Regional variations in HPV vaccination among 9–17 year old adolescent females from the BRFSS, 2008–2010

Abstract

Human papillomavirus (HPV) vaccine uptake among 18-26 y old women varies by geographic region in the US. However, little is known about regional variations in vaccination among girls who are in the vaccine's targeted age groups. Regional variation in HPV vaccination among female adolescents (9-17 y old) was examined using crosssectional data from the Behavioral Risk Factor Surveillance System (BRFSS) between 2008 and 2010. Multivariable logistic regression estimated the association of region of residence (10 states included questions about adolescent HPV vaccination) with uptake and completion of the 3-shot HPV vaccine series. Among 7,849 adolescents, 26.9% initiated, and 55.2% of initiators completed the series. Adolescents from Northeast/Midwest/West states were 1.74 (95% CI: 1.45-2.10) times more likely to have initiated HPV vaccination compared to the South/Southwestern states. Among initiators, vaccine series completion did not vary significantly between the South/Southwestern and Northeast/Midwest/West states. Flu vaccination was associated with increased odds of initiation in both regions and completion of the HPV vaccine series in the South/Southwestern states only. Girls 9-10 and 11-12 y old were less likely to have initiated and 11-12 y olds were less likely to have completed the HPV vaccine series compared to 13-17 y olds. The observed regional variations in vaccination could cause rates of cervical cancer to remain higher in the South/Southwest and widen currently observed regional disparities in cervical cancer rates.

Hepatitis C Testing Increased Among Baby Boomers Following The 2012 Change To CDC Testing Recommendations

“…Regional variation in the uptake of recommendations on a number of health interventions has previously been documented. 29,30 Additionally, Sourik Sarkar and coauthors found significant regional variability in hepatitis C testing. 28 Taken together, these findings suggest the need for region-specific programs to augment guidelines to further improve screening.…”

Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature

“…The Southern states, in particular, have had lower HPV vaccination rates compared to other regions of the US. 14 In 2008-2010, adolescents in the South and Southwestern states were less likely to initiate the HPV vaccine series compared to states in the rest of the US. 14,15 More recent data of 13-17 year olds showed that adolescents in the Western US states were more likely to have been vaccinated than those in the South.…”

“…14 In 2008-2010, adolescents in the South and Southwestern states were less likely to initiate the HPV vaccine series compared to states in the rest of the US. 14,15 More recent data of 13-17 year olds showed that adolescents in the Western US states were more likely to have been vaccinated than those in the South. 83 Unfortunately, many Southern states in the US also have high rates of cervical cancer.…”

“…[11][12][13] Further, vaccination rates vary by geography, and by race/ethnicity, which could contribute to continuing disparities in HPV-related cancers, including oral and cervical cancers. 8,[14][15][16][17][18][19][20][21] However, there is evidence that HPV prevalence is decreasing in the US since the HPV vaccine was introduced, and limited evidence of herd immunity has also been demonstrated. [22][23][24] Unfortunately, although we can anticipate decreasing HPV-related cancer rates across the US, it is likely that disparities will continue due to uneven vaccination rates across geographies and race/ethnicity.…”

State statutes and regulations related to human papillomavirus vaccination

“…This diversity is reflected in the variation of vaccination rates across states and regions with Northeastern, Midwestern, and Western states seeing higher rates of HPV vaccination coverage than Southern and Southwestern. 2,4,5 Several studies have attempted to demonstrate the impact of state policies on vaccine uptake; focusing on particular states and specific policies such as HPV vaccine school-entry requirements [6][7][8] or policies requiring vaccine education for parents. 8,9 As observed by Durham et al, 10 and Roberts et al, 11 variability in HPV vaccine uptake across the United States is probably a function, at least in part, of a collection of structural elements, such as law and policy.…”