title: Geospatial patterns of human papillomavirus vaccine uptake in Minnesota.
abstract: OBJECTIVE
  To identify factors associated with human papillomavirus (HPV) vaccination and to determine the geographic distribution of vaccine uptake while accounting for spatial autocorrelation.
  
  
  METHODS
  This study is cross-sectional in design using data collected via the Internet from the Survey of Minnesotans About Screening and HPV study.
  
  
  METHODS
  The sample consists of 760 individuals aged 18-30 years nested within 99 ZIP codes surrounding the downtown area of Minneapolis, Minnesota.
  
  
  RESULTS
  In all, 46.2% of participants had received ≥ 1 dose of HPV vaccine (67.7% of women and 13.0% of men). Prevalence of HPV vaccination was found to exhibit strong spatial dependence ([Formula: see text] = 0.9951) across ZIP codes. Accounting for spatial dependence, age (OR=0.76, 95% CI 0.70 to 0.83) and male gender (OR=0.04, 95% CI 0.03 to 0.07) were negatively associated with vaccination, while liberal political preferences (OR=4.31, 95% CI 2.32 to 8.01), and college education (OR=2.58, 95% CI 1.14 to 5.83) were found to be positively associated with HPV vaccination.
  
  
  CONCLUSIONS
  Strong spatial dependence and heterogeneity of HPV vaccination prevalence were found across ZIP codes, indicating that spatial statistical models are needed to accurately identify and estimate factors associated with vaccine uptake across geographic units. This study also underscores the need for more detailed data collected at local levels (eg, ZIP code), as patterns of HPV vaccine receipt were found to differ significantly from aggregated state and national patterns. Future work is needed to further pinpoint areas with the greatest disparities in HPV vaccination and how to then access these populations to improve vaccine uptake.
authors: Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA.
authors: Erik J
authors: EJ
authors: Nelson
authors: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors: John
authors: http://orcid.org/0000-0003-4150-4347
authors: J
authors: Hughes
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors: J Michael
authors: http://orcid.org/0000-0002-4507-1609
authors: JM
authors: Oakes
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors: James S
authors: http://orcid.org/0000-0001-7076-483X
authors: JS
authors: Pankow
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors: Shalini L
authors: SL
authors: Kulasingam
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D062206:Spatial Analysis; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: EPIDEMIOLOGY; PUBLIC HEALTH