Background
Methods
Study design
Measures
Individual-level variables
Area-based variables
Statistical analysis
Results
Survey participant characteristics
Characteristics | Survey Participants, n weighted % | Weighted % (95% CI), Vaccine Initiation (≥ 1 dose) |
P-value | Weighted % (95% CI), Vaccine Completion (≥3 doses) |
P-value |
---|---|---|---|---|---|
Total | 19,518 | 27.9 (26.6 - 29.2) | 10.38 (9.48 – 11.29) | ||
Year | <.0001 | <.0001 | |||
2012 | 10,265 | 20.8 (19.24 – 22.35) | 6.79 (5.84-7.74 | ||
2013 | 9253 | 35.26 (33.23 – 37.29) | 13.64 (12.24-15.05) | ||
Individual-level variables | |||||
Age | 0.7461 | 0.2899 | |||
13 | 3942 (19.99) | 26.4 (23.58 - 29.23) | 9.11 (7.48 – 10.74) | ||
14 | 4117 (20.54) | 28.26 (25.35 – 31.18) | 9.38 (7.47 – 11.29) | ||
15 | 3884 (20.63) | 28.09 (25.38 – 30.80) | 11.52 (9.38 – 13.67) | ||
16 | 3911 (19.66) | 28.50 (25.79 – 31.20) | 9.66 (7.85 – 11.46) | ||
17 | 3664 (19.18) | 26.58 (23.77 – 29.39) | 11.18 (9.21 – 13.15) | ||
Mother’s marital status | <.001 | < .3775 | |||
Married | 14,314 (65.46) | 25.39 (23.94-26.84) | 9.88 (8.85 – 10.91) | ||
Not married | 5204 (34.54) | 31.72 (29.40 – 34.05) | 10.71 (9.20 – 12.21) | ||
Mother’s age, years | <.0002 | <.1853 | |||
< = 34 | 1590 (9.77) | 34.55 (30.46 – 38.65) | 11.58 (8.93 – 14.23) | ||
35 TO 44 | 8112 (46.59) | 28.09 (26.11 – 30.07) | 9.36 (8.11 – 10.61) | ||
> = 45 | 9816 (43.64) | 25.47 (23.78 – 27.16) | 10.71 (9.42 – 12.01) | ||
Type of insurance coverage | <.0001 | <.0001 | |||
No insurance | 1269 (8.43) | 25.9 (21.22-30.59) | 5.73 (3.91-7.54) | ||
Employer or union | 10,645 (45.86) | 21.45 (20.03-22.87) | 8.34 (7.31-9.37) | ||
SCHIP or Medicaid | 4957 (33.39) | 35.91 (33.34-38.48) | 13.39 (11.56-15.22) | ||
IHS, military, other | 2647 (12.32) | 28.96 (25.43-32.48) | 11.29 (8.72-13.86) | ||
Mother’s education, years | <.0001 | < .0001 | |||
< 12 years | 2012 (13.93) | 40.97 (35.79-44.15) | 17.02 (13.63-20.41) | ||
12 years | 3615 (24.97) | 27.94 (25.08-30.79) | 9.09 (7.29-10.90) | ||
> 12 years, non-college graduate | 5451 (25.69) | 22.26 (20.14-24.39) | 8.29 (6.79-9.78)) | ||
College graduate | 8440 (35.41) | 25.92 (24.20-27.63) | 9.59 (8.54-10.65) | ||
Poverty Status | <.0001 | <.0034 | |||
Above poverty, Annual Income >$75,000 | 8574 (33.48) | 22.86 (21.31-24.42) | 8.93 (7.89-9.98) | ||
Above poverty, Annual Income ≤$75,000 | 7165 (38.07) | 24.85 (22.82-26.88) | 9.35 (7.91-10.79) | ||
Below poverty | 3225 (24.16) | 37.93 (34.92-40.95) | 13.10 (11.12-15.08) | ||
Unknown poverty status | 554 (4.29) | 30.29 (22.48-38.10) | 10.56 (4.29-16.83) | ||
Race/ethnicity of teen | <.0001 | <.0001 | |||
Hispanic | 2748 (22.18) | 40.75 (37.11-44.40) | 16.14 (13.30-18.97) | ||
Non-Hispanic White | 13,050 (55.23) | 20.67 (19.50-21.85) | 7.73 (6.95-8.51) | ||
