HPV Vaccination Coverage Among US Teens Across the Rural-Urban Continuum

Abstract

Background: In this study, we used data from the National Immunization Survey-Teen (NIS-Teen) to examine HPV vaccination uptake by rural and urban residence defined by ZIP code.

Methods: We used 2012-2013 NIS-Teen data to examine associations of HPV vaccination among teens aged 13-17 years with ZIP code measures of rural/urban (Rural-Urban Commuting Area (RUCA) codes, population density). Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation (≥ 1 dose) and completion (≥ 3 doses).

Results: HPV vaccination was lower among girls from isolated small rural towns (≥1 dose 51.0%; ≥3 doses 30.0%) and small rural towns (≥1 dose 50.2%; ≥3 doses 26.8%) than among urban girls (≥1 dose 56.0%; ≥3 doses 35.9%). Girls from small rural towns had lower odds of completion (0.74, 95% CI: 0.60-0.91) than girls from urban areas. HPV vaccination was lower among boys from isolated small rural towns (≥1 dose 17.3%; ≥3 doses 5.31%) and small rural towns (≥1 dose 18.7%; ≥3 doses 5.50%) than those in urban areas (≥1 dose 28.7%; ≥3 doses 10.7%). Boys in isolated small rural towns had statistically significantly lower odds of initiation (0.68, 95% CI: 0.52-0.88) and completion (0.63, 95% CI: 0.41-0.97) than urban boys. Girls and boys from high-poverty rural areas had lower odds of initiation and completion than did their counterparts from high-poverty urban areas.

Conclusion: Rural girls had lower odds of completing the HPV vaccine than their urban counterparts. Rural boys had lower odds than urban boys for HPV vaccination initiation and completion.

Keywords: health care disparities; human papilloma virus; human papilloma virus vaccines; preventive health; rural health.

Figure 1.

Adjusted Odds of Initiation (Receipt of at Least 1 Dose) and Completion (Receipt of ≥3 Doses) Among Boys (top) and Girls (bottom) Aged 13 to 17 Years and Their Families: National Immunization Survey – Teen, 2012–2013.

Figure 2.

Model Adjusted Percent of Girls (top) and Boys (bottom) That Initiated HPV Vaccination and Series Completion (receipt of ≥3 doses) by ZCTA Poverty and Urban and Rural Residence. The adjusted percentages are based on multivariable logistic regression models.