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Am J Prev Med. 2010 May;38(5):525-33. doi: 10.1016/j.amepre.2010.01.018.

Geographic disparity, area poverty, and human papillomavirus vaccination.

Author information

  • 1Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, Missouri 63108, USA. spruitt@dom.wustl.edu

Abstract

BACKGROUND:

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.

PURPOSE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
20409501
PMCID:
PMC3259737
DOI:
10.1016/j.amepre.2010.01.018
[PubMed - indexed for MEDLINE]
Free PMC Article
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