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Rural–Urban Differences in Human Papillomavirus Vaccination Among Young Adults in 8 U.S. States

  • Minjee Lee
    Correspondence
    Address correspondence to: Minjee Lee, PhD, MPH, Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 East Madison Street, Springfield IL 62702.
    Affiliations
    Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois

    Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, Illinois
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  • Mary A. Gerend
    Affiliations
    Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida
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  • Eric Adjei Boakye
    Affiliations
    Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois

    Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, Illinois
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Published:October 13, 2020DOI:https://doi.org/10.1016/j.amepre.2020.07.023
      Each year, nearly 44,000 new cancers attributable to human papillomavirus (HPV) infection are diagnosed in the U.S., approximately 79% of which could have been prevented by HPV vaccination.
      • Senkomago V
      • Henley SJ
      • Thomas CC
      • Mix JM
      • Markowitz LE
      • Saraiya M
      Human papillomavirus-attributable cancers - United States, 2012-2016.
      HPV vaccination is routinely recommended for all adolescents aged 11–12 years, with catch-up vaccination recommended through age 26 years.
      • Meites E
      • Szilagyi PG
      • Chesson HW
      • Unger ER
      • Romero JR
      • Markowitz LE
      Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices.
      For unvaccinated adults aged 27–45 years, a shared clinical decision-making approach to HPV vaccination is recommended.
      • Meites E
      • Szilagyi PG
      • Chesson HW
      • Unger ER
      • Romero JR
      • Markowitz LE
      Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices.
      HPV vaccination rates in the U.S. are suboptimal. In 2018, a total of 68.1% of adolescents aged 13–17 years received ≥1 dose of HPV vaccine, and 51.1% completed the series.
      • Walker TY
      • Elam-Evans LD
      • Yankey D
      • et al.
      National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2018.
      For young adults aged 18–26 years, uptake is even lower. In 2014–2015, only 26.8% and 15.6% of young adults had initiated and completed the HPV vaccine series, respectively.
      • Adjei Boakye E
      • Lew D
      • Muthukrishnan M
      • et al.
      Correlates of human papillomavirus (HPV) vaccination initiation and completion among 18-26 year olds in the United States.
      Moreover, notable disparities in adolescent HPV vaccination by metropolitan statistical areas have been reported, with completion rates being 15 percentage points lower among adolescents living in rural areas than those living in urban areas (40.7% vs 56.1%).
      • Walker TY
      • Elam-Evans LD
      • Yankey D
      • et al.
      National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2018.
      Such trends are concerning because the incidence of HPV-related cancers is higher in rural population than in urban population.
      • Zahnd WE
      • James AS
      • Jenkins WD
      • et al.
      Rural–urban differences in cancer incidence and trends in the United States.
      The purpose of this study is to examine whether such rural–urban disparities in HPV vaccination exist among young adults aged 18–26 years in the U.S.
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