Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination

Sandi L. Pruitt, Mario Schootman

Research output: Contribution to journalArticle

76 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)525-533
Number of pages9
JournalAmerican Journal of Preventive Medicine
Volume38
Issue number5
DOIs
StatePublished - May 2010

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Poverty Areas
Vaccination
Poverty
Papillomavirus Vaccines
Logistic Models
Behavioral Risk Factor Surveillance System
Censuses
United States Food and Drug Administration
Research

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology

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Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination. / Pruitt, Sandi L.; Schootman, Mario.

In: American Journal of Preventive Medicine, Vol. 38, No. 5, 05.2010, p. 525-533.

Research output: Contribution to journalArticle

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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.",
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