Table 2.
The proportion of adolescents aged 13–17 years not receiving HPV vaccine by MSA status for select sociodemographic and access-to-care characteristics – United States. National Immunization Survey – Teen, 2016–2017 (N = 41,424).
| Metropolitan Statistical Area (MSA) |
||||
|---|---|---|---|---|
| Overall |
Mostly urban |
Suburban |
Mostly rural |
|
| Characteristic | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) |
| Total | 37.0 (36.2–37.9) | 32.0 (30.6–33.3) | 39.2 (37.9–40.5)* | 45.4 (43.5–47.2)* |
| Survey Year | ||||
| 2016† | 39.6 (38.4–40.8) | 34.1 (32.1–36.0) | 41.5 (39.7–43.4) | 49.6 (47.0–52.2) |
| 2017 | 34.5 (33.3–35.7)‡ | 29.9 (28.1–31.8)‡ | 36.9 (35.2–38.7)*‡ | 40.7 (38.1–43.4)*‡ |
| Age (years) | ||||
| 13–15† | 38.8 (37.6–39.9) | 33.1 (31.4–34.9) | 41.7 (40.0–43.4) | 45.8 (43.4–48.2) |
| 16–17 | 34.4 (33.1–35.7)‡ | 30.2 (28.1–32.4)‡ | 35.3 (33.4–37.2)*‡ | 44.7 (41.8–47.7)* |
| Sex | ||||
| Female† | 33.2 (32.0–34.4) | 28.4 (26.5–30.3) | 35.1 (33.3–37.0) | 41.4 (38.8–44.1) |
| Male | 40.7 (39.5–41.9)¶ | 35.3 (33.4–37.2)¶ | 43.3 (41.5–45.0)*¶ | 49.1 (46.5–51.6)*¶ |
| Race/ethnicity | ||||
| Non-Hispanic white† | 42.7 (41.6–43.7) | 38.0 (36.2–39.9) | 43.7 (42.2–45.2)* | 48.4 (46.3–50.5)* |
| Non-Hispanic black | 32.1 (29.7–34.5)‡ | 31.9 (28.6–35.4)‡ | 30.8 (27.2–34.7)‡ | 38.2 (31.5–45.4)‡ |
| Hispanic | 27.8 (25.8–29.9)‡ | 23.7 (21.1–26.5)‡ | 31.0 (27.7–34.5)*‡ | 38.5 (32.9–44.5)*‡ |
| AI/AN | 38.7 (30.8–47.2) | 32.6 (21.0–46.8) | 50.8 (35.7–65.7) | 32.3 (21.8–45.1)‡ |
| Asian | 33.5 (29.2–38.0)‡ | 27.1 (22.0–32.9)‡ | 39.4 (32.7–46.5)* | 50.5 (27.6–73.1) |
| Other | 37.3 (33.9–40.8)‡ | 34.8 (29.7–40.4) | 38.0 (32.8–43.6) | 42.4 (34.7–50.5) |
| Immigration status | ||||
| U.S. born† | 37.5 (36.7–38.4) | 32.7 (31.3–34.1) | 39.4 (38.0–40.7) | 45.4 (43.5–47.3) |
| Foreign born | 29.6 (26.0–33.5)‡ | 25.1 (20.2–30.6)‡ | 35.4 (29.8–41.3)* | 41.2 (29.7–53.7)* |
| Region | ||||
| Northeast† | 31.2 (29.6–32.8) | 22.1 (19.7–24.8) | 35.0 (33.0–37.1)* | 37.0 (31.2–43.1)* |
| Midwest | 38.7 (37.3–40.2)¶ | 31.4 (29.2–33.7)¶ | 41.6 (39.3–44.0)*¶ | 46.8 (43.7–49.9)*¶ |
| South | 41.9 (40.6–43.1)¶ | 38.4 (36.4–40.4)¶ | 43.4 (41.6–45.3)*¶ | 46.8 (43.8–49.9)*¶ |
| West | 31.7 (29.4–34.1) | 28.2 (25.2–31.5)¶ | 34.0 (30.2–38.1)* | 42.8 (38.3–47.3)* |
| Maternal education | ||||
| <High school† | 26.8 (24.4–29.3) | 20.5 (17.4–24.1) | 30.4 (26.1–35.0)* | 41.0 (35.8–46.3)* |
| High school | 35.7 (33.9–37.6)¶ | 29.8 (26.9–32.8)¶ | 39.1 (36.1–42.1)*¶ | 42.1 (38.3–46.0)* |
| Some college/college graduate | 40.5 (38.8–42.3) ¶ | 36.5 (33.7–39.5) ¶ | 42.3 (39.7–45.0)*¶ | 44.9 (41.8–48.1)* |
| >College graduate | 39.0 (37.8–40.3) ¶ | 35.3 (33.3–37.4) ¶ | 39.8 (38.0–41.5)*¶ | 51.1 (47.9–54.3)* ¶ |
| Maternal age (years) | ||||
| ≤34† | 31.9 (29.1–34.8) | 27.6 (23.6–32.0) | 33.3 (28.7–38.2) | 42.6 (36.9–48.6)* |
| 35–44 | 37.1 (35.8–38.5)¶ | 31.4 (29.4–33.6) | 40.4 (38.4–42.5)*¶ | 42.8 (40.1–45.5)* |
| ≥45 | 37.9 (36.7–39.1)¶ | 33.4 (31.5–35.3)¶ | 39.1 (37.4–40.8)*¶ | 49.3 (46.4–52.2)*¶ |
| Parent aware of VFC program | ||||
| Yes† | 36.8 (35.5–38.2) | 31.4 (29.2–33.7) | 38.9 (36.8–41.1)* | 45.4 (42.7–48.3)* |
