{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T03:20:07Z","timestamp":1789960807533,"version":"4.0.1"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000},"content-version":"vor","delay-in-days":38,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Rural adolescents in the United States lag behind their urban counterparts in the uptake of the human papillomavirus (HPV) vaccine. However, a systematic assessment of factors associated with rural\u2010urban disparities in HPV vaccination coverage to inform potential vaccination promotion interventions is lacking in the literature. Prioritizing HPV vaccination for rural adolescents is necessary for increasing overall HPV vaccination coverage for adolescents and for reducing the incidence of HPV infections and future HPV\u2010related cancers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross\u2010sectional survey of caregivers of adolescents aged 9\u201017 years from 13 states located in the southern United States. Participants were recruited from a nationally representative online survey panel and self\u2010administered the survey from December 2019 to January 2020. The survey assessed HPV vaccination initiation and series completion for rural and urban adolescents, and sought to systematically identify modifiable factors (eg, caregiver knowledge and attitudes about HPV\/HPV vaccine, health care access) and nonmodifiable factors (eg, sociodemographic characteristics) that may be associated with rural\u2010urban disparities in adolescent HPV vaccination. Rural versus urban residence status of respondents was determined using the US Census definition and Federal Information Processing System (FIPS) codes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2,262 sampled caregivers, data from 987 respondents (43.6%) were included in the analysis; 193 respondents (19.6%) were from rural areas and 794 (80.4%) were from urban areas. Overall, 333 (33.7%) adolescents had received at least 1 dose of HPV vaccination and 259 (26.3%) adolescents had completed HPV vaccination. In comparison to urban adolescents, fewer rural adolescents had initiated (\u22127.7 percentage points) or completed (\u221214.9 percentage points) HPV vaccination. Uptake of tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal (MenACWY), and influenza vaccines was similar between urban and rural adolescents. Caregiver attitudes, but not their knowledge about HPV infection or the HPV vaccine, were associated with disparities in HPV vaccination initiation. Rural caregivers were more likely to report concerns with the HPV vaccine, lower access to a pediatric primary care provider, longer travel times to reach health care providers, and HPV vaccination at age 11 years or older compared with age 9 or 10 years. When compared with urban caregivers, fewer rural caregivers reported discussing HPV vaccination with their adolescent's provider although difference in the receipt of a provider recommendation was not statistically significant between rural and urban adolescents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings confirm rural\u2010urban disparities in HPV vaccination coverage for adolescents living in the 13 southern US states. Future research efforts to reduce rural\u2010urban disparities in HPV vaccination should evaluate the impacts of interventions that increase positive caregiver attitudes about HPV vaccination, expand access to vaccination services and pediatricians for rural adolescents, enable strong provider recommendations, and increase the window of HPV vaccination by promoting vaccination initiation at younger ages (9\u201010 years). While this analysis focused on rural\u2010urban disparities, lower rates of HPV vaccination overall suggest that interventions in rural areas be implemented alongside broader efforts to promote adolescent HPV vaccination coverage in the southern United States.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12913","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T03:13:40Z","timestamp":1744168420000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Rural\u2010urban disparities in human papillomavirus vaccination: Findings from a cross\u2010sectional survey of 13 southern US states, December 2019\u2010January 2020"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2900-6070","authenticated-orcid":false,"given":"Lavanya","family":"Vasudevan","sequence":"first","affiliation":[{"name":"Hubert Department of Global Health, Rollins School of Public Health Emory University  Atlanta Georgia USA"},{"name":"Duke Global Health Institute  Durham North Carolina USA"},{"name":"Department of Family Medicine and Community Health Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-6338","authenticated-orcid":false,"given":"Yunfei","family":"Wang","sequence":"additional","affiliation":[{"name":"Duke Human Vaccine Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8236-9500","authenticated-orcid":false,"given":"Jan","family":"Ostermann","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute  Durham North Carolina USA"},{"name":"Department of Health Services Policy &amp; Management University of South Carolina  Columbia South Carolina USA"},{"name":"South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9445-7022","authenticated-orcid":false,"given":"Valerie","family":"Yelverton","sequence":"additional","affiliation":[{"name":"Department of Health Services Policy &amp; Management University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0972-4342","authenticated-orcid":false,"given":"Jingyi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Psychology University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7296-3063","authenticated-orcid":false,"given":"Laura J.","family":"Fish","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health Duke University School of Medicine  Durham North Carolina USA"},{"name":"Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7316-7640","authenticated-orcid":false,"given":"Sayward E.","family":"Harrison","sequence":"additional","affiliation":[{"name":"South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health University of South Carolina  Columbia South Carolina USA"},{"name":"Department of Psychology University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charnetta","family":"Williams","sequence":"additional","affiliation":[{"name":"Immunization Services Division, National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention (CDC)  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6502-6736","authenticated-orcid":false,"given":"Emmanuel B.","family":"Walter","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute  Durham North Carolina USA"},{"name":"Duke Human Vaccine Institute  Durham North Carolina USA"},{"name":"Department of Pediatrics Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Centers for Disease Control and Prevention.How Many Cancers Are Linked with HPV Each Year?Updated October 3 2022. 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