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Socioeconomic Status an Important Determinant of HPV Vaccination

Surabhi Dangi-Garimella, PhD
A study published in Cancer Epidemiology, Biomarkers & Prevention has identified geographic and ethnic factors as an important determinant of vaccinating against the human papillomavirus.
According to the CDC, vaccination against the human papillomavirus (HPV) has been lagging in the United States, and results from a new study suggest that teenagers from poor neighborhoods are more likely to heed the advice of their physicians.

HPV is the most commonly transmitted sexual infection in the United States and is responsible for gynecological cancers, including cervical, vulvar, anal, vaginal, and oropharyngeal. Research has shown that vaccination could prevent the approximately 20,589 HPV-related cancers diagnosed each year in women. A survey conducted by the CDC for the year 2014 found that despite a rise in immunizations, HPV vaccination lagged behind Tdap and quadrivalent meningococcal conjugate vaccines. Nearly 40% of teenage girls and 60% of teenage boys had not been initiated on an HPV vaccine in 2014, based on the survey.

To understand whether geographic factors might influence the uptake of the HPV vaccine, researchers collected data on over 20,000 female adolescents, ages 13 to 17 years, from the 2011 and 2012 National Immunization Survey-Teen. The community-level factors evaluated in the study included area-based poverty, rural/urban residence, and residential racial-ethnic composition.

The analysis showed that of the 53% of girls who initiated the HPV vaccine in both 2011 and 2012, girls living in high-poverty communities had higher uptake rates than those living in low-poverty communities (61.1% vs 52.4%; adjusted odds ratio [AOR], 1.18; 95% CI, 1.04-1.33). There was also a racial bias, with girls from primarily Hispanic neighborhoods (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) presenting greater uptake.

In their discussion, the study authors point to safety-net immunization services that are available for poor populations as one of the contributing factors to the observed trend. These facilities have access to HPV vaccines through the Vaccine for Children program, which is a federally funded program providing free recommended vaccines to eligible children, the authors write. They also advice public health officials to pay increased attention to individual characteristics and geographic factors to be able to overcome barriers to HPV vaccination and ineffective public health interventions.


Henry KA, Stroup AM, Warner EL, Kepka D. Geographic factors and human papillomavirus (HPV) vaccination initiation among adolescent girls in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25:309.

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