Non-Hispanic Black | 1860 (13.93) | 34.26 (30.58-37.93) | 10.46 (8.29-12.63) | ||
Non-Hispanic other + multiple race | 1860 (8.66) | 27.13 (23.55-30.71) | 9.95 (7.79-12.10) | ||
Received provider recommendation to get HPV vaccine | <.0001 | <.0001 | |||
Yes | 7121 (35.01) | 53.66 (51.48-55.83) | 21.09 (19.20-22.98) | ||
No | 10,793 (57.49) | 12.21 (10.90-13.52) | 3.86 (3.05-4.67) | ||
Don’t Know | 1399 (7.50) | 25.18 (21.11-29.24) | 8.68 (6.07-11.29) | ||
Healthcare system factor | |||||
Facility types for teen’s providers | <.8268 | <.8739 | |||
All public facilities | 2722 (14.44) | 26.58 (22.86 – 30.31) | 9.26 (6.64-11.87) | ||
All hospital facilities | 1884 (8.18) | 28.97 (24.67 – 33.27) | 10.23 (7.79 – 12.67) | ||
All private facilities | 9086 (50.77) | 27.26 (25.57 – 28.96) | 10.44 (9.25 – 11.62) | ||
Mixed & STD/school/teen clinics or other facilities | 5250 (23.53) | 28.64 (26.17 – 31.12) | 9.88 (8.44 – 11.32) | ||
Unknown | 496 (3.08) | 28.28 (19.44 – 37.12) | 13.01 (4.49 – 21.53) | ||
ZCTA area-based measures | |||||
Racial Composition (50% + of specific race/ethnic group) | <.0001 | <.0002 | |||
Hispanic | 1150 (10.24) | 47.13 (41.30-52.97) | 16.58 (11.93-21.22) | ||
Mixed | 1783 (12.34) | 33.02 (28.80-37.24) | 13.66 (10.84-16.48) | ||
Non-Hispanic Black | 1083 (5.95) | 33.27 (28.83-37.71) | 9.88 (7.06-12.71) | ||
Non-Hispanic White | 15,155 (70.61) | 23.23 (22.03-24.43) | 8.69 (7.86-9.51) | ||
Non-Hispanic other | 245 (0.85) | 36.12 (15.79-56.46) | 6.26 (2.35-10.16) | ||
Poverty (% below poverty) | <.0001 | <.0217 | |||
0-4.99% low | 2981 (13.47) | 24.36 (21.58-27.13) | 9.01 (7.01-11.02) | ||
5-9.9% | 5192 (25.16) | 25.54 (23.30-27.78) | 9.52 (8.07-10.98) | ||
10-19.9% | 7170 (36.44) | 25.32 (23.20-27.44) | 9.14 (7.82-10.46) | ||
20 + %, high | 4070 (24.93) | 34.76 (31.96-37.57) | 12.92 (10.78 -5.06) | ||
Population density quartiles (people per square mile) | <.0001 | <.0001 | |||
Q1 1-20 (lowest density) | 1472 (3.25) | 19.32 (15.53-23.12) | 8.10 (5.08-11.12) | ||
Q2 21-71 | 2516 (10.29) | 20.41 (17.11-23.72) | 5.63 (3.99-7.28) | ||
Q3 72-651 | 5504 (26.97) | 23.44 (21.24-25.65) | 9.44 (7.79-11.09) | ||
Q4 > 651 (highest density) | 9924 (59.49) | 31.17 (29.44-32.91) | 11.38 (10.21-12.56) | ||
Residence type | <.0001 | <.0001 | |||
Isolated Small Rural Town | 964 (2.32) | 17.34 (13.51-21.16) | 5.31 (3.33-7.30) | ||
Small Rural Town | 938 (3.07) | 18.70 (13.94-23.45) | 5.50 (3.32-7.67) | ||
Large Rural Town | 1715 (5.66) | 18.55 (15.63-21.47) | 6.45 (4.69-8.21) | ||
Urban focused | 15,799 (88.95) | 28.74 (27.38-30.11) | 10.68 (9.74-11.63) |
Initiation
HPV vaccine initiationa
| ||||
---|---|---|---|---|
