Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination

Overview

Journal Am J Prev Med

Specialty Public Health

Date 2010 Apr 23

PMID 20409501

Citations 61

Authors

Sandi L Pruitt

Mario Schootman

Affiliations

Soon will be listed here.

Abstract

Background: A human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration for use among women/girls in 2006. Since that time, limited research has examined HPV vaccine uptake among adolescent girls and no studies have examined the role of geographic disparities in HPV vaccination.

Purpose: The purpose of this study is to examine geographic disparity in the prevalence of human papillomavirus (HPV) vaccination and to examine individual-, county-, and state-level correlates of vaccination.

Methods: Three-level random intercept multilevel logistic regression models were fitted to data from girls aged 13-17 years living in six U.S. states using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) and the 2000 U.S. census.

Results: Data from 1709 girls nested within 274 counties and six states were included. Girls were predominantly white (70.6%) and insured (74.5%). Overall, 34.4% of girls were vaccinated. Significant geographic disparity across states (variance=0.134, SE=0.065) and counties (variance=0.146, SE=0.063) was present, which was partially explained by state and county poverty levels. Independent of individual-level factors, poverty had differing effects at the state and county level: girls in states with higher levels of poverty were less likely whereas girls in counties with higher poverty levels were more likely to be vaccinated. Household income demonstrated a similar pattern to that of county-level poverty: Compared to girls in the highest-income families, girls in the lowest-income families were more likely to be vaccinated.

Conclusions: The results of this study suggest geographic disparity in HPV vaccination. Although higher state-level poverty is associated with a lower likelihood of vaccination, higher county-level poverty and lower income at the family level is associated with a higher likelihood of vaccination. Research is needed to better understand these disparities and to inform interventions to increase vaccination among all eligible girls.

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References

Middleman A . Race/ethnicity and gender disparities in the utilization of a school-based hepatitis B immunization initiative. J Adolesc Health. 2004; 34(5):414-9. DOI: 10.1016/j.jadohealth.2003.08.009. View

. Vaccination coverage among adolescents aged 13-17 years - United States, 2007. MMWR Morb Mortal Wkly Rep. 2008; 57(40):1100-3. View

Klug S, Hukelmann M, Blettner M . Knowledge about infection with human papillomavirus: a systematic review. Prev Med. 2007; 46(2):87-98. DOI: 10.1016/j.ypmed.2007.09.003. View

Ward E, Jemal A, Cokkinides V, Singh G, Cardinez C, Ghafoor A . Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004; 54(2):78-93. DOI: 10.3322/canjclin.54.2.78. View

. National, state, and local area vaccination coverage among adolescents aged 13-17 years--United States, 2008. MMWR Morb Mortal Wkly Rep. 2009; 58(36):997-1001. View

Orenstein W, Hinman A . The immunization system in the United States - the role of school immunization laws. Vaccine. 1999; 17 Suppl 3:S19-24. DOI: 10.1016/s0264-410x(99)00290-x. View

Pickett K, Pearl M . Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001; 55(2):111-22. PMC: 1731829. DOI: 10.1136/jech.55.2.111. View

Larsen K, Petersen J, Budtz-Jorgensen E, Endahl L . Interpreting parameters in the logistic regression model with random effects. Biometrics. 2000; 56(3):909-14. DOI: 10.1111/j.0006-341x.2000.00909.x. View

Smith P, Chu S, Barker L . Children who have received no vaccines: who are they and where do they live?. Pediatrics. 2004; 114(1):187-95. DOI: 10.1542/peds.114.1.187. View

10.

Datta G, Colditz G, Kawachi I, Subramanian S, Palmer J, Rosenberg L . Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. black women: a multilevel analysis. Cancer. 2005; 106(3):664-9. DOI: 10.1002/cncr.21660. View

11.

Kahn J, Rosenthal S, Jin Y, Huang B, Namakydoust A, Zimet G . Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women. Obstet Gynecol. 2008; 111(5):1103-10. DOI: 10.1097/AOG.0b013e31817051fa. View

12.

Katz M, Reiter P, Kluhsman B, Kennedy S, Dwyer S, Schoenberg N . Human papillomavirus (HPV) vaccine availability, recommendations, cost, and policies among health departments in seven Appalachian states. Vaccine. 2009; 27(24):3195-200. PMC: 2689551. DOI: 10.1016/j.vaccine.2009.03.042. View

13.

Findley S, Irigoyen M, Stockwell M, Chen S . Changes in childhood immunization disparities between central cities and their respective states, 2000 versus 2006. J Urban Health. 2009; 86(2):183-95. PMC: 2648888. DOI: 10.1007/s11524-008-9337-0. View

14.

Markowitz L, Dunne E, Saraiya M, Lawson H, Chesson H, Unger E . Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007; 56(RR-2):1-24. View

15.

Kahn J, Rosenthal S, Hamann T, Bernstein D . Attitudes about human papillomavirus vaccine in young women. Int J STD AIDS. 2003; 14(5):300-6. DOI: 10.1258/095646203321605486. View

16.

. National, state, and local area vaccination coverage among children aged 19-35 months--United States, 2007. MMWR Morb Mortal Wkly Rep. 2008; 57(35):961-6. View

17.

Chao C, Slezak J, Coleman K, Jacobsen S . Papanicolaou screening behavior in mothers and human papillomavirus vaccine uptake in adolescent girls. Am J Public Health. 2009; 99(6):1137-42. PMC: 2679804. DOI: 10.2105/AJPH.2008.147876. View

18.

Grant D, Kravitz-Wirtz N, Breen N, Tiro J, Tsui J . One in four California adolescent girls have had human papillomavirus vaccination. Policy Brief UCLA Cent Health Policy Res. 2009; (PB2009-3):1-6. View

19.

Pruitt S, Shim M, Mullen P, Vernon S, Amick 3rd B . Association of area socioeconomic status and breast, cervical, and colorectal cancer screening: a systematic review. Cancer Epidemiol Biomarkers Prev. 2009; 18(10):2579-99. PMC: 2760038. DOI: 10.1158/1055-9965.EPI-09-0135. View

20.

Larsen K, Merlo J . Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2004; 161(1):81-8. DOI: 10.1093/aje/kwi017. View