Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access

Abstract

Objectives: This study is among the first to examine metropolitan status differences in human papillomavirus (HPV) vaccine initiation and completion among United States adolescent girls and is unique in its focus on how maternal socioeconomic status and health care access moderate metropolitan status differences in HPV vaccination.

Methods: Using cross-sectional data from 3573 girls aged 12-17 in the U.S. from the 2008-2010 Behavioral Risk Factor Surveillance System, we estimate main and interaction effects from binary logistic regression models to identify subgroups of girls for which there are metropolitan versus non-metropolitan differences in HPV vaccination.

Results: Overall 34 % of girls initiated vaccination, and 19 % completed all three shots. On average, there were no metropolitan status differences in vaccination odds. However, there were important subgroup differences. Among low-income girls and girls whose mothers did not complete high school, those in non-metropolitan areas had significantly higher probability of vaccine initiation than those in metropolitan areas. Among high-income girls and girls whose mothers completed college, those in metropolitan areas had significantly higher odds of vaccine initiation than those in non-metropolitan areas. Moreover, among girls whose mothers experienced a medical cost barrier, non-metropolitan girls were less likely to initiate vaccination compared to metropolitan girls.

Conclusions: Mothers remain essential targets for public health efforts to increase HPV vaccination and combat cervical cancer. Public health experts who study barriers to HPV vaccination and physicians who come into contact with mothers should be aware of group-specific barriers to vaccination and employ more tailored efforts to increase vaccination.

Keywords: Adolescents; Cervical cancer; Human papillomavirus (HPV); Metropoltan versus non-metropolitan; Mothers; Sexually transmitted infections; USA; Vaccine.

Fig. 1

Top. Average predicted probabilities for HPV vaccine initiation from interaction model by metropolitan status and household income. Note Probabilities are calculated from adjusted interaction models with model coefficients available in appendix. Models are adjusted for all control variables and state fixed effects. Error bars represent 95 % confidence intervals around the mean predicted probability of vaccine initiation for each subgroup. Overlapping confidence bars indicate no significant difference between subgroups

Fig. 2

Top. Average predicted probabilities for HPV vaccine initiation by metropolitan status and maternal education. Note Probabilities are calculated from adjusted interaction models with model coefficients available in appendix. Models are adjusted for all control variables and state fixed effects. Error bars represent 95 % confidence intervals around the mean predicted probability of vaccine initiation for each subgroup. Overlapping confidence bars indicate no significant difference between subgroups

Fig. 3

Top. Average predicted probabilities for HPV vaccine initiation by metropolitan status and maternal experience with a medical cost barrier in the past year. Note: Probabilities are calculated from adjusted interaction models with model coefficients available in appendix. Models are adjusted for all control variables and state fixed effects. Error bars represent 95 % confidence intervals around the mean predicted probability of vaccine initiation for each subgroup. Overlapping confidence bars indicate no significant difference between subgroups