Factors Associated with Increased HPV Vaccine Use in Rural-Frontier U.S. States.
This study sought to examine sociodemographic factors surrounding human papillomavirus (HPV) vaccine initiation and three-dose completion rates in the Intermountain West (IW).



Analysis of the Centers for Disease Control and Prevention's 2012 National Immunization Survey-Teen dataset was conducted with a survey-weighted Pearson chi-square test and multivariable Poisson regression to produce bivariate and multivariate analyses. Participants with daughters aged 13-17 with provider-verified immunization records were included. Dual-frame adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were produced with provider-phase sampling weights.



Factors included parents' and adolescents' sociodemographic and healthcare usage variables. Outcome measures included adolescents' receipt and completion of the HPV vaccine.



Older parental ages (45 years and above) showed lower prevalence of adolescent HPV vaccine initiation (PR = 0.73, 95% CI = 0.59-0.87, p = .003) and completion (PR = 0.65, 95% CI = 0.44-0.96, p = .031) compared with parents younger than 35. Seventeen-year-old adolescents demonstrated highest prevalence of initiating (PR = 1.88, 95% CI = 1.47-2.39, p < .001) and completing (PR = 2.92, 95% CI = 1.97-4.33, p < .001) the vaccination series compared to 13-year olds. Those who had received meningitis vaccinations had high prevalence of initiating (PR = 1.93, 95% CI = 1.50-2.48, p < .001) and completing the HPV vaccine (PR = 2.52, 95% CI = 1.64-3.86, p < .001).



This study highlights parental, adolescent, and health care characteristics related to use of the HPV vaccine. Future research to investigate specific barriers and strategies for addressing HPV vaccination use in the IW is recommended.
Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.|College of Nursing, University of Utah, Salt Lake City, Utah.
Djin
D
Lai
Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, Utah.
Qian
Q
Ding
Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.
Julia
J
Bodson
Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.|College of Nursing, University of Utah, Salt Lake City, Utah.
Echo L
EL
Warner
Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.|College of Nursing, University of Utah, Salt Lake City, Utah.
Deanna
D
Kepka
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D022401:Meningococcal Vaccines / Q000008:administration & dosage; D008875:Middle Aged; D009679:Nuclear Family; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents / Q000523:psychology; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines
HPV; adolescent health; cancer; population-based nursing; prevention; public health systems; rural health; vaccination