Journal of Community Health

, Volume 44, Issue 1, pp 149–158 | Cite as

Social Determinants of Health and Human Papillomavirus Vaccination Among Young Adults, National Health Interview Survey 2016

  • Erika L. Thompson
  • Brittany L. Rosen
  • Sarah B. Maness
Original Paper


Human papillomavirus (HPV) vaccination has the potential to reduce the burden of anogenital cancers. Vaccine uptake remains suboptimal, especially among young adults. Social determinants of health (SDOH) are societal level conditions that may indirectly influence health behaviors, including HPV vaccination. The purpose of this study was to assess HPV vaccination and SDOH among young adult women and men. The 2016 National Health Interview Survey was restricted to participants ages 18–26 (n = 3593). The Healthy People 2020 SDOH Framework was used to identify variables for economic stability, health and healthcare, education, social and community context, and neighborhood and built environment. Survey-weighted logistic regression models identified SDOH variables significantly associated with HPV vaccination. Reported HPV vaccination occurred for 45.7% of women and 14.5% of men in the sample. Among women, education determinants—highest level of education completed and English language—were significantly associated with HPV vaccination. Men (adjusted OR 0.65, 95% CI 0.54, 0.79) and women (adjusted OR 0.66, 95% CI 0.49, 0.90) who did not use the Internet to look up health information were at lower odds to be vaccinated for HPV. These findings can inform future HPV vaccine uptake efforts by focusing specifically on these SDOH areas—education and health and healthcare. Identifying SDOH leverage points is critical to promoting HPV vaccination and ultimately reducing HPV-associated cancers.


HPV vaccination Social determinants of health Young adult Primary prevention Cancer 



This paper is the result of the authors’ analyses, interpretations, and conclusions, and not NCHS, which is responsible for the initial data. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to disclose.


