Article

Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination

Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, Missouri 63108, USA.
American journal of preventive medicine (Impact Factor: 4.28). 05/2010; 38(5):525-33. DOI: 10.1016/j.amepre.2010.01.018
Source: PubMed

ABSTRACT A human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration for use among women/girls in 2006. Since that time, limited research has examined HPV vaccine uptake among adolescent girls and no studies have examined the role of geographic disparities in HPV vaccination.
The purpose of this study is to examine geographic disparity in the prevalence of human papillomavirus (HPV) vaccination and to examine individual-, county-, and state-level correlates of vaccination.
Three-level random intercept multilevel logistic regression models were fitted to data from girls aged 13-17 years living in six U.S. states using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) and the 2000 U.S. census.
Data from 1709 girls nested within 274 counties and six states were included. Girls were predominantly white (70.6%) and insured (74.5%). Overall, 34.4% of girls were vaccinated. Significant geographic disparity across states (variance=0.134, SE=0.065) and counties (variance=0.146, SE=0.063) was present, which was partially explained by state and county poverty levels. Independent of individual-level factors, poverty had differing effects at the state and county level: girls in states with higher levels of poverty were less likely whereas girls in counties with higher poverty levels were more likely to be vaccinated. Household income demonstrated a similar pattern to that of county-level poverty: Compared to girls in the highest-income families, girls in the lowest-income families were more likely to be vaccinated.
The results of this study suggest geographic disparity in HPV vaccination. Although higher state-level poverty is associated with a lower likelihood of vaccination, higher county-level poverty and lower income at the family level is associated with a higher likelihood of vaccination. Research is needed to better understand these disparities and to inform interventions to increase vaccination among all eligible girls.

Full-text

Available from: Mario Schootman, Jun 13, 2015
0 Followers
 · 
161 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since the introduction of the human papillomavirus (HPV) vaccine in 2006, there have been considerable efforts at the national and state levels to monitor uptake and better understand the individual and system-level factors that predict who gets vaccinated. A common method of measuring the vaccination status of adolescents is through parental recall. We examined how the accuracy of parents' reports of their daughters' HPV vaccination status varied by social characteristics. Data were taken from the 2009-2010 National Immunization Survey (NIS)-Teen, which includes a household interview and a provider-completed immunization history. We evaluated concordance between parents' and providers' reports of teens' HPV vaccine initiation (≥1 dose) and completion (≥3 doses). We assessed bivariate associations of sociodemographic characteristics with having a concordant, false-positive (overreporting) or false-negative (underreporting) report, and used multinomial logistic regression to estimate the independent impact of each characteristic. In bivariate analyses, concordance of parent-reported HPV vaccine initiation was associated with each of the sociodemographic characteristics investigated. In regression models, self-reported nonwhite race, lower household income, and lower education level of the teen's mother were associated with a higher likelihood of having a false-negative parental report than a concordant report. Our results indicate that, while estimates of overall coverage based on parental report may be unbiased, the differences in the accuracy of parental report could result in misleading estimates of disparities in HPV vaccine coverage.
    Public Health Reports 01/2014; 129(3):237-244. · 1.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Advisory Committee on Immunization Practices (ACIP) has recommended routine human papillomavirus (HPV) vaccination at age 11 or 12 years for girls since 2006 and for boys since 2011. We sought to describe adolescent HPV vaccination coverage, doses administered from 2009 to 2012, and age at first vaccination by sex.
    Academic Pediatrics 06/2014; DOI:10.1016/j.acap.2014.03.005 · 2.23 Impact Factor
  • Source