Multilevel factors associated with human papillomavirus vaccination coverage in Iowa youth: Evidence from a statewide immunization registry

Human papillomavirus (HPV) vaccination at the earliest opportunity is critical for preventing cervical, vulvar, vaginal, anal, rectal, and oropharyngeal cancers. This study examined individual-level and area-level factors associated with HPV vaccination among Iowa youth.

We analyzed Iowa Immunization Registry Information System data for youth aged 9-17 years, linked to ZIP Code Tabulation Area socioeconomic and demographic measures. Hierarchical Bayesian spatial models estimated HPV vaccination initiation, completion at any age, and on-time completion.

Receipt of school-required and other routinely recommended vaccines was strongly associated with HPV vaccination. Compared with youth who received both vaccine types, those who received only school-required vaccines or only other routinely recommended vaccines had lower HPV vaccination odds (ORs = 0.01-0.42, 95% CrIs = [0.01, 0.43]). Female youth, insured youth, and those of Hispanic or Latino ethnicity had higher vaccination odds. Youth in rural, small town, and micropolitan areas had lower odds than those in metropolitan areas (ORs = 0.89-0.93, 95% CrIs = [0.85, 0.97]). Area-level education, housing, and local HPV vaccination rates were associated with vaccination.

Individual-level and area-level characteristics were associated with HPV vaccination. Interventions promoting preventive care and routine youth vaccination while addressing geographic disparities may improve vaccine coverage and reduce HPV-related cancer risk.