  1. 1.
    Alberts, C. J., van der Loeff, M. F., Hazeveld, Y., de Melker, H. E., van der Wal, M. F., Nielen, A., … Paulussen, T. G. (2017). A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands. BMC Public Health, 17(1), 220. Scholar
  2. 2.
    Barnard, M., George, P., Perryman, M. L., & Wolff, L. A. (2017). Human papillomavirus (HPV) vaccine knowledge, attitudes, and uptake in college students: Implications from the precaution adoption process model. PLoS ONE, 12(8), e0182266.CrossRefGoogle Scholar
  3. 3.
    Burdette, A. M., Gordon-Jokinen, H., & Hill, T. D. (2014). Social determinants of HPV vaccination delay rationales: Evidence from the 2011 National Immunization Survey-Teen. Preventive Medicine Reports, 1, 21–26. Scholar
  4. 4.
    Centers for Disease Control and Prevention. (2017). HPV associated cancer statistics—HPV and cancer. Retrieved from
  5. 5.
    Chao, B. A. (2005). Evaluating the educational content of direct-to-consumer fulfillment materials. American Journal of Health-System Pharmacy, 62(6), 620–625.Google Scholar
  6. 6.
    Federal Communications Commissions. (2010). Recent FCC broadband initatives. Retrieved from
  7. 7.
    Garrett, B. E., Dube, S. R., Babb, S., & McAfee, T. (2015). Addressing the social determinants of health to reduce tobacco-related disparities. Nicotine & Tobacco Research, 17(8), 892–897. Scholar
  8. 8.
    Gerend, M. A., & Shepherd, J. E. (2011). Correlates of HPV knowledge in the era of HPV vaccination: A study of unvaccinated young adult women. Women and Health, 51(1), 25–40. Scholar
  9. 9.
    Gerend, M. A., Shepherd, M. A., Lustria, M. L., & Shepherd, J. E. (2016). Predictors of provider recommendation for HPV vaccine among young adult men and women: Findings from a cross-sectional survey. Sexually Transmitted Infections, 92(2), 104–107. Scholar
  10. 10.
    Gilbert, N. L., Gilmour, H., Dube, E., Wilson, S. E., & Laroche, J. (2016). Estimates and determinants of HPV non-vaccination and vaccine refusal in girls 12 to 14 y of age in Canada: Results from the Childhood National Immunization Coverage Survey, 2013. Human Vaccines & Immunotherapeutics, 12(6), 1484–1490. Scholar
  11. 11.
    Holman, D. M., Benard, V., Roland, K. B., Watson, M., Liddon, N., & Stokley, S. (2014). Barriers to human papillomavirus vaccination among US adolescents: A systematic review of the literature. JAMA Pediatrics, 168(1), 76–82. Scholar
  12. 12.
    Kessels, S. J., Marshall, H. S., Watson, M., Braunack-Mayer, A. J., Reuzel, R., & Tooher, R. L. (2012). Factors associated with HPV vaccine uptake in teenage girls: A systematic review. Vaccine, 30(24), 3546–3556. Scholar
  13. 13.
    Kester, L. M., Zimet, G. D., Fortenberry, J. D., Kahn, J. A., & Shew, M. L. (2013). A national study of HPV vaccination of adolescent girls: Rates, predictors, and reasons for non-vaccination. Maternal and Child Health Journal, 17(5), 879–885. Scholar
  14. 14.
    Koch-Weser, S., Bradshaw, Y. S., Gualtieri, L., & Gallagher, S. S. (2010). The Internet as a health information source: Findings from the 2007 Health Information National Trends Survey and implications for health communication. Journal of Health Communication, 15(Suppl 3), 279–293. Scholar
  15. 15.
    Kontos, E. Z., Emmons, K. M., Puleo, E., & Viswanath, K. (2012). Contribution of communication inequalities to disparities in human papillomavirus vaccine awareness and knowledge. American Journal of Public Health, 102(10), 1911–1920. Scholar
  16. 16.
    Maness, S. B., & Thompson, E. L. (2016). Assessing the social determinants of HPV vaccination: A critical assessment of publicly avialable data. In Paper presented at the 144th American Public Health Association Conference, Denver, CO.Google Scholar
  17. 17.
    Markowitz, L. E., Liu, G., Hariri, S., Steinau, M., Dunne, E. F., & Unger, E. R. (2016). Prevalence of HPV after introduction of the vaccination program in the United States. Pediatrics, 137(3), e20151968. Scholar
  18. 18.
    McQuillan, G., Kruszon-Moran, D., Markowitz, L. E., Unger, E. R., & Paulose-Ram, R. (2017). Prevalence of HPV in adults aged 18–69: United States, 2011–2014. NCHS Data Brief, 280, 1–8.Google Scholar
  19. 19.
    National Center for Health Statistics. (2016). National Health Interview Survey, 2016: Public-use data file and documentation. Retrieved from
  20. 20.
    National Center for Health Statistics. (2017). Multiple imputation of family income and personal earnings in the National Health Interview Survey: Methods and examples. Retrieved from
  21. 21.
    National Center for Health Statistics. (2017). Survey description, National Health Interview Survey, 2016. Retrieved from
  22. 22.
    Pask, E. B., & Rawlins, S. T. (2016). Men’s intentions to engage in behaviors to protect against human papillomavirus (HPV): Testing the risk perception attitude framework. Health Communication, 31(2), 139–149. Scholar
  23. 23.
