Parents who receive a recommendation for the human papillomavirus (HPV) vaccine from a health care provider (HCP) are more likely to accept vaccination for their children. HPV vaccine coverage varies widely by geography and community level factors; however, little is known about how HCP recommendations for HPV vaccines vary at the community level. In this study, we examined the association between community level factors and receipt of a recommendation for the HPV vaccine. We also examined interaction between community level factors and patient characteristics.
We conducted a multilevel multivariable weighted logistic regression analysis of 2014-2019 National Immunization Survey – Teen (NIS–Teen) linked to 2010 Census Bureau data at the ZIP code level.
Parents’ report of receipt of a recommendation for the HPV vaccine was associated with higher population density (aOR: 1.20, 95% CI: 1.10-1.30), higher community-level education (aOR: 1.37, 95% CI: 1.23-1.52) and higher rates of unemployment (aOR: 1.14, 95% CI: 1.04-1.25). There was also a statistically significant interaction between adolescent race/ethnicity and ZIP code poverty status: non-White adolescents living in high poverty ZIP codes were 1.16 times more likely (95% CI: 1.02-1.32) to have received a HCP recommendation for the HPV vaccine compared to non-White adolescents in low poverty ZIP codes.
Our findings indicate that evidence-based interventions that focus on HCPs or are practice-based may have the greatest impact in non-urban areas. Efforts to promote vaccine recommendations to all age-eligible patients by HCPs will also promote more equitable coverage.
