Geographic variation in human papillomavirus vaccination uptake among 13-17 year old adolescent girls in the United States

Vaccine. 2014 May 1;32(21):2394-8. doi: 10.1016/j.vaccine.2014.02.097. Epub 2014 Mar 15.


Geographic variation in provider-verified human papillomavirus (HPV) vaccine uptake among adolescent girls in the US has not been examined. To investigate this, we analyzed 2011 National Immunization Survey-Teen data. Among 13-17 year old girls (n=11,236), weighted vaccine initiation (48.4%) and completion rates (30.6%) were the lowest in the South when compared to the Northeast (53.4% and 39.9%), Midwest (51.1% and 33.5%) and West (61.6% and 38.7%) (P<.001, both for initiation and completion). Multivariable log-binomial regression analysis indicated that 13-17 year old girls living in the South were less likely to initiate [adjusted prevalence ratio (aPR)=0.86, 95% confidence interval (CI) 0.75-0.97] and complete (aPR=0.83, 95% CI, 0.74-0.93) the HPV vaccine series compared to girls living in the Northeast. Similar differences were observed when the uptake rates in the South were compared to other regions in the US. Intervention programs to increase HPV vaccine uptake and reduce regional disparities are warranted.

Keywords: Cervical cancer; Geographic variation; HPV vaccine; Human papillomavirus; NIS-Teen.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cross-Sectional Studies
  • Female
  • Geography
  • Healthcare Disparities
  • Humans
  • Immunization Programs / statistics & numerical data*
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / administration & dosage*
  • United States
  • Uterine Cervical Neoplasms / prevention & control
  • Vaccination / statistics & numerical data*


  • Papillomavirus Vaccines