ASPO Abstracts
HPV vaccination coverage among U.S. teens across the rural-urban continuum
Category: Cancer Health Disparities, Behavioral Science & Health Communication
Conference Year: 2018
Abstract Body:
Purpose: A majority of studies examining HPV vaccination uptake in urban versus rural areas used measures of rural and urban based on county data. We analyzed data from the National Immunization Survey-Teen (NIS-Teen) to examine associations between HPV vaccination uptake and rural and urban residence measured at the zip code level. Methods: Data from the 2012-2013 NIS-Teen were used to examine associations of HPV vaccination initiation ( 1 dose) and series completion ( 3 doses) among boys and girls aged 13-17 years with ZIP Code Tabulation Area (ZCTA) measures of urban and rural based on Rural Urban Commuting Area Codes (RUCAs). Multivariable logistic regression including individual and ZCTA poverty was used to estimate the odds of HPV vaccination initiation and completion. Results: HPV vaccination coverage was lower among girls from isolated small rural towns ( 1 dose 51.0%; 3 doses 30.0%) and small rural towns ( 1 dose 50.2%; 3 doses 26.8%) as compared to urban areas ( 1 dose 56.0%; 3 doses 35.9%). In multivariable models, rural/urban residence was not statistically significantly associated with HPV vaccination initiation. However, girls from small rural towns had lower odds of completion (0.74, 95% CI 0.60-0.91) than girls from urban areas had. HPV vaccination was lower among boys from isolated small rural towns ( 1 dose 17.3%; 3 doses 5.3%) and small rural towns ( 1 dose 18.7%; 3 doses 5.5%) than in urban areas ( 1 dose 28.7%; 3 10.7%). In multivariable models, boys in isolated small rural towns had statistically significantly lower odds of initiation (0.68, 95% CI 0.52-0.88) and completion (0.63, 95% CI 0.41-0.97) compared to boys from urban areas. This relationship was similar for boys from small rural and large rural towns. Interactions between rural/urban and ZCTA poverty indicated significantly lower odds of initiation and completion for girls and boys from high-poverty rural areas than for their counterparts from high-poverty urban areas. Conclusion: Lower levels of HPV vaccination rates in rural areas may be attributable to less access to health-care programs for the poor, access to public transportation, and different cultural values than urban populations have. Public health vaccine programs should focus on the rural poor.
Keywords: HPV Vaccination; Geographic Factors; Rural