HPV vaccination among adolescent females from Appalachia: Who is getting vaccinated?

BACKGROUND. Appalachia is a geographic region with existing cervical cancer disparities. HPV vaccine coverage in Appalachia is mostly comparable to the rest of the United States, but data are lacking on correlates of HPV vaccination among Appalachian adolescents or reasons why Appalachian parents do not intend to vaccinate their daughters. METHODS. We analyzed 2008-2010 data from the National Immunization Survey-Teen for adolescent females ages 13-17 who resided in Appalachia (n=1,951). We used weighted logistic regression to identify correlates of HPV vaccine initiation (receipt of at least one dose), completion (receipt of at least three doses), and follow-through (completion among initiators). RESULTS. HPV vaccine initiation was 40.8%, completion was 27.7%, and follow-through was 67.8%. Initiation and completion were more common among females who had visited their healthcare provider in the last year or whose parents reported receiving a provider recommendation to have them vaccinated. Completion and follow-through were less common among younger females or those without healthcare coverage. Vaccination outcomes also varied greatly among Appalachian subregions. Only 41.0% of parents with unvaccinated daughters indicated intent to vaccinate their daughters against HPV in the next year. The most common reasons for not intending to vaccinate were believing vaccination is not necessary (21.5%), lack of knowledge (18.5%), and daughters not being sexually active (17.1%). CONCLUSIONS. Several subgroups in Appalachia are lagging behind in terms of HPV vaccination. Efforts to reduce missed opportunities for vaccination at healthcare visits and address reasons why parents are not vaccinating can help increase HPV vaccination in Appalachia.