Small area estimation of human papillomavirus vaccination coverage among school-age children in Alabama counties

Objectives: This study estimated county-level human papillomavirus (HPV) vaccination initiation rates in Alabama and determined whether disparities existed between counties in the Mississippi Delta region (MDR) and Appalachian region (AR). Study design: This study used an observational cross-sectional design. Methods: We used small area estimation methodology to estimate rates of medical provider-verified HPV vaccine initiation among school-age children in Alabama. Data for the study were retrieved from the 2015 National Immunization Survey (n = 22,205) and the US Census Bureau. Results: The predictive model results showed that older age (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.16, 1.29) was positively associated with vaccination initiation and black (OR = 0.79, 95% CI = 0.71, 0.87), white (OR = 0.56, 95% CI = 0.52, 0.60), and 'other' race/ethnicities (OR = 0.78, 95% CI = 0.70, 0.86), compared with Hispanics, and was negatively associated with vaccination initiation. The median ((x) over tilde)-modeled HPV vaccination initiation rate for all Alabama counties was 50.83% (interquartile range = 5.00%). Modeled HPV vaccination initiation rates were lowest in AR counties ((x) over tilde= 49.81%), followed by counties not in the AR or MDR ((x) over tilde= 53.26%) and MDR counties ((x) over tilde= 54.90%). Conclusions: Culturally sensitive school-based HPV vaccine delivery programs are needed for children living in AR counties in Alabama. (C) 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.