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. 2017 Jul 14;18(1):19.
doi: 10.1186/s12889-017-4567-2.

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

Kevin A Henry  1   2 , Allison L Swiecki-Sikora  3 , Antoinette M Stroup  4   5 , Echo L Warner  6 , Deanna Kepka  6   7
Affiliations

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

Kevin A Henry et al. BMC Public Health. .

Erratum in

  • Erratum to: BMC Public Health, Vol. 18.
    [No authors listed] [No authors listed] BMC Public Health. 2017 Sep 22;17(1):736. doi: 10.1186/s12889-017-4709-6. BMC Public Health. 2017. PMID: 28938882 Free PMC article. No abstract available.

Abstract

Background: 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.).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Cancer prevention; Cervical cancer; Geographic factors; HPV vaccination; Health disparities; Human papillomavirus.

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Conflict of interest statement

Ethics approval and consent to participate

Data collection for National Immunization Survey Teen (NIS-T) was approved by the United States National Center for Health Statistics (NCHS) Research Ethics Review Board. Analysis of de-identified data from the survey is exempt from the federal regulations for the protection of human research participants. Analysis of restricted data through the NCHS Research Data Center is also approved by the NCHS ERB. The Institutional Review Board at Temple University determined this study was exempt from review.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Model adjusted percent of boys that initiated HPV vaccination (a) and series completion (receipt of ≥3 doses) (b) by individual-level race/ethnicity and ZCTA Poverty. NHB: Non-Hispanic Black, NHW: Non-Hispanic White, NH-Other: Non-Hispanic Other. Initiation: > = 1 doses; Series Completion: > = 3 doses. ZCTA: ZIP Code Tabulation Areas. Poverty: proportion of ZCTA population living below poverty. The adjusted percent’s are based on a multivariable logistic regression that included year, child’s age, type of insurance coverage, mothers education (years), Mother’s marital status, Mother’s age, years, Poverty status, Race/ethnicity of teen, recommendation to get HPV vaccine, ZCTA population density, ZCTA poverty, state random effects and an interaction term of race/ethnicity by ZCTA Poverty
Fig. 2
Fig. 2
Adjusted Odds of initiation (Receipt of at Least One Dose) and completion (receipt of ≥3 doses) among male Adolescents Aged 13 to 17 Years and Their Families: National Immunization Survey–Teen, 2012-2013. Results based on statistically significant interactions between Race/ethnicity and ZCTA Poverty for HPV Vaccine Initiation. Note/legend: The adjusted odds ratios are based on a multivariable logistic regression that included year, teen’s age in years, type of insurance coverage, mothers education (years), Mother’s marital status, Mother’s age, survey year, poverty status, race/ethnicity of teen, recommendation to get HPV vaccine, ZCTA population density quartile, ZCTA poverty, state random effects and a interaction term of race/ethnicity by ZCTA poverty
See this image and copyright information in PMC

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