County-level estimates of human papillomavirus vaccine coverage among young adult women in Texas, 2008.
OBJECTIVE
The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among young women aged 18-26 in Texas using multilevel, small area estimation.


METHODS
Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (receipt of ≥ 1 dose Gardasil®) from the 2008 Behavioral Risk Factor Surveillance System and a number of secondary sources. Using the parameters from the final model, we simulated HPV vaccine coverage in each county.


RESULTS
Indirect county-level estimates ranged from 1.9-23.8%, with a weighted state average of 11.4%. The counties with the highest and lowest coverage estimates were Orange County, TX and Webb County, TX respectively. Significant correlations were observed between HPV vaccination and age, Hispanic ethnicity, and the percentage of uninsured at the county and public health region levels.


CONCLUSIONS
Small area analyses have been used in a variety of settings to assess a variety of health outcomes, and as shown in this study, can be used to highlight geographic disparities and opportunities for intervention in HPV vaccine coverage.
Section on Health Services Research, Division of Quantitative Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas.
Jan M
JM
Eberth
South Carolina Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health.
Xingyou
X
Zhang
Division of Adult and Community Health, Centers for Disease Control & Prevention, Atlanta, Georgia.
Monir
M
Hossain
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Jasmin A
JA
Tiro
Department of Clinical Sciences, UT Southwestern Medical School, Dallas, Texas.
James B
JB
Holt
Division of Behavioral Sciences, University of Texas School of Public Health, Houston, Texas.
Sally W
SW
Vernon