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Abstract
The importance of increasing human papillomavirus (HPV) vaccination coverage among adolescents is a public health imperative to prevent unnecessary morbidity and mortality associated with cervical, oropharyngeal and other HPV related cancers and conditions. Despite the availability of two vaccines that protect against 90% of genital warts and 70% of cervical cancers, national HPV vaccination rates remain below the Healthy People 2020 targets of 80% coverage for females and males. The purpose of this study is to investigate human papillomavirus vaccination behavior among rural adolescents in Georgia. Specifically, in an effort to increase HPV vaccination coverage among hard to reach populations, this study aims to understand barriers as well as facilitators to HPV initiation among adolescent males and females living in rural communities. This study used a cross-sectional survey implemented with parents of adolescents age 10-18 years old in rural communities to measure: 1) parental attitudes, 2) healthcare utilization, 3) subjective norms and 4) cues to action. A step-wise forward logistic regression analyses was conducted to better understand the correlates of HPV vaccination. A majority of the sample was African American (69%, n=131) and female (52%, n=100). The mean age was 14 years old (SD=2.1). Most adolescents were covered by Medicaid insurance (64%, n=123) and less than 2% were uninsured (1.6%, n=3). The final model contained three significant correlates: provider recommendation, social norm score and information exposure score (R2=0.41, 2 (3)=87.3, p<0.001). Results showed that three factors were significant predictors of HPV vaccine uptake: provider recommendation (OR: 23.24; CI [8.94, 60.44]), subjective norms (OR:1.14; CI [1.07,1.21]) and sources of information (OR:0.72; CI: [0.53,0.97]). Future studies should focus on increasing healthcare providers ability to provide strong recommendations for the HPV vaccine for age appropriate adolescents.