Associations of geographic-based socioeconomic factors and HPV vaccination among male and female children in five US states

Serena Xiong, Sarah Humble, Alan Barnette, Heather Brandt, Vetta Thompson, Lisa M. Klesges, Michelle I. Silver

Research output: Contribution to journalArticlepeer-review


Background: We assessed whether five geographic-based socioeconomic factors (medically underserved area (MUA); healthcare provider shortage area (HPSA); persistent poverty; persistent child poverty; and social vulnerability index (SVI)) were associated with the odds of HPV vaccination initiation, series completion, and parental vaccine hesitancy, and whether the observed relationships varied by gender of the child. Methods: An online panel service, administered through Qualtrics®, was used to recruit parents of adolescents 9–17 years of age to complete a one-time survey in 2021. Coverage of the panel included five US states: Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois. Generalized estimating equation (GEE) models were used to assess population-level associations between five geographic-based socioeconomic factors (MUA; HPSA; persistent poverty; persistent child poverty; and SVI) and three HPV vaccination outcomes (initiation, series completion, and hesitancy). All GEE models were adjusted for age of child and clustering at the state level. Results: Analyses were conducted using responses from 926 parents about their oldest child in the target age range (9–17 years). The analytic sample consisted of 471 male children and 438 female children across the five states. In adjusted GEE models, persistent child poverty and HPSA were negatively associated with HPV vaccination initiation and series completion among female children, respectively. Among male children, high social vulnerability was negatively associated with HPV vaccine series completion. Additionally, persistent poverty and high social vulnerability were negatively associated with HPV vaccine hesitancy in male children. Conclusions: The results of this cross-sectional study suggest that geographic-based socioeconomic factors, particularly, HPSA, persistent poverty, and SVI, should be considered when implementing efforts to increase HPV vaccine coverage for adolescents. The approaches to targeting these geographic factors should also be evaluated in future studies to determine if they need to be tailored for male and female children.

Original languageEnglish (US)
Article number702
JournalBMC public health
Issue number1
StatePublished - Dec 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.


  • Generalized estimation equation models
  • Geographic-based factors
  • HPV vaccination
  • Human papillomavirus (HPV)

PubMed: MeSH publication types

  • Journal Article


Dive into the research topics of 'Associations of geographic-based socioeconomic factors and HPV vaccination among male and female children in five US states'. Together they form a unique fingerprint.

Cite this