    Petrosky, E., Bocchini, J. A. Jr., Hariri, S., Chesson, H., Curtis, C. R., Saraiya, M., … Markowitz, L. E. (2015). Use of 9-valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morbidity & Mortality Weekly Report, 64(11), 300–304.Google Scholar
  24. 24.
    Polonijo, A. N., & Carpiano, R. M. (2013). Social inequalities in adolescent human papillomavirus (HPV) vaccination: A test of fundamental cause theory. Social Science & Medicine, 82, 115–125. Scholar
  25. 25.
    Radecki Breitkopf, C., Finney Rutten, L. J., Findley, V., Jacobson, D. J., Wilson, P. M., Albertie, M., … Colon-Otero, G. (2016). Awareness and knowledge of human papillomavirus (HPV), HPV-related cancers, and HPV vaccines in an uninsured adult clinic population. Cancer Medicine, 5(11), 3346–3352. Scholar
  26. 26.
    Rahman, M., Islam, M., & Berenson, A. B. (2015). Differences in HPV immunization levels among young adults in various regions of the United States. Journal of Community Health, 40(3), 404–408. Scholar
  27. 27.
    Reiter, P. L., Gupta, K., Brewer, N. T., Gilkey, M. B., Katz, M. L., Paskett, E. D., & Smith, J. S. (2014). Provider-verified HPV vaccine coverage among a national sample of Hispanic adolescent females. Cancer Epidemiology, Biomarkers & Prevention, 23(5), 742–754. Scholar
  28. 28.
    Reiter, P. L., McRee, A. L., Pepper, J. K., Gilkey, M. B., Galbraith, K. V., & Brewer, N. T. (2013). Longitudinal predictors of human papillomavirus vaccination among a national sample of adolescent males. American Journal of Public Health, 103(8), 1419–1427. Scholar
  29. 29.
    Schmidt, S., & Parsons, H. M. (2014). Vaccination interest and trends in human papillomavirus vaccine uptake in young adult women aged 18 to 26 years in the United States: An analysis using the 2008–2012 National Health Interview Survey. American Journal of Public Health, 104(5), 946–953.CrossRefGoogle Scholar
  30. 30.
    Shah, P. D., Gilkey, M. B., Pepper, J. K., Gottlieb, S. L., & Brewer, N. T. (2014). Promising alternative settings for HPV vaccination of US adolescents. Expert Review of Vaccines, 13(2), 235–246. Scholar
  31. 31.
    Thompson, E. L., Vamos, C. A., Straub, D. M., Sappenfield, W. M., & Daley, E. M. (2016). Human papillomavirus vaccine information, motivation, and behavioral skills among young adult US women. Journal of Health Psychology. Scholar
  32. 32.
    Thompson, V. L., Butler-Barnes, S. T., Jones, B. D., Wells, A. A., Cunningham-Williams, R. M., & Williams, S. L. (2017). Factors associated with human papillomavirus vaccination status at U.S. colleges and universities. Health & Social Work, 42(1), e1–e7. Scholar
  33. 33.
    Tiro, J. A., Tsui, J., Bauer, H. M., Yamada, E., Kobrin, S., & Breen, N. (2012). Human papillomavirus vaccine use among adolescent girls and young adult women: An analysis of the 2007 California Health Interview Survey. Journal of Women’s Health (Larchmt), 21(6), 656–665. Scholar
  34. 34.
    US Department of Health and Human Services. (2014). Immunization and infectious diseases. Retrieved from
  35. 35.
    US Department of Health and Human Services. (2014). Social determinants of health. Retrieved from
  36. 36.
    Viens, L. J., Henley, S. J., Watson, M., Markowitz, L. E., Thomas, C. C., Thompson, T. D., … Saraiya, M. (2016). Human papillomavirus-associated cancers—United States, 2008–2012. MMWR Morbidity and Mortality Weekly Report, 65(26), 661–666.CrossRefGoogle Scholar
  37. 37.
    Walker, T. Y., Elam-Evans, L. D., Singleton, J. A., Yankey, D., Markowitz, L. E., Fredua, B., … Stokley, S. (2017). National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2016. MMWR Morbidity and Mortality Weekly Report, 66(33), 874–882. Scholar
  38. 38.
    Walling, E. B., Benzoni, N., Dornfeld, J., Bhandari, R., Sisk, B. A., Garbutt, J., & Colditz, G. (2016). Interventions to improve HPV vaccine uptake: A systematic review. Pediatrics. Scholar
  39. 39.
    Williams, W. W., Lu, P. J., O’Halloran, A., Kim, D. K., Grohskopf, L. A., Pilishvili, T., … Bridges, C. B. (2016). Surveillance of vaccination coverage among adult populations—United States, 2014. MMWR Surveillance Summaries, 65(1), 1–36. Scholar
  40. 40.
    Williams, W. W., Lu, P. J., Saraiya, M., Yankey, D., Dorell, C., Rodriguez, J. L., … Markowitz, L. E. (2013). Factors associated with human papillomavirus vaccination among young adult women in the United States. Vaccine, 31(28), 2937–2946. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Erika L. Thompson
    • 1
  • Brittany L. Rosen
    • 2
  • Sarah B. Maness
    • 3
  1. 1.Department of Health Behavior and Health Systems, School of Public HealthUniversity of North Texas Health Science CenterFort WorthUSA
  2. 2.School of Human ServicesUniversity of CincinnatiCincinnatiUSA
  3. 3.Department of Health and Exercise Science, College of Arts and SciencesUniversity of OklahomaNormanUSA

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