Characteristics | UndadjustedbOR (95%CI) | Individual-level only, (Model 1) AOR b,c(95% CI) | Individual-level + ZCTA racial composition + ZCTA population density (Model 2), AOR b,c (95% CI) | Individual-level + ZCTA poverty, + ZCTA population density (Model 3), AOR b, c, d (95% CI) |
Individual-level variables | ||||
Age | ||||
13 | Ref | Ref | Ref | Ref |
14 | 1.14 (1.03, 1.26)* | 1.30 (1.16, 1.46)** | 1.30 (1.15, 1.46)** | 1.30 (1.15, 1.46)** |
15 | 1.12 (1,01, 1.23)* | 1.36 (1.21, 1.53)** | 1.34 (1.19, 1.51)** | 1.35 (1.20, 1.51)** |
16 | 1.18 (1.07, 1.31)* | 1.40 (1.24, 1.58)** | 1.40 (1.24, 1.58)** | 1.40 (1.24, 1.58)** |
17 | 1.03 (0.93, 1.15) | 1.32 (1.17, 1.49)** | 1.31 (1.16, 1.48)** | 1.31 (1.16, 1.48)** |
Mother’s age, years | ||||
< = 34 | 1.17 (1.10, 1.26)** | 1.12 (1.03, 1.22)** | 1.13 (1.04, 1.23)** | 1.13 (1.04, 1.23)** |
35 TO 44 | 1.63 (1.46, 1.82)** | 1.33 (1.16, 1.52)* | 1.33 (1.16, 1.53)* | 1.33 (1.16, 1.53)* |
> = 45 | Ref | Ref | Ref | Ref |
Type of insurance coverage insurance | ||||
No insurance | 1.26 (1.11, 1.42)* | 1.17 (0.97, 1.43) | 1.15 (0.94, 1.40) | 1.16 (0.99, 1.36) |
Employer or union | Ref | Ref | Ref | Ref |
SCHIP or Medicaid | 2.04 (1.89, 2.20)** | 1.53 (1.36, 1.71)** | 1.53 (1.37, 1.71)** | 1.54 (1.38, 1.73)** |
IHS, military, other | 1.43 (1.29, 1.58)** | 1.38 (1.22, 1.56)** | 1.37 (1.21, 1.55)** | 1.38 (1.22, 1.56)** |
Mother’s education, years | ||||
< 12 years | 1.90 (1.73, 2.09)** | 1.25 (1.09, 1.44)* | 1.23 (1.07, 1.42)* | 1.25 (1.09, 1.44)* |
12 years | 1.13 (1.04, 1.22)* | 0.83 (0.74, 0.93)* | 0.84 (0.75, 0.94)* | 0.84 (0.75, 0.94)* |
> 12 years, non-college graduate | 0.84 (0.77,0.92)** | 0.66 (0.60, 0.74)** | 0.67 (0.60, 0.74)** | 0.67 (0.60, 0.74)** |
College graduate | Ref | Ref | Ref | Ref |
Poverty status | ||||
Above poverty, >$75,000 | Ref | Ref | Ref | Ref |
Above poverty, ≤$75,000 | 1.17 (1.08, 1.27)** | 0.99 (0.89, 1.10) | 1.00 (0.90, 1.12) | 0.10 (0.90, 1.11) |
Below poverty | 2.13(1.96, 2.32)** | 1.35 (1.17, 1.55)** | 1.34 (1.16, 1.54)** | 1.34 (1.17, 1.55)** |
Unknown poverty status | 1.50 (1.27, 1.76)** | 1.18 (0.97, 1.43) | 1.15 (0.94, 1.40) | 1.18 (0.97, 1.44) |
Race/ethnicity of teen | ||||
Hispanic | 2.42 (2.22, 2.63)** | 2.14 (1.92, 2.39)** | 1.88 (1.68, 2.12)** | 2.02 (1.81, 2.26)** |
Non-Hispanic White | Ref | Ref | Ref | Ref |
Non-Hispanic Black | 2.07 (1.88, 2.28)** | 1.72 (1.53, 1.93)** | 1.57 (1.38, 1.78)** | 1.60 (1.41, 1.80)** |
Non-Hispanic other and multiple race | 1.31 (1.16, 1.48)** | 1.22 (1.06, 1.40)* | 1.19 (1.03, 1.37)* | 1.18 (1.02, 1.36)* |
Received provider recommendation to get HPV vaccine | ||||
Yes | 8.38 (7.77, 9.03)** | 9.40 (8.66, 10.20)** | 9.34 (8.61, 10.15)** | 9.34 (8.60-10.14)** |
No | Ref | Ref | Ref | Ref |
Don’t know | 2.41 (2.36, 2.47)** | 2.40 (2.09, 2.76)** | 2.39 (2.08, 2.75)** | 2.39 (2.07-2.75)** |
ZCTA Area-based measures | ||||
Racial composition (50% + of that groupin ZCTA) | ||||
