Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access.
OBJECTIVE
This study is among the first to examine metropolitan status differences in human papillomavirus (HPV) vaccine initiation and completion among United States adolescent girls and is unique in its focus on how maternal socioeconomic status and health care access moderate metropolitan status differences in HPV vaccination.


METHODS
Using cross-sectional data from 3573 girls aged 12-17 in the U.S. from the 2008-2010 Behavioral Risk Factor Surveillance System, we estimate main and interaction effects from binary logistic regression models to identify subgroups of girls for which there are metropolitan versus non-metropolitan differences in HPV vaccination.


RESULTS
Overall 34 % of girls initiated vaccination, and 19 % completed all three shots. On average, there were no metropolitan status differences in vaccination odds. However, there were important subgroup differences. Among low-income girls and girls whose mothers did not complete high school, those in non-metropolitan areas had significantly higher probability of vaccine initiation than those in metropolitan areas. Among high-income girls and girls whose mothers completed college, those in metropolitan areas had significantly higher odds of vaccine initiation than those in non-metropolitan areas. Moreover, among girls whose mothers experienced a medical cost barrier, non-metropolitan girls were less likely to initiate vaccination compared to metropolitan girls.


CONCLUSIONS
Mothers remain essential targets for public health efforts to increase HPV vaccination and combat cervical cancer. Public health experts who study barriers to HPV vaccination and physicians who come into contact with mothers should be aware of group-specific barriers to vaccination and employ more tailored efforts to increase vaccination.
Department of Agricultural Economics, Sociology, and Education, Penn State University, 110B Armsby Bldg, University Park, PA, 16802, USA. smm67@psu.edu.
Shannon M
SM
Monnat
Department of Agricultural Economics, Sociology, and Education, Penn State University, 110B Armsby Bldg, University Park, PA, 16802, USA. dcr185@psu.edu.
Danielle C
DC
Rhubart
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Research Building, W326A, 3970 Reservoir Rd., Washington, DC, 20057, USA. slw49@georgetown.edu.
Sherrie Flynt
SF
Wallington
D000293:Adolescent; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data / Q000639:trends; D007182:Income; D016015:Logistic Models; D008297:Male; D009035:Mothers; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012424:Rural Population; D012923:Social Class; D014481:United States; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends
D053918:Papillomavirus Vaccines
Adolescents; Cervical cancer; Human papillomavirus (HPV); Metropoltan versus non-metropolitan; Mothers; Sexually transmitted infections; USA; Vaccine