title: Racial disparities in human papillomavirus vaccination: does access matter?
abstract: OBJECTIVE
  To examine the association between race/ethnicity and human papillomavirus (HPV) vaccine initiation and to determine how access to health care influences this relationship.
  
  
  METHODS
  We used nationally representative data from the National Survey of Family Growth to assess HPV vaccine initiation in 2,168 females aged 15-24 years. A series of regression analyses were performed to determine the independent effect of race/ethnicity on HPV vaccine initiation after controlling for sociodemographic variables and health care access measures. Age-stratified regression analyses were also performed to assess whether the relationship between race/ethnicity and HPV vaccine initiation differed among females aged 15-18 and 19-24 years.
  
  
  RESULTS
  There were significant racial/ethnic disparities in HPV vaccination; United States (US)-born Hispanics, foreign-born Hispanics, and African-Americans were less likely to have initiated vaccination than were whites (p < .001). Adjusting for sociodemographic characteristics attenuated the disparity for both US-born and foreign-born Hispanics (adjusted odds ratio [AOR], .76; 95% confidence interval [CI], .50-1.16; and AOR, .67; 95% CI, .37-1.19) but not for African-Americans (AOR, .47, 95% CI, .33-.66). Adding health care access measures further attenuated the disparity for US-born and foreign-born Hispanics (AOR, .85, 95% CI, .54-1.34; and AOR, .84, 95% CI, .45-1.55). However, African-Americans remained less likely than whites to have initiated vaccination (AOR, .49, 95% CI, .36-.68). These racial/ethnic trends were similar for females aged 15-18 and 19-24 years.
  
  
  CONCLUSIONS
  Lower rates of HPV vaccination among African-American females do not appear to be explained by differential access to health care. More research is necessary to elucidate factors contributing to HPV vaccination in this population.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gelman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Aletha Y
authors.initials: AY
authors.lastname: Akers
authors.forename: Kwonho
authors.initials: K
authors.lastname: Jeong
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D030361:Papillomavirus Infections / Q000208:ethnology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Disparities; Human papillomavirus; National Survey of Family Growth; Race/ethnicity; Vaccination