The Role of Geographic Factors in Human Papillomavirus (HPV) Vaccine Uptake Among Adolescent Girls in the United States

Abstract

Abstract There has been limited research examining the role of geographic factors in human papillomavirus (HPV) vaccine uptake among adolescent girls. This study is one of the first to investigate and identify community-level geographic factors that may be associated with HPV vaccine uptake in the United States. We analyzed data from the 2011 and 2012 National Immunization Survey-Teen to examine associations of HPV vaccine initiation (receipt of at least one dose based on healthcare provider records) among female adolescents aged 13 to 17 years (N = 20,565) with ZIP code level geographic factors that were linked to the survey. Analyses were conducted using weighted logistic regression that included state-random effects. HPV vaccine initiation was approximately 53% in both 2011 and 2012. Racial composition and urban/rural residence were both independently associated with vaccine initiation (P = < 0.05). Initiation was higher among girls living in communities where the majority (>50%) of the population was Hispanic compared to communities where the majority of the population was non-Hispanic white (69.0% vs 49.9%; Adjusted Odds Ratio (AOR) 1.55, 95% CI, 1.33–1.80). Girls living in high population density areas (urban) had higher HPV vaccine initiation compared to those living in low population density areas (rural) (56% vs 44.6%; AOR 1.37, 95% CI, 1.13–1.65). Initiation was also higher among girls living in the most impoverished communities compared to girls living in the least impoverished communities (61% vs 50.4%), but community-level poverty was not significant in the adjusted analysis. Higher HPV vaccination coverage in poor urban communities with a high proportion of racial/ethnic minorities may be partly attributable to targeted interventions and the continued effectiveness of the Vaccines for Children program (VFC), which provides recommended vaccines at no cost to eligible children. Learning more about factors that influence higher HPV vaccination initiation rates among certain groups might inform intervention strategies for groups with lower initiation rates.