Area-based socioeconomic factors and Human Papillomavirus (HPV) vaccination among teen boys in the United States

• Published in: BMC public health Vol. 18; no. 1; p. 19
• Main Authors: Henry, Kevin A, Swiecki-Sikora, Allison L, Stroup, Antoinette M, Warner, Echo L, Kepka, Deanna
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.07.2017; BioMed Central; BMC
• Subjects: Adolescent; African Americans; Analysis; Cancer prevention; Cervical cancer; Children; Ethnic factors; Geographic factors; Health aspects; Health disparities; Health insurance; Hispanic Americans; HPV vaccination; Human papillomavirus; Humans; Immunization; Immunization Programs; Logistic Models; Male; Medical Assistance; Medically Uninsured; Minority & ethnic groups; Minority Groups; Odds Ratio; Papillomaviridae; Papillomavirus; Papillomavirus infections; Papillomavirus Infections - prevention & control; Papillomavirus Infections - virology; Papillomavirus Vaccines - administration & dosage; Patient Acceptance of Health Care; Population Density; Poverty; Poverty Areas; Prevention; Public health; Regression analysis; Residential density; Rural areas; Social factors; Socioeconomic data; Socioeconomic Factors; Socioeconomics; Tabulation; Teenage boys; United States; Urban areas; Urban Population; Vaccination; Vaccination Coverage; Vaccines; United States; United States > US; Cancer prevention; Geographic factors; Human papillomavirus; HPV vaccination; Cervical cancer; Health disparities
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-017-4567-2

This study is the first to examine associations between several area-based socioeconomic factors and human papillomavirus (HPV) vaccine uptake among boys in the United States (U.S.). Data from the 2012-2013 National Immunization Survey-Teen restricted-use data were analyzed to examine associations of HPV vaccination initiation (receipt of ≥1 dose) and series completion (receipt of three doses) among boys aged 13-17 years (N = 19,518) with several individual-level and ZIP Code Tabulation Area (ZCTA) census measures. Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation and series completion separately. In 2012-2013 approximately 27.9% (95% CI 26.6%-29.2%) of boys initiated and 10.38% (95% CI 9.48%-11.29%) completed the HPV vaccine series. Area-based poverty was not statistically significantly associated with HPV vaccination initiation. It was, however, associated with series completion, with boys living in high-poverty areas (≥20% of residents living below poverty) having higher odds of completing the series (AOR 1.22, 95% CI 1.01-1.48) than boys in low-poverty areas (0-4.99%). Interactions between race/ethnicity and ZIP code-level poverty indicated that Hispanic boys living in high-poverty areas had a statistically significantly higher odds of  HPV vaccine initiation (AOR 1.43, 95% CI 1.03-1.97) and series completion (AOR 1.56, 95% CI 1.05-2.32)  than Hispanic boys in  low-poverty areas. Non-Hispanic Black boys in high poverty areas had higher odds of initiation (AOR 2.23, 95% CI 1.33-3.75) and completion (AOR 2.61, 95% CI 1.06-6.44) than non-Hispanic Black boys in low-poverty areas. Rural/urban residence and population density were also significant factors, with boys from urban or densely populated areas having higher odds of initiation and completion compared to boys living in non-urban, less densely populated areas. Higher HPV vaccination coverage in urban areas and among racial/ethnic minorities in areas with high poverty may be attributable to factors such as vaccine acceptance, health-care practices, and their access to HPV vaccines through the Vaccines for Children Program, which provides free vaccines to uninsured and under-insured children. Given the low HPV vaccination rates among boys in the U.S., these results provide important evidence to inform public health interventions to increase HPV vaccination.