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J Rural Health. 2019 Jan 31. doi: 10.1111/jrh.12353. [Epub ahead of print]

HPV Vaccination Coverage Among US Teens Across the Rural-Urban Continuum.

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Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
Department of Geography, Temple University, Philadelphia, Pennsylvania.
Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
College of Nursing, University of Utah, Salt Lake City, Utah.
Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.



In this study, we used data from the National Immunization Survey-Teen (NIS-Teen) to examine HPV vaccination uptake by rural and urban residence defined by ZIP code.


We used 2012-2013 NIS-Teen data to examine associations of HPV vaccination among teens aged 13-17 years with ZIP code measures of rural/urban (Rural-Urban Commuting Area (RUCA) codes, population density). Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation (≥ 1 dose) and completion (≥ 3 doses).


HPV vaccination 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%) than among urban girls (≥1 dose 56.0%; ≥3 doses 35.9%). Girls from small rural towns had lower odds of completion (0.74, 95% CI: 0.60-0.91) than girls from urban areas. HPV vaccination was lower among boys from isolated small rural towns (≥1 dose 17.3%; ≥3 doses 5.31%) and small rural towns (≥1 dose 18.7%; ≥3 doses 5.50%) than those in urban areas (≥1 dose 28.7%; ≥3 doses 10.7%). 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) than urban boys. Girls and boys from high-poverty rural areas had lower odds of initiation and completion than did their counterparts from high-poverty urban areas.


Rural girls had lower odds of completing the HPV vaccine than their urban counterparts. Rural boys had lower odds than urban boys for HPV vaccination initiation and completion.


health care disparities; human papilloma virus; human papilloma virus vaccines; preventive health; rural health


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