title: Geographic Factors and Human Papillomavirus (HPV) Vaccination Initiation among Adolescent Girls in the United States.
abstract: BACKGROUND
  This study is among the first to explore geographic factors that may be associated with human papillomavirus (HPV) vaccine uptake in the United States.
  
  
  METHODS
  Data from the 2011 and 2012 National Immunization Survey-Teen for 20,565 female adolescents aged 13 to 17 years were analyzed to examine associations of HPV vaccine initiation (receipt of at least one dose) with ZIP code-level geographic factors. Logistic regression including individual and geographic factors was used to estimate the odds of HPV vaccine initiation.
  
  
  RESULTS
  Approximately 53% of girls initiated the HPV vaccine in both years. Girls in high poverty communities had higher HPV vaccine initiation compared with those in low poverty communities [61.1% vs. 52.4%; adjusted OR (AOR), 1.18; 95% confidence intervals (CI), 1.04-1.33]. Initiation was higher among girls in communities where the majority of the population was Hispanic (69.0% vs. 49.9%; AOR, 1.64; 95% CI, 1.43-1.87) or non-Hispanic mixed race (60.4% vs. 49.9%; AOR, 1.30; 95% CI, 1.17-1.44) compared with majority non-Hispanic white communities. Interactions between individual-level race/ethnicity and community racial-ethnic composition indicated significantly higher odds of initiation among Hispanic girls living in Hispanic communities compared with Hispanic girls living in predominantly non-Hispanic White (NHW) (AOR, 2.23; 95% CI, 1.87-2.65) or non-Hispanic Black (NHB) (AOR, 1.90; 95% CI, 1.20-3.04) communities, respectively.
  
  
  CONCLUSIONS
  Initiation rates of HPV vaccination among teen girls were highest in the poorest communities and among Hispanics living in communities where the racial-ethnic composition was predominantly Hispanic or mixed race.
  
  
  CONCLUSIONS
  Given low HPV vaccination rates in the United States, these results provide important evidence to inform public health interventions to increase HPV vaccination.
authors.affiliation: Department of Geography, Temple University, Philadelphia, Pennsylvania. Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, Pennsylvania. khenry1@temple.edu.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Henry
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey. Cancer Prevention and Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.affiliation: Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
authors.forename: Echo L
authors.initials: EL
authors.lastname: Warner
authors.affiliation: Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. University of Utah College of Nursing, Salt Lake City, Utah.
authors.forename: Deanna
authors.initials: D
authors.lastname: Kepka
mesh_terms: D000293:Adolescent; D005260:Female; D005843:Geography; D006801:Humans; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D014481:United States
chemical_list: D053918:Papillomavirus Vaccines