Hispanic | 2.62 (2.35, 2.93) | — | 1.41 (1.22, 1.63)** | --- |
Mixed | 1.47 (1.32, 1.62) | — | 1.00 (0.88, 1.13) | --- |
Non-Hispanic Black | 1.76 (1.54, 2.02) | — | 1.15 (0.97, 1.36) | --- |
Non-Hispanic White | Ref | — | Ref | Ref |
Non-Hispanic other | 1.44 (1.03, 2.01) | — | 0.96 (0.63, 1.44) | --- |
ZCTA poverty (% below poverty) c | ||||
0-4.99%, least impoverished | Ref | — | — | Ref |
5-9.9% | 1.08 (0.97, 1.21) | — | — | 1.04 (0.92, 1.19) |
10-19.9% | 1.15 (1.03, 1.29)* | — | — | 0.95 (0.83, 1.08) |
20 + %, poorest | 1.77 (1.58, 1.98)** | — | — | 1.13 (0.98, 1.31) |
ZCTA Population density quartiles (people per square mile) | ||||
Q1 1-20 (lowest density) | Ref | — | Ref | Ref |
Q2 21-71 | 1.12 (0.88, 1.41) | — | 0.95 (0.74, 1.24) | 0.97 (0.75 – 1.25) |
Q3 72-651 | 1.26 (1.02, 1.56)* | — | 1.12 (0.88, 1.43) | 1.14 (0.89 – 1.45) |
Q4 > 651 (highest density) | 1.70 (1.37, 2.10)** | 1.26 (0.99, 1.60) | 1.27 (1.00 – 1.62) | |
Q4 vs Q2 | 1.52 (1.35,1.72)** | 1.33 (1.04-1.25)* | 1.32 (1.14-1.52)* | |
Q4 vs Q3 | 1.35 (1.25, 1.46)* | 1.14 (1.25-1.04)* | 1.12 (1.02-1.23)* | |
ZCTA -Residence type | ||||
1. Isolated Small Rural T | Ref | — | — | |
2. Small Rural Town | 1.13 (0.82, 1.57) | — | — | |
3. Large Rural Town | 1.10 (0.82, 1.48) | — | — | |
4. Urban focused | 1.71 (1.33, 2.21)** | — | — |
Completion
HPV vaccine series completion a
| ||||
---|---|---|---|---|
Characteristics | Undadjustedb,cOR (95%CI) | Individual-level only, (Model 1) AOR a, b(95% CI) | Individual-level + ZCTA racial composition + ZCTA population density (Model 2), AOR a, b (95% CI) | Individual-level + ZCTA poverty, + ZCTA population density (Model 3), AOR a, b (95% CI) |
Individual-level variables | ||||
Teens Age | ||||
13 | Ref | Ref | Ref | Ref |
14 | 1.04 (0.89, 1.21) | 1.06 (0.91, 1.25) | 1.08 (0.92, 1.27) | 1.05 (0.90, 1.24) |
15 | 1.32 (1.14, 1.52)* | 1.50 (1.29, 1.75)** | 1.48 (1.27, 1.73)** | 1.48 (1.27, 1.73)** |
16 | 1.09 (0.84, 1.27) | 1.16 (0.99, 1.37) | 1.16 (0.98, 1.36) | 1.15 (0.98, 1.35) |
17 | 1.27 (1.10, 1.48)* | 1.48 (1.26, 1.74)** | 1.46 (1.24, 1.71)** | 1.45 (1.23, 1.70)** |
Mother’s marital status | ||||
Married | Ref | Ref | Ref | Ref |
Not married | 1.11 (1.01, 1.22)* | 0.93 (0.83, 1.04) | 0.94 (0.84, 1.05) | 0.93 (0.83, 1.04) |
Type of insurance coverage insurance | ||||
No insurance | 0.65 (0.52, 0.81)* | 0.60 (0.47, 0.76)** | 0.59 (0.46, 0.76)** | 0.59 (0.46, 0.75)** |
Employer or union | Ref | Ref | Ref | Ref |
SCHIP or Medicaid | 1.69 (1.52, 1.87)** | 1.37 (1.18, 1.59)** | 1.38 (1.18, 1.60)** | 1.36 (1.17, 1.58)** |
IHS, military, other | 1.35 (1.16, 1.56)** | 1.27 (1.08, 1.49)* | 1.30 (1.10, 1.53)* | 1.25 (1.06, 1.47)* |
Mother’s education, years | ||||
< 12 years | 1.90 (167, 2.16)** | 1.73 (1.45, 2.07)** | 1.77 (1.48, 2.13)** | 1.69 (1.41, 2.03)** |
