Community-level Geographic Factors and HPV Vaccination in the U.S.

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 DESCRIPTION (provided by applicant): While individual- and provider-level factors for low Human Papillomavirus (HPV) vaccination rates in the United States (U.S.) have been well examined, the role of community-level geographic factors in HPV vaccine initiation and 3-dose completion in the U.S. is unknown. Geographic and neighborhood factors could influence vaccination through several pathways linked to material resources of the neighborhood, availability and ease of access to health-care facilities and services, social capital (e.g., socia contagion, similar norms of behavior), and residential segregation. Using data from the National Immunization Survey-Teen (NIS-Teen), an annual survey conducted by the Centers for Disease Control and Prevention to monitor vaccination uptake in the U.S., associations between HPV vaccination among adolescent girls and boys and community-level geographic factors including poverty, rural/urban residence, and racial composition will be examined. Zip code and county- level geographic identifiers are not available in the public-use NIS-Teen datasets, and therefore these geographic identifiers will be accessed and linked via the restricted use NIS-Teen files to provide a novel examination of geographic factors' role in HPV vaccination. First, we will identify community-level geographic factors that are independent predictors of both vaccine initiation and series completion, among U.S. teen girls and boys separately. Next, we will investigate how geographic and community level socioeconomic factors impact and interact with individual level factors associated with HPV vaccine initiation and completion. This will be the first study to provide much needed information on the influence of community-level geographic factors on HPV vaccine initiation and completion among a nationally representative sample of adolescents in the U.S. Given the low rates of HPV vaccination in the U.S., the results from the proposed study will help inform public health practice and the development of geographically targeted interventions to improve HPV vaccination in the United States.