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Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access

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Abstract

Objectives This study is among the first to examine metropolitan status differences in human papillomavirus (HPV) vaccine initiation and completion among United States adolescent girls and is unique in its focus on how maternal socioeconomic status and health care access moderate metropolitan status differences in HPV vaccination. Methods Using cross-sectional data from 3573 girls aged 12–17 in the U.S. from the 2008–2010 Behavioral Risk Factor Surveillance System, we estimate main and interaction effects from binary logistic regression models to identify subgroups of girls for which there are metropolitan versus non-metropolitan differences in HPV vaccination. Results Overall 34 % of girls initiated vaccination, and 19 % completed all three shots. On average, there were no metropolitan status differences in vaccination odds. However, there were important subgroup differences. Among low-income girls and girls whose mothers did not complete high school, those in non-metropolitan areas had significantly higher probability of vaccine initiation than those in metropolitan areas. Among high-income girls and girls whose mothers completed college, those in metropolitan areas had significantly higher odds of vaccine initiation than those in non-metropolitan areas. Moreover, among girls whose mothers experienced a medical cost barrier, non-metropolitan girls were less likely to initiate vaccination compared to metropolitan girls. Conclusions Mothers remain essential targets for public health efforts to increase HPV vaccination and combat cervical cancer. Public health experts who study barriers to HPV vaccination and physicians who come into contact with mothers should be aware of group-specific barriers to vaccination and employ more tailored efforts to increase vaccination.

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Notes

  1. We excluded respondents from NY because NY excluded the question about number of HPV shots received, disabling us from identifying which girls completed the series.

  2. Rather than excluding respondents who were missing on income (N = 301), we created a dummy variable in order to keep them in our analyses. Excluding these respondents would introduce systematic bias into the results because girls of respondents missing on income were significantly less likely to be vaccinated than those not missing income.

  3. Data limitations prevent us from explaining why there are metropolitan status differences in vaccine initiation for Oklahoma but not for other states. We ran the vaccine initiation model on Oklahoma respondents (N = 233) using all covariates discussed in the methods section. None of those variables explained away the significantly higher odds of vaccine initiation for non-metropolitan respondents in Oklahoma.

  4. In the unadjusted model for vaccine completion, girls whose mothers had a high school degree had significantly lower odds (p < 0.05) of vaccine completion versus girls whose mothers had a college degree. In the adjusted model, that significant difference was eliminated. We found that income alone resulted in the elimination of significance of the high school versus college difference.

Abbreviations

BRFSS:

Behavioral Risk Factor Surveillance System

CDC:

Centers for Disease Control and Prevention

HPV:

Human papillomavirus

MSA:

Metropolitan statistical area

SES:

Socioeconomic status

STI:

Sexually transmitted infection

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Acknowledgments

The authors thank the U.S. Centers for Disease Control and Prevention for the Behavioral Risk Factor Surveillance System data. SM and DR acknowledge support from the Population Research Institute at Penn State, which receives center core funding from the National Institute of Child Health and Human Development (R24-HD041025). SFW receives research funding from the National Institutes of Health and the National Cancer Institute, K01CA155417-01A1. SM and SW also acknowledge support from the Robert Wood Johnson Foundation New Connections grant program. Everyone who has contributed to this study has been acknowledged herein. The authors do not have any potential, perceived, or real conflicts of interests. No honorarium, grant, or other form of payment was given to anyone to produce this article.

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Authors and Affiliations

  1. Department of Agricultural Economics, Sociology, and Education, Penn State University, 110B Armsby Bldg, University Park, PA, 16802, USA

    Shannon M. Monnat & Danielle C. Rhubart

  2. Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Research Building, W326A, 3970 Reservoir Rd., Washington, DC, 20057, USA

    Sherrie Flynt Wallington

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Correspondence to Shannon M. Monnat.

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Monnat, S.M., Rhubart, D.C. & Wallington, S.F. Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access. Matern Child Health J 20, 315–325 (2016). https://doi.org/10.1007/s10995-015-1831-x

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