| No | 37.1 (36.1–38.2) | 32.3 (30.6–34.0) | 39.4 (37.8–41.0)* | 45.3 (42.8–47.8)* |
| Income to poverty ratio | ||||
| <133%† | 29.8 (28.3–31.4) | 25.0 (22.9–27.3) | 32.5 (29.9–35.3)* | 39.4 (36.4–42.6)* |
| 133%–<322% | 41.3 (39.7–43.0)¶ | 36.3 (33.7–39.0)¶ | 42.8 (40.2–45.4)*¶ | 48.9 (45.8–52.0)*¶ |
| 322%–<503% | 43.0 (41.0–44.9)¶ | 39.4 (36.3–42.7)¶ | 44.1 (41.4–46.9)*¶ | 47.8 (43.4–52.2)*¶ |
| >503% | 37.2 (35.5–38.9)¶ | 34.4 (31.6–37.3)¶ | 37.5 (35.3–39.8)* ¶ | 51.5 (46.3–56.6)*¶ |
| Medical insurance** | ||||
| Private only† | 40.9 (39.7–42.0) | 36.5 (34.7–38.4) | 41.7 (40.1–43.3)* | 52.2 (49.6–54.9)* |
| Any Medicaid | 30.3 (28.9–31.8)‡ | 25.5 (23.4–27.8)‡ | 32.8 (30.3–35.3)*‡ | 38.8 (36.0–41.6)*‡ |
| Other†† | 40.7 (37.9–43.7) | 39.6 (35.1–44.2) | 42.0 (37.6–46.6) | 39.1 (32.9–45.7) ¶ |
| Uninsured | 43.5 (39.1–48.0) | 35.4 (29.3–42.0) | 46.7 (39.5–54.0)* | 61.3 (52.2–69.6)* |
| 11–12 y.o. well-child visit‡‡ | ||||
| Yes† | 30.7 (29.6–31.8) | 25.9 (24.2–27.7) | 33.4 (31.8–35.1)* | 35.1 (32.3–38.0)* |
| No | 46.3 (44.4–48.2)¶ | 40.0 (37.0–43.1)¶ | 49.6 (46.5–52.8)*¶ | 51.9 (48.8–54.9)*¶ |
| Don’t know | 40.0 (38.4–41.7)¶ | 35.0 (32.5–37.6)¶ | 42.4 (40.0–44.9)*¶ | 51.1 (47.3–54.8)*¶ |
| Provider recommendation for HPV vaccine¶¶ | ||||
| Yes† | 27.8 (26.9–28.8) | 24.6 (23.2–26.2) | 29.4 (28.0–30.8)* | 32.8 (30.6–35.1)* |
| No | 59.7 (57.6–61.6)¶ | 50.2 (46.9–53.5)¶ | 64.9 (61.9–67.8)*¶ | 68.7 (65.2–72.1)*¶ |
| Vaccination facility type | ||||
| All private facilities† | 36.9 (35.7–38.1) | 32.3 (30.4–34.2) | 39.6 (38.0–41.2)* | 43.6 (40.1–47.1)* |
| All public facilities | 36.9 (34.7–39.2) | 31.4 (27.9–35.1) | 35.9 (31.8–40.2) | 46.9 (43.5–50.3)* |
| All hospital facilities | 32.9 (30.5–35.4)‡ | 28.0 (24.6–31.7)‡ | 34.9 (31.1–38.9)*‡ | 45.8 (39.8–51.9)* |
| All STD/school/teen clinics or other facilities | 38.3 (31.1–45.9) | 38.2 (27.3–50.5) | 33.6 (24.0–44.7) | 59.1 (42.6–73.7)* |
| Mixed*** | 37.4 (35.5–39.3) | 30.4 (27.5–33.6) | 40.8 (37.7–44.0)* | 43.2 (39.9–46.5)* |
| Other††† | 52.4 (45.3–59.4)¶ | 48.3 (38.2–58.6)¶ | 54.8 (44.2–65.0)¶ | 63.1 (42.2–80.0)* |
Abbreviations: AI/AN = American Indian/Alaskan Native; CI = confidence interval; HPV = human papillomavirus; STD = sexually transmitted disease; y.o. = years old. VFC = Vaccines for Children.
*Statistically different compared with adolescents living in mostly urban areas (p < .05).
†Reference level for characteristic.
‡Statistically significantly lower (p < .05) compared to the reference level for characteristic.
¶Statistically significantly higher (p < .05) compared to the reference level for characteristic.
**Insurance categories are mutually exclusive.
††Includes Indian Health Service, military, Children’s Health Insurance Program, and some private.
‡‡Status of health-care visit at age 11–12 years based on provider-reported data.
¶¶By parental report.
***Mixed indicates that the facility is identified to be in more than one of the facility categories, such as private, public, hospital, and sexually transmitted disease/school/teen clinics.
†††Includes military, Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics, and pharmacies.