12 years | 0.95 (0.83, 1.07) | 0.90 (0.77, 1.05) | 0.91 (0.78, 1.07) | 0.90 (0.77, 1.05) |
> 12 years, non-college graduate | 0.88 (0.78, 1.00) | 0.90 (0.78, 1.04) | 0.92 (0.79, 1.05) | 0.90 (0.78, 1.04) |
College graduate | Ref | Ref | Ref | Ref |
Poverty status | ||||
Above poverty, >$75,000 | Ref | Ref | Ref | Ref |
Above poverty, ≤$75,000 | 1.08 (0.96, 1.21) | 0.99 (0.86, 1.14) | 0.99 (0.85, 1.14) | 0.10 (0.86, 1.15) |
Below poverty | 1.58 (1.40, 1.79)** | 1.11 (0.93, 1.34) | 1.13 (0.93, 1.36) | 1.11 (0.92, 1.34) |
Unknown poverty status | 1.21 (0.96, 1.53) | 0.91 (0.70, 1.19) | 0.90 (0.69, 1.18) | 0.90 (0.69, 1.17) |
Race/ethnicity of teen | ||||
Hispanic | 2.19 (1.95, 2.46)** | 1.95 (1.70, 2.24)** | 1.89 (1.62, 2.19)** | 1.86 (1.61, 2.15)** |
Non-Hispanic White | Ref | Ref | Ref | Ref |
Non-Hispanic Black | 1.44 (1.24, 1.66)** | 1.26 (1.08, 1.48)* | 1.21 (1.01, 1.44)* | 1.19 (1.01, 1.40)* |
Non-Hispanic other and multiple race | 1.24 (1.03, 1.48)* | 1.22 (1.01, 1.47)* | 1.24 (1.03, 1.51)* | 1.20 (0.10, 1.45) |
Received provider recommendation to get HPV vaccine | ||||
Yes | 6.59 (5.89, 7.36)** | 6.53 (5.83, 7.33)** | 6.60 (5.89, 7.42)** | 6.53 (5.82, 7.33)** |
No | Ref | Ref | Ref | Ref |
Don’t know | 2.20 (1.78, 2.71)** | 2.19 (1.77, 2.70)** | 2.20 (1.77, 2.73)** | 2.19 (1.78, 2.71)** |
ZCTA Area-based measures | ||||
Racial composition (50% + of that group) | ||||
Hispanic | 1.88 (1.62, 2.19) | — | 0.98 (0.81, 1.18) | --- |
Mixed | 1.58 (1.38, 1.81) | — | 1.16 (0.99, 1.36) | --- |
Non-Hispanic Black | 1.23 (1.00, 1.51) | — | 0.99 (0.78, 1.23) | --- |
Non-Hispanic White | Ref | — | Ref | Ref |
Non-Hispanic other | 0.60 (0.32, 1.14) | — | 0.27 (0.14, 0.54)* | --- |
Poverty (% below poverty) d
| ||||
0-4.99%, least impoverished | Ref | — | — | Ref |
5-9.9% | 1.08 (0.92, 1.28) | — | — | 1.09 (0.92, 1.30) |
10-19.9% | 1.08 (0.92, 1.27) | — | — | 1.05 (0.88, 1.25) |
20 + %, poorest | 1.58 (1.34, 1.86)** | — | — | 1.22 (1.01, 1.48)* |
Population density quartiles (people per sqr mile) | ||||
1, lowest density) 1-20 per sq. mile | Ref | — | Ref | Ref |
2. 21-71 persons per sq. mile | 0.71 (1.00, 0.50) | — | 0.60 (0.42, 0.86)* | 0.61 (0.42, 0.86)* |
3. 72-651 persons per sq. mile | 1.19 (0.88, 1.62) | — | 1.01 (0.73, 1.39) | 1.02 (0.74, 1.40) |
4. highest density > 651 person per sq. mile | 1.34 (0.99, 1.82) | 0.95 (0.69, 1.30) | 0.95 (0.69, 1.30) | |
Q4 vs Q2 | 1.90 (1.55, 2.32)** | 1.57 (1.27, 1.94)** | 1.57 (1.27, 1.94)** | |
Q4 vs Q3 | 1.13 (1.01, 1.26)* | 0.94 (083, 1.06) | 0.93 (0.83, 1.05) | |
Residence type | ||||
1. Isolated Small Rural T | Ref | — | — | |
2. Small Rural Town | 1.05 (0.61, 1.80) | — | — | |
3. Large Rural Town | 1.25 (0.77, 2.01 | — | — | |
4. Urban focused | 1.92 (1.26, 2.92)* | — | — |