99 (0.83, 1.18)	1.01 (0.88, 1.19)
Educationd
Vancouver
High school or less	Ref	Ref	Ref
Any post-secondary	1.01 (0.43, 2.40)	2.05 (0.74, 5.69)	2.32 (0.99, 5.48)
Toronto
High school or less	Ref	Ref	Ref
Any post-secondary	0.57 (0.18, 1.78)	1.72 (0.36, 8.32)	0.43 (0.14, 1.29)
Montreal
High school or less	Ref	Ref	Ref
Any post-secondary	0.21 (0.07, 0.61)	0.35 (0.12, 0.98)	0.90 (0.32, 2.54)

The first three stages of the cascade (dependent variable) are being compared to the last stage of the cascade, vaccine initiation. Modeled using multinomial logistic regression (PROC SURVEYLOGISTIC) and adjusted for the RDS design using RDS-II Volz-Heckathorn weights.⁴¹ Estimates presented as odds ratios with 95% confidence intervals. Missing 2.3% of data in multivariable model.

^aIncludes straight, questioning, asexual, pansexual, two-spirit, and other.

^bPoor health from a doctor, community health center, walk-in clinic, hospital, sexual health clinic, or another hospital clinic (all potential venues for vaccination).

^cMen who currently have at least one of the following: a primary care provider, a sexual health care provider, and among those living with HIV, a HIV care specialist.

^dEffect modification observed by city.

^eScale validated in general population samples measuring lack of ability to meet financial needs. Overall score is computed by adding response value across five questions. Higher score indicates greater financial strain.⁴⁰