title: Uptake of free HPV vaccination among young women: a comparison of rural versus urban rates.
abstract: OBJECTIVE
  To contrast rates of initial HPV vaccine uptake, offered at no cost, between a rural clinic, a rural community college, and an urban college clinic and to identify rural versus urban differences in uptake of free booster doses.
  
  
  METHODS
  Young rural women attending rural clinics (n = 246), young women attending a rural community college (n = 251) and young women attending an urban university health clinic (n = 209) were recruited in Kentucky. After completing a brief questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for the initial dose of vaccine served as the study outcome variable.
  
  
  RESULTS
  In controlled analyses, the contrast in initial uptake between urban clinic women (reference category) and rural college women was significant (P < .0001). However, the contrast in initial uptake between urban clinic women (reference category) and rural clinic women was not significant (P = .42). The model predicting uptake of subsequent doses among those with initial uptake (n = 235) also indicated significant differences as a function of recruitment location, with rural clinic women being about 7 times more likely than urban clinic women (P < .0001) to not return for at least 1 follow-up dose. The contrast between urban clinic women and rural college women was also significant (P = .014).
  
  
  CONCLUSIONS
  Initial uptake of free HPV vaccination among young rural college women may be problematic. Moreover, uptake of subsequent free doses among rural women may be problematic regardless of whether contact is made in a clinic or through college recruitment.
authors.affiliation: College of Public Health at the University of Kentucky, Lexington, Kentucky 40506, USA. crosby@uky.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Crosby
authors.forename: Baretta R
authors.initials: BR
authors.lastname: Casey
authors.forename: Robin
authors.initials: R
authors.lastname: Vanderpool
authors.forename: Tom
authors.initials: T
authors.lastname: Collins
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D007629:Kentucky; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines