title: Correlates of human papillomavirus vaccine coverage: a state-level analysis.
abstract: BACKGROUND
  We tested the hypothesis that states with higher rates of cancers associated with human papillomavirus (HPV) would have lower HPV vaccine coverage.
  
  
  METHODS
  We gathered state-level data on HPV-related cancer rates and HPV vaccine initiation coverage for girls and boys, separately, and HPV vaccine follow-through (i.e., receipt of 3 doses among those initiating the series) for girls only. In addition, we gathered state-level data on demographic composition and contact with the health care system. We calculated Pearson correlations for these ecological relationships.
  
  
  RESULTS
  Human papillomavirus vaccine initiation among girls was lower in states with higher levels of cervical cancer incidence and mortality (r = -0.29 and -0.46, respectively). In addition, vaccine follow-through among girls was lower in states with higher levels of cervical cancer mortality (r = -0.30). Other cancer rates were associated with HPV vaccine initiation and follow-through among girls, but not among boys. Human papillomavirus vaccine initiation among girls was lower in states with higher proportions of non-Hispanic black residents and lower proportions of higher-income residents. Human papillomavirus vaccine follow-through was higher in states with greater levels of adolescents' contact with the health care system.
  
  
  CONCLUSIONS
  Human papillomavirus vaccine coverage for girls was lower in states with higher HPV-related cancer rates. Public health efforts should concentrate on geographic areas with higher cancer rates. Strengthening adolescent preventive health care use may be particularly important to increase vaccine follow-through. Cost-effectiveness analyses may overestimate the benefits of current vaccination coverage and underestimate the benefits of increasing coverage.
authors.affiliation: From the *Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and †College of Medicine, The Ohio State University, Columbus, OH.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.forename: Paul L
authors.initials: PL
authors.lastname: Reiter
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D001005:Anus Neoplasms / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D011634:Public Health; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines