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Barriers and facilitators to HPV vaccine uptake among US rural populations: a scoping review

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Abstract

Purpose

Compared to US urban populations, rural residents have a higher incidence of HPV-related cancer and lower HPV vaccine coverage. This study determined what is known about barriers and facilitators to vaccine uptake in US rural settings.

Methods

A scoping review was conducted to describe individual, interpersonal, organizational, and community/societal barriers and facilitators to HPV vaccine initiation and completion among US rural populations and to identify gaps in the current research. A systematic search was conducted using PubMed/MEDLINE and CINAHL databases.

Results

A total of 1,083 abstracts were reviewed and 13 articles met the inclusion criteria. Major themes at the individual-level included caregiver and vaccine-recipient demographics, other immunizations received, pap test history, awareness/knowledge of cervical cancer, HPV vaccine, or HPV infection, attitudes and motivation to vaccinate, STD diagnosis, sexual behavior, cervical cancer history, contraceptive use, and cancer fatalism. Interpersonal themes focused on provider influence and communication, caregiver and peer influence, and social support for the caregiver. At the organizational-level, themes included health insurance, provider characteristics, school-based interventions, and provider/practice-based interventions. The only community/societal factor examined related to a social marketing campaign.

Conclusion

Additional research is needed on interpersonal, organizational, and community/societal factors, as well as an expanded focus on rural males. Future studies should account for rural heterogeneity by expanding the geographic areas studied. Our findings detailing factors found to be associated with HPV vaccine uptake will help inform future clinical, health services, and community research, as well as interventions and policy efforts.

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References

  1. Satterwhite CL, Torrone E, Meites E et al (2013) Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 40:187–193. https://doi.org/10.1097/OLQ.0b013e318286bb53

    Article  PubMed  Google Scholar 

  2. Chesson HW, Dunne EF, Hariri S, Markowitz LE (2014) The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis 41:660–664. https://doi.org/10.1097/OLQ.0000000000000193

    Article  PubMed  PubMed Central  Google Scholar 

  3. Center for Disease Control and Prevention (CDC) (2019) Genital HPV infection—fact sheet. https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Accessed 2 Apr 2020

  4. Park IU, Introcaso C, Dunne EF (2015) Human papillomavirus and genital warts: a review of the evidence for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis 61(Suppl 8):S849–855. https://doi.org/10.1093/cid/civ813

    Article  PubMed  Google Scholar 

  5. Maxwell JH, Grandis JR, Ferris RL (2016) HPV-Associated head and neck cancer: unique features of epidemiology and clinical management. Annu Rev Med 67:91–101. https://doi.org/10.1146/annurev-med-051914-021907

    Article  CAS  PubMed  Google Scholar 

  6. Bosch FX, Manos MM, Muñoz N et al (1995) Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst 87:796–802. https://doi.org/10.1093/jnci/87.11.796

    Article  CAS  PubMed  Google Scholar 

  7. Walboomers JM, Jacobs MV, Manos MM et al (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189:12–19. https://doi.org/10.1002/(SICI)1096-9896(199909)189:1<12:AID-PATH431>3.0.CO;2-F

    Article  CAS  PubMed  Google Scholar 

  8. De Vuyst H, Clifford GM, Nascimento MC et al (2009) Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 124:1626–1636. https://doi.org/10.1002/ijc.24116

    Article  CAS  PubMed  Google Scholar 

  9. Alemany L, Cubilla A, Halec G et al (2016) Role of human papillomavirus in penile carcinomas worldwide. Eur Urol 69:953–961. https://doi.org/10.1016/j.eururo.2015.12.007

    Article  PubMed  Google Scholar 

  10. Schiffman M, Castle PE (2005) The promise of global cervical-cancer prevention. N Engl J Med 353:2101–2104. https://doi.org/10.1056/NEJMp058171

    Article  CAS  PubMed  Google Scholar 

  11. Saraiya M, Unger ER, Thompson TD et al (2015) US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djv086

    Article  PubMed  PubMed Central  Google Scholar 

  12. Garland SM, Steben M, Sings HL et al (2009) Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis 199:805–814. https://doi.org/10.1086/597071

    Article  PubMed  Google Scholar 

  13. Drolet M, Bénard É, Pérez N et al (2019) Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 394:497–509. https://doi.org/10.1016/S0140-6736(19)30298-3

    Article  PubMed  PubMed Central  Google Scholar 

  14. (2019) ACIP HPV Vaccine Recommendations|CDC. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html. Accessed 2 Apr 2020

  15. Walker TY, Elam-Evans LD, Yankey D et al (2018) National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2017. MMWR Morb Mortal Wkly Rep 67:909–917

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hirth J (2019) Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature. Hum Vaccine Immunother 15:146–155. https://doi.org/10.1080/21645515.2018.1512453

    Article  Google Scholar 

  17. Spencer JC, Calo WA, Brewer NT (2019) Disparities and reverse disparities in HPV vaccination: a systematic review and meta-analysis. Prev Med 123:197–203. https://doi.org/10.1016/j.ypmed.2019.03.037

    Article  PubMed  PubMed Central  Google Scholar 

  18. Walker TY, Elam-Evans LD, Singleton JA et al (2017) National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2016. MMWR Morb Mortal Wkly Rep 66:874–882. https://doi.org/10.15585/mmwr.mm6633a2

    Article  PubMed  PubMed Central  Google Scholar 

  19. Crosby RA, Casey BR, Vanderpool R et al (2011) Uptake of free HPV vaccination among young women: a comparison of rural versus urban rates. J Rural Health 27:380–384. https://doi.org/10.1111/j.1748-0361.2010.00354.x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zahnd WE, James AS, Jenkins WD et al (2017) Rural-urban differences in cancer incidence and trends in the United States. Cancer Epidemiol Biomark Prev. https://doi.org/10.1158/1055-9965.EPI-17-0430

    Article  Google Scholar 

  21. Reiter PL, Fisher JL, Hudson AG et al (2013) Assessing the burden of HPV-related cancers in Appalachia. Hum Vaccine Immunother 9:90–96. https://doi.org/10.4161/hv.22389

    Article  Google Scholar 

  22. Viens LJ, Henley SJ, Watson M et al (2016) Human papillomavirus-associated cancers—United States, 2008–2012. MMWR Morb Mortal Wkly Rep 65:661–666. https://doi.org/10.15585/mmwr.mm6526a1

    Article  PubMed  Google Scholar 

  23. Mattson J (2011) Transportation, distance, and health care utilization for older adults in rural and small urban areas. Transp Res Rec. https://doi.org/10.3141/2265-22

    Article  Google Scholar 

  24. Buzza C, Ono SS, Turvey C et al (2011) Distance is relative: unpacking a principal barrier in rural healthcare. J Gen Intern Med 26(Suppl 2):648–654. https://doi.org/10.1007/s11606-011-1762-1

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hung P, Henning-Smith CE, Casey MM, Kozhimannil KB (2017) Access To obstetric services in rural counties still declining, with 9 percent losing services, 2004–14. Health Aff (Millwood) 36:1663–1671. https://doi.org/10.1377/hlthaff.2017.0338

    Article  Google Scholar 

  26. Douthit N, Kiv S, Dwolatzky T, Biswas S (2015) Exposing some important barriers to health care access in the rural USA. Public Health 129:611–620. https://doi.org/10.1016/j.puhe.2015.04.001

    Article  CAS  PubMed  Google Scholar 

  27. Befort CA, Nazir N, Engelman K, Choi W (2013) Fatalistic cancer beliefs and information sources among rural and urban adults in the USA. J Cancer Educ 28:521–526. https://doi.org/10.1007/s13187-013-0496-7

    Article  PubMed  PubMed Central  Google Scholar 

  28. Basu S, Berkowitz SA, Phillips RL et al (2019) Association of primary care physician supply with population mortality in the United States, 2005–2015. JAMA Intern Med 179:506–514. https://doi.org/10.1001/jamainternmed.2018.7624

    Article  PubMed  PubMed Central  Google Scholar 

  29. (2014) ACOG Committee Opinion No. 586: Health disparities in rural women. Obstet Gynecol 123:384–388. https://doi.org/10.1097/01.AOG.0000443278.06393.d6

  30. Lu N, Samuels ME, Kletke PR, Whitler ET (2010) Rural-urban differences in health insurance coverage and patterns among working-age adults in Kentucky. J Rural Health 26:129–138. https://doi.org/10.1111/j.1748-0361.2010.00274.x

    Article  PubMed  Google Scholar 

  31. Zimmermann K, Carnahan LR, Paulsey E, Molina Y (2016) Health care eligibility and availability and health care reform: are we addressing rural women’s barriers to accessing care? J Health Care Poor Underserved 27:204–219. https://doi.org/10.1353/hpu.2016.0177

    Article  PubMed  PubMed Central  Google Scholar 

  32. Weigel PAM, Ullrich F, Shane DM, Mueller KJ (2016) Variation in primary care service patterns by rural-urban location. J Rural Health 32:196–203. https://doi.org/10.1111/jrh.12146

    Article  PubMed  Google Scholar 

  33. Fernández ME, Allen JD, Mistry R, Kahn JA (2010) Integrating clinical, community, and policy perspectives on human papillomavirus vaccination. Annu Rev Public Health 31:235–252. https://doi.org/10.1146/annurev.publhealth.012809.103609

    Article  PubMed  PubMed Central  Google Scholar 

  34. Arksey H, O’Malley L (2005) Scoping studies: towards a methodological framework. Int J Soc Res Methodol 8:19–32. https://doi.org/10.1080/1364557032000119616

    Article  Google Scholar 

  35. Levac D, Colquhoun H, O’Brien KK (2010) Scoping studies: advancing the methodology. Implement Sci 5:69. https://doi.org/10.1186/1748-5908-5-69

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bhatta MP, Phillips L (2015) Human papillomavirus vaccine awareness, uptake, and parental and health care provider communication among 11- to 18-year-old adolescents in a rural Appalachian Ohio county in the United States. J Rural Health 31:67–75. https://doi.org/10.1111/jrh.12079

    Article  PubMed  Google Scholar 

  37. Casey BR, Crosby RA, Vanderpool RC et al (2013) Predictors of initial uptake of human papillomavirus vaccine uptake among rural Appalachian young women. J Prim Prev 34:71–80. https://doi.org/10.1007/s10935-013-0295-2

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cates JR, Shafer A, Diehl SJ, Deal AM (2011) Evaluating a county-sponsored social marketing campaign to increase mothers’ initiation of HPV vaccine for their pre-teen daughters in a primarily rural area. Soc Mar Q 17:4–26. https://doi.org/10.1080/15245004.2010.546943

    Article  PubMed  PubMed Central  Google Scholar 

  39. Chung RJ, Walter EB, Kemper AR, Dayton A (2015) Keen on teen vaccines: improvement of adolescent vaccine coverage in rural North Carolina. J Adolesc Health 56:S14–16. https://doi.org/10.1016/j.jadohealth.2014.10.272

    Article  PubMed  Google Scholar 

  40. Vanderpool RC, Cohen E, Crosby RA et al (2013) “1-2-3 Pap” intervention improves HPV vaccine series completion among Appalachian women. J Commun 63:95–115. https://doi.org/10.1111/jcom.12001

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kepka DL, Ulrich AK, Coronado GD (2012) Low knowledge of the three-dose HPV vaccine series among mothers of rural Hispanic adolescents. J Health Care Poor Underserv 23:626–635. https://doi.org/10.1353/hpu.2012.0040

    Article  Google Scholar 

  42. Mills L, Vanderpool R, Crosby R (2011) Sexually related behaviors as predictors of HPV vaccination among young rural women. J Womens Health (Larchmt). https://doi.org/10.1089/jwh.2011.3000

    Article  Google Scholar 

  43. Reiter PL, Brewer NT, Gottlieb SL et al (2009) Parents’ health beliefs and HPV vaccination of their adolescent daughters. Soc Sci Med 69:475–480. https://doi.org/10.1016/j.socscimed.2009.05.024

    Article  PubMed  Google Scholar 

  44. Vanderpool RC, Breheny PJ, Tiller PA et al (2015) Implementation and evaluation of a school-based human papillomavirus vaccination program in rural kentucky. Am J Prev Med 49:317–323. https://doi.org/10.1016/j.amepre.2015.05.001

    Article  PubMed  Google Scholar 

  45. Vanderpool RC, Dressler EVM, Stradtman LR, Crosby RA (2015) Fatalistic beliefs and completion of the HPV vaccination series among a sample of young Appalachian Kentucky women. J Rural Health 31:199–205. https://doi.org/10.1111/jrh.12102

    Article  PubMed  PubMed Central  Google Scholar 

  46. Vanderpool RC, Casey BR, Crosby RA (2011) HPV-related risk perceptions and HPV vaccine uptake among a sample of young rural women. J Community Health 36:903–909. https://doi.org/10.1007/s10900-010-9345-3

    Article  PubMed  Google Scholar 

  47. Bednarczyk RA, Whitehead JL, Stephenson R (2017) Moving beyond sex: assessing the impact of gender identity on human papillomavirus vaccine recommendations and uptake among a national sample of rural-residing LGBT young adults. Papillomavirus Res 3:121–125. https://doi.org/10.1016/j.pvr.2017.04.002

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lai D, Ding Q, Bodson J et al (2016) Factors associated with increased HPV vaccine use in rural-frontier U.S. States. Public Health Nurs 33:283–294. https://doi.org/10.1111/phn.12223

    Article  PubMed  Google Scholar 

  49. Lichter DT (2012) Immigration and the new racial diversity in rural America. Rural Sociol 77:3–35. https://doi.org/10.1111/j.1549-0831.2012.00070.x

    Article  PubMed  PubMed Central  Google Scholar 

  50. James CV, Moonesinghe R, Wilson-Frederick SM et al (2017) Racial/ethnic health disparities among rural adults—United States, 2012–2015. MMWR Surveill Summ 66:1–9. https://doi.org/10.15585/mmwr.ss6623a1

    Article  PubMed  PubMed Central  Google Scholar 

  51. Caldwell JT, Ford CL, Wallace SP et al (2016) Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States. Am J Public Health 106:1463–1469. https://doi.org/10.2105/AJPH.2016.303212

    Article  PubMed  PubMed Central  Google Scholar 

  52. Walker TY, Elam-Evans LD, Yankey D et al (2019) National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2018. MMWR Morb Mortal Wkly Rep 68:718–723. https://doi.org/10.15585/mmwr.mm6833a2

    Article  PubMed  PubMed Central  Google Scholar 

  53. Gilkey MB, Moss JL, McRee A-L, Brewer NT (2012) Do correlates of HPV vaccine initiation differ between adolescent boys and girls? Vaccine 30:5928–5934. https://doi.org/10.1016/j.vaccine.2012.07.045

    Article  PubMed  PubMed Central  Google Scholar 

  54. Shah PD, Calo WA, Marciniak MW et al (2018) Support for pharmacist-provided HPV vaccination: national surveys of U.S. physicians and parents. Cancer Epidemiol Biomark Prev 27:970–978. https://doi.org/10.1158/1055-9965.EPI-18-0380

    Article  Google Scholar 

  55. Shah PD, Gilkey MB, Pepper JK et al (2014) Promising alternative settings for HPV vaccination of US adolescents. Expert Rev Vaccines 13:235–246. https://doi.org/10.1586/14760584.2013.871204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Vercruysse J, Chigurupati NL, Fung L et al (2016) Parents’ and providers’ attitudes toward school-located provision and school-entry requirements for HPV vaccines. Hum Vaccine Immunother 12:1606–1614. https://doi.org/10.1080/21645515.2016.1140289

    Article  Google Scholar 

  57. Moss JL, Feld AL, O’Malley B et al (2014) Opportunities for increasing human papillomavirus vaccine provision in school health centers. J Sch Health 84:370–378. https://doi.org/10.1111/josh.12158

    Article  PubMed  PubMed Central  Google Scholar 

  58. Calo WA, Shah PD, Gilkey MB et al (2019) Implementing pharmacy-located HPV vaccination: findings from pilot projects in five U.S. states. Hum Vaccine Immunother 15:1831–1838. https://doi.org/10.1080/21645515.2019.1602433

    Article  Google Scholar 

  59. Islam JY, Gruber JF, Kepka D et al (2019) Pharmacist insights into adolescent human papillomavirus vaccination provision in the United States. Hum Vaccine Immunother 15:1839–1850. https://doi.org/10.1080/21645515.2018.1556077

    Article  Google Scholar 

  60. Calo WA, Gilkey MB, Shah PD et al (2016) Parents’ support for school-entry requirements for human papillomavirus vaccination: a national study. Cancer Epidemiol Biomark Prev 25:1317–1325. https://doi.org/10.1158/1055-9965.EPI-15-1159

    Article  Google Scholar 

  61. Robitz R, Gottlieb SL, De Rosa CJ et al (2011) Parent attitudes about school requirements for human papillomavirus vaccine in high-risk communities of Los Angeles, California. Cancer Epidemiol Biomark Prev 20:1421–1429. https://doi.org/10.1158/1055-9965.EPI-10-1236

    Article  Google Scholar 

  62. Gessert C, Waring S, Bailey-Davis L et al (2015) Rural definition of health: a systematic literature review. BMC Public Health 15:378. https://doi.org/10.1186/s12889-015-1658-9

    Article  PubMed  PubMed Central  Google Scholar 

  63. Weinert C, Long KA (1987) Understanding the health care needs of rural families. Fam Relat 36:450–455. https://doi.org/10.2307/584499

    Article  Google Scholar 

  64. Deskins S, Harris CV, Bradlyn AS et al (2006) Preventive care in Appalachia: use of the theory of planned behavior to identify barriers to participation in cholesterol screenings among West Virginians. J Rural Health 22:367–374. https://doi.org/10.1111/j.1748-0361.2006.00060.x

    Article  PubMed  Google Scholar 

  65. Markowitz LE, Drolet M, Perez N et al (2018) Human papillomavirus vaccine effectiveness by number of doses: systematic review of data from national immunization programs. Vaccine 36:4806–4815. https://doi.org/10.1016/j.vaccine.2018.01.057

    Article  PubMed  Google Scholar 

  66. Kreimer AR, Sherman ME, Sahasrabuddhe VV, Safaeian M (2015) The case for conducting a randomized clinical trial to assess the efficacy of a single dose of prophylactic HPV vaccines among adolescents. J Natl Cancer Inst. https://doi.org/10.1093/jnci/dju436

    Article  PubMed  PubMed Central  Google Scholar 

  67. Kreimer AR, Herrero R, Sampson JN et al (2018) Evidence for single-dose protection by the bivalent HPV vaccine-review of the Costa Rica HPV vaccine trial and future research studies. Vaccine 36:4774–4782. https://doi.org/10.1016/j.vaccine.2017.12.078

    Article  PubMed  PubMed Central  Google Scholar 

  68. Adjei Boakye E, Lew D, Muthukrishnan M et al (2018) Correlates of human papillomavirus (HPV) vaccination initiation and completion among 18–26 year olds in the United States. Hum Vaccine Immunother 14:2016–2024. https://doi.org/10.1080/21645515.2018.1467203

    Article  Google Scholar 

  69. Commission AR (2020) The Appalachian region—Appalachian regional commission. https://www.arc.gov/appalachian_region/theappalachianRegion.asp. Accessed 10 Apr 2020

  70. St Laurent J, Luckett R, Feldman S (2018) HPV vaccination and the effects on rates of HPV-related cancers. Curr Probl Cancer 42:493–506. https://doi.org/10.1016/j.currproblcancer.2018.06.004

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Public Health, University of Illinois at Chicago, Chicago, IL, USA

    Caryn E. Peterson

  2. University of Illinois Cancer Center, Chicago, IL, USA

    Caryn E. Peterson & Jon Andrew Dykens

  3. Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, USA

    Abigail Silva & Alexandrina Balanean

  4. Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Chicago, IL, USA

    Abigail Silva

  5. Department of Family Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL, USA

    Hunter K. Holt & Jon Andrew Dykens

  6. Health Sciences Library, University of Illinois at Chicago, Chicago, IL, USA

    Abigail H. Goben

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Peterson, C.E., Silva, A., Holt, H.K. et al. Barriers and facilitators to HPV vaccine uptake among US rural populations: a scoping review. Cancer Causes Control 31, 801–814 (2020). https://doi.org/10.1007/s10552-020-01323-y

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