Area-based socioeconomic factors and Human Papillomavirus (HPV) vaccination among teen boys in the United States

Abstract

Background: This study is the first to examine associations between several area-based socioeconomic factors and human papillomavirus (HPV) vaccine uptake among boys in the United States (U.S.).

Methods: Data from the 2012-2013 National Immunization Survey-Teen restricted-use data were analyzed to examine associations of HPV vaccination initiation (receipt of ≥1 dose) and series completion (receipt of three doses) among boys aged 13-17 years (N = 19,518) with several individual-level and ZIP Code Tabulation Area (ZCTA) census measures. Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation and series completion separately.

Results: In 2012-2013 approximately 27.9% (95% CI 26.6%-29.2%) of boys initiated and 10.38% (95% CI 9.48%-11.29%) completed the HPV vaccine series. Area-based poverty was not statistically significantly associated with HPV vaccination initiation. It was, however, associated with series completion, with boys living in high-poverty areas (≥20% of residents living below poverty) having higher odds of completing the series (AOR 1.22, 95% CI 1.01-1.48) than boys in low-poverty areas (0-4.99%). Interactions between race/ethnicity and ZIP code-level poverty indicated that Hispanic boys living in high-poverty areas had a statistically significantly higher odds of HPV vaccine initiation (AOR 1.43, 95% CI 1.03-1.97) and series completion (AOR 1.56, 95% CI 1.05-2.32) than Hispanic boys in low-poverty areas. Non-Hispanic Black boys in high poverty areas had higher odds of initiation (AOR 2.23, 95% CI 1.33-3.75) and completion (AOR 2.61, 95% CI 1.06-6.44) than non-Hispanic Black boys in low-poverty areas. Rural/urban residence and population density were also significant factors, with boys from urban or densely populated areas having higher odds of initiation and completion compared to boys living in non-urban, less densely populated areas.

Conclusion: Higher HPV vaccination coverage in urban areas and among racial/ethnic minorities in areas with high poverty may be attributable to factors such as vaccine acceptance, health-care practices, and their access to HPV vaccines through the Vaccines for Children Program, which provides free vaccines to uninsured and under-insured children. Given the low HPV vaccination rates among boys in the U.S., these results provide important evidence to inform public health interventions to increase HPV vaccination.

Keywords: Cancer prevention; Cervical cancer; Geographic factors; HPV vaccination; Health disparities; Human papillomavirus.

Fig. 1

Model adjusted percent of boys that initiated HPV vaccination (a) and series completion (receipt of ≥3 doses) (b) by individual-level race/ethnicity and ZCTA Poverty. NHB: Non-Hispanic Black, NHW: Non-Hispanic White, NH-Other: Non-Hispanic Other. Initiation: > = 1 doses; Series Completion: > = 3 doses. ZCTA: ZIP Code Tabulation Areas. Poverty: proportion of ZCTA population living below poverty. The adjusted percent’s are based on a multivariable logistic regression that included year, child’s age, type of insurance coverage, mothers education (years), Mother’s marital status, Mother’s age, years, Poverty status, Race/ethnicity of teen, recommendation to get HPV vaccine, ZCTA population density, ZCTA poverty, state random effects and an interaction term of race/ethnicity by ZCTA Poverty

Fig. 2

Adjusted Odds of initiation (Receipt of at Least One Dose) and completion (receipt of ≥3 doses) among male Adolescents Aged 13 to 17 Years and Their Families: National Immunization Survey–Teen, 2012-2013. Results based on statistically significant interactions between Race/ethnicity and ZCTA Poverty for HPV Vaccine Initiation. Note/legend: The adjusted odds ratios are based on a multivariable logistic regression that included year, teen’s age in years, type of insurance coverage, mothers education (years), Mother’s marital status, Mother’s age, survey year, poverty status, race/ethnicity of teen, recommendation to get HPV vaccine, ZCTA population density quartile, ZCTA poverty, state random effects and a interaction term of race/ethnicity by ZCTA poverty